WASHINGTON - Abbott Laboratories said Thursday it was halting sales of a 30-year-old attention deficit drug that a consumer group complained was too dangerous to stay on the market. Abbott decided to discontinue the drug, Cylert, because of declining sales, Abbott spokeswoman Melissa Brotz said. The drug's sales this year will be less than $1 million, she said.
      Brotz declined to comment on charges made earlier Thursday from consumer group Public Citizen that the drug had caused 21 cases of liver failure, including 13 that were fatal or required transplants. "We're in the process of discontinuing it ... but that's because of declining usage and sales and because there are generics available," Brotz said. Generic companies sell copycat versions of the drug under the name pemoline.
      Public Citizen asked the U.S. Food and Drug Administration on Thursday to ban Cylert and its generic competitors immediately. Generic companies can still sell their versions even after Abbott pulls the medicine, unless the FDA determines the drug was withdrawn for safety reasons. A petition from Public Citizen said Britain and Canada already had pulled the drug off the market, while the FDA opted to strengthen warnings twice and allow sales to continue. The warnings failed to increase doctors' monitoring of liver function in patients treated with pemoline, which offers no benefit over other therapies, the group said. "In light of this evidence of unique liver toxicity without evidence of unique therapeutic benefit, we contend that the only responsible course of action is to remove this dangerous drug from the market," Public Citizen said.
      Cylert is a stimulant that was approved to treat attention deficit hyperactivity disorder, or ADHD, in 1975. Last year, about 117,000 prescriptions for the drug were filled in the United States, according to Public Citizen. FDA spokeswoman Susan Cruzan said the agency would carefully review the petition, which also was signed by Dr. Fredric Solomon, a psychiatrist and ADHD specialist at the George Washington University School of Medicine.
      Public Citizen has filed several petitions with the FDA seeking to have various drugs withdrawn. Earlier this month, the FDA denied a petition from Public Citizen asking for a ban on AstraZeneca's cholesterol treatment Crestor.



Family Wonders if Prozac Prompted School Shootings
Monica Davey & Gardiner Harris, New York Times- 3/26/2005

RED LAKE, Minn. -- In their sleepless search for answers, the family of Jeff Weise, the teenager who killed nine people and then himself, says it is left wondering about the drugs he was prescribed for his waves of depression. On Friday, as Tammy Lussier prepared to bury Mr. Weise, who was her nephew and her father, who was among those he killed, she found herself looking back over the last year, she said, when Mr. Weise began taking the antidepressant Prozac after a suicide attempt that Ms. Lussier described as a "cry for help." "They kept upping the dose for him," she said, "and by the end, he was taking three of the 20 milligram pills a day. I can't help but think it was too much, that it must have set him off."  Lee Cook, another relative of Mr. Weise, said his medication had increased a few weeks before the shootings on Monday. "I do wonder," Mr. Cook said, "whether on top of everything else he had going on in his life, on top of all the other problems, whether the drugs could have been the final straw."
     The effects of antidepressants on young people remain a topic of fierce debate among scientists and doctors. Last year, a federal panel of drug experts said antidepressants could cause children and teenagers to become suicidal. The Food and Drug Administration has since required the makers of antidepressants to warn of that danger on their labels for the medications. The suicide risk is particularly acute when therapy starts or a dosage changes, the drug agency has warned.
      Although some studies link the drugs to an increased suicide risk, the research does not suggest such a connection to violence like Mr. Weise's rampage through Red Lake High School. Without knowing Mr. Weise's medical history or precise diagnosis, it is virtually, impossible to speculate on what factors may have affected him--the drugs, his underlying depression, a gloomy childhood wrapped in tragedy or something else entirely.
     "What I can say is that his physician, I'm sure, made the appropriate recommendations based on whatever the dosages were,"-said Morry Smulevitz, a spokesman for Eli Lilly, which makes Prozac. The dosage range, Mr. Smulevitz said, runs from 20 milligrams to 80 milligrams a day, so Mr. Weise's 60 milligram dose fell in that bracket. Mr. Weise, though just 16, was taller than 6 feet and weighed 250 pounds.
     Ms. Lussier, who lived with Mr. Weise in her mother's house on the Red Lake Indian reservation in far northern Minnesota, said she could not understand what else, aside from drugs, had changed to explain his sudden violence. Since his suicide attempt and 72-hour hospitalization a year ago, Mr. Weise had seemed to be improving, she said, and he was receiving mental health counseling and a doctor's care at the medical center on the reservation. Others in Red Lake said, however, that they had seen few signs of improvement in the dour, solitary boy. The driver of a school bus, Lorene Gurneau, said she often saw Mr. Weise standing outside the middle school, wearing his long black .clothes and strange hairdos, staring off into nothing, in a daze, even as children raced by or teachers passed him.
     Still, in at least one Internet posting last fall, Mr. Weise sounded determined to improve his life after his suicide attempt, and he noted that he was taking antidepressants. "I had went through a lot of things in my life that had driven me to a darker path than most choose to take," the posting said. "I split the flesh on my wrist with a box opener, painting the floor of my bedroom with blood I shouldn't have spilt. After sitting there for what seemed like hours (which apparently was only minutes), I had the revelation that this was not the path." "It was my dicision," he went on, "to seek medical treatment, as on then other hand I could've chose to sit there until enough blood drained from my downward lacerations on my wrists to die."
     On Monday, in the hours before then shooting, Mr. Weise had seemed cheerful and normal, Ms. Lussier said. His teacher, who was spending an hour a day at his house as part of: a "homebound" study program that the school system had created because of his troubles, arrived to give him his homework assignments as usual. At 12:30 p.m., less than three hours before the shootings, another aunt, Shauna, stopped in. "He was watching a movie on TV." Ms. Lussier said. "There was nothing out of the ordinary. People keep saying he was depressed, but if you saw him, he was getting better. All we can think of is, what about the drugs?"
     Though research has not linked antidepressants to acts of violence on others, several incidents have gained wide publicity. In 1989, Joseph Wesbecker walked into a printing plant in Louisville, Ky., with a bag of guns and killed eight co-workers and himself. He was taking Prozac, which had recently been approved. In 1999, a student involved in the Columbine High School shootings in Colorado had reportedly taken Luvox, an antidepressant similar to Prozac. In 2001, Christopher Pittman killed his grandparents while taking Zoloft, another antidepressant similar to Prozac. His lawyers faulted the drug, but a jury in Charleston, S.C., convicted him of murder in February.
     Still, Katherine S. Newman, a professor at Princeton University who has studied school killings, said just a small percentage appeared to have possibly involved psychiatric drugs. Of 27 such killings from 1974 to 2001, fewer than one-fifth of the suspects, had been diagnosed with a mental health disorder before the shootings. Professor Newman said. Dr. Frank Ochberg; a former associate director of the National Institute of Mental Health, said he once dismissed any links between antidepressants and suicides or homicidal acts. The recent research, however, has changed his mind, Dr. Ochberg said. "If your intention is shooting the place up and dying as you do it, you can put the fantasy together," he said. "Suicidal and homicidal intentions together could theoretically follow the same path."



New Law Can Force Mental Ill to Get Help
Sharon Emory, Ann Arbor News- 3/27/2005

LANSING - Faced with the problem of trying to talk sense to a mentally ill person who is acting irrationally -- and perhaps dangerously -- Michigan families, police and mental health professionals will have a new option starting Wednesday. "Kevin's Law," which stemmed from the beating death of a University of Michigan student by a mentally ill Ypsilanti man, allows judges to force people with mentally illnesses into outpatient treatment if they're considered dangerous and refuse to take psychiatric medication.
     Current law allows people with mental illnesses to be forced into treatment only if they meet the standard for inpatient hospitalization, which means they must pose an imminent threat. By then, backers of the new law say, it can be too late.
     It was too late when U-M student Kevin Heisinger was killed in 2000 in the men's room of the Kalamazoo Amtrak and bus station, Heisinger's father said during hearings on the bill. "The proof of that is found in blood -- in the blood of innocent victims like Kevin," Charles Heisinger testified. The attacker, Brian Williams, was diagnosed with schizophrenia, had a history of problems and did not comply with prescribed mental health treatment. He was found not guilty by reason of insanity in June 2001 and committed to the Center for Forensic Psychiatry in York Township.
     Under the new law, people with a history of mental illness could be subject to court-ordered treatment in the community if they were jailed or hospitalized at least twice in the last three years, or if they acted violently toward others or themselves in the last four. Companion legislation that
took effect in January allows a person to designate a patient advocate to make mental health treatment decisions for him or her in the future. Called an advance psychiatric directive, the document allows patients to specify preferred treatment in writing in case they are later
deemed incapable of making such decisions.
     The idea was to mitigate the element of coercion involved in forcing treatment under Kevin's Law by giving mentally ill people more control over what happens to them. The Michigan Protection & Advocacy Service, which originally opposed Kevin's Law, has since taken a neutral stand on the .package, largely due to the law about advance directives. "We will be monitoring Kevin's Law very closely, and making sure any amendments are given serious consideration," said Tom Masseau, director of public policy for the group which advocates on behalf of disabled people. He says he fears the law may create a "slippery slope," subjecting more groups of citizens -- such as homeless people -- to forced treatment.
     Some people with mental illnesses say getting treatment trumps tip-toeing around their rights.
"I'd rather be committed by a court than die with my rights on," said Donna Orrin, 52, of Ann Arbor, who has bipolar disorder with psychotic features. "It's not civil rights When you're giving the individual the right to be homeless, to be open to danger from themselves or others, to be incarcerated. "I've been involuntarily committed three times, and each time I was extraordinarily angry" said Orrin, who works part time for Washtenaw Community Health. Organization in Ypsilanti, helping to provide services to people with mental illnesses. "But each time I was extremely grateful afterward. I could have hurt myself or someone else."
     Sen. Tom George, R-Kalamazoo, a sponsor of the legislation, has said that fewer than 400 people would be subject to forced treatment annually, largely people with severe paranoid schizophrenia. Some two-dozen other states have similar laws.
     There is wide agreement that mental health services are in crisis in Michigan, and the Michigan Mental Health Commission late last year issued dozens of recommended changes. The Granholm administration is expected to issue a plan soon for implementing the recommendations. Supporters of Kevin's Law worry that the state's overburdened, cash-strapped system is ill-prepared to deal with an influx of patients. forced into treatment by the law. "This law could get some people into the system that are not currently in it," said Mark Reinstein, president of the Mental Health Association in Michigan, which advocates for people with mentally illnesses. "And without any new appropriation attached to it, we'll have to keep an eye on how it's working."
     Patrick Barrie," deputy director of mental health and substance abuse in the Department of Community Health, said it's too soon to say the state is unprepared. "At least one study (from a state with a similar law) showed use was much less than anticipated," Barrie said. "We don't have enough information to determine what will be the effect."
     Williams' brother Amos, a Detroit attorney, said Friday that Brian Williams is still treatment and doctors plan to keep him in custody "until they determine that he has gotten where he can be safely released." He said his brother's mental condition is improving, and he is complying with doctors and staff. "He went through a period of remorse," Amos Williams said of his brother. He said Brian Williams was recently allowed to move into an advanced treatment program in which he will attempt to learn how to deal with his illness, and "gain insights into his situation."



For Chronic Fatigue, Placebos Fail the Test
Nicholas Bakalar, New York Times- 3/29/2005

Many doctors believe that sugar pills are likely to be effective for patients with chronic fatigue syndrome, trusting that a placebo will help relieve the mental and physical exhaustion that characterize the illness. But a new study has found that people who have the syndrome respond at a lower rate to placebos than patients with other diseases. The paper was published in the March-April issue of Psychosomatic Medicine.
      Studies suggest that placebos relieve the symptoms for about 30 percent of patients suffering from a wide variety of illnesses. Migraine headaches, for example, respond at a rate of about 29 percent to placebo treatment, major depression at about 30 percent and reflux esophagitis at about 26 percent. In some diseases, placebo treatments are even more effective -- 36 to 44 percent of patients with duodenal ulcers improve on placebos, depending on how many of the treatments are offered each day.
     But by pooling results from more than two dozen studies, the researchers, led by Dr. Hyong Jin Cho, a professor of psychiatry at King's College London, found that, among people with chronic fatigue syndrome, only 19.6 percent responded to placebos, not the 50 percent found by previous, less systematic studies. To Dr. Cho, the results were both unexpected and disappointing: he says he believes placebos can be a legitimate and useful form of medical treatment. He concluded not that placebos were unhelpful in treating chronic fatigue but that their use should be perfected. "At the clinical practice level," he wrote, "the overall low placebo response emphasizes the need to enhance" the placebo effect in treating the illness.
     To many doctors, chronic fatigue syndrome seems like a perfect candidate for placebo treatment, Dr. Cho and his colleagues write. Its symptoms are often indistinct: in addition to general fatigue, patients complain of muscle and joint pain, headaches, memory impairment and mood disturbances. Moreover, the symptoms frequently fluctuate over time, and they are more acute when the patients are paying close attention to them. The illness has no cure, and the Centers for Disease Control and Prevention estimates that as many as 500,000 Americans suffer from it.
     Dr. Cho and his colleagues speculate that the skepticism about the illness on the part of health care professionals may damage the trust between doctor and patient -- a factor that may influence the effect of a placebo.
     According to the study, placebos presented as medical or alternative-complementary treatments have a greater effect with chronic fatigue patients than do those offered as psychiatric interventions. The researchers suggest that this may be because most patients have a firm prior belief that the illness is physical. They make no judgment about the accuracy of that belief.
     But Dr. Brian Fallon, an associate professor of psychiatry at Columbia University, offers a different interpretation. The fact that chronic fatigue syndrome responds so poorly to placebo treatment, he said, provides evidence that the syndrome has a physiological basis, though one that is still poorly understood. "The finding by Dr. Cho and colleagues will come as no surprise to patients with C.F.S. who experience debilitating fatigue despite numerous treatment interventions," Dr. Fallon said. "That the placebo response in C.F.S. was far lower that in primary psychiatric disorders such as depression highlights the distinct nature of C.F.S. and how little we know."
     Whatever conclusions may be drawn from the study's results, Dr. Cho says he sees placebo treatments as important. "Many alternative therapies may provide a cure that depends on this powerful placebo effect," he said in an e-mail message. "I'm not using the term pejoratively, since empathy and time spent with the patient by the professionals in this area are indeed of important therapeutic value."



Bread and Shelter, Yes. Psychiatrists, No.
Sally Satel, M.D., New York Times- 3/29/2005

Days after the tsunami struck South Asia, American mental health workers flew to Sri Lanka to offer counseling services to grief-stricken victims. "Psychological scarring needs to be dealt with as quickly as possible," one psychologist told The Washington Post in January. "The longer we wait, the more danger."
      Sri Lankan health officials saw things slightly differently. They discouraged aid agencies that offered to send counselors to their country. "'We believe the most important thing is to strengthen local coping mechanisms rather than imposing counseling," Dr. Athula Sumathipala, chief of the psychosocial desk at the Sri Lankan government's Center for National Operations, told The New York Times the same month.
     I found the contrast between the two men particularly striking because I had recently gone to Rome to attend an international conference on trauma. The conference, titled "Project One Billion," was organized by Dr. Richard Mollica, a psychiatrist at Harvard, under the auspices of the World Bank, the World Health Organization, and humanitarian nonprofit organizations. The United States also provided support. "One billion" signified the number of people worldwide, roughly one in six, suffering the psychological consequences of war, torture and terrorism. And though these people suffered human-caused horror rather than natural disaster, the question still applies: can outsiders bearing therapy provide meaningful help in times of crisis?
     One thing is clear. Even before strife ripped these societies apart, many of them had pitiful mental health systems. According to the W.H.O., most developing countries have fewer than 1 psychiatrist per 100,000 people; in rural areas, the gap is even larger. The entire country of Rwanda has only one psychiatrist. (The United States has about 14 psychiatrists per every 100,000 people; England has about 4 per 100,000.)
     Experts at the conference emphasized four undertreated mental conditions: psychoses (mainly schizophrenia), major depression, drug and alcohol abuse, and epilepsy (a neurological disorder often treated by psychiatrists). They noted that depression and drug and alcohol abuse increased in the aftermath of violence and destabilization. When they spoke of post-traumatic stress disorder, on the other hand, it was more as a nod to the organizing theme of the meeting. True, suffering was abundant -- "We cannot dry our tears," said one African representative -- but psychiatry was not the obvious answer.
     It would not be the first time that psychological aid was regarded by non-Western recipients as a kind gesture but a bad fit. For the last 15 years or so, humanitarian workers have been exporting the concept of post-traumatic stress disorder and trauma counseling around the globe. They have rushed in to impose Western "debriefing" -- a group therapy technique intended to get victims to express their feelings about a horrific event and to relive it as vividly as they can -- without regard to the needs of the victims, their natural healing systems or their very conception of what mental illness might be. Indeed, as literature from CARE International put it during the Balkan conflict: "Almost everyone in Kosovo will consider her- or himself traumatized." But is this true?
     Several years ago, a resettlement project run by the United States government for Albanian Kosovars at Fort Dix, N.J., was staffed with mental health specialists prepared to treat high rates of post-traumatic stress disorder among the refugees. Those expectations were not met, observed Elzbieta Gozdziak, an anthropologist at Georgetown University who was part of the team. "Only 7 of the 3,000 refugees were found to need psychiatric care," Dr. Gozdziak said. Indeed, many program evaluations reveal that actual use of specialized psychological help is typically low.
     Kenneth Miller, a psychologist in the Bosnian Mental Health Program in Chicago, saw much suffering among his clients -- they had been placed in concentration camps before migrating to the United States -- yet the most successful feature of his program was not therapy, which most clients rejected anyway. It was practical help like education and job training.
     Dr. Elie Karam, a psychiatrist at the Institute for Development, Research and Applied Care in Beirut, who attended Project One Billion, similarly concluded that post-traumatic stress disorder was not a major issue. "What we found was that the violence served as a catalyst for the destabilizing effects of pre-existing problems in people's lives such as poverty, marital discord, physical illness," Dr. Karam said.
     Project One Billion reflected this philosophy. Debriefing, Dr. Mollica stated, has been discredited in clinical trials. In its place, he strongly urged that Western mental health workers collaborate with indigenous healers. The W.H.O. now instructs aid workers to "listen, convey compassion, assure basic physical needs, not force talking, and provide or mobilize company preferably from family or significant others." Notably, mental health advisers acknowledge that local economic and social recovery is a prerequisite for improved psychology, not a consequence of it. As Dr. Mollica put it, "the best antidepressant is a job."
     The very same week that Project One Billion took place, a "Dare to Act" conference was held in Baltimore. Supported by federal tax dollars, the conference promoted an inward-looking "trauma paradigm," holding that childhood and adult traumatic experiences lie at the root of most psychopathology. A colleague of mine who works with Bosnians, Hmong and Somali refugees told me he was asked by organizers of the conference to provide a refugee woman to talk about "her trauma" at the conference. He asked around but couldn't find one. "They don't want to think of themselves as victims," he said.

'The High I Get Now Is Helping Addicts'
Bill Dow, Detroit Free Press- 3/29/2005

In a spacious, carpeted room with soft light and soothing music, 10 heroin, cocaine and alcohol abusers sit on comfortable couches to talk with a short, fast-talking, bleached-blond man with ear piercings, a mangled right hand tattooed with "Vietnam 1968" and a gun holster that now holds a cell phone and reading glasses instead of a pistol. In Danato Cimini, a recovering heroin addict and a drug addiction therapist at the Eastwood Clinic at St. John Northeast Community Hospital in Detroit, hundreds of patients have found a savior. His unconventional approach to drug addiction therapy helped them kick their habits and changed their lives forever.
      Every month, between 110 and 130 new drug- and alcohol-dependent patients are referred to the Eastwood Clinic. Of those, Cimini takes approximately 10 for his intensive outpatient therapy that involves small group sessions four hours a day, five days a week over a four- to six-week period. The patients are then referred to an outpatient therapist.
     "Danato has had more success with addicts than I've seen in my 21 years of practice," says Steve Candela, a psychotherapist and clinical manager at the Eastwood Clinic. Candela met Cimini in 1991, when the then-heroin addict and seven-time felon was a patient at the clinic. "Traditional psychotherapy takes more of a cognitive behavioral approach in addressing symptoms and behaviors," Candela says. "Danato's style is unconventional because he takes a humanistic approach that is both spiritual and reality based. By practicing self-disclosure of his own troubled life of addiction, using rough street language, hugging patients, taking them on field trips and being available 24/7, he gains their trust and they relate to him."
     During a recent session, Cimini, 57, of Harper Woods, begins by saying: "I don't expect you to believe this right now or that your top priority is recovery, but I guarantee that if you come to this room every day and run with what we teach in here, you'll never use again. But let me tell you, I am as close to using again as anyone else in this room. I know what you're going through."
     For Jimmie Flennoy, 44, a recovering cocaine addict who has been clean for seven years and now makes $35,000 a year driving a bus for a local school district, Cimini was a godsend. He was the person who finally showed Flennoy the way to recovery. "Danato was a guest at my wedding, and I told everyone that he was the one person who taught me how to save my life," says Flennoy. He still calls Cimini regularly to tell him how well he's doing and how much the therapist means to him. "The difference between Danato and other therapists I had previously seen is that he was real about his addiction. My feeling is that unless you've lived with an addiction, you can't tell me anything."

Booze, drugs and war
Cimini's life story could be a TV movie, perhaps one based on the book he cowrote with Brian Sullivan titled "From Psycho to Psychologist." An agent is shopping it to publishers. Raised in a spacious home in Grosse Pointe Park with three siblings, Cimini was drinking alcohol by age 10 and dabbling with recreational drugs and getting into trouble by the time he was a teenager. He was drafted into the Army in 1968 to fight in Vietnam, and within a month of the start of his tour, his right hand was blown apart in a firefight. By mistake, three different medics gave him three full doses of morphine within a short span of time. "It was the high I chased for the next 20 years," Cimini says.
      After his discharge, the Grosse Pointe High School (now Grosse Pointe South) graduate gravitated back to the Motor City and became a five-times-a-day heroin addict while running an east-side dope house. With seven felony convictions, including several armed robberies, Cimini spent 10 years in prison. While inside he changed his name from Danny to Danato so he would appear tougher.
     The prison term and 36 different drug treatment centers failed to turn him around, however. It took an epiphany after his release from prison to bring about the change. A day after he stole $3,600 from his father's dresser while he slept on Feb. 3, 1991, Cimini began a life of sobriety and a relentless commitment to recovery. "When I unfolded my Dad's money, I found a 50-cent coffee coupon and realized that I had blown several hundred dollars for a heroin fix while my father was trying to save money at the grocery store," Cimini says. "I wept at the sorry state of my wasted life but used $500 of the money on one last heroin fix. I then returned $3,100 to him, apologized and checked into a three-quarter house for rehabilitation." A three-quarter house is a residential drug rehab environment where only one-fourth of an addict's time is unstructured and independent.
     Having been told on a couple of occasions that he could be an excellent addiction therapist someday, Cimini convinced the Veterans Administration to give him a student loan so he could attend the University of Detroit Mercy's renowned addictionology program. Two years later, Cimini started working as a therapist at the Eastwood Clinic while attending classes. In 1994, he earned a bachelor's degree in addiction studies from UDM. He earned a master's degree in clinical psychology there two years later and a doctorate in psychology and addictionology in 2000. John Franklin, a professor of counseling and the department chair at UDM's addiction studies program, is the man who took a chance on Cimini and accepted him into school. "Danato is a blessing and a force for good that can't be measured because what he does has a rippling effect in the community," Franklin says. "He is one of the finest examples of a recovering addict who became a therapist and uses his ongoing personal recovery in helping addicts."

The Mother of All Social Issues
Jenn McKee, Ann Arbor News- 3/29/2005

Editor's note: University of Michigan communication studies professor Susan J. Douglas - coauthor (with Meredith Michaels) of the book "The Mommy Myth: The Idealization of Motherhood and How it Has Undermined All Women," just released in paperback -- recently talked about the ABC television shows "Desperate Housewives" and "Wife Swap," the sudden swell of books and articles about motherhood, and the current and future state of feminism.

Q. In your book, you argue that certain media figures who led the backlash against the women's movement forged a pejorative stereotype of feminists that still persists. Since you teach college-aged women, how do you see this manifesting itself now?
A. Well, I think that many young women who believe in equality for women -- equal opportunities and equal responsibilities for women -- are nonetheless quite reluctant to call themselves feminists, and so we get the "I'm not a feminist, but --" and then the young woman will espouse a feminist position. And it's really because she doesn't want to take on a stereotype that will marginalize her and has nothing to do with who she is. For many young women, they find that if they say, "Fm a feminist," then its a half hour conversation, explaining, "No, I don't hate men, I like them. No I don't hate children. Yes, I have a sense of humor."
Q. What shows or films do you now consider to be most responsible for reinforcing this stereotype?
A. It's kind of all over the place. And what you have going on here, particularly for young women, is the post-feminist age ... and the way post-feminism works is the following: We allegedly had a feminist moment, right? That's the first faulty assumption.... We had feminism, complete equality has been achieved now for women, there's nothing left to fight over, you've gotten it all, so lighten up, get a sense of humor. And now we can go back to having a show like "The Bachelor," in which one guy samples the wares of 25 women before choosing the one he likes best.
... I think that when a lot of young women become feminists is after they graduate from college and enter the workforce.... A lot of places have become very enlightened, but there's still a lot of discrimination and harassment ... out there, and young women ... get out into the world, and then it kind of hits them....The battle isn't won at all. And certainly, I think what we're seeing today is that motherhood remains really the unfinished business of the women's movement, because some studies have shown that when women and men ... enter the same job, ... usually things are relatively comparable ... (until) they have kids. That's where you see second-class citizenship coming in for women, because it's still women who are expected to give it all up for their children, and in some ways, that backlash has gotten worse in the past few years. So that's where you see feminism hitting a wall.
Q. Your book also discusses the proliferation of "celebrity mom" profiles in women's magazines and how those images of idealized motherhood put even more pressure on women to be perfect. But the profiles flourished, of course, because they succeeded in selling lots of magazines. What was and is the appeal of these articles?
A. I think when celebrity mom profiles started (in the mid to late '80s) ... mothers were going to work with infants or very small children. That was a really path-breaking, kind of revolutionary move, because for baby boomers, if their mothers worked, the mothers waited until the kids were in school. And so here was a generation of women in the '80s who... would go back to work after their baby was 6 weeks old.... And so, I think that when the celebrity mom profile first emerged ... sure, it helped sell magazines, and they still do ... but I don't think that in the beginning, anyway, this was a completely cynical ploy by the magazines. These women could be ... the role models that women didn't have in their real lives, because here were women with small children going to very demanding jobs.... I think women took a lot of sustenance from that, thinking, oh, well, if Cheryl Ladd of "Charlie's Angels" can do it, well, maybe I can, too. I think what's happened -- (the profiles) just got ossified into a form in which the celebrity mother could never admit that she was. tired. Could never admit that she might have some ambivalent moments about being a mother--you know, all of that stuff became forbidden.
     Now, why would people want to buy a magazine in which we see Meg Ryan or Kate Hudson or Reese Witherspoon on the cover -- well, motherhood is very demanding. It can be very stressful and exasperating, whether you work outside the home or not. It can be very tough on your marriage or your relationship. So who doesn't want to enter into some imaginative space for a little while, where motherhood is blissful, the kids are always happy, your husband is always doting, you're not tired, you're not stressed out? That's a very compelling fantasy about motherhood.... I think they're very appealing, and people still want to know, how does she do it? ... And of course the answer is she has a SWAT team of nannies, and you don't. That's the correct answer.
     ... What comes out of (the profiles) are a lot of normative messages. You're supposed to be available and spontaneous all the time. A really fun celebrity mother like Annette Bening is always willing, at the drop of a hat, to do somersaults with her kids in the park in between takes. In real life, you can't do that. So they suggest a kind of joyful spontaneity They tell you how you're supposed to feel. That's what I find particularly pernicious about them. You're supposed to be blissed out all the time, and the real mothers of America aren't, and that has nothing to do with, loving our kids -- of course, we love our kids, of course we do. That goes without saying. But that doesn't mean that you're necessarily ecstatic 24-7.
Q. Do you think the disconnect between such images and reality are playing into the overwhelming success of "Desperate Housewives?"
A. Oh, I think it's definitely part of a reaction against the myth of the perfect mother. Absolutely. (Douglas then referred to a specific "Housewives" moment, in which the character Lynette, after getting iced on her children's ADD medication, has a breakdown in a nearby park When her friends find her, they confess how difficult motherhood had been for them, too, and Lynette questions why mothers can't be more candid about being so overwhelmed)
     I was giving some talks around when that happened, and everybody was talking about that scene. Mothers were like, "Oh, my God, somebody finally said it on television." That (being a mother) is hard, that we're not honest enough with each other -- I mean, that scene was electrifying, and people were talking about it weeks afterward, so it's tapping into this desire that mothers have. We want to be able to tell the truth. We don't all want to have to pretend that it's all sweetness and light. ... And Bree (another character) -- when we first met her, we were set up to hate her. ... But she, too, puts the lie to the perfect housewife and mother. Even if you try really hard, you screw up and there are surprises for you. ... People feel huge relief when they watch that show, I think
Q. What do you think of "Wife Swap"?
A. It's a mixed bag, as all these things are. On the one hand... the mothers have a certain kind of authority about what should happen, and the ones that come off particularly well are the ones who make the kids clean their rooms and do the chores and are appalled when the kids aren't helping out.
     (Douglas referred to an episode featuring a work-obsessed mortician father and a father who drives his family around the country in an RV year-round.) ... Both of those fathers took it in the chops. One for being a workaholic, and the other for pursuing his desire for a particular lifestyle at the expense of his children, so it wasn't the mothers who came off badly, it was the fathers.... Now, having said that, the mothers judge each other, judge each others' child-rearing practices, so it reinforces the competition among mothers and again there's a buried message about
what's normal and what's mainstream in that show. So on the one hand, it validates mothers' work and authority ... but on the other hand, it pits mothers against each other. . .
Q. Given these television shows, several new books and numerous articles, it seems like the topic of motherhood is currently pervasive in the culture. Why do you think this has come to a head just now?
A. This conversation has been going on for a while, but it really exploded last winter and spring.
(At this point, Douglas referred to three books: Faulkner Fox's "Dispatches From a Not So Perfect Life," Daphne de Marneffe's "Maternal Desire," and Muffy Mead-Ferro's "Confessions of a Slacker Mom.") There were a bunch of these "momoirs" that came out, and I think a lot of them are really speaking to ... this ante just getting upped and upped and upped, and I just think there
was a cultural breaking point here. ... A convergence of women of different generations saying enough is enough.
Q. Your book discusses how, in the '70s, feminism engaged society in a debate about some important questions. Do you think we'll ever see a rebirth of that kind of feminism?
A. If things don't change in this country around government policies -- around family life, and certainly things at the workplace around family life -- you're going to have a generation of women who've grown up ... absolutely taking feminism for granted and assuming that equality is part of their lives, and then hitting the wall when they become mothers. And if you have enough women doing that, and enough reaction against what direction our government is currently going in ... you could very much have a rebirth of feminism. But I think that the issues ... center around the fact that we're the only industrialized country not to have a decent preschool or day care system; we have a total patchwork. We're the only industrialized country besides Australia that doesn't have paid maternity leave. We don't have good afterschool programs or enough flextime. ... So there are real policy changes that could make mothers' and for that matter families' lives easier, and make it more possible for mothers to do a good job at work and not have to be in there 12 hours a day. But I think one of the things that's happened is that in our country, we've become notorious for having so little leisure time, particularly compared to European countries. And the amount of leisure time has actually declined since the 1980s in the U.S., just at the same time when the standards for being the perfect mother have gone through the roof. So women are really caught here. All the rumblings around motherhood now suggest to me that that's where the action's going to be on feminism.



Alzheimer's Disease Appears to Have Multiple Causes"
Alice Dembner, Boston Globe- 3/29/2005

A century after Alois Alzheimer identified the debilitating dementia that carries his name, scientists are still trying to determine what causes the disease in old age. Their quest takes on increasing urgency, with predictions that unless a cure is found, the number of Americans with the disease will rise from about 4.5 million now to 13 million in 2050.
      Many scientists believe that Alzheimer’s results from a complex interplay of environmental factors, lifestyle choices, and genes and proteins gone haywire. But the changes in the brain that characterize the disease develop over decades and also occur in some healthy seniors, making it difficult to sort out the culprits from the bystanders.
     Yet, tantalizing tidbits have surfaced in the last few weeks, including discovery of a new genetic mutation that appears to increase the risk of getting Alzheimer’s and new evidence that insulin deficiencies may contribute to deterioration of the brain. ‘‘The pieces are coming together. We’ve got the outline of the puzzle in place, and we’re beginning to see the form,’’ said Stephen Snyder, who oversees research on the causes of Alzheimer’s for the National Institute on Aging. ‘‘It’s probably five or six genes and a dozen proteins that get out of kilter,’’ said Snyder, and certainly not just the sticky clumps of proteins called beta-amyloid plaques that have received the most attention.
     In the brain, the disease's hallmarks are those plaques, tangles of another protein called tau, and the progressive death of nerve cells, called neurons, that gradually strip a victim of memory, language, reasoning, and, finally, life. Mutations in three genes cause early-onset Alzheimer's, the rare form of the disease that strikes people in their 30s, 40s, or 50s. Those altered genes trigger production of too much beta-amyloid. But none appears to be involved in the kind of Alzheimer's that strikes after age 60.
     So far, researchers have linked two major genetic changes to old-age Alzheimer's and are on the trail of four or five more. These mutations do not cause the disease, but rather increase the risk of developing it. One, ApoE4, increases the risk of getting the disease three- to four-fold. A second potential gene mutation, called UBQLN-1, was identified this month by Rudy Tanzi, a geneticist at Massachusetts General Hospital. Tanzi, founder of TorreyPines Therapeutics, which is working on Alzheimer's drugs, said he believes it may increase the risk one- to two-fold, but its specific role in the disease has not been determined.
     The lead suspect in the search for a cause remains the protein beta-amyloid because of its clear involvement in early onset Alzheimer's and its big presence in Alzheimer's brains. Tests of an amyloid vaccine in people, which might have proved amyloid's leading role, were halted in 2002 when 18 of 300 subjects developed a potentially fatal brain inflammation. Nevertheless, some participants showed inklings of a positive effect, enough to keep researchers pursuing similar experiments. In addition, antibodies to amyloid reversed memory problems in mice, and cleared out amyloid deposits and then tau.  ''It's my feeling that all the cases of Alzheimer's are caused by an imbalance in the accumulation versus removal of the beta-amyloid protein," said Dr. Dennis Selkoe, a leading amyloid researcher who is codirector of the Center for Neurologic Diseases at Brigham and Women's Hospital, and who is a director of Elan Corp., which is working on amyloid-based treatments.
     Much of the amyloid research is shifting away from the big clumps called plaques to focus on smaller clusters that can still be dissolved by the body. The plaques are problematic for researchers because they also occur in people without symptoms of Alzheimer's and do not correlate well with memory problems. Some scientists are now suggesting that plaques, which develop outside the neuron, may be a defensive response, an effect rather than a cause. The small clusters, on the other hand, correlate closely with memory decline, even before plaques and tangles appear, according to research in mice. The clusters occur inside as well as outside neurons, and may interfere with the ability of neurons to signal each other.
     One critic of the amyloid focus, Peter Davies, a professor at Albert Einstein College of Medicine in New York, jokes about the new work on ''the" cause. ''Ten years ago, it was the visible amyloid deposits," he said. ''When everybody realized that didn't work, it became the invisible. It's only one more step before they get it right." A small group of scientists is instead stalking tau as the lead culprit. In healthy people, tau acts like a scaffolding to support a tube inside neurons that allows movement of nerve impulses. In Alzheimer's, the tau is misshapen and collects in tangles, causing the neuron tube to collapse. Damage to tau correlates better than amyloid with the severity of Alzheimer's. Research shows that people with mild cognitive impairment, often a precursor to Alzheimer's, have tau tangles but not amyloid plaques in their brains. Other research in mice, however, suggests that tau may need beta-amyloid to do its worst damage in Alzheimer's.
     Davies, who like Selkoe has been studying Alzheimer's for decades and is a founding scientist at Applied NeuroSolutions, which is working to develop treatments, said he believes that the disease starts well before tau and amyloid problems appear. He traces the illness back to a number of potential insults -- such as stroke, head injury or problems with insulin -- that he believes trigger nerve cells to try to divide. But unlike other cells, neurons cannot split, and they die in the process of trying, he said. It is this abnormal action of neurons, in this theory, that leads to amyloid plaques and tau tangles. While the evidence for the cell-cycle theory is still thin, many scientists are investigating possible ''insults" to the brain that might trigger abnormal amyloid and tau, or that might spur worsening of the illness. Stroke, serious head trauma, diabetes and a sedentary lifestyle, for example, are all associated with higher risk of getting Alzheimer's. ''Which is likely to be the originator of the disease?" asks William Thies, vice president of medical and scientific affairs for the national Alzheimer's Association. ''My guess is it's in the life stress."
     A paper published this month put insulin's role in the spotlight. Insulin's main role in the body is to help control levels of the sugar that fuels cells. The work at Brown Medical School found abnormally low levels of insulin and insulin growth factors in parts of the brain most affected by Alzheimer's, and that the low levels contributed to the ''brain rotting," said Dr. Suzanne de la Monte, a pathology professor there. Earlier research indicated that insulin helps regulate amyloid and also prevents formation of destructive forms of tau. Studies have also found that people with Type 2 diabetes, in which cells become insensitive to insulin, have a higher risk of developing Alzheimer's.
     Other work is focusing on damage caused by destructive oxygen molecules that the body creates when it turns food into energy. Research suggests that this damage and the inflammation it causes can trigger accumulation of beta-amyloid, which can generates more oxygen-related damage. Studies have also found that people who took anti-inflammatory drugs for other reasons had a lower risk of Alzheimer's. But one experiment testing these drugs as treatment for moderate Alzheimer's found no benefit, and a prevention trial in 2,400 healthy adults was halted late last year when the drugs were linked to increased risk of heart attack.
     A Seattle researcher, who is testing other possible anti-inflammatory substances, said he isn't sure which comes first, inflammation or accumulation of beta-amyloid and tau. ''That's going to be difficult to determine with certainty," said Dr. Tom Montine, a professor of neuropathology at the University of Washington. ''I view it as a circle. If it's important to the disease process, which one comes first may not be that meaningful."

You see them huddled against the wind outside office buildings, cupping hands to protect tiny flames. You see them in their cars, faces blurred by clouds of smoke. You smell them when they're sitting next to you on the Metro. You hear them ask the salesclerk for a pack of Marlboro Lights, and you wonder: Who are these people?
      By now, overwhelming evidence shows that smoking ravages your body, encourages fatal disease and shortens your life. And these facts are well publicized, indeed unavoidable: Well-funded anti-smoking campaigns have succeeded in painting the once-glamorized habit as dirty, smelly, costly and unsexy. Bans restrict smoking in all kinds of places where people used to light up. And yet 22.5 percent of U.S. adults -- 46 million Americans -- continue to smoke.
     Why? We put the question to several smokers, particularly people you might expect to know better, interviewing them first via e-mail, then by phone; their comments here come from both sorts of contacts. We were not out to endorse their habit, or to preach (although we'd much rather be referring them to the Center for Tobacco Cessation at www.ctcinfo.org, a site funded by the American Cancer Society and the Robert Wood Johnson Foundation). We just wanted to understand it better.
     Some told us they smoke because they like the taste -- or because they know how dreadful it feels to quit. Others said they'd developed a universe of habits in which lighting up plays a key role. Many started smoking when they were teenagers playing grown-up. They keep smoking, they said, to reduce stress or boost productivity. But when we asked experts on smoking behavior, we heard something else.
     Martin Jarvis, professor emeritus of health psychology at University College London's department of epidemiology and public health, has spent 27 years trying to figure smokers out; he published his "Why People Smoke" in the Jan. 31, 2004, issue of the British Medical Journal. In Jarvis's view (shared by most of the medical world, including other researchers interviewed for this story), the question can be answered in one word: addiction. "People's accounts of why they smoke are interesting, but not necessarily reliable," Jarvis writes. "You have to bear in mind that what we're talking about here is drug use, and people may not have accurate insight into how nicotine influences their behavior. So always take their stories with a large pinch of salt."
     Sig Seidenman, a former Air Force pilot and ex-smoker who runs Stop Smoking Clinics at businesses and hospitals in the Baltimore/Washington area, agrees. People's stories, said Seidenman, who has more than 20 years' experience helping people quit, "are all just rationalizations. They're excuses people tell themselves so they don't have to face the stress and strain of quitting. Because they're afraid." That said, here are their accounts:

'I Smoked Because I Could'
Twenty-eight-year-old Mark Palacio dabbled in smoking as a teenager but didn't take up the habit in earnest until his senior-year college roommate moved out, leaving Palacio with a room of his own. He relished the rush of independence: "I smoked because I could," he said. That was six years ago. He's puffed regularly ever since. "What's worst," he said, "I write for a medical trade magazine for radiology and cancer care. I smoke because I feel like I have no reason not to. I figure that at a pack a day of Marlboro menthols like I'm smoking now, I can go until I'm about 30 before I should seriously consider quitting -- again."
      Palacio, who lives in Philadelphia, doesn't hang out with smokers or look for validation in ads. "I never thought there was anything special about the Marlboro Man," he says. He has quit a couple of times -- each time resuming the habit, once after a death in the family made him crave "that emotional boost" that smoking offered, another time after a movie planted the idea.
     And then there's alcohol. "Drinking makes it difficult" not to smoke, Palacio said. "A glass of scotch and a cigarette . . . I really like that taste. It's so memorable. When I quit smoking and then have a scotch, it tastes hollow. It's only half the taste."
     Palacio has a mix of typical smoker traits -- took first drag when as a teen, derives a sense of independence from smoking, triggered to smoke by external cues, ties smoking to other habits or behaviors, aware he should quit but unable to do so -- and the confounding should-know-better fact of working for an oncology publication. It's this complexity across the broad population of smokers that makes it hard to say just who "these people" are.

'I Have Plenty of Years Ahead'
Like many others, Steve Irvine of Gaithersburg fell into smoking when he was a teenager. He hated the taste. "I really don't know why I started," said Irvine, 26. "A lot of my friends did it. I wanted to be in the 'in' crowd. It was nasty at first, but I got used to it."
      Ten years later, Irvine, whose job installing parking-garage systems keeps him on the road, said cigarettes don't "taste bad to me anymore." Even so, he said, he's tried to quit -- but found he couldn't. "I felt jittery if I got stressed out," when he wasn't smoking, he said. "I would be not the kind of person you'd want to be around." "I'll be blunt with you," Irvine wrote in an e-mail. "If I had a better job that was not as stressful, I probably would quit. But as for now, I will continue to smoke."  The stress rationale doesn't move Seidenman. He advises would-be quitters who crave cigarettes under stress to make sure in advance there are none within easy reach.
     Irvine noted that two of his grandparents -- both smokers -- recently were diagnosed with emphysema, and he wrote, "I know what can happen to me in the long run." But, he said, "I'm only 26. I have plenty of years ahead of me." Maybe so. But in the March 9, 2002, British Medical Journal, Jarvis pointed out that "most smokers overestimate the likelihood of stopping in the future and greatly underestimate how long it is likely to take." While some 83 percent of current smokers in Jarvis's survey of 893 Britons said they wouldn't start smoking if they had it to do over again, the study revealed what Jarvis calls a "delusion gap": While 53 percent of those surveyed expected to stop smoking within two years, only 6 percent actually did so.

'I Thoroughly Enjoy It'
If Sue Goodman were to quit smoking today, she said, it wouldn't be for herself; it would be for her husband and dog. Her last dog died of lung cancer, she explained. "I'm a heavy smoker. I know that's what killed him." Goodman doesn't wish the same fate on her 4-year-old Chesapeake Bay retriever, Bo. But still she smokes -- as she's been doing, at the rate of two or more packs of More Menthol 120s a day, for 56 years (give or take a handful of periods when she tried to quit). That's about 817,600 cigarettes.
      Research suggests that nearly all smokers take their first drags in their early teens. Goodman herself started at 14. "My girlfriend and I did it as a lark." At that age, she said, kids who smoked were "aping adults. I just kept it up." (Not unusual, said Seidenman. "You can't tell a 13-year-old they'll get cancer when they're 55," he said. "They won't care.")
     Goodman's long smoking history puts her at high risk of health problems ranging from heart disease to emphysema to any number of cancers. But Goodman, who lives in Lanham, has so far dodged all bullets. "I thoroughly enjoy smoking, and am surprised I'm even alive after all this time," she wrote in an e-mail. "I have regular lung X-rays which don't show anything negative; do not have emphysema or any difficulty breathing; am a rather sedentary person who does little exercise except for housework and gardening."
     Goodman believes she's both physically and psychologically addicted to smoking, not just to the nicotine, which she says gives her a slight buzz, but to her smoking routines. "You go to answer the phone, you smoke a cigarette. You eat, you smoke a cigarette. You work on the computer, you smoke a cigarette," she said. "I don't smoke when I'm taking a bath, though. It can be done; I just haven't done it." Whether she took to it at the start, she can't recall. But now, Goodman said, "I don't remember ever not liking it."

'People Rationalize Bad Habits'
Mary Sherman, 41, knows plenty of people who have had a problem. "My father died of cancer -- he smoked. My mom has emphysema -- she smoked." Sherman herself, who has been smoking since she was 17, is "in the process of quitting -- for the 150th time, it seems." "I am otherwise a health nut," said Sherman, a paralegal who lives in Falls Church. "I eat organic foods, take supplements and vitamins, visit the doctor regularly, exercise. And yet, up until January, I continued to smoke a pack to a pack and a half a day. Why? Good question.  "The nicotine addiction is one part of it, but addiction to cigarettes is more complex than that," Sherman said. "It has something to do with feeling like you're getting away with something -- being the 'bad girl' yet still maintaining the 'good girl' façade."
      Sherman started smoking as a teen, when the rest of her college-bound, academically and athletically successful peer group took up the habit. To her, the act of smoking telegraphed a message: "I'm tough, I'm bad, I can do what I want. I'm independent." Still, after a while, she grew to dislike it: "the way it looked, the smell, the expense." So she stopped -- until her husband, Sam, a nonsmoker, died of a heart attack in April 2003. The stress of that event "got me off on my last round of serious nonstop smoking," she said.
     Sherman struggles to reconcile her firsthand knowledge of smoking's devastation with her desire to smoke. Some days, she said, "I look at it somewhat as overeating or drinking too much," she explained. "Why hasten a process that's inevitable? Why speed up your own demise?" Other times she finds herself thinking, "The heck with it. I like smoking. I'm going to keep smoking." Even when her father died, she said, "in my smoker's mind, it wasn't lung cancer" that killed him. "It was not because of smoking." "People rationalize all kinds of bad habits," Sherman said. Seidenman agrees: "Knowing that you shouldn't smoke and not smoking are two different things."

'Quitting Is Worse'
Published statistics on who smokes and why wouldn't likely lead you to sniff out a 59-year-old woman with a college degree and a job that puts her well out of poverty's reach. Like Elaine Keller. A 59-year-old technical writer who lives in Springfield, Keller smokes about half a pack a day -- down from 2 1/2 packs -- of generic-brand cigarettes, "augmented by two or three lozenges or pieces of nicotine gum." In the course of her work, Keller spends a lot of time tooling around on MedLine, the federal government's online library of health-related research publications, so she's no stranger to smoking's dangers. "Why do I smoke, even though I know it is bad for me?" Keller ruminates in an e-mail. "Because I know, through bitter experience, that smoking cessation is even worse for me."
      Stop Smoking Clinic's Seidenman said Keller's feelings are common. "One of the main reasons people don't join the program is because they think their lives are going to be miserable" when they quit smoking, he said. "These people aren't willing to confront that discomfort."
     Keller's last attempt to quit smoking -- with the help of nicotine patches, gum and lozenges -- led, she said, to a 35-pound weight gain. Worse, she said, was her loss of ability to focus at work and on the road. When she smoked, she said, "I was producing 10 pages a day" at work; when she quit (with the help of the patch) last December for about five weeks, she said, "I was down to two pages a day." "It was like, forget it! I can't even read, let alone write," Keller said. "I was also extremely depressed. I can't function, I can't think, I can't even drive a car. I was sleeping 12 hours a day." So, though she said she's "concerned about my lungs," Keller's still smoking. "I don't think I'm in love with the cigarettes," she said. "The ritual is not important at all. I need the normalcy that nicotine brings. If I could find a way to get nicotine without drawing it in through my lungs, I would very happily give up smoking."