Autism Link to Vaccines Weakens
Peter Gorner, ChicagoTribune- 10/1/2003

A study of 467,000 children in Denmark found no link between widely used vaccines containing the preservative thimerosal and cases of autism, the Journal of the American Medical Association reported Tuesday. The study is the latest of several to cast doubts that thimerosal, which had been used in vaccines for 70 years and contains small amounts of ethylmercury, a heavy metal, could be responsible for an increase in the number of cases of autism, attention deficit-hyperactivity disorder, or speech delay in youngsters. Web sites and advocacy groups have demanded that research be conducted to determine if childhood vaccines are safe or have subjected generations of youngsters to mercury contamination.
    The number of reported cases of autism and its less severe forms increased from about 1 child in 2,000 before 1970 to as many as 1 child in 150 today, depending on various estimates. Reasons for the increase are unknown. It may reflect some environmental agent acting on the brains of genetically susceptible children or better diagnosis by physicians. But the rising incidence appeared to coincide with increased exposure of infants to thimersol that is used in such vaccines as for Homophiles influenzae, hepatitis B, diphtheria and tetanus.
    American infants receive up to 20 vaccines in the first two years of life. The first symptoms of autism--withdrawn behavior, failure to respond to surroundings, endless repetitions of movements or words--often show up in the same years that toddlers get most of their shots. Most experts have said the two events were coincidental. But three years ago, vaccinemakers, as a precaution, stopped using the preservative to prevent bacterial contamination of vaccines given to infants and small children.  In 2001, the Institute of Medicine of the National Academy of Sciences ruled there was a lack of evidence to prove or disprove any link between thimerosal and autism.
    The current study is the latest in a series from Denmark, the first country in the world to ban thimerosal. The Danish health system carefully monitors the health of its citizens over time. Anders Hviid and colleagues at the Statens Serum Institut in Copenhagen compared children born between 1990 and 1996 who were vaccinated with a thimerosal-containing pertussis vaccine and those who received the same vaccine formulated without the preservative. The risk of autism and other autistic-related disorders did not differ significantly between the two groups, the researchers said. They also found no relationship between autism and the amount of ethylmercury received through thimerosal.
    Among 467,000 children, the researchers identified 440 autism cases and 787 cases of other autistic-spectrum disorders. "The results do not support a causal relationship between childhood vaccination with thimerosal-containing vaccines and the development of autistic-spectrum disorders," they wrote. "The data presented here looks good. We have to take it in the context of other studies that have found the same thing," said Dr. Thomas Saari, a professor of pediatrics at the University of Wisconsin and a member of the American Academy of Pediatrics' committee on infectious disease.
    Many parents apparently are afraid that vaccines have harmed their children. Last year, fears about the measles, mumps and rubella (MMR) vaccine caused immunizations in Britain to drop to 84 percent, considerably below the rate that experts said was necessary to prevent the return of measles. Illinois public health officials said the rate of school vaccinations has remained steady at more than 95 percent.

Report Says 10% In D.C Addicted
Sewell Chan, Washington Post- 10/2/2003

About 60,000 District residents, more than one in 10, are addicted to illicit drugs or alcohol, and substance abuse costs the city $1.2 billion each year in lost productivity, illness, premature death and crime and incarceration, a study released yesterday by Mayor Anthony A. Williams has found.  The two-year study, which sought to measure the scope and effects of substance abuse, also found that half of all people arrested for violent crimes in Washington test positive for narcotics.
    A task force that Williams (D) convened in May 2001 announced two goals to achieve by 2010: reducing the number of addicts from 60,000 to 25,000 and cutting the total cost of substance abuse from $1.2 billion to $300 million. Officials billed the task force's study as a comprehensive, citywide substance abuse strategy and as the first-ever collaboration of 14 federal and city agencies, including D.C. Superior Court and the public schools, that deal with substance abuse and addiction.
    "This is truly a beginning," said James A. Buford, director of the D.C. Department of Health, who co-chaired the Interagency Task Force on Substance Abuse Prevention, Treatment and Control. But he cautioned: "We understand there are no quick fixes or overnight solutions." The other co-chairman, Police Chief Charles H. Ramsey, said, "For too long, people have treated drug abuse as only a crime problem, when it's both a public health and a crime problem."
    Much of the task force's work was in response to a survey commissioned by the Health Department in December 2000 and completed in September 2001. The survey of 1,535 households, which cost about $500,000, found that more than 9 percent of residents reported a drug or alcohol addiction, compared with an estimated national rate of 4.7 percent in 1999.
    The panel concluded that funding for drug-related programs is spread across many agencies. Although an estimated $356.1 million was spent on such programs in the fiscal year that ended Tuesday, only $53.3 million funded programs whose primary focus is on treatment, and of the smaller sum, only $34.5 million went to the direct provision of drug treatment.
    The task force also set four broad goals, but they largely comprise recommendations that the city is already trying to follow. For example, the third goal, reducing drug-related crime, includes closing open-air drug markets, expanding the use of "drug courts" for parents to keep their families together, and helping former prison inmates as they return to mainstream society. The other goals are to reduce the prevalence and incidence of drug use, to cut by more than half the number of addicts and to cooperate with federal and suburban officials on a regional response to substance abuse.
    Officials acknowledged that because the city assists only an estimated 14 percent of all addicts, much is unknown about the habits and demographic profile of the remainder. "We can't answer a lot of questions about the profile of people we aren't seeing today," said William H. Steward, interim chief of the Addiction Prevention and Recovery Administration, the branch of the Health Department that has the main responsibility for providing drug treatment.
    Advocates have criticized the addiction agency for its decision to close Karrick Hall, the city's inpatient drug rehabilitation facility. The agency's budget has been cut by about $3 million this year. Addicts seeking treatment face long waiting lists at the agency's central intake division at 1300 First St. NE and at its detoxification unit on the former campus of D.C. General Hospital in Southeast Washington. There is a shortage of long-term residential treatment spaces, officials acknowledge, and those seeking access often encounter bureaucratic obstacles. "Treatment beds lie empty, while people who want to get clean and sober are turned away from central intake and detox," said Robert H. Fleming, a community organizer who chairs an informal coalition of drug-treatment groups. "Right now, the best way to get into treatment is to commit a felony while under the influence of drugs and alcohol."

Steep Rise in Abuse of Legal Drugs
Alexandra Marks, Christian Science Monitor- 10/4/2003

NEW YORK  —  An estimated 9 million people use prescription drugs for non-medical purposes. One key factor: the Internet. Log onto e-mail anytime, and you can find one explanation for the recent dramatic and deadly spike in the abuse of prescription drugs. "Get ANY D-R-U-G-S You NEED!!" declares a piece of spam that was sent on a recent morning. "OUR U.S. Doctors will Write YOU a Prescription You will get it NEXT-DAY via Fed-Ex!!"
    It is simple and anonymous, and has helped lead to what experts are calling a national epidemic of abuse of everything from painkillers to sedatives to stimulants. Between 1995 and 2002, there was a 163 percent increase in the number of emergency-room visits tied to the abuse of prescription drugs, according to the Substance Abuse and Mental Health Services Agency.
    SAMHSA estimates 9 million people now abuse prescription drugs, meaning they use them for non-medical, and often recreational, purposes. Three million abusers are kids between the ages of 12 and 17 years old. And the abuse can be deadly: Prescription drugs now play a factor in a quarter of all overdose deaths reported in the United States. U.S. drug officials say this represents a dramatic surge — one that took them by surprise. It has presented a whole new set of challenges, such as a lack of law-enforcement resources to track down shadowy Internet sites and unethical doctors and pharmacists.
    Another key issue: finding a way to balance any law-enforcement measures with the needs of legitimate online pharmacies that have helped the elderly and others save money and time.

Fighting with Knowledge
Federal officials have decided one way to combat the problem is with education. SAMHSA and the Food and Drug Administration have launched a national campaign to warn people that the misuse of prescription drugs is dangerous, as well as illegal. "There's an assumption that these are legal, so they're OK — that they can use them and walk away without any consequences," says H. Westley Clark, director of SAMHSA's Center for Substance Abuse Treatment (CSAT). "They don't seem to realize that this misuse can lead to serious problems with addiction."
    A complex array of factors has led to the spike in abuse of prescription drugs. There's the overall increase in the legitimate use of prescription drugs as a society. For instance, since 1995, the number of Ritalin prescriptions written by doctors has quadrupled. During that same time, the stimulant became a favorite recreational drug among teens. The number of OxyContin prescriptions written between 1996 and 2000 increased 20-fold. One theory contends that the increase in HIV and hepatitis C has prompted some illegal substance abusers to switch to prescription drugs like OxyContin, which can have an effect similar to heroin.

The Internet Factor
Since 1999, online pharmacies — legitimate and otherwise — have mushroomed, giving kids and addicts alike what appears to be easy access to the drug of their choice. "Certainly the Internet has facilitated the average person obtaining controlled substances when they would not have done so," says Elizabeth Willis, chief of drug operations in the Drug Enforcement Administration's Office of Diversion Control. "Most people wouldn't go into their doctor and falsify medical complaints to their doctors, but over the Internet, they don't realize it's illegal, and they can do it anonymously."
    Government investigators can only estimate how many online pharmacies exist, in part because the illegitimate ones appear and disappear quickly. The first ones started appearing in abundance in 1999. An investigation done by the General Accounting Office in 2000 found 190 Internet pharmacies operating at the time. Of those, 79 provided drugs without a proper prescription.
    It's estimated there are now hundreds of such cyber-pharmacies operating from the United States and overseas. Like almost every kind of commerce on the Internet, they've proven to be very difficult to regulate and, for those operating illegally, to prosecute. In part, that's because no one agency has direct control. The FDA, which regulates medicines, has sent out letters warning some sites they may be acting illegally. But it doesn't have criminal enforcement capabilities.
    The Federal Trade Commission, which regulates fraudulent claims, can investigate what are known as "cyber-script mills" and file civil suits, but again, its hands are tied when it comes to criminal complaints. Even the DEA is operating with limited resources and capabilities. Of the 4,000 drug agents operating in the field, less than 10 percent are dedicated to tracking the misuse of prescription drugs, which in the agency is called drug diversion. Most of their efforts are dedicated to tracking down what are called the bricks and mortar — the doctors and pharmacists who appear to be over-prescribing or handing out controlled substances at will.

Clear Lines of Authority Missing
The Internet investigations are intermixed with those cases, and don't have a single unit or investigator dedicated to them. What's more complicated is that these diversion agents have no arrest authority: They have to call on other departments within the DEA.
    In 2002, the inspector general of the Justice Department criticized the DEA for not dedicating enough resources to drug diversion. That concern is echoed by experts in the field. "Very little is being done on the Internet situation," says Michael Montagne, a professor of social pharmacy at the Massachusetts College of Pharmacy and Health Science. "The DEA tries to monitor it, but they're just capturing a fraction of what's coming in over the board."
    The DEA currently has several cases pending against cyber-pharmacies, but can't talk about them. It's also been involved in several successful prosecutions, including one known as the Pill Box Pharmacy case. That was a pharmacy in San Antonio, Texas, that opened a Web site and began prescribing controlled substances after a two- to three-minute telephone interview with a doctor. In the 18 months it operated, it sold 9.3 million doses of the generic versions of Valium and the pain reliever Vicodin.

Troops Get Mandatory Postwar Counseling
Associated Press, 10/6/2003

FORT STEWART, Ga.— For U.S. soldiers who fought in Iraq, the war isn't necesarily over once they come home. Memories can linger, so the Army is trying to help troops cope with the aftermath by having them undergo mandatory counseling upon their return.
    Army Sgt. Joe Dombrowski did not see the worst of the war, but he witnessed some pretty bad stuff: the sound of enemy artillery as his unit crossed the Tigris River; the bloodstains on a Humvee after one of his commanders was killed; the soldier who survived a grenade blast that blackened even the whites of his eyes. Now, when the latest news from Iraq comes on his big-screen TV back home, Dombrowski looks away. "I listen to it, but I don't want to see it again," says Dombrowski, 31, who recently returned from Iraq. "Some of that stuff I want to push away, and I don't want to talk about it." Dombrowski is still working through his feelings, just as many of his comrades are doing.
    All 16,500 soldiers from Fort Stewart's 3rd Infantry who fought in Iraq have undergone mandatory counseling to deal with their feelings about the war and the return home. One of the most surprising things is how many soldiers have set aside the military machismo of the past and sought additional help, attending optional counseling sessions offered by the Army.
    "The soldiers and battalion commanders are asking for this `How can I talk to my wife?'" says Susan Wilder, a soldier's wife and head of Army Community Services counseling programs at Fort Stewart. "We couldn't even get in the door hardly after Desert Storm. The soldiers were like, `We're big, tough guys. We don't need that.'"
    The Army beefed up its postwar counseling programs after three soldiers from commando units at Fort Bragg, N.C., were accused of killing their wives in the summer of 2002 after returning from fighting in Afghanistan. "There were certain indicators there that we need to do better," says Lt. Col. Frank Emery, a Pentagon branch chief who oversees the postwar counseling program. "Our goal was to get them back to the way their lives were before the individuals deployed and reduce the stress, the anxiety."
    Before returning from the Persian Gulf, the 3rd Infantry soldiers had mandatory sessions with their chaplains to discuss readjustment to civilian life, alcohol problems and suicide prevention. Their spouses back home attended meetings on what to expect from returning troops fatigue, unwillingness to discuss the war, perhaps sexual dysfunction. Mandatory counseling continued once the soldiers came home. They underwent physical and psychological evaluations, attended training on how to handle postwar changes in their marriages and classes on drunken driving and even swimming and boating safety. "Safety, safety, safety anything that has to do with safety you can possibly think of," says Dombrowski, who joined the Army 13 years ago. "The Army does real good. They really take care of us."
    The 3rd Infantry, which led the assault on Baghdad, saw 21 straight days of combat during the war. Wilder says the close-in fighting, some of the heaviest U.S. troops have seen since Vietnam, has made some soldiers realize a need to talk. She says a battalion commander at one of her group sessions broke down in tears. "For his people, he set the precedent that it's OK not to be that ironclad man all the time," she says.
    Chaplain Timothy Sowers says he definitely notices a change in Fort Stewart soldiers since they returned from war, sometimes just by driving through the post's front gate. "You can see it, it can just be how soldiers drive down the street, not as courteous. A little more aggressive. People cutting others off," says Sowers, the post's family-life chaplain. Fort Stewart plans to offer new courses on anger management and stress management through the holidays. Chaplains are also planning soldier-spouse retreats that combine counseling sessions with a romantic getaway. "Probably the trickiest thing for families right now is getting reacquainted with each other," Sowers says. "You can talk to any soldiers and they'll tell you they're not quite as patient anymore and they can get quite easily frustrated or upset due to the deployment."
    Soldiers and their spouses are also seeking help off-post in neighboring Hinesville. At the Fraser Center, which provides private counseling, almost 95 percent of current patients are from military families, says Dr. Alan Baroody, executive director. He says his 10 therapists are booked solid. The center recently had one of its largest classes ever for children coping with divorce and most of them came from military households. "We're seeing a lot of divorces, separations, the toll some infidelity has taken on families throughout the long deployment," Baroody says. "It's tragic."
    Hinesville police saw reports of domestic disputes jump in August, when most of the 3rd Infantry had returned. Police responded to 76 such calls in August 43 percent higher than any other month this year. But police Capt. Johnetta Reid says the increase does not appear related to soldiers.
    It has been more than two months since Dombrowski came home to his wife, Michelle, and their two young daughters. They say their reunion has been smooth. He has not sought counseling outside of what the Army has required, and says many soldiers saw worse things than he did. When her husband talks about Iraq, Michelle Dombrowski listens hard. She usually refrains from asking him questions. "I just saw his pictures about a week and a half ago, and he's been back since July," she says. "And there's 20 questions going through my head that you want to ask, but you don't."

Police Learn New Methods for Handling Mentally Ill
Ellen Barry, Boston Globe- 10/6/2003

Faced with a young man holding a gun to his own head and yelling "Shoot me," police in Bridgewater last month used a crisis negotiator and three beanbags fired from a shotgun to soothe, and then stun, Michael Mendes into surrendering what turned out to be a BB gun. Across the country, police departments are adding new technology and training to prepare their officers for encounters with people with mental illness. Some police departments, like Bridgewater's, train officers to use nonlethal "de-escalation" methods when encountering mentally ill people in crisis, but many have no such training.
    A bill sponsored by Senator Cynthia Stone Creem of Newton, which is now before the Senate Ways and Means Committee, would require all Massachusetts police recruits to complete coursework in mental illnesses and strategies for handling interactions with mentally ill people. The bill also includes training in finding treatment options as an alternative to prosecution. "We could avoid some terrible things if we had it as a mandatory requirement," Creem said. "Other states have done this. It's hard to say why it isn't being done in Massachusetts."
    Here are some of the most common measures police use to avoid using lethal force on subjects who are suicidal or mentally ill:
*Beanbags: Fired from ordinary shotguns, beanbag rounds contain a load of shot encased in fabric. The shots are painful and carry enough force to knock a person down. In Mendes's case, the first shot stunned him so that he fled the yard, with police in pursuit. After two other blows, he surrendered.
*"Flash-bangs": These distraction devices produce a brilliant flash and loud sound that can disorient a subject long enough for police to disarm or overcome him or her.
*Dogs: Police dogs can be frightening or surprising, or they can simply give subjects an excuse to drop their weapons. Most people who attempt "suicide by cop" are ambivalent or unable to kill themselves. "Dogs are . . . enough of a show of force that they can surrender," said Sergeant Christopher Delmonte of the Bridgewater Police.
*Tasers: Some departments have used Taser guns, which carry a shock similar to that of a household outlet, to stun or paralyze people. They can be used from a distance of 12 to 18 feet.
*Negotiation: When police encounter a suicidal subject, the first seconds of the interaction "drives the whole scenario from then out," Delmonte said. When called to the scene, crisis negotiator Officer Edward Querzoli had the advantage of knowing Mendes's background, and succeeded in calming, not agitating, him.

Rapid Exposure to Fear May Work Best in Recovery
Lee Bowman, Scripps Howard News Service- 10/6/2003

Fear is one of the most basic responses -- and one of the hardest things for the rational mind to overcome. Behavioral therapists are working with thousands of anxious patients to extinguish fear brought on by various stimuli, from dogs barking to the smell of gasoline.  Typically, at least part of the therapy is to expose the patient to the things they fear, but in gradual, small doses. For instance, someone who developed a fear of dogs after being bitten is introduced in once-a-week sessions to friendly, gentle dogs as a way to relearn that most dogs are safe.
    A new study done on rodents at the University of California-Los Angeles suggests that "massing" the feared stimulus -- exposing patients to the fear trigger repeatedly with few breaks in between -- may be more effective than short exposures over a long period of time. "Our findings are already inspiring a search for a similar pattern of response in human anxiety patients," said Dr. Mark Barad, co-author of the study along with postdoctoral students Christopher Cain and Ashley Blouin. "It's part of a recent wave of important discoveries about fear extinction, findings that will transform both the practice of behavior therapy and the use of drugs as an adjunct to psychotherapy in the next few years." The research was published yesterday in the October issue of the Journal of Experimental Psychology: Animal Behavior Processes.
    The researchers taught mice (usually eight at a time) to fear harmless white noise by associating it with a mild, but still painful, shock administered through the floor of an experimental cage. After being shocked a couple of times, the mice "froze" in a fear response for about 72 seconds of a two-minute burst of white noise, although no more shocks were given. The white noise became a "conditioned stimulus" that was sufficiently associated with pain to cause fear all by itself. Then, the scientists measured how well the mice overcame their aversion to the white noise without shocks. They found that the mice lost their fear of the noise best when they were exposed to the noise over and over with only short gaps of silence in-between. "Therapists may wish to incorporate some massing of anxiety-inducing stimuli into exposure therapy sessions to more quickly reduce aversion to therapy," the researchers concluded.

Epilepsy Drugs May Curb Obesity
Rob Stein, Washington Post- 10/7/2003

Soon after a new epilepsy drug hit the market in 1996, doctors noticed something unexpected: Patients using the anti-seizure medication suddenly began losing weight -- rapidly.  That chance observation has led to tantalizing new insights into the underlying reasons why some people overeat and have such a hard time shedding pounds, and the provocative question of whether food can be an "addiction."
    When obesity specialists heard about the drug's side effect, some decided to try it for their patients. It seemed to work for many who had failed to lose weight by dieting, exercise or taking other drugs. And recent studies designed specifically to test the epilepsy drug as a weight-loss aid have found that it helps people, especially those prone to binge eating, to lose -- and keep off -- significant amounts of weight.
    Perhaps more importantly, the drug, called Topamax, has led scientists to explore what could be a new approach for controlling appetite and other cravings. The drug, along with another anti-seizure medication, an antidepressant and an experimental compound that blocks the "munchies" produced by marijuana, appears to help some people control obsessive behaviors, including overeating, smoking and alcohol abuse.
    Although the drugs work in different ways, they affect the parts of the brain involved in pleasure sensations. All of them may work by tamping down uncontrolled electrical firings of nerve cells that lead to compulsive eating, drinking or smoking in the same way that blocking uncontrolled electrical firing in the brain prevents seizures.   "It could be that the drive to eat in the higher levels of the brain is an electrical event that keeps recurring," said Lewis J. Aronne, director of the Comprehensive Weight Loss Center at the Weill Medical College of Cornell University in New York. "You think about food and go to the refrigerator. You want it to go away, but it comes back. That persistent thinking about eating is, like alcoholism, a neurological event that won't go away -- like a seizure. Could it be that Topamax quells that and allows you to turn it off? That's one way it could work."
    Addiction and obesity experts stress that both problems are extremely complex and in all likelihood have multiple environmental and biological causes. But many experts agree that they appear to have certain intriguing similarities.  "What characterizes addiction is the compulsion: A person may consciously not want to take it anymore, but the drive is so intense the person takes it anyway," said Nora Volkow, director of the National Institute on Drug Abuse. "That's what we see with cocaine and heroin. What's interesting is that in pathological overeating, you see the same syndrome -- a compulsion to eat an enormous amount of food."
    The apparent effectiveness of these drugs to treat compulsive behavior for weight loss supports an emerging theory that becoming overweight or obese is, in many cases, a two-stage process: People start to gain weight because they live in an environment where high-calorie, high-fat food is plentiful and exercise is rare. But once they have put on an extra 20 or 30 pounds, their bodies and their brains get caught in a vicious cycle in which more weight gain becomes increasingly easy and weight loss is increasingly difficult.
    "People still think that weight is just a matter of behavior -- if you would only push yourself away from the table it would be okay," said Aronne, vice president of the North American Association for the Study of Obesity. "But there are messages coming from your body once you gain weight that try to keep the status quo. So when you cut back on your food intake, your body is trying to stop you. It's tougher than it looks."
    When his weight neared 300 pounds, Richard Davis knew he had to do something. But nothing worked: not the diets, not the exercise, not the drugs. His doctor finally referred him to Aronne, who suggested he try Topamax, known generically as topiramate.  "I started losing weight almost immediately," said Davis, 58, of Brooklyn, N.Y. He dropped 70 pounds in about eight months on the new drug and has kept the weight off for more than a year. "I used to be a binge eater who would eat enormous amounts of food even when I wasn't hungry. Now I just eat regular amounts when I'm hungry. To me, it's a miracle."
    Aronne said other obesity experts caution that the search for weight loss drugs has long been marked by false hopes and shattering disappointments, and more testing is needed to fully evaluate the drug's usefulness.  Still, Aronne says, "This is the kind of drug that could be a breakthrough. I don't want to make it sound like a miracle cure, but it could turn out to be very helpful."
    The new insights come as public health experts have become increasingly alarmed by the rising number of Americans who are overweight or obese. About 65 percent of U.S. adults are overweight, and about a third are obese.  The obesity epidemic has triggered a flurry of research, yielding fundamental new understanding of how the body regulates weight, hunger and appetite. That, in turn, has led to at least a half-dozen experimental compounds that show promise as long-sought safe and effective appetite suppressants.  The two epilepsy drugs and the experimental compound based on marijuana's effects, in particular, have progressed to advanced testing, and they are providing intriguing clues.
    "I'm a psychiatrist, and I deal a lot with people who are obese and people who have mood and eating disorders," said Susan L. McElroy, a professor of psychiatry at the University of Cincinnati who has studied both epilepsy drugs. "I'm certainly not saying that everyone who is obese has a mental illness. But there's clearly a link between obesity, eating disregulation and mood disregulation that needs to be more fully explored."
    Topamax, made by Ortho-McNeil Pharmaceutical Inc., has helped obese people lose as much as 10 percent of their body weight, according to a study published in the June 6 issue of the journal Obesity Research. Unlike other drugs, it appears to continue to work for extended periods, enabling people to keep the weight off.
    The drug causes side effects in some people, including a tingling in the hands and feet, memory problems and difficulty thinking. As a result, it has earned the nickname "dopamax." But Topamax has been used for so long on so many epilepsy patients that experts consider it generally safe. Lower doses and different formulations may minimize or eliminate the side effects.  Researchers say it is not clear whether patients would have to use the drug indefinitely. For epilepsy, it sells for about $1.70 for a 25-mg pill, but is it not known what it would cost if marketed for obesity.
    The second epilepsy drug, zonisamide, which Elan Biopharmaceuticals sells as Zonegran, produced similar weight loss in obese adults in a study published April 9 in the Journal of the American Medical Association. The only side effect appears to be relatively minor fatigue. There is also some evidence it may help people quit smoking and drinking.
    Along with apparently reducing uncontrolled electrical firings in the brain, both drugs seem to affect chemical signals involved in pleasure -- serotonin and dopamine.  "Many of these neurotransmitters that regulate and modulate appetite signals and satiety signals are also involved in modulating many different things, such as depression and mood," said Kishore M. Gadde, a professor of psychiatry at the Duke University Medical Center in Durham, N.C., who led the Zonegran weight loss study.
    The experimental compound, called rimonabant, is very different. It has no anti-seizure effects, but it blocks one of the signals that marijuana triggers in a part of the brain involved in increasing appetite -- producing intense hunger. Studies have shown that rimonabant significantly reduces appetite, and it is undergoing a final round of testing involving several thousand people in the United States and Europe. Like Topamax, it also shows promise in helping people quit smoking and drinking. The only side effects have been minor digestive problems.
    Gadde noted that one of the new antidepressants, Wellbutrin, is also sold as Zyban to help people quit smoking, and it, too, appears to help some people lose weight.  Researchers are studying all these drugs in the hope of confirming their effectiveness and learning more about how the brain regulates food intake. Neither Topamax nor Zonegran has formally been approved as a weight-loss aid, but doctors are free to prescribe them to overweight patients frustrated by the lack of effective alternatives.
    Once he started taking Topamax, Davis said, he suddenly found he could control the urge to eat.  "Before, I would sit down and eat a quart of ice cream and a pizza. I was constantly eating throughout the day. I just couldn't stop thinking about it. I was obsessed with food," said Davis, a retired teacher. "Now, I look at it entirely differently. There's no question that I still enjoy food and going out for a good meal. But now I'll look for the least fattening food when I go out to a restaurant. And I can stop eating whenever I want."

Court Weighs Rights of Recovering Addicts
Gina Holland, Associated Press- 10/8/2003

WASHINGTON - The Supreme Court on Wednesday wrestled with the workplace rights of recovering drug addicts and alcoholics in a case with implications for thousands of employers and more than 5 million workers with substance abuse problems.  The justices are considering whether an Arizona missile plant worker who lost his job after testing positive for drugs deserved to be rehired after getting sober.
    In one of the most closely watched business cases of the term that began this week, the case of Joel Hernandez requires the court to clarify protections for workers under the landmark Americans With Disabilities Act.  The law specifically protects people who are clean after being treated for their addiction, but allows companies to discipline those who use substances on the job.
    At issue is Hughes Missile Systems' treatment of the 25-year employee, who was tested for drugs when he came to work one day in 1991 and reeked of alcohol. Hernandez quit when the test showed he had used cocaine. More than two years later, after completing drug and alcohol treatment, he was rebuffed when he tried to get rehired.   The company had an unwritten policy against rehiring workers who broke rules.   "Thousands of employers have precisely this rule," said the company's lawyer, Carter Phillips.
    The Bush administration argued that Hughes, now owned by Raytheon Co., and other companies should be allowed to permanently bar workers for misconduct such as showing up on the job while high on drugs or alcohol.  Hernandez's lawyer, Stephen Montoya of Phoenix, said his client has embraced religion and overcome drugs and alcohol. His recovery should trump Hughes' policy of never rehiring a rule-breaker, Montoya told the justices.  Hernandez, who said he earns much less now as a maintenance supervisor at a shopping center, attended the arguments.  "After considerable rehab, I turned my life around and went back to apply for a job that I qualified for," he said afterward. "I was trying to re-establish myself."
    The Supreme Court has never sided with an employee or former employee in cases testing the reach of the ADA in the workplace. At least two justices, Sandra Day O'Connor and Ruth Bader Ginsburg, questioned whether the Hernandez case was in the right posture for a Supreme Court ruling.  The court has several options: dismiss the case, overturn an appeals court ruling in favor of Hernandez without ruling on the merits, or address the issue and give Hernandez a chance to continue his case in lower courts.
    The 9th U.S. Circuit Court of Appeals in San Francisco, considered the most liberal appeals court in the country, ruled that a jury should decide if Hernandez was a discrimination victim under the 1990 disabilities law.  Groups such as the Betty Ford Center and National Council on Alcoholism and Drug Dependence filed briefs supporting Hernandez, arguing that most families have experience with addiction and that millions of people have overcome it.
    The court itself has some experience with that as well.  Chief Justice William H. Rehnquist developed a dependence on a prescription sedative and was in a detoxification program directed by a neurosurgeon at George Washington University Hospital, according to a 1982 report in Science magazine. Rehnquist, who has long battled chronic back pain, was hospitalized after suffering a withdrawal reaction in late 1981.
    The Supreme Court was told that 5.6 million workers have symptoms of drug addiction and nearly 16 million people illegally use drugs.  Two of the nine justices decided not to participate in the case - Stephen Breyer and David H. Souter. Neither gave a reason. Justices commonly decline to take part in cases in which they have financial or personal interests.  The case is Raytheon Co. v. Hernandez, 02-749.
    On the Net:  Supreme Court: http://www.supremecourtus.gov



Teen Sniper Suspect to Argue Insanity
Associated Press, 10/9/2003

FAIRFAX, Va. — Lee Boyd Malvo's lawyers said Thursday they will mount an insanity defense at his murder trial in the Washington sniper case, arguing that the teenager was a victim of "indoctrination" by the older John Allen Muhammad. Defense attorney Craig Cooley said the basis for the insanity defense comes from mental health experts not appointed by the court. "This case is so bizarre in its facts, and the degree of indoctrination is so severe, that we would be remiss if we failed" to put the sanity issue before a jury, Cooley said. Cooley said that indoctrination is a form of mental illness and that it will ultimately be up to a jury to decide if it amounts to insanity.
    A court-appointed psychiatrist has met with Malvo more than a dozen times, and the prosecutor in the case, Fairfax County Commonwealth Attorney's Robert F. Horan Jr., said Thursday there is nothing in that expert's report that points to insanity. "It says absolutely nothing about insanity," Horan said. "Apparently it's a late-blooming insanity."
    Malvo, 18, is set to go on trial Nov. 10 in the slaying of FBI analyst Linda Franklin outside a Home Depot store. She was among 13 people who were shot, 10 fatally, during a three-week spree in the Washington, D.C., are last fall. Muhammad, 42, goes on trial Tuesday in the slaying of man who was pumping gas near Manassas. Both trials were moved 200 miles to southeastern Virginia.
    Muhammad's lawyers have argued that Malvo was the triggerman, while Malvo's defense team has contended that the teenager was acting under the influence of the older man. Both defendants could be sentenced to death if convicted. Along with the 13 shootings in Maryland, Virginia, and Washington, D.C., the two are suspected in or charged with shootings in Georgia, Alabama, Louisiana, Arizona and Washington state.



Heroin Influx Spurs N.E. Drug Epidemic
Thanassis Cambanis, Boston Globe- 10/9/2003

Heroin dealers who target children as young as 12 with free samples and drug packets decorated with cartoon characters have spawned an epidemic of illicit heroin use in Massachusetts and New England, which now has the highest rate of illegal drug use among teenagers in the nation. "The extent of the problem has snuck up on us," Governor Mitt Romney said yesterday at a meeting in Faneuil Hall with the region's governors and White House drug czar John Walters. "The war on drugs hasn't been won."
    The six New England states, taken together, have the highest rate of illegal drug use of any region in the country, according to the latest survey by the White House Office of National Drug Control Policy. Massachusetts has the highest drug use rate among the New England states, the survey found. More than half of admissions for drug treatment programs in the Commonwealth are for heroin addiction, which is three times the national average, Romney said. In the last three years, Massachusetts heroin deaths have increased 76 percent, Romney said. Emergency room visits in Massachusetts due to heroin use have increased 60 percent every year since 1998, according to Janice F. Kauffman, a nurse and assistant professor of psychiatry at Harvard Medical School.
    Last month, a former Westford high school teacher was indicted on charges of selling heroin to her teenage students and helping them shoot up in her apartment. In another highly publicized case in Connecticut, State Police arrested a dealer with 300 bags of heroin less than 1,500 feet from an elementary school.
    Extremely pure and cheap Colombian heroin, imported directly to Boston, has fueled the regional epidemic, which Romney and Boston Mayor Thomas M. Menino described as a destabilizing public health and social crisis. Dealers give children two bags of free heroin for every eight they sell in an effort to get them hooked, Menino said. Colombian cocaine cartels, which started showering the Massachusetts market with cheap heroin in the late 1990s, have employed sophisticated marketing tools to target young users, including brightly colored envelopes and brand logos like Batman, cartoon frogs, dynamite, and the Playboy bunny. "At $4 a bag, heroin is cheaper than cigarettes," Menino said.
    According to the most recent National Survey on Drug Use and Health, done in 2000, 6 percent of Massachusetts residents ages 12 to 17 reported illicit drug dependence or abuse, the highest in New England, compared with 5.6 percent nationally. Within the New England states overall, 4.1 percent of children ages 12 to 17 were addicted to drugs, compared with 3.2 percent nationwide.
    Walters said that drug testing in schools could provide "a silver bullet" to identify young drug users early and direct them toward treatment. "Testing must be confidential," Walters said. "It must be used to help, not to punish." School-based drug testing is not illegal, but few states and communities have adopted it, even though $2 million in federal funding is available. Romney said he had not yet formed an opinion on the issue.
    Karen Tandy, administrator of the US Drug Enforcement Administration, said drug traffickers have found ways to transport heroin directly from Colombia and Mexico to Boston, bypassing the traditional entry point of New York City. "You might as well be sitting on the border of Colombia in this Northeast region," Tandy said. A bag of heroin, which a decade ago cost $40, currently retails on the street for $4. And the drug is now so pure that users can snort it, increasing its appeal for people who once avoided heroin because of the stigma associated with injecting the drug. "Purity has enabled people to shake the back-alley stigma of injecting heroin," Tandy said. In New Bedford, street heroin has reached 90 percent purity, as compared with an average purity nationwide of 57 percent, according to the DEA.
    Boston police have seen an upswing of people injecting heroin, Commissioner Paul Evans said. "Heroin has surpassed cocaine as the drug of choice," he said. Drug deaths in Boston, mostly from heroin, jumped 76 percent from 1998 to 2001, with the greatest number of victims in South Boston and the South End, according to the city's most recent health report. Overdoses and drug-related suicides claimed 88 lives that year.
    At yesterday's meeting, Walters reiterated the White House's goal to increase spending for drug treatment programs by $200 million a year, while Romney vowed to bolster the state's drug addiction programs, which in the last two years have been hurt by budget cuts.
    Last year, 67,414 people were admitted to drug or alcohol treatment programs in the state, down from 75,436 in 2001. Treatment for heroin addiction accounted for more than half the admissions, 35,739. In 2001, there were 687 federal drug arrests in Massachusetts and 16,528 drug arrests on state charges. So far this year, the DEA has prosecuted 50 heroin cases in Boston, compared with 40 during all of last year. Only Connecticut, among the New England states, had a similar number of drug arrests.
    Although medical professionals and law enforcement officers have seen indications of swelling heroin use in the region for years, the extent of drug use has taken New England political leaders by surprise, they admitted at yesterday's meeting. "I think we've been missing the boat in some ways," Romney said yesterday.
    Connecticut Governor John G. Rowland, once a strong proponent of targeting drug dealers, blasted a government approach that has ignored prevention and treatment. "We're facing a crisis situation that requires our leaders to have a sense of urgency," Rowland said. "It has to have the same sense of urgency as the war in Iraq, stopping smoking in the workplace, and putting on seatbelts."
    According to the DEA, Colombian and Dominican gangs have locked up heroin distribution in urban centers, especially Boston, New Bedford, Worcester, Springfield, Lawrence, and Lowell. But local police are limited in their ability to chase high-level drug lords, according to Evans. "Local law enforcement only deals with street-level drug abuse," Evans said. "We need more federal resources and assistance to bring to account those who profit the most from the distribution of heroin." With the US drug market estimated at $65 billion, Tandy said, "It is a very big business." The DEA has established special groups to track drug money and is trying to push cases as high up the distribution chain as possible, Tandy said, working closely with the Colombian government to shut down drug gangs at the source.
    But the governors all expressed support for increased treatment programs, saying that the White House's request for $200 million for treatment was just a start. "I believe we can't put a dent in supply," Rowland said. "The drugs are here because the demand is here. There are 6 million people who need treatment while only 1 million are getting treatment. We're debating nickels and dimes for American people who are dying, while we spend $87 billion for the reconstruction of Iraq."



Traumatic Stress Is Focus of Program
Lila Arzua, Washington Post- 10/9/2003

Montgomery County officials are launching a public awareness campaign about post-traumatic stress disorder, an effort to urge residents to seek professional help if they are having trouble coping in the aftermath of violent events. The campaign, known as the Healing Project, begins on the first anniversary of the sniper shootings and two years after the Sept. 11, 2001, terrorist attacks on the World Trade Center and the Pentagon. Both events created widespread distress and anxiety.
    After exposure to traumatic events, experts say, about 8 percent of men and 20 percent of women develop symptoms such as unexplained anxiety and physical ailments and constant reliving of painful moments. For that reason, the federal government gave Maryland, Virginia and the District $250,000 each to help communities deal with the problem.
    "This grant has been a huge help," said Montgomery County Executive Douglas M. Duncan (D), who emphasized his concern about anxiety among residents who are remembering the sniper shootings and who may be experiencing difficulty as the trials of the suspects approach. "They're going to remember things that they wish they never would," Duncan said. "We won't achieve closure until the trials are over and sentences handed out."
    Most of the county's share of the grant, about $180,000, will be directed to the Towson-based Sidran Institute, a nonprofit organization that provides education about traumatic stress. The Sidran Institute has participated in similar awareness projects before, most notably for Oklahoma City after the bombing of a federal building in 1995. However, in this campaign, the institute is emphasizing a new approach -- reaching out to faith communities in an effort to get the word out. It is planning to distribute about 50,000 brochures in English and Spanish in churches and synagogues, libraries and schools. In addition, the Sidran Institute is helping the county prepare a public service announcement for television and is working on the Healing Project link on the county's Web site, www.montgomerycountymd.gov.
    "When bad things happen to people, it can affect their sense of spirituality," said Esther Giller, president and CEO of the Sidran Institute. "This is an opportunity to use faith and spirituality as a healing connection." Giller said that in addition to receiving help from mental health professionals, affected individuals can receive support from friends and family members who listen to their stories. "It might take a while to get back to feeling like themselves," she said.
    The grant's services are designed to reach people who might experience reactions long after the original traumatic event, said Seth Hassett of the Substance Abuse and Mental Health Services Administration, the agency of the U.S. Department of Health and Human Services that provided the grant. "Anniversaries are very important times for any kind of traumatic event," Hassett said. "It brings attention to the issue, both good and bad. People are experiencing anxiety, and they may not even know why."
    In Montgomery County, the money also will supply about $55,000 to provide training to a cross section of community members -- police and rescue workers, school and other county employees -- on how to handle sensitive situations. Other money will be used to create an up-to-date guide to county services and to purchase laptops and other equipment. About $34,000 goes to the Mental Health Association of Montgomery County for its help during the sniper shootings, according to Daryl Plevy, the county's mental health chief. "We want to make sure people in the community know what to do when they're not feeling safe," said Plevy, who added that without treatment, post-traumatic stress disorder can lead to higher risk of sleep disorders, domestic violence and abuse of drugs and alcohol. The solution, she said, is identifying the problem. "We want to let people know it's a normal reaction to an abnormal event," she said.

Rush Limbaugh Admits Painkiller Addiction
Associated Press, 10/10/2003

NEW YORK— Conservative commentator Rush Limbaugh announced during his radio program Friday that he is addicted to painkillers and is checking into a rehab center to "break the hold this highly addictive medication has on me."  "You know I have always tried to be honest with you and open about my life," Limbaugh said during a stunning admission aired nationwide. "So I need to tell you today that part of what you have heard and read is correct. I am addicted to prescription pain medication." "Immediately following this broadcast, I am checking myself into a treatment center for the next 30 days to once and for all break the hold this highly addictive medication has on me," he added.
    Limbaugh gave up his job as an ESPN sports analyst Oct. 1, three days after saying on the sports network's "Sunday NFL Countdown" that Philadelphia Eagles quarterback Donovan McNabb was overrated because the media wanted to see a black quarterback succeed. The reports of possible drug abuse surfaced at about the same time, first in the National Enquirer. The tabloid had interviewed Wilma Cline, who said she became Limbaugh's drug connection after working as his maid. She said Limbaugh had abused OxyContin and other painkillers.
    Law enforcement sources who spoke on condition of anonymity confirmed to The Associated Press that Limbaugh was being investigated by the Palm Beach County, Fla., state attorney's office. "At the present time, the authorities are conducting an investigation, and I have been asked to limit my public comments until this investigation is complete," Limbaugh said Friday. Mike Edmondson, a spokesman for the Palm Beach County state attorney's office, said Friday his office could neither confirm nor deny that an investigation was under way. Limbaugh's attorney, Roy Black, did not return a message seeking comment.
    Limbaugh said he started taking painkillers "some years ago" after a doctor prescribed them following a spinal surgery. His back pain stemming from the surgery persisted, so Limbaugh said he started taking pills and became hooked. "Over the past several years I have tried to break my dependence on pain pills and, in fact, twice checked myself into medical facilities in an attempt to do so. I have recently agreed with my physician about the next steps."


Halle Berry Breakup Triggers Talk of Sex Addiction
Virginia Anderson, Cox News Service- 10/10/2003

To anyone who wonders why men repeatedly run around on beautiful women, experts say this: Sexual addiction is not about the sex. News last week that actress Halle Berry had separated from her second husband, Eric Benet, raised an inevitable flood of "whys." While the couple didn't cite a reason for the separation, talk that Benet had been unfaithful to Berry -- repeatedly -- had circulated for as long as the couple had been married. A report last year in Essence magazine said that Benet had sought treatment for sexual addiction.
    So news of the breakup brought out discussion on the disorder, which is fast becoming a more frequent malady in a sex-saturated society, experts and researchers said. Sex addiction causes its victims and those who care about them immeasurable pain. "I think it's one of the most destructive disorders I work with," said Linda Hudson, an Atlanta therapist who has worked with sex addicts for about 20 years. "They treat people as objects to be used, not as people to be related to. It's never about the sex. It's about power, and how do I feel better."
    Sexual addiction, or "problematic hypersexuality" as researchers call it, is a disorder in which thoughts of sex or sex itself so preoccupy a person that his or her behavior becomes destructive. A cycle starts with the preoccupation, which then becomes obsessive, overtaking most of the person's waking thoughts."It's about using sex as an emotional need," said Richard Blankenship, an Atlanta therapist. "It's an intimacy disorder." Blankenship said it's one that can come with a heavy price tag, not only in emotional carnage.
    Blankenship said he has a client who has spent as much as $75,000 a month on Internet pornography. Another spent a quarter of a million dollars over a few years on prostitutes. Several have been arrested, and some have had the FBI show up on their doorsteps, investigating whether their interests include child porn. "I've had many people tell me that they will be in church, fantasizing about pornography," Blankenship said. The person will then seek sexual release ranging from masturbation to risky sexual encounters with married people or prostitutes. In extreme cases, addicts have been known to have unprotected sex with diseased partners, risking the spread of AIDS. The act itself does not matter, the therapists said. The "fix" is the high.
    But as in all addictions, coming down is the payback. In sex addicts' cases, they are so overcome with shame that they will start the cycle all over again, sometimes immediately going on the prowl, on the Internet, looking for a new challenge. A businessman who requested anonymity described his dangerous liaisons with pornography on his computer as an easy high. "I'm basically a shy person, but on the Internet, with the computer, I can go into a chat room. ... It's tailor-made to bring out the worst in you."
    Researchers at Vanderbilt University in Nashville are trying to find out what happens in the brains of sex addicts to find out whether the disorder has a biological component. The inappropriate and destructive behavior of sex addiction can range from sexual harassment, which could cost someone a job, to the antics of high-profile politicians and celebrities (Bill Clinton and Hugh Grant for example) who suffer public humiliation. "It doesn't matter if you're married to Miss August or Miss America," said Blankenship. "If you're an addict, you will not be satisfied."



Many Desparate Patients Turn to Powerful Painkillers
Patricia Anstett, Detroit Free Press- 10/11/2003

Failed back surgery syndrome is the term medical science has coined for people who develop even worse pain after an operation to relieve back pain. Equally common is the companion problem of addiction to narcotic painkillers patients take to relieve the pain. The latest to acknowledge the problem is conservative radio commentator Rush Limbaugh. On Friday, he told listeners during his radio program that he is addicted to painkillers and is checking into a rehabilitation center. One of the drugs he reportedly used is OxyContin, a highly abused prescription drug with euphoric effects similar to heroin. Limbaugh started taking narcotic painkillers "some years ago" when a doctor prescribed them after spinal surgery. The pain worsened, and he started taking more pills. "Rush Limbaugh is one of hundreds of thousands of Americans who are addicted to pain medication," said Joseph Califano Jr., chairman and president of the National Center on Addiction and Substance Abuse at Columbia University.
    The problem of drug dependence on painkillers after back surgery is not new. U.S. Supreme Court Chief Justice William Rehnquist, who has a long history of back pain, developed a dependence on a prescription sedative and was in a detoxification program directed by a neurosurgeon at George Washington University Hospital in the 1980s. "Many patients with back surgery have persistent pain and are at risk of addiction," said Dr. Dennis Dobritt, president of Tri-County Pain Consultants, a Farmington Hills facility associated with Providence Hospital.
    Each year, as many as 150,000 Americans undergo spine fusion procedures to shore up portions of the back that have degenerated because of overuse, age or injury. Surgery may not work. Three or 4 of every 10 people who undergo traditional back operations develop scarring that can contribute to more back and leg pain, experts say. To control escalating pain, people often turn to higher amounts of painkillers.
    Dr. Michael Boyle, medical director of the Maplegrove Treatment Center, a West Bloomfield, MI program affiliated with the Henry Ford Health System, said painkiller addiction is hard to treat. First, the person must be taken off or weaned from the painkillers. Then, an alternative to narcotics to control the pain should be found, he said. "To get the person off the pain medication is not a major problem," Boyle said. "Keeping them off is the hard part."
    Dr. Samir Fuleihan, chief of the anesthesiology department at Wayne State University and Harper University Hospital, Detroit, said his clinic requires patients to sign contracts agreeing to random urine and blood tests for narcotics to ensure patients don't get drugs from other sources. Then they try a variety of approaches first to try to reduce pain.
    A new drug, buprenorphine, promoted as a treatment for heroin addiction, helps when other approaches to prescription painkiller addiction fail, said Dr. Maher Karam-Hage, medical director of the Chelsea Arbor Addiction Treatment Center.Still, rehabilitation typically takes six to eight weeks in the hospital and as long as six months of recovery and weekly doctor visits, he said.
    Dobritt said several new procedures are helping people with unrelieved back pain. Another new technique, discography, helps determine which patients with pain might benefit from surgery or some other procedure. But despite the advances, many are forced to live with pain. "The problem is we don't have the best treatment for a lot of these spinal conditions," Dobritt said.