Noteworthy News Articles on Mental Health Topics, June 12-19, 2001

Drugs Give Gamblers Relief From Impulse
Linda Marsa, Los Angeles Times- 6/12/2001

Mike Ambrose, a computer systems analyst, often would spend 36 hours straight on weekends playing slot machines until his paycheck was gone. After blowing $15,000 to $20,000 a year on his habit for more than a decade, Ambrose, in desperation, volunteered as a patient in a clinical study to test a drug to control his gambling urge. The medication, naltrexone, originally devised to combat heroin addiction and alcoholism, changed his life. Within two weeks, the Fridley, Minn., man noticed a "tremendous difference--suddenly, the urges stopped." Three years later, Ambrose, 60, still takes a maintenance dose of the drug. "Even the few times I've gone to the casinos out of curiosity, I didn't enjoy it," he says. "Naltrexone takes all the excitement out of it, and I don't get the rush anymore."
    The final results of this study conducted at the University of Minnesota were reported earlier this month in the journal Biological Psychiatry. The study found that people who took naltrexone reported that their gambling urges--once so powerful that they stole from their children and even turned to prostitution to pay gambling debts--either vanished or were diminished enough that they could resist temptation.
    The Minnesota research is among a handful of recent studies suggesting that the gambling urge has its roots in biology, rather than human frailty. Researchers say that gambling may be, at least in part, sparked by a short circuit in the brain's wiring or an imbalance in key brain chemicals. And drugs such as naltrexone, which blocks the brain's pleasure pathways, are helping people control their impulses.
    The findings offer new hope to the estimated 1% to 3% of the population that suffers from a gambling addiction, for which there is no standard treatment. The University of Minnesota experiment, for example, involved 45 compulsive gamblers. For 11 weeks, 20 people received naltrexone, which dulls the sensation of pleasure that is associated with addictive cravings. The remainder were given a placebo, or dummy pill. Each week, participants were interviewed about the severity of their symptoms, the frequency and duration of their urges, the time they were consumed with thoughts about gambling and the time they actually spent gambling.
    Three-quarters of those on the medication reported substantial relief from the compulsion that had seriously disrupted their lives, contrasted with only one-fourth of the placebo group. "Their symptoms are under control, so they can have a normal life," says Dr. Suck Won Kim, a psychiatrist at the University of Minnesota Medical School in Minneapolis and co-author of the study. "The data shocked us. We got fantastic results."
    Researchers studying gambling behavior at Rhode Island Hospital in Providence reported similar findings with another drug, Celexa, or citalopram, a type of antidepressant known as an SSRI. The study was, however, relatively small, involving just 15 compulsive gamblers, and lasted for just 12 weeks. (The study was funded by Forest Laboratories, which markets Celexa.)
    Previous studies have suggested that people with obsessive-compulsive behavior disorders, such as pathological gambling, suffer from a deficiency of serotonin, a brain chemical that may be involved in the ability to delay or prevent acting on impulses. The class of drugs known as SSRIs (or serotonin reuptake inhibitors) prevent serotonin from being removed from the synapses in the brain.
In the Rhode Island research, 13 out of 15 of the study participants reported significant improvements in all gambling measures, including the number of days gambled and their preoccupation with gambling. The amount of money participants lost dropped from an average of $1,900 in the two weeks prior to the study to $145 in the final two weeks.
    "Individuals who are struggling to get a handle on this devastating problem should be aware of the possible treatment options," said Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and the study's lead author. However, the Food and Drug Administration has not yet approved these medications for use in curbing gambling urges. Still, these studies suggest that medications that compensate for deficits in brain chemistry may hold the key to controlling impulses.
    Researchers at Massachusetts General Hospital in Boston, writing in the May issue of the journal Neuron, reported that the same pathways in the brain that are stimulated by cocaine also became activated in the anticipation and experience of winning at gambling.
And researchers at the University of Cambridge in England found in another recent study that impulsive behavior, which is a feature of addictions such as pathological gambling, may be caused by a defect in a region of the brain known as the nucleus accumbens.
"Impulse disorders like gambling are likely the result of genetic vulnerabilities that cause abnormalities in the brain circuits," said Dr. Eric Hollander, a professor of psychiatry and director of the Compulsive, Impulsive and Anxiety Disorder program at Mt. Sinai Medical School in New York. "These treatments may help people put the brakes on their impulses."

Journal Article Finds Shortcomings in the New Version of Prozac
Marc Borbely, Washington Post- 6/12/2001

Eli Lilly's ad campaign to convert some satisfied Prozac users to a new once-a-week formulation is being greeted with caution by the Medical Letter on Drugs and Therapeutics, an independent, peer-reviewed journal for doctors. Lilly's drive, which encourages current Prozac users to discuss the switch to the weekly pill with their doctors, comes in the months before its patent on Prozac, the best-selling antidepressant, expires. Lower-priced generic versions of Prozac are expected to hit the market in August.
    A recent article in the Medical Letter pointed to data from company-sponsored clinical trials in which 501 patients were given Prozac Weekly, the daily version or a placebo. The article pointed out that those patients who were given the weekly form experienced diarrhea and cognitive problems more often than patients given the daily form. It said 37 percent of patients taking the weekly form experienced a relapse of depression symptoms, compared with 26 percent of patients taking the daily dose and 50 percent of patients taking a placebo.
    The publication also said dosing may be difficult. The 90 mg weekly pill is intended only for patients who are taking 20 mg of the daily pill. Some patients take as little as 10 mg or as much as 80 mg per day. It also questioned whether patients would remember to take the drug once a week. "More studies are needed to determine whether once-weekly [Prozac] is as effective and safe as taking smaller doses of the drug once daily," it concluded.
    Eli Lilly calls Prozac Weekly an excellent alternative for most patients and disputes the Medical Letter's conclusions. Lilly says patients on a weekly schedule are more likely to remember to take their medicine. "People have shown that they will stick with their therapy with Prozac Weekly better than they would with Prozac daily," says John Plewes, a clinical research physician at Lilly. A company-sponsored study found that compliance rates for weekly- and daily-dose patients were 86 percent and 79 percent, respectively. Plewes says the difference in relapse rates between the weekly and daily dose groups was not statistically significant. Although more patients on the weekly formulation complained of nervousness and thinking problems, he says, they complained no more often than did patients taking a placebo. He says that although weekly-dose patients complained of diarrhea more frequently than did daily-dose patients, none cited diarrhea as a reason for dropping out of the trials. Besides, he says, when these patients were asked a second time, there was no difference. As for dosing, Plewes says about 80 percent of Prozac patients currently take the 20 mg daily dose that corresponds with the weekly pill's dose.
    Competitors may begin to market generic forms of Prozac -- but not Prozac Weekly -- as early as August, when Lilly's patent for the drug expires. Lilly holds exclusive marketing rights to Prozac Weekly until 2004. When the Food and Drug Administration (FDA) determined in February that Prozac Weekly was safe and effective, it withheld judgment on the comparative efficacy of the daily and weekly treatments. The agency is requiring Lilly to say in its labeling for the new product that "it is unknown whether or not Prozac Weekly given on a once-weekly basis provides the same level of protection from relapse as that provided by Prozac 20 mg daily." The FDA also ordered Lilly to disclose that in clinical trials more weekly users experienced diarrhea.
    A recent newspaper ad for Prozac Weekly says side effects for the two treatments are similar, and it lists diarrhea as one of more than 25 side effects but it does not point out any difference in diarrhea rates despite FDA regulations mandating presentation of all material facts with respect to consequences of taking the drug as suggested. The ad also fails to reveal that the two forms may not be equivalent in terms of efficacy. "You try to make it understandable for people," Plewes says. Another Lilly spokesman says the company's goal with its ads is partly to educate patients but also to encourage them to discuss a switch of medication with their doctor.

2000 Census: Data Show Big Increase in Gay Households
Seattle Post-Intelligencer, 6/13/2001

The number of American households reporting same-sex partners skyrocketed over the past decade, according to 2000 Census figures. Same-sex unmarried partner homes rose in Vermont from an estimated 370 in 1990 to 1,933 in 2000, an increase of more than 400 percent, according to data released last Wednesday by the Census Bureau. Delaware saw an even greater increase: up more than 700 percent to 1,868 households. Vermont and Delaware were the first states to receive the latest wave of census data, with Washington and many other states expected to have their figures within a month.
    Researchers and many gay couples say they don't believe that the census numbers mean there are now more gay people or more gay couples living together than in years past. "I don't know any more lesbian or gay people cohabitating today than I did five or 10 years ago," said Mardi Moore of Seattle, who's been living with her partner, Ellen Hurtado, for the past seven years. Seattle-based author and sex advice columnist Dan Savage has been living with his boyfriend for seven years. "I don't think homosexuality is a craze that's sweeping the nation, and I certainly don't think that straight people are an endangered species," he said. "But increasingly people are willing to be open and out about that and tell the truth about their relationships.  "I would even venture that those numbers are smaller than what you would discover if everyone was honest," Savage said. "People are paranoid about filling out forms. And a lot of people who are in same-sex relationships may live places where they don't feel safe and they're not going to necessarily trust that their census data isn't going to fall into the wrong hands or be traced to them."
    Still, Holly Puterbaugh, of South Burlington, Vt., considered it one of the most thorough counts yet of homosexuals in this country. "It's one more way for the recognition of same-sex couples to come about," said Puterbaugh, who took part in a civil union ceremony last year in Vermont with her partner of 28 years. "There are a lot more same-sex couples in this world than most people realize."
    Unmarried partner statistics in 1990 were based on a sample of responses; 2000 data were based on a count of all households.  Nationally, unmarried partner homes, regardless of sexual orientation, increased 72 percent from 3.2 million in 1990 to 5.5 million in 2000. Less than 5 percent of the country's unmarried partner households in 1990 were made up of same-sex couples. Comparable numbers for 2000 will not be known until all state figures are released. The statistics come from answers to questions posed on census forms including gender and, if two or more people lived in a home, "What is your relationship?" The census did not ask about sexuality. However, it did offer "unmarried partner" as a way to describe a relationship between two unrelated people living together.
    What affect this new insight into the gay population will have on the American population is unclear. Moore said she's concerned that Christian conservative organizations will use the numbers as a scare tactic. "My fear is that they're going to be scared to death ... that the right wing will use those numbers to say, 'See, we told you it was going to happen, here they come.'" But she and Savage said the numbers may also help the country reassess its attitudes toward the homosexual population and, perhaps, allow same-sex couples to have some of the same benefits given to heterosexual couples. Savage said, for instance, that he and his boyfriend pay high home insurance rates because they are not seen as a couple.

Routine Autism Screening Should Be Done at an Early Age, Experts Say
Martha Groves, Los Angeles Times- 6/14/2001

Children as young as 2 should be routinely screened for autism, just as they are for vision and hearing problems, a national committee of experts recommended Wednesday. Early diagnosis is crucial because prompt intervention using various educational programs greatly improves the chances that very young autistic children will learn to communicate properly and develop appropriate social skills, according to a report by the National Research Council panel. Autism is a disease of the brain, which is more malleable at younger ages. "We need to have coordination of services and intensive intervention starting very early," said Catherine Lord, a professor of psychiatry at the University of Chicago who headed the panel. "These efforts should be systematically planned, tailored to the needs and strengths of individual children and their families, and regularly evaluated."
    `The panel urged that federal, state and local public agencies coordinate efforts to ensure that children receive services free of charge. Because of sparse funding and the growth in autism cases, the availability of services varies drastically from school to school, district to district and state to state. Many children seeking services end up on long waiting lists. "It shouldn't be up to parents to pay for that or have to fight for that," Lord said.
    Autism is a severe and perplexing developmental disorder in which children often become isolated from the world around them and develop poor communication and social skills. Diagnoses within the autism spectrum include autism, pervasive developmental disorder not otherwise specified, Asperger's syndrome and childhood disintegrative disorder. These disabilities differ in severity and the age of onset.
    The reported incidence of autism has surged over the last two decades, the researchers noted in their report. From 1975 to 1985, studies showed the worldwide rate of autism to be about 4 cases per 10,000 people. From 1985 to 1995, the numbers tripled to 12 per 10,000. Researchers now believe that the actual rate is much higher, on the order of 1 in 500 or even 1 in 250. As of April, there were 14,777 children with autism enrolled in the California Department of Developmental Services' 21 regional programs. That was up more than 280% from the number enrolled in 1987. In the Los Angeles Unified School District, the number of students eligible for special education services because of autism has soared to 2,797 from 623 a decade ago. Whether the reported increases result from improved diagnosis and greater awareness or from an actual growth in the disorder has yet to be settled, researchers said.
    The notion that children should be screened at a very young age grows out of the recommendation of another group of psychologists, speech pathologists and pediatricians. That group recently developed screening guidelines and is attempting to get the word out to pediatricians, who often serve as the first line of defense. "Routinely, we weren't picking up kids [with autism] until about age 3," said Susan Schmidt-Lackner, an assistant professor at UCLA's Neuropsychiatric Institute. "Now I'm picking them up as early as a year to 14 months." Although much about how to treat autism remains a mystery, Schmidt-Lackner said, "the one thing we do know is that early intervention, when the brain is still very plastic and connections can be changed, will optimize prognosis and outcome."
    The panel recommended that services for young children be offered a minimum of 25 hours a week year-round, although many autism experts say it should be more like 30 to 40 hours, if the child can tolerate it. The recommended education programs would include training in how to conduct appropriate conversation, read body language and control aggressive behaviors. The panel also endorsed a rich ratio of teachers to students and called for further research to sort out treatments work best.
    The report is available on the Web at http://www.national-academies.org.

Mental Health Help for Young Offenders Urged
Margaret Taus, Seattle Post Intelligencer- 6/15/2001

SNOQUALMIE -- The suicide of a 17-year-old girl at a state juvenile rehabilitation center highlights the overwhelming need for more mental health treatment for young offenders, according to a report released yesterday. An independent three-member panel reviewed the death of Angela Miller, who was found hanging from a ceiling vent in her room at Echo Glen Children's Center near Snoqualmie on March 1. Miller, of Riverside in Okanogan County, died two days later at a hospital after she was removed from life support. Her family is seeking $2 million in damages from the state.
    Earlier this week, King County Executive Ron Sims ordered an inquest into Miller's death. While the review panel found that staff followed proper procedures in responding to the incident, it said that Miller didn't have "timely access to psychiatric assessment and consultation." The report also noted "breakdowns in communication" between two facilities where she was housed. Tim Tesh, an attorney for Miller's mother, Christina Gonzales, said the report "confirmed her worst fears, that this was a preventable tragedy." The panel made several recommendations to improve mental health care at Echo Glen and the state's five other juvenile residential facilities. The department has asked for $1.7 million from the Legislature over the next two years. The latest budget proposal contained $1.1 million, Stephani said.
    In the past 20 years, eight youths have committed suicide at Washington juvenile rehabilitation centers. Three of those suicides took place at Echo Glen; the others occurred in Maple Lane School in Centralia; Green Hill School in Chehalis; and Mission Creek Youth Camp in Belfair. Echo Glen already has made some changes since Miller's death, such as having an on-call psychologist available full time instead of part time and ensuring that the view into a resident's room can't be obstructed. Miller had partially covered her door window with paper.
    The Juvenile Rehabilitation Administration plans to work on other recommendations. It will review policies on room searches and access to potentially harmful items, such as jewelry, shoelaces or clothing items. Miller was found hanging from a thin "hemp-type" rope and was wearing a hemp necklace, although it isn't clear whether she used the necklace in the suicide, the report said.
    JRA also will work on improving communication between juvenile facilities. Dr. John Dunne, a child and adolescent psychiatrist who served on the panel, noted apparent "breakdowns in communication" between the NaselleYouth Camp, where Miller previously attempted suicide by cutting her wrists, and Echo Glen. "While a framework and future plan for providing mental health service to youth is in place in JRA, these services and resources are extremely limited, making mental health service provision for all mental health youth difficult at best," the report concluded.
    An estimated 40 percent of the youth in state custody need some type of mental health care, said Cheryl Stephani, assistant secretary for the Juvenile Rehabilitation Administration. Dunne said the percentage of Echo Glen residents needing mental health services has more than doubled in the past two years, reflecting a national trend.

Flashpoint in Gender Wars: Male Victims of Domestic Violence
David Crary, Associated Press- 6/15/2001

NEW YORK (AP) Battered men. On the front lines of America's gender wars, few phrases are more polarizing. That such men exist in America, suffering one-sided physical abuse from their female partners, is widely accepted. Almost every other aspect of the topic including the numbers of abused men and the gravity of their plight is heatedly disputed. It's a debate loaded with mistrust between the genders, with activists on each side seeing the issue as a prime example of the other sex grabbing for power, either by inflating the suffering of men or ignoring it.
    Advocates for battered men cite academic studies asserting that women, although receiving the overwhelming share of victim-support services, engage in domestic violence as often as men. Women's groups, and many domestic violence experts, challenge key aspects of those studies and insist that women are far more likely than men to suffer psychological trauma and serious injuries at the hands of their partners.
    ''Do women batter? Sure, but not very often,'' said Bonnie Campbell, who headed the federal Violence Against Women office under President Clinton. ''The more success we have as a society in highlighting violence against women, the more of a backlash we get,'' she said. ''I view a lot of this talk about battered men as a significant part of the backlash.'' Campbell, and others in the field, are proud of the huge strides taken over the past 25 years in raising awareness about domestic abuse of women. But advocates for battered men contend that many of the programs have been politicized by feminist groups with anti-male agendas.
    ''What you have is government-sponsored sex discrimination,'' said Philip Cook, author of ''Abused Men: The Hidden Side of Domestic Violence.'' ''It was appropriate that domestic-violence services and education primarily be focused on women in the '70s and '80s. But now it's time to turn on the rest of the lights on the stage and see who else is out there.''
    In Minnesota, a group of men has filed a lawsuit in U.S. District Court, seeking to quash the state's Battered Women's Act on grounds it discriminates against men. Cathy Young, a columnist and author often critical of feminist organizations, contends that the staff at many battered women's shelters emphasizes feminist consciousness-raising over practical services. ''Obviously, there are instances of unilateral battering by men, and sometimes it happens the other way,'' she said. ''In many relationships, there's mutual violence, where you can't pin the blame on one person, and that poses a threat to policies predicated on blaming everything on men.''
    Trying to pin down gender-based statistics for domestic battering is difficult; activists on each side can cite studies and surveys supporting their views. A major survey released last year by the Justice Department and the Centers for Disease Control and Prevention estimated that 1.5 million American women and 835,000 men are assaulted annually by an ''intimate partner'' a current and former spouse, boyfriend or girlfriend, including partners of the same sex. However, the estimates in the National Violence Against Women survey, based on 16,000 interviews, don't necessary correlate with being ''battered.'' The assaults included one-time occurrences and acts of self-defense or retaliation.
    Richard Gelles, an expert on family conflict at the University of Pennsylvania, was among the scholars whose studies in the 1980s concluded that women and men hit one another in equal numbers during domestic disputes. Gelles complained later that his findings were misused to falsely suggest there were as many battered men as battered women. He has estimated that 100,000 men are battered each year, compared to at least 2 million women. Some other statistics: In West Virginia, according to recent state figures, women were arrested in 15 percent of domestic violence cases; in California, the percentage as of 1998 was 16 percent.
    To men like Dave Nevers and Jade Rubick, who have made the unusual decision to go public with accounts of being abused during their marriages, the argument should focus on fairness as well as numbers. Rubick, 28, says he was targeted with recurring verbal and physical abuse during two years of marriage in his early 20s. At one point, he said, he telephoned to seek help from a domestic violence shelter in Eugene, Ore. ''The woman there, I think she was supposed to treat it like a prank call, yet she could tell it wasn't,'' he said. ''She was nice and understanding, but she didn't know what to do with me.'' Since then, Rubick has founded an organization called Stop Abuse For Everyone, that offers help to male victims of domestic violence. He would like to see greater social acceptance of abused men, accompanied by expanded programs such as help lines, referral services and counseling.
    Nevers, 48, a telecommunications consultant from Hillsdale, Ill., has spoken out repeatedly about injuries including burns, cuts and broken bones that resulted in several trips to the hospital. He remains angry that his ex-wife won custody of their children even though he felt there was clear evidence of her abusiveness. ''I get a lot of surprised looks, because I'm a big guy,'' he said in a telephone interview. ''I think a lot more guys have gone through it than have ever admitted it. Where men are at, on this issue, is where women were 25 years ago.''
    The president of the National Organization for Women, Patricia Ireland, says she can empathize with men who indeed were victimized by their partners. ''If I were a guy who'd been battered and nobody seemed to care, I'd probably have some deep anger myself,'' she said. ''You are injured. You are, culturally, an object of ridicule. The support services are harder to find.'' But Ireland said women are overwhelmingly the most frequent victims of domestic violence. She contends the legitimate concerns of battered men ''have been hijacked by anti-feminist advocates and policy-makers for their own political purposes.''
    One of the most contentious aspects of domestic violence is how police officers are trained to handle it. Cook, the author, says officers and other professionals dealing with domestic violence need ''an accurate, balanced picture'' so they do not automatically presume men are to blame. Yet Rita Smith, executive director of the National Coalition Against Domestic Violence, is concerned about an apparent spread of mandatory dual arrests instances when officers arrest both feuding partners in cases with no overwhelming evidence that only one person is at fault. ''If the man is choking the woman, and she's scratching him to get him to stop there has to be some discernment,'' Smith said. ''Men choose violence much more often than women; that's a reality that it would be dangerous for the police to ignore.''
    Smith also contends that some of the impetus behind the battered-men's movement comes from men who have been abusers themselves. ''They're using this issue in custody battles,'' she said. ''Their premise is to make it look like there's all kinds of lying and misrepresentation by women's advocates.''
    One of the scholars most deeply entangled in the debate is Murray Straus, a sociologist who co-directs the University of New Hampshire's Family Research Laboratory. His studies two decades ago suggesting a high frequency of wife-to-husband violence led to what he calls his ''excommunication'' by the women's movement. ''I thought of myself as a feminist,'' Straus said. ''To be attacked by the very people on whose side I am was pretty painful.'' Straus says his studies should not be used to suggest women do not deserve a bigger share of victim-support services. But he believes male victims should be treated evenhandedly, so they can seek help without fear of suspicion or ridicule. ''Family violence, no matter by who, is wrong, and should cease,'' he said. ''If women want to be safe, to put it crudely, they have to quit it, too. They regard that as blaming the victim; I regard it as reality.''
    Battered men's advocacy site: http://www.vix.com/menmag/battered.htm
    National Coalition Against Domestic Violence: http://www.ncadv.org

Abuse of Painkiller OxyContin Looms as NJ's Next Drug Epidemic
Associated Press, 6/15/2001

NEWARK, N.J. (AP) A prescription drug intended to ease terminally ill cancer patients' severe pain is growing in popularity among New Jersey drug users seeking its intense, heroinlike high. The drug, OxyContin, has been blamed for 37 overdose deaths in Kentucky, Ohio, Virginia and West Virginia since 1998. So far, there have been no known overdose deaths in New Jersey. But state law enforcement officials remain concerned, given recent arrests and seizures of the drug, a pill therapeutically hailed for its 12-hour, time-released painkilling capabilities.
    Two weeks ago, Union County authorities arrested a Cranford man suspected of possessing 4,000 of pills of OxyContin, which is made by Connecticut-based Purdue Pharma. In February, authorities in Gloucester County arrested 14 people they say forged prescriptions to get 8,000 tablets and submitted claims to insurers for reimbursement. A case in Ocean County that began as a medical fraud investigation led to the arrest of a former nurse from Toms River who obtained 11,000 pills over 14 months, beginning in January 2000.
    Law enforcement officials say the lure of ''oxy,'' as it's called, is its cheap price (as little as $2 per pill), ease of use swallowed, chewed or ground up and inhaled and its intense heroinlike high. But the drug is also highly addictive and potent, making it easy to overdose on. ''It is the epidemic problem in half a dozen states already,'' said Ocean County's First Assistant Prosecutor Terrence Farley. ''Heroin users are telling us it's more addictive than heroin and harder to get off it, a longer withdrawal.''
    Among the disconcerting facts about oxy, Farley said, is that its emergence has defied conventional drug trends, surfacing initially not in cities or the East and West Coast but in heartland and rural areas. ''Incredibly, it popped in places where drugs never start,'' said Farley, who has conducted seminars with the federal Drug Enforcement Administration.
    Michael Bizzarro, director of outpatient adult and adolescent substance abuse at Trinitas Hospital in Elizabeth, said he has seen more OxyContin use among patients. ''It's like any other new drug that hits the market,'' Bizzarro told The Star-Ledger of Newark for Friday's editions. ''It takes some time before the word spreads, the use spreads and then abuse spreads.''
    Union County authorities say that although heroin and cocaine still reign, the arrests in Cranford and elsewhere are a sign that oxy is finding place in New Jersey drug culture. ''It's pretty new to most of the strike forces around the state,'' said Lt. Gregory Clay of Union County's Narcotics Strike Force. ''We're trying to figure out where it's coming from.''

Understanding Childhood Depression
Rama Pemmaraju Rao, MD, University of Alabama Medical School, ABC News- 6/16/2001

They may even paint images of themselves and family members that seem lifeless, sad or morbid. These may be signs that their mood is being greatly affected. Such depressive themes in art and play may indicate the possibility of a primary genetic inheritance of depression, a reaction to family and school stressors, or both.

Behavioral problems
Depressed children may develop new behavioral problems at home and school. They may be persistently irritable and edgy and may not know why. Often their tolerance of conflict and frustration is very low. Attention span is markedly limited, which means that children who are depressed may appear very distracted. The common reaction to this type of behavior is disciplinary action, and often the consideration of depression is overlooked.

School performance
A key clue to depression that should not be ignored is a sudden change in school performance. If a child is falling into the "grade danger zone", or shows significant and sudden change in performance, this may be a clue that the child is depressed. Children who are becoming more seriously depressed often isolate themselves from friends and family in a way that is not characteristic of that child.

Lethargy
Some children sleep for longer than usual periods during the day; they may appear to be slow, lethargic and lack interest in their usual activities.

Physical complaints
Many younger children suffering from depression are preoccupied by a wide variety of complaints such as headache, stomach ache, or leg and arm pain. If such symptoms are occurring often, parents need to keep depression in mind. These complaints may be particularly significant if a child is consistently using them to avoid school, friends, and other family members. Children may also be so focused on their aching head, or may tantrum so severely about an abdominal pain, that getting ready for school becomes an ordeal. If persistent, these children may be dealing with depressive feelings that they cannot put into words.  Parents, teachers, and counselors need to be aware of such patterns of bodily complaints over time, along with the other symptoms of depression that may not necessarily be directly related to sadness.

Drugs and alcohol
A turn to the "wrong crowd" or a sudden binge with drugs and alcohol could mean that your child is dealing with a serious depression. Instead of harsh confrontation, parents need to examine whether depression is a possible cause. Kids who use drugs may have a primary substance abuse problem but some children mask their depression through drugs and alcohol in an attempt to relieve their pain.

Suicide threats
An attempt or threat of suicide is a cry for help. Direct intervention by health care practitioners is vital in order to discern what is really behind the threat, and whether the threat is in fact serious. In any case, a suicide threat is a clear indication that a child or teenager is in need of professional help.  Parents need to take seriously any themes of death and dying through the child's writings, drawings and conversation. Intervention starts with asking children directly about their feelings, and making them feel comfortable enough to reveal often awkward and difficult ones. School counselors are a valuable resource. The child's primary pediatrician will definitely lend a hand in helping to screen an indication of depression. A child and adolescent psychiatric physician will help families discern the diagnosis and help balance the treatment with outpatient therapy, medications and even hospitalization when needed.

Become a Sherlock Holmes of kid's symptoms
To identify and then understand the nature of a child's depression, it requires that parents, educators, and health practitioners become "symptom sleuths". A little investigation, research, and treatment could help spare children from years of suffering, and may perhaps save lives.

In Appalachia and Beyond, OxyContin Abuse Called 'a Plague'
Allen G. Breed, Associated Press, 6/16/2001

GILBERT, W.Va.--Kristen Rutledge had watched friends slowly kill themselves with OxyContin. Her own cousin, just 18, shot herself in the head, when she couldn't get more of the drug. Girlfriends were prostituting themselves for another fix. Still, when someone offered her a yellowish 40 milligram pill, she took it, chopped it up and snorted it. It was the start of a three-day binge, and she was hooked. ''It's not like any other drug I've ever done,'' the 20-year-old says as she takes a drag off her umpteenth cigarette.   Over the next year, her habit grew until she was taking up to eight ''40s'' a day, she says. When her dad, a county school board member and former mayor, found out, she tricked him into giving her more money by saying she was being threatened by drug dealers.   The cash drain contributed to Tim Rutledge's loss of his grocery franchise. But Kristen didn't care. ''When I got down to two, I started panicking,'' she says. ''I had to get out and buy some more.''
    Many in Appalachia call OxyContin ''Hillbilly heroin.'' Its abuse may not have started in the mountains, but it exploded here. Across the region, people have overdosed on the powerful prescription painkiller and robbed pharmacies and family members to feed their habits. ''If this was an infectious disease, the Centers for Disease Control would be in here in white vans,'' says Tim Rutledge. ''There's no doubt it's very much a plague.''
    To cancer patients and chronic pain sufferers, OxyContin is a wonder drug that can return them to a semblance of normal life.  Dr. Michael Levy, director of pain management at the Fox Chase Cancer Center in Philadelphia, calls Oxy ''close to an ideal opiate.'' While most strong pain medicines last only about four hours and take an hour or so to work, patients on Oxy get a steady 12-hour release of pain medicine with fewer side effects and less risk of liver damage. ''This product is better than anyone thought it would be when it was released five years ago,'' he says. ''This is a drug we need to protect, because it really helps patients.''
    But to addicts who chew the pill or crush it to snort or inject, Oxy produces a one-shot, heroin-like high that can kill. Purdue Pharma, the drug's maker, is willing to concede that Oxy abuse has led to ''somewhere between dozens and hundreds'' of deaths in the past two years, says David Haddox, Purdue Pharma's medical director. ''I am sure it has caused some deaths,'' he says, ''but my feeling is there is a magnification of this in the media.''
    On Monday, the state of West Virginia sued the drug's makers, accusing them of pressuring and enticing doctors to over-prescribe Oxy and of failing to adequately warn of potential abuse. Purdue Pharma called the suit's claims ''completely baseless.'' Purdue Pharma has taken steps to limit the damage. The company has stopped shipping its 160 milligram pills and has suspended shipment of 40s to Mexico because too many were finding their way back across the border. The firm has offered tamper-resistant prescription pads in Maine and other states, and it expects to help pay for a federal pilot program to track narcotics prescriptions in Florida, Mississippi, Ohio, Virginia and West Virginia. Purdue Pharma sent a representative to Gilbert in January to address concerns; and it is running public service announcements on local radio to warn against abuse.
    Law enforcement officials insist the problems have not been overblown. At least one dealer in Virginia has been charged with murder, and manslaughter charges were filed in a Florida Oxy death. Several Virginia doctors have been convicted of illegally dispensing the drug. Breaking and entering and armed robbery charges related to Oxy have been filed from Maine to Mississippi.
    Michael Pratt, a prosecutor focusing on drug crimes in Kentucky, Tennessee and West Virginia, sees reasons why OxyContin hit Appalachia especially hard. The Appalachian economy has long been dependent on coal and timber. Those are industries that produce serious injuries, so there are large numbers of people on painkillers. ''A lot of places, you got a headache, you'll tough it out,'' Pratt says. ''Down here it's like, `Well, my grandfather's got some drugs. I'll take that and it'll go away.' And it just escalates.'' In addition, OxyContin sells on the street for $1 a milligram up to $160 for the highest-dosage pill. In an area with chronic unemployment, that kind of money is hard to turn down.
    For years, prescription fraud for Valium and other drugs has been a problem. ''But,'' Pratt says, ''we've never come upon something that kills people so much. I mean, if it killed them, they really had to work at it. ''Oxy rolls in. It's so powerful, it just lays waste.'' ''This is a nuclear bomb,'' adds Gregory Wood, a health fraud investigator with the U.S. attorney's office in Roanoke, Va. ''I was a cop in Detroit and saw crack come through the ghettos, and I've never seen anything like this.''
    Neither had the tiny town of Gilbert. Like many coal towns, Gilbert, pop. 417, winds like a centipede along the riverbank, pushing leg-like hollows out into the surrounding hills near the Kentucky line. OxyContin found its way here about five years ago. What started as a gentle rain soon turned into a flash flood. Police Chief Greg Cline blames the drug for at least four deaths in town, and state police Sgt. J.J. Miller put the number at about a dozen for the entire county. But that number includes people who may also have been abusing other drugs. A mental health counselor tells of a man who was having his teeth pulled two at a time, because each visit meant a new Oxy prescription. Kristen Rutledge has known people to shoot themselves for a prescription. Cline has talked to cancer patients who were selling some of their pills.
    ''It seems like if you're around people who are doing it, you catch it,'' says Judy Compton, manager of the Compton Inn. ''It's contagious.'' She knows all too well. Her sister caught it, too. Jeanie Compton was spoiled. Her mother gave her a red convertible BMW before she could even drive, and a trailer home to live in. When she wanted to get married at age 15, her mother drove her across the Tug River. Now it's all gone. The BMW? Traded for OxyContin. The trailer? Sold for a few thousand dollars' worth of pills. The husband? Found slumped over in the bathroom with a needle nearby, dead of a suspected Oxy overdose. Jeanie's troubles began around 1991, when her adoring father died suddenly at age 50. She started experimenting with drugs. Along came Oxy. At one point, Joyce Compton says her daughter was raiding the family's motel for televisions, microwaves, mattresses, to supply her habit. Judy Compton stopped letting her come to her house. ''She'd get up to leave and my stuff would fall out of her pantlegs,'' she says.
    On more than one occasion, Judy has found her little sister slumped in a chair, her head lolled over. Last Sunday was Jeanie Compton's 23rd birthday. She spent it in a jail cell, where she was serving time for violating home confinement to seek Oxy. Back home Wednesday, wearing a monitoring anklet, she says she's ready to get serious about kicking Oxy. ''I've said I'm either going to end up in jail or dead,'' she says. ''Well, I made it to the jail. I can't come back from the grave.''
    Locals have a nickname for the road: Pill Hollow. ''On one occasion I timed them, and in 30 minutes we had 45 cars coming to one house,'' says Clyde Lester, a local school board member. Of the 20 or so homes wedged into the mountains around him, he says four were occupied by dealers. People are starting to lock their doors, and establishing community watches. Isolation, long an obstacle for Appalachia, has become something people miss. ''A lot of those troubles that used to be in the cities have really come home to plague this community,'' says the Rev. Denny May, whose 19-year-old daughter, Shanda, killed herself in 1999 shortly after getting involved with Oxy.
    When Pastor Clayton Cline asked his Baisden Community Church congregation who had been affected by OxyContin, he says, ''Almost every one raised their hands.'' One hand was his own. About a year and a half ago, his daughter became addicted to OxyContin after her husband received a prescription for an accidental gunshot. For the past six months, Cline's daughter and son-in-law have been attending a church-based methadone program in Georgia. Cline is a coal operator and has the means to get his daughter treatment. He has paid for some others to receive methadone at a clinic in Charleston, the only one in the state. ''It's no disgrace to have a problem. What's the disgrace is when you try to hide it,'' he says. ''You can't hide this OxyContin. I've found that out.''
    Debbie Trent sits in a middle school auditorium in Bluefield, Va., and listens. She is a mental health counselor from Gilbert, where she is a member of a new drug-awareness group called STOP Strong Through Our Plan. She has driven two hours along mountain roads to see what folks in southwestern Virginia are doing to battle OxyContin. A self-described OxyContin abuser named Mary tells the group, ''Addiction stands on a mountaintop and throws down commandments: `Thou shalt not abandon me. Thou shalt put no one or nothing before me.''' She says she lost her job and committed prescription fraud because of OxyContin. Another recovering addict, a 38-year-old mother of two identified only as Cindy, shuffles from one foot to the other as she explains how she took 320 milligrams of Oxy in the morning before she had the strength to take her boys to school. Friends thought she had cancer. For two hours, people talk about the problem. Dennis Lee, Tazewell County's top prosecutor, says 80 percent of the crime in his jurisdiction is now related to OxyContin.
    Sheriff H.S. Caudill says efforts to get a statewide prescription tracking system failed in the legislature this past year. Just as local firefighting is done by volunteers, Caudill tells the crowd, much of the burden of stopping Oxy abuse will fall on them. ''I look at OxyContin as a huge forest fire,'' he says. ''It's burning everywhere in Tazewell County. ... There's not enough of us, ladies and gentlemen. We need you.''
    Kristen Rutledge has three tattoos she doesn't remember getting. She went through physical problems not menstruating for months, constipated for weeks. She stopped writing in her journal. When she finally decided to quit Oxy, she did it cold turkey. The withdrawal lasted three days, the same as her first Oxy binge. ''I'd rather have died,'' she says, drawing her knees up to her chest. ''I was vomiting. I could hear things and see things. I had pain all over my body, all over me my head all the way down to my calf.''   Her habit cost her father tens of thousands of dollars. OxyContin is still costing Tim Rutledge: Now, he's giving the cash-strapped police department money for undercover drug buys and taking out full-page newspaper ads warning others about drugs.  Kristen says she's been clean for a month. But she's not kidding herself. ''I'm still addicted,'' she says. ''I'm just not using.''

Former Addicts File Multibillion-Dollar Lawsuit Against Maker of OxyContin
Associated Press, 6/16/2001

JONESVILLE, Va.--A multibillion-dollar lawsuit has been filed against the makers of the painkiller OxyContin and two doctors, claiming they failed to warn patients that the drug was dangerously addictive. The drug, intended for use by terminal cancer patients and chronic pain sufferers, has been linked to at least 120 overdose deaths nationwide. The suit was filed Friday in Lee County Circuit Court by seven people who are former addicts or relatives of addicts. The suit, which seeks class-action status for other victims, alleges the drug's makers aggressively marketed the painkiller while downplaying its risks. Named as defendants are Purdue Frederick Co., Purdue Pharma L.P. and Purdue Pharma Inc., all based in Stamford, Conn., and Abbott Laboratories Inc. and Abbott Laboratories, both based in Chicago.
    On Monday, West Virginia also sued the makers of OxyContin, claiming they tried to get doctors to overprescribe the drug while failing to warn of its potential for abuse. ''What has happened is an atrocity,'' said Dawn Stewart of Hedrichsen Siegel, a Washington law firm representing the plaintiffs. ''We have reason to believe there could be potentially thousands affected by OxyContin.'' Also named in the suit are doctors Richard Norton and Shireen Brohi. Norton is a former emergency room doctor now serving a federal prison sentence in South Carolina for embezzling from a hospital. ''I do not prescribe the drug and I have no comment,'' Brohi told The Associated Press Saturday. She then said she has prescribed the drug once in the last six to eight months. Calls to a Purdue Pharma official were not immediately returned Saturday. The plaintiffs are seeking more than $5.2 billion in compensatory damages from Purdue. They also want the pharmaceutical giant to set up rehabilitation facilities in the region and provide ongoing medical monitoring for patients using the drug.
    If taken properly, Oxycontin's active ingredient is released slowly into the body. But abusers circumvent the time-release by crushing the pills and inhaling or injecting the powder to get the same kind of euphoric high that heroin brings. The federal Drug Enforcement Administration has chosen Mississippi, West Virginia, Virginia, Florida and Ohio to participate in a pilot program to monitor prescriptions and try to stop OxyContin abuse.

Doctors Want AMA to Seek Ban on Prescription Drug Ads for Consumers
Lindsey Tanner, Associated Press- 6/17/2001

CHICAGO--The American Medical Association would urge the government to ban prescription drug ads from television, newspapers and magazines under a proposal many doctors say is needed to keep patients from being misinformed. ''This is catastrophic in my office, with patients coming in and demanding a drug they saw on television,'' Dr. David Priver of San Diego told an AMA committee Sunday, the start of the AMA's five-day annual meeting.
    The ads can undermine doctors' credibility, especially if a physician thinks an advertised drug isn't the best choice for a patient who demands it, said Dr. Angelo Agro of the AMA's New Jersey delegation, which drafted the proposal. Ads by their nature are biased and compressed, and driven more by drug companies' financial concerns than by concern for the patients' best interest, said Agro, an ear, nose and throat specialist from Voorhees, N.J. The ads have turned into a competition ''to see who can sell more of their antihistamines or nasal sprays. The patient is at best incompletely informed and at worst ... deluded,'' Agro said.
    The proposed resolution asks the AMA to petition the Food and Drug Administration to ban ''direct to consumer'' prescription drug ads. It is one of several resolutions at the meeting that seek to curb what many doctors think is interference from the pharmaceutical industry into the doctor-patient relationship. Another proposal asks the AMA to lobby for requiring the ads to display language telling patients that their doctors may recommend other, more appropriate treatment options.
    Dr. Jeffrey Shuren, the FDA's medical officer, told the committee overseeing the proposals that the FDA doesn't have the authority to implement a ban since the ads are allowed by law. Several doctors told the committee a ban would violate free-speech rights. Drug companies spend hundreds of millions of dollars each year on the ads, which have been around since the 1980s. The AMA initially opposed the ads, but current policy says they're acceptable as long as they contain a clear health message, refer patients to their doctors for more information and don't encourage self-diagnosis and self-treatment. Several doctors told committee members that they like the ads since they may encourage patients who wouldn't otherwise seek needed medical attention to schedule a doctor's visit. Psychiatrist Dr. Saul Levin said ads for antidepressants, for example, help take the stigma out of depression and may make sufferers realize they're not alone. The committee will review the resolutions before deciding whether to send them on to the AMA's policy-making House of Delegates, which starts voting Tuesday on the more than 250 reports and resolutions presented during the annual meeting.

Mental Health Treatment in New York Jails Criticized
Associated Press, 6/17/2001

GOSHEN, N.Y.--Orange County's jail administrator says the agency's mental health treatment of inmates is even worse than when two nurses were fired after complaining about it three years ago. Last week, a federal jury ordered the county and the nurses' employer, Eastern Healthcare Group, to pay $2.2 million for wrongful dismissal. The county plans to appeal.
    Susan Menon and Lurana Berwerger said the county's mental health unit at times blocked them from speaking with the psychiatrist treating patients. They also said county officials, instead of doctors, were ordering that inmates be restrained. Menon had complained because 47 percent of approximately 600 inmates were on psychotropic mediations. That's higher than at other nearby jails. At Sullivan County Jail, seven percent were medicated. The amount ranged from 18 to 21 percent at Ulster County Jail. The National Commission of Correctional Health Care estimated that up to 20 percent of inmates nationwide suffer from serious psychiatric disorders or addictions.
    ''I have not noticed any discernible change for the better,'' administrator Col. Theodore Catletti told the Middletown Times-Herald Record in Sunday editions. ''As a matter of fact, I think in a lot of ways it's gotten worse.'' Chris Ashman, the county's mental health commissioner, would not comment, citing advice from legal counsel. County Executive Joseph Rampe called the jury verdict ''absurd.''

National Battle Brews Over Suits vs. HMOs
Sue Kirchhoff, Boston Globe- 6/18/2001

WASHINGTON - After more than four years of struggle, Congress is closer than ever to passing a law that regulates health-care plans. But first, lawmakers and President Bush have to figure out how to regulate lawsuits against those plans. The politically volatile issue will be fought out on the Senate floor starting tomorrow, when the chamber takes up a bipartisan Patients' Bill of Rights sponsored by Senators Edward M. Kennedy, Democrat of Massachusetts; John McCain, Republican of Arizona; and John Edwards, Democrat of North Carolina. The bill would ease access to emergency room care, allow external appeals of health-plan decisions, and make it easier for consumers to see specialists and obtain new drugs. Opponents and supporters agree this time may be the clincher, though getting there will not be easy.
    Bush, who ran for the White House boasting of Texas's first-in-the-nation law letting patients sue health plans for shoddy care, has threatened to veto the Kennedy-McCain plan. The president endorses a narrower alternative that supporters say will minimize costly lawsuits and premium increases that could prompt many businesses to drop health coverage. Insurers and business groups have mounted a lobbying and advertising blitz to kill the Kennedy-McCain bill. The American Medical Association and consumer groups are fighting back with rallies and grass-roots efforts. House Republican leaders are rushing to put together a more limited bill. The proposal ''is very similar to the law in Texas, which President Bush first vetoed and then allowed to become law without his signature,'' said Kennedy, who was modifying the bill last week in hopes of picking up support. ''I hope we can avoid the veto part ... a reasonable compromise would be to let it become law without his signature.''
    Polls indicate that as many as 85 percent of Americans support tougher regulation of health plans. Democrats clearly see the issue as a winner; the Patients' Bill of Rights is the first measure they have brought up since gaining control of the Senate this month. White House officials say that despite the president's tough talk, he sincerely wants to sign a bipartisan bill. They also say he believes Americans have not had sufficient opportunity to challenge health plans in court.
    t the American Medical Association's annual meeting yesterday in Chicago, Health and Human Services Secretary Tommy Thompson said the administration believes a Patients' Bill of Rights will probably become a reality. ''We can't continue to have gridlock,'' said Karen Ignagni, president and CEO of the American Association of Health Plans. Her group opposes both Kennedy-McCain and the alternative preferred by the White House, by Senator Bill Frist, a Tennessee Republican, and John Breaux, a Louisiana Democrat. ''Members of Congress, who have been looking at this issue very politically, are now looking at the words and looking at the specific provisions, and a number are starting to have reservations ... this (Kennedy-McCain) has been drafted by the plantiff's bar for the plaintiff's bar,'' Ignagni said.
    The basic dispute concerns liability. Although all sides agree that some consumer lawsuits against health-care plans should be permitted, they disagree on when and where to allow them and how much patients can collect. These issues were noted yesterday by Trent Lott, the Senate minority leader. ''It is a question of when can you file a lawsuit, what are the limits on liability, what is the scope, who is covered,'' the Mississippi Republican said on CBS News's ''Face the Nation.'' ''I think we can do a lot of good in this area without... this loss of coverage and increase in rates.''
    Since the 1970s, many health plans, especially those of large corporations, have been regulated not by states, but by the federal government. Individuals increasingly have been allowed to go to state court in cases involving malpractice or quality-of-care issues. But on health-plan management, decisions about scope of coverage or denial of benefits, states have been stymied by federal rules.
    The Kennedy-McCain measure, and a companion House bill, would lift many federal restrictions, giving states more freedom to legislate. Consumers, generally after an appeals process, could file lawsuits in state courts in cases where medically negligent care caused injury or death. Disputes over benefits, where health plans were accused of denying services, would be heard in federal court. Federal penalties for insurer misconduct would be capped at $5 million. Opponents say the bill would expand both state power and the number of lawsuits, while creating new federal challenges. ''Unlimited lawsuits are the fatal flaw in the McCain-Kennedy Patients' Bill of Rights,'' said Dan Danner, chairman of the Health Benefits Coalition, which represents employers.
    Bush is insisting on the Frist-Breaux measure, also backed by James Jeffords, a Vermont Independent. Under that bill, patients could go to federal court seeking damages only if they prevailed against a managed-care plan in an appeals process specified in the legislation. There would be a $500,000 limit on noneconomic damages. States would continue to hear cases involving quality of care, but their legal authority would not be expanded. Critics say the Frist-Breaux bill could jeopardize current, external procedures for appeals in about 40 states.
    The Congressional Budget Office estimates premiums would increase by 4.3 percent under Kennedy-McCain and 2.9 percent under the alternative. There is general agreement on issues such as emergency room access and other consumer protections, but the Kennedy-McCain provisions would create a national Patients' Bill of Rights, except in states with tougher protections. The White House-backed plan would let state laws remain if they were comparable to, though not as sweeping as, federal protections.
    ''States have hardly stood still as Congress has debated this issue. Patients' rights has been debated or passed in every state in the country,'' said Larry Levitt, vice president of Kaiser Family Foundation, a health-care think tank. ''It's very clear that states can't touch about half the work force because of [federal laws] and there's a lot of legal ambiguity. ... If Congress acted it would certainly clarify things a great deal.''
    Last year Massachusetts passed its own Patients' Bill of Rights, which does not include a right to sue. It does guarantee that all health maintenance organizations provide the same protections to every member, sets out rules for external review, and has an independent body to settle issues regarding denial of coverage. Many lawmakers say the issue is so popular that a bill will eventually pass, though it may take weeks on the Senate floor. Republicans want amendments that expand tax breaks for health coverage. The situation is similarly unsettled in the House. Representative Charlie Norwood, a Georgia Republican, flanked by other moderates, announced his support for a companion bill to Kennedy-McCain at a splashy news conference last week.

Texas Sex Offenders Forced to Publicize Crimes
ABC News, 6/18/2001

Is forcing paroled sex offenders to post a sign publicizing their past crimes a fair punishment or a ruling gone too far? A judge in Corpus Christi, Texas, ruled last month that some sex offenders must post warning signs in the front yard of their homes reading "Danger! Registered Sex Offender Lives Here!" Similar signs must be posted on their cars as well. While Judge J. Manuel Bañales and others in the neighborhood argue that neighbors have the right to know where a sex offender lives, the offenders believe it's an unjust ruling.
    "It's a second punishment," says one man who molested a 14-year-old girl. He says the sign - not the crime - has made him feel too humiliated to even go out. "You're already embarrassed, now you're ashamed," says John Lee, who pleaded guilty to indecency with his friend's 15-year-old daughter, though he says it was consensual. "It's constantly with you," he says of the bumper sticker on his truck and the sign in his rear window. "You're toxic." Even worse, says Lee, the sign makes him feel like a moving target for someone with a grudge. "Someone pointed an imaginary gun at me," he says. "I felt like it's open season for vigilantes to just come over there. That's not a good feeling." His mother, too, is concerned about the label he is forced to carry. "I'm worried that someone is going to knock on this door and he's going to answer it and he'll be shot."
For Lee's initial sentence, he was ordered to spend 10 days in jail every Christmas for three years. He must go to therapy, cannot have alcohol or tobacco, must submit to polygraphs, and because he's allegedly a risk to children, he is forbidden to be near kids - including his girlfriend's daughter. Then, prompted by two cases in which convicted sexual predators who had served time were involved in additional crimes, Judge Bañales decided to get tougher. He took another look at every sex offender who had ever come through his court, including Lee. Bañales decided to change the rules for the offenders he considered high-risk, tacking on the signs as an additional condition of their probation, saying he was worried about people the offenders might harm in the future.
    Sex offenders' names, addresses, photos and criminal records have been advertised in newspapers and are available on a state Web site under Texas' sex offender registration and community notification laws. But Bañales thought that was inadequate because not everyone reads newspapers or has Internet access, he says. "Whatever I did was not an act against these probationers," says Bañales. "What I did was give … the neighbors of a neighborhood the right to know where a sex offender lives." In Lee's case, says Bañales, he was ordered to post the danger signs partly because he admitted to probation officers that he had a drink, a violation of the court's orders, but also because the judge was troubled by Lee's response to another question. "I asked him, 'Is it alright for a 32-year-old man such as yourself to have sex with a 14-year-old girl if she consents to it?' And he could not answer no." Lee and other probationers are appealing the judge's decision.

Minimum Sentence for 'Rebirthing' Therapists
ABC News, 6/18/2001

Two therapists were sentenced today to the minimum 16 years in prison for the death of a 10-year-old girl following a "rebirthing" session. Connell Watkins, 54, and Julie Ponder, 40, faced up to 48 years in prison for the April 2000 death of Candace Newmaker. They were found guilty of reckless child abuse this past April in the girl's death. During their separate sentencings in a Golden, Colo., courtroom, Jefferson County Judge Jane Tidball said Candace's death was horrifying, but there was no evidence that the therapists intended to harm the child. In a brief statement read in court, Watkins accepted responsibility for Candace's death. "I feel sorrow, regret and remorse that torments me every waking hour," Watkins said. "I failed Candace and I failed her mother. I accept full responsibility. I'm ready to accept what you require of me."
    During the fatal rebirthing session, Candace was being treated for what the therapists called reactive attachment disorder, a condition in which children avoid forming loving relationships and often become disruptive and violent. Candace's adoptive mother, Jeane Newmaker, flew the child from their home in North Carolina to Colorado specifically for the therapy. Candace was supposed to force her way out of a blanket, becoming "reborn" to form a bond with her adoptive mother. At the end of the session - 70 minutes after it started - Watkins and Ponder unwrapped Candace and found her not breathing. Efforts to revive her failed and Candace died the next day at a hospital. Medical examiners later determined she died of asphyxiation.
    A videotape of Candace's "rebirth" was the key evidence prosecutors used at trial. On the tape, Candace is heard crying and pleading with Watkins, Ponder and their two assistants to let her out. Candace was wrapped in the blanket with large pillows on either side of her. "I'm dying! … It feels like I'm dying!" Candace cried as the four adults pushed pillows against both sides of the girl to simulate birth contractions. When asked why she and her assistants continued the session while Candace was crying, Watkins told ABCNEWS' 20/20: "Our children say 'I'm going to die' a lot, and I don't believe that she [Candace] thought she was. If I thought she was going to die, she would have been out of there."
    While a coroner found that she died of asphyxiation, the defense argued that other factors may have caused the girl's death. A defense forensic pathologist testified that a powerful medication Candace was taking at the time of her death may have killed her. The pathologist also said Candace may have succumbed to an undetected heart condition. The rebirthing case spurred legislation signed by Colorado Gov. Bill Owens in April outlawing that kind of therapy. Newmaker faces trial in November on a charge of criminally negligent child abuse in the death. The therapists' assistants in the fatal session, Brita St. Clair and Jack McDaniel, will be tried in September on child abuse charges.

Study: Even Police Can't Identify a Drunk
Rose Palazzolo- ABC News- 6/18/2001

It's hard to tell if someone has been drinking too much to drive. A new study says even "trained professionals," such as police officers, were not always able to assess drunkenness when they screened a videotape of drinkers. "When people are far too intoxicated to drive they might not appear to be intoxicated by casual observation," said the study's lead author, psychologist John Brick, executive director of Intoxicon, a Pennsylvania-based company that provides research on drug and alcohol use. "The fact that highly trained individuals, police officers, were like other people and didn't possess the ability to identify someone who was visibly intoxicated was interesting."
    Brick says if police officers can't tell if someone is drunk, how can a bartender or a friend know when to take the keys away from someone who has been drinking too much? In the study, New Jersey police officers were shown videotaped interviews with drinkers at low (0.08 to 0.09), medium (0.11 to 0.13) and high (0.15 to 0.16) blood-alcohol levels. The officers were then asked questions about the subjects' levels of intoxication and how confident they were that these drinkers could be allowed to drive. The officers could only discern intoxication when blood levels exceeded 0.15 percent. Below that level, the officers made incorrect judgments.
    President Clinton signed legislation in October 2000 that provided incentive for states to adopt 0.08 percent blood-alcohol concentration as the standard for drunken driving. So far, 25 states have adopted the incentive; most other states have a 0.10 percent law. The results were consistent with other studies Brick has done with bartenders. The study appears in the June issue of the journal Alcoholism: Clinical & Experimental Research. "This type of example is what might happen in a bar or in someone's home," Brick said. "People just don't have the ability to know when someone is too drunk to drive just by observing, unless there is slurred speech or a swagger."
    Given their ability to perform intoxication tests, police may have a better chance at assessing someone's status than a bartender or friend. "Observing casual conversation may not be adequate to judge balance dexterity, pupil dilation, or even flushness," said Edward Sponzilli, an attorney. "These limits are not inconsistent with the context in which a social host, bartender or potential passenger may observe." Some state laws actually make it a crime to give your car to an intoxicated person. In New Jersey, for example, the law imposes a duty not to entrust your car to a person whose blood-alcohol level is 0.10 percent or higher. "If an alcohol influence is found, then the car owner may face a six-month to a one-year loss of license," Sponzilli said. Earlier this year, a Salem, N.J., man was charged with manslaughter after he let his drunken friend drive his car. The two got into a deadly wreck in which the drunken driver and an innocent bystander were killed. The bottom line, Brick concludes, is that no matter what someone says they feel like or even look like, chances are, if they've been drinking, they are too impaired to drive.

S. C. Court to Consider Whether Moms on Drugs Can Be Charged for Child Abuse
Jeffrey Collins, Associated Press- 6/19/2001

GREENWOOD, S.C.--After giving birth to her stillborn daughter, Brenda Peppers struggled to save her own life, a crack-addicted, comatose 30-year-old who doctors would revive four times over the next six weeks. After her recovery, Peppers never smoked crack again. But almost two years later, prosecutors charged her with abusing her unborn child by taking cocaine while pregnant. Peppers accepted a plea bargain in 1999, pleaded guilty and was sentenced to two years' probation. Now the 35-year-old is fighting the law she was convicted under, hoping her battle can help other women. ''I never want another woman to ever go through what I have had to go through,'' Peppers said. C. Rauch Wise, Peppers' lawyer, is scheduled to appear before the state Supreme Court on Wednesday asking to overturn a ruling that allows prosecutors to charge women who take cocaine when their fetuses can live outside the womb. At issue is whether a viable fetus should be considered a child under the state's child abuse laws, said Wise.
    Punishing pregnant women for illegal drug use has been a contentious issue in South Carolina for more than a decade. In March, the U.S. Supreme Court ruled that public hospitals cannot test pregnant women for drugs and turn the results over to police without consent. The ruling followed complaints that some women at a public hospital were arrested from their beds shortly after giving birth.
    While Peppers and her infant were tested for drugs, her case goes beyond the issue of illegal search and seizure, Wise said. ''The South Carolina Supreme Court stands alone among the 50 states in permitting the prosecution, conviction and punishment for child endangerment of pregnant drug users for ingesting substances on which they are dependent,'' Daniel Abrahamson, a San Francisco lawyer, wrote in a brief on behalf of seven national and state medical associations. State Attorney General Charlie Condon has said the law is part of the state's effort to protect unborn children.
    ''I am proud of having started this fight on behalf of innocent, unborn children killed through the mother's use of illegal drugs,'' Condon said last month, after 23-year-old Regina McKnight was sentenced to 12 years in prison. McKnight had given birth to a stillborn baby that tested positive for a cocaine byproduct. Prosecutor Greg Hembree said McKnight, a mother of three, should have known better. ''Why should a viable fetus, able to live outside the womb, be treated any different than a month-old infant?'' Hembree said. ''If you contribute to killing a child that can live, you should face the consequences.''
    After McKnight was sentenced, the phone started ringing at the office of Wyndi Anderson, the executive director of the South Carolina Advocates for Pregnant Women. ''People across the country can't believe South Carolina can do this without providing a better network of drug treatment,'' Anderson said. Anderson wonders if prosecutors would be as tough on a middle class woman who smoke cigarettes or drink heavily. Recent studies show using cocaine is about as harmful on a fetus as cigarette smoking and less harmful than heavy drinking, said Dr. Deborah A. Frank, an associate professor of pediatrics at Boston University and author of a study on the topic published in the Journal of the American Medical Association in March.
    Frank calls South Carolina's prosecution of mothers who abuse drugs ''irresponsible public health policy'' and said it could mean an increase in infant mortality as addicted women avoid prenatal care because they fear prosecution. ''Anything that frightens people away from health care is dangerous,'' Frank said. Peppers said she has remained drug-free since coming out of the coma, but is afraid to have children again. She plans to be in the audience when the justices hear her case Wednesday.
On the Net:
South Carolina Advocates for Pregnant Women: http://www.scapw.org
South Carolina Attorney General: http://www.scattorneygeneral.org

HMO Bills See Heavy Lobbying in Senate
James Kuhnhenn, Detroit Free Press- 6/19/2001

WASHINGTON -- On a sunny, humid day last week, about 20 top manufacturing executives from across the country huddled with freshman Sen. Ben Nelson, D-Neb., to make their case against legislation that would let patients sue their HMOs. Nelson, who is undecided on the bill, attracted business leaders such as Richard Thompson, president of Caterpillar Inc., the world's leading maker of heavy mining and construction equipment based in Peoria, Ill. For the managed-health-care industry, which has been fighting the legislation for more than four years, Thompson and others like him are the vanguard of the opposition to a patients bill of rights.
    With the Senate debate on the legislation scheduled to begin as early as today, the opposing interests are sharply defined. Doctors, labor unions and consumer groups provide the core of support for a Democratic bill that would give patients greater control over their health plans. Health insurers and business groups maintain that the legislation, with provisions allowing lawsuits by patients, will drive up insurance premiums and hurt employers and their workers as the economy is weakening. Congress is expected to spend the next two weeks almost exclusively on the legislation. In this pressured environment, both sides aren't even trying to sway the public. Instead, they are focusing their energies on only enough lawmakers to prevail, spending millions of dollars on lobbying and advertising to change just a few minds. "This is going to be war," Holly Bailey of the Center for Responsive Politics said Monday.
    Over time, health maintenance organizations have undergone a public image transformation -- lauded first as the answer to high-cost health care, they are now maligned as bureaucratic penny-pinchers that put profits above the welfare of patients. That image has not helped attract congressional allies, so the industry's strategists have focused on the impact the legislation could have on businesses that provide health-care benefits to the millions of people they employ.
    "We've recruited thousands of small-business allies across America in key congressional districts who will either be having to drop their health care because it's too expensive or will cut back benefits or hire fewer workers," said Mark Merritt, the lead strategist for the American Association of Health Plans, which opposes the legislation. Until now, the health-insurance industry and its business allies have been able to stop legislation that would give patients in managed-care plans greater protections. The main point of contention is whether patients should have the right to sue their HMOs if the health plans deny them access to certain specialists.
    The issue has not moved in Congress; it's caught in the tug-of-war between two powerful coalitions that have lined up loyal lawmakers on both sides. The American Medical Association and the trial lawyers have been generous donors to the Democratic Party and its candidates, while members of the Health Benefits Coalition, a group that represents insurers and businesses, routinely support Republicans. Critics of the role that money plays in legislation say the history of the patients bill of rights illustrates how too much money can paralyze Congress. "It has a gridlock effect because it stops the Democrats on one side and it stops the Republicans on the other," said Rep. Christopher Shays, R-Conn.
    But the politics are changing. In 1999, the Senate passed an HMO bill that did not contain a right to sue; now both competing Senate bills do. President George W. Bush and many congressional Republicans favor a bill sponsored by Sens. John Breaux, D-La., James Jeffords, the Vermont independent, and Bill Frist, a Republican heart surgeon from Tennessee. It would permit lawsuits against HMOs only in federal courts, and would set a cap on monetary awards. A bill backed by the AMA is sponsored by Sens. John McCain, R-Ariz., Edward Kennedy, D-Mass., and John Edwards, D-N.C. It would permit lawsuits in both state and federal courts, and limit awards at $5 million, 10 times higher than the competing bill. Health insurers oppose both versions but are focusing on the McCain-Edwards-Kennedy bill because it appears to have support from more than half of the Senate.