Daughter Says Father's Confessional Book Didn't Confess Molestation
N.R. Kleinfield, New York Times- 7/1/2004

In the new best-selling book "Father Joe," Tony Hendra recounts his 40-year friendship with a wise Benedictine monk whom he credits with salvaging his soul and enabling him to accept God's love. Throughout the book Mr. Hendra, a noted satirist, appears unstinting in his contrition, exhuming his recurrent failings as a husband and father and his wayward indulgences in alcohol and drugs. "Father Joe" has been widely praised, the accolades including a lead review in The New York Times Book Review, and critics have lauded Mr. Hendra for his raw honesty in baring his sins and for his lyrical distillation of the pitted road to redemption.
      But when Jessica Hendra, his 39-year-old daughter from his first marriage, read the book recently, her reaction was stunned anger. Unmentioned in the narrative, she said, is the far darker story of how her father sexually molested her when she was a child and consistently discounted the devastating effect on her. Her version of her father's past challenges the premise of "Father Joe": that Tony Hendra found deliverance through faith and atoning for his failings. "It's being seen as completely confessional, totally honest, the whole story," Ms. Hendra said. "It's not the whole story. By not saying anything, I felt I was being complicit in it. This book is an erasing of what happened to me. I want people to understand these things don't go away."
      Mr. Hendra, 62, who lives in New York and is now remarried and has three children with his second wife, said: "I can only just categorically deny this. It's not a new allegation. It's simply not true, I'm afraid."
      Ms. Hendra, an actress who now spends her time raising two young daughters in Los Angeles with her husband, said she confronted her father about what she called the book's hypocrisy in a series of e-mail messages in which, according to copies she provided, he begs her to meet with him and "find a path once and for all out of this terrible place" and wonders if she intends to "bring all this crashing down." In speaking to The Times, Ms. Hendra authorized a reporter to talk to two therapists who treated her, as well as three friends in whom she confided, and her husband and mother. All said that Ms. Hendra credibly told them at different junctures of being molested, one of them when she was 12.
      The central thread of "Father Joe" is the decades' worth of guidance Mr. Hendra gleaned from the Rev. Joseph Warrilow, an English Benedictine monk who lived in a monastery on the Isle of Wight. He died in 1998. Mr. Hendra first met Father Joe when he was taken to the monastery for spiritual discipline after being caught in the nascent stages of an affair with a married woman when he was 14.
      In the book, Mr. Hendra devotes relatively modest space to the particulars of his marriages. He married Judith Christmas in 1964, and they had two daughters, Jessica being the younger. He evokes the marriage largely through sweeping admissions like, "No father could have been more selfish — treating his family like props, possessions, inconveniences, mostly forgetting them completely in his precious mission to save the world through laughter." He never mentions Jessica by name, though she is included as part of the dedication.

A Frenzied Childhood
Judith Hendra said in an interview that Tony Hendra was always possessive of Jessica. For her part, Jessica said that she felt boundless affection for him. "I loved my father," she said. "I absolutely adored him. He was very charismatic. He still is charismatic." The household itself was rambunctious. There was drug and alcohol abuse by Mr. Hendra, carousing and bizarre incidents, Judith Hendra said, like the time Mr. Hendra, after taking drugs, was driving the family to New Jersey and roared through the Holland Tunnel the wrong way. During much of the marriage, Mr. Hendra worked primarily as a writer and editor at National Lampoon. He had also been a stand-up comic and television scriptwriter.
      When she was 7, Jessica Hendra said, her life capsized. The family was living in New Jersey. She was about to fall asleep in her bunk bed, her older sister, Katherine, asleep below her. She said her father came in to say he was going out, and when she implored him not to, he said he would lie with her until she dozed off. As she drifted off, she said, he began touching her and had her perform oral sex on him. Afterward, she said, he told her it was something people did when they loved each other. The next morning, she said, he apologized and blamed some alcoholic or drug-induced haze for his behavior.
      She said the episode terrified and disoriented her. In the immediate aftermath, she feigned having conjunctivitis by rubbing her eye raw so that she didn't have to go to school for three weeks. "After I went back to school, I became very self-conscious," she said. "There were other times I made up illnesses. I'd put my face on the radiator and pretend I was very hot."
      No more instances of molestation occurred, she said, until she was 9 or 10, and they lived in New York, when, she said, on two occasions her father took showers with her and touched her inappropriately.
      Judith Hendra, who had an acrimonious divorce from Mr. Hendra in 1985 and is now remarried, initially said during an interview that she never suspected Jessica had been molested until she attended a therapy session with her 10 years ago. She called a reporter for The Times yesterday and said that this was untrue and that one night when her daughter was 10 or 11, Mr. Hendra told her he had taken a shower with Jessica and had her masturbate him. "He collapsed and said, `I'm a monster, I'm a monster,' " she said. She said she was horrified but did nothing because she was afraid of him. "I'm desperately ashamed of this," she said. She said she told Jessica yesterday. Mr. Hendra denied that this had happened, saying that "this is absolutely getting outrageous," and said there was no shower in their loft. Judith Hendra said there was a hand shower, and a friend who stayed there said he took showers there.
      Jessica Hendra said that she battled self-hatred that expressed itself in bulimia, truancy and anorexia. "I really felt I had some secret thing I was carrying around that marked me as a bad person," she said. "I blamed myself for allowing this to happen."

Confiding in Friends
For a long time, she said, she never told anyone about the abuse except her best friend, Krisztina Zugor, a classmate who remains a friend. Ms. Zugor, in a telephone interview from her home in France, said that when they were both 12, Ms. Hendra told her that her father "took liberties with her that a father should not take." "It was very clear to me that she suffered a lot," Ms. Zugor added.
      Another friend, Alison Graham, said that Ms. Hendra intimated to her that there was something strange about her relationship with her father when they were drama students together in London in the late 1980's, and that several years later when they were living in New York, Ms. Hendra told her she had been sexually molested by her father. "It really became an anxiety for her when she had her first child," Ms. Graham said. "She had real fears about her father being around her daughter, or her father being with her daughter alone."
      Gage Johnston, a director who became a friend, said Ms. Hendra told her she was molested by Mr. Hendra soon after they met in 1991. "We talked about it on numerous, numerous occasions," she said. However, Pablo Alvarez de Toledo, a Spanish painter and former boyfriend of Ms. Hendra who is friends with Mr. Hendra (who suggested he be interviewed for this article), said that Ms. Hendra never told him about being molested during their years together and that she was "very unstable emotionally," adding, "I can't believe it happened."
      Ms. Hendra did maintain a civil relationship with her father. When she was in her early 20's and studying in England, she said, her father and his second wife and their infant son came to England around Christmas so he could show the child to Father Joe. While they were at her aunt's for Christmas dinner, Ms. Hendra said, she broke down at the table and ran upstairs. Her father went after her. She said that she told him that what had happened in New Jersey was torturing her, and that he apologized and said that they would talk after Mass the next morning.
When they did, Ms. Hendra said, her father was dismissive, sardonically telling her that far worse things had happened to children, like the Holocaust and the brutal reign of the Khmer Rouge in Cambodia. She said he told her that "perhaps I needed to see myself as a victim in order to excuse my failures in life" and that she ought to "get over it." Mr. Hendra said that his daughter did accuse him of sexual molestation in a general way at that time, and that he denied it.
      Ms. Hendra said that, crushed by the encounter, she became horribly depressed and soon afterward left drama school and returned to New York. Her bulimia worsened. A few years later, she met her husband, Kurt Fuller an actor, and moved to California. Mr. Fuller said that Ms. Hendra told him soon after they married that she had been sexually attacked by her father. Once they had children, he made it clear to her that they would never be left alone with Mr. Hendra, being uncomforted when a doctor told him that a father who abuses a daughter usually doesn't abuse the grandchildren.
      Ms. Hendra never severed relations with her father, she said, because of the complicated emotions she felt. "I didn't hate him," she said. "He's my father, and it's hard to hate your father." The past continued to torment her, though, she said, and she became gripped by severe anorexia. Finally, 10 years ago, she underwent treatment at a respected medical center in California. The principal therapist she saw, who spoke on condition of anonymity because his institution preferred that, said that she told him of sexual abuse by her father and that he felt it was part of the cause of her anorexia and poor self-image. He said that he had seen many patients who told of sexual abuse, credible and not, and that he considered her entirely believable.
      The therapy led Ms. Hendra to write to her father about the accusations. Though she said she no longer had those letters, she said his replies were belittling. "He said I was in love with being a victim, that I was part of the Sally Jessy Raphael culture," she said. "And he said it's really not that big a deal." In one response that he read, Mr. Fuller said, Mr. Hendra told her that "maybe I'm guilty of leftist child rearing," and in another he said to her that "what we need to do is get together and write a play."
      Mr. Hendra said that Ms. Hendra did write him and tell him that through hypnosis she had recovered the details of being molested. "I was not only appalled, but I denied it categorically," he said. Her therapist said she did not undergo hypnosis and told of the incidents spontaneously, not through prompting or recovered memory.
      Her treatment ended her anorexia and bolstered her self-image, though she said she never achieved resolution with her father. About a year ago, she said, she began seeing a clinical psychologist because of lingering damage. The psychologist, who spoke on condition of anonymity, said, "She absolutely told me about the sexual abuse, and I have absolutely found her credible."

E-Mail Exchanges
Ms. Hendra said that when she expressed her anger to her father about his book several weeks ago, he explained that it wasn't a "comprehensive confessional." In the e-mail exchanges with her, he indicated that he had told Father Joe about her accusations and that he suggested she accompany him to see Father Joe, but that she refused. She said she had no recollection of that invitation.
      In one e-mail message, he told her that he was devastated by her reaction to his book and that his intention was, in part, to make amends to her. He wrote, "It's only a book and will be gone from people's attention in a few weeks." In the e-mail messages, Mr. Hendra does not admit he abused his daughter, but neither does he deny it. Asked during an interview why he didn't deny it, he said, "I didn't want to hurt her further."
      During the interview, Mr. Hendra at first simply impugned Ms. Hendra's accusations. When informed that friends and therapists said that Ms. Hendra had told them of abuse, he was quiet and sounded shaken and, saying that these were developments he was unaware of, asked if he could have five minutes to catch his breath and then call back.
      When he resumed the interview 45 minutes later, he was more collected. He suggested that Ms. Hendra made up the episodes because he left her and started a new family. "I don't want to say that my beautiful little daughter has a pathology, but that's what it seems to be," he said. "There is an enormous amount of invention going on." Carla Hendra, Mr. Hendra's wife, said she felt that "this is a reaction and a ploy to grab publicity."
      Tom Perry, the director of publicity for Random House, publisher of "Father Joe," said, "We have found Tony to be a truthful and caring person in every regard and the publication of his book a very positive experience." Unsure how to respond to the book, Ms. Hendra originally submitted an essay to the Op-Ed page of The New York Times. The paper chose instead to have a reporter look into her allegations. Last week, Ms. Hendra said that she told her father she was talking to a reporter and that he grew infuriated and vowed never to speak to her again "on this earth."
      In the bumpy path to this public denouement, Ms. Hendra said she believed that it was somehow ordained that it would end this way. Her husband agreed. "It's like that Frost poem, `Design,' about the moth and the spider and what brings them to the point where one eats the other," Mr. Fuller said. "I think this is inevitable. It was all leading up to this. These secrets just don't lie there."

Mental Toll on Troops Detailed
Raja Mishra, Boston Globe- 7/1/2004

Nearly one in five US combat troops returning from war-torn Iraq suffered from post-traumatic stress, major depression, or other serious mental afflictions, according to new data detailing the psychological costs of the bloodiest war in a generation. A study conducted by the US Army shows that combat-related mental problems have been higher among those who have served in Iraq than in any military action since Vietnam.
     It also paints the first broad statistical picture of the battlefield horrors encountered by the American combatants on the front lines in Iraq. For instance, one in four Marines surveyed reported killing Iraqi civilians. About one in five Army members surveyed reported engaging in hand-to-hand combat. More than 85 percent of those in Marine or Army combat units said they knew someone who had been injured or killed. More than half said they had handled corpses or human remains. The figures were based on soldiers' responses; the military does not have statistics available to confirm them.
     Up to 17 percent of these troops in Iraq suffered mental health problems, though less than half said they had sought professional help after ending their tours, according to the study, published today in the New England Journal of Medicine. "There's no question that these service members have truly experienced the spectrum of things that happen during the war," said Dr. Charles Hoge, psychiatry chief at the US Army Walter Reed Medical Center and lead author of the study. "This is real, sustained war."
     The Pentagon's health affairs chief, Dr. William Winkenwerder, said it was premature to compare service in Iraq with Vietnam, but added, "We can certainly surmise there's plenty of stress." With more than 800 US soldiers killed and more than 5,000 wounded, Operation Iraqi Freedom has become the deadliest American military conflict since the Vietnam War, in which some 58,000 Americans died.
     The new study's chief purpose was to gauge the effectiveness of mental health services provided by the military. The data indicated a dramatic improvement since the Vietnam era, when the military's mental health care was relatively unsophisticated. But the study still revealed gaps in the system, chief among them a continued stigma about mental illness among troops despite considerable educational efforts by Pentagon brass over the last decade. Also, nearly half of Iraq veterans reporting mental symptoms said they had trouble scheduling a psychiatric appointment.
     The mental trauma from the Iraq war appears to be approaching Vietnam-like levels for the 40,000-plus US soldiers in the thick of daily violence, according to the new study. Mental distress, particularly post-traumatic stress disorder, or PTSD, can hurt troops' morale, as well as disrupt their lives back home, producing flashbacks, insomnia, and alienation.
     Wartime psychology was in its infancy during the Vietnam conflict, and no comparable studies were done of soldiers during the war. Later research found that about 15 percent of troops who served there suffered PTSD. The most recent studies found that about 30 percent of Vietnam veterans had developed psychological problems after the war, as condemnation of soldiers by stateside critics exacerbated combat stress in someThe study found that 12 to 13 percent of troops returning from Iraq reported PTSD symptoms, and another 3 to 4 percent reported other mental distress. By contrast, PTSD estimates for veterans of the first Gulf War range between 2 and 10 percent. The rate is about 4 percent in the US adult population. The new Army study found about 11 percent of troops returning from Afghanistan reported symptoms of mental distress. The Army researchers found a direct correlation between PTSD rates and exposure to combat. In Iraq, 86 percent of Marines and 71 percent of Army troops surveyed said they were involved in firefights; five firefights per soldier was the median. Among those never encountering a firefight, 4.5 percent reported suffering PTSD-like symptoms. Those who said they had been in five or more had nearly a 20 percent rate of such symptoms.
     More than 6,000 Marines and Army soldiers from units involved in combat in Iraq and Afghanistan were surveyed for the study. The results, said the Army researchers, could be extrapolated to the roughly one-third of the 140,000 troops now in Iraq who regularly engage in combat. The other two-thirds serve support roles.
     The study said the front-line soldiers faced a horrific tableau of violence in Iraq. More than 90 percent said they had been shot at. Nearly 20 percent said they saved someone's life. More than 80 percent of Marines said they saw injured women and children they had been unable to help.
     Of those Iraq veterans surveyed who reported symptoms of mental distress, 40 percent of Army troops and 29 percent of Marines said they had sought professional help. The top reasons given for avoiding such help, from a multiple-choice list provided by the researchers, were, in order: "I would be seen as weak"; "My unit leadership might treat me differently"; "Members of my unit might have less confidence in me"; and "It would harm my career."
     The study's author, Hoge, asserted there was no evidence that soldiers receiving mental health treatment would suffer job discrimination. He said that all returning soldiers are screened for mental distress and referred to military psychiatrists when necessary. If requested, they can get confidential treatment outside the military health care system; the government covers the costs. "We're a lot better off now than ever in the past, in terms of the treatments available and the awareness," he said.
Lieutenant General James Peake, the Army's surgeon general, said of the study yesterday, "We do want to take care of our soldiers." He said the military had put unprecedented resources into mental health outreach. "We put extra mental health units . . . into Iraq. They're ubiquitous," he said.
     But Dr. Roger K. Pitman, a Massachusetts General Hospital psychiatrist specializing in combat-related PTSD, said the soldiers' fear of stigmatization was "not entirely unfounded." "A negative mental health review can hurt your military career," he said. Nonetheless, he said, "The system has become more cognizant of these disorders. In Vietnam, the percentage of soldiers seeking help was in the single digits."



1 in 10 Schoolchildren Face Sexual Misconduct
Ben Feller, Associated Press- 7/1/2004

WASHINGTON -- More than 4.5 million students endure sexual misconduct by employees at their schools, from inappropriate jokes to forced sex, according to a report to Congress. The best estimate available shows nearly one in 10 children faces misbehavior ranging from unprofessional to criminal sometime between kindergarten and 12th grade, says the report by Charol Shakeshaft, a Hofstra University professor. ''Most people just don't think this can really happen," said Shakeshaft, hired by the Education Department to study the prevalence of sexual abuse in schools. ''We imagine that all teachers are like most teachers, in that they've gone into teaching to help children. Most do, but not all." The report, required by the No Child Left Behind law and delivered to Congress yesterday, is the first to analyze research about sexual misconduct at schools.
      Some educators took issue with the way the report combines sexual abuse with other behaviors, such as inappropriate jokes, in one broad category of sexual misconduct. ''Lumping harassment together with serious sexual misconduct does more harm than good by creating unjustified alarm and undermining confidence in public schools," said Michael Pons, spokesman for the National Education Association, a union of 2.7 million school employees. ''Statistically, public schools remain one of the safest places for children to be."
      But the American Association of University Women, whose surveys of students were at the core of the report, stood by its research. And Robert Shoop, a Kansas State University professor of education law and a specialist on the problem of sexual exploitation in schools, said the estimate that one in 10 children endures abuse is not high. The actual number may be larger, he said, because of underreporting of the problem.
      There have been no nationally financed surveys of how common sexual misconduct is in school, one of many areas Shakeshaft suggests must be addressed. She examined existing research, finding almost 900 documents that have dealt with the topic in some way. Among those, the best estimate of misconduct came from surveys in 2000 of students in grades eight to 11, Shakeshaft said. That research, commissioned by the AAUW Educational Foundation, found nearly 9.6 percent of students had been sexually harassed or abused by school workers.

Treatment for Boys to Be Phased Out at Adrian Youth Center
Jack Kresnak, Detroit Free Press- 7/1/2004

The 123-year-old Adrian Training School, which some state officials wanted to closed to save money, will remain open and see its programming expanded and enriched, the director of the Michigan Family Independence Agency said Wednesday. But the training school will no longer admit boys, and the 34 youths in the male sex offender treatment program will be phased out over the next several months, FIA Director Marianne Udow said. As youths graduate from their treatment program, the two units will be reduced to one 20-bed unit. During the next several months, new placements will be found for those who have not completed their programs, Udow said. The decision to save the training school came about "very much because of the extensive community involvement," Udow said.
      While many neighborhoods and communities want nothing to do with a residential facility for juvenile delinquents, the residents in and near Adrian have welcomed and supported the training school. The open, campus-like school has reported few escapes or other serious problems. The 100-bed facility has 132 employees and an $11-million annual budget. Udow said she hopes to turn the Adrian Training School into "the premier juvenile justice treatment program for girls in Michigan."
      Juvenile justice officials at the FIA had proposed sending the boys and girls at Adrian to the W. J. Maxey Training School in Green Oak Township. It would have been the first time girls would have been placed on the Maxey campus.
      Cynthia Gray, one of Adrian's 35 citizen volunteers, said her group, called Citizens for Youth Advocacy, generally was happy with Wednesday's announcement but skeptical about the FIA's intentions for the long term. Gray said she doesn't believe anyone, boy or girl, should be transferred to Maxey, where a recent report from the U.S. Justice Department found several civil rights violations.
      Udow said several national and local juvenile justice experts had recommended changing the Adrian Training School to an all-girl campus.

Empathy for Mentally Ill Increasing, Survey Shows
Rosanna Ruiz, Houston Chronicle- 7/1/2004

When Philip Burguieres resigned as head of a local Fortune 500 oil-field service company in 1996, he and his family felt crushing embarrassment from news reports about the unexpected move, blamed on stress, he said. A year later, he publicly disclosed he had suffered from "debilitating depression." He made the announcement despite warnings the consequences would ruin his career and personal life. "Exactly the opposite happened -- friends and other CEOs reached out to me," said Burguieres, chairman emeritus of Weatherford International and vice chairman of the Houston Texans.
      His experience likely can be retold many times today as public perception and understanding of mental illnesses continues to improve -- an attitudinal shift recorded by the Houston Area Survey completed in March. The majority of respondents, 63 percent of 650 random Harris County residents, said mental illness is primarily due to a brain disorder while only 5 percent cited a character flaw as the reason. The Mental Health Association of Greater Houston released the results of the mental health portion of the survey at a news conference Wednesday.
      The findings demonstrate an "evolving understanding" of mental illness that has markedly improved since a 1996 national survey showed 35 percent of people surveyed attributed mental illness to sinful or immoral behavior, said Stephen Klineberg, a Rice University sociology professor. "Sometimes you think you know how the world looks -- we were surprised. This was quite a striking picture," said Klineberg, who has directed the survey of local attitudes and demographics since 1982. "This shows that public perception has moved to a more enlightened view than expected."
      This year's survey included six questions regarding mental health -- the first scientific assessment of public perception regarding mental health conducted in a metropolitan area such as Houston, Klineberg said. The survey shows the declining social stigma associated with mental illness and the willingness to support legislation mandating mental health insurance parity, officials said. "We believe these are extraordinary findings," said Betsy Schwartz, executive director of the local MHA, which asked Rice University to include mental health issues in the survey. "The results of this survey support our efforts to encourage companies to provide insurance coverage that offers mental health benefits equal to medical and surgical benefits."
      Klineberg said the next survey will delve deeper into perceptions about specific mental illnesses. The use of the word "mental illness" often conjures up the most severe forms such as schizophrenia, bipolar disorder or clinically severe depression, while the term "mental health" is associated with less severe anxiety, panic or eating disorders.
      Despite the report's findings, the fear of being socially ostracized prevents many people from admitting they have a mental illness. Burguieres, who spoke at Wednesday's news conference, said he knows of many CEOs who pay in cash for visits to a psychiatrist so no record ties them to the treatment. Many people, he said, are also visibly uncomfortable when filling prescriptions for antidepressants. Still, he said, the results show a positive change in public perception. "Mental illness will be viewed very soon as a normal illness just like arthritis or anything else," Burguieres said.
      Other findings of the survey on mental health:
* Democrats and liberals are more likely than Republicans and conservatives to approve legislation requiring corporations to provide mental health insurance or raising taxes to improve access to mental health care.
* Minorities are more liable than whites to be concerned if someone in their neighborhood is being treated for mental illness.
* Women are more inclined than men to agree that most people undergoing treatment can lead a normal life.
* Those who know someone with mental illness were more likely to favor equal insurance coverage and higher taxes for greater access to services. They also had a greater belief in the efficacy of treatment.

Brain Therapy May Ease Alzheimer's
Judith Graham, Chicago Tribune- 7/4/2004

People in the early stages of Alzheimer's disease retain the ability to learn and can benefit from therapies designed to stimulate the brain, two new research studies show. The reports add to a growing body of evidence indicating that Alzheimer's harms certain memory functions while leaving others relatively intact in its initial phases. "The findings are very exciting because they give us a different handle on how the brain handles memory in its different forms," said Dr. Marsel Mesulam, director of cognitive neurology at Northwestern University. Because it harms certain brain functions while not disabling others, "Alzheimer's disease is a condition that allows us to ask questions about the human brain and how it functions and undertake experiments that otherwise would be impossible," he said.
      From a practical perspective, the studies advance prospects for developing therapies to strengthen mental functioning for people struck by Alzheimer's that could be administered in combination with drug therapies. "What we're learning is that this disease is not as bleak and uniformly un-modifiable as we formerly thought," said Robert Wilson, professor of neuropsychology at Rush University Medical Center.
      One of the areas of the brain most affected by Alzheimer's is the medial/temporal lobe, especially the hippocampus, which consolidates and stores short-term memories. It's why people with this disease often can't say what they ate for lunch or where they put things or who they spoke to on the phone. But other types of memory that appear to rely on different neural systems in the brain remain accessible, several research studies have demonstrated. These include motor memory, such as how to ride a bike, or procedural memory, such as how to count from one to 10.
      David Loewenstein, a professor of psychology and behavioral sciences, set out to explore if a combination package of therapies stimulating these mental processes, combined with drug therapies, could enhance the functioning of Alzheimer's patients early on in the disease. Loewenstein is director of research at the Wien Center for Alzheimer's Disease and Memory Disorders at Mount Sinai Medical Center in Miami Beach; his study was funded by the National Institute on Aging.
      The report, published Friday in the American Journal of Geriatric Psychiatry, found that mildly impaired Alzheimer's patients showed marked improvements in their ability to recall faces and names (170 percent) and their ability to calculate change after a purchase (71 percent). The patients each received 24 sessions of mental training.
      For the first time, the study demonstrated that people with Alzheimer's could be taught to process information more rapidly, compensating for impaired mental acuity. It also established that patients who kept "memory journals" were significantly better oriented to time and place. "The exciting thing about this research is it tells us [early stage Alzheimer's] can learn if you give them the right kind of tasks that work around their neuropsychological deficits," Loewenstein said. Historically, research has looked at how to modify Alzheimer's patients' behavior so they're less disruptive in interactions with caregivers. "Now we're moving into a more hopeful arena by looking at what can be done to enhance those cognitive functions that are preserved early on in the disease," said Neil Buchkoltz, chief of the dementias of aging branch for the National Institute on Aging.
      The second study published last month in Neuron is the first to measure brain activity in people with Alzheimer's when they are exposed to repeated images--in this case, words--at various intervals over a period of time. This kind of repetition is thought to involve "implicit" memory, or things we know through repeated exposure without consciously thinking about them, such as the steps involved in driving a car through traffic.
      Previous research has indicated implicit memory is preserved in people with mild symptoms of Alzheimer's. The new Neuron study shows that brain activity related to implicit memories was essentially the same in older people and Alzheimer's patients. This suggests "even with Alzheimer's, brains can still benefit from practice," said lead author Cindy Lustig of Washington University's department of psychology. An estimated 4.5 million Americans have Alzheimer's; of those, more than half are in the early stages of this illness.

Older Women, Too, Struggle With a Dangerous Secret
Bonnie Rothman Morris, New York Times- 7/6/2004

Mention anorexia or bulimia, and what comes to mind is a skin-and-bones teenager caught in a ferocious struggle to be thin. But doctors say they are seeing a disturbing trend: a growing group of women in their 30's, 40's and 50's who have eating disorders. Most have husbands, children, jobs and aging parents. They live with their secret while trying to manage the other aspects of their lives.
      Lori Varecka, 44, said she hid her bouts of starving and purging from her husband, her mother and her three children for more than two decades. But by 1997, what Mrs. Varecka was hiding was plain to see: At 5 feet 7 inches, she weighed 94 pounds. That year, she admitted to her doctor that she was ill. Eventually, she also told her family.
      In some cases, experts say, older women with eating disorders know something is wrong, but they do not give a name to their problem. Some feel ashamed to have an illness normally associated with teenagers. "Women feel so invalid. They feel that they should grow up," said Dr. Margo Maine, an eating disorders expert in Hartford and the author of a coming book on midlife eating disorders, "The Shape We're In: Overcoming Women's Obsessions with Weight, Food and Body Image." No one knows how many older women have the disorders. Many have struggled with anorexia or bulimia for decades. Others vanquished their eating disorders as young women, only to relapse later. Another group first develops anorexia or bulimia in midlife.
      Doctors suspect that most women who develop the disorders at midlife have been overly concerned with weight and body image throughout their lives. Sudden onset of an eating disorder is very rare, they say. "Lots of people in our culture diet," said Dr. Walter Kaye, the principal investigator in an international study of the genetics of eating disorders. "Relatively few end up with an eating disorder."
      In March, Dr. Kaye's study expanded the criteria for participation to include women who developed an eating disorder after the age of 25. The five-year study was already well into its second year when the criteria were changed. But so many older women were calling to volunteer that the researchers thought it prudent to include them.
      Anorexics severely restrict their calories. Bulimics binge and then purge, either by vomiting or by taking laxatives. Both groups often exercise excessively. Older women with eating disorders, experts say, have much in common with teenagers who suffer from the illnesses. Isolation, loneliness, lack of self-esteem and a drive for perfection are present for older women, too. What differs are the triggers that set off the disorders. "Loss may be a particular issue for midlife women; sexuality may be a burning issue for younger people," said Dr. William Davis, vice president for research at the Renfrew Center, a Philadelphia-based residential treatment center for eating disorders.
      A child going off to college, or the loss of a spouse or a close relative, can set off eating problems. In some cases, women fight against the loss of their bodies, as they gain the 10 to 15 pounds typical during the natural course of menopause. When Valerie Garcia turned 40, she said, she "didn't want to accept that." At the time, her 12-year-old daughter was suffering from depression and she felt powerless to help. To gain some control, Mrs. Garcia, of Valley Stream on Long Island, went on a diet. Pretty soon, she was abusing laxatives and purging. It was Mrs. Garcia's second battle with anorexia and bulimia. At 25, she was treated in an in-hospital program and had stayed well for 15 years. Her husband encouraged her to get help each time. But some patients say their husbands have no idea they are ill. Nancy Harris, who struggled with anorexia for decades, said her husband never said a word, though the two were business partners and rarely separated. "He just thought I had funny eating habits," said Mrs. Harris, 54, who lives in Rhode Island and is now improving.
      Many primary-care doctors also do not notice. "Many doctors who have not been exposed to eating disorders really have difficulty in suspecting it and making the diagnosis," said Dr. Ira Sacker, a co-author of "Dying to Be Thin" (Warner Books, 1987) and the director of adolescent and young adult medicine at the Brookdale University Hospital and Medical Center in Brooklyn. Other experts said primary-care doctors might turn a blind eye because the problem seems intractable. Chronic sufferers often do not know how to live another way: their eating disorder is their identity. "The binging and purging becomes a habitual mode of living, of daily life," said Dr. Bart Blinder, the director of the eating disorders program at the University of California, Irvine. "It's a tension relief, anxiety relief, a mechanism of dealing with loneliness and separation."
      Patients with eating disorders can suffer serious mental and physical consequences. Anorexia can lead to osteoporosis, cardiac problems, thinning hair and skin that bruises easily. Severe tooth decay and gastrointestinal problems are frequent complications of bulimia. Researchers have found that anorexia in particular is one of the most deadly mental disorders: in one study that followed patients for 30 years, 18 to 20 percent of the women died. For middle-aged women, the physical toll may be more severe than for younger women, whose bodies are more resilient.
      Older women with eating disorders can recover, experts say, but it may take years. The relapse rate is as high as 20 percent. Unlike younger patients, who may be treated at their parents' urging, adults generally seek help on their own, and can leave just as easily. Yet doctors report that many older patients who seek treatment are highly motivated to get well. "It's easier to treat them in that they have the insight," said Dr. Kathryn J. Zerbe, vice chairwoman for psychotherapy at Oregon Health and Science University in Portland.
      In-hospital treatment programs that accept older patients -- some do not -- are recording an increase in patients. Recently, five or six women over 35 checked into the Renfrew Center in a single week, said Dr. Davis. At the Remuda Ranch center in Wickenburg, Ariz., the number of patients over 40 has risen to 11 percent this year, from 3 percent in 1990, when the center opened, said Dr. Edward Cumella, its director of research, education and quality.
      The treatment offered by such programs is somewhat modified for older patients. Like younger women, they receive medical care, psychological counseling and nutritional counseling. Group therapy is common, but putting older patients with teenagers may not always work. Individualized therapy also works well for older patients. But doctors say recovery is often a compromise, with patients and doctors accepting tiny slices of success. "People don't come to treatment with the idea that they would like to change themselves, and some don't want to change much at all," said Dr. David Herzog, founder of the Harvard Eating Disorders Center at Massachusetts General Hospital in Boston. Outside factors, like a desire to maintain a marriage or to avoid being a burden to their children, are often motivators.
      After Mrs. Varecka told her family that she was ill, she was in and out of an inpatient program near her home in suburban Minneapolis four times over the next two years. Today, she is still preoccupied with her body, and though she has not looked at a scale in two years every day is a struggle, she said. "It's a torment; it's the devil," Ms. Varecka said. "Unfortunately, it affects other people in my life."

Drug Firms Violate U.S. Law By Not Registering Trials
Shankar Vedantam, Washington Post- 7/6/2004

The pharmaceutical industry has repeatedly violated federal law by failing to disclose the existence of large numbers of its clinical trials to a government database, according to the Food and Drug Administration. Doctors and patients say that compliance with the law would go a long way toward addressing their growing concerns that they are not being given the full picture about the effectiveness of many drugs because they are not told about drug trials that fail. The issue has gained urgency with recent disclosures that the publicly available research on treating children with antidepressants obscured the fact that in most studies, the drugs were no better than sugar pills. Drugmakers chose not to publish those studies.
      The 1997 law is so little known that scientific journal editors and professional medical associations have recently debated whether to create a system of private incentives for disclosure of trials. When she was told the law already requires companies to register trials, Catherine DeAngelis, editor in chief of the Journal of the American Medical Association, said, "That's a surprise to me. Tell me why it's not enforced." Although the law was primarily passed for other reasons, DeAngelis said it could very well address her concerns. The FDA acknowledges it has not enforced the law -- officials said the statute did not spell out penalties or explicitly give the agency authority to crack down on violators.
      An FDA analysis found that in 2002 only 48 percent of trials of cancer drugs had been registered, and a preliminary review now indicates the listing rate for drugs for some other serious diseases is in the single digits. Some companies have listed no studies; some trials are listed without identifying the sponsoring company or the drug being tested.
      As of Friday, the database, ClinicalTrials.gov, listed 5,754 ongoing studies, but only 13 percent were industry sponsored. The federal government, mainly the National Institutes of Health, accounted for 55 percent. Those proportions are in stark contrast to the true picture, DeAngelis said. "Over 80 percent of trials are funded by for-profit companies, not by the government," she said. FDA officials said they are re-examining whether they have the power to step in. Members of Congress are also considering adding enforcement provisions to the law, which was part of the FDA Modernization Act of 1997.
      The registry was begun in 1998 and the ClinicalTrials.gov site went online in February 2000, said Alexa McCray, director of biomedical communications at the National Library of Medicine, which hosts the registry. Since then, nearly 11,000 trials have been registered from all 50 states and 90 countries. Virtually all studies sponsored by the National Institutes of Health are listed, and industry trials started coming in after March 2002, when the FDA issued a formal "guidance" on implementing the law.
      Although some companies say they are amenable to wider disclosure, the patient advocacy group that fought the hardest to create the requirement predicted it would never be enforced.
"Obviously it needs an enforcement mechanism attached to it," said Abbey S. Meyers, president of the National Organization for Rare Disorders. "I can guarantee you, however, that the full force of the drug industry will stop it. They don't want you to know about clinical trials that fail. They are afraid what it will do to their stock price. A lot of trials are for drugs already on the market, and it would ruin their sales if the news got out."
     The Pharmaceutical Research and Manufacturers of America countered that the registry had initially been slow to list industry-sponsored trials, and that companies started supplying the information after the FDA issued its guidance. Alan Goldhammer, PhRMA's associate vice president for regulatory affairs, said he had heard anecdotally that companies are now fully complying with the law.
      But Theresa Toigo, director of the FDA's Office of Special Health Issues, painted a different picture. "Many pharmaceutical trials are not participating in ClinicalTrials.gov or are not fully participating," she wrote in a recent report in the Journal of Biolaw and Business. Responding to assertions by PhRMA that the 2002 data do not reflect the current situation, she said, "It's not like we've seen a big increase in the monthly submissions of privately sponsored protocols."
      Sen. Edward M. Kennedy (D-Mass.), who helped create the registry in 1997, plans to seek revisions to enforce the registration requirement and to find a way to report study results. Meyers and Paul Kim, a former Kennedy staff member who now works for the law firm Foley Hoag LLP, said the original purpose of the registry was to link patients who wanted to join clinical trials with the researchers. The law required companies to register all effectiveness trials, known as Phase 2, 3 or 4 studies, for serious and life-threatening diseases. In 2002 , the FDA defined "serious" diseases broadly, including everything from AIDS and cancer to arthritis, depression and diabetes.
      Some companies have boasted to stockholders of having many ongoing studies in the pipeline but not listed any with the registry. Forest Laboratories Inc., which recently touted results for an Alzheimer's disease drug called memantine and last month published a children's depression study showing positive results for its antidepressant Celexa, has no trials registered. Company spokesman Charles Triano said the law does not require companies to register trials if other drugs are available for the same disease. Triano said the company did not need to list its trials of memantine, a new class of Alzheimer's drug, because the FDA had not given it the "fast-track" status reserved for breakthrough medicines and deadly diseases with limited treatments. The FDA's Toigo said the law required companies to register trials whether or not medicines exist for the disease. "It doesn't say anything about existing drugs on the market," she said.
      Although 246 pharmaceutical and biotech companies had ongoing trials in the database Friday, about half listed just one. GlaxoSmithKline had five, but spokesman Rick Koenig said many of the company's trials are not listed under the company's name. "We didn't understand that to be a requirement or the sort of information that is of use to a patient looking into where that patient might enroll in a trial," he said. Toigo said the FDA's 2002 guidelines called for companies to include their names.
      Journal editor DeAngelis, who is helping spearhead an editors' initiative to get all trials registered, said a government-enforced registry would be vastly superior to any system of private incentives. "It will come as a surprise to the vast majority of your readers," she said about the law's requirements. "I had personally assumed it was only for federally funded clinical trials."
      Toigo said her analysis of industry compliance, which she hopes to complete by the end of the year, will examine whether more than 2,000 trials submitted to the FDA by companies seeking approval for medicines in 2002 had been properly listed.
      Companies are hesitant to register trials because they want to control data, said Kay Dickersin, a professor at Brown University who has sought such data for two decades. Some are worried that trade secrets will leak out, or that a competitor will poach on patient networks. Others don't want patients to petition them for medicines on "compassionate grounds." One way to increase registration, said Dickersin, is for patients to insist trials be registered before participating. Drummond Rennie, a professor at the University of California in San Francisco, added that physicians who conduct trials for companies "should examine their consciences" before agreeing to let trials be kept secret.
      "If I buy a camera and the thing falls apart, it's a lemon, I shrug and say I'm never going back to that firm," said Rennie, who is also deputy editor at JAMA. "But if I get a drug and it makes me worse, it can kill me or maim me. "We give pharmaceutical companies a lot of tax advantages and a whole lot of support in the Congress and a good business environment and patent protection," he said. "They owe us more information."

Drug Makers Accused of Aiding in Deaths
Mark Scolforo, Associated Press- 7/6/2004

HARRISBURG, Pa. -- A psychiatrist has filed a federal lawsuit alleging that children have been harmed and even killed by the misuse of drugs he blames on aggressive marketing by drug manufacturers. Dr. Stefan P. Kruszewski claims he was fired in July 2003 from a consulting job at the Pennsylvania Department of Public Welfare because he reported "fraud and other violations of civil and criminal law constituting pervasive abuses." Kruszewski accuses the drug companies of distorting statistics, violating regulations and exaggerating the effect of their psychotropic products -- practices he says have victimized juvenile wards of the state, mental patients and prisoners. Allegedly "corrupt practices" by drug companies described in the suit include overmedication of patients, fraudulent billing, abuses of Pennsylvania's involuntary commitment law and "mistreatment of children resulting in deaths in Pennsylvania, Texas and Oklahoma."
     Don Bailey, Kruszewski's lawyer, said patient confidentiality rules prevented giving specific examples of patients who have died as a result of the alleged practices. Defendants include Public Welfare Secretary Estelle B. Richman; Columbus Medical Services, the consulting company Kruszewski worked for; and drug makers Pfizer Inc., Johnson & Johnson, Novartis, AstraZeneca, GlaxoSmithKline and Eli Lilly & Co. The drugs at issue include Paxil, Neurontin, Gortan, Seroquel, Topmax, Risperdal, Trileptal and Zyprexa.
     The suit was filed Thursday in Harrisburg federal court. The defendants or their spokesmen either did not return phone messages or declined comment Tuesday. The suit says Kruszewski conducted medical reviews and appeals for Public Welfare and served as a medical-psychiatric consultant for the department's Bureau of Program Integrity. Kruszewski seeks damages of more than $1 million for future lost wages and for allegedly being deprived of his right to speak out on matters of public concern without retaliation. He also alleges fraud, defamation and conspiracy.

Counseling Service Helps Adult Survivors of Sexual Abuse
Claudia Rowe, Seattle Post-Intelligencer- 7/6/2004

There is no sign on the door to Shepherd's Counseling Services, where dozens of adults recount devastating moments from their early lives, no marker to show what goes on inside or how close the agency came to fading away altogether. The anonymity is fitting. Child sexual abuse is still largely hidden from mainstream discussion, and Shepherd's chronic financial problems were equally obscure to its therapists. But with the help of a former client, three of the center's counselors are taking a bare-knuckles approach to ensuring that both the issue and the agency gain new prominence.
     The notion of a non-profit in financial need is hardly new, but when Shepherd's board of directors sounded the death knell last fall, therapists Janice Palm, Barbara Brodsky and Doug Holwerda -- none of whom had much fund-raising experience -- resolved to ignore the pessimists and run the office themselves. They met on Sundays to handle paperwork, went without pay or accepted minuscule fees, and now, 10 months later, have managed to keep the Capitol Hill office afloat without ever breaking stride. "This was an opportunity to say, 'OK, we think we're helping? We believe in this kind of work? Well, let's really walk our talk,' " said Brodsky, who has been with the office almost all of its 18 years.
     For Palm there seemed to be little choice. During end-of-days board meetings she'd think of her clients -- a man who hadn't been able to ask for help until reaching his 70s, a woman who'd searched for years before finding an agency dedicated solely to helping adult sufferers of childhood abuse; another so fragile that Palm found herself mentally rehearsing a "we have to close" speech, just to achieve a gentle enough tone.
     None of them was turned away, and while scrambling to keep Shepherd's afloat, the therapists discovered in themselves a newfound commitment for community education about child sexual abuse. "There's a lot of silence surrounding this -- these people have been silenced -- so I found myself really wanting to advocate and support," said Holwerda, who splits his time between running a men's group at Shepherd's and working with teens as a mental health counselor at Roosevelt High School. "Even today, people are reluctant to face the issue. They're pretty naïve that this abuse happens and even more so about its ramifications."
     Cathy Rider can detail them in spades -- the inability to sleep, function normally or manage relationships. Her own childhood experience resulted in memories so crippling that the one-time banking executive suddenly could handle work no more complex than packing software on the night shift at Microsoft Corp. At 40, after 20 successful years of marriage and a high-powered career, Rider was starting to implode. "It meant that instead of being a management consultant, I put labels on boxes," she said.
     When Rider went to her family for help, gingerly raising the issue of a relative who had molested her throughout childhood, the reaction from some was swift and firm as a door slam. There were years of therapy for Rider, her husband and sons -- all of whom suffered as she worked to rebuild her psyche. But late last year, once again on her feet, she agreed to serve as a new board member and help the agency she credits with saving all of them. "I struggle with the effects of child sexual abuse every single day, and I have a great life," she said. "If I had not gotten the help -- if our family had not gotten the help -- my sons would not be giving back as they are today. I know I wouldn't be around and I know one of my sons wouldn't be around either."
     Shepherd's financial problems stemmed from a confluence of events -- recession-era budget tightening for social-service agencies across King County, coupled with poor deployment of the funds they already had. Vera Gallagher, a nun who had written several books on surviving sexual abuse, started the agency in 1987 and Shepherd's had always relied on her sheer charisma to drum up support. But after Gallagher died in 2002, there was little in the way of a contingency plan. Her estate went to fund scholarships for clients, instead of seeding the future, and once the money was gone, there was nothing to replenish it. "Things are very different than they were 10 years ago for agencies doing this kind of work," said Mary Ellen Stone, executive director of the King County Sexual Assault Resources Center, who has referred clients to Shepherd's. "But the need is still very much there."