Jailed Man Fights Efforts To Medicate Him for Trial
Jo Thomas, New York Times- 12/26/2002

Dr. Charles T. Sell, a St. Louis dentist, once spat in the face of a federal magistrate who was deciding whether to revoke his bail on charges of Medicaid fraud. That helped to land him behind bars, and five years later, facing more charges and after a diagnosis of mental illness, Dr. Sell is still locked up awaiting trial. His situation has posed a question that the Supreme Court has agreed to answer: Can the government forcibly medicate a person charged with a nonviolent crime to make him mentally competent to stand trial? Psychiatrists say Dr. Sell, who is 53, suffers from a "delusional disorder of the persecutory type." The government wants to give him antipsychotic medicine so it can prosecute him. Dr. Sell and his lawyers contend that medicating him by force would violate his fundamental right to bodily integrity.
    Judges in the Federal District Court and the United States Court of Appeals for the Eighth Circuit, in St. Louis, have agreed with the government, though the appellate court split 5 to 4. On Nov. 4, the Supreme Court decided to accept the case. The appeals court noted that Dr. Sell was also charged in a separate indictment, handed down nine months after the first, with conspiring to murder an F.B.I. agent and a witness in his fraud case, but said, "We base our reasoning solely on the seriousness of the fraud charges." "It is possible," the judges wrote, "that Sell's threats after his first indictment were a manifestation of his delusional disorder and we decline to make a determination about whether those charges suffice to involuntarily medicate him."
    The case of Dr. Sell first came to national attention in early 2001 when John Ashcroft, formerly a senator from Missouri, was seeking confirmation as attorney general and there were reports that as senator, he had once met briefly with Thomas S. Bugel, a friend of Dr. Sell, who was asking the Missouri Congressional delegation to look into accusations Dr. Sell had been abused in prison. Both Dr. Sell and Mr. Bugel were members of the Council of Conservative Citizens, a far-right group whose leaders have expressed extreme racial views.
    Mr. Bugel contended that Dr. Sell was brutally shackled on a concrete slab for nearly two days in 1999 and deliberately scalded by guards a few months later. Prison authorities have denied any abuse, but refused requests from Dr. Sell's family to release surveillance videos that might have recorded these events. Dr. Sell and his wife, Mary, were arrested in May 1997 on charges of submitting false claims, including false documents and X-rays, to Medicaid and private insurers for dental services he did not provide. Dr. Sell would later say that his crime was filling teeth for poor people instead of extracting them.
    Shortly after his arrest, federal prosecutors asked for a psychiatric examination of Dr. Sell, who was found competent to stand trial. He was indicted in July 1997 on 56 counts of mail fraud, 6 counts of Medicaid fraud and a count of money laundering. Prosecutors asked to revoke Dr. Sell's bond in January 1998, saying that he had tried to intimidate a witness. At the first hearing before a federal magistrate, Dr. Sell screamed at the magistrate, using racial epithets. When she tried to continue the hearing, he shouted and spat in her face.
    A psychiatrist who was treating Dr. Sell reported that the dentist was staying up night after night, expecting the F.B.I. to "come busting through the door," and that his mental condition was deteriorating. The psychiatrist recommended antipsychotic medications, and Dr. Sell was ordered detained.
    The second indictment, for conspiring to murder and the attempted murder of a witness in the fraud case and an F.B.I. agent, came in April 1998. By the following February, his lawyers said, Dr. Sell's behavior was becoming increasingly erratic, worsened, they said, by his time in prison. The lawyers, worried that their client might not be able to help in his own defense, were joined by the prosecutors in asking for a second hearing to determine whether Dr. Sell was competent to go to trial. Dr. Sell's psychiatrist said he was not. At the government's request, Dr. Sell was examined at the Medical Center for Federal Prisoners in Springfield, Mo., and found mentally incompetent to stand trial.
    On April 14, 1999, Dr. Sell was ordered hospitalized for treatment. That July, the court ordered that he be given antipsychotic drugs against his will but a month later it agreed to a delay, pending another hearing. The months turned to years. Dr. Sell lost his dental practice and his $250,000 home in Creve Coeur, Mo. Mary Sell pleaded guilty to 10 counts of mail fraud in September 1998 and was sentenced in January 2000 to two years in prison. In August 2000, another magistrate granted the government's request to medicate Dr. Sell by force. Dr. Sell's lawyers then began a series of appeals. In its decision not to rehear the case last May, the United States Court of Appeals for the Eighth Circuit split 5 to 4.
    Theodore B. Olson, the solicitor general, said in his brief to the Supreme Court that the appeals court was correct in finding that the government had an essential interest in bringing Dr. Sell to trial, that there were no less intrusive means to do so and that antipsychotic medicine was appropriate for his condition. Dr. Sell's lawyers argued that if the appeals court decision was allowed to stand, "a mentally incompetent individual will lose his right to refuse medication based solely on the government's unproven assertion that the individual is guilty of a nonviolent crime."

Increased Suicides Worry Marines
Eric Rosenberg, Hearst News Service- 12/28/2002

WASHINGTON -- Marine Corps officials are concerned about a recent rash of suicides in their ranks. The Marines currently have the highest suicide rate among the four branches of the armed forces, although the service has significantly reduced the rate of self-inflicted deaths through prevention programs over the last decade.
    Marine Corps Commandant Gen. James Jones sent a message to all Marines Nov. 26 urging them to renew their efforts at suicide prevention. "Recent reports of suicide in the Marine Corps highlight a disturbing trend that needs our immediate attention and renewed commitment," Jones said. "We must focus our attention on ensuring every possible measure is taken to battle this tragic and senseless loss of life."
    As of Dec. 1, seven Marines had killed themselves in the fiscal year that began Oct. 1 -- three in October and four in November. "If the current trend continues" for the rest of the 2003 fiscal year, Jones warned, "we will effectively double the suicide rate" compared with last year. The current trend would point to a total of approximately 42 suicides this fiscal year; by comparison, the Marines have averaged 24 suicides annually for the last four years.
    The seven suicides in two months amounted to a sharp uptick compared with prior months. One Marine died in an apparent suicide in September, while two died in suicides in August, according to monthly data compiled by Jones' office. There were no Marine suicides in July, three in June, two in May, none in April, three in March, one in February and one in January.
    Navy Cmdr. Thomas Gaskin, staff psychologist in the Marine Corps Personnel and Family Readiness division, said Jones was "concerned with the trend as we head into the holiday season, which is considered by many to be a stressful time of year." The Christmas and New Year's period and the weeks following can be fraught with isolation and emotional distress for both civilians and service personnel alike. In an advisory sent to Marine commanders last year, service mental health officials warned that the post-holiday period especially can be most "tumultuous" for people contemplating suicide. "January can bring serious financial burden and feelings of isolation and therefore requires our closest attention," the memo warned. Gaskin said there was no special cause for the recent increase in suicides and that the additional deployments and transfers linked to increased anti-terrorist operations weren't a factor. Instead, he said, the causes are "the same old stuff everybody else faces," including relationship problems, legal problems, financial problems, alcohol and drug abuse.
    Marines who kill themselves typically are younger, junior enlisted. But in 2000, the Marines began to notice a demographic shift -- an increasing percentage of the victims were staff non-commissioned officers and officers. The number of suicide deaths in the entire military is small compared with the overall active duty force of about 1.4 million service members. The suicide rate for the armed forces is about 12 deaths per 100,000, about one-half to two-thirds the rate for a comparable segment of the civilian population. Military officials reported at least 118 suicides in all services in 2001, with rulings still pending in 69 other deaths. Nonetheless, suicide often has been the second-leading cause of death in the U.S. armed forces, after accidents, over the last 10 years.
    Suicide prevention received new attention after the death in 1996 of Navy Chief of Naval Operations Adm. Jeremy "Mike" Boorda, who fatally shot himself after questions were raised about whether he deserved some of his military decorations. Jones said that the purpose of his suicide-warning message was to "sound a call for action" among the troops and encourage Marines to watch for suicidal tendencies among colleagues. "Warning signs are often presented to Marines close to the victim, but these are sometimes ignored," he said. " `Taking care of our own has been a hallmark of the U.S. Marine Corps for 227 years. There is no substitute for the vital role that each of us plays in suicide prevention," Jones said.
    As part of the Marine Corps effort to fight suicide, all Marines are required to take annual suicide awareness training. In addition, suicide awareness training is given at leadership schools such as basic officer courses, the staff noncommissioned officers' academies and infantry seminars. The instruction varies in length but is up to two hours long. Counseling also is available to all Marines for help in problem-solving, anger and stress management, financial problems and substance abuse.

Women Find Hope for Sex Dysfunction
Judy Peres, Chicago Tribune- 12/29/2002

Since the advent of Viagra, men have been flocking to doctors' offices and Internet sites to get help for what once was an unspoken affliction. Now women want to know "What about us?" And pharmaceutical companies are scrambling to develop products they can sell to the other half of the population.
    The result is a new science dedicated to the biology of female sexual dysfunction. Many of the players in this new field are urologists, gynecologists, neurologists and endocrinologists--unlike the pre-Viagra days, when unglamorous and underfunded research was pursued mainly by sociologists and sex therapists. The new sex researchers believe that many problems are associated with aging, hormonal imbalance, poor circulation, disease and the medications taken to control those diseases. The physiology of sex has replaced the emphasis on guilt and performance anxiety that stemmed from the 1966 work of Dr. William Masters and Virginia Johnson.
    When the members of the International Society for the Study of Women's Sexual Health held their first meeting in the fall, they heard presentations on topics such as "Reciprocal Regulators of Vaginal Blood Flow" and "Female Androgen Deficiency Syndrome." Not coincidentally, the meeting was funded by grants from Pfizer, Lilly ICOS, Wyeth-Ayerst and other large drug companies.
    This nexus has spurred critics to warn that the "medicalization" of women's sexual problems may enrich drug company stockholders and the careers of anointed researchers, but not the majority of women who need help. That, they say, is because women's sexual complaints are more likely to be caused by ignorance, social conditions, psychological conflicts or inept partners than by impaired blood flow to their genitals. "It's misguided to think a significant number of female sexual dysfunctions are organic," said psychologist Sandra Leiblum, director of the Center for Sexual and Marital Health at Robert Wood Johnson Medical School in Piscataway, N.J.
    Although experts disagree on how much female dysfunction has biological roots, researchers and their sponsors sense a large untapped market for medical remedies: A 1999 study published in the Journal of the American Medical Association found that 43 percent of U.S. women (compared with 31 percent of men) complain of sexual problems. With the chance to share in what could grow into a market worth billions of dollars, drug companies are working feverishly to discover what pathways control women's sexual response and what agents can fix it when it's broken.

`Basic science'
Dr. Irwin Goldstein, director of the Institute of Sexual Medicine, and his team at Boston University have conducted a series of pioneering, if somewhat primitive, experiments. "We're doing basic science research and beginning to understand the mechanics of the female sexual response," Goldstein said. "It's very exciting because it hasn't been done before."
    Among other things, the Boston researchers have discovered that:
*Genital arousal is controlled by certain nerves and can be triggered in laboratory animals by applying an electrical stimulus to those nerves.
*The blood vessels in the clitoris undergo a process of progressive hardening as women age. Animal experiments suggest this impairs normal arousal.
*The nerves that control sexual arousal are very close to the cervix, raising the possibility that surgeons doing hysterectomies and other pelvic procedures may unwittingly nick or sever them, leaving many women unable to respond to sexual stimulation--and believing mistakenly that it's because they're getting old.
    In fact, experts agree, sexual intensity may decrease with age and the response may slow down, but it doesn't naturally stop. It generally takes an illness or an injury of some sort--physical or psychological or a combination--to bring sexuality to a halt. Mainly because of Viagra, more sexual problems are being reported to doctors and more people are talking openly about the issue.
    For many Americans, experts say, this could mean not only better understanding of a central aspect of their lives, but also better lives. "The importance of sexuality to quality of life has come on the agenda," said Dr. John Bancroft, director of the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University. Still, Americans don't have much success in solving this most personal of problems. The 1999 JAMA study found that 26 percent of women are unable to achieve orgasm, 32 percent seldom want sex and 23 percent don't find it pleasurable.
    Part of the explanation for the stunning prevalence of dysfunction, experts say, is ignorance. "Many people know more about the insides of their car engines than about how their sexual bodies work," said Gina Ogden, a Boston-area sex therapist. Most couples aren't aware that the average woman requires nearly 14 minutes to complete the sexual response cycle from arousal to orgasm--four times as long as her male partner, said Dr. Domeena Renshaw, founder and director of the Loyola Sex Therapy Clinic in west suburban Maywood. This could account for what some women report as failure to achieve orgasm (and some partners label frigidity).
    Because sexual dysfunction creates unnecessary suffering, some therapists welcome the idea of treating it with a pill or a salve or a nasal spray--although experts agree such products are still years away. Viagra, the blockbuster anti-impotence pill that earned Pfizer $1.5 billion last year, is being tested in women (Loyola is one of about 100 trial sites). One of the first female patients to try it was Elizabeth Belt of Richmond, Ind. Belt, 39, a cabinet factory employee, lost most of the sensation in her vagina after a routine surgical procedure when she was 19. A few years ago, the numbness spread to her clitoris. When she read three years ago that researchers at Boston University were testing Viagra on women, she told her fiance, Frank Woods, "We're going." And they did. The experiment's preliminary results were hopeful: "I definitely had more sensation on the Viagra," Belt said. But her medical insurance doesn't cover the drug for women, and she can't afford to pay for it. She's also not convinced there isn't a psychological component to her problem. So she's where she was three years ago.
    Although therapists are leery of treatment approaches that imply sexual problems are purely medical, they acknowledge that such therapies have the power to increase awareness of sexual dysfunction. Viagra, launched in 1998, spurred an estimated tenfold increase in the number of men willing to admit they had sexual problems, and it caused women to begin seeking solutions to their problems. But research on women has been extremely limited until recently. "Historically, there has not been a lot of money for research in female sexual dysfunction," said Dr. Linda Hughey Holt, assistant professor of obstetrics and gynecology at Northwestern University Medical School. "But that's now changing. Interest in Viagra has moved the idea that there may be pharmacologic treatments into the mainstream."
    The implications--social, political, scientific, economic--are enormous. Unlike their mothers and grandmothers, who had no expectation of remaining sexual in their later years, female Baby Boomers plan to stay fit, healthy, young-looking and attractive long past menopause. Goldstein is banking on them using their political clout. "There will be twice as many older women in 25 years," he said. "There will be a huge demand for products and treatments."
    Some experts fear the pendulum swing from "it's all in your head" to "just take this little blue pill" will not be helpful in the long run. "Having effective medications and being able to look a patient in the eye and talk about physical causes makes it more acceptable to go to a doctor and bring it out in the open," Holt said. "My concern is that we'll focus on the physical aspects and neglect the emotional, sociological and interpersonal aspects of sexuality."
    It already has happened in the treatment of depression. "Insurance companies seem to think that with a prescription and two visits to a primary care physician you can treat depression," Holt said. "The same thing is happening with sexuality because of people's bias in favor of quick fixes and because of the way the medical system is set up: a brief visit and a prescription, not counseling about the broader aspects of sex in their lives." Julia Heiman, a professor of psychiatry at the University of Washington in Seattle, said she hopes to see some combination of medication and psychotherapy in the future because "sex is both a brain and a body phenomenon."
    Sexologists say their field is undergoing rapid change in uncertain directions. Scientists don't even agree on the definitions of female sexual dysfunction. Many point out that the existing definitions are rooted in a male model that focuses on intercourse and makes orgasm the goal, whereas many women say intercourse is not central to their enjoyment of sex, and most don't have orgasms through intercourse.

4 categories of dysfunction
Clinicians these days recognize four main categories of female sexual dysfunction: desire disorder, or loss of libido; arousal disorder, which includes lack of lubrication and decreased genital sensation; difficulty achieving orgasm; and pain with intercourse. (In each case, the problem must be severe enough to cause the patient "personal distress"; it's not enough that her partner be distressed.) But many therapists say these categories do not reflect women's experiences in the real world. The main usefulness of the classifications, critics say, is that they create target diseases for future medications.
    Leonore Tiefer, a psychologist at New York University School of Medicine, said female sexual dysfunction is the product of "disease-mongering" by drugmakers. Tiefer, the leader of a dissident group of clinicians and social scientists called Campaign for a New View of Women's Sexual Problems, is suspicious of the financial backing drug companies provide for the new science. For one thing, she said, "Pharmaceutical industry involvement leads to epidemiological studies that overestimate the problem their proposed drugs are meant to solve." "He who pays the piper calls the tune," Tiefer warned.
    A respected sexologist and feminist scholar, Tiefer said she's concerned that the new international society could end up promoting simple solutions to complex problems. In the process, she said, "Women will be offered reasons to feel sexually insecure. Sex education will be slighted. And insurance companies will feel more justified in emphasizing drug treatments over relationship counseling and other sex therapies."

Couple Expand Anti-DUI Crusade
Ken O'Brien, Chicago Tribune- 12/29/2002

After Gary and Cristy Pirc of Joliet lost their 4-year-old daughter, Taylor, in a 1999 accident involving a drunken driver, their grief evolved into a mission: to preserve her memory in a way that benefited their community. They initially vowed to equip one squad car in Will County with a dash-mounted camera to record the behavior of drunken-driving suspects at the time of their arrest. Such cameras, according to law enforcement officials, allow everyone involved in the case--prosecutors, defense lawyers and, if the case goes that far, jurors--to see the suspect as the arresting officer saw him or her. The project blossomed far beyond that goal, eventually raising $250,000 to purchase 60 cameras for 31 law enforcement agencies serving Will County, including municipal police departments, the sheriff and the state police.
    Now, the family is changing its strategy. Instead of continuing to raise money for video cameras, the Pircs announced recently that they want to start a college scholarship in Taylor's name for Will County students interested in becoming substance-abuse counselors. "We fully exceeded our goal, which was to buy one camera and change one person's mind about drinking and driving," Cristy Pirc said. The cameras "put the jury in the back seat of the squad car," she said, and many people have told the Pircs that they've been prompted to adopt the "designated driver" policy whenever they mix drinking and traveling.
    Taylor Pirc died on the afternoon of Feb. 21, 1999. She was buckled into the back seat of her grandmother's car when it was hit by a station wagon at a Joliet intersection. The driver of the station wagon, Thomas Pomykala, flunked a field sobriety test and was found to have a blood alcohol level of 0.21, more than double the legal limit, according to testimony at his trial. Pomykala, who previously had been convicted of drunken driving in 1976 and 1983, was convicted of reckless homicide by a Will County jury in 1999 and was sentenced to 14 years in prison. Last year an Illinois appeals court last year granted Pomykala a new trial on the grounds that the reckless homicide law improperly says evidence of alcohol intoxication must be considered evidence of recklessness. That requirement, the court wrote, improperly relieves the state of the burden of proving the defendant acted recklessly. Prosecutors have appealed that decision to the Illinois Supreme Court.
    The Pircs, along with friends and law enforcement officials, started raising money for video cameras soon after Pomykala was convicted. The Rockdale Police Department received the first camera in August 1999. Joliet got two cameras and, including those bought with its own funds, now has 17 camera-equipped squad cars. Chief David Gerdes said the cars are used on evening shifts and for roadside safety checks. "The death of Taylor Pirc and the publicity surrounding it changed a lot of attitudes about drunken driving within the community and also the attitudes of some of our officers," Gerdes said.
    In 2000, the department launched a drunken-driving enforcement program, putting officers on patrol near bars on busy nights. That resulted in an increase in DUI arrests from 120 in 1998 to 345 in 2000, though arrests have dropped since, to 268 in 2001 and 225 through mid-December, Gerdes said.
    Officials in the state's attorney's office said convictions for drunken driving have increased because of the Taylor Pirc Video Camera Project. "Nine times out of 10, when we have a case with a video, we get a plea of guilty," State's Atty. Jeff Tomczak said. "The defendant looks at that video and realizes that the evidence is there to convict him. "I know the project is over, but I'm hoping that the departments will add even more cameras. I think it provides an element of safety for the officers and an element of accuracy as far as the cases are concerned in court."
    The Pircs and their supporters still have to work out details for the scholarship, including how much should be raised. The family plans to continue fundraising events such as a bowling tournament in March and a softball tournament in August. The family hopes the scholarship fund will keep Taylor's memory alive and produce substance-abuse counselors who will work with first-time drunken drivers to change their ways, Cristy Pirc said.
    The camera project was therapeutic for the family, she said. "It made Taylor's death not be senseless," she said. "Taylor's death meant us making a difference in a community so another family wouldn't have to go through this and bringing an awareness so drinking and driving is no longer tolerated." Gary and Cristy Pirc also have a daughter Lauren, 11, and a son Lucas, born July 25. They plan to tell their son about Taylor. "I'm going to say that she was an incredible little girl and she would have loved him and he would have loved her," Pirc said. "He will have a guardian angel that will always watch over him."
    In 2001, alcohol was a factor in 17,448 of the 42,116 traffic deaths nationwide, according to Mothers Against Drunk Driving.

A Spirited Debate Over DUI Laws
Ralph Vartabedian, Los Angeles Times- 12/30/2002

A high-pressure federal effort to toughen drunk driving laws across the nation is meeting resistance in a third of the states, where many politicians say the policy is counterproductive and misguided. Highway safety regulators in 1998 called on states to lower the allowable blood-alcohol level for drivers to 0.08%, or risk losing millions of dollars in federal highway grants. The majority of the states have conformed, but 17 states -- from Minnesota to South Carolina and Nevada to Delaware -- have rejected the approach and maintain laws that define drunk driving at 0.10% blood-alcohol.
    Though no one defends drunk drivers or suggests abandoning the campaign against them, the states say federal officials have not shown that 0.08% laws save lives. Critics say the tougher laws weaken the emphasis on catching hard-core drunks who cause the most deadly crashes and saddle states with the costs of prosecuting tens of thousands of additional violators. "I don't think there would be one person saved by a .08 law," said Tom Rukavina, a Minnesota legislator representing the state's Iron Range, a sparsely populated region west of Lake Superior. "All we would have is more arrests. Almost every court case up here already involves drunk driving." Rukavina estimates that a 0.08% law would result in 6,000 additional criminal arrests costing the state about $60 million, outweighing the potential loss of federal highway funding. Nevada legislators have voted down 0.08% laws repeatedly for similar reasons, said Bernie Anderson, chairman of the state Assembly Judiciary Committee.
    The federal-state standoff reflects broader controversies about the nation's campaign against drunk driving. Some safety experts express frustration that the campaign against drunk driving has become such a politically powerful force that many safety issues involving roads, car standards and driver behavior are left in the shadows. They say the dimensions of the drunk driving problem also may be misrepresented by complex government statistics. Federal officials reject the criticism, asserting that 0.08% laws save lives and that the statistics showing that 40% of highway deaths involve alcohol do not exaggerate the problem.
    In the midst of the holiday season, the airwaves are again filled with warnings to motorists to avoid drinking and driving. An average of 1,000 alcohol-related deaths occur between Christmas and New Year's, the deadliest holiday period of the year. Jeffrey Runge, chief of the National Highway Traffic Safety Administration, launched a campaign this month to further step up enforcement, citing the continuing threat posed by "1 billion drinking and driving trips annually, which kill more than 45 people every day."
    Nobody questions that the fight against drunk driving has resulted in tremendous progress during the last half a century, saving by some estimates 21,000 lives and radically changing the public mind-set about alcohol. But progress in reducing drunk driving deaths has stalled in recent years. Between 1993 and 2001, alcohol-related driving deaths leveled out at about 17,000 a year despite many states adopting tougher laws and stepped-up enforcement.
    Mothers Against Drunk Driving, the most powerful advocacy group on the issue and a driving force behind the federal government's push to lower the legal blood-alcohol limit, says the nation risks losing the battle and must pass even stricter laws, raise beer taxes and beef up enforcement. Federal officials launched a holiday season campaign with the motto: "You Drink & Drive, You Lose." The advice for drivers is to avoid all drinking.
    But many state officials and some accident experts worry that other types of driver impairments may not be getting the same kind of attention. "Theoretically, very small amounts of alcohol in your blood impairs you, but so do antihistamines and lack of sleep," said Brian O'Neill, president of the highly respected Insurance Institute for Highway Safety. "We should focus on people who are seriously impaired at the kind of levels that are illegal. That's one reason the problem is overstated."
    Advocates for safer cars and improved roads support the drunk driving effort, but say federal officials lack the same commitment to preventing the nearly 24,700 highway deaths involving sober drivers last year. That death toll has leaped 39% in the last two decades. "There are other elements to highway safety than stopping drunk drivers," said Bella Dinh-Zarr, director of traffic safety policy at the American Automobile Assn. "We don't think the campaign against drunk driving is a silver bullet." Added Clarence Ditlow, executive director of the Center for Auto Safety, an organization that often butts heads with the auto industry and government concerning vehicle safety standards: "It is a lot easier and cheaper to blame the driver than to blame the vehicle or the road design."
    The federal highway safety agency has made drunk driving its priority, spending more than $300 million annually on the issue, more than half its budget. Apart from the money, the issue occupies center stage politically, a coveted position MADD fiercely defends. "We don't want cell phones and drowsy driving to become the next hot-button issue for the country, because they don't even compare with the problem of drunk driving," MADD President Wendy Hamilton said.
    One of MADD's most unlikely critics, however, is its founder, Candace Lightner. She says MADD has turned into a "neo-prohibitionist" organization that has lost its focus on safety. "I thought the emphasis on .08 laws was not where the emphasis should have been placed," she said. "The majority of crashes occur with high blood-alcohol levels, the .15, .18 and .25 drinkers. Lowering the blood-alcohol concentration was not a solution to the alcohol problem."
    The toll of drunk driving is tabulated annually by the NHTSA; its Fatality Analysis Reporting System compiles figures from accident reports by police across the country. In 2001, the system reported that alcohol-involved crashes took the lives of 17,448 people. That includes cases where there was direct evidence of alcohol and others where no evidence of alcohol was reported. Those cases are statistically estimated by a complex mathematical model that uses variables such as driver age, time of crash and gender. For example, if a young man hits a tree early in the morning, the model would classify the crash as alcohol-related, even without any evidence of alcohol.
    A breakdown of the 17,448 deaths in 2001 includes:
* About 2,500 to 3,500 crash deaths in which no driver was legally drunk but alcohol was detected.
* 1,770 deaths involved drunk pedestrians killed when they walked in front of sober drivers.
* About 8,000 deaths involved only a single car and in most of those cases the only death was the drunk driver.
* That leaves about 5,000 sober victims killed by legally drunk drivers.
    Those statistics are compiled largely through police reports that sometimes provide an incomplete and equivocal historical record. Police sometimes blame alcohol with little or no evidence. For example, when Alabama State Trooper Darrick Dorough investigated a fatal crash last year in the town of Aliceville, he suspected that the driver, Marvin B. Turnipseed, had been drinking. No alcohol test was reported and the family would later allege in a lawsuit that a defect caused their Ford Explorer to roll over. Now Dorough can't recall why he suspected drinking. "I don't think drinking was the primary cause of the accident. It could have contributed to it. That's a guess." Nonetheless, NHTSA Administrator Runge says the agency's statistics and its mathematical models to estimate drunk driving data are scientifically valid and represent the actual risks of alcohol consumption in the U.S. "It doesn't overstate it at all," Runge said. "The question is, is it a solvable problem? It is solvable."
    More than 1.5 million people in the U.S. will be stopped, handcuffed and detained on drunk driving charges this year, putting it near the top categories of criminal behavior. A heavy legal hammer falls on the convicted, often including mandatory jail time, heavy fines and large legal defense costs. A drunk driving arrest can cost a motorist $10,000, as well as license suspension. While critics say that's well-deserved punishment, they are concerned that merely arresting more drivers will not reduce highway deaths.
    The federal push for lowering the blood-alcohol limit to 0.08% is based on the assertion that it would save 500 lives per year nationwide, according to the formal rule issued by the NHTSA. But that estimate is highly controversial. A June 1999 report by the General Accounting Office, the investigative arm of Congress, found that NHTSA's death reduction estimate was based on four studies that were flawed and failed to "provide conclusive evidence that 0.08% ... laws by themselves have resulted in reductions in drunk driving crashes and fatalities." The NHTSA estimate also seems squishy to some drunk driving researchers. "You are not going to see a big statistical difference between .08 and .10 blood alcohol level," said Kurt M. Dubowski, a pioneer in drunk driving medical research at Indiana University. "While we lower the standard, brakes are getting better, highways are becoming safer, but congestion is growing. You can't peel those factors apart."
    But the NHTSA's Runge argues strongly that impairment begins with the first sip of alcohol. "Is it better to drive stone cold sober? Sure," he said. "Clearly, by .08 virtually all of the population is too impaired to react to a simple emergency." Joseph Carra, director of the National Center for Statistics and Analysis, the NHTSA office that compiles the data, contends that all 17,448 alcohol-related highway deaths in 2001 would have been prevented if alcohol was removed from every driver.
    NHTSA rests its case with studies such as those conducted by Herbert Moskowitz, a medical doctor, who is president of the Southern California Research Institute and regarded as a top alcohol researcher. "There is no question that with any level of alcohol you increase the probability of a crash," Moskowitz said. "Most people don't realize the effects of low blood-alcohol. You are not intoxicated. You are not staggering." A Moskowitz study, funded by NHTSA in April 2000, noted that activities requiring mental activity begin to degrade at below 0.05% blood-alcohol levels. Specifically, low levels of alcohol impair the ability to perform tasks that require divided attention, commonplace in driving.
    But many accident investigators say it is often wrong to automatically blame alcohol whenever it is present in a crash. "If you were to take away all that alcohol, would you take away all those accidents?" asked Kerry M. Clark, a human factors accident investigator in Southern California. "No. I can say that pretty strongly. "I hate drunk drivers with a passion," he said, "but I have reviewed many circumstances where accidents by drunk drivers involved a reaction within the normal range of human response. In some cases, people would still make mistakes."
    Among the states that still have 0.10% laws, there are bitter feelings about the federal government's pressure. Under NHTSA's rule, the states that refuse to lower the drunk driving limit are losing portions of a six-year, $500-million incentive grant program. Brad Hutto, a South Carolina senator, has long opposed a lower legal limit and says he doubts his state will change its law even with the loss of funds. "I call it blackmail," said Stewart Iverson, the Iowa Senate majority leader. "Why is .08 the magic number? By lowering it to .08, we are going to catch more of what I call the social drinkers. I had two friends killed by drunk drivers, but we have to be realistic."
    And in Ohio, the anger is equally great. "Nobody is for drunk driving, but they are after the wrong end of the stick," said Richard Finan, president of the Ohio Senate. "The people who have had a few beers or a glass of wine are not the problem. We call it prohibition drip by drip. It is prohibitionists who want this. Their goal is zero tolerance."
    MADD President Hamilton said she has heard such criticism many times before. "My family has seen a lot of sorrow because of drunk driving, but it doesn't mean people should stop drinking. I am sitting here right now with a beer," Hamilton said on the evening she was interviewed by The Times. MADD and its allies say the legislators are influenced by the alcohol and restaurant lobby. Legislators and their advocates deny that allegation and say MADD's $50-million annual budget distorts the issue.
    Although highway safety organizations endorse tough drunk driving laws, they lament the government's lack of commitment on other issues. Jackie Gillan, a vice president for Advocates for Highway & Auto Safety, notes that federal regulators have set a formal goal of reducing drunk driving deaths to 11,000 a year by 2005. "Why don't they have a goal for reducing rollover deaths, which is increasing yearly and now exceeds 10,000 deaths a year," Gillan asked. "Their solution to rollover is to get people to buckle up to prevent death and injury. What about preventing the rollover from occurring in the first place?"
    Roadway safety advocates say they are in the same boat. "It is easier to pass a law that raises the threshold on drunk driving than it is to get rid of dead man's curve," said William Fay, president of the Roadway Safety Foundation. "A lot of politicians don't want to spend money on things that don't have high visibility. But 15,000 deaths are caused every year due to maintenance and design of roadways. Our roads are designed for a fraction of the current traffic load."

Nicotine Can Be Beaten
Detroit Free Press, 12/31/2002

Reality check. Nothing on God's green earth is going to make you stop smoking except your own grit and hard work. The patch, pills, sprays, hypnosis and other antismoking products are nifty tools. But tools are not magic. The magic, well, that's the part you supply. It happens when one day you get sick of your nefarious friend nicotine running your life and you begin to plot to get rid of him. He'll not go quietly. He'll scream and kick and protest. When that doesn't work, he'll beguile and beg you and make you feel jumpy and sick and desperate. What nicotine does not want you to know is this: He can be beaten. There are 47 million smokers in America. But there also are 44 million ex-smokers. Which category will you choose?
    There are numerous quitting methods. None is perfect, but all have worked for someone. If you have tried cold turkey and failed, try something else. A few methods are expensive. Many are covered by insurance.  "People are very unrealistic about what it takes to quit smoking. They don't put out any effort," says Karen Keeler, a psychotherapist and hypnotist at Health Improvement Network in Southfield. She's not just criticizing. She's an ex-smoker and remembers how hard it was to quit. Most of her hypnosis is spent building up the smoker's positive resolve, not planting negatives. "If I told you cigarettes tasted like cow manure, after a while that would wear off," she says. "I try to anchor people to the positive."    
    Experts say one crucial element to quitting smoking is self-efficacy -- you really have to believe you can do it. Another is a strong desire. "You have to want to quit more than you want anything else," says John Watkins, 53, a 1 1/2-pack-a-day man from Westland. Watkins has tried four times to halt a 40-year habit that costs him $2,000 a year. He's tried the patch, cold turkey and gum. No luck. He's still smoking.
    East Lansing acupuncturist Jeff Gould can predict which of his patients will quit smoking -- the determined ones. The needles he carefully places in the ears, scalp, legs, wrists and forehead help curb the addiction, he believes. But that's all. Last month, Michigan voters defeated a proposal to pour $8.1 billion of tobacco settlement money toward antismoking efforts in the next 20 years. But even if all that money came pouring in tomorrow, it still wouldn't change one thing: each smoker needs the personal grit to quit.

What works and how to keep trying to quit Nicotine
Dr. William Wadland is an expert on smoking cessation methods and their real-world challenges. He is professor and chairman of family practice at the Michigan State University College of Human Medicine in East Lansing. We called him to ask 10 hard questions.
Q: Is there ever a point at which you should give up trying to quit smoking?
A: If your life expectancy is only three months and you already have lung cancer, you might say it's not worth it. But the truth is, whenever you quit smokingyou will breathe better and your food will taste better and you'll have positive effects in the short term even if you don't have long to live.
Q: Do you increase your chance of quitting the more times you try, or are you just setting yourself up for repeated failure?
A: It's always worth trying again. Generally, the more times you try, the greater chance you have of succeeding, up to a point. If you reach five to seven times and haven't succeeded, take a class. Most people don't want to go to a group, but you get the biggest success rates -- up to 50 percent -- with the reinforcement from group counseling. If you are really serious about quitting, try it.
Q: Right now 23 percent of the U.S. population smokes. That's down from the 1999 rate of 25 percent. Is this the lowest rate we can hope for?
A: By 2010 we'd like to have it below 20 percent. Health promotions and media campaigns work, if states make the investment.
Q: Is there anything new coming down the pike to help people stop smoking? People have tried all the current methods -- the antidepressant Zyban (buproprion), nicotine replacement, etc.
A: Down the whole buproprion road, there may be other drugs in the same category that may be able to be tailored to certain smokers. Also, genetic testing shows that some people are more responsive to nicotine and have more nicotine receptors in the brain. It may be we can map out risk factors and tailor medication to their needs. We also know more about combinations than we did. For instance, inhalers and sprays are mostly for people who have not succeeded with the patch. Heavy smokers seem to do well with Zyban, plus the patch, plus counseling.
Q: Is there a correlation between the length of time you have smoked and the difficulty of quitting?
A: Yes. The probability of addiction increases the longer you have smoked. That's the whole problem with teenagers starting. Many start out as chippers, who only smoke one or two cigarettes a day and a pack on the weekend. But 60 percent to 70 percent of them become long-term smokers. And the longer you smoke, the more nicotine it takes to prevent withdrawal symptoms.
Q: Studies this fall showed that the patch didn't work well when people bought it over the counter, mostly because they stopped too soon or didn't follow directions. Are you doomed to fail if you try quitting on your own with a patch?
A: If people purchase products, they should try to do it in conjunction with some kind of support -- some type of counseling, or advice and follow-up from their physician. These products don't work as well if used alone. I've been a big advocate of telephone counseling. It is widely available and success rates increase.
Q: Can you believe success rates advertised for products?
A: The clinical trials for drugs are conducted under rigorous conditions. The long-term quit rates -- six months, one year and two years -- the most sound.
Q: If a method fails once, should you try it again?
A: Yes, in a different combination. Repeat what works and give up what didn't. What you do is to try different techniques to get through the triggers and stimulus that provoked your smoking. You might have tried listening to relaxing music while driving, and that didn't work. Next time chew gum, but still keep the music. A common trigger with women is when they are home alone with the kids and feeling stressed. How do you get out of that mood to smoke? Find little different strategies.
Q: Do Internet support groups work? There sure are a lot of them.
A: Many give general information, and that's like picking up a brochure. But interactive programs do seem to work. They haven't been as well-tested as telephone counseling.
Q: Is it harder to quit smoking if your spouse, partner or roommate smokes?
A: It's much more difficult. It's best to quit as a group. One of my greatest successes was a group of MSU students. They were all in AA (Alcoholics Anonymous) and were sober, but they were all heavy smokers. We met as a group. Using Zyban and group counseling, they all quit.

Here are a list of sources that offer free support and assistance to help you quit smoking:
* Get a "Quit Kit" from the Michigan Department of Community Health, 800-537-5666 or www.mdch.state.mi.us/smoke. The department also can link you to 290 stop-smoking classes.
* The American Lung Association "Freedom from Smoking" program now has a free online version. Go to www.ffsonline.org. Find classes in your area by calling 248-784-2000.
* "The Quit Wizard" is an excellent program available through the Massachusetts Department of Public Health. It also has good suggestions for partners of smokers who want their loved ones to quit. www.trytostop.org
* See your family doctor and ask for help. There is a big move in Michigan to give family doctors and nurses better tools to help smokers quit. Regular phone calls from a doctor or nurse can help prevent relapse. (Physicians who wish to receive a free smoking cessation tool kit can request one by fax at 248-448-7992 anytime.)
* Get stop-smoking help in English and Spanish from the U.S. Surgeon General's office at www.surgeongeneral.gov/tobacco.
* Check hospital community education programs for classes, counseling, hypnosis and acupuncture.
* Find out what your employer offers. Many run stop-smoking programs.
* Check your insurance coverage. Most pay for smoking cessation products and services. For instance, "Quit the Nic" is a telephone-based stop-smoking counseling service free to Blue Cross Blue Shield of Michigan members and Blue Care Network members. Call 800-811-1764 anytime for information. Health Alliance Plan members can attend classes and get telephone stop-smoking intervention counseling. For information, call 888-427-7587.

Nicotine: A Mother and Son Exchange Promises of Healthy Change
Ellen Creager, Detroit Free Press- 12/31/2002

Neither doctors' warnings, asthma nor the cost of cigarettes deterred Tommie Miller from a 2-pack-a-day smoking habit. It was only when she realized her son's obesity had ballooned to 480 pounds that she took the biggest step of her life. Two years ago this month, she vowed to quit smoking if her son would vow to lose weight. That was the promise. That was the pact. Since then, Bill Miller has lost 266 pounds, and Tommie Miller has not had a cigarette. "I'm more proud of my son, and he's more proud of me," says Tommie, 60, of Madison Heights, who smoked 45 years before quitting. "I did it to save my son's life and mine."
    If you say you cannot quit smoking or lose weight, it may be only that you do not have the proper motivation. In the whirlwind of antismoking and weight-loss treatments, one powerful motivation is often overlooked -- love, and our fear of losing those we love. Tommie saw Bill, now 34, frustrated and depressed by his expanding weight. The Sterling Heights man's blood pressure was so high, he was on medication. His liver was stressed. As a nurse and mother, she worried about the future of the son she so dearly loved. Bill, meanwhile, saw his mother still smoking despite asthma that took her breath away. He was alarmed for her. As a cardiac rehabilitation technician, he knew about the risks she faced, and he feared losing his mother too soon.
    One day, he heard a song on the radio by singer Tim McGraw, "My Next Thirty Years," about a man contemplating his life.
"My next thirty years, I'm gonna watch my weight
Eat a few more salads and not stay up so late
Drink a little lemonade and not so many beers
Maybe I'll remember my next thirty years."
    Somewhere, a bell rang. Bill knew it was time to change. So on Jan. 13, 2001, the two began their pact. And the woman who had smoked nearly half a century quit. And the man who weighed a quarter of a ton got slim. The mother did it to save her son, and the son did it to save his mother.

45 years a smoker
Tommie started smoking in the 1950s at age 12, sneaking cigarettes from her grandfather's house. She liked smoking so much that as a teen she even spent her lunch money on unfiltered Kools. "When I started, cigarettes were dirt cheap, 25 cents a pack. But even when they went up to $4 a pack, that didn't bother me," she says. Like millions of other smokers, she smoked at work, at home, in the car, everywhere. As a young nurse, she could even smoke on patient wards.
    For decades, when she got up at night to go to the bathroom, she would smoke a cigarette before going back to sleep. "It was the first thing I did when I opened my eyes and the last thing before bed," she says. "I tried to quit a couple times. Once, the doctor sent me to a hypnotist. As I left the hypnotist I was lighting a cigarette on the way to the car, because I really didn't want to quit. And once, I told my family I quit for three months, but I was still smoking in the backyard, just not in the house." Once during a snowstorm, she bundled up and trudged to a distant party store -- not for food, but for cigarettes.
    Friends nagged her to quit, to no avail. New laws pushed her smoking outside the workplace. Her Virginia Slims habit cost her $3,000 a year, but she gladly paid it. Her husband, Glen, quit smoking 30 years ago, cold turkey. "He just threw away his cigarettes, but he never pressured me to quit," she says. "That's good, because if you pressure someone, they're going to do it more. There has to be a bigger reason."
    There never was one until two years ago, when Tommie was admitted to the hospital after a serious asthma attack. Bill came to visit and saw her lying there. He knew the doctor had given her an ultimatum to quit smoking. He suddenly said, "Mom, I'll lose weight if you quit smoking." She looked at her son. Could he do it? Could she? There was only one way to find out. "OK," she said. It was a momentous step.
    "I always made a joke that when I died, they should bury me with a carton of cigarettes," she says. "But when it came down to my son's life, and his blood pressure was high, and he was having liver problems, I had to make a choice between cigarettes and my child. That was the spark and motivation. "If he hadn't forced me into that pact, I probably would still be smoking, because honestly, my being sick had no effect on me."
    To help her quit, the doctor put her on the drug Wellbutrin. It worked, but she didn't like how it made her feel, so after 2 weeks she switched to a Nicotrol inhaler. That worked, too. She stayed on it 3 months. After that, she weaned herself to Nicoret gum. That helped more. The first 3 months were the hardest, and she struggled and felt sorry for herself. Then she would look at her son and see him struggling mightily to lose nearly 300 pounds. "It was so hard for him," she says, "and I knew I was not doing anything harder than what he was doing. So I kept going."
    This February, Tommie will have been triumphantly cigarette-free for two years. "I haven't even sneaked one, smelled one, or had the desire," she says. "Well, that's a lie. I still have the desire, but I think once you get past the addiction part, about three months, it gets easier. It's hard because you go through full withdrawal. Once I got through that, it was more the psychological part that was hard. Occasionally, I still find myself rummaging in my purse for cigarettes.
    "I know now that the gimmicks, the patches, the gum, those things all help, but nothing works unless you want to quit. It has to be your choice. You have to have a reason that you deem more important than smoking. My child was. My health wasn't, obviously. Now my son has lost 266 pounds. It is totally unbelievable. What I did pales in comparison."
    Since she quit, Tommie has not had an asthma attack. She takes no medication. "The most wonderful thing is, everyone remarks that I have such beautiful skin! I think, well, gosh, what did I look like before?" she says. Tommie has gained 15 pounds, but her doctor says that is nothing to worry about, compared to the health benefits from quitting cigarettes.
    At St. John Oakland Hospital where she works in the same day surgery department, she will tell her story, but only if a smoker asks how she quit. "I'm not a pushy ex-smoker. I can't say right now that I will never smoke again," she says. "All I do is the 12 steps and tell myself I won't smoke today. I still say that every day, I won't smoke today."

The 480-pound challenge
When he was 12, Bill tried smoking. It wasn't for him. "I only smoked very briefly," he says. "Cigarettes went up to 85 cents a pack, and I couldn't afford it so I quit." But Bill had a different problem than his mother did. Always overweight, he grew wider and wider until at age 32, the 6-foot-3 man weighed 480 pounds. He just couldn't lose weight. And he had tried. Once he lost 75 pounds on the diet drug Redux, but when the FDA pulled it off the market, Bill regained all the weight, plus more. He began to consider gastric bypass surgery, but longed to lose weight naturally.
    As a cardiac technician, Bill knew what obesity could do to the heart. He was shocked when he stepped on a scale at work and found he weighed 100 pounds more than he thought he did. "Here at work I'm telling patients they need to change and do this or that, but I wasn't the best person to tell other people to change their lifestyle," he says. There was more. His father was diagnosed with congestive heart problems. Then his mother landed in the hospital with a severe asthma attack.
    Worried, he went to visit his mother. And an idea hit him. "She needed to quit smoking, and I needed to lose the weight. So we kind of made a deal that we would both do it together," he says. He had a friend who was an instructor at Weight Watchers, so he decided to go there for help. He used the Weight Watchers points plan, which gives foods a point value and people a daily point limit. He also started working out on the St. John Oakland cardiac rehab exercise equipment 5 days a week. "At first, it was really difficult. I could only go for 20 minutes at a time, but as the weeks went by, I went from doing 5 miles in half an hour on the bike to where I could do 25 miles in little more than an hour," he says.
    When he struggled those first few months and felt sorry for himself, he would look over at his mother, who was valiantly trying to walk away from 45 years of smoking. Somehow, it reinforced his determination. Within 16 months, he had lost more than half his body weight and was down to 214 pounds. He has stayed at that weight since. A lifetime member of Weight Watchers, he still goes to the meetings. "My mother helped because we both encouraged each other," he says. "The more weight I lost, the longer she went without smoking, and we kept each other going. In fact, I kept thinking she might make it and I wouldn't. But we both set our minds to it, and we did it. There now are a lot of people here at work who see me and tell them that I've inspired them."
    Bill still follows the Weight Watchers points system. He still works out 4 to 5 days a week at work, either on the bike, Stairmaster or with weights, 45 minutes each time. He no longer has to take blood pressure medication. He feels good and has energy. Most of all, he is comfortable talking to patients about lifestyle changes. But like his mother, he doesn't go around lecturing anyone else. "Like smoking, losing weight is a mind-set thing. You can tell people they need to do something, they should do something, but unless it gets focused in their minds, they're just not going to do it," he says.
    "I don't know how many years I made New Year's resolutions to lose weight. But the year I didn't make a resolution was the year I started on this journey."
"My next thirty years will be the best years of my life
Raise a little family and hang out with my wife
Spend precious moments with the ones I hold dear
Make up for lost time here in my next thirty years."

Born To Be Happy, Through a Twist of Human Hard Wire
Richard A. Friedman, M.D., New York Times- 12/31/2002

In the course of the last year, the woman lost her husband to cancer and then her job. But she did not come to my office as a patient; she sought advice about her teenage son who was having trouble dealing with his father's death. Despite crushing loss and stress, she was not at all depressed -- sad, yes, but still upbeat. I found myself stunned by her resilience. What accounted for her ability to weather such sorrow with buoyant optimism? So I asked her directly. "All my life," she recalled recently, "I've been happy for no good reason. It's just my nature, I guess." But it was more than that. She was a happy extrovert, full of energy and enthusiasm who was indefatigably sociable. And she could get by with five or six hours of sleep each night. Like this woman, a journalist I know realized when she was a teenager that she was different from others. "It's actually kind of embarrassing to be so cheerful and happy all the time," she said. "When I was in high school I read the Robert Browning poem 'My Last Duchess.' In it, the narrator said he killed his wife, the duchess, because, 'she had a heart-- how shall I say, too soon made glad?' And I thought, uh-oh, that's me."
    These two women were lucky to be born with a joyous temperament, which in its most extreme forms is called hyperthyrhia. Cheerful despite life's misfortunes, energetic and productive, they are often the envy of all who know them because they don't even have to work at it. In a sense, they are the psychiatric mirror image of people who suffer from a chronic, often lifelong, mild depression called dysthymia, which affects about 3 percent of American adults. Always down, dysthymics experience little pleasure and battle through life with a dreary pessimism. Despite whatever fortune comes their way, they remain glum.
    But hyperthymia certainly doesn't look like an illness; there appears to be no disadvantage to being a euphoric extrovert, except, perhaps, for inspiring an occasional homicidal impulse from jealous friends or peers. But little is actually known about people with hyperthymia for the simple reason that they don't see psychiatrists complaining that they are happy. If dysthymia is hyperthymia's dark twin, then hyperthymia may not always be so rosy. That is because about 90 percent of dysthymic people experience episodes of more severe depression in their lifetimes. Are hyperthymics at risk of some mood disorders, too?
    If hyperthymics bear a kinship with any psychiatric illness, it may be bipolar disorder. Bipolar patients live on a roller coaster of depressive troughs and manic peaks. But unlike hyperthymia, mania is an inherently unstable state of euphoria, irritability and often psychosis that causes profound morbidity and impaired functioning. Some researchers believe hyperthymics may be at increased risk of depression or hypomania, a mild variant of mania. And they may have high rates of affective disorders in their closest relatives.
    Hyperthymic and bipolar people may also share a tendency to be highly creative, given the strong association between bipolar disorder and creativity. For example, a 1987 study of creative writers at the University of Iowa Writers' Workshop by Dr. Nancy Andreasen showed that writers had bipolar illness at a rate four times as high as control group members who were not writers.
    Of course, the notion of a hyperthymic temperament is hardly new. Some 2,400 years ago, Hippocrates proposed that a mixture of four basic humors -- blood, phlegm, yellow bile and black bile -- determined human temperament; depending on which humor predominates, one's nature is happy, phlegmatic, irritable or sad.
    Modern science has renamed the humors neurotransmitters, like serotonin and dopamine, and tried to link them to abnormal mental states. For example, depression was thought to result from a functional deficit of serotonin or norepinephrine in the brain. But one problem with this theory is that antidepressants increase the levels of these neurotransmitters within days, yet their clinical effects take several weeks. If the theory were correct, then depression should clear up within days of taking an antidepressant, not weeks. Still, many dysthymic people respond to antidepressants and watch their unhappiness melt away in a matter of weeks. If a lifelong depressive state like dysthymia can be erased in some cases with medication, is it possible then to make a person better than well, let's say hyperthymic?
    Of course, humans have experimented with various recreational drugs for this purpose since recorded history without much success. Cocaine, to name one, produces an instant and intense euphoria by flooding the brain with dopamine. But the pleasure of cocaine is fleeting because the neurons that are activated by dopamine become rapidly desensitized to it, leading to a state of apathy and depression. Ecstasy can induce tranquil euphoria, largely by enhancing brain serotonin activity, but it is short-lived. And it can permanently damage serotonin-containing neurons in animals, hardly good news for humans. In fact, the pleasure brought on by all recreational drugs will fade sooner or later because of the brain's own homeostatic mechanisms.
    What about psychotropic medications? A study by Dr. Brian Knutson at the University of California at San Francisco looked at the effects of the serotonin-enhancing antidepressant Paxil among normal volunteers, randomly assigned to either Paxil or a placebo. Neither the volunteers nor the researchers knew who was taking Paxil and who was taking the placebo. Compared with the placebo, Paxil reduced hostile feelings and slightly increased social affiliation. But Paxil did not make the normal people any happier. In short, no drug -- recreational or prescribed -- comes close to creating the stable euphoria of hyperthymic people. Of course, antidepressants, unlike recreational drugs, are nonaddicting and retain their benefits over time.
    So if some people are just born happy and stay happy for no good reason, does this mean that happiness is nothing more than a lucky combination of neurotransmitters? For most people, no. Circumstance and experience count for a lot, and being happy takes work. But hyperthymic people have it easy: they have won the temperamental sweepstakes and may be hard-wired for happiness.