A proposal that antidepressants carry a prominent warning that the drugs can increase the risk of suicide in children has made some family practitioners and pediatricians hesitant to prescribe the medications. But doctors said they will likely send young patients to psychiatrists, many of whom believe in the drugs and will continue prescribing them. Based on a recommendation this week by two federal advisory panels, the Food and Drug Administration is likely to order drug makers to include the most stringent warning label — a "black box" — in packaging, advertisements and information sent to doctors.
      The committees analyzed data from nearly two dozen clinical trials and concluded that minors given the drugs were 2% to 3% more likely to have suicidal thoughts than those given placebos. The same trials also failed to show that the drugs worked in children, with the exception of Prozac. Nobody in the clinical trials committed suicide.
      Some psychiatrists said they were unlikely to be dissuaded from writing prescriptions. They consider the trials too limited in scope and argue that it is far from clear that the drugs do no good. In 2002, 10.8 million antidepressant prescriptions were for children, about 7% of the total, according to the FDA. The recommendation from the FDA committees "is going to force more discussion between doctors and patients," said Dr. Carl Feinstein, a child psychiatrist at Stanford University. "Doctors are reluctant to change prescribing practice because they have a lot of experience that tells them the drugs are effective."
      The most important message from the debate, doctors said, is that young patients taking the medications should be closely monitored, particularly when they are starting a regimen or changing dosage. That is why nonpsychiatrists said they would be more likely to defer to their expert peers rather than prescribe the drugs themselves. According to the FDA's most recent statistics, from 2002, psychiatrists already write about 65% of antidepressant prescriptions for people under age 18. Family practitioners and pediatricians account for just over 25%.
      Some of those doctors, such as Dr. Eleanore Meyer, a Santa Monica pediatrician, prescribe the drugs only in consultation with psychologists or social workers, who provide therapy but are not licensed to offer medication. With the new proposal, she said she would refer depressed patients to psychiatrists. "We're going to be pretty hesitant to use these medicines," she said. When British medical authorities last year warned that the antidepressant Paxil increased the risk of suicide in youths, Meyer ordered that her patients be weaned off it. "It's really hard when a patient is already on a medicine and doing well," she said.
      But it is far from clear that a labeling requirement would result in fewer overall prescriptions of antidepressants for children. After the FDA ordered drug makers to include a milder warning of a possible suicide link in March, antidepressant prescriptions for minors rose at the same pace as prescriptions overall — about 7%. Drug industry analysts do not believe a black box warning would have much effect on demand for antidepressants.
      Other black box warnings have led to a shift to drugs without the warning and not an overall decline in prescriptions for a particular class of drugs. But the current recommendation would apply to all antidepressants. There are no alternative drugs. "This time next year there should be very little difference in the growth rate for these drugs in the U.S.," said Neil Sweig, a pharmaceutical analyst at Fulcrum Global Partners, a stock research firm in New York. Nor is the warning likely to spark a legal backlash that could stall sales, experts said. Suicide is a complex behavior related to many factors, and it would be difficult to prove in a specific case that a drug caused an already depressed person to commit suicide. "Maybe in the entire country you can find 30 children who died from this, and that is 30 too many, but it isn't something that all of a sudden is going to gin up an industry for the plaintiffs' bar," said Jonathan M. Zasloff, a UCLA law professor.
      While the warnings could deter some parents from agreeing to put their children on antidepressants, most would likely follow the advice of their physicians, doctors predicted. It could, however, become more cumbersome for children to get the medications. Managed-care administrators may find themselves having to process more referrals to psychiatrists. There are just 6,000 child psychiatrists nationwide and 1 million to 2 million minors taking antidepressants.
      Nonpsychiatrists will eventually have to "educate themselves as to what constitutes a major depression," said Dr. Richard Gorman, a pediatrician in Baltimore and a representative of the American Academy of Pediatrics. Antidepressants are not for people who are "blue or a little sad for a while."
      Dr. Donald Errante, a behavioral pediatrician in Greenbrae, Calif., has been giving parents an information sheet warning of the side effects of the antidepressants he prescribes to dozens of patients. Now, he is considering having them sign a waiver accepting the risks. "I can live with the black box warning," he said, "as long as they don't take the drugs away."



Parents Wary of Antidepressants for Kids
Associated Press, 9/18/2004

WASHINGTON -- Alarmed at a recommendation that antidepressants for children carry a strict new warning label, some parents are not letting their kids take the drugs as part of a clinical trial for young people who have attempted suicide. Government health advisers said last week the labels on these drugs should have bold warnings surrounded by a black box to draw attention and say that, in some cases, the medication increases suicidal thoughts and behavior.
      A study financed by the National Institute of Mental Health is designed to determine whether treatment -- medication or behavioral therapy, alone or combined -- can prevent future suicide attempts. Children enrolled in the small pilot study have attempted suicide previously, which normally would exclude them from such scientific trials.
      Dr. Graham Emslie, principal investigator at one of the study's five sites, said only 15 percent of children diagnosed as depressed take medication. ``We're trying to increase the number who are treated,'' said Emslie, who works in Dallas, and the black box warning ``is definitely not going to help.''
      The Food and Drug Administration said it generally supports the recommendation from the advisory panel that labels on antidepressants have warnings about increased risk of suicidal thoughts and behavior. For every 100 children taking antidepressants in controlled clinical trials, an additional two to three experienced increased suicidal tendencies.
      In the trial, the parents of a child who had attempted suicide within the previous 45 days -- a requirement to participate in the study -- refused to let researchers use an antidepressant as planned. In a second instance, divorced parents could not agree whether their suicidal child should take the medication. Emslie said two refusals by parents in a single week, each citing the advisory panel's comments, mark the beginning of a worrisome trend. ``I don't think it was isolated. I think it will continue,'' Emslie said. On Capitol Hill, lawmakers are pushing for greater disclosure of the results from drug clinical trials.
      The FDA said last week it has begun to adopt more strident warning labels for all antidepressants, not only those involved in pediatric clinical trials: Celexa, Effexor, Luvox, Paxil, Prozac, Remeron, Serzone, Wellbutrin and Zoloft. The agency has not yet said whether that will be a black-box warning as the advisory panel recommended.
      Last week's public hearings on the issue have led to changes already in how antidepressants are prescribed. For psychiatrists like Dan Medeiros, the push to ensure that doctors first discuss the medication's risks and benefits simply reinforces what he has done for 14 years. Medeiros runs a day treatment program for New York teenagers who skip school or fail because of depression. Medeiros' warnings already include the risk that an antidepressant can boost energy. ``People can be so depressed they don't even have the energy to get out of bed. If the medication starts improving energy level ... you then have the means to commit suicide,'' he said.
      John March, chief of child and adolescent psychiatry at Duke University Medical Center, said he's inclined to prescribe Prozac first among the new generation of antidepressants. The federal recommendations won't change that since three studies, including one led by March, point to Prozac's effectiveness.
      Kathy Bruce's husband, Marty, killed himself in 1993, and her 10-year-old daughter, McLain, was diagnosed as bipolar in May. For the past month, the girl has taken Zoloft, which is linked to increased suicidal thoughts among children. When prescribing the drug, McLain's doctor mentioned a ``small risk'' associated with the antidepressant, Kathy Bruce said. ``It was a risk I was willing to take,'' Bruce said from her home near Atlanta. ``She's coming home every day happy and loving school.''
      Dr. Phillip Kennedy said he limited antidepressant prescriptions after the FDA in March sent a warning letter to doctors. A black box warning would make prescribing physicians and drug companies ``liability targets,'' Kennedy said. His strategy has been to tell slightly depressed adolescents and their parents that a drug could help, but that he would prefer that a psychiatrist prescribe it. ``You get resistance from the mother and child. It's a weekly occurrence, if not more,'' Kennedy said. In Augusta, Ga., where Kennedy runs a family practice, he said youths can face a three-month delay before seeing a psychiatrist.
      Dr. Elissa Benedek, past president of the American Psychiatric Association, said referrals to mental health specialists are likely to increase. ``If it makes some people more careful and more thoughtful about what they do, it's not a bad thing,'' said Benedek, a child psychiatrist in Ann Arbor, Mich.



When Gender Isn't a Given
Mireya Navarro, New York Times- 9/19/2004

At the moment after labor when a mother hears whether her new child is a boy or a girl, Lisa Greene was told she had a son. She named her baby Ryan and went home. Ms. Greene learned five days after the birth that her baby was really a girl. Doctors who ran tests diagnosed congenital adrenal hyperplasia, a condition that, put simply, can make baby girls' genitals look male. As the young mother struggled to get over her shock, to give explanations to relatives and put away the blue baby clothes, she also had to make a decision: whether to subject her daughter to surgery to reduce the enlarged clitoris that made her look like a boy, or leave it alone. Thus Ms. Greene, a 26-year-old cashier in East Providence, R.I., was thrown into a raging debate over a rare but increasingly controversial type of cosmetic surgery.
      For decades, parents and pediatricians have sought to offer children whose anatomy does not conform to strictly male or female standards a surgical fix. But the private quest for "normal" is now being challenged in a very public way by some adults who underwent genital surgery and speak of a high physical and emotional toll. Some of them gave tearful testimony at a hearing last May before the San Francisco Human Rights Commission, which has taken up the surgeries as a human rights issue and is expected to announce recommendations before the end of the year. They spoke of lives burdened by secrecy, shame and medical complications: some said the surgeries robbed them of sexual sensation and likened the procedures to mutilation; others said they were made to feel like freaks when nothing was really wrong with them. But a more common argument was that the surgeries are medically unnecessary and should at least wait for the patient's consent. Some doctors are starting to agree. "Everyone's rethinking this," said Dr. Bruce Buckingham, associate professor of pediatric endocrinology at Stanford University. "We're probably a little less aggressive than we used to be. There's a lot of opinion."
      But more opinions and inconsistent medical practices have made the decision tougher than ever for parents, many of whom are confronted with the word "intersex" for the first time. The term describes cases that arise from a host of conditions that cause sex chromosomes, external genitals and internal reproductive systems not strictly to fit the male or female standard.
      Although no national statistics are available on the surgeries, some pediatric urologists and surgeons say they are doing fewer of them early. Doctors say the majority of cases involve girls with congenital adrenal hyperplasia, or C.A.H., a hereditary disorder that affects the synthesis of adrenal hormones and leaves girls with high levels of male hormones. The condition may cause not only male-looking genitals, even in the presence of fully formed ovaries and uterus, but also personality traits and interests typically associated with boys.
      The incidence of anomalous genitals in C.A.H. patients is not known precisely, but some studies indicate it may occur in as few as one in about 30,000 births because only girls are affected. Surgeries for other intersex conditions are even rarer, doctors say. But for the minority of parents who must choose whether surgery is the best course of action, the decision is unlike most others they may make on behalf of their children.
      Some parents say they choose largely in the dark because there are no comprehensive long-term studies showing how patients fare as they grow up, with or without genital surgery: data on sexual function, for example. At the same time, some parents note, some doctors inform them of the option to do nothing, while others advise to do the surgery right away.
      There is the steady drumbeat of opposition to surgery from a vocal intersex movement, but some parents wonder whether there is a silent majority of satisfied patients. And then there is the question: What would the child want them to do? Worries about such an intensely personal matter often surface anonymously on computer message boards. "It's very hard to know what her feelings will be when she is older," read one message posted this summer on a Web site for families affected by congenital adrenal hyperplasia. "Will she hate us for letting her have the surgery? Or will she thank us for having it done when she was young enough not to know?"
      In Rhode Island, Ms. Greene said she was confused and overwhelmed at first, not just with the news of her baby's change of gender but also with medical problems related to C.A.H., which kept her daughter in and out of the hospital for the first year. Ms. Greene said that at first she was determined to do a clitoroplasty, or reduction of clitoral size, fretting over whether people would call her daughter hermaphrodite, a term from Greek meaning one with male and female sexual organs, and suggestive, in modern times, of a sideshow attraction. "She looked identical to a boy," said Ms. Greene, explaining that in addition to a large clitoris, her daughter's labia was fused together and she had no vaginal opening. "It's hard for a parent not to think of the psychological damage." She said she was speaking candidly because "in a way, I'm telling other parents that it's not something to be ashamed of."
      Ms. Greene said her child's doctors recommended against surgery, warning her of risks like possible nerve damage. Skeptical, she went to the library to do her own research and on the Internet, where she said she sent e-mail messages back and forth with adults with the same condition. In the end she consented only to creating a vaginal opening and rebuilding the urethra last year. Although whether vaginoplasties should be done early is also a subject of debate, Ms. Greene said her daughter, now 4 1/2, would have needed to undergo the procedures sooner or later to menstruate and for heterosexual intercourse. Ms. Greene deemed them medically and psychologically easier on the child if done early. But Ms. Greene said she opted to wait for her daughter to grow old enough to make other decisions for herself. "They tell me that what I've done is the best compromise," she said.
      Some parents weigh the same pros and cons and come out in favor of surgery, however. In San Jose, Calif., the 28-year-old mother of another girl diagnosed with the same congenital condition said doctors told her that today's surgical techniques spare nerves and are less extreme. To her the psychological issues seemed more crucial than the physical risks and her daughter underwent a clitoroplasty last month at the age of 4. "My problem is the adolescent period," said the mother, a medical assistant who spoke on condition of anonymity to protect the privacy of her family. "Growing up a teenage girl is hard enough. I never want her to feel different. I never want her to have extra issues to deal with." "When she's a teenager, and she's in a girl's locker room, it's not going to be a cute situation," the mother said. "Society is a big issue here. I tell my husband, if we lived in a deserted island she'd never need this."
      Jeff Spear, 37, a farmer in Maine whose 11-month-old daughter underwent a clitoroplasty along with other surgical procedures six months after birth, said he hardly considered the surgery cosmetic given how male she looked. Mr. Spear rejected the idea of waiting for his daughter's consent. "You're the parent, you make the decisions," he said. "We felt this needed to be done right now."
      The more "virilized" the appearance, the more likely parents will choose surgery, said Kelly R. Leight, executive director of the Cares Foundation, a support and educational group for families affected by congenital adrenal hyperplasia. While more parents are beginning to question the surgeries, more often than not they choose to operate within the first year, said Katrina A. Karkazis, a medical anthropologist and research associate with the Stanford Center for Biomedical Ethics.
      Ms. Karkazis, who interviewed parents, doctors and people who had undergone early surgery of the clitoris, vagina and testes because of C.A.H. or androgen insensitivity syndrome, another condition that affects the development of genital organs, said doctors and parents who favored genital surgery were driven by cultural factors, like their own values about appearance and worries about how the child would be treated by others. Most of the adults who had undergone the surgery as children, however, told Ms. Karkazis they were unhappy with the results and complained of lack of sensation or pain, of the need for repeated surgeries and of the fact that they had thick scarring and the genitals never looked "normal." Few were in intimate relationships, she said.
      Since the 1990's, adults unhappy with the operations have been raising their profile, denouncing a standard of treatment they say is based on cultural biases, and on arbitrary ideas of male and female and of the ability to assign gender. The most famous case of "gender management" was not intersex but illustrated the point: David Reimer, raised as a girl after a botched circumcision, rejected the identity assigned to him later on in life and lived his teenage years and adulthood as a man, proving wrong researchers who believed sexual identity is made rather than born. He shared his story in a 2000 book, "As Nature Made Him" by John Colapinto, and appeared on "The Oprah Winfrey Show." Last May, depressed after losing a job and separating from his wife, relatives said, he committed suicide at 38. Some doctors say that even when gender seems certain, as in the case of C.A.H. patients, who can also be fertile and bear children, there are questions surrounding the effect on the girls of high levels of androgens.
      Dr. Patrick H. McKenna, chairman of the division of urology at Southern Illinois University School of Medicine and a member of an intersex task force of the American Academy of Pediatrics, said that both the mixed results of surgery on sexual sensation and the idea that some patients may identify more with the opposite gender upon growing up has led him to recommend against early surgery in intersex cases. He and other doctors said medical centers are increasingly involving psychologists and other specialists in handling intersex cases because of their complexity. "There's no good scientific data, and more and more we're leaning toward waiting," he said.
      The Intersex Society of North America, a group representing intersex adults founded in 1993, advocates that children with anomalous genitals be raised in a specific gender even without surgery, but not be regarded as "a social emergency," as pediatric guidelines have called these cases in the past. Cheryl Chase, the group's executive director, said its efforts are now focused on influencing how medical schools teach the intersex subject; she said that if doctors learned alternatives to early genital surgeries, including a treatment model that incorporates psychological support for families, they would in turn help parents see their children's condition more as a natural variation than a cause for panic.
      In many cases, opponents of the surgery say, parents have hidden the medical history from their children. Betsy Driver, 40, a television news freelancer from Easton, Pa., who runs an online support group, Bodies Like Ours, said she underwent an extreme form of clitoral surgery as an infant because of congenital adrenal hyperplasia but did not fully learn the details of her condition until her 30's. "I felt my parents could not love me the way I was," she said. "There was nothing wrong with the genitals. They just looked different." It took her years of therapy to come to terms with her intersex condition, said Ms. Driver, who said she was left with no clitoral sensation. "Dating was exceptionally difficult," said Ms. Driver, who is gay and said she did not start dating until her 20's. "It was body image, fear of rejection and not being able to explain why I was different. Now, because I can explain, it's no big deal." But she added, "Not doing the surgery is not a magic bullet." Parents need to talk openly about their children's bodies and teach self-esteem, she said.
      Ms. Greene said she was trying hard to do just that. She said her daughter was old enough to be curious and constantly asked questions about the way she looked. "Bigger means better," Ms. Greene tells her. Ms. Greene said she had warned preschool teachers about her daughter's physique "so they're not surprised" if she ever has an accident. She said she was compiling a huge folder with information so her daughter had the facts as she grew up. "We're not ashamed of it, and she should not be ashamed of it," Ms. Greene said. "I just came to the conclusion that we'd raise her with as much confidence as we can," she said. "If she chooses as an adult to have the surgery, I'll support her."

Who Was Abused?
Maggie Jones, New York Times Magazine- 9/19/2004

There are several ways to view the small white house on Center Street in Bakersfield, Calif. From one perspective it's just another low-slung home in a working-class neighborhood, with a front yard, brown carpeting, a TV in the living room. Now consider it from the standpoint of the Kern County district attorney's office: 20 years ago, this was a crime scene of depraved proportions. According to investigators, in the living room with brown carpeting and a TV, boys between the ages of 6 and 8 were made to pose for pornographic photos. On a water bed in the back bedroom, the boys were sodomized by three men, while a mother had sex with her own son.
      But look at the house once again -- this time, through Ed Sampley's eyes. Twenty years ago he was one of the boys molested in the house where sex abuse was part of the weekend fabric. That's what he told Kern County investigators. That's what he told a judge, a jury and a courtroom of lawyers. The testimony of Sampley and five other boys was the prosecution's key evidence in a trial in which four defendants were convicted, with John Stoll, a 41-year-old carpenter, receiving the longest sentence of the group: 40 years for 17 counts of lewd and lascivious conduct.
      Now for the first time in 20 years, Sampley is back in the driveway of that small white house. ''It never happened,'' he tells me. He lied about Stoll, an easygoing divorced father who always insisted the neighborhood kids call him John rather than Mr. Stoll and let them run in and out of his house in their bathing suits, eat popcorn on the living-room floor and watch ''fright night'' videos.
     Last January, Sampley and three other former accusers returned to the courthouse where they had testified against Stoll. This time they came to say Stoll never molested them. They are in their late 20's now. They have jobs in construction, car repair, sales. A couple of them have children about the same age as they were when they testified. Although most of the boys drifted apart after the trial, their life stories echo with similarities. Each of them said he always knew the truth -- that Stoll had never touched them. Each said that he felt pressured by the investigators to describe sex acts. A fifth accuser isn't sure what happened all those years ago but has no memory of being molested. During the court hearing to release Stoll, only his son Jed remained adamant that his father had molested him, though he couldn't remember details of the abuse: ''I've been through many years of therapy to try to get over that,'' he told the court.
      Maggie Bruck, co-author of ''Jeopardy in the Courtroom: A Scientific Analysis of Children's Testimony'' and a professor of psychiatry at Johns Hopkins University, says no long-term psychological studies exist that track groups of children involved in alleged sex-abuse rings, in part because of confidentiality issues. But Bruck has studied follow-up interviews of children involved in cases similar to the notorious McMartin preschool trial. Some kids continue to believe they were abused. Bruck suspects it's because their families or therapists have reinforced the stories of abuse. ''The children say they don't remember the salient, allegedly terrifying details,'' she told me. ''But they are sure it happened.''
     Then there are other kids -- kids like Sampley who have always known nothing happened and have spent years tormented by it. Linda Starr, the legal director of the Northern California Innocence Project at Santa Clara University School of Law, which represented Stoll in his hearing this year, is a former sex-crimes prosecutor and was surprised to see how much the events of 20 years ago had affected the children. ''Before I met them, I didn't appreciate that these kids, who had not been sexually abused, would have experienced trauma comparable to kids who had been,'' Starr says.
      In part, Sampley, now 28 and a worker for a commercial-sign maker, is haunted by his own role. ''Why couldn't I withstand the pressure?'' he says. ''I didn't smoke when I was pressured by my friends. But when I was pressured by the investigators, I broke down. I still search for that moment I gave in.'' He is also haunted by how the investigation distorted his trust. Several years ago, he realized that each time his stepdaughter, then 6, invited friends to the house, he shut himself in his bedroom; he didn't want to play with strangers' kids or even be around them. For a year, he also wouldn't give his own daughter, now 3, a bath. ''I'm afraid of somebody saying something that isn't true.'' A child or an angry ex-girlfriend might twist the truth into a lie. A tickle becomes molestation; a hug is lechery. He knows firsthand that children do lie.
      In September 1983, when John Stoll rented the white three-bedroom house in an east Bakersfield neighborhood, Eddie Sampley was a sweet, polite second grader with sun-blond hair and plenty of freckles. His mother kept a close eye on her only child; Eddie wasn't allowed to bike more than three houses away without permission and had to check in every 30 minutes when he was out in the neighborhood. Among his friends, Eddie was the kid with the cool, chrome-colored bike who won cycling races and maneuvered the concrete embankments of the nearby reservoir on his skateboard.
      That winter, Eddie met a new kid in the neighborhood named Jed Stoll. His parents were divorced, and Jed spent every other weekend at his father's house, six doors from Eddie's. Jed had a collection of Matchbox cars, cap guns and a dad who didn't have too many rules. The house was busy on the weekends Jed visited. Stoll often picked up Jed's friends, Donnie, 6, and Allen, 8, whose mother, Margie Grafton, was a friend of Stoll's, and he drove the pack of boys to the beach in his black Toyota truck with a camper shell. Or he would bring them back to the house where they and other neighborhood kids caught frogs, dug in the irrigation ditches out back or swam in the pool.
      One June afternoon, a sheriff's deputy named Conny Ericsson, along with Velda Murillo, a social worker with the county's Child Protective Services, came to Eddie's house to talk to him about a possible neighborhood sex ring. Ericsson was a recent transfer to the sex-crimes unit and had no training in sex-abuse investigations. Murillo was the more experienced one, and several kids say she led many of the interviews. She was small, with long dark hair and bangs, and might have been mistaken for a schoolteacher. By many accounts, she was intense about her work.
      That day, Ericsson and Murillo told Mr. and Mrs. Sampley that they needed to speak to their son alone. As Karen Sampley tried to listen through a heating vent in the kitchen, the investigators asked Eddie about John Stoll. They told him that other boys said Mr. Stoll did something sexual to Eddie and that Eddie had seen Mr. Stoll do bad things to other kids, too. ''I kept telling them no, that nothing happened,'' Sampley remembers. ''I didn't understand what they were talking about.'' Murillo and Ericsson described sex acts that embarrassed the 8-year-old boy, and he started crying. ''I kept telling them, 'No, no,' but it wasn't working,'' he now says. After what ''seemed like forever,'' Ericsson and Murillo told him they'd be back to talk to him again. At the Sampleys' front door, they told Karen that her son denied being molested, but that they suspected otherwise. ''I asked what information they could give me,'' Karen says. ''They told me that it might be a child-porn ring that was linked to the East Coast, or a satanic cult or a molestation ring. They weren't sure yet.''
      A few weeks later, Karen took her son downtown for another interview. This one was in the sheriff's office, and Eddie remembers sitting on a metal chair, at a table too high to rest his elbows. According to the police report, Ericsson asked Eddie ''what he calls his penis.'' (''I chose 'hot dog,''' he says, ''because it was the least embarrassing.'') The deputy also asked about the first time he saw ''adults playing sex games with the kids.'' ''They told me that John Stoll was a bad man and I needed to help put him in prison so he wouldn't hurt any more children,'' Sampley says. ''They said everything would be O.K. if I just told them something had happened.'' And at some point -- Sampley doesn't remember when or exactly why -- he changed his story. He told them yes, Stoll had done something very bad to him. And Stoll had done worse things to other boys.
      By then, the investigators were convinced they were on the trail of another sex ring. Kern County prosecuted the first major child-sex ring in the United States in 1982, and within two years the investigations of Stoll and the McMartin teachers in Manhattan Beach, Calif., were under way. The hysteria began creeping across the country, to Maplewood, N.J. (Wee Care Day Nursery), to Malden, Mass. (Fells Acres), and to Great Neck, Long Island, where the documentary ''Capturing the Friedmans'' takes place.
     Sometimes an investigation began with a legitimate complaint of the abuse of one child, which then transmogrified into a sex ring. In the Stoll case, the only defendant with a previous conviction of molestation was Grant Self, who rented Stoll's pool house briefly. Jed's mother, Ann Karlen, had, in fact, told the sheriff's department that Self had inappropriately touched Jed. (Self denies ever molesting any of the kids.) But Stoll didn't know about Karlen's charge or Grant Self's criminal record, Stoll says.
      Neither a child nor Karlen had lodged any abuse allegations against Stoll. In fact, a social worker was the first person to name him as a suspect. In June 1984, two Child Protective Service workers went to talk to Karlen after Stoll complained about her child-rearing. Karlen had her own grievances: Stoll's parenting practices were too lax, and he often had numerous children at the house where Jed had also told his mother that he was involved in sex play with another kid. According to county records, one of the social workers asked Karlen if Stoll might be a child molester. Karlen said she had never considered it, but ''he's so weird, maybe.'' After talking to Karlen, the social worker noted, ''I told her he sounded like he possibly could be molesting children, including Jed.''
      When Murillo and another social worker asked Jed about being abused, he ''had some difficulty talking about his father,'' according to Murillo's report. But as she continued the interview, encouraging Jed to talk about his father by using a puppet, Jed did accuse his dad. Within a few days, the Sheriff's Department suspected that Grant Self, Stoll, Stoll's friend Margie Grafton and her boyfriend, Tim Palomo, were all part of a sex ring.
      Murillo and Ericsson removed Donnie and Allen from their home and placed them in a juvenile center where Murillo repeatedly questioned them about their mother and the other adults. A few days later, the investigators interviewed 8-year-old Victor Monge, one of Eddie's best friends. Though Victor didn't know what happened to the Grafton boys, he also feared losing his mother. Mrs. Monge was an illegal immigrant from Mexico, and Victor thought his mother would be deported if he didn't tell Murillo what he thought she wanted to hear. So, Victor told her that Stoll molested him.
      It was a school day when Eddie went to court to testify against Stoll in November 1984. It had been five months since the investigation began, and Eddie was now a third grader. He remembers the big court seal over the judge's head and being very embarrassed. But he can't recall any of his testimony. ''You don't remember the lies,'' he says. ''You remember the truth.'' On the witness stand, Eddie said that Stoll had told him to ''get on the water bed.'' He told him to take his clothes off. Stoll touched his ''hot dog.'' He told him to turn over. Eddie didn't want to, so he left the room. He testified that on another day, he walked by Jed's bedroom and the door was slightly open. He saw Stoll trying to put his penis in Allen. Another time, the door was ajar again and he saw Stoll trying to put his penis in Donnie.
      The other boys offered more extravagant stories. Allen testified that the children had to stand in a line to have sex with Stoll on his water bed and that another time, Margie Grafton took pictures of the adults and kids naked, ''doing sex things.'' And Donnie detailed being sodomized by Stoll and having oral sex with Grant Self.
      Prosecutions of child sex-rings later led to dozens of studies about interviewing techniques, many of which suggested that with a little coaxing, children tell adults what they think the grown-ups want to hear -- especially if it means they will go home sooner or be rewarded for providing information. Several years ago two Chicago boys, 7 and 8, were accused (and later exonerated) of killing 11-year-old Ryan Harris. In part, the boys were enticed by a McDonald's Happy Meal to confess.
      James Wood, a psychologist at the University of Texas at El Paso who studies interview techniques used with children, says investigators should use nonsuggestive prompts to help kids to narrate their own stories. ''They shouldn't tell children they have information from other witnesses,'' he says. Or praise them when they provide information. Or express disapproval when they don't. Murillo, who retired from the D.A.'s office a couple of years ago, won't talk about her investigations in detail, but she did say: ''We never pressured the children. Those boys were telling the truth when they first testified.''
      Yet even if you believe that someone did molest one or more of the boys, much of the kids' testimony pushed the bounds of plausibility -- and of anatomy. Chris Diuri, four feet tall, testified that he had to sodomize men two feet taller than him. Asked how he did it, he said: ''I stand on my toes.'' Jed, who was 6 years old and so small he had to kneel on the chair to reach the microphone at the witness stand, could not remember how many months are in a year or the names of all the months. But he was positive that his father molested him exactly 19 times. One occasion was a Saturday morning while his friends Donnie, Allen, Victor and Eddie were in the next room watching TV. Jed testified that he missed 10 cartoons.
      When the trial ended in the winter of 1985 and all four defendants -- Stoll, Self, Grafton and her boyfriend -- were convicted, a quiet descended on many of the boys' families. ''I don't remember ever allowing a child to spend the night after that,'' Karen Sampley says. ''You felt like you couldn't even speak to a child on the street. We were scared we might be next.'' Eddie told his parents that Stoll had never hurt him, but investigators told her that her son was too embarrassed to tell her the truth. ''I didn't know what to believe,'' she says.
      By the end of the trial, the Grafton boys went to live with their father outside Bakersfield. Jed moved with his mother to Pennsylvania. Within a few years, Victor's family moved to another Bakersfield neighborhood. The case began receding into history.
      But in small ways, some of the boys tried to keep the story alive -- and to change it. In the year following the trial, Donnie Grafton told a therapist that he had lied in court. After the session, the counselor reported to Donnie's father that his son was ''in denial.'' Donnie and his brother didn't talk about what had happened during the investigation. Neither did Donnie and his dad. But as a frustrated and angry 12-year-old, one afternoon Donnie shut his bedroom door and wrote:
Who is the one I see in the mirror every morning?
I get good grades
But still others get the parades
Never me!
But still it comes up, Who am I?
As I cry!
My mother imprisoned innocently for 7 years
Here come the tears.
As I cried & lied & put her there
She didn't do it.
I was forced to lie.
Here I go to cry, cry, cry.
But I lie to myself as the question
Comes again
Who am I.
      By that time, Eddie had told his fourth-grade girlfriend that he lied about Stoll. On a camping trip a few years later, he told his uncle too. ''He wasn't very helpful,'' Sampley says. ''He just said, 'Well, what are you going to do about it?'''
      Eddie was the only accuser left in the Center Street neighborhood. When he rode his bike by, he could still see Stoll's living room where he had watched ''fright night'' videos. There were other reminders too -- like the school field trips to the courthouse. ''It was like going to a doctor's office,'' he remembers. ''I had that creepy feeling. I didn't want to be there.'' Eddie didn't need external reminders to torment him. He thought about Stoll all the time. By high school, he couldn't remember what Stoll looked like, but he often imagined what his life must be like in prison. He thought about writing him a letter. ''But then I'd think about it for a while, the idea would pass and I'd do nothing,'' he says. Still, he kept confessing; he told every girlfriend he ever had and he told his closest friends. In part, he was revealing a painful lie. But he was also trying, in some way, to get help. ''People would say we should do something about it,'' he says, ''but no one really knew how to help me.''
      The authority figures with the power to help all seemed suspect to him. He could have gone to the district attorney's office, but ''they were the ones who did this to me,'' he says. He could have called Child Protective Services. But that was where Velda Murillo worked. He couldn't go to the sheriff's office. Conny Ericsson worked there. What about Stoll's defense attorney? ''He lost the case,'' Sampley said. ''How could he lose that case?''
      Bakersfield isn't a town that welcomes challenges to law enforcement. Though it's just two hours north of Los Angeles, the city feels more like Texas than California, surrounded by miles of oil and agriculture fields. Many residents are proud of the small-town conservative flavor. On its Web site, the Kern County D.A. office highlights having ''the highest per-capita prison-commitment rate of any major California county,'' and the longtime district attorney, Ed Jagels, a subject of the book ''Mean Justice,'' by Edward Humes, is considered one of the toughest prosecutors in the state. (Jagels declined comment for this article.) ''You have to understand the power of Ed Jagels,'' says Michael Snedeker, an attorney who helped overturn 18 convictions of Bakersfield defendants in sex-ring cases and co-author of ''Satan's Silence: Ritual Abuse and the Making of a Modern American Witch Hunt'' with the journalist Debbie Nathan. ''He is more important than the mayor in that city. He's more feared than J. Edgar Hoover on his best day.''
     In three years during the 1980's, Jagels and his predecessor prosecuted eight sex rings involving 46 defendants. Consider the example of Scott Kniffen, who agreed to be a character witness for his friends Alvin and Deborah McCuan, accused of molesting their own children. Within weeks, Kniffen and his wife, Brenda, were under arrest for supposed involvement in the same sex ring. They were subsequently convicted. (Their convictions were reversed 12 years later). Or consider Jeffrey Modahl. He was a single dad of two daughters who suspected two relatives had molested his girls. After Modahl asked Velda Murillo for help, Murillo's suspicions turned to him. He was sentenced to 48 years in prison for running a family sex ring that included tying his preadolescent daughters to hooks in a bedroom. (No evidence of hooks was ever found.) ''Velda said, 'Tell us what happened and you'll go home,''' remembers Carla Jo Modahl, who was 9 when she testified against her father and subsequently tried to commit suicide several times after his conviction. ''I didn't understand what would happen. I didn't realize it until everyone was in prison.'' Carla was scared that if she recanted her testimony, she, too, would be imprisoned. Still, when she was 12, she told a judge she'd lied on the witness stand. The judge didn't believe her, and her father remained in prison for a dozen more years -- until his conviction was finally reversed.
      One night in 1999, Ed Sampley walked into a Mexican restaurant and saw his childhood friend Victor Monge at the bar. They had lost touch after the trial, and now, 15 years later, they were both in their early 20's. Monge had a job selling phones; Sampley had completed a two-year degree in computer technology and was installing Internet wiring in schools. As they headed outside to catch up and smoke cigarettes, Sampley brought up the D.A.'s office. He always blamed them for what happened to Stoll. That trial was messed up, Sampley said, wasn't it? And then Sampley told Monge than Stoll had never molested him. Monge said the same thing.
      Until then Sampley's main obsession about the trial was his own guilt. But now he and Monge were comparing notes. ''Things started to make sense,'' Sampley says. They told each other that they had denied any abuse in the beginning. But investigators kept pushing and pushing, and they finally said yes. They talked about how it made their families insular and more protective. For the same reason that Karen Sampley didn't want children in her house anymore, Victor's mom didn't either. ''We never hugged or showed affection after that,'' Victor says. That night might have been a turning point, a moment when two young men head to a payphone, put a quarter in the slot and dial -- who exactly? They weren't sure. ''We talked about it,'' Sampley says. ''But we didn't really come up with anything.''
      Meanwhile, Stoll had spent 15 years in prison. He was 56 years old. His son Jed was about 20 by now and had stopped writing to his father eight years earlier. Stoll's mother, who always believed in her son's innocence, died while he was in prison. From time to time, Stoll thought about Eddie and the rest of the kids. ''I was never angry at them,'' he says. ''I was just disappointed that they'd testified.''
      The convictions of most other defendants in Kern County molestation rings were overturned -- including Margie Grafton's and Tim Palomo's -- as appellate judges issued often harsh rebukes of the county's overzealous prosecutions. (After completing his sentence, Grant Self was moved to a state mental hospital, where he remains because the court deemed him a ''sexually violent predator.'') Stoll's case lacked easy grounds for appeal and required a significant pro bono investment from a law firm. Finally, in 2002, Michael Snedeker got the Northern California Innocence Project interested in the case, and two N.C.I.P. attorneys, Jill Kent and Linda Starr, sent a private investigator to Salmon, Idaho, to track down Donald Grafton. ''You're either going to love that I'm here or you're going to hate it,'' Sheila Klopper, the investigator, told Grafton when he answered the door. Over seven hours the next day, Grafton told Klopper his story, and showed her the poem he had written at age 12. A second private investigator had already found Chris Diuri, Victor Monge and Ed Sampley. When the investigator showed up at the home of Sampley's parents, Ed was standing in the front yard, six doors away from Stoll's house. It was as if he'd been waiting all those years.
      When Sampley walked into the courtroom on the first day of Stoll's hearing last January, he says he wouldn't have recognized Stoll if he wasn't wearing a brown jailhouse jumpsuit. He expected Stoll to be bigger and tougher than the man who had lost most of his teeth after years of prison dental care and who at age 60 was balding and wore glasses. Sampley took vacation time from his job to attend as many days of the hearing as possible. Each time he arrived in the courtroom, he tried to catch Stoll's eye. ''I wanted him to know I was there.''
      With some exceptions, much of the original cast from two decades ago appeared during the 12-day hearing. Conny Ericsson, now a narcotics detective in Redding, Calif., denied tape-recording any of the children, which contradicted the hearing testimony of Diuri, Monge and Sampley. Donald Grafton drove 17 hours from Idaho to recant his testimony. His brother, Allen, arrived in court the next day. Articulate and introspective, Allen may have had the most vexing experience of the six kids. For most of his life, he has assumed he was molested by his mother, Stoll and the other adults. And he has spent years in therapy, including a 10-week Adults Molested as Children program. But when he learned that his brother and others were recanting their testimony, he tried to dredge up specific memories of abuse -- and realized that he didn't have any. When a prosecutor, Lisa Green, suggested he might have repressed the memories, Grafton wasn't convinced. ''I remember getting hit with a board across the back,'' he told Green. ''I remember being kicked out of the house for days. I have reasonable memories about certain tragic events in my life.'' Later, Grafton tells me: ''I've been lied to one way or another. But I know I have to let go of victim feelings regardless of what happened. There's something that's missing in my memory. Or maybe not, and that's the big joke. Maybe I keep looking for something that's not there.''
      On April 30, Judge John Kelly overturned Stoll's conviction. He said the children had been improperly interviewed, making their testimony unreliable. In the days before Stoll's release, Sampley went to visit him in prison. ''Eddie started to apologize,'' Stoll says. 'I said: 'No. Stop right there. You have nothing to be sorry about. Don't be sorry; be angry at the people who did this to you.''' Stoll, who now lives in the San Jose guesthouse of two of his lawyers while he figures out how to spend the rest of his life, telephones Sampley and some of the other kids every once in a while. There is something fatherly in his voice when Stoll talks about the boys -- as if they were as much victims as he was. ''I worry about them,'' he says. ''It seems to me they're all struggling in one way or another.''
      Though Sampley clearly helped win Stoll's release by recanting his testimony, it hasn't purged the past. It hasn't erased his feelings of guilt for telling investigators what he thought they wanted to hear. It hasn't quieted his questions about why he did it. And it doesn't end his unease around strangers' children. ''I'll never coach Little League,'' he says. Recently, he was at a playground with his daughter when a kid in the next swing asked Sampley to give him a push. ''I said no. It just made me uncomfortable.''
      Certainly prosecutors aren't chasing phantom sex rings as they once did, and investigators are more educated about proper interview techniques, but some of the investigative tactics and the mind-set from that era still linger. In England and Israel, sex-abuse investigators routinely videotape their interviews. In the United States, only a minority of prosecutors and investigators are required to do so, and the American Professional Society on the Abuse of Children, an organization of child-protection workers, has never officially supported recording interviews. Some members have claimed it confuses juries. ''It's shameful -- they should have taken a stance on it a long time ago,'' says Wood, the University of Texas psychologist and an Apsac member. ''If you want to know what really happened, without an audiotape of the interview it's like trying to diagnose lung cancer without an X-ray.'' If Murillo and Ericsson had recorded the interviews, life might have turned out differently for Stoll and his co-defendants, as well as for his accusers. The McMartin trial ended without convictions after the jury saw videotapes of therapists' suggestive questioning of kids.
      Still, discredited child-sex rings like McMartin actually may not be a bogeyman of the past. Some parents, therapists and child-protection professionals continue to believe ritual sex abuse took place at McMartin preschool. ''In 10 to 15 years, there will be an attempt to rehabilitate the ritual abuse scare,'' Wood says. ''You can bet on it.''
      On an August night three months after Stoll's release from prison, Sampley and I stand outside Stoll's former house. ''I think this is where the pool was,'' he says, pointing to the end of the driveway now covered with asphalt. As Sampley talks, the owner of the house walks up and introduces himself. He's a Mexican immigrant who moved in in the early 90's. He has never heard of John Stoll or the trial, but he invites us inside for a tour. We walk through the living room where, according to the D.A.'s version of events, children were lined up and photographed naked. We go to the back of the house -- once a den of sex abuse, prosecutors say -- now a studio apartment that was Stoll's bedroom with custom-built shelves for Jed's collection of Matchbox cars and where Stoll's water bed was decorated with the Pac-Man pillowcases and sheets that Jed loved. ''I don't know,'' Sampley says. ''None of it really looks familiar.'' He says he thinks he remembers where the TV was, where he watched a ''fright night'' video about man-eating cockroaches. But Stoll later tells me it was on a different wall. Sampley remembers some kid showed him a Playboy magazine in one of the bedrooms. But he isn't sure which kid or which room. These are just the vague memories of typical childhood days at a neighborhood house. From Sampley's perspective, the inside of the Center Street house is, in fact, just an ordinary home with brown carpeting and a TV in the living room. As we leave that evening, Sampley says that it's the outside of the house that gnaws at him. That's what still triggers his feelings of disillusionment and of self-recrimination. ''I don't think it will ever completely go away,'' he says. ''Even now, when I see the house, it's like a statue.'' It's a monument to deception.

Students' Binge Drinking Getting Heavier, Report Says
Jim Hughes, Denver Post- 9/19/2004

For generations, many college students have been drinking too much booze. But when today's college students drink, they drink more — much more. Some freshmen regularly toss back more than 24 drinks in a sitting, according to the latest figures released by the nonprofit Pacific Institute for Research and Evaluation. "Up until now, we've only looked at binge drinking as five or more drinks," said Jim Gogek of the institute, which surveyed 1,000 male college students in California. "As it turns out, some kids are drinking a lot more."
      The results did not startle Henry Wechsler, the social psychologist who runs Harvard University's national college drinking surveys. "Look, there's a practice of drinking that some students do on their 21st birthday," he said. "They celebrate it by having 21 drinks. That is a dosage that will kill you and has killed people."
      The dangers of binge drinking have become strikingly apparent in the case of Colorado State University student Samantha Spady. Spady, 19, was found dead in the lounge of a fraternity house near the Fort Collins campus Sept. 5. Preliminary tests measured her blood-alcohol level at 0.43 percent, more than five times the legal limit for driving.
      Her death has caused some students and their parents to reconsider their attitudes about drinking, said Pam McCracken, director of CSU's Center for Drug and Alcohol Education. "I think it's definitely a wake-up call, and probably in both arenas — whether it's a student looking at their own behavior or parents looking at their kids in college," McCracken said. "I've had calls from both students and parents."
      Meanwhile, University of Colorado football fans observed a moment of silence Saturday for an 18-year-old freshman found dead at a fraternity house. Lynn Gordon Bailey, of Dallas, was found in a common room at the Chi Psi house after police received a 911 call early Friday. Bailey, a business major and a pledge at the fraternity, had smudged ink stains on his face, but Boulder police spokeswoman Julie Brooks said investigators did not know where they came from. A cause of death had not been released by late Saturday. The Rocky Mountain News reported that grief counselors told students the death was alcohol related, which Brooks would not confirm.
      Part of the problem, Wechsler said, is that some students are more complacent about alcohol than drugs. "I think the feeling is that if it's beer, it's safe," he said. "That has to be dispelled." Meanwhile, the number of so-called "binge drinkers" — men who imbibe five or more alcoholic drinks in a sitting and women who drink at least four — is not going up. Ever since researchers at Harvard started measuring the phenomenon in 1993, the binge-drinking population has stayed the same size, about 44 percent of the collegiate population. According to the surveys, college-age Americans who are not in school are less likely to abuse alcohol. "There's something about college that really leads to heavier drinking," Wechsler said.