Can Smarter Marriages Stem the 'Starter' Marriage Trend?
Libby Copeland, Washington Post- 3/20/2002

WASHINGTON - There's nothing like a book on why marriages fail to leave you staggered by how much the institution of marriage is up against. Not just what marriage is up against now, in the fast-paced, "one-click" culture of modern America, blah, blah, blah. No. Consider how much marriage is up against as a concept: How is it we can decide at 25 or 30 or even 35 what we want for the rest of our lives? It seems to necessitate a breathtaking leap of faith, sometimes idiocy. And yet most of us treat marriage as the necessary, inevitable entree of our lives.
    If anything, we're trending toward marriage these days, despite talk of how high divorce rates have cheapened matrimony. In her new book, "The Starter Marriage and the Future of Matrimony," social demographer Pamela Paul points to evidence that Generation X reveres marriage more than the baby boom generation does. "Young people today," she writes, "hold marriage in unusually high regard." And that may be part of the problem.
    Paul, 30, wants to talk about the starter marriage: a brief, training-wheels union that she says is becoming an unfortunate phenomenon within her generation. Some of her contemporaries, she says, spent more time planning their weddings than they did being married. She defines the starter marriage as one that lasts no more than five years, produces no children and ends by the time the couple are in their early thirties. The theory goes that Gen-X treats marriage the way it treats jobs -- hopping, hummingbird-like, from one to the next in a quest for individual fulfillment.
    Why? False expectations, Paul says. "We are setting up marriage as this idealized institution," she says over dinner in Washington, where she is promoting her book. She is plucking clams from their shells and speaking with an ease -- and a passion -- that seem surprising for a first time author on her first press junket. "Marriage is not a transformative act. It does not make you more successful or more balanced." No one enters a starter marriage calling it that, she says -- least of all Paul herself, who was "heartbroken" when her own marriage of less than a year ended when she was 28. She started to see starter marriages everywhere: in the divorces of a colleague, a neighbor, a friend, an eye doctor. She began to wonder why there were so many of her.
    Paul points to opinion surveys that suggest Gen-Xers are more conservative with regard to marriage and homemaking than their boomer parents, possibly as a means of rebellion. At the same time, boomers, for whom divorce was common, may not have given their children good guidance about what successful marriage requires, she says.
    Ironically, many of those Paul spoke with were acutely aware of their own parents' failed unions. "There's a sense that 'I'm going to do it right,'" Paul says. The concept of starter marriages isn't new. Margaret Mead spoke of a similar idea in the 1960s, calling them "trial marriages." But the notion has recently taken off in the popular media, Paul's research suggests. She lists an almost comic collection of recent snippets from magazines: a headline in Jane that read "Young, Hot and Divorced," an Entertainment Weekly piece that included "divorcing in your 20s" on its list of "in" things to do.
    Through the words of her anonymous interviewees -- an admittedly limited pool of 60 mostly white, mostly middle-class men and women, Paul weighs a burden that many a single twenty-something labors under. The way she describes it, one day you look around at all the friends who are engaged or married, check your watch and think, "(Expletive)! When's my turn?" Even if you don't really want it to be your turn, you want it to be your turn. We're only human, after all -- social creatures. We survive by conforming.
    "People talk about the culture glorifying single people," Paul says. "I feel like nothing could be further from the truth." Notice, she says, how the single people on television shows from "Seinfeld" to "Friends" to "Sex and the City" are neurotic. Notice how their entire purpose -- the perpetual plot line -- is finding "the right one." And what about the wedding industry? Did you know that a recent issue of Bride's magazine was the largest consumer magazine ever, weighing 4.9 pounds? (Paul, an editor at American Demographics, spews statistics like a human computer.) American culture focuses on the wedding day, Paul says. "You never hear about what marriage is like after you walk away from the altar." As one of her subjects, "Isabel," describes her decision to marry at 25: "Once one person gets engaged, everybody has to get engaged. And then you get so wrapped up in whose ring is bigger and who's getting married where and how much everything costs."
    Census Bureau surveys show that in 2000, almost 7 percent of Americans ages 25 to 34 identified their status as divorced, compared with 2 percent in 1960. Also, couples are waiting longer to have children, which Paul suggests increases the chances that their first union will be a childless one. Martin O'Connell, chief of family statistics at the Census Bureau, says the nation's divorce rate has been stabilizing or declining over two decades (it's now greater than 40 percent), and the vast majority of Americans who marry do so only once.
    Is there any way to prevent starter marriages? Paul says people should go into marriages "smarter." Perhaps the challenge is best voiced by "James," whose wife left him for another man. "People don't try their hardest," he says. "They think everything should be easy, that there shouldn't be a struggle."
    Many of Paul's subjects say they learned a lot from their first marriages, that they think they could get it right the second time around. Which makes you wonder: Is a failed marriage the only way for some folks to make a good, lifelong one? And if they think they know so much more now than they did when they first married at, say, 25, won't they say the same thing 10 years from now? In which case, why the heck does anybody ever get married?
    Nancy Cott can shed light on this. A Harvard historian who wrote "Public Vows: A History of Marriage and the Nation," she points out that the very notion of lifelong monogamy is a fairly recent one, propounded by Christianity. When the idea gained currency, "marriages did not used to last this long," she says. Even within the last few hundred years, "marriages probably rarely lasted with the same couple longer than 15 years. One member of the couple would die." Thus, she adds, "We can't assume that the lifelong marriage is still the best model for our society." Though Paul hopes it will be for her: "I hope that my next marriage would last a lifetime."

Best Friend Says She Begged Russell Yates to Get Help
ABC News, 3/20/2002

Throughout her depression and the battles with her demons, Andrea Yates had a best friend. Deborah Holmes, Yates' friend of 16 years, said she wanted to force the troubled Houston woman into treatment without Russell Yates' permission. "I don't know that he really believed that she was mentally ill, but that she was just weak," Holmes told ABC News' Good Morning America.
    Holmes said she pleaded with Russell Yates on several occasions to take Andrea to a doctor. "He said, 'I am not going to coddle her, I'm not going to hold her hand,' and, you know, 'She needs to be strong, she needs to help herself,'" Holmes said. "I said, 'That's the point. She can't help herself. She is not able. She's not capable.'" Holmes said she spoke to Russell Yates "numerous times" about taking Andrea to seek medical help. "I don't know if he was in denial or, just, he wanted to be in control," she said on Good Morning America, adding, "There are times when I think I could just kick him."
    ABC News reported Friday that prosecutors intend to consider factors that could lead them to prosecute Russell Yates for either child endangerment or negligent homicide in connection with the deaths of his five children. Prosecutors would charge Russell if and when the evidence warrants, but do not have the evidence now, sources said.
    Holmes said she and Andrea Yates were best friends for 16 years. The two raised their children together, and Holmes sometimes left her kids in Yates' care. The two friends saw each other twice in the eight days before Yates' arrest. Holmes said it was very clear that Yates was suffering from severe mental illness. "I saw a very scared, very shaken woman," she said. "There were times that when I would see her look so scary, I would not let her out of my sight. I would not even turn my back on her." Holmes said she became so concerned that she thought to getting Andrea into a treatment program herself. But Holmes' husband, Bob, didn't think this would be possible. "He said, 'Are you suggesting that you kidnap her?'" Holmes said she learned of the killings from a co-worker who saw Yates' arrest on the news. "I just fell to the floor," she recalled, in tears. "My little girl just collapsed when I said, 'Andrea has killed all the kids.'"
    Bob Holmes said he once asked Russell Yates whether he wanted to have more children, considering the depression his wife had suffered after her last two pregnancies. "I said, 'Don't you think it's time to think about not having more children?' And he said to me that, 'Well, the first three turned out just fine.' I was sure he was going to say, 'Yes, we will not have more children,'" he said.
    Deborah Holmes wonders whether she could have done anything to prevent the killings. "Could I have brought one more meal? Could I have taken the kids to the park more often? Could I have visited her more? Could I have screamed louder?" she said. Even now, although it will be 40 years before Andrea Yates is eligible for parole, Holmes stands by her best friend. "I wish everyone could have a friend like I have had, and I will continue to have," she said. "I just love her so much. I'll never turn my back on her."

State Fires Therapist from Sex-Predator Program
Tacoma News Tribune, 3/20/2002

TACOMA -- A therapist for the state's sex-predator program was fired after an investigation found he used his office computer to view racy photos and told rapists and pedophiles they should deal with their sexual urges by visiting prostitutes, records show. Thomas Smith was fired Feb. 12 from the Special Commitment Center, a program for about 150 sexual predators at the McNeil Island Correctional Center.
    In Smith's dismissal letter, the Department of Social and Health Services said the advice he gave rapists and pedophiles was "not only illegal but also completely contrary to the treatment goals and mission of the SCC." Smith said he is appealing the termination. He denies telling sex predators to visit prostitutes and says that viewing racy Web sites was part of his job. "What I did was really kind of minor," he told the newspaper. He says the state fired him to appease three female co-workers who had accused him of sexual harassment. The complaints resulted in a written reprimand in April 2001. His dismissal letter said he used his office computer to access sexually oriented Web sites 57 times. Those included an escort service site that featured photos of partially clad or naked women. About 85 percent of the e-mails on his computer were personal rather than work-related, the investigation found. "There wasn't any doubt he should be terminated," said program superintendent Mark Seling.

Dying or Lying: Fabrication of Impending Demise
ABC News, 3/20/2002

WAUKEE, Iowa,— When news spread that Charlene Zimmerman, a 34-year-old wife and mother, had only six months to live, her community opened its arms. "Everybody started rallying around," said Waukee Police Chief Larry Phillips, "doing whatever they could to help the family in any way they could." The town's schools and charities reportedly raised about $10,000 for the Zimmermans, who had just moved to the small town of Waukee months earlier. "Everybody just opened up everything," said Phillips. "Even the little kids were taking pennies out of their banks and donating money."
    Charlene started to say goodbye to her children, videotaping messages for them to watch in years to come. Her husband Chuck stood by helplessly as Charlene deteriorated: her hair fell out, and she was hooked to an IV. When the 1998 holiday season approached, the community wanted what might be the Zimmermans last Christmas together to be memorable. "I thought, you know, a last Christmas, that's going to stick in the kids' mind," said Nikki Samson, whose daughter was in the same class as one of the Zimmerman children. Samson spoke to the principal at the elementary school, who "went around to each teacher and took cash donations just on the spur of the moment." That money went to Charlene at the end of the day so her family could afford to buy a Christmas tree.
    One year after she broke the news of her terminal illness, the dying mother, her caring husband and their beautiful children touched hearts across America when they appeared on Oprah. Host Winfrey gave Charlene an expensive wig that had belonged to Madonna and a home video camera to preserve family memories for her children. More than a year later, the town came to the family's rescue again, raising thousands of dollars after a fire gutted the Zimmerman home.

Suspicion and an Investigation
Years passed, and Charlene didn't seem to be getting any worse. In fact, her hair grew back and Charlene gained weight. People started to get suspicious, wondering if she really was suffering from terminal cancer. Chief Phillips launched an investigation. He contacted the clinics where Charlene claimed she had been getting chemotherapy, and discovered she had not been getting treatment. He confronted Charlene, asking her if she had cancer. She said she did not. "She was devastated, her head was bowed, she was, of course crying," said Phillips. "She acted as if maybe a large weight was taken off her shoulders … She was caught."
    The subject of the town's sympathy became the object of its scorn. The community was outraged. Charlene pleaded no contest to theft and was ordered to return $1,400 to the angry friends and neighbors she had deceived. "The lengths she went to to do it and the fact that she led her kids to believe that she really was dying," said Samson. "That's bizarre to me." "She twisted people around," said Zimmerman's brother, Walter Bonham. "She manipulated them. She used cancer to get what she wanted."

'I Assumed I Must Have Cancer'
Though Dr. Marc Feldman, a psychiatrist, never examined Charlene, he believes she may have in fact been sick: not with cancer, but with a psychological condition called factitious disorder, whose sufferers feign, exaggerate or self-induce illness in order to get attention and nurturing. "It's a little counterintuitive. Most of us don't want to be sick," he said. "But in reality, a person who's perceived as sick gets attention and sympathy and nurturing, care and concern." People who suffer from this psychological disorder, he said, can be "sublime actors and actresses. So much of an act that Charlene even fooled her own husband, who insists he never knew. "I believed what she was telling me," said Chuck. "I had no reason to doubt her."
    Charlene now says her delusion grew out of a deep depression caused by an abusive father. The depression was made worse, she claims, when she stopped therapy and medication. Finally, depressed and fearful, she went in for a simple physical check-up. "My liver enzymes were four times higher than normal," she says. "I assumed I must have cancer if this is going on. And there's been no explanation. It has to be something terrible like that." Charlene says she wanted to die.
    The Zimmermans eventually moved far away from Iowa, and in the years since the incident, Charlene has remained in therapy and on medication. She has made no further claims of life-threatening illness. "It upsets me that I put my family … that I put my friends … that I put this town through this," she said. "And I never meant to hurt anyone. The only one I wanted to hurt was myself."

Q&A on Factitious Disorder
Though Dr. Marc Feldman did not examine Charlene Zimmerman, the psychiatrist spoke with ABC News' Tom Jarriel about her possible condition.
Q: What is factitious disorder?
A: In factitious disorder, an individual either claims to be ill or actually makes himself ill. He then presents himself for medical treatment while denying any real source of the problem. And the whole goal seems to be to accrue the sick role, the benefits of the sick role … About one percent of all hospitalized patients appear to have either full-blown Munchausen's syndrome, or a milder form called factitious disorder … The Munchausen's patient is looking for intangibles: attention, support, love … The malingering patient, we can discern very early, is after money.
Q: In Charlene Zimmerman's case, the disorder seemed to be suddenly cured when the sheriff got the goods on her. Is it possible that the delusion just disappeared when confronted with the facts?
A: People with factitious disorder or Munchausen's syndrome, interestingly know exactly what they're doing. If one spends time creating elaborate falsehoods to explain the illness, if one is able to carry it along for years and even go public with the claim that one is sick, one knows that it's not true. However, a lot of these patients genuinely don't know why they're doing it. And so their protests of innocence or of somehow being buffeted by psychological forces they don't understand can appear very sincere.
Q: She looks like a woman dying of cancer. Her hair is gone. An IV appears to be in her arm and she is saying things from the heart, very, very convincing. Could that be by someone who knew she didn't have a fatal disease?
A: I've worked almost full-time in the areas of factitious disorder and Munchausen's syndrome for 12 years. And each time I think I've seen the most masterful performance or the most exotic illness claim, the next day someone tells me something even more burlesque.

This Time, 'Forgetting' Is Healthy
Richard A Friedman, M.D., New York Times- 3/20/2002

When the first jet hit the north tower of the World Trade Center on Sept.11, my patient Alan was in his office on the 81st floor of the south tower. He remembers the blue sky turning white with a rain of paper and debris. And within minutes, the sight of people jumping to their deaths was burned into his memory. Alan is a chronic worrier, always tense and anxious. So he was not reassured when he heard the announcement that his tower was safe and that he should stay put. Instinctively, he fled, running down all 81 flights of stairs. What had been a lifelong liability, his generalized anxiety disorder, had clearly saved his life that morning. His worrying finally paid off.
    Now, more than six months later, most of us who experienced the horrifying events of that day via television and newspapers have been able to put the sickening images out of our everyday awareness. Most of us have been able to do what Alan and many others who were at ground zero have not been able to do -- to, in a way, forget.
    We don't usually think of forgetting as healthy or adaptive; we see it as annoying. Everyone is keen on memory in America. Psychotherapists make their living helping patients uncover and cope. Drug companies are eager for memory enhancing drugs. The message is clear: a memory can never be too sharp.
    Alan would disagree. He is flooded by vivid, intrusive memories of that day. Burning odors and crashing sounds bring the scenes back with terrifying clarity, and at these moments Alan has never really left ground zero. Desperate to avoid anything that will set off these memories, AIan has withdrawn from social life. He has what Aeschylus called the pain that cannot forget.
    Alan cannot easily forget what has happened to him because traumatic memories are processed and encoded in the brain in a way different from routine memories. They just don't fade with time. This explains, for example, why you can constantly misplace your keys but never forget that you were raped. The key is fear-conditioning. Like other animals, humans come hard-wired with a fear response. Natural dangers, like fire and predators, that are encoded in our brains will elicit fear and physical changes like increased heart rate. When Alan witnessed the attack, he had a natural fear response that was instantly paired with the crashing sound of the jet and an acrid burning odor. From then on, either the sound or the odor, the conditioned stimuli, was enough to elicit a full fear reaction.
    We know, from recent pioneering work in animals by Dr. Joseph LeDoux, that fear-conditioning is processed in the limbic system, an ancient part of the brain that mediates basic emotions. This kind of learning is very fast and enduring, if not permanent, and it operates outside of conscious awareness. The advantage of fear-conditioning is that our innate fear response can be recruited by all kinds of new potentially dangerous situations, which may, save our lives if we are exposed to these dangers again. If you are mugged on a dark street, you will probably become anxious walking on dark streets and avoid them.
    But these permanent traumatic memories can be set off when the actual danger is long past, and they can cause great suffering. That is exactly what has happened to Alan. Most of us can watch jets overhead and walk near ground zero with little anxiety. That's because forgetting is an effortless hard-wired ability; bad memories not associated with trauma fade naturally.
    But in Alan's case, the best way to forget was to remember. In the safety of a therapist's office, he was repeatedly exposed to the images and stimuli that set off his painful memories. Through cognitive-behavioral therapy, the everyday triggers are presented without the trauma, and that process breaks the link, depriving the triggers of their power to unleash his fear reaction. But the traumatic memories remain, permanently stored and easily stirred by a new trauma.
    And this gets to the heart of what kind of memorial to build. Can we preserve memory without exposing the thousands of traumatized survivors to the images that will unleash those memories? Should we, for example, display the crushed jet-engine, the World Trade Center antenna or a remnant of the towers' "skin"? To forget, of course, is not to erase memory; forgotten painful memories remain with us, even if outside our everyday awareness. And forgetting isn't callous or disrespectful. It is healthy because it loosens the grip of painful memory on our conscious minds and allows us to get on with our lives

Bias Complaint Against Alabama Justice Rejected
Jay Reeves, Associated Press- 3/21/2002

BIRMINGHAM, Ala. -- A judicial panel has dismissed a bias complaint against state Chief Justice Roy Moore, who called homosexuality an ''inherent evil'' in ruling that a lesbian was an unfit mother. The gay rights group Lambda Legal Defense and Education Fund had filed a petition alleging Moore's comments showed he could not be an impartial judge. The statement issued Thursday by the Judicial Inquiry Commission said it ''found no reasonable basis to charge a violation of the Alabama Canons of Judicial Ethics.''
    The Supreme Court on Feb. 15 gave custody of three teen-agers to their father in Birmingham instead of their mother a lesbian who lives with her partner in California. Moore, writing for the court, said the mother's relationship made her an unfit parent and that homosexuality is ''abhorrent, immoral, detestable, a crime against nature, and a violation of the laws of nature.''
    Moore's attorney, Stephen Melchior, said the panel ''did the right thing'' in clearing the chief justice, a conservative Christian best known for hanging a plaque of the Ten Commandments in court. A lawyer for the gay rights group, Ruth Harlow, said the commission sent the group a letter saying it does not act against judges for statements made in opinions unless there is evidence of ''ill will.'' ''We don't agree with the explanation,'' she said.
    As a circuit judge in Etowah County, Moore in 1996 cited homosexuality in refusing to award a lesbian custody of her children. An appeals court later ordered him to step aside from the case after the woman complained Moore couldn't be fair because of his religious beliefs.

Study Shows Nevada Leads Nation in Problem Gamblers
Lisa Snedeker, Associated Press- 3/22/2002

LAS VEGAS -- Nevada could be home to more than 117,000 people with gambling problems and have the highest percentage of such residents in the nation, a study released Friday revealed. The first-ever study on Nevada residents with gambling problems found 40,100 to 63,900 ''probable pathological gamblers.'' Based on 2000 data, the Gemini Research Inc. of Northampton, Mass., study also found there were an additional 32,700 to 53,500 Nevada residents who could be classified as ''current problem gamblers.''
    Pathological gamblers are those who lose control over gambling, progressively wager more money, more often and become preoccupied with it despite the consequences, the study said. Problem gamblers have less serious difficulties but are at risk of developing into pathological gamblers. The state's percentage of problem gamblers 6.4 is higher than every other place where similar surveys have been done, the study found. Other studies showed the pathological gambling rate in North Dakota was 2.1 percent in 2000 and 4.9 percent in Mississippi in 1996.
    Problem gambling prevalence rates in Nevada are highest among men, young adults and minorities as well as among those employed in the gambling industry, those with less or the equivalent of a high school education and those with annual household incomes of less than $35,000. Non-gamblers or infrequent gamblers are most likely to be Hispanic women, younger than 35, who stay at home and have annual household incomes below $35,000, researcher Rachel Volberg said. ''Weekly gamblers are most likely to be male, over the age of 55, white and have an annual household income of over $35,000,'' she said.
    The $200,000 study was authorized in 1998 by Legislative Interim Finance Committee and was presented to a state panel studying problem gambling. Problem gambling was higher among those who have lived in Nevada for 10 years or less compared with people who were natives, Volberg added.
    A second study on adolescents found that 2 percent of Nevada adolescents were problem gamblers and 10 percent more were at risk of developing gambling problems. The report said that 67 percent of the state's teen-agers had made a bet before they reached 21 years old, 49 percent had gambled in the past year and 7 percent bet on one or more types of gambling once a week or more often. The study estimated there were 1,700 to 4,000 adolescents who have ''experienced severe difficulties related to their gambling in the past year.'' Adolescents in Nevada were less likely to gamble weekly or more often than their counterparts in Georgia, Texas, New York and Washington, which Volberg attributed, in part, to the state's public awareness efforts that have focused on youth, but admitted the reason wasn't clear.
    Dennis Neilander, chairman of the state Gaming Control Board and a state panel member, expressed surprise at the high number of adolescents who gamble on the Internet or privately on card, dice or board games with family and friends. ''There's so much data that we're going to have to take time to analyze what it means for Nevada,'' he said. The adult survey contacted 2,200 homes by telephone and followed up with lengthier interviews of 733 people.
    Nevada is one of the few states with legalized gambling that provides no public dollars to problem gambling treatment and research. The Gemini Research report could set the stage for a debate on whether the state should provide such funding, Volberg said. A bill in the 2001 Legislature that would have given problem gamblers the same legal standing that alcoholics or drug addicts have in seeking access to sentencing alternatives died in committee. The report suggested Nevada consider a variety of programs to help solve gambling problems, including extending health insurance coverage for treatment.
    To date, the casino industry has provided most of the money for the state's problem gambling services, the report said. Alan Feldman, spokesman for MGM Mirage Inc., the largest operator of Las Vegas Strip hotels, said that though he was concerned with some of the report's methodology, he hopes the study will persuade the Legislature to fund services for problem gamblers. ''If nothing else, we now have basic information that we didn't have before,'' he said. ''The question is where do we go from here?''

Mauling Case Opens Door for Gay Rights
Associated Press, 3/23/2002

SAN FRANCISCO -- The focus in the San Francisco dog-mauling case is shifting to a wrongful-death suit filed by the victim's lesbian partner -- a legal milestone made possible by a law passed in the wake of the savage attack. After Diane Whipple's ghastly death last year, the California Legislature enacted a law granting gay partners the same right to sue as spouses or family members. That enabled Whipple's partner, Sharon Smith, to bring a lawsuit against the dogs' keepers. No trial date has been set for the closely watched case. "It will lead to other things that will be good for me and my partner, and my friends and their partners," said Johnnie Pratt, a San Francisco lesbian.
    On Thursday, Marjorie Knoller and her husband, Robert Noel, were convicted of murder and involuntary manslaughter, respectively, for the January 2001 mauling of Whipple by two huge dogs in the hallway outside her San Francisco apartment. Knoller is believed to be the first person in California and the third person in recent U.S. history to be convicted of murder in a dog-mauling case.
    Before Whipple's death, state Assemblywoman Carole Migden, a San Francisco Democrat, had introduced the legislation granting gays the right to sue. But she said the case helped it clear the Legislature and Gov. Gray Davis. "It created a very compelling, real-life image of the consequences of tragedy and the inequities in society," Migden said Friday.
    Only California, Hawaii and Vermont grant such status to gays to sue on behalf of their partners, said David Smith of the Human Rights Campaign, the nation's largest gay advocacy group, based in Washington. Other states may follow suit. A key legislator in Connecticut said a gay rights bill being crafted may include a provision granting someone the right to be treated as a crime victim if a gay partner is murdered. "I think this case certainly did illustrate the lack of legal recognition and the compounded pain that that causes with the lack of legal recognition," said Smith of the Human Rights Campaign.
    Sharon Smith's lawsuit is the same type family members used to sue O.J. Simpson after his acquittal on charges of murdering his ex-wife Nicole and her friend Ronald Goldman. Simpson was ordered to pay $33.5 million. Sharon Smith is seeking unspecified damages and has said any financial award would go to support a nonprofit women's lacrosse foundation in memory of Whipple, 33, who was a college lacrosse coach. Even before the Legislature acted, a California judge had ruled that Smith's wrongful-death suit should go forward, saying it would violate the state constitution to give legal standing only to surviving spouses.
    The National Center for Lesbian Rights in San Francisco, one of the law firms behind Smith's suit, said the group soon will seek a trial date in the civil case. It was delayed pending the outcome of the trial, which was moved to Los Angeles because of publicity in San Francisco. Ruth Herring, one of the group's directors, said California's legislation "was an acknowledgment that Sharon and Diane were actually family members like any family spouse would have been."

Therapist Gets 90 Years in Sex Case
Tracy Wilson, Los Angeles Times- 3/23/2002

A Chatsworth family therapist who specialized in treating minors was sentenced Friday to 90 years in state prison after pleading guilty to multiple counts of having unlawful sex with a 14-year-old girl he was counseling. Allen Eldredge, 57, admitted using his position as a licensed therapist to coerce the Fillmore girl into sexual acts with him and his then-wife.
    Eldredge pleaded guilty in November to 29 counts of forcible sex and one count of conspiracy. His former wife, Judy Eldredge, 46, pleaded guilty to aiding and abetting a rape as well as two counts of having unlawful sex with a minor. She was sentenced last month to six years in state prison. The couple were arrested at their Chatsworth home on Nov. 25, 2000, after the girl, then 19, reported the incidents to Ventura County sheriff's deputies. A search turned up videotapes of the sexual assaults as well as journals in which Allen Eldredge had documented numerous encounters with the girl, prosecutors said.
    The sexual abuse started in 1994, when Eldredge began to counsel her, and continued through 1996. Deputy Dist. Atty. Wendy Macfarlane, who prosecuted the case, said Eldredge was not paid for the therapy sessions because he was a friend of the girl's family. Eldredge manipulated the girl into having sex after gradually gaining her trust, the prosecutor said. "Because he was a therapist, whatever he told her had a lot more credibility," Macfarlane said. "It was very much like an incestuous-molestation type of thing."
    Eldredge initially denied the charges. But he changed his plea to guilty two days into his trial in Ventura County Superior Court after jurors heard excerpts from his journals. Eldredge faced up to 240 years in state prison--eight years for each of the 30 criminal counts. Macfarlane argued for that sentence based on the plotting that went into molesting the girl. "He planned out everything," she said, "and his pursuit of her was relentless."
    But Judge Roland Purnell handed down a minimum 90-year sentence, or three years for each count served consecutively, in part because Eldredge spared the girl from testifying, Macfarlane said. Eldredge probably will die in prison, since he must serve 72 years before he is eligible for parole. Sherman Oaks attorney Michael Zimbert, who represented Eldredge, could not be reached for comment late Friday.

Slaying Raises Mental Health Care Questions
Phuong Ly, Washington Post- 3/23/2002

In a cash-strapped and overburdened mental health care system, Nicole Castro was a low-paid but passionate worker, tending to the unpredictable needs of the mentally ill. On Wednesday, police say, a routine visit with a client turned violent: Castro, 23, was stabbed in the face, neck, hands and arms. Her body was dumped in front of two trash bins in the parking lot of a White Oak apartment complex, Montgomery County police said.
    John Edward Lutz, 64, of the 11500 block of February Circle, was charged with first-degree murder late Thursday. Lutz, a former patient at Springfield State Hospital in Sykesville, suffers from a delusional disorder and had been Castro's client for less than a month, according to court charging documents. The slaying is raising questions about Montgomery County's mental health system, which a County Council task force recently described as severely underfunded and "in collapse," and the work of overloaded case managers such as Castro.
    The Maryland Department of Health and Mental Hygiene is reviewing the case to see whether Lutz was receiving adequate treatment and whether Castro's death could have been prevented. Castro worked for Threshold Services, anonprofit agency in Silver Spring that has a contract with the county to provide mental health services. "Whatever the circumstances, it's still an indicator of our continuing failure to meet the crisis in mental health," said council member Blair G. Ewing (D-At Large), who has been a vocal advocate of improved mental health services. "There are people in the system who basically are unknown unless they are visited or visit a clinic." He said that the county should make the "moral choice" to pay for more case managers, better care and increased accountability.
    But Daryl Plevy, acting chief of the county's adult mental and substance abuse services, said there is no evidence that Castro's death occurred because a client received inadequate treatment. "It would be wrongheaded and would compound this tragedy to start pointing fingers," Plevy said. Lutz "was, in fact, getting consistent care, and it was funded. I'm concerned that we not jump to conclusions about what happened in this case." Craig Knoll, executive director of Threshold Services, also said finances did not contribute to Castro's death.
    A state budget crisis has imperiled mental health services for an estimated 74,000 residents who are covered by programs for the poor. Four clinics in Montgomery closed last year, and eight are struggling, including two operated by Threshold. Fewer than 850 of the county's estimated 34,000 residents with serious mental illness have a case manager.
    Plevy said that the county and state are taking strong steps to address problems and improve services. The state and county recently announced a plan to spend $1 million to shore up the local system, a proposal that critics -- including Threshold officials -- say is only a short-term fix.
    Officials declined yesterday to detail Lutz's mental history, citing patient confidentiality. Lutz, a tall, heavyset man, appeared for a bond hearing yesterday in Montgomery County District Court. Holding a prayerbook, he remained silent as a judge ordered him held without bond. Computer court records show that in 1991, Lutz, who had no fixed address, was arrested and charged with burglary in Howard County and that he was temporarily committed for mental instability. The outcome of the case was unavailable yesterday. A Montgomery County prosecutor said that Lutz had no criminal convictions.
    Knoll said Castro began weekly visits with Lutz this month after taking over for a co-worker who was on leave. She had an appointment with him at noon Wednesday, investigators said. Her co-workers called police when she did not report to work Thursday. At 3:30 a.m. Thursday, a resident of the apartment complex discovered Castro's body, wrapped in bloodstained sheets, police said. Investigators canvassing the neighborhood that day became suspicious when they heard movement inside Lutz's apartment but no one would answer the door, police said. After obtaining a warrant, police searched the home and found a fresh bloodstain under the living room couch and Castro's car key in the bedroom, court papers state.
    Plevy said the circumstances of Castro's death were unusual because few mentally ill clients are violent. She said that several county workers knew Castro, who offered her Spanish-speaking skills to help others. Susan Schiff, a neighbor of Castro's in Silver Spring, said the young woman lived with her mother and an older sister in an apartment off Hewitt Avenue. Since high school, Schiff said, Castro had wanted to be a social worker or teacher. "There was no way you could not like her," Schiff said. "She was a warm, outgoing young woman. She outgrew her silence -- she had been a little withdrawn as a child -- and started respecting herself and following her true life plan."

Texas Drug Court to Offer Jail Alternative
Analisa Nazareno, San Antonio Express News- 3/23/2002

SAN ANTONIO -- San Antonio is in the early stages of establishing a "therapeutic model" drug court to place nonviolent offenders who have problems with drug or alcohol abuse in treatment programs rather than jail or the traditional probation system. A 2001 state law requires the 12 county court-at-law judges serving the San Antonio area to establish such a court by September 2003.
    The counties containing Dallas and Austin have long-established drug courts that refer defendants for treatment. Other urban counties started them more recently. They generally use a non-adversarial approach, test participants weekly for drugs and alcohol, and require participation in Alcoholics Anonymous and drug treatment programs, according to a recent study.
    "What makes their justice model work is that it gives them the treatment that they need and jail sanctions if they mess up," County Court-at-Law Judge Al Alonso said. "If you treat the drug problem, the thinking is it will cut down on the recidivism," he said. "But treatment by itself does not work. You need to have the threat of jail time to make it work."
    Alonso and his colleagues are starting to meet with prosecutors, defense lawyers and rehabilitation counselors to establish program guidelines. Alonso himself is receiving training from the Justice Department so the county can apply for federal funds. The judge already is working with 75 people facing misdemeanor drug possession or drunken driving charges.
    Last year, the county courts handled 5,575 misdemeanor drunken driving cases and 3,527 misdemeanor drug possession cases, such as using drugs without prescriptions or possession of marijuana weighing less than 4 ounces. The idea of the court is to stop problems early, before defendants become chronic offenders or commit felonies, and to "help people get better and out of the system," said Joan Padrade, county court assistant administrator "Because people who are in the system cost a lot of money, and people who recommit cost a lot more money," she said. "It is an investment to treat people."

The Internet Fix: Easy Narcotics
Alice Dembner, Boston Globe- 3/24/2002

Three doctors and a Texas pharmacist provided prescription narcotics through the Internet over the last two years to thousands of patients they never met or examined, according to a federal indictment issued last week that provides a stark example of what prosecutors say is a growing problem of computer-assisted drug abuse.
    A flood of Cipro and Viagra sales over the Web rang the first alarm bells about Internet pharmacies, but officials say the increasing availability of controlled substances such as OxyContin and other narcotics is even more worrisome. As many as 150 rogue pharmacies offer drugs over the Internet to people without legitimate prescriptions. This includes 15 to 30 Web sites that provide easy access to dangerous narcotics, according to the National Association of Boards of Pharmacy. A Globe correspondent was able to purchase generic hydrocodone, one of the most abused prescription painkillers, through the Medical Service Network with remarkable ease.
    In the Texas case, prosecutors say patients, including hundreds from New England, found the doctors through an Internet Web site called The Pill Box Pharmacy. After filling out a questionnaire, they had a brief telephone consultation with a doctor, who received $45 to $50 from the pharmacy for each prescription. According to the Texas State Board of Medical Examiners, one doctor even allowed his girlfriend to conduct phone consultations, although she had no medical credentials.
    Investigators say people all over the country have gotten sick as a result of drugs purchased from The Pill Box. One Illinois patient suffered an overdose after getting four successive prescriptions for hydrocodone, according to the medical board, and a San Francisco patient with a history of addiction developed liver damage after he was prescribed the painkiller Darvocet.
    But as authorities begin to tackle this new front in the war on drugs, they acknowledge that they are several steps behind the sellers. ''Because we haven't seen a significant prosecution, some of the sites have become emboldened, and we've seen a growth in the number offering narcotics,'' said Carmen Catizone, executive director of the pharmacy association. ''Because of the highly addictive and dangerous nature of the narcotics, having these sites operating poses a serious risk to public health. They're used illicitly on the streets and could get into the hands of children.''
    Nationally, 20 million people abuse painkillers such as hydrocodone and OxyContin, according to the Substance Abuse and Mental Health Services Administration, which has no statistics on how many get their drugs through the Internet. Drug abusers have clearly discovered Internet pharmacies. Already, there is a subculture of patients and addicts who meet on the Web to trade information on the easiest Internet sources, best prices, and how to tap into more than one pharmacy at a time without getting caught.
    Under federal law, narcotics may not be distributed without a prescription, and the pharmacist must have the original written prescription in hand for the most addictive narcotics, such as morphine and OxyContin. Most states, including Massachusetts, do not consider an Internet questionnaire or a brief phone consultation legitimate justification for writing a prescription. As a result, legal online pharmacy sites, such as Walgreens.com, will fill only prescriptions provided by the patient's regular doctor.
    Many of the online pharmacies that dispense drugs based on questionnaires and phone consultations are based in the United States, while some that don't require prescriptions at all are based overseas, where prescribing laws are looser. That doesn't make the business legal; importing narcotics through the mail, even for personal medical use, is illegal.

Doctor asks reporter how much, not why
A Globe correspondent demonstrated how easy it is to acquire narcotics over the Internet, buying hydrocodone with little trouble. The reporter entered personal information and a brief medical history on an online questionnaire, faxed in a copy of her driver's license, and paid a $125 ''consultation fee'' by credit card. Within 48 hours, she was speaking by phone with Dr. Sean Aldridge. During the two-minute conversation, she complained of migraine headaches and said hydrocodone had been helpful in the past. Aldridge never asked for medical records or questioned her about the possibility of addiction. But he did want to know whether 90 tablets a month would be enough. He also authorized two refills. Two days and an additional $100 later, the pills arrived by a delivery service.
    In response to a request for an interview about its practices, Medical Service Network faxed a handout saying, ''We do not 'take orders' for medication.'' Aldridge, a doctor licensed in California, declined to discuss his arrangement with Medical Service Network. ''As far as I know, I am providing a good-faith examination, and that is legal. If there's anything I'm doing illegally, that will have to change,'' he said.
    Some Web pharmacies are tightening their procedures. Many that previously relied on a questionnaire now require a phone consultation, and some are asking for medical records. At Norco Direct, a site specializing in ''strong pain relief'' and named for a brand of hydrocodone, all customers must agree to language stating they have an emergency medical condition. Officials say these sites are still operating illegally unless the physician does an exam. ''The folks who remain know they are walking on the edge,'' said Dale Austin, deputy executive vice president of the Federation of State Medical Boards. Norco Direct e-mailed a reporter to ''stop badgering us'' when asked questions about the operation. ''We are also in the process of arranging home physical exams ... our doctors ... will not `dish out' medication on a whim,'' e-mailed a company representative who would not identify himself.
    Prosecutions of Internet pharmacies for narcotics sales are just beginning, in part because investigators find it difficult to trace sites to their sources because of the Internet's anonymity. So the federal Drug Enforcement Administration, and even some state medical boards, are assigning staff members to work full time on Internet drug fraud. Massachusetts is not among them. In one of the first federal convictions, an Oklahoma jury in January found Dr. Ricky Joe Nelson guilty of conspiring to distribute controlled substances over the Internet. Working through PlanetPills.com, the Oklahoma surgeon wrote as many as 300 prescriptions a day -- most for narcotics -- to patients all over the country based on their answers on an Internet questionnaire. One admitted addict testified at the trial that she used the company because it was easier than lying to her family doctor, US Attorney Robert McCampbell said. Patients paid $250 for 100 pain pills, five times the retail price, earning Nelson $175,000 in just six weeks. According to Nelson's lawyer, the doctor turned to Internet work after he was traumatized while helping rescue victims of the Oklahoma City bombing in 1995. Now he's in jail awaiting sentencing and planning an appeal. ''The doctor never intended to break the law,'' Paul Antonio Lacy said. ''He was trying to do something on the cutting edge of medicine. Unfortunately, some of the patients were liars.''

''Inventing a new type of medical service''
The federal indictment handed up in Texas last Wednesday alleges that The Pill Box conspired to distribute hydrocodone and addictive tranquilizers and made the three doctors, pharmacist, and middleman involved about $14 million in 30 months. Separate cases pending before the New Jersey and Texas medical and pharmacy boards allege doctors recruited by the Texas pharmacist, William Stallknecht, issued tens of thousands of prescriptions to patients across the United States and abroad they never examined. Stallknecht did not respond to requests for comment.
    One doctor he recruited, Ernesto Cantu of San Antonio, allegedly prescribed 570 hydrocodone pills to a New Jersey woman who was in treatment for addiction to prescription painkillers. He also allegedly prescribed painkillers to the Illinois patient who suffered an overdose, and to himself and his girlfriend. Some patients who called him to get prescriptions were actually interviewed by his girlfriend, who was masquerading as ''Dr. Cantu,'' officials allege. Cantu's lawyer declined to comment on the allegations.
    Dr. David Bryson is also facing charges in The Pill Box case. He defends his role as ''inventing a new type of medical service'' that didn't harm anyone. Bryson, who was unemployed and facing bankruptcy when he started working with Stallknecht in 1999, says he made as much as $9,000 a week writing narcotic and tranquilizer prescriptions. He says most of his patients, including about 100 in Boston and a lobsterman from Maine, needed the drugs for chronic pain and couldn't get them from their local doctors. ''I didn't need or want any drug abusers in the practice,'' he said. ''That would have been suicidal.'' But officials say that without doing a physical examination Bryson and other doctors have little means of ferreting out addicts. ''Locally, pharmacists know who they are and doctors recognize the drug-seeking behavior,'' said Paul Nasca, an Internet investigator for the California medical board. ''Over the Internet, there's no safety net.''

'A Beautiful Mind'? She Hasn't Seen It, but She's Heard the Voices
David M. Halbfinger, New York Times- 3/24/2002

HEMPSTEAD, N.Y. --John Forbes Nash, Jr. can have his Nobel. Lenora Brown wants only this out of life: a good man, a home of her own, and a driver's license. A replacement for her missing front tooth can wait. Your priorities have a way of sorting themselves out when you have spent half of your 44 tumultuous years bouncing back and forth between a bench at the bus station and the psychiatric ward at the county hospital.
    "A Beautiful Mind" and Russell Crowe may have given moviegoers a glimpse through the eyes of someone suffering paranoid delusions. But most schizophrenics do not make such miraculous recoveries. Screaming headlines notwithstanding, most schizophrenics do not go into churches and shoot people, either, or drown their babies, or push people off subway platforms.
    For most people suffering from schizophrenia, the miracle, and the tragedy, exist side by side, in the constant struggle to make it through the day. Ms. Brown's struggle began after she graduated from high school in Elmont. She enrolled at a college in Ohio, but came home after three months. Her parents died when she was 19. For two years she landed and lost jobs. She started hearing voices while briefly a clerk at a Manhattan law firm. "I'm thinking I'm living through life as it's happening in the holy Bible," she recalled. "Jesus is sitting right next to me. The president on TV knows who I am." Later, her hallucinations would recur along two threads: she was a prophet doing battle with Satan, or she was in communication with NASA.
    An older sister first took Ms. Brown to the hospital. But the treatment didn't take. "I'd just take the medicine and flush it down the toilet," she said. "I couldn't accept that I had mental illness." Time and torment led to acceptance. Ms. Brown grew to look forward to her hospital stays. At 28, disowned by her family and desperate for a new start, she lied about her medical history and enlisted in the Army. Her spells gave her away after a year. In the early 1990's, she went into treatment again. She landed a rent subsidy and a part-time job. But she took up with a man who brought home crack cocaine instead of food. She partook. And she was homeless again.
    It has been a long and uphill road back. But the past two years have been among her best. Ms. Brown took a job at the Mental Health Association of Nassau County, here in Hempstead, where professionals help her and she, in turn, helps those who are less capable. A year ago she was placed in a house with two other mentally ill women.
    Her struggle now starts over again each dawn. Ms. Brown's bedtime drugs include a long-acting antipsychotic and a sleep aid. But she still cannot help waking between 4 and 5 am. Her pills at breakfast include a powerful antidepressant and an antianxiety drug. It is hard to imagine how anxious she would be without it. She frets ceaselessly about Nassau's budget problems, naming everyone in the mental-health system who has helped her and praying aloud that they will not be belt-tightened out of their jobs.
    Ms. Brown works 20 hours a week. She rides the bus to help her five clients get to their appointments and to master the mundane tasks of living. She must learn to drive if she is to increase her caseload. She must see more clients to justify working full time. And she must work full-time if she is to get benefits like dental coverage. So the bridge that would cost $1,500 -- and which would make whole what is nonetheless a tremendous smile -- will have to wait.
    Last summer, her boyfriend threw her over for a younger woman. She cried and cried, but Ms. Brown now says she understands. "The girl is not mentally ill," she said "And he had to deal with my breakdowns, and all the embarrassment -- the people in the community saying, 'You're going with someone retarded' " She does little in her free time but steel herself for the next chore. She has not seen a movie in years, including "A Beautiful Mind", but she watches the news several times a day. She was terribly upset by the Andrea Yates case, by the fatal shootings at the church in Lynbrook. Before, she would complain that criminals who pleaded not guilty by reason of insanity were giving the mentally ill a bad name.
    But now, "Every time I turn around, whatever crime has been committed, they have mental illness," Ms. Brown said. "All of them can't be schizophrenic. It really makes me nervous," she said. "What ever happened to criminals who committed crimes just because they wanted to commit a crime?"

Gay-Straight Clubs Spread Through High Schools Nationwide
David Crary, Associated Press, 3/24/2002

STRATFORD, Conn. -- For the Gay-Straight Alliance at Stratford High School, progress can be measured in the hallways: These days, only some of its posters get torn down. Harassment and name-calling haven't vanished from the 900-student school. But its gay students and their straight allies are pleased to have a club of their own, a weekly forum to share worries, frustrations and laughs. For Michael Burgess, a sophomore who co-founded the club with some friends in the fall of 2000, it was partly an act of self-protection. ''We were having a lot of problems,'' Burgess said. ''Not one day passed that I wasn't being called a fag.''
    Gay-straight alliances, or GSAs, first appeared in Massachusetts in 1989 and have spread rapidly coast-to-coast in recent years. About 1,000 of America's 26,000 high schools now have them, according to the Gay, Lesbian and Straight Education Network. Critics argue that GSAs promote homosexuality and have no place in schools. Defenders say the clubs are invaluable in encouraging tolerance and easing the isolation that drives many gay students into substance abuse and suicide attempts.
    ''Any other minority group has their families, churches and communities behind them,'' said Patricia Boland, a school psychologist in Chesterfield County near Richmond, Va. ''Gay youth don't. If they're getting harassed, often they don't tell their parents. They're very much on their own.'' She said anti-gay sentiment can be damaging even to straight students. ''Kids shy away from the arts, or get pushed into having sex way before they're ready, just to prove they're not gay,'' Boland said.
    Some GSAs consist almost entirely of gay and lesbian students. Others, like Stratford High's, have many straight members. ''A lot of my friends are gay,'' said junior Julie Baron. ''I'm straight, but because I'm in the club, somebody called me a fag. They need to grow up.'' About 50 students attended the first Stratford GSA meeting last year. The club now has about 20 regular members, and seems to have established a comfortable niche in this middle-class town of 50,000.
    Early on, the group's posters were torn down swiftly, members said. A year later, gay students say face-to-face harassment has eased, and posters often manage to stay in place, though they sometimes get defaced with slurs and swastikas. ''We know the people doing it,'' Burgess said. ''But we try to ignore it. It's hard to get inside their minds, because they're so closed.'' The GSA's adviser, English teacher Michael Fiorello, is heartened by the high-spirited camaraderie that has developed among the students. ''When I was in high school, if you wanted to experience anything gay, it was going to be dark and dangerous,'' he said.
    In some schools, GSAs emerged due to the efforts of a few activist students, then collapsed after they graduated. Kevin Jennings, executive director of the Gay, Lesbian and Straight Education Network, blames indifferent and hostile school administrators. ''With other school clubs the French club, the math club the system commits to supporting them so they will always be there, but the system hasn't made that commitment to GSAs,'' Jennings said. ''In too many cases, once the student activist graduates or the dedicated teacher is transferred, the GSA goes with them.''
    Efforts to form GSAs have been resisted in some communities by parents, school boards and clergy. But court rulings generally side with GSA supporters, primarily because of a federal law that requires equal access to public school facilities. In California's Orange County, the Orange Unified School District tried two years ago to ban a GSA from meeting at an area high school, then reversed course in the face of a lawsuit. As part of the settlement, the board prohibited student clubs from discussing sexual activity.
    In Utah, the Salt Lake City School District voted in September 2000 to end a four-year ban on all nonacademic clubs that was imposed to keep a GSA from meeting. The outcome in Utah dismayed other foes of GSAs, including Christine Watson, mother of two high school students in Vista, Calif. She tried to rally opposition to a new GSA at their school, but was rebuffed by the principal. ''I look at this as parents' rights being eroded,'' Watson said. ''But there's nothing we can do. The parents in Utah spent a quarter of a million dollars fighting, and they lost.''
    In Arlington, Texas, Martin High School senior Jesse Brown has been struggling since last year to form a GSA. His latest hopes were dashed in December when the one teacher who volunteered to sponsor the club backed away from the commitment. ''Many teachers are very fearful of backlash,'' Jennings said. ''They have mortgages to pay, they're very vulnerable.''
    The National Education Association, the country's largest teachers union, has asked school districts to crack down on harassment of gay students and staff. Gerald Newberry, executive director of the NEA's health information network, said some teachers worry that working with a GSA may label them as gay, but students generally find a faculty sponsor. ''They have rather well-developed radar they seek out someone who through overt or covert messages has communicated that they care about all kids in the school,'' he said.
    Massachusetts, where more than half the high schools have GSAs, is the only state to help finance them. The attitude of the state's principals toward the clubs varies, depending partly on how much opposition surfaces among parents. ''It's a delicate balance, a dance that a principal has to do,'' said David Rudewick, director of a student civil rights project run by the Governor's Task Force on Hate Crimes. Parental resistance in Massachusetts has waned over the past decade, Rudewick said. ''Society has changed. It's hard for them to say now that these clubs are going to turn kids gay.''
    However, Rudewick said GSAs can backfire if members find themselves isolated. ''If the school doesn't give them resources, allow them to have projects that bring people across lines, it can be divisive,'' he said. ''It can leave students even more exposed to harassment, and the administration might turn a blind eye.'' Jennings agreed that joining a GSA can entail risks. ''But it's more damaging to feel invisible than it is to feel like a target,'' he said. ''When they form a group and have allies, that gives them a sense of power they don't have when they feel alone.''
    Mike Haley, a youth policy specialist with the conservative Christian group Focus on the Family, argues that GSAs do isolate gay students. Haley campaigns against GSAs in articles and speeches that cite his personal background: He was an active homosexual during his teens and 20s, and now has a wife and child. ''I've visited GSAs,'' he said. ''They want to be all-inclusive, but they tend to become a homosexual clique on campus. The last thing I needed, when I was in high school, was to be further isolated.''
    Other critics say GSAs serve as recruitment centers, drawing students into homosexuality who are still wrestling with their sexual identity. ''You get lonely, mixed-up kids, not getting along with their parents, not doing well in school, and someone tells them, 'It's not your fault,''' said conservative activist Phyllis Schlafly. ''It's simply a recruitment device.''
    Michael Burgess has heard this argument, saying some Stratford parents have pressured students to shun the GSA because ''they thought we would convert them.'' Alliance members said their main purpose is to boost solidarity and have fun, not to proselytize. ''I've had friends ask me, 'Do you have to be gay, or be straight, to be in the group?''' said Ellyn Lambeck, a junior. ''They don't get it. The whole point is to unify.''

Prescription Drug Abuse: Lethal Roulette
Karessa E. Weir, Ann Arbor News- 3/25/2002

Tom Gibney was a drug addict. But you would never find him dealing in an alley, hiding out in a crack house or shooting up in a back room. The Unadilla Township businessman got his fixes through doctors' offices and pharmacies that accommodated his addiction to prescription drugs without question until it killed him. When he died of an overdose on Christmas Day, the 44-year-old had more than 600 pills of various controlled substances, all legally obtained through valid prescriptions.
     Now his sister, Cathy Looby, is trying to get someone to recognize that the drug addiction - the same social ill that puts thousands in jail every year across the nation - was not only overlooked in her brother's case, it was legal and largely unregulated. "I don't blame just the pharmacy and the doctors. Our community looks the other way when it comes to prescription drug addictions," Looby said. "I know that he didn't want to die, and he certainly did not want to die in the manner in which he did."
     Prescription drug abuse is a growing problem nationwide. The National Institute on Drug Abuse said more than 1.6 million people reported using prescription pills for non-medical reasons in 1998. Most recently, the drug of choice has been a painkiller called OxyContin, an addictive and deadly narcotic, even more powerful than heroin. Abusers crush the pill into powder, then snort or inject it, leading to more than 100 overdoses nationwide in the past two years.

No checks, no balances
After her brother's death, Looby petitioned local pharmacies for records of his purchases. What she found shocked and scared her. In October, Gibney managed to get 300 pills of diazepam, a habit-forming anti-anxiety drug, from the same pharmacy. From November to January, he had a prescription for the narcotic painkiller hydrocodone refilled 19 times. Over a nine-month period, he received prescriptions for 660 Vicodin pills from one doctor's office, Looby said. There was no one to stop Gibney from refilling his prescriptions or "doctor-shopping" for more prescriptions.
     A single thought continues to rise to the top of Looby's "what if" list: What if their parents hadn't been wealthy? Because their parents left him well-off, Gibney didn't need to work and didn't have - or need - medical insurance. Perhaps if he had, she thinks, an insurance company would have balked at paying for the multiple prescriptions that were refilled sometimes twice a week. But Gibney, who with his sister owned a grocery store, had the money to pay for the drugs so there was no one to question the frequency or dosages. "He never knew what moderation was," Looby said.

Detecting doctor-shoppers
There is a way for pharmacists to detect doctor-shoppers such as Gibney, but it is a tool they have to be willing to use. A two-decade-old law requires physicians to report to the state any time a prescription is written for 15 Schedule II substances, highly addictive, yet legal drugs. They are also those drugs that are most often abused.
     Each time a Schedule II drug is prescribed, a copy of the prescription form is supposed to be entered into the state's prescription drug database. When a patient goes to fill a prescription, the pharmacist should be able to determine all the other Schedule II prescriptions filled by that patient anywhere in Michigan. By 2003, the database will be expanded to include all prescription drugs.
     "It allows us to keep track of patients, especially doctor shoppers," said Bob Ulieru, director of the health regulatory department for the state Consumer Industry Services, which operates the data base. If the pharmacist notices multiple prescriptions, they can call the physicians and alert them to a potential problem. "Then the physicians can determine whether their patients have a legitimate need or if they are just addicts," Ulieru said. A person who does engage in doctor shopping can be charged with obtaining a controlled substance through fraud or deceit, Ulieru said. But the databases don't do any good if the pharmacists don't check every prescription.

A downward spiral
At Stockbridge High School, Gibney was an honor roll student. He attended business classes at Lansing Community College on a scholarship. Gibney's addiction began more than a decade ago when his back was injured in a car wreck. As recently as last summer, he knew he had a problem and wanted to fix it. He asked his ex-wife to set up a place for him at the substance abuse treatment center at Brighton Hospital, but backed out at the last minute, Looby said. Near the end, he was "paranoid as hell, almost psychotic," his sister said. He was pushing people away, including his two teen-age children.
     Looby said his death is on the hands of many others who could have stopped her brother's downward spiral into addiction. "My brother could have never played out the hand that dealt him his death without additional players. These players included the physicians, the pharmacists, and the enabling friends, all of whom sat with Tom at that lethal card table. Granted, Tom held the ace card and he played it," Looby wrote recently. "For the betterment of our community, I want to know how we all can play our cards differently in the future to prevent any more needless deaths."

A delicate balance
There is responsibility that comes with the ability to prescribe and distribute such powerful substances. But there is also a delicate balance that health care professions must maintain, said Christian Teter, a post-doctoral student in the University of Michigan's College of Pharmacy. The newest drugs, such as OxyContin, have revolutionized pain management and can dramatically improve the lives of people in chronic pain, Teter said. But at the same time, the most effective drugs tend to be the most highly addictive, a side effect that leads some physicians to shying away from prescribing the drug. "They pull away because of the fears of abuse but there are patients who legitimately need to be treated," said Teter, who is working on a new study on prescription drug use. "The number of people who need to be treated for pain greatly outweighs the number of people abusing the drugs."
     The key to fighting the abuse is careful prescribing and strict monitoring by both the physicians and the pharmacists. As a working pharmacist, Teter has tales of doctors prescribing huge quantities of pain killers for relatively minor problems. Instead, they should stick to smaller doses that give more control over how much medicine a patient can have at one time and provide more frequent opportunities to check the effectiveness. Pharmacists are trained to look for forged prescriptions, people who try to call in fake prescriptions or any prescriptions that appear inappropriate. But there are many loopholes that addicts can find to gain their fix. "If someone has three prescriptions for the same narcotic by different physicians, alarms should be ringing in your head," Teter said. "Often the patients are willing to pay cash so there are no limits on their insurance. It is up to you the pharmacists to question whether this prescription will be used for pain relief or for abuse."

U-M Study Says Alcohol Most Serious Threat at Universities
Jo Collins Mathis, Ann Arbor News- 3/25/2002

Alcohol abuse remains the No. 1 public health problem at American universities, including the University of Michigan, two studies released this week show. "Alcohol use and its adverse consequences pose the most serious threat to the intellectual, psychological and physical development of traditional-age undergraduates," said Carol Boyd, director of the U-M Substance Abuse Research Center (UMSARC) and professor of nursing and women's studies.
     The U-M findings come from the latest student life survey conducted last March by UMSARC in collaboration with the research firm, MSInteractive. The national findings come from the College Alcohol Study conducted bi-annually by Harvard University's School of Public Health, using random samples of more than 10,000 undergraduate students at 119 colleges and universities. According to the U-M survey, 86 percent of U-M undergraduate students say alcohol use is a problem on campus.
     "Not surprisingly, alcohol was the most often-used drug among the students," said Sean Esteban McCabe, UMSARDC researcher. "College students who engage in higher rates of alcohol misuse and other drug use have been shown to experience significantly higher rates of motor vehicle fatalities, unsafe sex, emergency care visits and poor academic performance."
     The U-M survey mirrors national results showing that alcohol and other drug use among college students increases the probability of negative consequences, both to the drinker and those affected by the drinker's behavior. Royster Harper, vice president for students affairs, said the survey shows there is still a lot of educating to do about high-risk drinking. "Over the past several years, we've initiated and reenergized programs designed to help our students make good decisions," she said.
     Boyd said other than an increase in female binge drinking, there were no real surprises in the survey. And despite what some might see as pessimistic results, she is hopeful that the negative consequences of college drinking can be reduced. "Binge drinking on campus has remained pretty steady for the last 20 years and most of these folks will grow up to be just fine adults," she said. "But in the meantime, while our students are going through what is often referred to as a development phase, albeit a problematic phase, they're drinking to the point where both the community at large and student community are suffering negative consequences." Those consequences include drunken driving and resulting accidents and injury, as well as sexual assault.
     Boyd said it may be unrealistic to expect binge drinking to decrease substantially. "If they can't stop their drinking, at least let's get this right in terms of keeping our community safe," she said. "I think we can impact the negative impacts through programming, targeting high-risk groups, simple things. Maybe we offer classes at different times during the week so students are forced to get up earlier and come to class rather than sleep in." She said those who live in substance-free housing and in living/learning communities on campus binge-drink less than other students.
     Among the 2001 U-M Student Life Survey and Harvard study findings:
* The rate of heavy episodic drinking among U-M undergraduate students was 50 percent. This compares to 44 percent nationally, according to the Harvard 2001 study. Harvard's study showed heavy episodic drinking holding steady, as 1999 research also found a 44 percent rate; in 1999, U-M's survey showed 45 percent. (Heavy episodic drinking was defined in the 2001 Student Life Survey as having five or more drinks in a row for men and four or more drinks for women in the past two weeks.)
* There was a notable increase in heavy drinking among U-M undergraduate women in 2001 with 51 percent engaging in heavy episodic drinking relative to 42 percent in 1999.
* Besides alcohol, other drugs used most often by U-M undergraduates were nicotine, marijuana and Ecstasy. In particular, there was a significant increase in annual Ecstasy use among U-M students from 4 percent in 1999 to 7 percent in 2001.
* 76 percent of undergraduate students living in fraternities and sororities reported heavy episodic drinking in a two-week period at U-M, close to the 75 percent rate reported by Harvard.

Employers Look to Sidestep HMOs
Liz Kowalczyk, Boston Globe- 3/26/2002

Massachusetts employers, frustrated over another year of double-digit increases in health insurance premiums, are supporting an unusual solution: Cut out HMOs and contract directly with doctors and hospitals to provide medical care to their employees. At the request of the two largest employer organizations in the state, a Minnesota company said yesterday it will set up a direct-contracting program by January. Similar programs, already underway in Minnesota, Colorado, and Oregon, promise to save employers money by cutting out the middleman and by requiring hospitals and doctors to compete more aggressively on their fees.
     ''We're getting killed this year,'' said Marc Waldman, treasurer for the town of Wellesley, where premiums will increase 15 percent on July 1. ''You can imagine how devastating that is to a small town. We're looking at any alternative within reason.'' In Massachusetts and some other states, health insurance premiums have climbed more than 10 percent a year for the last three years. The state government and most cities and towns, which sign new health insurance contracts effective July 1, are often bellwethers of what private companies will face when they negotiate new contracts in the fall. And early indications are that premiums will rise again significantly in 2003.
     Minnesota-based Patient Choice will sell a direct-contracting product starting Jan. 1. Its plan works like this: Patient Choice will ask doctors and hospitals to form 15 to 20 small networks. Some networks, such as Caritas Christi, the Catholic hospital system, and Partners HealthCare, the parent organization of Massachusetts General Hospital and Brigham and Women's Hospital, already exist; in other cases, providers in the same geographic region can band together to offer services.
     The networks will then submit their prices for various medical services to employers. What happens after this will vary by employer. But Patient Choice executives said most companies agree to fully cover care at the least expensive network; if employees want their medical care with the more expensive doctors and hospitals, they must pay the difference. Patient Choice also rates the networks on quality.
     Under traditional Massachusetts health insurance, hospitals and doctors belong to all health maintenance organization networks. Consumers pay their HMO a fixed premium, whether they are treated at an expensive academic medical center or a less costly community hospital. ''We're creating a market dynamic that encourages providers to care about the cost of the care they're providing,'' said Ann Robinow, president and chief operating officer of Patient Choice. She said the strategy also encourages networks to compete on price as a way to attract more consumers to their hospitals and doctors.
     In recent years, employers have responded to soaring premiums by shifting at least some costs to their employees. They are charging workers higher copayments to visit doctors, buy prescription drugs, and check into hospitals. On July 1 the state, which insures 260,000 state workers, their families, and retirees, will start charging copayments of $200 per hospital admission and $75 for out-patient surgery for HMO members. Companies also are increasing medical deductibles, the amount of money an employee has to shell out before health insurance kicks in. This year, Tufts Health Plan and Blue Cross and Blue Shield of Massachusetts both began offering employers new products that charge employees a higher copayment for seeking surgery at an academic medical center rather than a less-expensive community hospital.
     Waldman said Wellesley will consider Patient Choice because ''it will make employees think a little bit more about the decisions they're making. There's no consequence now for going to the most expensive and least effective hospitals,'' he said. ''It's just like buying a car. You can't have the Rolls-Royce at the same price as you get a Yugo.''
     Still, it's unclear how many Massachusetts employers will choose to buy the Patient Choice plan. The company now enrolls 120,000 employees in Minnesota, Oregon, and Colorado, but it hasn't caught on among large numbers of employers. Patient Choice executives say they have kept premium increases for their companies several percentage points below average market increases. But some employers have questioned whether the plan actually saves money.
     Massachusetts employers are extremely interested in Patient Choice but will need to review details in the fall, said Richard Lord, president of the Associated Industries of Massachusetts, which, along with the Massachusetts Healthcare Purchasers Group, paid Patient Choice $15,000 to evaluate the Boston and Worcester markets. The two organizations represent 6,000 companies with 2 million insured employees and relatives. Lord said most employers that buy Patient Choice probably will continue to offer traditional HMOs as well. ''We believe there has to be more competition to bring about some cost control,'' he said. ''We don't have a lot of choices here in Eastern Massachusetts. The HMOs are all very good but they all look the same; there is not product differentiation.''
     For Patient Choice to work, hospitals and doctors must agree to participate. Patient Choice has met with nearly 50 providers so far, and some are concerned about whether the company will use accurate data. Executives at Partners, the largest hospital and physician network in the state, said they need to review the details of the plan before making a decision. Others questioned whether Patient Choice will be able to squeeze cost out of the state's expensive health care system.
     Even if Patient Choice cuts out the HMO, it still must hire a company to pay medical claims and perform other administrative functions. ''Someone is still going to have to do that work,'' said Steven Tringale, a Boston health care consultant who has worked for numerous hospitals. ''And I don't think providers are going to be crawling all over each other to give employers a better deal. Is there a market out there? Yeah. But at this point in time hospitals are not robust enough to make the product work through additional discounting.''
     The state's health plans don't seem especially worried about Patient Choice. ''We welcome the competition,'' said Blue Cross spokeswoman Susan Leahy. Jon Kingsdale, Tufts senior vice president for planning and development, said: ''We use an awful lot of negotiating leverage to get the best price we can for our clients. I'd be surprised if the new boy on the block can get better prices. But if they can, it's fair to say we'll be looking for the same deals ourselves.''

Connecticut Center Treats Pedophile Priests
Masha Herbst, Associated Press- 3/26/2002

HARTFORD, Conn. -- In the 19th century, the Institute of Living treated Christian missionaries who were having trouble readjusting to life in the United States after years abroad. The center still treats missionaries, but another religious group as well: Roman Catholic priests who have molested children. Each year, a few priests receive treatment at the institute for what experts call a ''disorder of desire.''
     The private institution founded in 1822 says it is not in the business of ''curing'' patients of their sexual desire for children. ''This isn't something that goes away, any more than you can change the sexual desire of a heterosexual or homosexual person,'' said Heidi McCloskey, who directs the treatment program. ''What we have to do is figure out how to manage it.'' Managing the problem typically involves a stay of three to six months. During the first couple of weeks, patients undergo extensive testing to determine their arousal and behavioral patterns, and to find out if there is a physical explanation for the behavior a brain tumor, for example. Patients participate in three group psychotherapy sessions a day and meet one-on-one with therapists two to three times a week. They also take medication, usually antidepressants, which have the side effect of curbing sexual desire. McCloskey, who estimates she has treated 60 priests, would not discuss any specific cases or allow a reporter to speak with any of the patients.
     The nation's Catholic church has been engulfed by a child-molestation scandal in recent months, after it was disclosed that a Boston-area priest suspected of abusing youngsters was moved from parish to parish. The now-defrocked priest, John Geoghan, is in prison for groping a boy in a swimming pool and has been accused of molesting more than 130 children over 30 years. Since then, dozens of priests across the country out of more than 47,000 nationwide have been suspended or forced to resign.
     The Institute of Living started its treatment program for pedophile priests in the mid-1980s, when the problem first received national attention. In 1985, the Rev. Gilbert Gauthe of Lafayette, La., pleaded guilty to abusing 11 boys and admitted molesting dozens more. He served 10 years in prison. ''That was really a watershed event,'' said the Rev. Stephen Rossetti, a psychologist and sexual abuse consultant to the U.S. Conference of Catholic Bishops.
     Now there are numerous centers in the United States and Canada that treat priests for a variety of problems. Some of the centers, such as the Saint Luke Institute in Silver Spring, Md., the Southdown Institute in Ontario, Canada, and the St. John Marie Vianney Program in Dittmer, Mo., treat clergy and other religious leaders almost exclusively, Rossetti said. Clinicians at the Hartford institute do not decide whether a priest can serve again, but offer a psychological evaluation to the bishop so that he can decide.
     It is unclear how many U.S. priests are sent for treatment each year. The bishops' conference said no one tracks that information. The Institute of Living which serves people of all occupations treats three to six priests each year, probably a low number for most centers, McCloskey said.
     While the treatment centers focus on remedies, the Christian Institute for the Study of Human Sexuality in Chicago concentrates on prevention. Experts in psychology, medicine and theology train seminary instructors to deal with sexuality issues among students. Dr. James Gill founded the Chicago institute in 1995, and since then 700 seminary instructors have been trained there.
     Gill, Rossetti and McCloskey agree that the celibacy rule for priests is not what causes some to abuse children. Experts instead theorize that some priests with tendencies to molest children choose a celibate lifestyle in an attempt to control their behavior, McCloskey said.
     On the Net:
Institute of Living http://www.instituteofliving.org
U.S. Conference of Catholic Bishops http://www.nccbuscc.org
Christian Institute for the Study of Human Sexuality http://www.ctu.edu/GetToKnowUs/human.htm

District Attorney Weighs More Charges in Yates Case
Carol Christian, Houston Chronicle- 3/26/2002

Maintaining the stance he took the day Andrea Pia Yates was sentenced to life in prison, Harris County District Attorney Chuck Rosenthal said again Monday he had assigned a member of his staff to look into the possibility of more charges in the case. Rosenthal reiterated that it is too soon to talk about any potential charges, but media speculation has focused on Yates' husband, Russell Yates.
     Rosenthal has said several times that his office would not rush into any investigation of Russell Yates or anyone else connected to the case. He said only that he has assigned someone not involved in the initial case to "look at it." "Right now, there's a vigilante mentality," he said. "We don't want to cave to that."
     Yates was transferred Thursday from the Harris County Jail to a prison unit near Rusk, about 160 miles north of Houston. She will be there at least 30 days undergoing psychological and medical evaluations, prison officials said. Yates will be eligible for parole after 40 years, receiving credit for the nine months she served in jail after her arrest June 20.
     While published reports have said Rosenthal's office may prosecute Russell Yates on charges of either child endangerment or negligent homicide, Rosenthal said Monday those reports were incorrect. He said he had told a Newsweek reporter he had assigned someone to "see if anybody is guilty of anything." When the reporter asked for specifics, Rosenthal said he responded: "I don't know. The Texas Code of Criminal Procedures covers a lot of ground. I have no idea, but one (possibility) off the top of my head might be child endangerment."
     Rosenthal noted Monday that Texas law allows prosecution for crimes of omission as well as commission. "But are we going anyplace in particular? No," Rosenthal said. "Are we going to stampede? No. We're not going to do anything until we're sure what the facts are going to be." But he said anyone guilty of contributing to the children's deaths will be prosecuted. "If anyone had any criminal culpability with respect to those kids, I want to know about it," he said. "I want to see if we can prove it."
     Russell Yates' attorney, Edward Mallett, said Monday it is Rosenthal's job to investigate crimes, but he doesn't believe his client committed any offense. "He is a victim by the very definition in the penal code -- the next of kin of a victim of homicide," Mallett said. "It's an awful thing. A man who has lost his children and his wife now becomes the subject of gossip reported as though it's news."