Scientists Explore Meth's Role in Immune System
Anahad O'Connor, New York Times- 2/22/2005

Reports that a New York man may be carrying a rare and possibly virulent strain of H.I.V. have focused new attention on the biological relationship between the virus and methamphetamine, a drug that has become increasingly entwined in the spread of sexually transmitted diseases in cities from San Francisco to Miami to New York.
      Although methamphetamine, often called crystal meth or speed, is most troubling to health officials because of its role in blotting out inhibitions and fueling high-risk sexual behavior, experts say they are also grappling with mounting evidence that the drug by itself may increase a person's susceptibility to infection by crippling immune function and facilitating disease transmission. "There seems to be something about methamphetamine that predisposes people to H.I.V. infection," said Dr. Grant Colfax, co-director of the H.I.V. epidemiology biostatistics and intervention section at the AIDS office of the San Francisco Department of Public Health. "When we look at why methamphetamine is increasingly responsible for the H.I.V. epidemic, I do think we need to look more closely at whether it is somehow suppressing immunity and increasing viral loads."
      The National Institute on Drug Abuse has increased its funding of research on methamphetamine -- including studies looking at how it interacts with H.I.V. -- to $37 million in 2004 from $27 million in 2003.
      Knowing what, if any, direct impact the drug may have on the virus has gained a sense of urgency in recent months. Nationwide, methamphetamine addiction has become the second most frequent reason for seeking substance abuse treatment, behind alcohol. And experts fear that more and more people, particularly gay men, are relying on the stimulating effects of the drug - in many cases combined with Viagra or other similar drugs - to engage in unprotected sex with multiple partners. The man reported by health officials in New York to be carrying a rare strain of H.I.V. is believed to have used methamphetamine.
      A long-term study of more than 4,000 gay men sexually active with more than one partner recently found that the odds of contracting H.I.V. climb substantially while using crystal meth, independent of other risk factors. About a quarter of the men who were followed said that they had used crystal meth in the six months before the start of the study. They were all H.I.V. negative when it began. By the end of the study, called the Explore Project, about 2.1 percent of the men had become infected. Unprotected sex with multiple partners was strongly associated with infection. But even after the researchers controlled for those behaviors and others, like injection drug use, the men who were taking crystal meth were twice as likely to contract H.I.V.
      "This was a really surprising finding," said Dr. Colfax, a principal investigator on the study. "There's reason to think there's a combination of factors involved." One of them may be crystal meth's impact on immune cells. Although research is limited, studies in animals and on cell cultures have found that methamphetamine suppresses killer T cells, a type of white blood cell that fights off pathogens. That, combined with the drug's tendency to dry out mucosal membranes and cause abrasions in the mouth and rectum, might slightly increase a person's vulnerability to infection, said Dr. Antonio Urbina, the lead author of a study on crystal meth and H.I.V. that appeared last year in the journal Clinical Infectious Diseases.
      In those who are already infected, crystal meth may take a greater toll. Studies have found that it can interfere with antiretroviral medications and set off a surge in viral loads, accelerating the progression of the disease and making a person more infectious to others. In a study published in the journal Infectious Diseases last year, for example, researchers looked at 230 people who were H.I.V. positive, two-thirds of them either former or active users of crystal meth. Compared with other subjects, those who were regularly using crystal meth and were also on an antiretroviral medication had far higher viral loads.
      Dr. Igor Grant, an author of the study, said one possibility was that the crystal meth users had failed to adhere to their treatment regimens, as often happens with drug abusers. But stopping and starting a medication can be deadly in its own right, other experts point out, because it allows drug resistant strains to emerge, similar to what occurs when antibiotics are not taken properly. "If you're a person who is not adhering to your diabetes medication, that's one thing because you can hurt yourself but not others," said Dr. Roger J. Pomerantz, an AIDS specialist at Thomas Jefferson University in Philadelphia who studies interactions between drugs and the virus. "But with this you can hurt others by increasing the likelihood of both transmission and drug resistance."
      In studies, Dr. Pomerantz has found that although substances like heroin and alcohol also appear to increase viral replication, others, like caffeine, can actually reduce it. Whatever crystal meth's influence on the immune system and viral replication turns out to be, experts stress that its most alarming impact is on behavior. "I think that's really the biggest gorilla in the room," said Dr. Steve Shoptaw, a research psychologist at the University of California, Los Angeles, Integrated Substance Abuse Programs. "Being in a sex club for 36 hours on crystal meth and engaging in unprotected anal sex is really the most profound effect."

CDC Seeks Earlier Detection of Autism
Associated Press, 2/22/2005

ATLANTA -- Because half of all children with autism or similar developmental disorders aren't diagnosed until age 4 to 6, the Centers for Disease Control and Prevention on Monday was launching a campaign to make doctors and parents aware of the need of early diagnosis. Children can be diagnosed as early as 18 months old. The CDC is working to fill doctors' offices around the country with posters and checklists that describe developmental milestones for each age. The agency also created for parents a height chart with similar information.
     The health agency places autism in a category called autism spectrum disorders. People with such disorders may have problems with social, emotional and communication skills. The disorders can begin in early childhood and last throughout life. For example, the CDC's information for parents says a 2-year-old should be able to point to an object when named, use two- to four-word phrases and follow simple instructions. A 3-year-old can imitate adults and playmates, play make-believe with dolls and use pronouns or plural words. ``It's important for families and providers -- if a child has a developmental concern, early intervention really can have a positive impact,'' said Catherine Rice, a behavioral scientist with the federal health agency. ``It doesn't necessarily cure or clean up the issue, but it can help the child to a higher level'' of learning and living.
      About 24,000 of the 4 million children born each year eventually will be diagnosed with autism or other developmental disorders. The agency estimated that up to half a million Americans under age 21 have an autism spectrum disorder, the CDC said. The agency says it's a pressing issue because more children than ever before fall into the category of autism or autism-related disorders, primarily because medical officials and the government widened the definition of autism in the early 1990s.
      CDC officials want to make sure parents and doctors know what to look for. If parents or doctors think there could be a developmental problem in a child, they should contact a developmental pediatrician, a specialist or a local early intervention agency, the CDC said. ``It's become more clear in the case of autism that it really is an urgent public health concern -- before we used to think of it as a pretty low public health disorder; it's much more common than we previously thought,'' Rice said. The early detection campaign will help educate doctors about when to diagnose the condition. Doctors know a lot about autism but many times it's not recognized until later, said Joe Guzzardo, spokesman for the National Alliance for Autism Research.
      Tiffany Fleming knew something was wrong with her son, Connor, when he was just 6 months old. He would let loose bloodcurdling screams with enough emotion and intensity that he would turn purple and shake. Connor's screaming continued. The Duluth, Ga., boy earned the title of one of the ``Top 10'' screamers at his doctor's office. Other strange behavior developed -- he would repeatedly open and close drawers and it seemed like he didn't know how to play.
      At age 2, Connor was diagnosed with a form of autism. After therapy and a special diet, ``he started learning how to be a kid,'' Fleming said. ``It was like his brain was able to be rewired,'' said Fleming about her son, now 6. ``If he hadn't been diagnosed and we hadn't started with early intervention, I can't imagine what he'd be like today -- so much happens early.'' In Duluth, Connor now attends preschool and Fleming said her family and doctors are happy they ``were able to stop a lot of stuff before it manifested.'' ``He's very social, very cute, and has lots of friends,'' she added. ``His biggest trouble is he wants things his way ... he has some extra anxieties but just overall, he's just an amazing, sweet kid. He's still a work in progress, but aren't we all?''
      On the Net:
CDC autism campaign: www.cdc.gov/actearly
National Alliance for Autism Research: www.naar.org

Feel Ready to Pop?
Sue Shellenbarger, Wall Street Journal- 2/22/2005

Like re-balancing your investment portfolio, re-balancing your work and family life in critical areas is necessary from time to time, too. Here is how to tell if you have problems in five big areas, and how to jump-start solutions if you do.
• Cut off from family life? Could any of the following be you? a) You call home and your child summons your wife by yelling, "Hey Mom, it's the Invisible Man!" b) You lean down to comfort your crying preschooler and she runs away; c)You fail to recognize your son performing onstage in a school pageant
     If you picked any of these options -- all actual incidents from the lives of executives -- you need to schedule some family time. Books are the best resource for honing the deep, universal qualities of a good family life. Two excellent ones are "The Intentional Family," by William Doherty, and "The Book of New Family Traditions," by Meg Cox, a former Wall Street Journal reporter, and Sarah McMenemy.
     A more radical cure can be found in "Family 360," a book by management consultants Perry Christensen and Ben Porter on applying 360-feedback performance-review techniques to family life. This process can be like throwing a bucket of psychic ice water on emotionally absent adults.
• Workaholic hours? Hard work can be a great thing; whether you're going overboard shows up in how you feel. Do a gut check for signs of burnout: If your outlook is uncharacteristically cynical or self-doubting, if you feel cold or negative toward customers, co-workers and family, or if you're failing to reap any sense of accomplishment from your work, you're probably burning out.
     Feeding your mind with books or Web sites won't help; burnout victims are too drained to take good advice to heart. The best remedies are getting away for a while and increasing closeness with others.
     You'll know you've gone to the next stage--into workaholism, or compulsive overwork--if you feel anxious when you stop working, if you need work to satisfy a craving for approval, or if you. feel numb, unable to experience any emotions at all. You'll probably need therapy and/or small-group support to solve this one. A directory of therapists can be found at www.aamft.org.      Workaholics Anonymous, a Menlo Park., Calif., self-help group at (510) 273-9253, offers a program and support. For reference, see "Workaholics, the Respectable Addicts," by Barbara Killinger.
• A rigid job? If protocols of your work are forcing you into continual compromises that make you or your loved ones feel cheated, it's time for a change. For help developing flexible schedules, see www.workoptions.com, which has templates for writing proposals you can submit to the boss.
     If your heart is set on telecommuting, www.gilgordon.com, by management consultant Gil Gordon, has Q&A's on the topic and www.joannepratt.com, by telework consultant Joanne Pratt, offers a work-at-home self-test and tips. The acid test: If the scheduling changes you make are good ones, your productivity should go up.
• Elder-care strain? You're in trouble on this front if you worry about an elderly loved one but a) have no plan for caring for her, b) haven't talked to other relatives about her future needs; or c) lack knowledge of her financial and legal affairs.
     Begin talking with your elder about her wishes and gather information. To assess community services, contact the area agency on aging nearest your relative's home, available online at www.eldercare.gov or (800) 677-1116. The Web is unmatched for finding elder-care help. Some extraordinary sites include www.caregiving.org which assigns quality ratings to elder
books, videos and Web sites; www.caregiver.org, which offers resources including a state-by-state program guide; and www.benefitscheckup.org, which uses information you provide to identify programs and benefits your relative might receive.
• Too much stress? Some stress is good; the bad kind hinders progress. The key to making the distinction is how you feel about work. If you're psyched about it, with the adrenaline pumping, you're having "challenge stress," a term used by some researchers to. describe a beneficial kind that can be motivating, Bad stress, or "hindrance stress," is marked by waning productivity, dissatisfaction, anxiety and physical symptoms such as frequent illness.
Educating, yourself with books and Web sites can help; tap www.yourmedicalsource.com for stress-management tips. A book, "Slack," by Tom DeMarco, documents the value of unstructured time. The most enduring remedy, however, is to change your daily habits. Massage, meditation or any other good quiet-time rituals, are stress antidotes.

Red flags
Some signs that you need to rebalance your life:
• You are working harder and getting less done.
• You get anxious if you have to stop working.
• You feel disconnected and remote from your children.
• Work continually forces objectionable family compromises.
• You have made no plans to care for a frail elderly relative.



A Mormon Daughter's Book Stirs a Storm
Edward Wyatt, New York Times- 2/24/2005

The daughter of one of Mormonism's most prominent religious scholars has accused her father of sexually abusing her as a child in a forthcoming memoir that is shining an unwelcome spotlight on the practices and beliefs of the much-scrutinized but protectively private Mormon religious community.
"Leaving the Saints: How I Lost the Mormons and Found My Faith" details how the author, Dr. Martha Beck, a sociologist and therapist, recovered memories in 1990 of her ritual sexual abuse more than 20 years earlier by her father, Dr. Hugh Nibley, professor emeritus of ancient scripture at Brigham Young University and arguably the leading living authority on Mormon teaching. The book, being published next month by Crown, an imprint of Random House, has attracted significant criticism both for its depiction of sacred Mormon ceremonies and for the author's effort to tie her sexual abuse to what she says were mental disturbances suffered by her father because of his role as the Mormon Church's "chief apologist."
      Dr. Nibley, who is 95, is ailing and is physically unable to respond to questions, Alex Nibley, one of eight Nibley children, said in a statement. Dr. Nibley has been aware of Dr. Beck's accusations for several years, Alex Nibley said, and maintains that they are false. As part of a defense of their father, Dr. Beck's seven siblings have condemned her assertions and have hired a psychologist and lawyer who has worked on lawsuits against therapists practicing recovered-memory therapy.
      The Mormon Church issued a statement condemning the book, calling it "seriously flawed in the way it depicts the church, its members and teachings." Dr. Beck and her publisher have said she has received e-mail messages containing death threats. In addition, Mormons around the country have participated in an e-mail campaign against the book, sending more than 3,500 messages to Oprah Winfrey, who has featured "Leaving the Saints" on her Internet site and in the March issue of O, the Oprah Magazine. The magazine includes a monthly self-help column by Dr. Beck, who has a doctorate from Harvard.
      Though other recent books have taken aim at parts of the Church of Jesus Christ of Latter-day Saints, at well-known Mormons or at Mormon culture, rarely have they focused on so prominent a figure as Dr. Nibley. In 2003, for example, Jon Krakauer wrote about a group of renegade Mormon fundamentalists in "Under the Banner of Heaven: A Story of Violent Faith." As with the Beck book, the Mormon Church issued a statement condemning it before it was published.
      Recovered memory, in which a suppressed traumatic incident is recalled years later, has been one of the most disputed topics among mental-health professionals in the last 15 years. The American Psychological Association states that while "there is a consensus among memory researchers and clinicians that most people who were sexually abused as children remember all or part of what happened to them," most leaders in the field also agree "that although it is a rare occurrence, a memory of early childhood abuse that has been forgotten can be remembered later."
      But "Leaving the Saints," Dr. Beck's fourth book, seems as likely to be discussed for the things it leaves out as for those it includes. Among the omissions is an incident of sexual abuse that Dr. Beck said recently in an interview was never suppressed. When she was about 9, she said, a teenage neighbor barricaded her in his room, stripped most of her clothes off and sexually assaulted her. He did not achieve penetration, Dr. Beck said, and the incident was interrupted by her father, who was in the neighbor's house at the time. Though she called the event "extremely traumatizing," she said the incident was cut in the editing of her manuscript to shorten the book.
      Dr. Beck also does not mention that one person she consulted about her sexual abuse was Lynne Finney, a Utah psychotherapist who has said that up to one out of three Americans were sexually abused as children. In the early 1990's, Ms. Finney, who is referred to in "Leaving the Saints" by the pseudonym "Mona," was a leading practitioner of recovered-memory therapy, including the use of self-hypnosis, a practice that some studies have shown can result in the creation of false memories. Asked about the omission, Dr. Beck said she consulted Ms. Finney only after having already recovered the memories of abuse. She said that she practiced self-hypnosis once under Ms. Finney but that it did not play a part in her memory recovery.
      While Dr. Beck is now highly critical of the Mormon Church, in 1990, she and her husband, John C. Beck, had a book published by a company owned by the Mormon Church arguing that homosexuality is a compulsive behavior that can be overcome. After leaving the church, however, the Becks divorced and have lived openly as homosexuals, something each acknowledged in interviews. Dr. Beck said she left those details out of the book to keep it focused on the accusations of sexual abuse; John Beck declined to comment further on the book.
      Those and other facets of Dr. Beck's story have been discussed online in chat rooms and on bulletin boards, at sites devoted to Mormonism and at those favored by people who have left the church and view its practices unfavorably. The book's own Web site, www.leavingthesaints.com, has had more than 6,500 visitors in February alone, triple the number in January, and has received more than 200 e-mail messages, 80 percent of them expressing outrage at the book, the publisher says.
      In an interview, Dr. Beck said she did not intend "Leaving the Saints" to be an indictment of Mormonism. Though she said her book did not reveal any church secrets, it discusses Mormon rites like the temple ceremony, a sacred ritual, and subjects like regulation temple garments, which Mormons wear under their clothes -- in a sometimes mocking tone that has infuriated many devout Mormons. Her publisher said Dr. Beck had received at least one death threat by e-mail that cited her depictions of Mormon ceremonies. "I didn't write it to convince anyone not to be Mormon or not to join the Mormons," she said. "I just needed to get the story of my childhood out of my system."
      Her childhood was marked, she said, by unexplained depression, anorexia and despair that at times left her suicidal. Even before she recovered her memories of sexual abuse, she said, she recalled suffering unexplained pain and bleeding between her thighs when she was about 5. She writes that she remembered thinking that "if anyone finds out about it, no one will ever marry me." In her teens and 20's, she writes, several doctors commented on unusual scar tissue in her vaginal area, which she cites as physical evidence of the abuse. Later, she said, doctors confirmed to her that the vaginal scarring was not the result of childbirth. It was not until she was in her late 20's, however, while teaching at Brigham Young, that Dr. Beck experienced a flashback that resulted in the memories of what she describes as ritualistic rape by her father. During the incident, which she believes took place in her home while her older siblings were at school, her father recited incantations about Abraham and Isaac.
      Dr. Beck's siblings, who have known about her claims for almost a decade and several of whom attended at least one family-group session with one of Dr. Beck's therapists, dispute her account, saying that no evidence exists of abuse and that incidents in the book are either inaccurate or made up. Rebecca Nibley, a sister, said Dr. Beck "encouraged me to get my own recovered memories of being abused." "As hard as I tried, I couldn't remember anything untoward concerning my father's behavior toward me, and I can't validate any of Martha's claims," she added.
      Dr. Beck twice confronted her father about the claims, once at a family therapy session with her husband and her parents shortly after she recovered the memories. The other time was at a 2001 meeting in a hotel, an event that she uses as a device in "Leaving the Saints" as the story of her life and her understanding of her sexual abuse unfolds. Joining her at that hotel meeting was a member of her extended family who has supported Dr. Beck's assertions from the beginning. The family member, who is identified in the book by a pseudonym, agreed to speak only on the condition of anonymity after receiving threats of physical violence because of her support of Dr. Beck. "I believed Martha from the beginning because the memories she had of elements of the abuse -- memories that never went away and were always part of her history -- also fit with the outward signs of the abuse I saw in her growing up," the family member said. Speaking to Dr. Beck's parents about it since, she said, "has only served to strengthen my belief in the veracity of her reporting of her experience."

Suicides in Marine Corps Rise by 29%
Ann Scott Tyson, Washington Post- 2/25/2005

The Marine Corps suffered a 29 percent spike in suicides last year, reaching the highest number in at least a decade, with the demanding pace of military operations likely contributing to the deaths, the top-ranking U.S. Marine said yesterday. Thirty-one Marines committed suicide in 2004, all of them enlisted men, not commissioned officers. The majority were younger than 25 and took their lives with gunshot wounds, according to Marine statistics. Another 83 Marines attempted suicide. There were 24 suicides in 2003, and there have not been more than 29 in any year in the last 10.
      Although last year's suicide rate rose, it was still below the national average for a comparable civilian group, in keeping with an established pattern of suicide being lower in the U.S. military than in the civilian population.
     Marine commanders say the rise in suicides continues a worrisome three-year trend that is likely linked to stress from the sharply increased pace of war-zone rotations. At the same time, they said the increase in suicides is not directly related to service in Iraq or Afghanistan; since 2001 24 percent of the suicides have been committed by Marines who have been deployed there, the statistics show. It is "not only Iraq, it's just the ops tempo [operational tempo] in general, that's what I think," Gen. Michael W. Hagee, the Marine Corps commandant, told reporters at a breakfast meeting yesterday.
     Hagee's remarks echoed a strong warning in a Dec. 13 memo that he issued on suicide prevention. "This problem is pervasive and is impacting Marines throughout the Corps, not just those who have been deployed in support of the global war on terrorism," the memo said. "The increased operational tempo that our Corps is experiencing may be affecting the ability of our Marines to deal with perceived overwhelming stresses associated with relationship, financial, and disciplinary problems." Indeed, about 70 percent of Marine suicides over the past four years have been caused by problems in personal relationships, which can be exacerbated by heavy workloads, said Cmdr. Thomas Gaskin, a behavioral health specialist for the Corps' Personal and Family Readiness Division at Quantico. "That is the single biggest stressor," he said.
     With a force that is the youngest in the military services and predominantly male, the Marine Corps has generally experienced the highest suicide rate among the military branches because its demographics mirror a high-risk group in the general population. More than 60 percent of Marines are younger than 25, and 16 percent are teenagers.
     Suicide rates for all the services began rising in 2002, and the Army had an increase in 2003, the first year of the Iraq war. This leads experts to believe that stress is broadly linked to deployments. However, despite ongoing rotations to Iraq, the Army's suicides in that country fell back closer to historic levels last year, officials said. That may suggest that, as with the Marine Corps, suicide rates may be more connected to the general demands on the force than to service in combat zones, officials said. Marine officials said the suicides in their force show no definitive causal patterns. "There are no clear trends among any specific groups," said Greg Gordon, a spokesman for the Personal and Family Readiness Division.
     Hagee warned that while some Marines have displayed obvious warning signs of suicidal tendencies -- such as a preoccupation with dying, risky behavior, withdrawal or giving away their possessions -- many do not. In his memo, he warned that some Marines feel stigmatized for seeking help. "They may feel it is not acceptable to ask for help because they don't want to be labeled as 'weak' or 'defective' in the eyes of their subordinates, peers, or leaders," he wrote. Commanders, he emphasized, must redouble their efforts to make Marines feel comfortable in revealing problems that could lead to suicide.
     Growing concerns over suicide have led both the Army and Marines to dispatch more mental health professionals to Iraq and Afghanistan, in an effort to provide more immediate prevention. In response to the rising number of suicides in Iraq in 2003, the Army deployed several "combat stress" detachments there to allow psychologists to treat soldiers who demonstrate suicidal tendencies without requiring them to leave the country. Similarly, the Marines in 2004 launched an "operational stress control and readiness program" in which mental health professionals are embedded in Marine divisions in Iraq and travel to individual units to treat Marines. "Before, we had to ship them out of theater. Now they can provide help immediately," Gordon said. The Marines are also developing a prevention tool for commanders called "a leader's guide for managing Marines under stress," which is expected to be issued early this year and includes checklists of what to do for suicidal behavior.



Marital Spats Have Health Benefits
Kim Chipman, Chicago Tribune- 2/25/2005

Women who avoid fights with their husbands have a risk of dying from any cause that is four times higher than for women who always express their feelings, researchers say. Married women who come home anxious about work are in more danger of developing heart disease, according to a report presented Thursday at the second annual Women, Heart Disease and Stroke conference in Orlando.
      Previous studies have found a link between marital tension and the health of people who already have heart disease. There has been little research examining how such strain might contribute to heart disease or death from any cause, the study said. "These findings are unique," said Elaine Eaker, the study's lead author and head of Eaker Epidemiology Enterprises in Chili, Wis. "We believe we have found characteristics of marriages that have an impact on peoples' health and longevity."
      Researchers analyzed data on participants of the Framingham Offspring Study, a broad, continuing project that tracks heart disease and other social characteristics such as marital problems in people of Framingham, Mass. The study, aided by scientists at Boston University, included 1,769 men and 1,913 women ages 18 to 77. Of these people, 84 percent of the men and 78 percent of the women were married or living in a marital situation. Initial exams were done from 1984 to 1987. Researchers then monitored the health of the participants for 10 years to find out if they got heart disease or died.
     "Married men were heavier, older and had higher blood pressure and a less-favorable lipid profile compared to unmarried men," Eaker said. "Unmarried men were more likely to be smokers."
After adjusting for age, cigarette smoking and other factors, researchers found that married men in the study were about half as likely to die compared with unmarried men.
      Marital status had no effect on women developing heart disease or dying, said the study, a summary of which also appeared in this month's issue of Circulation: Journal of the American Heart Association. General marital strain also didn't have an effect on the women, though those who said they usually or always kept their feelings to themselves in a dispute with their husbands had more than four times the risk of dying from any cause compared with women who always expressed their feelings, according to the study.



Small Study Ties Ritalin to Higher Cancer Risk
Todd Ackerman, Houston Chronicle- 2/25/2005

In a small but potentially alarming new study, local scientists have linked the most popular drug used to treat attention-deficit problems with increased risks of cancer. The study of 12 children on Ritalin found every one experienced a significant increase in their level of chromosome abnormalities — occurrences associated with increased risks of cancer and other adverse health effects.
      "Assuming it holds up, this study doesn't mean these kids are going to get cancer, but it does mean they're exposed to an additional risk factor," said Marvin Legator, a professor of environmental toxicology at the University of Texas Medical Branch at Galveston and the study's principal investigator and senior author. "Smoking doesn't mean you'll get cancer. It's a risk factor." But Legator said the study was too small for Ritalin to be considered a risk factor for cancer yet. He said he hopes larger studies refute the finding.
     The study is the first to look at the potential chromosome-damaging effects associated with methylphenidate, the generic name for Ritalin, the most widely prescribed drug used to treat attention deficit/hyperactivity disorder (ADHD). Between 1991 and 1999, U.S. sales of Ritalin and its variants, including Concerta and Metadata CD, increased more than 500 percent. The study, conducted by researchers at UTMB and UT M.D. Anderson Cancer Center, will be published in an upcoming edition of the journal Cancer Letters. It was made available online Thursday.

Other medications cited
The study is just the latest to cast doubt on ADHD medication. Earlier this month, Canadian regulators suspended sales of Adderall amid reports of 20 deaths of patients, including 12 children, taking the drug between 1999 and 2003. In the same time period, American regulators logged seven sudden deaths of children taking Ritalin and Concerta. A third ADHD drug, Strattera, can cause severe liver injury.
      In the study, researchers drew blood from children diagnosed with ADHD before they began taking Ritalin and again three months after, then employed a method of analysis that has detected 48 of the 53 known carcinogens in humans. All the children — 10 boys and 2 girls averaging 8.5 years old — were taking normal doses. For all 12, blood analysis tests showed a twofold to threefold increase in abnormalities in the chromosomes, the bodies within cells that carry genes and genetic information. Most consisted of chromosome breaks, which are associated with an increased risk of cancer.
     All people have chromosome abnormalities, typically about 1 percent. The children in the study had levels increased to 2 to 3 percent. Legator said he was amazed by the consistency of the findings, that all 12 children showed the same result. But he and other investigators stressed that more research needs to be done — for instance, researchers didn't follow up so it's not known whether the chromosome abnormalities are permanent or go into repair once the patient goes off the drug.

Follow-up study planned
Study investigators said parents should respond cautiously to the study and not take their child off Ritalin if he or she is doing well. But Melissa Bondy, an M.D. Anderson epidemiologist who was part of the study, said she understood parents' natural reaction. "My child was recently diagnosed with ADHD and it was very difficult to decide to use medication after knowing these results," said Bondy. "That's why we need to do further research."
      The investigators said they plan to propose a follow-up study with hundreds of patients, multiple sites and longer study periods. Although there are millions of children on Ritalin, participation is limited by the need to enroll patients before they start treatment. ADHD, the most common neurobehavioral disorder in childhood, affects 4 to 12 percent of U.S. school-age children. Symptoms include short attention span, impulsive behavior and difficulty focusing.



How Shy Is Too Shy?
Peter Jaret, Los Angeles Times- 2/25/2005

Years ago, when parents came to him worried because their kids seemed abnormally shy, Murray Stein, a psychiatrist at UC San Diego, would tell them not to worry — that most children outgrow periods of intense shyness. "Now we're not so quick to dismiss their concern," he says.
      Although most very shy kids do emerge from their shells, as many as one in three become more and more troubled, according to Stein, one of the country's leading experts in childhood anxiety disorders. They go on to develop social phobia, also called social anxiety disorder — shyness so extreme that it causes physical symptoms, such as racing heartbeats and shortness of breath, and interferes with a normal life. As their dread of meeting people or being in the spotlight intensifies, they withdraw more and more from the world. "These are kids who eventually drop out of college because they're so terrified of being called on in class," says epidemiologist Ronald Kessler, a professor of healthcare policy at Harvard Medical School who studies anxiety disorders. "They miss out on jobs they're qualified for because they're too afraid to go to interviews."
      There are other dangers. Recent nationwide surveys that Kessler has directed show that people with social phobia are at greater risk of developing severe depression, panic attacks and substance abuse problems. They are also more likely to commit suicide. Given those risks, a growing number of childhood psychiatrists and psychologists say it's important to be alert to early signs of problem shyness. "Social phobia has the earliest onset of almost any mental disorder," says Stein. "People with the earliest onset generally fare the worse. So if we can intervene and treat children or adolescents early, we may be able to help prevent more serious problems later."
      Fortunately, the disorder has turned out to be among the most treatable of all mental conditions.
Several classes of prescription drugs that were first developed to treat depression or anxiety have been shown to relieve the symptoms of social phobia in many sufferers. The newest and most widely used are selective serotonin reuptake inhibitors, or SSRIs, which were first developed to treat depression. To date, the U.S. Food and Drug Administration has approved three SSRIs specifically for social phobia: paroxetine (Paxil), sertraline (Zoloft) and venlafaxine (Effexor). The drugs appear to work in both children and adults. A 2004 University of Texas study of 319 children and adolescents with social phobia found that 48% were "very much" improved after taking Paxil, compared with 15% of those on a placebo.
     Another approach is psychosocial therapy, which uses counseling to encourage people to face their fears, overcome them and then develop social skills to feel more comfortable in the company of others. One widely used approach is cognitive behavioral therapy. Although individual programs vary, most involve helping patients recognize negative thoughts that feed their fears — for example, "If I say something, everyone will laugh at me" — and replace them with more realistic expectations. The next step is to disarm anxieties by being gradually exposed to the social situations that trigger them. The treatment usually involves 12 to 16 weekly sessions. "Exposure is a powerful tool," says Thomas Rodebaugh, associate director of the Adult Anxiety Clinic at Temple University in Philadelphia. "When the worst thing people fear doesn't happen, they begin to lose that fear."
     In one experiment, 67 children ages 8 through 12 who were diagnosed with social anxiety disorder were randomly divided into two groups. One received behavioral therapy aimed at easing fears and increasing social skills. The control group received counseling to improve test-taking skills. At the end of 12 weeks, 67% of the children in the behavioral group no longer met the criteria for social disorder, compared with 5% in the test-taking group.
     Both medication and psychotherapy are remarkably similar in effectiveness, according to Rodebaugh. But there are important differences. Studies suggest that medication works faster and may be more effective in the short term. Psychotherapy has longer-lasting benefits and appears to be more effective than medication at preventing relapses. In practice, many mental health experts use both medication and counseling to treat social phobia.
     The toughest challenge, experts say, is getting help to the people who need it most. Only about 15% of people with serious social phobia seek medical help, surveys suggest, making it one of the most under-treated of all psychiatric disorders. "Most extremely shy people are just too shy to ask for help until their problems become so severe that they feel they have no other choice," Kessler says. The very nature of the disorder prevents many people from getting treatment.
     At the other end of the spectrum, some people with garden-variety shyness are being inappropriately diagnosed and treated for social phobia, some experts acknowledge. Part of the problem lies in the definition of social phobia. Ever since social phobia was added to the list of anxiety disorders in the 1986 revision of the official classification of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), critics have complained that there is no objective way to distinguish between normal shyness and social phobia. "We don't have a laboratory test for social phobia, the way we do for blood pressure or cholesterol or cancer," says Paul Chodoff, a psychiatrist at George Washington University. "Even the term 'disorder' is deliberately vague." As a result, he worries, people whose shyness falls well within the range of a normal personality trait may be told that they have a mental problem that needs to be treated.
     Critics say drug companies have helped blur the line between normal shyness and social phobia — a charge echoed by the FDA, which recently objected to a television commercial for the drug Paxil. In the commercial, people are depicted in everyday situations — walking into the cafeteria at work, sitting on a sofa at a party, putting on lipstick in the mirror — wearing nametags that supposedly describe their emotions, including "self-conscious" and "nervous." In a letter last year to Glaxo- SmithKline, which markets Paxil, the FDA charged that the ad fails to distinguish between social anxiety disorder and "lesser degrees of performance anxiety or shyness that do not generally require psychopharmacological treatment." The ad has since been pulled.
     Roughly half the adult population describe themselves as shy, recent surveys have found, and medications offer a quick fix. That's a vast market for drugs. What's more, recent surveys have shown that more and more adults are troubled by shyness. The reason, experts suspect, is that current society places a high premium on being outgoing and vivacious. "There used to be many more opportunities for people who were socially shy and reticent to live in small communities, work at home and limit their social interactions," says Stein. "Now, particularly as women have entered the workplace, people have to interact more. If you want to get ahead, you have to be out there in people's faces." The percentage of people who have true social phobia is much smaller — only 3% to 4% of the population, according to Stein. Moreover, the distress that they experience is much more extreme than simply feeling uncomfortable at a cocktail party.
     According to the official definition, the disorder is a "marked and persistent fear" of certain social or performance situations. People with social phobia experience anxiety that can approach the intensity of a panic attack. To qualify as a disorder, extreme shyness also has to interfere with people's ability to function at work, in school, or in personal relationships.
     The definition has been a work in progress, however. In 1994, the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Assn., dropped two categories — avoidant disorder and overanxious disorder — and merged their symptoms into social phobia. It acknowledged that social phobia may be expressed differently in children than adults — with crying, tantrums or withdrawal, for example. And it added another crucial distinction: While adults with social phobia know they aren't behaving normally, children typically don't realize that their fears are unreasonable or abnormal.
     That children are often unaware that they have a problem is just one of several factors that make diagnosing and treating young patients tricky. Another is knowing whom to treat. "We know that some very shy children will outgrow it," says Stein. "Some will go on to have serious problems. Unfortunately, we're still not very good yet at knowing who we should worry about." One clue is family history. Social phobia tends to be inherited, researchers have found. Another is how long the symptoms persist. If children remain shy and withdrawn for more than two years, there's a good chance they will develop severe social phobia.
     In his practice at UC San Diego, Stein usually starts with psychosocial approaches — strategies as simple as boosting children's confidence, improving their social skills and gradually exposing them to fearful situations in manageable doses. When children don't respond adequately, he may recommend medication.
     The idea of putting children or adolescents on mind-altering drugs of any kind — whether for depression, attention deficit disorder, or social phobia — has long been controversial. The controversy intensified when recent studies showed an increased risk of suicidal thoughts among kids on antidepressants. Even so, the number of children using antidepressants continues to increase, rising from 1.6% to 2.4% from 1998 to 2002, according to a report published in the journal Psychiatric Services in April 2004. How many of the drugs are prescribed specifically for social phobia isn't known.
     In practice, most psychiatrists and parents are extremely reluctant to put children on prescription drugs, according to Stein. "Believe me, I don't have parents coming into my office asking me to put their kids on medication," he says. "It's almost always a last resort." At the same time, he's seen medication work wonders, helping kids who were overwhelmed with fear begin to lead normal lives — making friends, participating in school, living free of fear. "When we're successful, we can really change these kids' lives forever."


A Safety Net for Problem Drinkers Hartford Courant, 2/25/2005

Websites that help people assess whether they are alcoholics might be helpful in changing harmful drinking behavior. Researchers report in the February issue of Alcoholism: Clinical & Experimental Research that the websites mimic methods that successful counselors employ during face-to-face encounters with problem drinkers. The series of reports was originally presented last June at a meeting of the Research Society on Alcoholism. The sites offer questionnaires about drinking habits, give feedback in a nonjudgmental manner and offer several options for people who want to change their drinking habits. Computer counseling has the extra benefit of anonymity, said Scott Walters, symposium organizer and assistant professor of behavioral sciences at the University of Texas School of Public Health. "It's a way to save face, and drinkers can begin to look at their drinking in a private and nonjudgmental way," Walters said.
     Among websites that offer such informal counseling services are Drinker's Check-up at http://www.drinkerscheckup.com , E-Chug at http://www.e-chug.com and MyStudentBody.com at http://www.mystudentbody.com



As Autistic Children Grow, So Does Social Gap
Jane Gross, New York Times- 2/26/2005

Sixth grade was a trying time for Karen Singer's autistic son, who spent recess wandering the periphery of the playground by himself and sometimes hid in the school bathroom when he needed a safe place to cry. He knew he was doing something wrong as he reached the social crucible of middle school, but he did not know how to fix it. At home he begged his mother to explain: "Why am I like this? What's wrong with me?"
      Intensive behavioral treatment, popularized over the last 10 years, prepared him academically and helped him get by in regular classes for years. But social skills are more elusive for autistic children, and the gap widens with each passing year. Classmates who once tolerated his peculiarities now shunned him. Their interests had changed to hanging out and being cool, while he remained preoccupied with saltwater fish and Yu-Gi-Oh trading cards. During group projects the boy rigidly held his ground on small matters, like what color ink to use. When challenged, he blurted out, "You're stupid!" or other inappropriate retorts. "It was shocking how it all of a sudden fell apart," said Ms. Singer, who asked that her son, now 13, not be identified by name or hometown and thus be further stigmatized. "He'd never say, 'I don't want to go to school.' He'd make it through the day, then come home and melt down."  Last fall the Singers moved their son to a private school for children with learning disabilities, persuading him that it was not a failure but rather an opportunity to feel less anxious. And he does.
     The Singers' anguished choice is an unintended consequence of improved diagnosis and new behavioral therapy. A generation ago most autistic children would have been written off as hopeless. Now, as their numbers are increasing, many learn to speak and to tame their most difficult behavioral traits. They are autism's success stories, moving from one-on-one instruction to typical public school settings. Last year 27 percent of this country's 141,022 autistic children were educated in public school classrooms with normal children, up from 11 percent of the 22,664 autistic children of a decade ago. But these high-functioning children face a host of new problems as they approach adolescence, when social interactions become more complicated. Parents, educators, researchers and clinicians all say that the majority of such children become conspicuous in the third grade and are bullied or ostracized by the time they reach middle school.
     Dr. Sandra L. Harris of Rutgers University, a pioneering educator and researcher in autism, said advances might have fed false hopes. "The intellectual skills of some of these children may lead people to expect more than is possible socially," Dr. Harris said. "They miss so much nuance that it can't be fixed in a 100-percent way. That was the hope. Now we know it's more elusive than that." Christine Grogan, the director of a school for autistic children in Paramus, N.J., urges educators to be cautious about what they promise parents, adding, "There are many people in the field giving false hope" about whether remaining in the mainstream is realistic for more than a tiny number of children over the long haul.
     Virtually nothing in the social arena comes naturally to autistic children. They must be taught how to have a conversation. To show empathy by asking questions. To resist arcane topics that do not interest others. Not to talk too loudly or to stand too close to the other person. To master the vocabularies of sports and flirting. Even those with I.Q.'s above average struggle to read body language or to imagine what other people are thinking. If they learn a joke, they may tell it a dozen times. They are too literal-minded to understand white lies and too rule-bound to understand they should not tattle. They overreact to routine teasing and invite ridicule by carrying their books over their heads or accepting a dare to kiss a girl. Faux pas that go unnoticed in the early grades later turn a child into a pariah. "Kids have very short memories when they're young," said Terese Dana, one of a growing number of behavioral therapists and psychologists who are making a career of teaching social skills. "They are much less forgiving as they get older."
     Experts say it is possible to teach autistic children to be more interpersonally aware, just as it is possible to teach their peers to be more sensitive. All of Ms. Dana's clients, including Ms. Singer's son, have made significant improvements. But these children do best at an age when parents still organize their social lives and before having a one-on-one school aide becomes embarrassing.
     Social skills training was critical for Jake Exkorn, 8. Right now Jake is indistinguishable from his peers in a small private school in Rockland County after six years of work with Ms. Dana. He has frequent play dates, no classroom aide and, according to his mother, Karen Siff Exkorn, no longer meets the diagnostic criteria for autism. "Yes, we got him ready, like training an athlete for a marathon," Ms. Exkorn said. "But at the end of the day we probably just got lucky in the way Jake was wired."
     Ms. Exkorn knows of other children who thrived at 8 and hit the wall at 11, so she remains vigilant. Ms. Dana visits Jake's classroom once a month to smooth a few rough edges, like his tendency to behave competitively in noncompetitive situations, for instance racing to get his coat and then announcing, "I'm first!" "Terese has said that the stakes change every year, which scared me a little," Ms. Exkorn said. "But, I don't want to consume myself with worry about middle school now. So far, so good."
     Jake is an exception. More typical is Kevin Lyons's 13-year-old son. When the telephone rings around 3:00 in Mr. Lyons's house in southern New Jersey, he can safely assume his son has unwittingly gotten into trouble. One recent day he yelled at a classmate on a school bus after the other boy taunted him. Mr. Lyons's son, unlike his frequent tormentor, did not know enough to retaliate when no adults were around. "It's like he's got the words but not the music," Mr. Lyons said, reeling off a list of social situations that mystify his son, including inviting himself to parties where he is not welcome and crying in class when he misses one math problem. But Mr. Lyons, like many parents of autistic children, says that on balance his son has made more progress among typical children than he would have in a segregated setting.
     Laura Sestito's 11-year-old son has withdrawn from the social fray in a Westchester public school. He dislikes sports, rejected a teacher's suggestion to play board games indoors during recess and has refused so many play dates that he is no longer invited. "His teacher reports he gets along with all his classmates but hasn't really connected with any of them," Ms. Sestito said.
     Autism experts say that social skills training is the new frontier and that the burden has shifted from special schools and one-on-one settings to public schools because of the stunning increase in autistic children now able to attend. Catherine Lord, a researcher at the University of Michigan and the primary author of a federal report on educational strategies for autistic children, said that many school districts are "still debating whether social development is even considered an educational objective," although social deficiencies are a hallmark of the disorder. Dr. Lord encourages parents to insist on having specific social skills spelled out in a child's individual education plan, mandated by federal law, and to call in a lawyer if necessary.
     A few districts are using novel techniques, like the Montecito Union School, near the University of California, Santa Barbara, where graduate students from its Autism Research and Training Center help autistic children integrate at recess, an especially vulnerable time. On a larger scale four districts in the New York region use a curriculum designed by Michelle Dunn, a pediatric neuropsychologist at Albert Einstein College of Medicine, which combines social skills groups for autistic children with schoolwide attention to the need for tolerance and trains school staff members to continue the curriculum on their own. "We used to focus on one kid at a time," Dr. Dunn said. "But the problem is now too big for that."
     Many educators who champion the behavioral techniques that made widespread mainstreaming possible are lowering their expectations. Bridget Taylor, a behavioral researcher who is the director of another school in Paramus, said she now tells parents of kindergartners ready for a regular classroom that "over time it's not necessarily a realistic placement."
     Gary S. Mayerson, a New York lawyer who represents families seeking services for autistic children, says none of the options are ideal. Schools for learning disabilities rarely offer sufficient academic challenge. And private schools can choose which children to accept or to expel. Ms. Singer knows well the agony of that choice. When her son's autism was diagnosed at age 2, he could not speak, make eye contact or sit in a chair. By kindergarten, thanks to a 40-hour-a-week home program with a behavioral therapist, he was in school with normal children, her heart's desire. "In the beginning you have to reach for the moon," Ms. Singer said. "He would not be where he is today if we hadn't. But you also have to face reality. Do I wish he was a perfect child in a perfect school in a perfect world? Hey, who doesn't? I had to get over that in order to be fair to him."




Suspected Child Abuse Should Be Reported
Amalie Nash, Ann Arbor News- 2/26/2005

Child abuse is reported to authorities about once every 10 seconds in the United States. Experts estimate that for every reported abuse and neglect case, there are three unreported ones. The Washtenaw County Sheriff's Department took more than 120 calls last year reporting suspected abuse and neglect, Sheriff's Cmdr. Dave Egeler said. Those calls ranged from reports of children left unattended in a vehicle to allegations of serious beatings, he said. The calls prompted 59 investigations, and about a third of those were turned over to the County Prosecutor's Office for review, Egeler said. Ann Arbor police had 26 reported abuse cases last year. The Family Independence Agency, which investigates all cases of suspected abuse, had 281 substantiated cases of abuse in Washtenaw County and 136 cases of substantiated abuse in Livingston County last year. "Child abuse is bigger than we even know," said Cheryl Mayer, who directs the National Childhelp USA hotline, based in Arizona. "There's a sense that for every abuse reported, there are many that no one ever knows about or don't learn about until well after or when a child is killed."
      The last child abuse fatality in Washtenaw County occurred in 1998, when a 3-year-old girl was beaten to death by her mother's boyfriend. He is now serving life in prison, and the mother was convicted of second-degree child abuse for failing to act after her daughter was injured. More recently, an Ypsilanti Township man has been charged with manslaughter in a child neglect case that resulted in the death of his infant daughter. Noah Jenkins, the father of a 1-year-old girl, is accused of not properly supervising his daughter on the afternoon that she fell into a bucket and drowned.
     State laws allow prosecutors to begin proceedings in juvenile court to terminate parental rights or criminally charge adults who abuse of fail to protect children, Washtenaw County Deputy Chief Assistant Prosecutor Steve Hiller said. Hiller said prosecutors consider the circumstances of each case and injuries to the child when determining what action to take. The definitions of second- and fourth-degree child abuse include cases when a person's "omission" or "reckless act" cause harm to the child, and an omission can be a failure to act, Hiller said.
     Pittsfield Deputy Police Director Elizabeth McGuire, who is involved in the local Child Advocacy Center, said people who suspect abuse should call the Family Independence Agency, or police, if the child is in immediate danger. People can call the FIA anonymously and will not face any civil liability if they're acting in good faith, McGuire said. The Childhelp USA hot line fields 400-600 calls a day nationwide, and the majority are from people who suspect child abuse, Mayer said. "I believe child abuse is something that we as a community have a duty to look at," McGuire said. "Violence against women and violence against children should not be tolerated in this community. We're each responsible for making this stop." The Washtenaw County FIA office can be reached at (734) 481-9110, and the Childhelp USA hot line is 1-800-4-A-CHILD.