Gays' Use of Viagra and Methamphetamine Is Linked to Diseases
Lawrence Altman, New York Times- 3/11/2004

PHILADELPHIA, March 10 — The expanding recreational use of crystal methamphetamine and Viagra is apparently fueling increases in syphilis, H.I.V. and other sexually transmitted diseases among gay and bisexual men in the United States, according to new studies reported here on At a meeting on preventing sexually transmitted diseases, Dr. Samuel J. Mitchell of the San Francisco Health Department said a study had found that 17.4 percent of 1,263 gay men who had gone to the city's sexually transmitted disease clinic had used crystal in the four weeks before their visit. Crystal users were more than twice as likely as nonusers to be infected with H.I.V., the virus that causes AIDS, 4.9 times as likely to receive a diagnosis of syphilis and 1.7 times as likely to test positive for gonorrhea. Dr. William Wong of the San Francisco Health Department said that another study found that gay men who used both crystal and Viagra together were 6.1 times as likely to receive a diagnosis of syphilis as those who did not use either drug.
      In a study of 388 gay men, Dr. Gordon Mansergh reported that his team from the Centers for Disease Control and Prevention and the San Francisco Health Department found that 16 percent had used crystal methamphetamine the last time they had anal sex. Crystal users in the study were twice as likely as nonusers to have engaged in unprotected receptive anal intercourse. In the men's last anal sex encounter, 6 percent had used Viagra. The Viagra users were 6.5 times more likely to report having had unprotected insertive anal sex during that encounter. Viagra was not linked to receptive anal risk behavior.
      For three consecutive years through 2003, syphilis rates among women have fallen by 50 percent but have increased by 65 percent among men. Among women in 2003, there were 1,229 syphilis cases reported, down from 2,445 in 2000. Among men in 2003, there were 5,844 cases, up from 3,532 in 2000. Gay men accounted for more than 60 percent of all syphilis cases in 2003, compared with 5 percent in 1999. "We are very, very concerned" about the trend, Dr. Ronald O. Valdiserri, an official of the Centers for Disease Control and Prevention, said at a news conference at the meeting.
      Health officials from Seattle also reported a sharp increase among gay men in cases of gonorrhea that is resistant to a commonly prescribed antibiotic, ciprofloxacin. As an alternative, many doctors are now prescribing another antibiotic, cefpodoxime, that has not been as well studied for its effect against gonorrhea, said Dr. Hunter H. Handsfield of the Seattle-King County Health Department and University of Washington.
      From October 2003 through December 2003, ciprofloxacin-resistant gonorrhea accounted for 22 of 133 cases, or 16.5 percent, compared with 6 of 159 cases, or 3.8 percent, from July through September 2003. The overwhelming majority of drug-resistant gonorrhea was among gay men. Such drug-resistant gonorrhea has also being reported in Boston and New York.
      Los Angeles County health officials reported new evidence from two studies that the Internet and commercial sex clubs helped increase syphilis rates among gay men. One study found that 22 percent of those who received a diagnosis of syphilis had met sexual partners on the Internet about the time they were most likely infected. A second study found that 28 percent of gay men with syphilis met sex partners at commercial sex clubs.



A Word to Finns: 'For Your Own Good, Blow Your Top'
Lizette Alvarez, New York Times- 3/11/2004

HELSINKI, Finland — Turo Herala is the first to admit that his mission to teach Finns how to get angry and make a scene, or even to feel joy and happiness is, in all likelihood, bound for failure. Three months ago, Mr. Herala, a theater director with a yen for therapy, took it upon himself to bring "anger venting" classes to Helsinki on the theory that his famously silent and stoic compatriots were about to combust from repressed emotion. Finland, while infinitely livable and likable, suffers from some of the world's highest rates of suicide, depression and alcoholism. "How to control and express anger safely," read his classified advertisement in a local newspaper.
      He has had few takers. An organization that handles domestic violence called to enlist, as did a smattering of individuals. But it was so odd a notion — tutorials in how to get angry — that Mr. Herala made headlines in the largest daily newspaper here. "Yes, it has been difficult to get people to sign up," he said over a glass of white wine at a local bar, pleased nonetheless at all the attention. "Anger in Finland is a bigger taboo than sex."
      Psychologists and academics here said they were not surprised that Mr. Herala's advertisement would attract attention as a novelty, and then go largely ignored. "Self-control is very important in Finland," said Dr. Liisa Keltikangas-Jarvinen, a professor of psychology at the University of Helsinki. "You cannot show anger; it means you can't cope. If a person is very temperamental and alive, expresses emotions like anger and happiness, the person is seen as infantile." Even among Nordic peoples, the Finns' stolid nature stands apart.
      Ben Furman, a psychiatrist who until recently was the host of a popular, but very serious, television talk show here, was pilloried last year for suggesting that the government should stop paying for psychotherapy sessions. As he prepared to defend himself in interviews, over and over again, Mr. Furman said the one piece of advice he consistently got was "don't get angry, no matter how much you are provoked." "People would assume I was guilty if I got angry," said Mr. Furman, co-director of the Brief Therapy Institute here. "I had to rehearse and behave in a way where no emotion was shown. A normal person would react emotionally to these charges. If I was in Italy, I believe I would receive the opposite advice. You must be guilty because you are not reacting emotionally enough."
      Here, experts say, a car accident brings, not blame and insults, but a polite exchange of information. A bus breakdown causes no complaints; rather, the Finns on the bus will file off and try to push it to the next stop. It is no coincidence that 80 percent of women who give birth here refuse pain-killing epidurals, according to one study. In America, 90 percent of women ask for them. But Dr. Keltikangas-Jarvinen said suppressing anger in Finland was only one piece of the country's entrenched cultural code. Here, it is not unusual to walk into a restaurant and spot most people eating dinner in silence, content to chew and not chatter. Silence is a sign of wisdom and good manners, not boredom and half-wittedness. Some would say this taciturnity has served Finland well, particularly during the cold war, when the Soviet Union was literally a short tank roll away. "For 30 to 40 years there," Dr. Keltikangas-Jarvinen said, "it was politically very wise to be silent."
      Finns also cringe over compliments. They don't dole them out and they don't take them in. As part of a group therapy exercise, Dr. Furman asked the participants to name one thing they each could do well, he recounted. No reply. Then, he asked the people in the group to give someone else a compliment. They couldn't. Stumped, he broke them up into groups and asked them to say one nice thing about someone outside the circle. Finally, they did. "We needed to back up a couple of steps, to teach people how to talk positively about one another," he said.
      Ingrained with modesty, Finns are almost physically unable to boast or show off. In an era of unattenuated hype, they cannot self-promote. "It is considered a sin," Dr. Furman said, with a laugh. Dr. Keltikangas-Jarvinen said she receives American résumés, and sometimes cannot help but view them suspiciously. To her, they throb with hyperbole. "I feel shame when I read these `excellent' portfolios,' " she said.
      The flip side of this modesty, Dr. Keltikangas-Jarvinen and others say, is that Finns, despite their many advances, particularly in the technological field, seem to suffer from a self-esteem crisis. Theirs is such a consensus-driven, homogenous culture that a free exchange of ideas sometimes proves difficult. "I mean, the president has something like a 90 percent approval rating — please," Dr. Furman said. "For our country to keep up with competitiveness, we need to respond differently." Mr. Herala, the "anger teacher," said much would be solved if people could just learn to say what they think and express their emotions, be it "I am angry because,"or "I love you because," he said. "We are," he said, "the Finnish version of the Japanese character."



New Mental Health Hospital to Open in Detroit
Associated Press- 3/14/2004

DETROIT -- A new mental health hospital to serve Wayne, Oakland and Macomb counties is expected to help stem a decline in hospital beds for the mentally ill in southeast Michigan. The former Saratoga Hospital is being refurbished into the Circle of Life Health Care Center, a private 90-bed facility that would serve mentally ill adults and children, The Detroit News reported Sunday. The center could open as soon as August.
     The hospital would help fill the void left by the closure of the Northville Psychiatric Hospital in May. Hospital beds for the mentally ill in the region have declined 45 percent over the last decade, from 1,965 in 1994 to 1,088 last year. The only public facility for adults left in the Detroit are is the Walter P. Reuther Psychiatric Hospital in Westland. Circle of Life would provide a closer option for some of the 270 former residents of the Northville Psychiatric Hospital who were relocated to state-operated facilities as far away as Kalamazoo and Caro.

Teach Kids to Cope With Bullies, Expert Says
Claire Luna, Los Angeles Times- 3/14/2004

At Columbine High School, football players enjoyed picking on students like Eric Harris and Dylan Klebold, once squirting ketchup and mustard on them while calling them cruel names at lunch. Two weeks later, Harris and Klebold walked into their Colorado school and killed 12 students and a teacher before taking their own lives.     
      The bullying endured by Harris, Klebold and other students responsible for school shootings doesn't excuse their behavior, but it helps explain some of their rage, an expert said Saturday at a conference at Crystal Cathedral in Garden Grove. In an hourlong lecture attended by dozens of Southern California educators, former schoolteacher Barbara Coloroso explored the causes of bullying and gave examples of the effects such cruelty can have. She spoke on the last day of Crystal Cathedral's three-day International Conference on Care and Kindness.
      Bullying is more pervasive than commonly believed, she said, citing such examples as a redheaded girl whose hair was set on fire, and a stocky boy whose peers took pictures of him in the locker room and posted them on the Internet. A 2001 federally funded study of students in the sixth to 10th grades found that about three in 10 students are either a victim, a bully or both.
      Coloroso's son was bullied as a child, she said, giving her insight into the roles students, teachers and parents play. Almost as culpable as the bullies themselves, she said, are bystanders who do nothing.
      By teaching children to think for themselves as early as possible, parents play a key role in preventing them from ignoring the actions of bullies, she said. Those children will then have the inner strength to know when and how to report bullying and to withstand it if they are bullied themselves. "You don't want to raise children who are only taught to please others, whether that's adults or their peers," said Coloroso, author of "The Bully, the Bullied and the Bystander."
      Just teaching a child to rise above bullying isn't enough, she said. "If your child is above it but doesn't tell an adult, that bully will target someone who can't deal with it," Coloroso said. "That's not doing anything to stop the bully's behavior."
      In addition to leading to a desire for revenge, bullying can trigger truancy, introversion and suicide. Coloroso recounted the story of a 14-year-old girl constantly taunted by three other girls at school and by cellphone. The bullied girl hanged herself with her dog's leash.
      Typical school anti-bullying programs don't work because teachers are only taught to look for physical or verbal warning signs, and aren't attuned to the more subtle intimidation tools of rumor, gossip and exclusion. Worse, she said, is the tolerant attitude many adults still have toward bullying, thinking that it is to be expected in childhood. "Conflict is a normal part of growing up," she said. "Bullying is not."
      Coloroso says bullying is typically learned from family members who condone disliking others simply because they are different. She said bullies put down others because they feel inferior themselves. "A strong sense of self is an antidote for all three roles: bully, the bullied and the bystander," she said.
      Teachers who attended the lecture agreed that most school programs don't go far enough. "The programs don't address the issues behind bullying," said Cara Pettite, who teaches sixth- through 12th-graders at a county-run alternative school in Fullerton. "Lectures like this are definitely good to bring up the awareness that bullying is a problem we can't solve that easily."
      San Jacinto fifth-grade teacher Nicole Bourbeau said her children, ages 5 and 14, are frequently the targets of school bullies. She said she appreciated Coloroso's suggestions on how parents should report bullying to school authorities, including tracking the incidents in writing first and making sure administrators have a plan to prevent the bully's behavior. "As a parent, it rips your heart out to see your child come home tortured by another student," Bourbeau said. "You agonize over what you can do to help them. This helps me figure out concrete ways I can make life easier for my children."

Meth-Makers Become Addicted to N.C.
Holly Hickman, Associated Press- 3/14/2004

BOONE, N.C. - Mark Shook says he's fighting a war in this mountain town -- complete with explosions, abandoned children and an enemy that won't give up. Shook is Watauga County's sheriff and, for the past year, he and others have tried to beat back the spread of methamphetamine through the hills and hollows of western North Carolina. "Meth is choking this town," Shook said recently, moments before taking a call about yet another raid on a possible meth lab. "We are fighting a war -- and it's going to spread. I've never seen anything like it."
      Meth is a highly addictive and potent powder "cooked" from such common ingredients as ammonia, lithium from car batteries and pseudoephedrine from cold tablets. After snorting, eating or injecting the drug, users experience rushes of energy and euphoria. "You feel like Superman," said David Mclemore, a former addict who now counsels substance abusers here. "You can get addicted the first time. And then it takes more and more and more to get high."
      Popularized by bikers and truckers in the late 1980s, meth and its makers have migrated eastward from California and other Western states. They've increasingly taken root in the Blue Ridge Mountains near the border between North Carolina and Tennessee. The latter state led the South with more than 1,150 of the nation's roughly 8,000 meth lab seizures last year.
      Boone, a town of 13,500 that is home to Appalachian State University, is surrounded by rugged terrain that offers meth-makers the kind of protection it once provided to moonshiners. The open, isolated spaces diffuse the pungent, nauseating odors that are the meth labs' giveaway. "You can't cook when you're living on top of each other in a city," Shook said.
      Last year, 34 meth labs were seized here, and social workers removed 17 children from homes where the chemicals saturated the walls, furniture and carpet. Because these so-called "meth orphans" were often covered in dangerous toxins, doctors had to decontaminate them. Their toys, books and clothes had to be burned. "The kids didn't always understand why they couldn't take their Barbie with them," social worker Chad Slagle said. Children sometimes unwittingly caused their parents' arrest. A first-grader told her teacher how to cook meth. An older student included meth cooking in a "How I Spent My Summer" essay. "We call Watauga County ground zero," said State Bureau of Investigation Director Robin Pendergraft, who is urging North Carolina lawmakers to increase penalties for operating meth labs.
      The list of problems presented by the meth boom is long. Meth-making, with its combustible ingredients and "cooks" who are often strung out, comes with the ever-present possibility of explosions. Meth-makers dump poisonous byproducts into sewage systems, streams and fields. And their labs render houses uninhabitable and depress surrounding property values. With every meth-lab bust, taxpayers must spend $2,000 to $4,000 to have hazardous materials teams and other specially trained workers clean up the toxic mess, which includes phosphine gas, a chemical weapons component. The human cost is also high. Some 3,300 "meth orphans" were removed from homes nationwide last year, authorities said. Many have ingested meth, said John Martyny, industrial hygiene expert. "Kids crawl on the carpet, put their fingers in their mouths. They might as well have been taking it directly."
      Martyny recently led a study of meth labs at the National Jewish Medical and Research Center in Denver. It found that meth and its ingredients drifted down hallways and seeped under closed doors. They saturated walls, carpeting, sofas and ventilation ducts. Even tests on clothing fibers and the interiors of microwave ovens came back positive. Many of the ingredients of methamphetamine are linked to cancer, kidney and liver damage, and respiratory failure.
      What leads people to this dangerous drug? Boredom as much as anything, said one recovering North Carolina addict, who spoke on condition of anonymity. "There's nothing to do here," said the woman, recalling how she snorted meth for the first time at her kitchen table. She and her husband lost all their savings and isolated themselves in their mountain home. She only recently regained custody of their three children after satisfying a judge that she had been drug-free for a year. Dr. Andrew Mason, a Boone forensic toxicologist, said the woman is a rarity. Efforts to get meth users off the drug fail at a rate of 94%, he said. "This thing is worse than heroin. It's worse than crack. And it's going up and down highways," said Shook, predicting its spread, like moonshine's, to bigger cities. "That's why we're attacking it here, now."

Addict is Denied Bail to Spare Unborn Triplets
Associated Press, 3/15/2004

LAWRENCE, MASS. -- A judge has ordered a known heroin addict pregnant with triplets to be held on bail to protect the mother's unborn children following her 27th arrest. Christien Rivera, 24, has already lost custody of three children to the state. Officials hope her $5,000 cash bail will be too high to result in her release from the state prison for women, MCI-Framingham, the Eagle-Tribune reported yesterday. Rivera's youngest child, born in 2002, tested positive for drugs hours after its birth, and officials do not want the same for the triplets. She is due in three months. "If she wants to poison her own body that's one thing, but assuming what is in the police report is true, she's affecting three other people," said Lawrence District Court Judge Allen J. Jarasitis when he set Rivera's bail.
     On Thursday, Rivera coaxed an undercover officer to drive her to her drug dealer, where she obtained crack cocaine. Rivera offered to share it with the officer for $10, officers said. During a police search, officers also found Rivera carrying a bag of heroin. Rivera's lawyer, David E. Timmons, sought house arrest for her instead of bail, saying his client's high-risk pregnancy required weekly medical visits and that Rivera's "biggest concern is the care of her children." Edward J. Foley, deputy superintendent at MCI-Framingham, said the prison sees an average of 145 pregnant women per year. He said of those pregnancies, roughly 10 babies will be born while the mother is incarcerated.
     Rivera's three other children, born in 1998, 2000, and 2002, were all taken by the state. Two were taken on the day they were born. Rivera can never see the three children again, according to records. The Department of Social Services cannot step in until children are born, DSS spokeswoman Denise Monteiro said. Monteiro said Social Services workers have tried to help Rivera get drug counseling. "She wanted the help and originally began to do the work, but was not able to complete it," Monteiro said.
     Rivera's friend Edwin Alicea, who knows Rivera as Roxi, says she is homeless. "She was telling me she wanted to go get methadone -- that way she can get an apartment," he said. "She's got a heroin problem. She hasn't had any luck." In prison, a program called Catch the Hope will provide Rivera with a social worker and a nurse. Foley said services also include weekly prenatal classes that address childbirth, reproductive health, and substance abuse.

Group Sues FDA for Ban on Antidepressant
Associated Press, 3/15/2004
WASHINGTON -- A consumer advocacy group sued the government Monday, seeking to force a ban on sales of the antidepressant Serzone. The drug can cause deadly liver failure and is linked to 20 deaths -- and it's impossible to predict which patient is at risk, said the consumer group Public Citizen.
     Serzone already has been taken off the market in Canada and Europe, and will quit selling in Australia and New Zealand in May, said Public Citizen's Dr. Sidney Wolfe. He first petitioned the FDA to take Serzone off the U.S. market a year ago, but FDA didn't act. Public Citizen filed suit Monday, asking a federal judge to declare FDA's delay illegal and force the agency to act to ``protect public safety and prevent needless death and injury.'' The FDA is reviewing the issue, said spokeswoman Susan Cruzan.
     But the agency has maintained that liver failure is a rare risk adequately managed by warning patients. In 2002, the FDA added to Serzone's label the agency's strongest type of warning, one set off by a black box. Wolfe argues that warnings haven't helped. He details 55 cases of liver failure, including the 20 deaths, and another 39 cases of less severe liver injury reported to the FDA since Serzone began selling in 1994.
     Rather than seeing side-effect reports trickle off as the years pass, as is typical with older medications, the FDA received more reports of liver failure in the 17 months after strengthening the warning than in the five previous years, the lawsuit contends. The FDA estimates its monitoring system counts fewer than 10 percent of the side effects caused by medications, meaning far more Serzone users may have been harmed, Wolfe said. The drug works no better than older, safer antidepressants, he added, pointing to a report from the World Health Organization and Health Canada that compared a number of popular antidepressants and found only Serzone linked to serious liver injury.
     Serzone maker Bristol-Myers Squibb declined comment on the suit. Serzone, known chemically as nefazodone, inhibits an enzyme key to drug metabolism, allowing the antidepressant to sometimes build to toxic levels in the liver, Wolfe said. That enzyme also metabolizes numerous other drugs, meaning patients taking multiple medications could be at higher risk, he said.

As Workloads Increase, More Professional Moms Opting Out
ABC News, 3/15/2004

Cheryl Nevins, who is eight months pregnant with her third child, loves her powerful, lucrative position as a labor lawyer for the Chicago Board of Education. But she is about to give it up. After giving birth, the 34-year-old mom plans to take an extended leave of two or three years to devote herself to motherhood. It doesn't mean she is permanently out of the work force, though, Nevins said.
     "I definitely want to go back. I love my job and what I do and I'll miss it," Nevins said. Still, she enjoyed spending time with her two younger children, and looks forward to the opportunity to do it again. Her husband, a finance manager for Kraft Foods, supports her decision to stay home with their two sons, ages 2½ and 11, and the new baby. Currently, Nevins works between 50 and 60 hours a week and spends time checking e-mails and juggling phone calls at home. "I just want to spend more time with my children," Nevins said.

Not Quite June Cleavers
Nevins is part of a growing trend, featured in a Time magazine report, in which more professional women are opting out of the rat race, at least temporarily. For the first time, the percentage of workplace participation by married mothers with children less than a year old fell from 59 percent in 1997 to 53 percent in 2000 -- a significant change, even though it impacts only a small group, experts say.
     There are various reasons for the move toward old-fashioned motherhood, but for many, it is a sign of some women's new, non-linear approach to their careers. "In the woman who can afford it, there is an increase," said Claudia Wallis, who reported the story for Time magazine. "They don't want to recreate the lives of Ozzie and Harriet Nelson. This is just a new approach to their career," Wallis said.
     One of the reasons women are ducking out of their careers is because the workplace has become more unfriendly toward those who want to have a family life, Wallis said. New technology, such as cell phones, e-mail and wireless devices allow work to intrude on family life more than ever, so that many mothers find their attention is divided at home, after the work day is over.

No Regrets
Marilyn Montgomery, who worked in advertising and public relations for 17 years, quit her job at Commerce Bank about a year ago to devote herself to being a mother. "When I was working and taking care of one child I was in an amazing race, running from day care to work, getting everything done," Montgomery, 39, said. But a month before her second child was born last year, she felt as though she was not able to give either her job or her family 100 percent, so she quit.
     Though it can be difficult at times, she has no regrets. "I couldn't be happier," Montgomery said. "I have adjusted so much that I've decided never to go back to work again. I love being with my children." Though she sometimes misses her career, two children keep her busy, she said. Financially it has been harder than she and her husband, a salesman, anticipated, but Montgomery still does some freelance work from home.
     Given that women now make up such a significant percentage of the professional labor force, Wallis says that it does not appear that women will lose ground in the workplace, even if more leave to devote time to motherhood. She is optimistic that companies will have to start responding to the demands of women who are juggling motherhood and family duties. Both Montgomery and Nevis said they would both be happy to return to the workplace sooner if on-site day-care and more flexible hours were available.
     Wallis says the workplace will be forced to respond as more and more baby boomers retire. Wallis says female professionals will soon be in great demand. "They already have a name for them: the 'boomerrangers,' and companies want to lure these women back into the work force a few years down the road after this recession, and as the boomers retire," Wallis said. Some companies are staying in touch with mothers who left the work force, and are calling the process "alumni relations."

New Clues to Women Veiled in Black
Susan Gilbert, New York Times- 3/16/2004

For centuries, doctors have recognized women's vulnerability to depression and proposed a variety of explanations. The female of the species, with her "excitable nervous system," was thought to wilt under the strain of menstruation and childbirth, or later, the pressures of work and family. But researchers are now constructing more scientific theories to explain why women are nearly twice as likely as men to become depressed. Social bias and women's higher rates of physical and sexual abuse and poverty, experts say, clearly play a role. But scientists are also studying genes that may predispose girls and women to the disorder. They are examining the likely role of estrogen and even linking the development of clinical depression to negative thinking, which is more common in women than in men.
      There is no question that women bear the brunt of the illness that Winston Churchill referred to as his "black dog." The National Comorbidity Study, a large survey of adults in the United States released last year, found that 1.7 women for every man had experienced at least one episode of depression. Roughly the same ratio has been found in recent studies in nine other countries, including Canada, Brazil, Germany and Japan, said Dr. Marta Meana, an associate professor of psychology at the University of Nevada at Las Vegas. "This is a global phenomenon," said Dr. Meana, who will address the issue at a meeting of the International Association for Women's Mental Health in Washington this week.
      It is unlikely that any single gene, hormone level or type of experience explains the higher incidence of depression in women, experts say. Instead, several genes probably work in concert with the ebb and flow of reproductive hormones to change brain chemistry in ways that might set the stage for depression, especially after an emotional ordeal.
      Another risk factor appears to be something that researchers call overthinking, a tendency to dwell on petty slights, to mentally replay testy encounters and to wallow in sad feelings. Studies show that this type of negative thinking is far more common in women than in men, and that it can be a harbinger of clinical depression. "The gender difference in overthinking is strongly tied to the gender difference in depression," said Dr. Susan Nolen-Hoeksema, a professor at the University of Michigan and a leading researcher on women and depression.
      About half the risk of depression is thought to be genetic. The single gene, 5-HTT, that has been definitively linked to depression is no more common in women than in men. But preliminary research suggests that there are other depression-related genes that mainly affect women. For example, after scanning the genomes of people with major depression in 81 families, Dr. George Zubenko, a professor of psychiatry at the University of Pittsburgh School of Medicine, identified 19 regions of chromosomes that were especially common and, therefore, likely to contain genes that promote depression. Four of these regions showed up only in the women and one only in the men, Dr. Zubenko and his colleagues reported last July in The American Journal of Medical Genetics, an online publication.
     Such findings suggest that more genes may help to set off depression in women than in men, Dr. Zubenko said, explaining in part why more women become depressed. One may be CREB1, a gene that Dr. Zubenko's group has identified as a strong candidate. Especially intriguing, Dr. Zubenko said, is that CREB1 interacts with estrogen receptors. Though the details of the relationship between CREB1 and estrogen are unknown, researchers have long thought that levels of sex hormones play some role in depression. For one thing, the sex difference in depression is most pronounced in women during their reproductive years, when sex hormone levels are highest. Before puberty, boys and girls have roughly equal rates of depression. The incidence of depression climbs in both sexes during puberty, but the climb is steepest for girls.
      In a national telephone survey of 4,028 adolescents ages 12 to 17, about 14 percent of girls and 7 percent of boys met the criteria for major depression. The survey was published in August in The Journal of Consulting and Clinical Psychology.
      In their reproductive years, women are also especially prone to bouts of depression when their sex hormones are in flux — just before menstruation and just after childbirth. Two subtypes of depression that affect only women — premenstrual dysphoric disorder and postpartum depression — occur then.
      A leading theory is that sex hormones help induce depression in some women by affecting messenger chemicals in the brain that influence mood. Dr. Meir Steiner, director of the Women's Health Concerns Clinic at St. Joseph's Healthcare in Hamilton, Ontario, who studies the relationship between hormones and mood, thinks that the sensitivity of these neurotransmitters may increase when hormone levels are high or in a state of flux and decrease when they are low and stable.
      But to blame women's higher rate of depression on hormones is too simplistic, experts say. Not all women become depressed when their hormone levels seesaw. A study sponsored by the National Institute of Mental Health showed that manipulating women's levels of estrogen and progesterone affected the moods of some women but not others.
      Specifically, women who usually suffered from premenstrual syndrome, a condition characterized by moodiness in the week or so before menstruation that is less severe than premenstrual dysphoric disorder, found that their moods lifted when they were given a drug that kept their hormone levels low. When their hormone levels went back to normal, these women felt blue. But women who did not suffer from premenstrual syndrome did not experience ups and downs in mood during the study.
      Such findings indicate that it is not hormone levels per se that make some women feel moody or depressed at times of hormonal flux, but an underlying vulnerability, said Dr. Mary Blehar, formerly of the National Institute of Mental Health and now director of cancer prevention, control, behavior and science at the National Cancer Institute. "What that vulnerability is is the big question," she said.
      Genes may tell much of this story. Dr. Zubenko, for example, suggests that some genes that raise women's risk of depression may exert their effect in the presence of high levels of estrogen, their influence then decreasing when estrogen falls after menopause. But biology cannot entirely explain the sex difference. "It's not just genetics," Dr. Steiner said.
      Women, Dr. Nolen-Hoeksema says, are at least twice as likely as men to be abused, and abuse often leads to depression. Another important factor, she said, is the greater tendency of girls and women to ruminate over the common curveballs of life, like criticism at work or school or rejection by a friend. In studies over the last decade, Dr. Nolen-Hoeksema has consistently found that women react more strongly than men to such experiences, mulling them over and over without being able to come to a resolution or to simply move on. Dwelling on problems causes the initial sadness to snowball, she said. By contrast, men are more likely than women to distract themselves from a problem, often by going off and doing something active, a healthy reaction, Dr. Nolen-Hoeksema said, because it blunts the emotional sting of everyday disappointments and setbacks.
      Dr. Nolen-Hoeksema's studies have found that people who habitually ruminate but are not depressed are more likely than non-ruminators to develop depression later. There may be biological reasons behind women's tendency to brood, but no genetic predisposition or difference in the brain has been found. Still, Dr. Nolen-Hoeksema said, "There are cultural and personality contributors to rumination." Women tend to forge intense emotional connections and to care deeply about relationships, she said. "Our investment in relationships can be a source of great richness in our lives," but taken too far, it can also become destructive, Dr. Nolen-Hoeksema said.
     In her research, Dr. Nolen-Hoeksema has found that the sex difference in negative thinking is apparent in children as young as 9, several years earlier than the sex difference in depression emerges. In a book published last year, "Women Who Think Too Much" Dr. Nolen-Hoeksema recommends a variety of strategies to help teenage and adult women cut down on overthinking. Staying active can help. For teenage girls, playing a sport or engaging in other extracurricular activities can keep them from brooding about bad grades or broken romances. "If you have your self-esteem hinged on one thing, like a single relationship, you don't have a fallback if something goes wrong," Dr. Nolen-Hoesksema said. Another strategy is to cultivate a circle of friends. "When women ruminate, we blow things up," she says. "It helps to have friends who can help you reflect on a problem and find a solution." Just make sure, she adds, that the friends are not too prone to rumination themselves.

One of the most crucial bonds between patient and physician is the absolute promise of confidentiality. Most people are simply not comfortable discussing sensitive topics unless this promise is proffered and strictly upheld. Because it is impossible to predict what might shame one person but not another, doctors pledge confidentiality to all, with the proviso that they may discuss cases with medical colleagues to provide better care and, in much rarer instances, with legal authorities, when a child is being abused, for example. The goal is to create an environment where patients are willing to be forthcoming. After all, if patients do not tell me what is troubling them, how can I help them?
      Yet, recently, serious threats have arisen to this essential social contract between physician and patient. In February, for instance, attorneys for the Justice Department subpoenaed the medical records of women who had had abortions at Planned Parenthood clinics in California, Kansas, Missouri, Pennsylvania, New York City and Washington, saying that federal law does not recognize a physician-patient privilege. On March 5, a federal district court, citing privacy issues, blocked the department's demand for access to abortion records from a public hospital in California and six Planned Parenthood affiliates there. Just last Friday, another federal judge ordered hospitals at the University of Michigan to turn over abortion records, but with all identifying information removed. The Justice Department had argued that the records were central to a court case challenging the Partial-Birth Abortion Act.
      It may be tempting to view this as merely another skirmish in the continuing war between those who favor abortion rights and those who oppose them. But the assault on abortion clinics is not the sole example. Last month, Florida state prosecutors seized Rush Limbaugh's medical records to investigate whether narcotics had been obtained illegally.
     The promise of physician-patient confidentiality probably made its first recorded appearance in the Hippocratic Oath, named for the Greek physician Hippocrates, who lived on the island of Kos from about 460 to 370 B.C. It was the beginning of the tradition in which newly minted physicians publicly take an oath to practice medicine ethically. This June, across the United States, 16,000 graduating medical students will take some type of ethical oath. Although Hippocrates would probably not recognize a majority of the texts, one passage from the original Hippocratic Oath remains constant in all modern versions. Indeed, it is a promise all physicians make to themselves, in some fashion, every day: "What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account must spread abroad, I will keep to myself, holding such things to be shameful to be spoken about."
      In essence, this vow prohibits the physician from discussing patient-related issues no matter how or where the information was acquired. It is intended to prevent more than gossip. Doctors have learned all too painfully that discussing a patient's medical history with an outsider can be hazardous to the patient's present or future health.
      Having been a physician for almost two decades, I have seen few more vexing barriers to providing health care than those raised by patients who cannot trust their doctors to keep their medical problems away from prying eyes. A number of studies demonstrate that when patients fear that their confidentiality may be threatened, they avoid full disclosure or stop visiting doctors altogether. This is especially true for people who suffer from sexually transmitted diseases, mental illness or addiction, or who are coming to grips with reproductive decisions, though it is hardly restricted to those conditions.
      Wherever one stands on the political spectrum, it seems desirable to codify into federal law a protection that we know benefits everyone's health — and that physicians have honored for thousands of years. Simply put, what you say to your doctor ought to stay in his office without the threat of being aired in a courtroom or public forum.

Drug-Fighters Turn to Rising Tide of Prescription Abuse
Michael Janofsky, New York Times- 3/18/2004

WASHINGTON — After years in which marijuana, cocaine and heroin were by far the main focus of the nation's war on drugs, the Bush administration is now attacking the rising abuse of prescription drugs. While marijuana remains the nation's most abused drug, according to government and private studies, narcotic pain relievers like OxyContin and Vicodin, along with a variety of some other prescription medications, have overtaken amphetamines to rank second.
      A recent nationwide study by the University of Michigan showed that from the 2002 to 2003 school year, nonmedical use of prescription drugs among students in the 8th, 10th and 12th grades increased even as use of other illicit drugs dropped by 11 percent. Doctors, other health care providers and law enforcement officials say prescription drug abuse produces the same problems as street drugs: addiction, crime and broken families. And, like street drugs, it produces headlines about celebrity drug users, notably Rush Limbaugh, who admitted last year that he was addicted to painkillers. The authorities in Palm Beach County, Fla., are investigating Mr. Limbaugh and several of his doctors on suspicion of "doctor shopping," the practice of contacting a number of physicians as a way of getting more drugs than are medically necessary. That activity is a felony in Florida.
      One part of the problem is that prescription drugs are advertised to millions of people every day over the Internet. Many of those drugs are from foreign sources that state and federal authorities cannot easily trace, let alone regulate. The House Government Reform Committee has scheduled a hearing for Thursday on a bill that would require such Web sites to identify their place of business, as well as affiliated doctors and pharmacists, and would ban any sales made without an in-person consultation with a doctor and a valid prescription.
      Beyond Congressional interest, the White House Office of National Drug Control Policy has for the first time instructed federal agencies with antidrug programs to develop new strategies to combat prescription drugs' abuse and illegal marketing. "We don't want to wait until we get what we had with the crack epidemic," John P. Walters, who as the office's director serves as the nation's "drug czar," said in an interview. "Hopefully we're a little bit earlier in the process." Mr. Walters's office is largely a bully pulpit for the war on drugs, setting policy and then lobbying Congress for money that is distributed to the agencies carrying out the efforts. As a measure of the administration's concern about prescription drugs, President Bush is seeking $12.6 billion for antidrug programs next year. That would be a 4.6 percent increase, a request nine times as high as the average increase proposed for programs that do not involve defense or national security.
      Much of the responsibility for the new focus on prescription drugs falls on the Food and Drug Administration and the Drug Enforcement Administration. Mr. Walters said the F.D.A. was being instructed to improve labeling of commonly abused drugs and to provide doctors more information about the medicines they prescribe. The D.E.A. has been asked to shut down online pharmacies selling drugs without prescriptions and to discourage credit card companies from facilitating sales.
      Some drug experts say the effort, while impressive, comes late. "I'm not a big subscriber to the fact that prescription drug abuse is new," said John Burke, a former Cincinnati police officer who now leads a regional antidrug task force in southern Ohio. "It's always been there. There has been some increase, but it's just getting more attention because of certain drugs, like OxyContin obviously." Mark Kleiman, a professor of public policy at U.C.L.A., said the widespread abuse of prescription painkillers began nearly a decade ago. "It would have been great if people looking at those numbers had started to move in the mid-1990's," Professor Kleiman said. "That's not to say it's bad to do something now. We still have a major drug problem here that hasn't been addressed in any serious way."
      Since arriving on the market in 1996, OxyContin has become one of the most commonly prescribed narcotics for treating pain, notable for a time-release delivery and an active ingredient that is twice as potent as morphine. Abusers crush the tablets to gain its full impact at once through snorting or injection. The effect is a euphoria that many drug experts say is equal to that produced by heroin. Rural areas and other regions where many are employed in physical labor have been hit especially hard by the growing popularity of OxyContin and other painkillers. Louise Howell, executive director of Kentucky River Community Care, a social services agency in the state's Appalachian region, said easy access to prescription drugs through doctor shopping and Internet sales had brought enormously painful consequences. Citing cases in which users were supporting their habits by selling their homes and stealing from their families, she said: "It's overwhelming us. We're imploding, and it's shameful."
      Sgt. Bill Purcell of the Virginia state police reports the same problems in southwest Virginia, where he supervises a regional drug task force. In the last five years, he said, there have been "dramatic increases" in illicit use of prescription drugs, a trend characterized by the theft of doctors' prescription pads, callers to pharmacies who pretend to be physicians, and nurses who call in prescriptions for themselves. "These drugs are everywhere," Sergeant Purcell said.
      Mr. Walters, the White House antidrug official, said his office intended to press more states to adopt computerized monitoring programs that help reduce doctor shopping by tracking the identities of those who write prescriptions and those who receive them; fewer than half the states now have such programs. And Michael Horn, director of the National Drug Intelligence Center, a Justice Department agency that provides analysis for policy makers and support for drug-fighting programs, said he planned to shift more resources into generating information on prescription drug abuse. "The increasing rates we've seen," Mr. Horn said, "are kind of scary." But even the proposed level of federal spending may not make much difference, state and local law enforcement officers say. "Even the D.E.A. people I talk to say they are hurting for resources," said Sergeant Purcell. "Unless we get more resources, we'll always be behind the eight ball."

Government Warns of Inhalant Abuse Among Kids
Associated Press, 3/18/2004

WASHINGTON - When 16-year-old David Manlove left his home in June 2001, he told his mother he was going to swim at a friend's house. He didn't tell her what else they planned to do.
He and a friend purchased a can of computer duster and "huffed" it while they swam. David inhaled the fumes and dove under water to intensify the high. He didn't surface. By the time his mother Marissa arrived at the pool, he was in cardiac arrest. "My beautiful boy stretched out on a gurney, paramedics frantically conducting CPR," she said Thursday, recalling the scene."The first thing I noticed is that David's feet were blue." Her son was dead. It was "the worst kind of loss that parents can endure" said Marissa's husband, Kim, choking back tears.
     The Manloves joined the nation's drug policy chief, John Walters, on Thursday to help highlight the problem of inhalant abuse, or "huffing" when kids or adults intentionally inhale common household products such as glue, paint, shoe polish, and gasoline to get a high. Inhalants provide an instant rush for users but they have harmful side effects nausea, seizures, heart palpitations and vomiting. Over time, they can lead to brain damage and death.
     Charles Curie, administrator at the Substance Abuse and Mental Health Services Administration, said inhalant abuse is a great concern because the products used are legal and therefore easy for children to get their hands on. "It's a silent epidemic in many ways, overshadowed and ignored perhaps because it's not considered a quote illegal drug," he said.
     The National Inhalant Prevention Coalition said it knows of about 125 inhalant deaths each year. The estimate is based mostly on the number of calls the group gets from parents or other family members. Harvey Weiss, executive director of the Texas-based advocacy group, said many more deaths likely are undiagnosed and unreported. Weiss unveiled new guidelines for medical examiners, coroners and others to help better detect and document inhalant deaths. He said the framework would hopefully aid in getting a more accurate picture on the scope of the problem. The guidelines encourage thorough crime scene searches to determine whether aerosol containers and inhalant paraphernalia, such as plastic bags, were present. Teens fill the bags with hair spray or other aerosol products and then breathe in the fumes.

Livingston County, MI Drug Overdose Cases Escalate
Susan L. Oppat, Ann Arbor News- 3/18/2004

An 18-year-old Fowlerville man took eight doses of methadone at a party and died on Jan. 5, after several days on a ventilator. He lay unconscious for several hours before friends noticed he was in trouble. A 41-year-old Livingston County man died early this year of an overdose of OxyContin. He had no history of substance abuse, and had a legal prescription for the strong painkiller for a back problem. He filled his last prescription for 60 pills, which should have lasted a month, two days before he died. Only 11 pills were left.
     Shaken by the recent fatal and near-fatal overdoses, Fowlerville Police Sgt. Everett DeGrush had an idea. He planned a meeting for all interested Livingston County residents, Sunday, in Fowlerville, and is bringing together experts on substance abuse. Police, school officials, social workers, drug experts and even the mothers of two young men who overdosed -- one who lived, and one who didn't -- will talk about the problem that has alarmed some in the county. After the meeting, they'll listen to anyone who wants to talk, one on one. DeGrush hopes it might help a family or save a life.
     According to figures from the Southeast Michigan Council of Governments, Livingston County has had the fastest growing population of any county in the state for several years. An officer from the Livingston and Washtenaw Narcotics Enforcement Team, who asked not to be identified because he works undercover, said two rural Livingston County areas are home to a three-county drug ring. The officer said with people streaming into the county along two major highways come illegal and abused prescription drugs and all their accouterments -- weapons, dirty cash, drug raids and overdoses. Marijuana, the undercover officer said, is the most widely abused drug in Livingston County and powder cocaine is second. OxyContin and heroin are hard on its heels, along with Ecstasy, methamphetamine and methadone.
     In 2001, LAWNET seized the components for more than 20,000 doses of methamphetamine in one raid. The number of illegal prescription drug doses seized last year is about double what it was in 2002. LAWNET confiscated nearly four times the marijuana last year as in the year before.
Before 2003, DeGrush says, Livingston County saw two or three serious overdoses a year. The last fatality he remembers, north of Fowlerville, occurred four years earlier. Although no statistics are kept, there have been at least four deaths in the county since 2002 due to overdoses. Now more powerful drugs are becoming more available. According to the LAWNET officer, heroin on the street now is 10 times more powerful than it was 20 years ago.
     DeGrush believes it is the responsibility of the entire community to do something about the problem of substance abuse. As a volunteer Catholic-religion teacher who works with kids on his own time and as a cop, DeGrush recalls being shaken by the "no big deal" attitude of a 15-year-old Fowlerville boy who chugged most of a half-gallon of vodka and spent days in a coma and a week on a ventilator.
     DeGrush will host the meeting, with open discussions from school liaisons who want to help children and parents make good decisions; Livingston County DARE officers who can tell parents what drugs are out there, and a secure display of the actual drugs; a Livingston County parole officer who can explain the penalties for drug abuse; a social worker with avenues of help; and a Fowlerville doctor with information about abuse of prescription drugs. And the mothers. "It's not going to be easy to talk about it," DeGrush said of the women. But they're willing to tell their tragic family stories because "they need to make a difference." It's not a police meeting, DeGrush emphasizes. Or a religious meeting. "It's for anyone who walks in the door," he said.

A snapshot of overdoses in Livingston County:
* A 48-year-old Handy Township man overdosed on prescription OxyContin, Xanax and Flexeril on Sunday. He was in good condition at St. Joseph Mercy Hospital Wednesday. The man had a documented back injury, and the overdose is believed to have been accidental.
* Andrew Fletcher, 18 , of Fowlerville, died of a methadone overdose on Jan. 5, after several days on a ventilator. He lay unconscious for several hours before friends tried to wake him. Another friend also overdosed at that party, but survived.
* Richard Shipkowski, 41, suffered a back injury as a child, and had a legal prescription for OxyContin. He started taking it a year ago. He had no documented problem with drug abuse. He filled his last prescription for 60 pills two days before he died. Only 11 were left.
* David Michael Boschma, 37, of Northville, was found dead on Dec. 23, 2002 in an apartment in Brighton where he'd spent the night as a guest. Preliminary toxicology results indicated Boschma had opiates, likely heroin or a heroin derivative, and a depressant, benzodiazepine, in his bloodstream.
* A 27-year-old Brighton man died in his apartment of an overdose of OxyContin. His father found his body.
* A 17-year-old boy overdosed on methadone and Xanax at Fowlerville High School in January. He spent several days in a coma, but recovered.
* A 21-year-old man, father of a small child in his custody, suffered a heart attack in Fowlerville on Feb. 5, when he overdosed on heroin. His mother found him unresponsive in their home. Officials found a used syringe in his pocket. He survived.
* A 15-year-old Fowlerville boy with a blood alcohol content of 0.386 -- nearly five times the legal limit for driving -- spent days in a coma after he overdosed on Jan. 17, and more than a week on a ventilator. He and six other youths 12-15 years old chugged a pair of half-gallon jugs of vodka. Police are seeking charges against an adult who bought the alcohol for the teens.