Study: New Drug May Aid Autistic Children
Shankar Vedantam, Washington Post- 8/1/2002

Parents and educators can control the tantrums, aggression and self-injurious behavior of children with autism and related disorders by placing them on an antipsychotic medicine that is approved only to treat schizophrenia in adults, researchers reported yesterday. Many psychiatrists have already placed children with autism and related problems on Risperdal, a member of a new class of schizophrenia medicines. Although the Food and Drug Administration has not approved such "off-label" use, doctors expect the new report to greatly expand antipsychotic prescriptions for this purpose. Some mental health experts have expressed concern about the use of powerful medicines among young children. Worried by a spiraling rise in prescriptions, the New York State Office of Mental Health recently asked a panel of experts to study the long-term risks.
    Some children with autism, an incurable disorder that can impair language, cognition and social skills, are easily provoked to uncontrolled bursts of anger and frustration, making it difficult for them to benefit from the intense learning structure that is the only way such children can acquire knowledge and routine social skills. These outbursts range from tantrums, during which autistic children might slam doors or tip over tables, to outright violence, in which they might throw things at people, bite or scratch themselves or others, or bang their head with their fists, said Lawrence Scahill, an associate professor in child psychiatry and nursing at Yale University. "If the medicine could reduce these behaviors, the child may be more available to remedial and rehabilitative efforts to learn, to dress themselves, to get on the school bus and make it to school," said Scahill, the principal investigator in a study published today in the New England Journal of Medicine.
    Although a few small studies conducted by pharmaceutical companies had indicated similar results, the new report is the first comprehensive evaluation. It was paid for by the federal government's National Institute of Mental Health. Scahill and a team of researchers at several universities studied the use of Risperdal in a trial of 101 children ages 5 to 17. The autistic children received either the medicine or a dud pill for eight weeks, and were then tracked for six months. "At relatively low doses, the medicine was effective in reducing serious behavioral problems in children with autism," Scahill said. "It did not make a big impact on the core symptoms [of autism] but had a big effect on aggression, self-injury and tantrums."
    It is unclear exactly how many children may be candidates for the treatment, because estimates of autism numbers vary. The federal government estimates that 75,000 to 150,000 children nationwide have autism. "An autistic child can endanger his siblings," said Eric London, the founder of the National Alliance for Autism Research, an advocacy group in Princeton, N.J. "If you have a small baby in the home, it's intolerable to have an autistic child rampaging through the house. For those families, Risperdal could be a godsend." About 40 percent to 50 percent of autistic children may already be on psychotropic medicines, London said
    Sharon Carpinello, executive deputy commissioner of the New York State Office of Mental Health, whose panel on the trend was first reported July 23 in USA Today, said in an interview yesterday: "Our concern in the increase in the use of antipsychotic drugs for children is that most of the trials that have been done are on the adult side. . . . We know very little about the long-term effects in children." Diabetes, obesity and sedation were among the concerns generally associated with the class of drugs -- children in the trial on Risperdal had significant weight gain. "How does that translate into children as they move through adolescence?" Carpinello asked.
    But Joseph Coyle, a Harvard University psychiatrist, said, "The advantage of Risperdal over the classical antipsychotics is a much reduced risk of both acute neurologic side effects and delayed side effects." The researchers agreed that autistic children should be placed on the medicine only as a last resort, only at low doses and only long enough to become stabilized.
    On the Net: New England Journal: http://www.nejm.org

Treatments of Autism Raise More Questions
ABC News, 8/1/2002

Sean Green was a happy, easygoing baby until one morning, when everything changed. "He didn't know who I was," his mother, Cyndi Greene, told ABCNEWS correspondent Jackie Judd on World News Tonight. "He looked right through me." The diagnosis was autism. The brain disorder left Sean lethargic, unresponsive to sounds, disconnected from the world around him.
    Dr. Jeff Bradstreet says he sees more and more children like Sean. In fact, he has a waiting list just to get on the waiting list. "We all feel like we're the captain of a lifeboat of the Titanic trying to decide who can we let in when we're surrounded by people who are more or less drowning with the disease," says Bradstreet.

Rising Numbers
A decade ago in Loudon County, Va., four autistic children attended public schools. Today, there are 181. And it costs twice as much money to educate them as other children "With the rising numbers, the growing needs, the individual needs of students, because students with autism vary so greatly, I think it's going to be quite a challenge," says Charlotte Crane, an autism resource specialist in the county. The great mystery is why the number of children with this disorder, which affects how different parts of the brain communicate, is rising.
    "It presumably affects the developing brain prior to birth," says Wendy Stone, a clinical psychologist at Vanderbilt University Medical Center in Nashville, Tenn. "It is generally assumed that there is no single cause of autism in all cases, but that a variety of different causes, alone and in combination, contribute to the development of autism in different individuals, " she adds.
    Nancy Minshew, director of the Collaborative Program of Excellence in Autism at the University of Pittsburgh, says the environment may play a part. "It's a polygenetic disorder, which means each case is caused by three to four interacting genes, but you can't have a genetic epidemic. So the increase would have to be a genetic-environmental interaction. I don't think anybody had a clue, which is scary," she says.

Vaccines Safe
Echoing the debate about how best to treat autism, there is similar disagreement about what causes the condition. "It presumably affects the developing brain prior to birth," says Stone. "It is generally assumed that there is no single cause of autism in all cases, but that a variety of different causes, alone and in combination, contribute to the development of autism in different individuals."
    Another controversial theory points to vaccines as a possible cause of autism. But experts say there is no scientific evidence to support this. "There have been studies looking at the MMR vaccine and the relationship of that to autism," says Lisa Freund, a developmental neuro-psychologist at the National Institutes of Health in Bethesda, Md. "But they haven't produced any solid evidence of a connection. Many show absolutely no relationship at all." She says this theory has scared a lot of parents, but strongly discourages them from steering away from vaccines. "Until we have some evidence that there is a strong relationship between the two, it can't be recommended to not have vaccines. Not having them could be disastrous," she says.

Mercury Myth
Mercury, which has been known to cause neurological defects, particularly if exposure occurs in utero, is at the center of another controversial theory. Some parents feared that the mercury in vaccines might cause autism, but scientists say there is actually very little or no mercury in vaccines these days. "Vaccines have not had mercury in them for years," says Freund. "And if that had a direct impact, we would probably have seen a decrease in a reporting of the disorder, and that has not occurred. However, it would be important to know the symptoms of children who did receive this and have the disorder. It could be that some children, because of a genetic predisposition, have a vulnerability to low doses of mercury, which results in something along the autism spectrum."
    Researchers at the Centers for Disease Control in Atlanta are now planning to conduct research revolving around mercury. Dr. Pauline A. Filipek, director of the Departments of Pediatrics & Neurology at the University of California-Irvine College of Medicine, says if mercury were the culprit, statistics would have pointed to the association earlier. "There would be a much higher prevalence in countries that consume fish [which can have a higher mercury content] as a major staple to their diet, like Japan," she says, but notes "the prevalence is the same there as it is in the U.S."

Cautious Approach
There is also disagreement about how best to help autistic children Some parents use a variety of treatments. More than half try alternative methods such as special diets, nutritional supplements, even medications to remove mercury from a child's body. Cyndi Green and her husband, John, tried a variety of treatments for their son, but taking Sean off milk helped the most. "The result was nothing short of spectacular. Within two to three days Sean started to actually speak again, which we hadn't heard in a long time," says John Greene.
    Minshew advises parents to approach alternative treatments with caution. "There's always a miracle story like that going around," she says. "The problem is that we have a disorder where we have some treatments that are effective, but not in all children and not to the extent that we want them to be." She adds: "It is important to keep in mind that there is no cure. Parents have to put their foot down, because they're so vulnerable, and say, 'Give me some proof before I put my heart on the line and put my child through this.' These children don't like change."

Mainstream Treatments
Experts agree that mainstream treatments, which involve behavior modification to learn gestures and words, are the most effective. "The best treatments are educational and behavioral. Children with autism require specialized interventions because of their unique learning and behavioral characteristics. The use of different forms of Applied Behavior Analysis is generally considered best practice," says Stone. Jadie Vigil's three autistic children went through this process. "The difference after the therapy is amazing, really amazing. It completely turned around]my children's lives, I feel, completely," she says.
    One drug has also shown promise. A study in a recent issue of the New England Journal of Medicine focused on Risperidone, a drug shown to improve disruptive behaviors associated with autism. "These disruptive behaviors not only interfere with the acquisition of adaptive skills but are very distressing to families and therapists," says Deborah Fein, professor of psychology at the University of Connecticut in Storrs. But Fein admits the drug's potential is otherwise limited. "It is disappointing, but not surprising, that the medication had no effect on the more central symptoms of autism that were measured, namely social withdrawal and noncommunicative use of speech." However, eliminating some symptoms could pave the way for different drugs to treat other symptoms. "If irritability, hyperactivity, and stereotypes were reduced by use of Risperidone, the child's core autistic symptoms and deficits might be more amenable to other treatments, such as behavioral treatments, over the long term," says Fein.
    Minshew believes that in this day and age, with all of the scientific advancements being made, hope for a cure is at an all-time high. "With the decoding of the human genome, there will be a cure for children born today with autism," she says. "Progress is moving at a visible pace. So our goal right now is to get what we do know and implement it into practice."

Organizations
The National Alliance for Autism Research (NAAR)- www.naar.org   — specializes in biomedical research; dedicated to finding biological treatments, prevention and a cure for autism.
Cure Autism Now (CAN)- www.cureautismnow.org   — also specializes in biomedical research.
The Association for Behavior Analysis- www.wmich.edu/aba
Behavior Analyst Certification Board (BACB)- www.bacb.com
Cambridge Center for Behavioral Studies- www.behavior.org/autism
Autism Society of America (ASA)- www.autism-society.org
National Library of Medicine- www.nlm.nih.gov

Stress May Be Linked to Army Wives' Killings
ABC News, 8/1/2002

As Army officials at Fort Bragg, N.C., look deeper into a series of domestic slayings at the base, the families of the military spouses who were victims are wondering what went wrong, and whether signals of trouble were missed. Joan Shannon, the 35-year-old wife of an Army special operations officer has been charged with first-degree murder in the shooting death of her husband, Maj. David Shannon, 40. Joan Shannon could be heard screaming in what seemed like a desperate 911 call for help on the night of July 23.
Operator: "This is 911, we just received a call from there, is everything OK?"
Joan Shannon: "I need an ambulance …"
Operator: "What?"
Shannon: "I need an ambulance here, I need the police here now."
Operator: "Ok, what do you need a police officer for?"
Shannon: "Somebody shot my husband."
Police say Shannon's call was a lie. They say financial gain was one of the primary motives in the slaying — just the latest in a string of domestic-related killings on the base.
    In the course of six weeks, between June 11 and July 23, four Army soldiers from the base allegedly killed their wives. Two of the men killed themselves. Three of the men were special operations soldiers who had recently returned from Afghanistan. It has raised the question: Is the military doing enough to smooth the soldiers' transition to civilian life?
    Col. Tad. Davis, the Fort Bragg garrison commander and the chairman of Fort Bragg's Family Advocacy Program, said Tuesday that the base offers a full range of counseling services and is working to get to the bottom of what happened in each of the killings. "What I can tell you is that we have a wide range of programs that contain training and counseling for both our soldiers and their spouses," Davis told Good Morning America. "I can assure you that we take our responsibilities here very seriously."
    After hearing Davis' comments on GMA, dozens of women from Fort Bragg reached out to a local reporter who has been closely covering the story for the Fayetteville Observer. Tanya Biank, the military affairs reporter for the Observer, told GMA that many women from Fort Bragg said help is hard to find on the base. "I received a lot of phone calls from wives who had very different experiences when they had reported abuse through their chain of commands," Biank said. "One woman in particular was physically abused by her husband, and she said that she did report this to military officials and that she was never taken seriously," she said.

Tales of Sorrow
One of the victims, 32-year-old Jennifer Wright, was allegedly strangled by her husband, Army Special Forces Master Sgt. William Wright, who had just returned from the Afghanistan front, police said. Investigators reported that after the July 19 killing, he allegedly wrapped his wife's body in a parachute bag, then buried it in a shallow grave. Archie Watson, Jennifer Wright's father, told Good Morning America on Monday that he didn't see any signs that his son-in-law was violent, but said stress was certainly bubbling beneath the surface since his return from Afghanistan in May. Wright had spent time in many of the war's hot spots. "It seemed like it changed him, but he kind of kept it hid," Watson said. "He didn't want his boys to see it." His son-in-law sought counseling and legal help in connection with his marriage, but did not get any help from the military, Watson said. "I do know Bill asked for help three times on an e-mail, and he wasn't given any help," he said.

A Cry for Help?
The review into the killings at the base will include looking into whether William Wright sought help and whether he didn't receive any, Davis said. "If we find things like that may be out there, those are things that we need to roll back into our programs to make them even better than they are right now," Davis said. He acknowledged that soldiers who perform duties in combat zones have extra stress, as do their loved ones. "Life on planet Earth is very stressful and you add on top of that military life, and soldiers moving in harm's way in a combat zone adds to the stress not only on the soldiers but also their families back here at Fort Bragg," Davis said. "And so as we work through our programs, we will try to identify what the points of stress are, what those points of friction are in the lives of these families, in order to determine what programs may benefit them."
    Leroy Zeigler, the father Andrea Floyd, said that the special operations unit seemed particularly affected by the stresses of war, and that the Army should be doing more to address problems within its elite forces. Police say that Floyd's husband, Brandon, shot her with a handgun, then killed himself. He was a sergeant first class in the army special forces. "Well, I'm sure the training that these gentlemen are receiving is vigorous enough as it is. When they come home, I just think they need to de-program these fellows because there's a lot of violence that's going on when these guys are getting home," Ziegler said. "So I think they really need to look into this."

Study Links Past Abuse, Gene to Violent Acts
Ellen Barry, Boston Globe, 8/2/2002

A child is beaten. For decades, social scientists have asked the same question: When the victim of such violence grows up, will he be a scarred but responsible adult, or will he be violent himself? The answer, according to a study published today in the journal Science, is encoded in a small strip of genetic material on a child's X chromosome. According to the study, children genetically primed to produce high levels of an important brain enzyme will probably develop into normal adults despite abuse. But abused children with low levels of the enzyme, called MAOA, may be launched toward episodes that include robbery, rape, homicide, deceitfulness, and lack of remorse.
    After high expectations that such disorders as alcoholism and depression could be genetically mapped, researchers in the last 20 years have found few of the clear links they sought. Ethicists, meanwhile, have questioned the wisdom of labeling children with any predisposition. This paper shows that genes indicate vulnerability, not fate, said Dr. Peter McGuffin, who directs the London research center that produced it.
    ''People often talk about gene-environment interaction and wave their hands around, but there are very few concrete examples,'' said McGuffin, director of the Psychiatric Research Centre at King's College, London. ''It's a thing that I think is going to crop up time and time again. There's no effect of this gene on its own [unless] you put it together with an adverse environment.''
    The authors -- a team of psychologists from the University of Wisconsin and King's College -- studied 1,037 children from New Zealand, born in 1972 and assessed at various ages. Eight percent of the children were found to be ''severely'' maltreated between the ages of 3 and 11, and 36 percent were likely to have been maltreated.
    Severe maltreatment, coupled with the genetic marker known to produce low MAOA, predicted violent behavior. Of the children in the study who had both characteristics, 85 percent developed antisocial problems. And although abused children with low levels of MAOA were only 12 percent of the male population in their age group in one city, they accounted for 44 percent of convictions of violent crime.
    Dr. Emil Coccaro, director of Clinical Neuroscience and Psychopharmacology Research at the University of Chicago, said that if the results can be replicated, their public policy applications could be ''explosive.'' ''Let's say you know at birth'' that a child has low levels of MAOA, Coccaro said. ''We better make sure this kid doesn't get abused, because it's going to be a problem for society. The big thing would be surveillance. ''
    Harvard genetics professor Jonathan Beckwith said proving the effect of environment on genes will contribute to a more nuanced view of genetics, which ''tend to have the implication to people of something that's fated, unchangeable.'' But Beckwith also expressed hesitation about how the study would be used - based largely on what happened when the MAOA gene was first presented to the public as an indicator of potential violence.
    The study's history was remarkable: A Dutch woman had approached Dr. Han Brunner complaining that although she and her female relatives were normal, for generations her male relatives had displayed extraordinary violence: one had raped his sister, one had run over his employer with a car, and two were arsonists. It turned out they shared a defect on the gene that prompts production of MAOA, an enzyme that breaks down such neurotransmitters as dopamine, seratonin, epinephrine and noradrenaline.
    Publication of the results in 1993 was greeted with such overheated headlines as ''BAD GENES.'' One man facing murder charges in Georgia based his criminal defense on MAOA deficiency, recalled Beckwith. UMass neurologist Xandra Breakefield, one of the authors of the 1993 study, said she had been shocked and disappointed by the way social scientists proposed to use the MAOA results. ''A lot of people ... want to measure MAOA activity, and I'm not sure what they're going to do'' when they get results, Breakefield said. ''I lived through one of these, and I can tell you people don't know what to do with this information.'' Breakefield also said that the researchers did not really measure MAOA levels in the brain, but only checked for an abnormality in gene sequence that has been correlated with low levels in cell culture. McGuffin, however, said it was ''established'' that the genetic mutation determines the enzyme levels.

OxyContin Probe Focuses On N.Va. Doctors
Josh White, Washington Post- 8/4/2002

A nationwide drug investigation is substantially focused on two Northern Virginia doctors who have written prescriptions for OxyContin, a powerful painkiller that has killed nearly 450 people, for patients from as far away as Oregon, California, Maine and Louisiana. More than a dozen federal agencies and scores of local and state law enforcement officials have been working for more than a year to build cases against doctors, pharmacies and patients who have been prescribing or selling OxyContin and other potent painkillers that are abused as recreational drugs. They are pursuing investigations in Kentucky, Tennessee, the Carolinas and Maine, in addition to Virginia, as an epidemic of prescription drug abuse continues to grow.
    The Virginia doctors acknowledge they are the focus of a criminal probe but say they have done nothing illegal and are providing a valuable service to chronic pain sufferers who need the drugs. OxyContin is a mainstream pain remedy approved by the Food and Drug Administration and prescribed more than 6 million times last year, but it has come under intense scrutiny recently as its abuse has become widely documented.
    The investigation shows the government's concern about the surge of OxyContin overdoses, but it also highlights the complexities of finding -- and proving -- criminal culpability in cases of licensed and reputable physicians prescribing a painkiller that's completely legal. "The problem with the prosecution is demonstrating that the doctors knew or should have known that these were not bona fide patients," said Robert Dupont, who was director of the National Institute on Drug Abuse under Presidents Richard M. Nixon and Gerald R. Ford.
    But the federal authorities insist that, just as in any drug investigation, the only way to stop the problem is to go after the source, which in this case happens to be doctors. Several U.S. officials said the government has devoted more resources in more locations to this probe than to any other drug investigation in recent memory because of its complexity. "We're moving up the food chain right now," said Gregg Wood, a health care fraud investigator with the U.S. attorney's office in Roanoke. Investigators have started with the drug abusers and are working backward. "Most OxyContin gets written at the end of a doctor's pen," Wood said. "Some of these doctors are nothing more than clearinghouses."
    A federal grand jury in Alexandria has been investigating William E. Hurwitz and Joseph K. Statkus, sole practitioners who run pain clinics in Fairfax County, and some pharmacies since last year to determine whether they have been conspiring to distribute controlled substances and whether their actions have led to overdose deaths, sources said. "I will neither confirm, deny nor comment except to say that the growing national plague of Oxy addictions, overdoses and deaths caused by the illegal activity of some doctors, pharmacists and patients has been focused on like a laser beam by this office and other U.S. attorneys' offices," said Gene Rossi, a federal prosecutor in Alexandria. "If any person falls into one of those three categories, our office will try our best to root that person out like the Taliban. Stay tuned."
    Law enforcement officials have arrested dozens of suspected prescription drug dealers throughout Virginia in the past month. Some are being held by federal authorities in the Alexandria jail under U.S. racketeering statutes; others are in custody elsewhere on drug and other charges, facing intense pressure from investigators to offer anything they know about the doctors, according to defense attorneys.
    Both Hurwitz and Statkus deny wrongdoing. They said separately in interviews that the government is making them scapegoats for a wave of abuse touched off by what they say is a small percentage of unscrupulous pain patients who sell their medication. "This is a symbolic investigation with a political agenda to squelch OxyContin and other pain medications," Hurwitz said. "It's easy to put fear in the mom-and-pop pharmacies and into the doctors because we are easy to scare to death. They're looking at us as Mafia dons and the heads of drug cartels, while we're just trying to help patients who are in serious pain and are in dire need of help." Statkus, whose offices were raided by the FBI in January, said he knows federal agents are talking to his patients, but he said they won't find anything. "I really haven't done anything wrong," he said. "It seems like they're just waiting for something bad to happen. They're looking to find something where there may be nothing."
    OxyContin abuse has proved a difficult problem for the government. The drug is a synthetic morphine pill that has eased the pain of the chronically ill. But it also has been transformed into a terrifying street drug. Rural Appalachian communities have been ravaged by OxyContin abuse, suburban teenagers have experienced its powerful euphoric rush, and urban street dealers have come to recognize it as one of the best moneymakers around. But unlike crack cocaine or heroin, which are necessarily obtained illegally, OxyContin almost always wends its way through a legitimate pipeline, with doctors and pharmacies controlling its output.
    Because painkillers are legal drugs, prosecutors must show that the doctors are prescribing them to patients who don't need them, largely for financial gain. Investigators say the doctors enter into agreements with independent pharmacies so no one asks questions when they prescribe thousands of pills worth tens of thousands of dollars. "When you've got 400 patients and you're charging $250 each month to see them, sometimes for only 15 minutes or not at all, it's a lot of money. You do the math," one federal investigator said. "And you're creating drug addicts who have to come back to you, each month, forever, until they die."
    Prosecutors are using the same racketeering and drug kingpin statutes before the grand jury in Alexandria that have brought down Mafia capos and high-level drug dealers, sources close to the investigation said. So far, the federal investigation has resulted in a number of arrests and convictions in Florida, Connecticut, Kentucky, Pennsylvania, Tennessee, Ohio and the Carolinas. A Maryland doctor was charged in June with distribution of OxyContin, and a Roanoke doctor was charged in a 60-count indictment in May with drug trafficking violations and operating an enterprise that engaged in a pattern of fraud. A South Carolina neurologist pleaded guilty in April to federal charges of illegally distributing OxyContin and conspiracy to commit fraud. Facing up to 45 years in prison, the doctor, Benjamin Moore, killed himself last month.
    Authorities have secured indictments by alleging conspiracies with pharmacists and patients. They also have charged doctors with Medicare fraud and money laundering. "The statutes used to be reserved for kingpin drug lords and Mafia bosses," Wood said. "But they also work on these doctors. . . . These are very involved investigations because we're looking for a very small percentage of the doctors out there." Investigators are largely working with the doctors' own records that they are required to submit to the government. They're also talking to the people they find on the streets and learning where the drugs are coming from.
    Documents that Hurwitz has filed with the Drug Enforcement Administration over the past two years show that some patients have received as many as 1,200 40-milligram OxyContin pills each month. In some cases, the documents show, they received that many in three weeks even though the patients were on a monthly regimen. With OxyContin worth about $1 per milligram on the street, such a prescription would be worth about $48,000. A number of those patients are now in federal custody, sources said. Hurwitz defends the practice, saying patients become tolerant to the drugs and need more and more to get the same relief. Besides, he said, it's impossible for doctors to weed out patients who might defraud them. "Assuming that . . . there will be diversion and abuse, it may be that we need to administer the drugs in a more controlled setting," Hurwitz said. "Blaming me for taking care of patients according to an approved protocol as if it were criminally negligent is a solution, but it's not a solution that will allow pain management to continue as we know it." Hurwitz said he's telling his patients to stock up on their drugs or find other doctors willing to take them on. He also is teaching them how to safely withdraw because he believes his practice might be in jeopardy.
    Federal investigators also are tracking deaths associated with OxyContin. Sources said one case they are looking at is that of Rennie Scott Buras, a New Orleans oysterman who died in October 1999. Buras became a Hurwitz patient in 1999 after seeing him on "60 Minutes," following Hurwitz's unrelated license suspension. M. Suzanne Montero, an attorney for Buras's son, said Buras was a successful businessman who lost everything when he got hooked on OxyContin after a back injury. She said he was looking for someone who could give him drugs and found Hurwitz.
    According to depositions taken in 2000 in a civil lawsuit Buras's son filed against Hurwitz, Buras got his drugs by sending e-mails to Hurwitz and telling him how much he wanted. Prescriptions for OxyContin, methadone, Dilaudid and other medications were sent to a Fairfax pharmacy, and the drugs were mailed to Buras. Buras had three appointments with Hurwitz in Virginia in the nine months he was a patient until his death. The civil suit was settled with a confidentiality agreement. Hurwitz acknowledged in the depositions that in the months before he reopened his practice, he coordinated with some pharmacists to handle his prescriptions. "I don't think the doctors want to kill anyone, and I don't think that Dr. Hurwitz wanted Rennie Buras dead," Montero said. "But did he stand by and give a clearly impaired human being an arsenal of ways to kill himself? Yeah."
    Federal authorities also point to the case of Cindy Jean Harris as an example of why they are trying to prosecute doctors and pharmacies. Harris, 40, of Dale City said she went to Statkus when she was in pain. She knew it could be treated with ibuprofen, but she wanted the highs of Demerol, methadone and OxyContin. She faked more severe pain and got the drugs, she said. "It was almost like a game to play," Harris said in an interview from the Virginia Correctional Center for Women in Goochland, where she is serving a 3 1/2-year term for selling drugs and neglecting her children. "Going to Statkus was like going to a candy store." Statkus called Harris a "very talented liar" who duped him into giving her drugs. Both he and Hurwitz said it's inevitable that some clever criminals will sneak into their practices.
    After Harris's husband, David, died in August 2000, Harris went downhill. By October 2000, she was crushing and injecting OxyContin along with other drugs and had track marks on each arm, from wrist to elbow. "I gave him some lame excuse that even I wouldn't have believed," Harris said. "A blind man couldn't have missed it. But still, he gave me more. It was entirely too easy. . . . It's kind of frightening to know that when I walk out of these gates I could find another doctor and start doing this all over again."

Fatal Overdoses Rise at Alarming Rate
Amalie Nash, Ann Arbor News- 8/4/2002

Amy Fletcher was a junior at Eastern Michigan University. Her infectious, outgoing personality and love of children led her toward a teaching career. She left her hometown of Port Huron after high school and came to live in Ann Arbor, but she was never far out of reach from her parents and three siblings. They were both 21, mapping out futures they would never get to live. They didn't know each other, but they shared a tragic fate. Goodman and Fletcher both died within the last year -- he to heroin and her to a mixture of heroin, cocaine and amphetamines -- two faces drawn from statistics that point to a disturbing rise in drug overdose deaths in Washtenaw and Livingston counties. "It's still so hard to believe because, ultimately, everyone thinks it won't happen to them or their families," said Ludell Goodman, Dustin's mother. "If someone tries it once and they don't die, they don't fear it anymore, or they see their friends doing drugs and think they must be OK."

The numbers say otherwise.
Washtenaw County saw a 93 percent increase in fatal overdoses from 2000 to 2001, when 56 people succumbed to narcotics, medications and alcohol, according to an analysis by The News of medical examiner records and death certificates. Livingston County has already seen as many drug deaths in the first six months of this year as it had all of last year. If Washtenaw County keeps pace for the second six months of this year, overdose deaths will surpass the average of 36 per year since 1997. The county Medical Examiner's Office handled 22 overdose deaths from January through June.
    Police and other experts can't say for certain what's behind the surge in fatal overdoses; perhaps it's due to a resurgence in heroin use, the availability and decreasing cost of hard drugs, or the more potent mixtures on the streets. Nor do they have any quick solutions. Most drug overdose deaths occur under the public radar, and usually go unreported by the news media. It's a problem that many families don't want to talk about, especially those affected most deeply. But those who are willing to share their stories tell of poor decisions that led to an unexpected death, and the pain that continues in the lives of those they left behind.

Something new
Dustin Goodman showed up at a party on March 28 at a fraternity house near the University of Michigan campus. He told a friend that he got his hands on "something new" and planned to try it out. Goodman and the others drank beer until the party wound down after 3 a.m., then he and another friend decided to sleep in the basement so they wouldn't have to drive home after drinking. Goodman pulled out a baggy of white powder that he said was heroin and snorted a line, his friend told detectives. They talked for a bit, then went to sleep. The friend got up later that morning, showered, then returned to the room to find Goodman lying in an odd position with vomit on his face, police reports indicate. By the time emergency crews arrived, Goodman was dead.
    Gary Goodman was cleaning up his son's room in their Scio Township home when he answered the door to find a police officer on the other side. He would not learn until several days later what killed his son. Gary and Ludell Goodman knew their son drank alcohol, but never imagined he'd try heroin. Other friends at his funeral said he had never done anything like that before, Gary Goodman said. Goodman's parents are left with many more questions than answers, and reading the inconsistent variations among people at the party in the police reports only confused matters. They don't believe he was the only one using drugs that night or that no one else knew where he got the heroin. "Why he would do it is part of the question, and where it came from," Ludell Goodman said. "There are a lot of scenarios possible, and a lot of holes in the stories. I would have thought someone who died of this had done it a lot. I never thought someone would die that easily."
    The Goodmans believe the drug scene in the Ann Arbor area is much worse than most people suspect, and they question what is being done by police to stop drug sales. They also wonder why the fraternity, Zeta Psi, was even allowed to operate after similar problems occurred there a few years ago. The fraternity was not affiliated with the U-M at the time of Goodman's death and has since been closed. "These kids think it's OK to experiment with drugs. It's become like a rite of passage," Gary Goodman said. "Parents, the community, law enforcement and the university need to open their eyes and recognize that we have a serious drug problem in this town."
    Dustin Goodman's death came at a time when his life was coming together. He was making plans to purchase Bill's Market in Ann Arbor, and he was involved in the music scene, where he enjoyed playing the drums and piano. Gary and Ludell Goodman said their sometimes wild child was showing signs of settling down. The boy who dyed his hair bright red for graduation from Community High School four years ago was becoming a responsible young man. "He was really finding his way in life. He had been very focused on his future," Gary Goodman said. "He wasn't the kind of kid who just settled down right away. He had so much energy." His parents and three younger siblings have been devastated by Dustin's death. They're a close-knit Christian family, and nothing will be the same without the tall, thin 21-year-old who friends said would have given anyone the shirt off his back. They're now trying to get the message across that trying a drug, even once, can be a deadly mistake. "It still doesn't seem possible. Life for our family, every day, has changed forever," Ludell Goodman said. "This has ripped apart the lives of many people. He had a whole life of adventures that he left behind."

All-American girl
Amy Fletcher decided to spend a fall weekend last year with her family, so she headed from Ann Arbor to Port Huron, seeking comfort from her parents after a difficult break-up with her boyfriend. She stayed through mid-week, then made the drive back to return to her studies at Eastern Michigan University. She seemed better by the time she waved good-bye, less distraught over the end of the relationship, her father said. Had she still been too upset, they would have insisted she stay. It was the last time Gary and Mary Lynne Fletcher saw their daughter alive. Only a few days later, they would be rushing to the University of Michigan Medical Center, wondering what went so wrong.
    The months that followed have been filled with shock and grief. The Fletchers cling to memories of family vacations skiing and diving with Amy and her three siblings. "We're still stunned about her death and how it happened," Gary Fletcher said. "Never in my wildest dreams could I have believed this would have happened."
    Amy Fletcher was at a bar early the morning of Friday, Oct. 5, and called a friend to pick her up. Her friend said she was drunk and snorted lines of cocaine at his apartment before lying on the couch to go to sleep sometime after 8:30 a.m., police reports indicate. The friend and a roommate said Fletcher slept, snoring on the couch all day and into the night. One of the men checked on her at 4:30 a.m. Oct. 6, and her lips were blue. They couldn't wake her, so they carried her to the car and drove her to the emergency room at U-M, where she was pronounced dead.
    A few months before her death, Fletcher's parents learned their daughter had experimented with cocaine when a friend told them she had a baggy in her purse. They confronted her, and she admitted trying it. She said she used it at a bachelorette party, but didn't plan to do it again, Gary Fletcher said. "We were very, very concerned," said Gary Fletcher, who is an attorney in Port Huron. "She said she didn't have a problem. We encouraged her to get help or counseling at school and she repeatedly assured us she was OK. We asked her boyfriend every time we talked to him and he always said no, she didn't have a problem. "She wasn't having any problems at work or at school. She was doing well and getting good grades. No signs jumped out at us."
    When the Fletchers arrived at the hospital emergency room that October morning, they had no idea what caused their daughter's death. It wasn't until a day or two later that they learned detectives believed it was a fatal drug overdose. Detectives tracked down the two men accused of supplying her with heroin and cocaine, and they have been criminally charged.
    Nearly 1,000 people packed the funeral to remember the young woman who was always smiling and loved being surrounded by friends, Gary Fletcher said. Her friends who were aware that she was using drugs have been wracked with guilt for not speaking up. "I feel awful for her friends, and it's not their fault," Gary Fletcher said. Fletcher hopes his daughter's tragic death will lead others to be more vigilant and will give people who see a loved one with a problem the courage to take action before it's too late. He also said it shows the need for immediate medical attention; his daughter might still be alive if the others had acted earlier to get her to the hospital. That fact, he says, is even more heart-breaking. "I hope the charges send a message that it's not some trivial thing to bring drugs to hand out at parties, and there can be some serious consequences."

Investigative theories
Ann Arbor Detective Sgt. Richard Kinsey says that he's seen more drug overdose deaths in the last three years than he saw in the other 17 years of his 20-year career. He believes the resurgence of heroin is a large factor. "Heroin is back, it's cheaper and it's more potent than it used to be," Kinsey said. "Oddly, it really runs the gamut. We're seeing people die in their 40s and 50s and we're seeing teen-agers die."
    National statistics seem to back Kinsey's theory. Figures from the Drug Abuse Warning Network (DAWN) indicate that the use of heroin is increasing in most large cities, and so are heroin-related deaths. The U.S. Drug Enforcement Administration attributes the rise in heroin use to the newer high-purity form that can be snorted, which eliminates the stigma of needle use. During the four-year span between 1994-98, the number of heroin overdose deaths reported to DAWN increased by 26 percent. The total figure of drug-related deaths in those four years where heroin or related opiates were detected was 20,140.
    Locally, narcotics officers on the streets say they aren't seeing a marked difference in the availability of heroin. Officers with the Livingston and Washtenaw Narcotics Enforcement Team say they primarily see marijuana and powdered cocaine in Ann Arbor and crack cocaine in Ypsilanti. Designer drugs also are gaining popularity, they say.
    In the first six months of this year, LAWNET officers seized about 1,712 grams of cocaine, 14.57 grams of heroin, 127 grams of crack cocaine, 528 grams of mushrooms and 107.65 pounds of marijuana. Late last month, LAWNET officers searched an Ypsilanti home and found 12 small packages of powdered heroin ready for sale, Lt. Jerry Cooley said. "It seemed like a few years ago there was a bad batch of heroin going around," Cooley said. "We were kicking down doors to find out where it was coming from. It seemed to stop and less people were dying."
    Washtenaw County Sheriff's Detective Sgt. Patrick Bell said his agency hasn't seen as many overdose cases this year; last year they investigated 20 of the 40 overdose deaths. Bell said most of the people who died had used drugs for many years before they overdosed. "You never know when a drug will push a person over the edge," Bell said. "We're trained that it's not necessarily a bad product, and what could kill one person might not kill another. People are really taking their chances with drugs because you never know what you're going to get."
    Many times, investigators don't know the death was caused by a drug overdose until toxicology reports come back, sometimes weeks later. Drug paraphernalia at the scene can provide clues, but often that isn't there, Bell said. After someone dies of a drug overdose, detectives try to determine who supplied the drugs, and they can be criminally charged. But often, that's next to impossible because the user is dead and others won't talk, Bell said. When detectives investigate overdose deaths, they usually discover that someone knew the person had a drug problem, Kinsey said. "They're extremely tragic deaths, and they hit families very hard because everyone second-guesses what they could have done differently to prevent it," Kinsey said. "It comes down to individual choices, and drugs and alcohol really do cause a lot of tragedies."

Statistics on drug-overdose deaths reveal victims of all backgrounds
Nationally, Drug Abuse Warning Network (DAWN) studies have determined that - like Washtenaw County - the three most frequently mentioned drugs in overdose cases were heroin, cocaine and alcohol.  An analysis by The Ann Arbor News of autopsy reports and death certificates for the 40 Washtenaw County cases showed that:
* Eight of the drug overdoses were suicides, and the other 32 were accidental or undetermined, which means that the medical examiners didn't know the exact manner of death.
* Of the 32 non-suicide deaths, 26 people had more than one drug in their systems. The most prevalent were heroin (19) and cocaine (16) - and of those same people, 13 tested positive for both. Twelve people had alcohol in their systems at the time of death. The other deaths were caused by a mixture of drugs, including morphine and amphetamines. Most of the suicide deaths were caused by sleeping pills, medication and carbon monoxide.
* The average age of a drug overdose victim was 40. Only 10 percent were under 25 years old, which mirrors national statistics compiled by DAWN.
* Twenty-five were men and 15 were women.
* Eleven of the overdose victims were divorced, nine were married, 18 were never married, one was widowed and one is unknown.
* Thirty of the overdose victims were white, six were black, one was Indian and the race of three others is not known.
* Twenty-nine of the people who overdosed in Washtenaw County also lived here, with the majority residing in Ann Arbor, Ypsilanti Township and Ypsilanti.
* Twenty-four of the people died at home, four died in hospital emergency rooms, four died in motels, four died as inpatients at the hospital, two died at other people's homes, one died in a parking structure and one died at a bus stop.
* Eight of the people had fresh needle marks in their arms when they were found; drug paraphernalia was found on the scene in nine cases.
* Autopsy reports show that 18 people had a history of drug and/or alcohol abuse. Five people overdosed on medication.

 Ann Arbor Police Investigating OxyContin Abuse
Amalie Nash, Ann Arbor News- 8/4/2002

The first time Ann Arbor Police Detective Brian Zasadny ran across OxyContin was two years ago when he was called to investigate the death of a 24-year-old medical student and discovered prescription bottles bearing the label of the painkiller. Zasadny had read about OxyContin shortly before that, but he had never seen it. All he knew was that the drug is much like morphine, is used to treat many cancer patients and was being abused on the streets -- particularly in the South. Since then, many detectives and police officers have learned about the drug that's now being abused locally at an alarming rate and was blamed for two drug overdose deaths in Washtenaw County last year, authorities say. "It's coming on pretty strong here in the last year and a half," said Lt. Jerry Cooley of the Livingston and Washtenaw Narcotics Enforcement Team. "We've done several purchases and raids and have seized decent amounts of it." OxyContin, a high-potency pain reliever touted for its medical benefits, has been described as giving a heroin-like high by addicts who are snorting it, chewing it and injecting it to disable the time-release effect in the tablet, police said.
    Last December, a 30-year-old man with a five-year history of medication abuse died at the Superior Township home of friends after snorting OxyContin, Washtenaw County Sheriff's detectives said. He had a mixture of opiates, medications and amphetamines in his system, reports show. A 31-year-old Ypsilanti Township man died in his basement in February 2001, and three medications including OxyContin were found in his system. The man, who had a history of drug and alcohol abuse, also had recently been exposed to cocaine, autopsy reports show. In the case that Zasadny handled in 2000, a medical student took his father's medication after his father died.
    "My experience has been that those who abuse pain medication have a background in the use of street narcotics or legitimately obtain the prescription for a viable medical condition and then become addicted," Washtenaw County Sheriff's Cmdr. John Southworth said. "Vicodin is a very desirable drug as far as street addicts go, but OxyContin is probably the Cadillac of prescription drugs out there right now."
    OxyContin is the brand name for the tablet form of oxycondon, an opium derivative similar to codeine but more powerful. On the street, it's referred to as "oxies," Southworth said. It was approved by the Food & Drug Administration in 1995 and is used to treat chronic moderate to severe pain. The FDA strengthened warning labels on the drug last year because of reports of abuse. Purdue Pharma, which formulated the drug, has disputed reports linking OxyContin to "hundreds of deaths," and says many of the deaths occurred in people who took several other drugs and drank alcohol, leading to a deadly cocktail. The company also stopped distributing the drug in 160 milligram tablets, its highest-strength dosage, in an attempt to reduce abuse.
    OxyContin also has been linked with several crimes statewide in the last year, including break-ins and robberies at pharmacies. In Lansing, at least two pharmacies posted signs that they don't stock OxyContin. A pharmacy at the East Ann Arbor Health Center has been broken into four times since March 2001, and OxyContin was taken in one of the thefts, said Diane Brown, a spokeswoman for the University of Michigan Department of Public Safety. OxyContin was also taken during an armed robbery at a house in Ypsilanti, Cooley said.
    LAWNET officers recently arrested a man accused of selling the drug out of his home after he received a legitimate prescription for a medical problem, Cooley said. His case on drug delivery charges is pending. Prices for the drug vary based on dosages, but officers say users will pay $20-$30 to buy a low-dose pill on the street.

Alternative Therapy Offered to Maine Abuse Victims
Associated Press, 8/5/2002

AUGUSTA, Maine --Victims of clergy abuse are being invited to a workshop that uses an uncommon therapy to help victims deal with their abuse. The workshop from Aug. 16-18 will have eight therapists who use a therapy known as therapeutic spiral model, in which victims act out their pain with professionals, said Katherine Amsden, a counselor in Auburn who is organizing the workshop. Amsden said therapeutic spiral modeling uses art, drama and song ''and gives people a chance, if they feel strong enough, to act out their trauma and look at their trauma within a circle of safety within a group.''
    Amsden said the therapy is intended to go deeper than talking sessions allow. Even if abuse happened years or decades ago, it still can scar a person, wreaking havoc with relationships and the victim's ability to trust others, Amsden said. ''No matter how many years ago it happened it stays on the body. It's something that doesn't go away,'' she said. ''There are visual scenes of it in flashbacks. In psychodrama you safely re-enact scenes. You confront your abuser (played by a therapist) and say what you feel, things you couldn't say then.''
    Amsden said she is organizing the workshop because she is Catholic and the church abuse scandal has affected the whole ''Catholic family.'' The scandal has resulted in the removal of more than 170 priests from churches nationwide this year. In Maine, three priests have been removed and prosecutors say they have a list of allegations against 33 inactive or retired priests who are still alive and 18 who are dead. Amsden said the therapeutic spiral model approach was developed by Kate Hudgins of Virginia, who has treated trauma victims in South Africa and Northern Ireland and will be at the Augusta workshop.

Police Say Ft. Bragg Marriages Were Rocky
Associated Press, 8/5/2002

FAYETTEVILLE, N.C.-- Four Army wives who investigators say were killed by their husbands all wanted to get out of their marriages, the Fayetteville Observer reported yesterday. The deaths at Fort Bragg in June and July have prompted post officials to promise a review that will include how the military deals with marital problems.
    Three of the husbands were special operations soldiers who had been deployed to Afghanistan, but investigators discounted a direct connection with the deaths to wartime service. ''It's not like all three went to Afghanistan, came back, and killed their wives,'' Lieutenant Sam Pennica of the Cumberland County Sheriff's Office told the Observer. ''They all had ongoing marital problems before the war.''
    The newspaper reported that Jennifer Wright, 32, told her parents in January she was ''tired of being a military wife'' and wanted a divorce. Investigators said her husband, Master Sergeant William Wright, 36, killed her at the end of June, then confessed three weeks later and led authorities to her body. Marilyn Griffin, 32, separated from her husband of eight years in May, for the third time. Two months later, she was stabbed to death and her body set on fire in her home. Sergeant Cedric Griffin, 28, who worked in the commissary and never went to Afghanistan, was charged. Investigators believe Teresa Nieves, 28, and Andrea Floyd also told their husbands they wanted to separate in June. Lawmen said Sergeant First Class Rigoberto Nieves, 32, shot his wife in the head and then shot himself June 11. Sergeant First Class Brandon Floyd killed Andrea Floyd on July 19, then shot himself. There was no indication that threats of separation played any role in a fifth death on July 23, of Major David Shannon, 40. His wife and a teenager were arrested last week. Investigators believe Shannon was killed for insurance money.
    Andrea Floyd's mother, Penny Flitcraft, told the newspaper she believes her daughter's desire to leave undercut Brandon Floyd's sense of control. Kendra League, one of Andrea's best friends, said he was a perfectionist and wanted the perfect wife. ''She struggled to please him. She was tall, blond, and beautiful. He would tell her she was fat and she needed to do something with herself,'' said League.

Psychiatric Outcast Ponders Parasitic Mental Illness
Keay Davidson, San Francisco Chronicle- 8/5/2002

An unknown infectious agent may be responsible for a five-fold increase in mental illness over the last two centuries, a controversial psychiatrist proposes in a new book. The claim by Dr. E. Fuller Torrey, a noted psychiatrist-author and scourge of mainstream psychiatry, challenges common explanations that mental illness is caused by a combination of genetic factors and environmental influences, such as family upbringing.
    Torrey's new book also defies two schools of academic thought: One is that rates of at least one major type of mental illness, schizophrenia, have sharply declined or remained stable. The second is that the extensive construction of "insane" asylums from the 18th to the mid-20th centuries was at least partly driven by nonmedical aims -- to suppress iconoclasts and other socially marginal people.
    To test his hypothesis, Torrey and his associates are quietly investigating whether they can ease mentally ill persons' symptoms by giving them antiviral and anti-parasitic drugs. More than 100 volunteers are presently involved in the trials, now under way at Sheppard-Pratt psychiatric hospital in Baltimore and at a psychiatric hospital in Addis Ababa, Ethiopia, where Torrey was a Peace Corps physician in the 1960s.
    Torrey, 65, is a prolific author and veteran gadfly who is also a professor of psychiatry at the Uniformed Services University in Bethesda, Md. From 1970 to 1975, he was a special assistant to the director of the National Institutes of Mental Health. Over the years, he has antagonized figures on both sides of long-running debates over mental health care and involuntary commitment of the mentally ill.
    His new book, "The Invisible Plague: The Rise of Mental Illness from 1750 to the Present" (Rutgers University Press), co-authored with his research assistant Judy Miller, has received respectful but not uncritical reviews. Acknowledging he is "a distinguished U.S. researcher in psychiatry," Nature magazine's review of the book called it a "highly informative and stimulating work."

Traditional Debate
Traditionally, debates over the origin of mental illness, like debates over human nature in general, have tended to fall into two broad camps, "nature" and "nurture." The "nature" approach holds that biological factors, such as genes and biochemical influences, control mental illness. The "nurture" approach emphasizes environmental factors such as family upbringing. Historically, psychiatry seems to swing back and forth between favoring one explanation or the other. The most famous "nurture" explanation, one that dominated American psychiatry after World War II, came from psychoanalysis, especially the Freudian school, which emphasized the importance of childhood sexual experiences. "There was no scientific evidence to support it," Torrey and Miller assert. Nowadays, "nature" theories attract more attention, especially with the purported success of psychiatric medications such as Prozac, and the studies that claim to link certain genes to specific mental illnesses.
    Torrey acknowledges that mental illness, like most illnesses, is influenced by genetic tendencies. Yet the genes are not overriding: Even genetically identical twins can markedly differ in their degree of mental health. Furthermore, as Torrey and Miller write in their book, "the most serious criticism of genetic theories of schizophrenia and manic-depressive illness . . . is what (the late British psychiatrist) Edward Hare labeled 'the persistence problem.' "From the middle of the 19th century until the middle of the 20th century, most individuals with schizophrenia and manic-depressive illness were confined to asylums for the majority of their reproductive years. Their rate of procreation was extraordinarily low, and so the transmission of their genes was infrequent. Yet during these same years, the prevalence of schizophrenia and manic-depressive illness increased rapidly." This, plus the fact that scientists have had great difficulty finding a specific genetic factor -- one that is consistently replicated in study after study -- "is a strong argument against these diseases being primarily genetic in origin."

Rates Increasing
What makes Torrey and Miller almost unique is that they are among the few scholars (Hare is another one) who have seriously argued that rates are increasing. In their book, Torrey and Miller cite medical records that show a five-fold rise in mental illness since the 18th century. By mental illness, they are referring to schizophrenia, severe manic depression and psychotic depression. They note that around 1750, the British author Samuel Johnson claimed that insanity was increasing. One chart in their book shows that between 1840 and 1955, the number of "mentally ill" in the United States soared from 2,561 to 558,922. During that same period, the U.S. rate of mental illness rose from 0. 15 case per 1,000 persons to 3.38 per 1,000.
    The best explanation for this trend, they argue, is biological. They suspect that an unknown infectious agent is responsible for the increase, and possibly other biological factors as well, such as "changes in diet and exposure to toxins." Growing population and urbanization allowed the infectious agent -- a virus or parasite -- to spread more rapidly in the densely populated cities, they suggest.
    But Torrey and Miller's argument contradicts older epidemiological studies that show schizophrenia is decreasing or stable. In 1990, the British medical journal The Lancet published the article "Is Schizophrenia Disappearing?" by Geoffrey Der of the Institute of Psychiatry in London and two colleagues. Their statistical analysis of patient data from England and Wales persuaded them that "there has been a substantial decrease, beginning in the mid-1960s, in the incidence of schizophrenia."

Changing Diagnoses
Critics accuse Torrey and Miller of sociological naivete. That's because they don't adequately take into account the ever-changing standards of psychiatric diagnosis. In other words, what one generation defines as "mental disturbance" may be defined differently by another generation. Their attempt to lump together mental illness rates from different centuries "seems akin to comparing apples and oranges," Dr. Kenneth S. Piver said in a review of their book for the June 26 Journal of the American Medical Association. There's a famous recent example of shifting psychiatric diagnoses: homosexuality. Until the 1970s, psychiatrists classified it as a mental disorder.

Historians Attacked
Torrey and Miller's book also attacks historians of psychiatry. Since the 1960s, historians have argued that many asylum builders were driven by nonmedical, even ignoble, motives. The most famous of these scholars is the late Michel Foucault, a French luminary who taught intermittently at UC Berkeley just before his death in 1984. According to Foucault and researchers inspired by him, in the 18th, 19th and 20th centuries many so-called "insane" people were really just iconoclasts of one sort or another -- harmless eccentrics, sexual deviants, troublesome elderly people and the politically unorthodox. By defining them as "insane" and locking them up, the authorities got rid of potential troublemakers.
    Torrey and Miller disagree. They cite historical accounts indicating that our ancestors were genuinely baffled by rising levels of insanity. It struck them as something very new and terrifying, as not being merely the latest fashion in iconoclasm. Judging by 19th century clinical descriptions of insane patients, they would probably be judged mentally ill nowadays, too, Torrey says.
    Torrey and Miller attack intellectuals, including Foucault, who they charge, "have claimed that insane asylums were built merely to put away troublesome people." These writers "got it completely wrong. The evidence we discuss in the book makes it clear that insane asylums were built in response to a perceived need to accommodate increasing numbers of insane persons."

Psychiatrist Says He Was Surprised by Furor
Erica Goode, New York Times- 8/5/2002

The center of controversy is not an unfamiliar spot for Dr. Paul R. McHugh, the psychiatrist whose appointment recently to the lay panel assembled by the Roman Catholic Church to look into sexual abuse by priests drew protest from victims' groups and some metal health professionals. His penchant for riling colleagues with his outspoken and often contrarian opinions on topics like multiple personality disorder and sex-change operations has often landed him in the midst of furor. But Dr. McHugh said he was surprised by the objections to his presence on the 12-member panel, which stemmed from his role in challenging accusations of childhood sexual abuse based on so-called recovered memories, because his views on the church scandal did not differ greatly from those of his critics.
    Dr. McHugh, 71, a professor at Johns Hopkins University who was the chairman of psychiatry there for 26 years, said that like the victims' groups he regarded the sexual molestation of minors by priests as "a major outbreak of child abuse among a privileged group of men, who were then protected in some way by suspicious administrative decisions. "I am appalled by the callousness with which this was approached" by church officials, he said.
    Dr. McHugh said that to his knowledge his involvement in the debate over recovered memories, one of the most freighted controversies in modern psychiatry, had nothing to do with his appointment. In any case, he added, the debate was not pertinent, because hardly any of the sexual abuse charges against priests involved such memories. "These are legitimate cases; they are not problematic cases; and they are scandalous cases," Dr. McHugh said.
    Msgr. Francis J. Maniscalco, a spokesman for the United States Conference of Catholic Bishops, said the bishops did not discuss Dr. McHugh's association with the recovered memory issue when they selected the panel's members. Like other panel members, Dr. McHugh, is a practicing Catholic. "If the question is, was he selected because of his association, that was not the case."
    The only factor considered by the bishops, Monsignor Maniscalco said, was Dr. McHugh's reputation as the chairman at Johns Hopkins. "He was appointed because of his distinguished career in psychiatry," he said, adding that the matter of recovered memories "never came up, I never heard it mentioned, so I would presume that this was something either not known or not considered relevant to the purposes of the board." Dan Mahoney, a spokesman for Gov. Frank Keating of Oklahoma, who is chairman of the panel, said the governor knew only of Dr. McHugh's academic credentials.
    But David Clohessy, the director of the Survivors Network of Those Abused by Priests, said it strained credulity to believe that Dr. McHugh's appointment had not been influenced by his stance on recovered memories, and that what Dr. McHugh said about the church scandal was irrelevant. "What matters is what he does," Mr. Clohessy said. "And he has testified in court repeatedly on behalf of molesters and accused molesters. I have yet to see him speak out in any way, shape or form on behalf of abuse victims."
    The choice of Dr. McHugh as the panel's lone mental health professional was disturbing, said Dr. Mary Gail Frawley-0'Dea, a psychologist and psychoanalyst in New York, because there were so many other experts available who specialized in treating victims of sexual abuse. "The whole problem with the church has been that as victims have come forward they have been dismissed in one way or the other," Dr. Frawley-O'Dea said. "To have someone on the board who has been in the business of ferreting out false claims is a terrible mistake."
    Dr: McHugh said his role on the panel was not to root out false accusations -- the panel will not review individual cases, he said -- but to offer his expertise and experience in psychiatry. His willingness to stand up for people falsely accused of sexual abuse, he said, should be viewed as an asset. "If the victims are serious about wanting people who are brave enough to confront the powers that would victimize them," he said, "then they should see that my record is a record of confronting power. And therefore, they shouldn't worry about me."
    In the early 1990's, Dr. McHugh was among those in psychiatry who argued that memories of sexual abuse recovered by adults were almost always false, a byproduct of poor practice by psychotherapists, who often elicited the memories through hypnosis or other techniques, failed to look for evidence corroborating the abuse and encouraged patients to press charges against the supposed abusers. He said that a proliferation in the 1990's of abuse charges brought by adults against parents or other relatives was the equivalent of the Salem witch trials. Dr. McHugh serves on the scientific advisory board of the False Memory Syndrome Foundation, an organization founded in 1992 by a Philadelphia couple, Peter and Pamela Freyd, as a resource for families facing such accusations. The couple's daughter had accused her father of sexually abusing her. Many therapists agree that recovered memories have sometimes proved false. But not always, they say. They say studies indicate that it is not uncommon for victims of sexual abuse to repress memory.
    Dr. McHugh says his quarrel is not with the notion that victims can forget traumatic events-- they can, he said -- but with therapists failure to make "a good-faith effort" to determine if the memories are true. Yet he added that in the few cases in which accusations of sexual abuse by priests were based on recovered memories, especially those recovered in psychotherapy, the authorities needed to investigate carefully. "If you discover that the content is wild," Dr. McHugh said, "like the person says the priest and they went to a Satanic cult, if you discover that the person has another serious mental illness that deranges them, and if you can't find any corroborating evidence of any sort, then those things should be weighed into account."
    Dr. McHugh is known among his colleagues in psychiatry as a man who does not run from a fight. He has challenged the Freudian psychoanalysts, whose dominance in psychiatry during much of the 20th century, he contends, held back scientific progress. He has argued with the gurus of psychiatric diagnosis, asserting that labels like "multiple personality disorder" describe conditions "that often seem to exist only in the minds of their champions." In essays in Commentary, The American Scholar and the Weekly Standard, he has dueled with Dr. Jack Kevorkian over assisted: suicide, railed against the over-diagnosis of post-traumatic stress disorder and challenged the legitimacy of sex- change operations. "We don't do liposuction on anorexics," he wrote in one essay. "Why amputate the genitals of these poor men? Surely the fault is in the mind, not the member."
    Born in Lowell, Mass., the son of a high school teacher and a housewife, Dr. McHugh describes himself as religiously orthodox, politically liberal (he is a Democrat) and culturally conservative -- a believer in marriage and the Marines, a supporter of institutions and family values. In his childhood, Dr. McHugh said, the priests at his church were respected, but not put on pedestals. "No one thought the priests walked on water," he said, "and if any of them had laid a hand an us, our brothers and fathers would have turned up at the rectory and taken them out." Dr. McHugh went to Harvard, receiving his undergraduate degree in 1952 and graduating from medical school in 1956. He then completed residencies in neurology and in psychiatry.
    Dr. McHugh said he first became aware of recovered memory when the parents of an anorexic girl came to him in the early 1990's Encouraged by therapists, the girl had accused her father of sexual abuse, Dr. McHugh said, and filed criminal charges against him. "I was horrified at the many psychiatric mistakes that had been made," he said. "I didn't go looking for a fight, it came to me." The daughter, he said, later retracted the accusations.
    Dr. McHugh has his fans. The writer Tom Wolfe, who sought treatment from Dr. McHugh when he became depressed after bypass surgery, dedicated his novel "A Man in Full" to him. His colleagues at Johns Hopkins say he turned around a faltering department and helped move psychiatry to a more scientific era. He is, they say, generous and intellectually demanding, sensitive to criticism but thoughtful about what he says, intolerant of ambiguity but also willing to change his mind. "If he thought he were in the way of the commission he would step down," said Dr. Raymond DePaulo, a resident when Dr. McHugh arrived at Johns Hopkins and now his successor as department chairman. "But I think he thinks he can be a lot of help. He's seen the victims. He's seen the perpetrators, and he will quickly tell you that there is no excuse for their behavior."
    But Dr. McHugh also has critics, some of whom describe him as arrogant and controlling. Some say that he has been consistently more sympathetic to abusers than to victims, and that he ignores details that contradict his arguments. Dr. David Spiegel, a professor of psychiatry at Stanford University, who has debated Dr. McHugh on the recovered memories issue, said: "I don't think he's very thorough in his review of the literature or in those aspects of the literature that don't support his point of view. He just relies upon his convictions."
    Dr. McHugh, though, said he approaches controversies with an open mind. "What I am looking for is a conversation he said, "a broad-ranging conversation In which all the doors are expected to be open. And if they're closed, we're going to open them."

Study: U.S. Child Abuse Deaths Underestimated
Charnicia E. Huggins, Reuters News Service- 8/6/2002

NEW YORK -- Many children's death certificates do not correctly list abuse, neglect or other forms of maltreatment as the cause of death, Colorado researchers report. Because of this child abuse deaths may be more common than current figures indicate, their study suggests. "Child abuse is underrecognized as a problem in the United States," Tessa Crume, an epidemiologist at the Colorado Department of Public Health and Environment, told Reuters Health. The current ways of assessing child abuse--analyzing data from death certificates--"are drastically underestimating it," she said. "I don't think death certificates are the place to assess child abuse," Crume added. "We look to death certificates, but we shouldn't."
    Crume and her colleagues compared data collected by a statewide child fatality review committee, including information from the coroner's office, social services, law enforcement and other vital records, with information on the death certificates of children who died in Colorado from January 1990 to December 1998. The children ranged in age from newborn to 16 years. Of the 295 deaths that the committee identified as maltreatment-related, only half were listed as such on the children's death certificates, Crume and her team report in the August online issue of Pediatrics.
    The researchers also found biases in how child abuse information was recorded on death certificates, the report indicates. For example, death certificates for black children and girls were more likely to have child abuse or neglect correctly listed as the cause of death than were death certificates for boys or for Hispanic or white children, study findings indicate. Further, maltreatment was 60% less likely to be recorded on the death certificates of children who died in rural areas as opposed to those who died in metropolitan areas. "These discrepancies in ascertainment raise concerns that professionals who investigate child deaths may be more likely to conclude that maltreatment was a contributing factor in the cause of death for children with certain sociodemographic characteristics," the authors write.
    Children who died from shaking, by blows from a blunt or sharp object, firearms or some other violent means were more likely to have their death recorded as maltreatment-related than those whose death was caused by neglect and abandonment, drowning or some other act of omission, the report indicates. What's more, although parents were most commonly responsible for the abuse or neglect, maltreatment was nearly nine times more likely to be recorded on a death certificate if the perpetrator was someone unrelated to the child, study findings indicate. This may be due to a number of factors including the hesitancy of law enforcement officials to consider grieving parents as potential abusers, the researchers note.
    In addition, "the same police officers who investigate child deaths are the same ones who investigate adult crime scenes," Crume said. Many investigators are not trained to recognize certain types of evidence that are different from what they would look to find in the case of an adult death, she explained. In light of the findings, rather than looking to death certificates, "the only way to assess child abuse fatality is to have a multidisciplinary child death review team," Crume said. The study was partially funded by a grant from the Centers for Disease Control and Prevention in Atlanta, Georgia.
    SOURCE: Pediatrics 2002;110:e18.

Study Shows 1 in 5 Gay Men Considers Suicide
Detroit Free Press, 8/8/2002

At least 1 in 5 gay and bisexual men has planned suicide, and 12 percent have tried to kill themselves. The study says suicidal plans and attempts were especially common among younger gay men who lack a support system of peers, said psychologist Jay Paul, study coauthor and an investigator at the University of California at San Francisco's Center for AIDS Prevention Studies. He and his colleagues reviewed the findings of a telephone survey of 2,881 gay and bisexual men in New York, Los Angeles, Chicago and San Francisco. Researchers did the survey from 1996 to 1998. The findings appear in this month's issue of the American Journal of Public Health. By contrast, according to the study researchers, 9 percent to 15 percent of heterosexual men make plans to commit suicide.

Drug Overdose at Florida Detox Center
Associated Press, 8/12/2002

ST. PETERSBURG, Fla. -- A patient at a drug treatment center died of an overdose of heroin that was smuggled into the facility by another resident, police said. Aaron Kononitz died Saturday, a day before he was to graduate from Operation PAR's residential drug treatment program in Largo.
    Initially, authorities said they believed the heroin was brought into the center by another resident. But after interviews with other residents, investigators determined that wasn't the case, said Pinellas County sheriff's spokeswoman Marianne Pasha. "What we're trying to do now is determine how the drug got into the facility and how it got into the hands of Mr. Kononitz," Pasha said Monday.
    Sometime late Friday night or early Saturday morning, Kononitz and two other residents hid in a storage room and used the drug, Pasha said. They were jailed Monday after admitting they violated probation by using the drug. The investigation was continuing, Pasha said. It was the first death in the 32 years of operation at the center. Kononitz, 28, of Tampa, was ordered there by a judge after a drug arrest, said Nancy Hamilton, the center's chief operating officer. Others are there voluntarily. Residents of the facility are allowed to come and go from the center during treatment, Hamilton said. She said clinic officials weren't responsible for the death. "The real culprit here is addiction," Hamilton said.

Seasonal Depression Can Accompany Summer Sun
Sara Ivry, New York Times- 8/13/2002

No one looks forward to spring more than people with seasonal affective disorder, who grow depressed in the waning light of winter. A smaller group of people, however, suffer on the opposite side of the calendar. Consider Violet Adair, a 39-yearold artist in Oakland, Calif., who gets ready for summer by filling plastic bottles with water. "I'll put them in my freezer and I'll sleep with them," she said "I'll sleep hugging a two-liter Pepsi bottle filled with ice."
    These makeshift cooling devices help her cope with the distress that has come upon her each summer for roughly a decade: This year, she is going a step further. Many of the rooms in Ms. Adair's loft are windowless, and she plans to paint the walls blue and aqua. She will hide out in these darkened chambers, equipped with a fan, avoiding the outdoors as much as possible until the nights again grow long.
    At least Ms. Adair knows that she has summer SAD, also as reverse seasonal affective disorder. About 5 percent of adult Americans are thought to have winter seasonal affective disorder; researchers estimate that fewer than 1 percent have its summer variant. Because it is a fairly esoteric condition whose origins are unknown, many people who become depressed in the summer may not realize they have SAD. They may simply think of their bouts. of depression as new events rather than parts of a pattern.
    "We've kind of de-seasonalized ourselves as much as possible," said Dr. Thomas Wehr, a research psychiatrist at the National Institute of Mental Health and an expert on seasonal affective disorder. "You know, we turn the lights on after. dark, we turn the heat on in winter, we turn the air-conditioning on in summer, and you could almost not notice. We tend to think more in a linear way rather than in a cyclic way."
    As with depression generally; more women than men appear to suffer from this condition at a ratio some estimates put as high as two to one. It is most common among women in their reproductive years, but its onset sometimes comes as early childhood. Researchers think it may also have a genetic component; more than two-thirds of patients with SAD have a relative with a major mood disorder.
    The symptoms of the two forms of the disorder often vary, heightening the confusion. People with the more common variety typically feel lethargic in the colder months, crave carbohydrates, gain weight and sleep excessively. Those afflicted during the summer often experience agitation, loss of appetite, insomnia and, in extreme cases, increased suicidal fantasies.
    The cause may differ, as well. Seasonal depression in the winter seems linked to increases in the production of melatonin, a chemical that helps set the brain's daily rhythm, set off by the decrease' in light. But "the seasonal trigger for the summer depression is less clear-cut," said Dr: Norman E. Rosenthal, a Washington psychiatrist and the author of "Winter Blues." "Conventionally, the thought has been that they are more sensitive to the heat. The question of whether it's too much heat or too much light has yet to be resolved."
    Reports of summer seasonal affective disorder are often more frequent in hotter regions. A study published in the journal Comprehensive Psychiatry two years ago found that the rate of summer SAD among a group of students in Dining, 200 miles north-west of Beijing, exceeded that of students with the winter disorder. Epidemiological data in the United States have shown a higher proportion of people in the South depressed in the summer. The proportion rises as the latitude diminishes.
    When moods deviate, Dr. Rosenthal said, the systems geared toward normalizing them generally take action. In seasonal affective disorder, The more common winter malady has another side he said, "The challenges encountered with changing seasons seem to overwhelm those internal regulating mechanisms."
    Dr. Rosenthal and Dr. Wehr first identified winter SAD in 1984. Their findings prompted queries from many people who said they also felt depression, but in the summer. To explore the summer disorder, Dr. Wehr manipulated patients' body temperatures. People with severe depression, he said, tend to have higher temperatures at night; among healthy people, temperatures tend to drop. Anti-depressants have been shown to lower brain and body temperature.
    Dr. Wehr tried to cool down patients with a kind of reverse thermal blanket, carefully making sure the environmental drop in temperature would not cause shivering as a defense against the cold. After the treatment was over, however, the patients walked out of the building into summer heat, their body temperatures rose, and the symptoms of their depression returned. The effect of re-entering a hot summer environment undid whatever effect the treatment might have had.
    Like Ms. Adair, many summer SAD patients have developed strategies for combating symptoms. Air conditioning seems to help some but not others, the doctors say. One man is meticulous about spending his time in air-conditioned environments, going from apartment to parking lot to office and back again. Another person takes frequent cold' showers. A woman reportedly swam daily in the English Channel where' the cold water gave her respite.
    For many, the only reliable defense against summer is pharmacological. A designer in Northern Californian her early 50's takes a combination of mood stabilizers and a small dose of antidepressants throughout the year. Before summer begins, she increases the dosage as needed in consultation with her doctor. She also is careful about staying inside, a frustrating challenge, she says, because she considers herself an outdoors person. She first suspected a seasonal link to her depression in her 30's and became more attuned to it after she learned that she had a bipolar disorder around age 40. She said that she thought that it was the light more than the heat that affected her and that she felt frantic and depressed as spring ended. "I actually feel kind of attacked by the sun," the designer said. "I feet like it's piercing into me, and I start to feel more and more desperate to escape it. I have a hard time organizing and managing daily life. By August, I'm barely able to function and don't really recover ' until autumn. "October is reliably a good month. I'm waking up, and I feel like I'm being released from my summer, what I would call, jail cell."

Research Indicates Zoloft Safe for Heart Patients
Associated Press, 8/13/2002

CHICAGO -- The popular antidepressant Zoloft appears to be safe and effective for heart attack patients, a company-sponsored study suggests. Researchers found Zoloft caused no more chest pain, heart rate abnormalities or irregular heartbeats than placebos. Zoloft patients even appeared to have fewer life-threatening events, such as recurrent heart attacks, heart failure and strokes, though those results were not statistically significant. The drug, as expected, reduced depression. Researchers said its effects on heart attack survivors had not been demonstrated before.
    Zoloft maker Pfizer Inc. helped fund the study, and a Pfizer employee was part of the study design and analysis. The results are in the Journal of the American Medical Association today. Older drugs known as tricyclic antidepressants have been linked with heart problems including arrhythmia and heart attacks, especially in high doses. Some tricyclicsare not recommended for patients with recent heart attacks. Enrollment in the latest study began in 1997, a year after the Food and Drug Administration warned Pfizer against marketing Zoloft for heart attack patients because of concerns it might cause chest pain and a rapid heartbeat.
    The findings are significant because about 20 percent of the more than 1 million Americans who have heart attacks each year will also experience major depression. Those who develop depression are nearly three times more likely to die prematurely than heart attack survivors who aren't depressed, said lead researcher Dr. Alexander Glassman of the New York State Psychiatric Institute. The study excluded severely medically ill patients and those for whom drugs like Zoloft are not recommended. Thus, the results cannot be generalized to all heart attack patients, an editorial by Drs. Robert Carney and Allan Jaffe said.