Heightening Interest in Drug-Free Treatments
January W. Payne, Washington Post- 1/4/2004

Gwenn Herman knows chronic pain -- the regular backaches, the stiffness and freezing of her neck after her 1995 car accident, the pain that didn't respond, or responded inconsistently, to prescription and nonprescription painkillers. That's why she learned, long before last month's rash of safety alerts about three commonly used pain medications, to explore alternative treatments like meditation, guided imagery and breathing exercises. Today, she teaches the techniques, all of which she uses daily, to members of support groups sponsored by the Pain Connection, a Potomac-based nonprofit organization she runs. "What works for one person doesn't work for another," said Herman. "The more alternatives, the better."
      That view is likely to find more adherents following last month's crush of sometimes-conflicting reports linking the highly advertised pain drugs Vioxx and Celebrex and, more recently, the popular over-the-counter painkiller Aleve (naproxen) to potentially life-threatening side effects. The safety concerns led to Vioxx's removal from the market at the end of September and the halting of a major clinical trial for Celebrex last month.
      Experts advise patients not to stop pain medications without consulting their doctor, noting that further analysis of the data is needed and acceptable health risks must be evaluated individually. The drugs now subject to so much publicity may remain the best choices for some patients. Nonetheless, the reports have focused more attention on alternative pain relief treatments, particularly those that don't involve drugs.
      Palliative effects for some of these techniques, like meditation, have been shown in several studies. Some other methods, like guided imagery, so far tend to rest on more anecdotal evidence. "I find guided imagery extremely helpful in controlling my pain," said Herman. "The images that I use helps give an outlet to the pain and a pathway out of my body." Still waiting to be established is to what extent any of the treatments can effectively relieve the chronic, often daily pain of those with such conditions as arthritis, severe headaches, lupus and fibromyalgia.
      Pain sufferers confused or upset by recent painkiller news got a small dose of hope last month from a study funded by two branches of the National Institutes of Health: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM). That study found that acupuncture -- a 2,000 year-old Eastern practice that involves the insertion of thin needles at specific points on the body -- appeared to help relieve pain and improve function for patients with knee osteoarthritis.
      The large study, published in the Annals of Internal Medicine, assigned about 190 of 570 patients ages 50 and older to receive acupuncture. By week eight, these participants functioned better than those receiving sham acupuncture or educational therapy. By week 14, those who were getting acupuncture reported less pain than the others, but the sham treatment group also reported pain reduction, though at a slightly lower level. Researchers plan to analyze the data to see if the pain relief from acupuncture was sufficient to reduce or eliminate the need for pain medications. "From clinical experience, that's what we do think is happening," said study author Brian Berman, director of the University of Maryland School of Medicine's Center for Integrative Medicine. "They may need less of the medication, which may mean less side effects."
      Beyond special pain treatments, there are other basic steps that doctors and experts say may help ease patient pain. Weight loss, for example, can help relieve the pressure on arthritic joints, according to NIAMS. Andrew Weil, professor of internal medicine and director of the Program in Integrative Medicine at the University of Arizona, tells patients a diet low in "pro-inflammatory fats" such as margarine can also help ease arthritis pain.
      Several non-drug approaches besides acupuncture that some doctors regard as helpful -- or at least promising -- are listed below. But there's an important caveat: Even non-drug treatments can be dangerous. Some treatments can interact with prescription and over-the-counter medications. Excessive doses of supplements may cause harmful side effects. And pursuing alternative treatments in place of necessary conventional care can create additional dangers. Experts advise against stopping or starting any therapy -- traditional or alternative -- without first consulting a physician.

Mind-body Therapies
Meditation One of the most commonly used mind-body therapies, meditation has been shown to increase activity in parts of the brain associated with positive emotional states, according to NCCAM. Some studies suggest meditation may relieve pain from arthritis and other conditions, but the pain relief reported by participants could also have resulted from other therapies they were receiving. Clinical trials are investigating the pain-relieving effects of meditation on patients with rheumatoid arthritis and other chronic conditions.Biofeedback This technique teaches patients to control functions such as heart rate, muscle tension, breathing, skin temperature and blood pressure to relieve stress and chronic pain. Sensors track changes in pulse, skin temperature and muscle tone, among others, and signal patients. Biofeedback therapists teach patients how to recognize such changes on their own. Biofeedback has been shown to be helpful in treating about 150 medical conditions, including migraines, arthritis and fibromyalgia, according to the Mayo Clinic.
Hypnosis "You can learn to change the perceptions of pain," Weil said. An NCCAM-funded clinical trial is exploring whether hypnosis and other nontraditional therapies can ease muscle tension in children with spastic cerebral palsy. Studies suggest a benefit from hypnosis for patients with many different types of pain, including low back, tension headache, osteoarthritis and chronic pain. But larger, better-designed studies are needed to confirm early findings, according to Harvard Medical School, through its online partner Aetna InteliHealth.
Cognitive behavioral therapy "Thoughts and emotions can affect pain," Berman said, so cognitive behavioral therapy -- a kind of talk therapy that helps people recognize and change negative behaviors -- may help relieve the depression, stress and chronic pain that can accompany disabling diseases. Duke University researchers have developed a talk therapy program for arthritis patients and their spouses to see if this helps patients cope with the disease. They are exploring whether patients' aerobic fitness or coping abilities decrease their pain or disability.

Hands-on Treatments
Exercise and movement therapy A regular program of physical movement is sometimes helpful in relieving pain. But patients should use care when selecting a workout regimen, as overexertion can cause additional pain, according to NIAMS. Light exercise regimens, physical therapy, pool exercise and "movement therapies" such as tai chi are recommended as good starting points for many patients.
Osteopathic manipulation Manipulation of the joints "restores the normal range of motion of a particular joint, [and] can restore the normal blood flow and drainage to an area," said Martin Levine, an osteopathic physician in New Jersey and a member of the board of trustees for the American Osteopathic Association. Growing evidence suggests that osteopathic manipulation may ease low back pain and may be useful for a variety of other conditions, including depression, fibromyalgia, menstrual pain and neck pain, according to Harvard.
Chiropractic treatments Spinal manipulations, focusing on the relationship between the body's structure (primarily of the spine) and function, are mainly used to treat musculoskeletal conditions. Evidence of benefits from chiropractic treatments varies with the condition being treated. Harvard counts at least 150 published studies or case reports on chiropractic manipulation therapy for patients with low back pain, but many are poorly designed and results are mixed. Several studies have also shown pain relief for patients with tension or migraine headaches, but most of these studies were also poorly designed, according to Harvard.
Massage The stroking or kneading of sore muscles by a therapist can increase blood flow to painful areas, sometimes providing relief, according to NIAMS. But arthritic joints are sensitive, so patients should go to a therapist trained in handling the disease. Some studies suggest improvements in low back pain from massage techniques, though most of the studies were not well designed, according to Harvard. Preliminary research also shows that massage may help relieve chronic pain from musculoskeletal conditions. But more studies are needed to confirm the results.

Herbs and Supplements
Glucosamine and Chondroitin Sulfate "There's a fair amount of evidence that shows that [supplements containing glucosamine and chondroitin] can help, especially for arthritis pain and inflammation," Berman said. The cartilage building blocks -- glucosamine is a glucose derivative that some experts believe may help cartilage form and repair itself; chondroitin sulfate is part of a large protein molecule that gives cartilage elasticity -- are made into supplements from shellfish and other animal tissue. A study sponsored by NCCAM and the Department of Veterans Affairs is exploring whether this combination treatment is more effective than placebo in treating osteoarthritis of the knee. The study will also look at whether either supplement alone is more effective than the combination.
Omega-3 Oils There is some evidence that capsules containing these oils may reduce pain, inflammation and stiffness associated with rheumatoid arthritis, but not osteoarthritis, according to Harvard. An NCCAM-funded study is investigating whether a combination of fish oil and borage seed oil may work better for rheumatoid arthritis than either oil alone.
Turmeric and Ginger Weil calls the combination, available as a supplement, a "very effective herbal anti-inflammatory [that] works as well as NSAIDs [nonsteroidal anti-inflammatory drugs]." But the Mayo Clinic finds little evidence to support an anti-inflammatory benefit. NCCAM is funding a study to see if these botanicals reduce inflammation associated with arthritis and asthma. It's also funding a center at the University of Arizona to investigate their benefits.

Other Alternatives
Heat/Cold Therapy Applying heating pads or cold packs to sore joints and muscles may ease pain temporarily. But arthritis patients should consult their doctors or physical therapists because the recommendation for cold or heat varies with arthritis type, according to NIAMS. Moist or dry heat or an ice pack can be placed on the sore area for about 15 minutes to relieve pain. Patients with poor circulation should not use cold packs, according to NIAMS.
Transcutaneous Electrical Nerve Stimulation (TENS) The wearing of a small, portable electric stimulation unit may help ease pain temporarily, according to NIAMS, by blocking pain messages to the brain and modifying pain perception. The unit sends mild electric pulses to nerve endings under the skin in the painful area.

Review Puts Faces on Domestic Violence Statistics
Hector Castro, Seattle Post-Intelligencer- 1/4/2005

A Washington State study on domestic violence deaths found new wrinkles in the pattern of those fatalities, including a troubling link between suicides and domestic violence slayings, the continued use of firearms in most such deaths and the increased risk to victims who try to leave their abusers. The study, released last week, also examined common barriers for victims of domestic violence by reviewing in detail the deaths of 13 of them, including a woman married 25 years who worried that telling anyone about her husband's abuse would damage his career at a local school district and a 22-year-old woman who did not call police about her abusive boyfriend because of her own previous arrests. "It really just gives you a depth of understanding that you just can't get from looking at numbers," said Merril Cousin, executive director of the King County Coalition Against Domestic Violence. "In most cases, if it's happened in this case, you know it's happening in others."
      The fatality review project began in 1997 as a way to track domestic violence homicides and determine trends, said Kelly Starr with the Washington Coalition Against Domestic Violence. "It's not about assigning blame," Starr said. "Everybody comes to the table wanting to learn from these tragedies."
      For the 2004 Washington State Domestic Violence Fatality Review, researchers with the non-profit advocacy group examined 81 deaths from September 2002 through the end of June 2004. But to study trends, the researchers included findings that came from reviewing all 313 deaths examined since the project began in January 1997.
      Among those findings for the entire period since 1997:
Thirty-two percent of the abusers who killed also took their own lives.
Firearms were used in 57 percent of the domestic violence deaths.
Victims had already left their abusers in 44 percent of the cases.
Half the victims had children living with them at the time of their deaths, and of those 147 children, 40 witnessed the killing.
At least 45 of the abusers, or 14 percent, were subject to some sort of protective order.
One recurring issue is the role firearms frequently play in domestic violence homicides. Guns were used in 159 domestic violence deaths since 1997 and 39 deaths in the most recent two-year period studied.
      A similar report issued by the group in 2002 recommended police and courts do more to enforce existing state laws prohibiting firearms for people charged or convicted of certain domestic violence crimes, but to date, the King County Sheriff's Office is the only police agency with a working program that does this. "We're finding that's still a significant issue," Starr said.
      Sgt. Thad Frampton, head of the King County Sheriff's Office domestic violence unit, said the 2002 report helped bolster the case for a gun-forfeiture program when the office sought funding for the project. "It's actually a very valuable report," he said.
      The threat posed by suicidal abusers also was noted in previous reports, but not to the same degree as in this most recent study, said Lisa Olsen, executive director of the Eastside Domestic Violence Program. "It was something we talked about anecdotally, that whenever an abuser talked about suicide, it heightened the whole threat, the whole danger level," Olsen said. "It meant that individual didn't mind taking out other people." The statistics offered by the report, she said, should remind agencies who work with victims of domestic violence that when they learn of threats of suicide on the part of the abuser, the effort to provide safety for that victim needs to be stepped up.
      Also widely recognized for some time was the threat posed to victims when they try to leave their abusers, called separation violence. Contrary to a common belief that abused women too often don't do enough to get away from the abusers, researchers found that almost half had left the relationship or were trying to when they were killed. Many also tried to involve the court system by seeking orders for protection from the abusers. But the paperwork itself isn't enough, and Starr said more needs to be done to make sure victims have a plan to keep safe.
      To that end, the report recommends more courts provide legal advocates to victims seeking orders of protection to help them navigate the system and protect themselves. The vast majority of court systems in the state that issue civil protection orders, more than 80 percent, have no legal advocate to assist victims, and in almost all of those situations, a victim ends up talking to a clerk who may have no experience dealing with domestic violence. "It's a significant gap," Starr said.
      Cousin called the report enlightening in its examination of how the system that deals with domestic violence works. "Our society, our communities, have come a long way in terms of recognizing that domestic violence is a major problem," she said. At the same time, shrinking government budgets mean financial support for many of the services that deal with the problem is dwindling. "We have to decide if we want to live in a community where those services are in place. What we already have is being threatened."
      To view the complete report, the 2004 Washington State Domestic Violence Fatality Review, go to www.wscadv.org



Teen Temper Tantrum: It's the Biology
Kathleen Megan, Hartford Courant- 1/4/2005

One minute your teenage daughter is having a relaxed, happy conversation with her friend on the phone. The next, she stumbles over an algebra problem and is instantly as angry as you've seen her. She flings her pencil across the room, stomps up to her room, slams the door and shouts, "I hate my life!" Your teenage son appears to be in a good mood, and you ask him in your best modulated tone if he remembered to empty the dishwasher. "Why are you always yelling at me? I hate this family!" he shouts, storming out of the room. For decades, parents have attributed such hair-trigger emotions to raging hormones, and they weren't wrong. However, in recent years more has become known about how brain development -- in concert with racing hormones -- accounts for the differences in how teens act and think.
     Psychologist David Walsh has written a book, "Why Do They Act That Way" (Free Press), that offers an up-to-date explanation of the bio-logical reasons for teens' behavior and offers parents tips to communicate and stay connected with the kids. Walsh, who is president and founder of the National Institute on Media and the Family in Minneapolis, says parents often think kids are deliberately, misinterpreting situations or trying to drive their parents crazy, but this isn't the case. It's because a teenager's prefrontal cortex -- the brain's center for moderation, impulse control and the understanding of consequences is still under construction. Simultaneously, the body's hormones -- which Walsh calls the accelerator center of the brain -- are surging. "The prefrontal, cortex is supposed to harness the accelerator center of the brain, but the impulse control center is under construction," said Walsh. "This is the reason teens are impulsive, risk-taking, quick to anger. The acceleration center of the brain is in high gear, while the brakes are on back order."
     In addition, he said, the adolescent brain processes visual stimuli or body language differently than grown-ups do. In a study that asked adults and teens to interpret facial expressions, adults were more likely to correctly identify emotions, while adolescents often mistook fear or surprise for anger.
     The study further showed, Walsh says, that adults rely on their prefrontal cortex to interpret facial expressions, while adolescents rely on the amygdala, in the anterior portion of the temporal lobe. "Adults use the rational part of the brain to read emotions," Walsh writes, "but adolescents basically do it with a gut reaction. And they are frequently wrong." Thus a teenager may think a parent is yelling at them when they're not, or they may think a peer is insulting them when that's not the case.
     So, knowing all this, how can you better communicate with your child? First of all, Walsh says that although it may not be the teen's "fault" that he is volatile or erratic or impulsive, that does not absolve him or her of responsibility. Teens must learn to control their behavior, "and it's your responsibility as a parent to help," Walsh writes. "You can't simply dismiss his behavior or let it go. The experiences a teen has right now will have a big bearing on how he eventually learns to manage his own emotions and impulses."
     Walsh suggests sitting down with your teen in quiet times and discussing what behavior is expected and what the consequences will be if rules are not followed. "Don't communicate the consequences as threats," Walsh writes. "Just let him know in a matter-of-fact way what will happen and that the consequences will be his own choices." Walsh emphasizes that parents should not get dragged into power struggles. "Teenagers are built for power struggles. The accelerator goes down to the floor so quickly," he said. But parents must keep their cool if their kid doesn't. When it's time to enforce a consequence, Walsh says, do it calmly. Your child may want to argue, but don't get drawn in. "If you feel your blood pressure rising, take a deep breath and remember this advice: `When you feel like taking the wind out of his sails, it is a better idea to take your sails out of his wind."'
     In cases of extreme problems, Walsh suggests drawing up behavioral contracts that clearly spell out the rules and the consequences. To reduce the level of misinterpretation between kids and grownups, Walsh suggests telling kids how you feel. He suggests prefacing statements with 'I'm not angry, but it does irritate me when..." or "I'm not angry, but I do worry when..."

Parents Can Turn a Mistake Into a Lesson
Gregory Ramey, Cox New Service- 1/4/2005

DAYTON, OHIO - In an impulsive act of frustration and anger, Angie's mom kicked their 7week-old puppy against the wall. The dog has just urinated on the family's newly installed carpet.
The puppy that the children promised to care for had, as anticipated, become the sole responsibility of Angie's mom, who was doing more than kicking the dog. She was telling her family she was fed up. She was tired of the children's whining, overwhelmed with household and professional work, and irritated with the lack of cooperation.
     Her mom briefly apologized later that day and reassured her children that the puppy was fine. However, Angie was not. Ten-year-old Angie was confused and scared. She had never seen her mom act that way. Were her parents going to get a divorce? Did her mom have an alcohol problem? Was it Angie's fault her mom lacked the dog? Afraid, Angie kept these feelings to herself.
     This is the real world of parenting, where we make mistakes under the intense magnifying glass of our children's scrutiny. Our responsibilities are never-ending. In the presence of our children, we are always "on." We always are teaching, trying to be the perfect role model. Our every word and action become daily lessons in how we expect them to behave.
     How should we handle such situations?
* Acknowledge what happened. We are not perfect, even though our children do expect us to always do the right thing. It is important for children to see us as real people, who sometimes
make mistakes butt keep trying to do better.
*Be a role model for problem solving. It's not enough to simply apologize. Use such incidents as a way to teach your children about how to solve problems. Tell them, if appropriate, what specific steps you will take to change your behavior. "Trying harder" rarely solves any problem. We need a strategy to change something about the way we are acting. This involves asking questions about what prompted a certain behavior, and what specific things we can do differently. Angie was concerned that her mom might hurt their puppy again. I encouraged her mom to speak with Angie not only about anger control, but some of the other issues in the family.
* Always respond honestly to questions. Your children's trust depends upon their honest relationship with you. Never lie. Honesty doesn't mean you have to answer all their questions. A teenage client recently asked me to tell him the worst thing I ever did in my life. I respectfully declined to answer that one, despite his persistent questioning.
*You have a right to privacy, and should not burden your children with personal issues. It would not have been appropriate for Angie's mom to tell her daughter about the marital issues that led to such frustration.
*Keep it in perspective. Taking care of children is intensely rewarding but difficult. At times, we will falter and fail. Those occasional shortfalls don't diminish our countless sacrifices and successes. Keep it in perspective, and help your children do the same.

Ozone House: A Shelter in a Storm
Liz Cobbs, Ann Arbor News- 1/4/2005

Years ago, Mary Jo Callan sensed she had a special connection with young people. Callan worked as a school teacher in Inkster and the Traverse City area and discovered that students felt comfortable confiding in her. "I was the teacher they came to when they had problems," Callan recalled. "But I didn't have a clue about how to help them because I didn't have the experience."
Her experience as a teacher helped prod Callan to pursue a graduate degree at the University of Michigan in social work. As she was looking for a job, she spotted an ad for a counseling position at Ozone House. She got the job. That was 10 years ago. Today, Callan, 36, is executive director.
"Ozone House is a one-of-a-kind agency," said Callan, who became its leader in 2001. "We provide a safe haven for homeless youths."
     This past fall, Ozone House, located at 1705 Washtenaw Ave. near the University of Michigan's Central Campus in Ann Arbor, celebrated its 35th year in operation. The agency provides a wide range of services for young people from 10 to 21 years old, including 24-hour crisis intervention, an emergency youth shelter, a drop-in center; transitional and permanent supportive housing and youth and family counseling. Youths cannot stay at the shelter without parental approval. Callan oversees a staff of 41 full-time and part-time staff. The agency can have 50 volunteers at any given time.
Ozone House was created in 1969 as a safe place for teenage runaways who had come to Ann Arbor because of the drug and political scenes. Volunteers fed the teens, provided counseling and helped them to return home. Now, Ozone House has grown dramatically and primarily sees teenagers and their families from Washtenaw County, Callan said. "Kids are not running away for adventure, they're running away from something, such as poverty, abuse, or domestic violence," Callan explained. "They're trying to get help."
     Under Callan's leadership, Ozone House has received several awards for its operation, including Best Managed Nonprofit in Southeastern Michigan in 2002 from Crain's Detroit Business Magazine. It was also named an exemplary agency for use of Best Practices in a 2001 Michigan State University study. Ozone House was also honored three times since 1997 for Nonprofit Management Excellence by the Ann Arbor-based Nonprofit Enterprise at Work Center.
"Ozone House has been honored so many times, and I think that's a credit to Mary Jo," said Diane Davidson, executive director of the Washtenaw Housing Alliance, a coalition of 10 nonprofit organizations, including Ozone House, that serve the homeless and at-risk in Washtenaw County. "She is constantly focusing on the kinds of principles of service delivery that puts teens first and helps them re-establish a quality of life." For one of the oldest nonprofit organizations in Ann Arbor to receive management awards says a lot about Callan's efficiency in running the agency, said Ann Arbor attorney Constance Jones. "She always gets her job done," said Jones, a former Ozone House board member. "Perhaps one of her best qualities is she makes everyone around her feel confident and she engenders staff loyalty. You look good when you're around her." Angela Williams, a volunteer crisis counselor who serves on the organization's board of directors, also praised Callan's leadership style and the organization as a whole. "The staff and volunteers here never lose their vision and never give up on young people," said Williams, who's lived in Ann Arbor for 40 years. "They work hard and they're flexible.. And you wouldn't see that here if it didn't come from the leadership. Mary Jo is a very approachable person and staff feel they can share things with her."
      "Being flexible and able to see "the shades of gray is a part of who we are," Callan said. "While youth have similar needs, every young person is different and needs direction." "If you have hard and fast policies, you will fall short for some kids," Callan said. "We try to stretch and bend as best we can and leave room for all the different and unique kinds of characteristics of every person and family."
     Callan keeps a sharp eye on Ozone House's $1.4 million budget and has diversified its funding sources so as to not depend solely on government funding. Callan also evaluates the outcomes of the agency's services. "We track this because we want to see if we are making a difference or are we just spinning our wheels."
Despite her success, Callan has also encountered some trying times at the agency. In June 2003, Ozone House sued the city of Ypsilanti, claiming the city was trying to block its purchase of a two-story building downtown. Ozone House had been leasing the first floor of 30 N. Huron St. M a drop-in and youth counseling center for six years. The organization wanted to buy the building for $180,000, and spend another $100,000 to renovate it and rent the two second-floor apartments to some of the 18- to 21-year-olds it serves. City officials, however, were concerned that the proposed use of the building might be inconsistent with the purpose of the downtown district and did not contribute to its economic vitality. Six months later, a Washtenaw County Circuit Court judge's ruling cleared the way for Ozone House to buy the building.
     Leading a large nonprofit agency isn't easy, Callan said, but it's the best job she could imagine having. "It's always challenging and always rewarding," she said.; "While it's also always stressful, seeing the young people and the difference that we make them keeps me focused and motivated. We work very hard to make Ozone House a special place.



The Id Aside, Neurosis Is Really a Lot of Laughs
Alessandra Stanley, New York Times- 1/4/2005

Mental illness is the new sex. NBC's new sitcom, "Committed," a series centered on the romance between Nate (Josh Cooke), an obsessive-compulsive math genius and his nutty girlfriend, Marni (Jennifer Finnigan), makes it clear: psychological disorders are the next big thing. First there was "Mad About You," then "Friends," "Sex and the City" and "Will & Grace." Now, its "O.C.D. About You."
      It makes sense. Seratonin is like sex: everybody does it. Psychopharmacology has turned from a luxury good to a commonplace service, and nowadays it seems that almost everyone is either a patient or close to someone who is. Children are as medicated as their parents and therapy is in the air, in the culture and in everyone's medicine cabinet. So of course the generation that took sex public would move the other sphere of traditional privacy out of the confessional and into retail space. On prime time mental illness is a topic that is no longer taboo, but it is still just novel enough to incite laughter.
      "Committed" is a much more conventional sitcom than "Arrested Development," a farcical Fox comedy that also makes light of the latest trends in neurosis and brain chemistry, but it is amusing, particularly when it pushes the boundaries of black humor and political correctness. (It is an equal opportunity lampoon of disabilities, from a dying clown who lives in a walk-in closet, to Marni's friend Todd (RonReaco Lee), a passive-aggressive black man in a wheelchair who torments Nate behind his back. "Just because I'm in a wheelchair doesn't mean I can't play basketball," he tells Nate. "And just because I'm black doesn't mean I can."
      The evolution from Eros to Id has been gradual. Risqué jokes about sex were at the center of sitcoms about the urban singles scene like "Seinfeld," "Friends" and "Sex and the City," but the humor eventually wore thin. ("Coupling," an NBC knock-off of a sex-obsessed British sitcom, flopped.) NBC's "Will & Grace" set a milestone by introducing gay leading men to a network sitcom, but the series' funniest riffs revolve around Karen's screwball substance abuse.
      "Committed" may be the first network sitcom explicitly to frame psychological disorders as a central comic conceit, but the mental health motif began showing up years ago in books like "Prozac Nation" and "The Corrections," and it is part of the landscape in movies from as "As Good as It Gets" to "Garden State." The theme is not even new to television, though until now it has mostly popped up on cable, from HBO's "Sopranos," which began as the story of a mobster who consults a psychiatrist about his anxiety attacks, to "Monk," the USA series about an obsessive-compulsive detective. (That show is merely a modern revival of a 1970's trend in detective series. Back then, physical disability, not neurotic compulsion, was the fashion: Raymond Burr played a sleuth in a wheelchair on "Ironside," James Franciscus was a blind one on "Longstreet," and on "Cannon," William Conrad played a detective who was dangerously fat.)
      Sitcoms have always relied on eccentrics and kooky characters, but "Committed" takes it further, right into the cuckoo's nest. Nate, a math genius whose family makes the Tennenbaums seem like the Partridge family, works in a used-record store and nurses his fixations: he has an obsessive fear of elevators, blocked emergency exits and throwing things out. One episode revolves around Nate's attempts to keep Marni from seeing his apartment, which looks like a cross between the CollyerBrothers' brownstone and the schizophrenic mathematician's garage in "A Beautiful Mind." Or perhaps worse. Marni's friend and neighbor Tess (Tammy Lynn Michaels), a nanny with her own set of psychological blocks, helps Marni break into Nate's apartment and declares that it looks like the Unabomber's cabin. "We should probably go," she tells Marni. "The police are going to want to talk to you before he kills again."
      "Committed" has charm and wit, but its success depends on the writing and the lasting power of the two leads. Mr. Cooke is appealing in the role of Nate, but he seems a little wholesome for someone who makes Venn diagrams to map out a conversational point. Ms. Finnigan has a lively presence as Marni, though her vivacity at times verges on the shrill. Marni is an occupational therapist who is wacky and almost psychotically cheerful and optimistic. Her diagnosis is left undeclared, but she clearly has some issues of her own. On her first date with Nate, she asks the waiter for sparkling water, then changes her mind. "I keep forgetting I'm off the medication now," she says gaily. "I'll have a merlot."

Andrea Yates' Conviction Thrown Out
Ruth Rendon, Houston Chronicle- 1/6/2005

The 1st Texas Court of Appeals threw out today the capital murder conviction of Clear Lake mom Andrea Yates, who's been serving a life sentence for drowning her children in a bathtub. In ordering a new trial, the three-member appeals court cited false testimony by the state’s expert psychiatric witness, who said Yates had patterned her actions after a Law & Order television episode in which a woman drowned her children and was found innocent by reason of insanity. It turned out there was no such episode, and the appellate court said the trial judge erred in not granting a mistrial once it was learned Dr. Park Dietz's testimony was untrue. Assistant District Attorney Alan Curry said today that there was plenty of other evidence besides the Law & Order testimony that warranted Yates' conviction. Prosecutors will try to get the appeals judges to change their minds and barring that, take the case to a still higher court.
      Yates was reportedly cheered when news of today's ruling reached the Skyview prison psychiatric unit near Rusk. "She smiled and said she was basically just kind of in shock,'' said warden Todd Foxworth, who delivered the news. "But she was very happy. Physically and mentally, she's doing as well as I've ever seen her." Yates' attorney and family were jubilant. “It’s unbelievable,” defense attorney George Parnham said. “I’m stunned, unbelievably happy.”
      Yates' mother, Jutta Kennedy, heard the news by phone from network TV reporters Matt Lauer and Katie Couric. "I was speechless, shaking, '' Kennedy said. "I thought a decision would take a long time -- I was told four to six months.'' Kennedy's usually somber voice was considerably lighter today as she said that her daughter appeared to be well thought of and well taken care of in prison. "I saw her two weeks ago, and she's getting better. She's able to hold conversations, and yes, she was aware of the appeal." Yates' husband, a NASA engineer who filed for divorce in July, said today he hadn't heard a ruling had been made. When informed of the reversal, Rusty Yates paused, then said, "It's good news.''
      Parnham said he and Yates' legal team do not plan to seek her release from prison during the interim. "Andrea is where she needs to be right now, as far as security is concerned for her,'' he said. "The last thing Andrea needs, quite frankly from my perspective, is to walk from the TDCJ Skyview Unit into the public arena.''
      It was Andrea Yates herself who called police to her house on June 20, 2001. There police were horrified to discover the bodies of John, 5; Paul, 3; Luke, 2; and Mary, 6 months, tucked into the bed of the master bedroom. Seven-year-old Noah's body was still floating in the tub. The 37-year-old stay-at-home mom confessed to drowning her children, but she pleaded not guilty by reason of insanity, and psychiatrists determined she suffered from schizophrenia and postpartum depression. She told psychiatrists that she drowned the children because they were not "righteous" and would burn in hell if she did not take their lives while they were still innocent. Her case generated national interest and put a spotlight on postpartum depression. The case also raised questions about Texas’ legal system, which permits the conviction of mentally ill defendants as long as they know the difference between right and wrong.
      During her 2002 trial in the Houston courtroom of State District Judge Belinda Hill, Yates’ attorneys argued she didn't know what she was doing when she filled up the family’s bathtub and drowned her children one by one, but the Harris County jury deliberated just 3-1/2 hours before convicting her of drowning three of her children. She was not tried in the deaths of her other two children.
      Yates' attorneys vowed at the trial's end that they would appeal the case because of the testimony of Dietz, who told the jury he had served as a consultant on an episode of the television drama Law & Order in which a woman drowned her children in the bathtub and was judged insane. He testified the show aired shortly before Yates drowned her own children. Prosecutors referred to Dietz's testimony in his closing arguments of the trial's guilt or innocence phase, noting that Yates regularly watched the show and that she had alluded to finding "a way out" when Dietz interviewed her in the Harris County Jail after the drownings. But right after Yates' conviction, defense attorneys discovered no such episode was produced. As a result, both sides agreed to tell jurors who'd moved on to consider Yates' punishment that Dietz had erred in his testimony and to disregard that portion of his account. Dietz later said he had confused the show with others and wrote a letter to prosecutors, saying, "I do not believe that watching Law & Order played any causal role in Mrs. Yates' drowning of her children."
      Prosecutors told the Houston-based appeals court they didn't know that Dietz was wrong about the television show, and they argued the erroneous testimony wasn't material anyway. Although four mental health experts called by the defense testified to Yates' insanity, prosecutors' expert, Dietz, contended that Yates may have been psychotic but nonetheless knew the impulse to kill must be wrong because she believed the thoughts came from Satan.
      Yates' appeal cited 19 trial errors, but the appeals court ruled only on the false-testimony issue, since that was enough to reverse the conviction. Writing for the appeals court, Justice Sam Nuchia agreed the state hadn't knowingly used perjured testimony but expressed concern that the jury could have been prejudiced when weighing Yates' guilt. "We conclude that there is a reasonable likelihood that Dr. Dietz's false testimony could have affected the judgment of the jury,'' the court ruled. "We further conclude that Dr. Dietz's false testimony affected the substantial rights of appellant.''
      Curry said today that if the appellate judges reject prosecutors' motion to reconsider their decision, prosecutors can appeal to the Court of Criminal Appeals, the state's highest court. Despite the false testimony, Yates received a fair trial and was convicted because the jury believed she knew what she was doing and she knew it was wrong, Curry said. "It's an interesting issue, but it's not something that should have played a large role in the jury's verdict, based on the other testimony and the facts presented,'' he said. It could be several months before prosecutors have to decide whether to seek a new trial.

Expert in Spotlight After Yates Testimony
Associated Press, 1/6/2005

LOS ANGELES -- The resume of psychiatrist Park Dietz reads like a who's who of notorious killers of the last quarter-century. The one-time FBI profiler has testified about criminals including Unabomber Theodore Kaczynski, serial murderer Jeffrey Dahmer and would-be presidential assassin John Hinckley Jr. Now Dietz, often the go-to guy for prosecutors, is himself under the microscope. His erroneous testimony led a Houston appeals court on Thursday to overturn the murder conviction of Andrea Yates for drowning three of her children.
A receptionist at Dietz's Newport Beach, Calif., office said Thursday neither Dietz nor his firm had an immediate comment on the court's decision. In their opinion, the judges noted Dietz ``acknowledged that he had made an error in his testimony.''
      It is an uncharacteristic black mark on a career expert witness whom courtroom friends and foes alike admire for his thoroughness and integrity. ``I absolutely believe he's not a bought-and-paid for (witness). He absolutely believes what he says and backs it up with work,'' said Gerald P. Boyle, Dahmer's defense lawyer. ``I will never believe that he knowingly said anything that's a misstatement.''
      Dietz spent 18 hours interviewing Dahmer before testifying for the prosecution that he believed the serial killer could have stopped himself from murdering 17 young men and boys. In a telephone interview from Milwaukee, Boyle said his own defense psychiatrists held Dietz in ``high regard,'' even as they disputed his conclusions.
      In Yates' case, Dietz testified that while she may have been mentally ill, she also knew right from wrong when she killed her children. But Dietz also told jurors that before the crimes occurred in 2001, an episode of the television show ``Law & Order'' aired about a mentally ill woman who drowned her children and was found innocent by reason of insanity. Dietz, who has been a technical consultant for the show, suggested the Texas mother got the idea from the episode, but a defense lawyer later said he was told by the show's executive producer that no such episode ever aired. Prosecutor Joe Owmby mentioned Dietz's reference to the episode in his closing arguments before jurors convicted Yates, but later said the psychiatrist had been confused and had erred. The First Texas Court of Appeals ruled there is ``a reasonable likelihood that Dr. Dietz's false testimony could have affected the judgment of the jury.''
      Dietz runs two consulting firms out of the wealthy Orange County suburb of Newport Beach. The companies' experts have testified in high-profile court cases and have advised hundreds of major corporations, government agencies and celebrities on how to prevent stalkers, school shootings, workplace mass murders and other threats. He has sometimes irked mental health colleagues with his strict views on mental illness as a legal defense, and his contention that violent TV news, movies and TV shows inspire copycat sexual violence, school shootings and other crimes. ``With rare exceptions, people are responsible for what they do,'' he told Psychology Today in a 1999 interview. ``Killers seldom meet the legal standard for insanity, which is quite different from the way most people use the word every day. ``Killers may be disturbed, but that doesn't necessarily mean that they can't tell right from wrong or are compelled to maim or murder.''

Drug Industry Groups Vow To Publish More Results
Marc Kaufman, Washington Post- 1/6/2005

The world's four main pharmaceutical trade groups announced yesterday that they will publish far more data about clinical drug trials than is now required by law. The Pharmaceutical Research and Manufacturers Association, along with industry groups in Europe, Japan and some developing nations, said they will begin posting expanded information about new and ongoing trials by summer.
      American companies are required by law to provide information on clinical trials dealing with life-threatening diseases, but the groups said yesterday they are now committed to going beyond that requirement and will provide information about trials for all diseases. "Patients and physicians have asked pharmaceutical companies to make available information about all clinical trials, not just some trials, and make that information more accessible," PhRMA President Billy Tauzin said. "We're doing this because our industry recognizes that sometimes what the law requires doesn't give patients all they need."
      After heavy criticism from medical and consumer groups for withholding information about trials with negative findings about their products, drug companies have been under considerable pressure to change their ways. The American Medical Association, as well as editors from top medical journals, has called for mandatory publishing of all clinical trials.
      The new industry commitment to publish more clinical trial data will not be binding, however, and critics said that makes it insufficient. Reps. Henry A. Waxman (D-Calif.) and Edward J. Markey (D-Mass.) said earlier that they would introduce legislation requiring public disclosure of all later-stage clinical trial information. "A voluntary proposal from the drug industry that is unenforceable and full of loopholes doesn't really move us forward," Waxman said. "We already know many companies ignore the current law."
      Under the industry plan, information about new clinical trials will be posted on the government Web site, www.clinicaltrials.gov, beginning July 1. Trials of ongoing medicines will be posted by Sept. 13.

DUI Court Is Long on Support, Short on Jail Time
Christine Hanley, Los Angeles Times- 1/7/2005

Every Friday, the second floor of Harbor Justice Center in Newport Beach echoes with the curious sound of applause, breaking the somber silence that otherwise pervades these hallways when DUI hearings are in full swing. The cheering section is in courtroom No. 7, where Judge Carlton P. Biggs is conducting Orange County's new once-a-week session for repeat drunk drivers. He treats defendants to a raffle, quotes from French essayists and compliments the people who cared enough to get spiffed up for their appearance. Everyone who shows up gets a round of applause.
      Positive reinforcement is a central tenet of Orange County's DUI court, which opened in October. It is one of only two courts of its kind in California but is one of a growing number nationwide. They're designed to reduce recidivism among drunk drivers by providing encouragement and strict supervision to help treat addiction rather than imposing jail sentences or fines. "This is a major change in direction for courts," Biggs said. "People are starting to realize our traditional approaches don't work…. I wouldn't be surprised in years to come to see this approach taken a lot more."
      More than 1.5 million U.S. motorists are arrested each year on suspicion of drinking and driving. In California, 179,663 people were arrested on suspicion of driving under the influence in 2002, according to the latest statistics available from the Department of Motor Vehicles. Alcohol was a factor in 1,416 traffic fatalities and 32,013 injuries that year.
      Orange County's program is being funded for a year through a $1-million grant from the state Office of Traffic Safety, and developed with input from police and the O.C. chapter of Mothers Against Drunk Driving. The program borrows from the philosophy of special drug courts in the county and elsewhere that have reduced substance abuse by treating addictions rather than punishing defendants with jail time and fines. The biggest difference between the two courts is that the DUI conviction is not erased from graduates' records.
      Drivers with at least two arrests for DUI are eligible. They cannot have prior convictions for violent crimes, weapons or drug charges, or have been involved in a fatal DUI accident. To qualify, offenders agree to plead guilty to misdemeanor DUI, admit they're addicted to alcohol and commit to sobriety. They must write an essay, attend Alcoholics Anonymous meetings and be tested several times a week for as long as they're in the program. The length of time people are in the program varies. Their progress is monitored by a probation officer and a court-appointed health official. They can be jailed for refusing to be tested or if they drop out of the program.
      Biggs, who has also presided over the county's drug court, opens his DUI sessions with a raffle, giving away movie tickets and other small prizes as a reward to those who show up. He follows with an assortment of quotes, including one from Michel de Montaigne, a French essayist from the 1500s: "The value of life is not in the length of days, but in the use we make of them; a man may live long yet very little." He wraps up this philosophical interlude with the Nike slogan "Just Do It." "The goal is sobriety and to get your life back in order," Biggs reminds his audience. "I think it's a very significant goal … you will reach one day at a time."
      In its first three months, 50 people were accepted into the program. Among them is Mitchel Matthews, 46, of Costa Mesa. He was arrested in August for the third time in two years on a DUI charge. In court, Biggs compliments his personal essay, and for "dressing so nicely." Biggs tells him he is eligible to proceed to the next phase. Matthews said alcohol has taken a toll on his life. His last arrest cost him his job at a clinical lab. While he was in jail, he decided to volunteer for the program to take responsibility for his life. "By the time you get your third DUI, you know you have a problem and you are a menace to society," Matthews said. "Alcohol has affected everything I've done in my life."
      The program is too new to determine how recidivism rates have been affected. There will never be a way of knowing how many people "aren't dying or being injured by drunk drivers," Biggs said. There are an estimated 165 DUI courts or DUI/drug courts across the country, a recent survey by the National Assn. of Drug Court Professionals shows. One of them is in Northern California's Butte County, a DUI court that has been operating since 1996. A study showed that graduates of the program had about an 18% chance of repeat offenses, compared with 85% for those who went through the regular court system. "They're not repeating. And we are also seeing that their kids don't follow them," said Butte Superior Court Judge Darrell Stevens, who started the program. "DUI courts are very effective. The idea keeps getting bigger and bigger, because the other way doesn't work."
      Reidel Post, the executive director of MADD Orange County who helped develop the county's program, said it's imperative that all DUI courts be closely monitored to ensure that they offer defendants a fair chance at turning their lives around without sacrificing public safety. "We want to do everything we can to save lives and injuries caused by driving under the influence," she said.

New Trial for a Mother Who Drowned 5 Children
Adam Liptak, New York Times- 1/7/2005

Andrea Yates, the Texas woman convicted of drowning her children in a bathtub, was granted a new trial by an appeals court in Houston yesterday. The court ruled that a prosecution expert's false testimony about the television program "Law & Order" required a retrial. Ms. Yates, who had received diagnoses of postpartum depression and psychosis, confessed to the police in 2001 that she had drowned her five children, ages 6 months to 7 years. A Houston jury convicted her of murder the next year for three of the drownings, rejecting her insanity defense. The case ignited a national debate about mental illness, postpartum depression and the legal definition of insanity.
      Yesterday's ruling was narrow and novel. It turned on testimony by Dr. Park Dietz, a psychiatrist who was the prosecution's sole mental health expert. Dr. Dietz testified that Ms. Yates was psychotic at the time of the murders but knew right from wrong. The latter conclusion meant that she was not insane under Texas' unusually narrow definition of legal insanity. On cross-examination, Dr. Dietz was asked about his work as a consultant on "Law & Order," a program Ms. Yates, the appeals court said, "was known to watch." He was asked whether any of the episodes he had worked on concerned "postpartum depression or women's mental health." "As a matter of fact," he answered, "there was a show of a woman with postpartum depression who drowned her children in the bathtub and was found insane, and it was aired shortly before the crime occurred." That statement was false: There was no such episode. The falsehood was discovered after the jury convicted Ms. Yates. Dr. Dietz, who did not respond to several messages seeking comment yesterday, said at the time that his testimony had been based on a mistaken recollection. The trial court denied a defense request for a mistrial, but the jury was told about the false testimony during the sentencing hearing. The jury rejected the death penalty and sentenced Ms. Yates to life in prison.
      Yesterday, the Court of Appeals for the First District of Texas ruled that the motion for a mistrial should have been granted. "The state used Dr. Dietz's false testimony to suggest to the jury that appellant patterned her actions after that 'Law & Order' episode," the decision said. "We conclude that there is a reasonable likelihood that Dr. Dietz's false testimony could have affected the judgment of the jury." Dr. Dietz did not explain the supposed significance of the "Law & Order" episode at the trial. But prosecutors returned to the subject in a separate cross-examination and in closing arguments, suggesting that she had copied the program in a way that implied lucid planning and premeditation.
      Dr. Lucy Puryear, a psychiatric expert for the defense, was questioned about the nonexistent episode. In an interview yesterday, Dr. Puryear said the questions to her conveyed a powerful impression to jurors. "Had she seen that show and gotten ideas from it," she said, "it would say that she had the ability to think in an abstract way and come up with a plan. That would mean she could tell the difference between right and wrong."
      The appeals court said that there was no evidence that prosecutors had knowingly offered or discussed false testimony. Joseph Owmby, one of the prosecutors, said his office would ask the three-judge panel to reconsider. If that fails, he said, prosecutors will ask the entire appeals court and then the state's highest court for criminal matters, its Court of Criminal Appeals, to reverse the panel's decision. "It wasn't material," Mr. Owmby said, meaning that Dr. Dietz's testimony about "Law & Order" was not a significant factor in the jury's decisions. "It didn't affect her fair and just trial rights at the trial level." He said no decision had been made about whether to retry Ms. Yates should the appeals fail.
      At a televised news conference yesterday, George Parnham, one of Ms. Yates's lawyers, said she was not seeking an immediate release from prison. Ms. Yates "was surprised and not unpleased" by the decision, Mr. Parnham said. "She understands what's happening."
      Deborah W. Denno, a law professor at Fordham University who has studied and written extensively about the Yates case, was critical of other aspects of Dr. Dietz's testimony, too. He testified, for instance, that Ms. Yates's delusions that her thoughts were coming from Satan indicated that she must have known they were wrong. "He interpreted everything she did as evidence of premeditation and intention," Professor Denno said. "He is a hired gun in the worst sense."
      In an interview with The New York Times a month after Ms. Yates was convicted, Dr. Dietz said he had found the case troubling. "It would have been the easier course of action," he said of his own testimony, "to distort the law a little, ignore the evidence a little and pretend that she didn't know what she did was wrong."