BOSTON -- Once dubbed "The Dish" by brother-in-law John F. Kennedy, Joan Kennedy clearly had the looks to fit in with one of America's most glamorous families. Whether she had the legendary Kennedy toughness was another matter. The former wife of Sen. Edward M. Kennedy has struggled for decades with alcoholism. She found herself back in the public eye this week after a passer-by found her sprawled on a Boston sidewalk in the rain. She was hospitalized with a concussion and broken shoulder.
      Exactly what happened to her is unclear. The Kennedys are not saying, and no police report was filed. The next day, her son, Rep. Patrick Kennedy, who has also battled substance abuse, decided not to seek a seat in the U.S. Senate. His top aide said the decision wasn't prompted by his mother's troubles but acknowledged that it has been a painful ordeal for the Rhode Island Democrat.
     It was another sad episode for a family that known great triumphs and crushing tragedy. Virginia Joan Bennett was born into a prominent Bronxville, N.Y., family and as a teen she worked as a model in TV ads. She was a classmate of Jean Kennedy, the future senator's sister, at Manhattanville College, where her exceptional beauty caught Ted Kennedy's eye when he visited the campus for a building dedication in 1957. They married a year later, but Joan Kennedy struggled from the start to fit in to the high-powered family. "Joan was shy and a really reserved person, and the Kennedys aren't," said Adam Clymer, author of "Edward M. Kennedy: A Biography."
      Joan Kennedy came from a family that had its own history of alcoholism, and she married into another that has had numerous bouts with substance abuse. Her drinking worsened after the Chappaquiddick scandal of 1969, when a car driven by her husband ran off a bridge, killing his passenger, Mary Jo Kopechne. Kennedy did not immediately report the tragedy, and later pleaded guilty to leaving the scene of an accident. Joan Kennedy, pregnant at the time with a child she would later miscarry, stood by her husband, but Laurence Leamer, author of "The Kennedy Women," said the ordeal took a huge toll. Joan Kennedy has "this incredibly guileless quality," he said. "She never learned you just can't trust people. ... She's a total innocent, even now."
      A series of drunken driving arrests followed, starting in 1974. As her problem worsened, other Kennedys would mock her binges at the family compound in Hyannis Port, Leamer said. "They used to point at her and say, 'She's a drunk,' while they're lying there with a drink in their hands," he said. Marcia Chellis, who worked as Joan Kennedy's secretary from 1979 to 1982, said she couldn't shake off the hurt from her husband's infidelity and spoke of the strain of portraying herself as sober when she wasn't. 
      Ultimately, Kennedy was miscast in a family famous for strong women, such as Ethel, Rose and Jacqueline, Chellis said. She took on something she just couldn't handle," said Chellis, who became estranged from Kennedy after her 1985 book, "Living With The Kennedys: The Joan Kennedy Story," which Joan Kennedy said contained distortions and inaccuracies. Still, the couple stayed together through Sen. Kennedy's unsuccessful presidential bid in 1980 and had three children -- Kara, born in 1960; Edward Jr., born in 1961, and Patrick, born in 1967.
      Edward Jr. acknowledged being treating for alcohol abuse in 1991 and Patrick has admitted to using cocaine when he was younger. The six-term congressman has also seen his political career at times overshadowed by some embarrassing public incidents, including a shoving match with an airport security guard that was caught on video, and an episode in which his date had to be rescued from his boat by the Coast Guard after an argument.
      After Joan Kennedy's third drunken driving arrest in 1991, she was ordered into an alcohol treatment program. Her fourth arrest in 2000 on Cape Cod led to two years' probation and another round of treatment. And her fall on Beacon Street Monday afternoon again brought Kennedy's alcoholism back into the public eye. "She's very courageous and she does seem normal and fine and suddenly, 'Boom!'" said friend Ann Gund. "It's really heart wrenching."
      Last year, her children took temporary guardianship of their mother, an arrangement they plan to renew in the next few months. Patrick Kennedy did not say whether the burden of handling his mother's affairs led to his decision not to seek the Senate seat held by Rhode Island Republican Lincoln Chafee. His chief of staff, Sean Richardson, said the decision was made before her fall. "I think it was a separate issue," he said.
      Patrick Kennedy has also acknowledged that there have been other incidents involving his mother that didn't get as much attention as her fall. Friends and observers say the Kennedys' 1982 divorce was generally amicable. Joan attended Kennedy family events until her ex-husband remarried in 1992, and friends say they have occasional contact. "I've never heard her say anything but wonderful things about Ted and her kids," said her friend, Stephanie Warburg of Boston.
      Sen. Kennedy said this week that he's proud of how his children have stood by their mother. "It's been a long, difficult, very hard struggle," he said. "I think people whose lives have been touched by (alcoholism) can understand."
      Today, Joan Kennedy splits her time between a home on Cape Cod and a condominium in Boston's affluent Back Bay neighborhood. She has been praised for her frequent charity work, and also as an accomplished pianist. In 1992, she wrote "The Joy of Classical Music," for children. She showed up unannounced one Christmas to play the piano at the Pine Street Inn, a Boston homeless shelter. When Warburg's 11-year-old son, Max, died of cancer in 1991, Joan Kennedy comforted her. She later became active in promoting an elementary school curriculum named after Warburg's son.
      Though discouraged by her struggles with what they called her "terrible disease," friends remain hopeful that the worst is behind her. "You don't get cured of alcoholism," Gund said. "You have to handle it every single day. She's had a hard time with it. She's not the only one." 



Study of Social Interactions Starts With a Test of Trust
Henry Fontain, New York Times- 4/1/2005

In a finding that could help explain why a sucker never gets an even break, scientists are reporting today that they have succeeded in visualizing feelings of trust developing in a specific region of the brain. In the study, pairs of anonymous subjects were strapped into magnetic resonance imaging scanners 1,500 miles apart. The participants played 10 consecutive rounds of a risk-taking game that involved balancing monetary profit and trust. While they played, the scanners, synchronized through the Internet, measured how the subjects' brains reacted. With the development of trusting feelings, increased blood flow occurred in the caudate nucleus, an area in the rear part of the brain that is involved in processing rewards. Over time, this increased blood flow appeared earlier as an expectation of trustworthiness was established.
     The study's authors, from Baylor College of Medicine in Houston and the California Institute of Technology, say their work shows that, at some level, the process of building trust is as basic as obtaining food or other rewards. The caudate nucleus appears to play a central role in evaluating the fairness of another person's actions and in signaling the intention to trust that person. Future studies, they said, may prove useful for understanding autism, schizophrenia or other behavioral disorders where the ability to form internal models of other people may be impaired.
     By allowing neuroscientists to measure how two brains act and interact, the novel M.R.I. technique, called hyperscanning, also opens avenues of research in a relatively new field, real-time brain imaging of human social interactions. "Researchers have been stuck looking at one brain at a time," said Dr. Steven R. Quartz, a neuroscientist at Caltech and an author of the study, which is being published today in the journal Science. "This really begins a new chapter in looking at the neural basis of human social interaction."
      Dr. Joy Hirsch, a professor at Columbia and director of the Functional Magnetic Resonance Imaging Research Center at the university, called the paper a "tour de force." "It's rich with innovation, both from the experimental paradigm point of view and from the view of extending brain imaging into very complex social domains," Dr. Hirsch said.
     In the game used in the study, one participant, called the investor, is given $20 and instructed that he may hold on to it or give some or all of it to his anonymous partner, called the trustee. The amount given to the trustee is then tripled, and the trustee must decide how much to return to the investor. Players can either trust each other, by increasing the amount they turn over in each round, for example, or betray each other by reducing the amount.
     The real-time brain scans showed that as the players proceeded through several rounds, an "intention to trust" signal, signified by activity in the caudate nucleus, developed in the trustee. Initially, this signal came after it was revealed how much money the investor would give. But with succeeding rounds of the game, the signal developed earlier, eventually appearing even before the investor's decision was revealed. "The trustee is acting on what we think is their internal model of the investor," said Dr. P. Read Montague, a professor of neuroscience at Baylor and an author of the paper.
     Dr. Richard J. Davidson, a professor of psychology and psychiatry at the University of Wisconsin, who was not involved in the work, said the finding of an "unfolding" of trust over time was something predicted from other studies. "The circuits being engaged are areas we know play an important role in reward," Dr. Davidson said. The study, he added, "shows how these brain regions come to be recruited in establishing a phenomenon as complex as trust."
     Researchers are using imaging techniques, including functional or fast M.R.I. scans, which detect brain activity through changes in oxygen flow, to observe the brains of gamblers or alcoholics, say, or of people when they are afraid or anxious. The new technique allows scientists to observe social interactions from both sides in real time, to see how each person's actions affect brain activity in the other.
     Dr. Montague spent three years developing software to compensate for lag times and other delays through the Internet so the scanners could be synchronized. This allows them to be far apart, which is critical to the experimental design.
     Trust is a complex phenomenon, one that many scientists would think incapable of being studied. In order to do so, the social interaction under study must be stripped to a bare minimum. In this case, by having the scanners 1,500 miles apart, the players in the risk-taking game were completely anonymous. The participants never saw each other, instead seeing simple bar charts and numbers indicating how much money they were receiving. "As social interactions go, this was about as impoverished as you can get," Dr. Montague said. "Because of that, we were able to make all sorts of findings."
     Dr. Montague said that in building trust, the brain drew on existing mental models of the other person. "The thing to remember is that we have to conjure a kind of virtual model of what is going on that is very similar to each other, or we won't be able to understand each other," he said. So rather than building a model from scratch, he said, as trust builds up "you're probably augmenting an extremely rich model you come equipped with."

Gays Mobilize Against Meth Addiction
Associated Press, 4/3/2005

NEW YORK -- It's a Friday evening, traditional kickoff time for the party scene in New York's gay community, but the 75 men packed into a small room at a gay health center aren't in a partying mood. Through a humbling 12-step program modeled after Alcoholics Anonymous, they are battling to kick their addiction to methamphetamine, and in doing so escape an epidemic that is roiling urban gay communities nationwide with disease, despair, embarrassment and anger.
      Meth is an equal-opportunity menace -- many thousands of men and women, gay and straight, have fallen prey to it in rural villages, placid suburbs and city slums. But gay leaders in New York, California and elsewhere bluntly acknowledge that their communities have distinctive problems with the drug, and an unavoidable responsibility to combat it. ``Years from now we'll look back, as gay men, and be pretty despondent that we popularized and glamorized this drug,'' said Dan Carlson, an ex-addict who has become one of New York's leading anti-meth campaigners. ``I'm not anti-partying or anti-sex,'' he said. ``But how can we fight for our rights as a sexual minority if we don't establish what's right and wrong in our community, and look out for each other.''
     Crystal meth -- which can be snorted, smoked or injected -- has been a popular gay party drug on the West Coast for more than a decade, and in New York since the late 1990s. In many cities, however, gay activists and health officials were not quick to confront the fact that the drug, by curbing inhibitions and boosting energy, encourages unsafe multi-partner sex and thus increases the risk of HIV transmission.
     In New York, alarm over meth intensified in February, when health officials reported a rare strain of highly resistant, rapidly progressing HIV in a gay man who regularly engaged in meth-fueled sex parties. But the tide began turning against the drug a year earlier, when gay activists held the first of several forums on the epidemic and an ex-addict named Peter Staley circulated posters with an eye-catching message: ``Buy Crystal. Get HIV Free.'' Staley, a bond trader-turned-AIDS activist, is guardedly optimistic that the forums and ad campaigns are helping stigmatize the drug. ``A year and a half ago, this was a whispered-about epidemic,'' he said. ``If it came up, it was someone bragging about their wild weekend on meth, and no one had the courage to say, 'What the hell are you laughing about?' ``That's completely changed,'' Staley said. ``When gay men ask a friend about it now, they're as likely to hear, 'That stuff destroys lives,' as they are to hear, 'Oh, you should try this; it's amazing.'''
     One indicator that the anti-meth message is spreading is a surge of addicts seeking help at Crystal Meth Anonymous and other recovery programs. Meth Anonymous started in New York six years ago with one weekly meeting, attended by a half-dozen men. It now offers 24 meetings a week, attended by anywhere from a dozen to more than 100 people. Some of the men at the recent Friday meeting, clearly on edge, were just beginning their attempt to quit; others had been off meth for two years, yet still embraced the intensive group support in trying to stay sober.
     The evening's speaker, a former flight attendant celebrating one year off meth, riveted the audience with a wrenching account of his unhappy youth, his descent into prolonged addiction, his years as a hustler getting paid for sex even as he contracted HIV and other diseases. ``Darkness'' was how he described his life at the nadir.
     The spiritual, abstinence-only philosophy of Meth Anonymous works for some men, but repels others. Some counselors espouse an alternative known as ``harm reduction,'' cautioning users about meth's risks while encouraging addicts who can't quit to avoid overdoses, take care of their health and -- to the extent possible -- engage in safe sex even while high.
     Jean Malpas, a gay psychotherapist in New York, has been handling meth-related cases for four years. He won't condemn harm reduction, but says he has yet to encounter anyone who can use meth recreationally without developing an addiction. ``At some point, when Friday night comes along, they don't know what else to do,'' he said.
     Increased publicity about the gay meth epidemic comes at an awkward time for the national gay-rights movement as it pushes for same-sex marriage rights. ``There is anger at the opportunity this phenomenon is giving the rest of the world to associate the gay identity with promiscuous sex, with out-of-control behavior,'' Malpas said. ``We don't need additional opportunities to be perceived negatively.''
     Kathleen Watt, who runs the Van Ness addiction-recovery center in Los Angeles, believes some major gay advocacy groups have tried to play down the epidemic. ``They're afraid people are going to say, 'Why should we put money into HIV treatment when these guys are knowingly going out and having sex and infecting other people?''' she said.
     Matt Foreman, executive director of the National Gay and Lesbian Task Force, said some accounts of the gay meth problem had been ``salacious'' and ``overjudgmental'' -- highlighting the role of promiscuous sex while underplaying the destructive addictiveness of meth for any user, gay or straight. He praised gay activists for taking the lead in fighting the epidemic. Foreman and other gay-rights leaders also note that even in the hardest-hit communities, most gay men don't use meth. Estimates have ranged from 10 percent or 20 percent of all gay men, and as high as 40 percent in San Francisco -- by any measure a problem that can't be wished away.
     Perry Halkitis, a New York University psychologist specializing in the study of HIV/AIDS and drugs, says the root cause of meth addiction for many gays is not sex or partying, but deeper problems of isolation and low self-esteem, particularly if they are HIV positive. ``Users are often experiencing mental health problems,'' he said. ``You have this really vicious cycle -- HIV, meth, depression.''
     Experts say many men in this category are experiencing ``safe-sex fatigue'' -- they are tired of using condoms, believe medication can contain their HIV, and are emboldened by meth to forget their difficulties and engage in unprotected sex. ``Meth was the drug that would turn your head off and allow you to have the sex you thought you were missing out on,'' Kathleen Watt said.
     At the Callen-Lorde health center, which serves New York's gay community, the staff wrestles constantly with cases involving meth and unsafe sex. ``Safer sex is not everybody's idea of a good time,'' said Callen-Lorde's executive director, Jay Laudato. ``When you're high, you decide not to make the healthy choice -- you think, 'Why should I?''' The resulting addictions are often disastrous, Laudato said -- men lose their jobs, their friends and, because of one alarming side effect, even their teeth.
     The current prevention campaigning tries to promote the concept of healthy, meth-free sex. Peter Staley's latest ads, for example, feature posters of buff male models, accompanied by the slogan, ``Crystal Free and Sexy.'' New York City's health department contributed $300,000 last year to support the activists' education campaigns. More money is coming this year. ``When gay men saw their peers' lives destroyed, it was like another HIV/AIDS plague,'' said Brett Larson, director of the city's office of lesbian and gay health. ``This was something they weren't going to tolerate. The community has done an incredible job getting the word out.''
     One of the celebrities who enlisted in the campaign is John Cameron Mitchell, director and star of the hit film ``Hedwig and the Angry Inch.'' ``I've seen a lot of friends wasting away -- they start to look like a ghost and can't even see it,'' he said. ``What we need are intelligent scare tactics, to convince people the drug is uncool.'' Such messages may not sway hard-core users, Mitchell said, but should be targeted at gays who might be tempted to sample meth, particularly newcomers to big cities. ``You have a lot of young gay men coming into the city -- they were the nerds in high school, the wallflower, the ugly kid,'' he said. ``They feel the city is the place to be sexy, to be a star, and they get a false burst of confidence with a drug like this.''
     Internet gay sex sites are a particular concern to anti-meth activists. Staley said at least one major site has been cooperative, displaying health messages amid the dating profiles. Other sites have been slow to help, and personal ads hinting at sex-and-meth parties still appear, though less often than a year ago, he said.
     In California, West Hollywood Mayor John Duran has been discussing anti-meth strategies with players in the gay sex industry including pornographic filmmakers and sex club operators. ``We didn't come through the AIDS epidemic, and the battles over gays in the military and gay marriage, to end up here, a community filled with drug addicts,'' said Duran, who is gay and HIV-positive. ``We've fought too long and too hard to let this drug take us down.''
     On the Net: Crystal Meth Anonymous: http://www.crystalmeth.org/index.php

Study Links Free Radicals to the Spectrum of Autism
Robert Lee Hotz, Los Angeles Times- 4/3/2005

Many autistic children share a chronic flaw in the body's natural defenses against oxygen free radicals — corrosive molecules in the body that can severely damage developing brain cells, scientists said Saturday in San Diego. The molecular havoc caused by free radicals — natural byproducts of metabolism — is believed to be a major factor in the cell damage that underlies aging.
     Researchers at the University of Arkansas for Medical Sciences in Little Rock found that a single breakdown in the body's metabolism might underlie many of the puzzling symptoms of autism, a complex developmental disability with a spectrum of behaviors. "This is a very promising thing to look at because it gets at the actual metabolic processes in the brain," said UCLA neurologist George Bartzokis, who did not participate in the research. "The brain is especially vulnerable to damage from free radicals."
      Those with autism typically have difficulty communicating and interacting with other people. It strikes some in infancy. Other children may develop normally for several years before falling into a private world where normal social interaction and behavior becomes impossible. The new findings also may help shed light on the condition's range in severity because maturing neurons and synapses are especially vulnerable to this biomolecular bombardment. Autism could therefore cause different symptoms and degrees of severity in children depending on when the disorder is triggered.
     Normally, the body shields itself from such damage with a chemical produced by every cell called glutathione, which neutralizes oxygen free radicals. It binds to them, altering their electron balance and sees them safely expelled from the body. By analyzing blood samples from 95 autistic children and 75 healthy ones, researchers led by biochemist S. Jill James at the University of Arkansas determined that levels of this protective antioxidant were abnormally low in many autistic children. They presented their work at the Experimental Biology 2005 conference in San Diego.
     The finding is suggestive, several experts said, because glutathione also is crucial for neutralizing toxic heavy metals such as mercury, which is found in food, the air and, at one time, a vaccine preservative called thimerosal. "When glutathione is less available, then it is easier for things to get out of balance and the free radicals can cause more damage," James said. "One interpretation of this finding is that children with autism would be less able to detoxify and eliminate these heavy metals."
      The researchers cautioned that they do not know whether this metabolic flaw precedes the disorder or is one of its symptoms. Indeed, no one knows what causes autism, which has increased in prevalence 10-fold during the last 15 years. So far, there is no medical test that can identify it reliably. Most experts agree that autism most probably involves the interaction of many genes that together predispose a child to the condition, combined with some outside factor that triggers the disorder. No one has identified any genes for autism, nor is there any consensus on what environmental factor is involved. "We have added now the fact that there may also be a metabolic component that reflects both the underlying genetics and the environment," James said.



Think Hard Before Rushing Into Divorce
Gregory Ramey, Cox News Service- 4/4/2005

DAYTON, OHIO - There was a time when your marriage was filled with passion and commitment. Then passion was replaced by a preoccupation with the daily tasks of living. Caring for your children gave you little time to focus on your needs or your spouse. It's normal to wonder, "Do I really want to live the rest of my life with this person?"
     Divorce rates have doubled in the past 50 years. Half of the people married this year will divorce or separate within 15 years. However, divorces are substantially less likely for couples who are religious, make more than $50,000 per year, marry after the age of 25, attended college or were raised in intact families.
     The decision about whether to stay married is more complicated if you have children. Children raised by divorced parents are statistically more likely to have more emotional and behavioral problems.
     Here are some things to try before you consider a divorce.
* Let go of yesterday's hurts. Relationships are difficult, and even loving and caring people sometimes hurt each other. Thinking and talking about yesterday's pains may detract from focusing on what you can do differently right now. Be gentle with your spouse and with yourself.
* Compromise. One sign of a deteriorating relationship is the tendency of spouses to refuse to compromise, or to feel resentment if they do. Give in, lighten up and don't hake a big deal over minor matters. Stay focused on what is really important -- the love between you and your marriage partner.
* Don't make your children the center of your life. Children need us, but you and your spouse need to take care of your marriage relationship. Make sure you have some private time. Talk about the things you have in common as a way to reconnect with your spouse.
* Consider counseling. Therapy can help get beyond yesterday's hurts and today's boredom. Focus on small changes. Care for your spouse as you'd like to be cared for.
* Make a decision. At some point, you need to either get a divorce or stay together for the sake of the children and stop the complaining and arguing. This is one of the most important decisions in your life. Approach it with a calm demeanor, open heart and willingness to change.



Nuture and Authority: Fathers Need Balance
Samantha Critchell, Associated Press- 4/4/2005

NEW YORK -As mothers and fathers, psychologists and academics debate what the role of a father should be, children are getting mixed. signals about masculinity and discipline, according to psychologist Mark O'Connell. Fatherhood has become confused and politicized, he says, as one camp argues that men need to hold the hard line in the household no matter what the circumstance, while others argue that fathers should be more nurturing and in touch with their children's emotions.
     O'Connell, a father of two sons, ages 16 and 11, and a 14-year-old daughter, serves on the faculty at Boston Psychoanalytic Institute and Harvard Medical School. He said he wrote the book "The Good Father" (Scribner) to start a thoughtful conversation and not to give sound-bite advice.
"One thing that's really important to talk about when it comes to fathers is context. When you ask `What is a dad?' you get different ideas and strong reactions depending on who you ask," he said.
In general you'll probably hear that men tend to be more aggressive and hierarchical, and there's a perception those traits translate into more direct orders to the kids than conversations, O'Connell observes. But in single-parent families, for example, fathers tend to be much more maternal. "This shows that we have the potential to act in different ways, that we're able to fill the role that we need to fill," O'Connell said.
     O'Connell believes that most men have that softer side within them, but there's such pressure for them to be "masculine," rough and tough, that they don't get the opportunity use their innate characteristics. Yet, while it's expected of men to be aggressive in many areas of their lives, there's a lot of criticism when fathers approach parenting that way, he said. Instead, O'Connell suggests figuring out how aggression and authoritativeness can be best put to use within the family structure and decide how much is enough.
     Some men are now so afraid to put their foot down that women have become the disciplinarians in many households because they can get away with more, O'Connell said. "Men know society is watching." Believe it or not, children crave some discipline and authority, just not so much that they're living in fear.
     Parents need to establish rules and enforce them effectively so that kids will know how to behave but also so they know how to deal with emotions such as anger or disappointment, according to O'Connell. "Children aren't only the product of cerebral negotiation. Parents need to be able to convey their anger that children aren't, putting toys away. ... One of the things that motivated me to write this book was that there is an increasing amount of parenting literature out there about negotiation and the need for kinder and gentler parents, but not all authority is knee-jerk conservative authoritarianism."
     "Kids need to learn that the world isn't always the exact way they want it to be," O'Connell said.
Boys tend to need more structure and organization and fathers usually are more willing to be firm with their sons since they're among men, albeit pint-size ones, O'Connell said, while fathers sometimes make the mistake of being overly delicate with girls. "Girls get an adoring-father but not an authoritative father;" he says. "I think there is a way in which the whole negotiation of sexuality of childhood is very complicated between fathers and daughters, and aspects of discipline can be about excitement of power and that's frightening to a lot of fathers so they abdicate and back off. Daughters lose out when fathers do that."



Study: Suicide Query Won't Plant the Idea
Associated Press, 4/5/2005

CHICAGO -- Asking teenagers about suicide won't make them more likely to contemplate it, as some parents and school officials fear, a study suggests. In fact, the study found that simply asking troubled students about any suicidal impulses appears to ease their distress and might make some of them less likely to try killing themselves. The results confirm what many mental health experts already believe and should alleviate fears among some parents and schools that just mentioning suicide might plant the idea in teens' minds, said study author Madelyn Gould, a researcher at Columbia University and New York Psychiatric Institute.
     National data suggest that each year more than 3 million youngsters ages 15 to 19 think seriously about committing suicide. About 1.7 million try it, with more than half of the attempts requiring medical attention; and about 1,600 succeed. ``Without asking a kid directly, it's sometimes hard to pick up,'' Gould said.
    Her study involved 2,342 students at six suburban New York high schools who answered two mental health questionnaires two days apart. Half the students -- the experimental group -- also received about 20 suicide-related questions on both surveys. The questions included whether they had considered suicide and whether they thought it would be better if they were dead. The other half got suicide-related questions only on the second survey. The groups' scores on emotional distress measures were similar before and after the first survey. And roughly 4 percent in both groups said they had had suicidal ideas since the first survey.
     Among teens with previous suicide attempts, the experimental group had slightly fewer suicidal ideas than the comparison group after the first survey. Among depressed teens, the experimental group had slightly less emotional distress than the comparison group after the first survey. Those results bolster the idea that asking troubled teens about suicide gives them a chance to ``unburden themselves,'' while not asking may signal ``that you don't care,'' said Lenny Berman, executive director of the American Association of Suicidology. The study appears in Wednesday's Journal of the American Medical Association.
     The notion that asking teens about suicide might be harmful stems from ``the centuries-long history of suicide being stigmatized'' as something to be avoided, Berman said. ``It comes from people who are anxious about even using the word.''
     Hundreds of U.S. schools have used suicide screening, ``but there is a lot of resistance,'' Gould said. She said s 5 62 91 4 7ol officials are worried about being blamed if students harm themselves after taking a survey. Michael Carr, spokesman for the National Associaton of Secondary School Principals, said the group generally supports suicide screening in schools, particularly if professionals are identifying these kids as early as possible.''
     Signs that a teenager might be contemplating suicide:
-- Talking or writing about suicide.
-- Extreme irritability.
-- A major change in sleeping patterns.
-- A decline in academic performance.
-- Abandoning once-favored activities.
National Institute of Mental Health: www.nimh.nih.gov/suicideprevention/suifact.cfm
National Youth Violence Prevention Resource Ctr: www.safeyouth.org/scripts/faq/suicidesigns.asp

Project Sheds Light on Disability Born of Alcohol
Tracy Johnson, Seattle Post-Intelligencer- 4/5/2005

When police questioned Gabe Baddeley about a fire set in the teachers' lounge of the local high school, he said he did it. At first, he was wrong on some of the details. But he bent his description of the crime to fit what Prosser police told him. He'd already served a short jail sentence by the time he was exonerated.
      Baddeley, 23, suffers from the effects of a mother who drank alcohol while pregnant. Being highly suggestible and overly willing to tell authorities what he thinks they want to hear are symptoms. And his case is just one reason University of Washington researchers want to identify people with fetal alcohol spectrum disorders who have run-ins with the law -- and most of them do -- to better address their needs and help them stay out of trouble.
     The federally funded project -- involving King County prosecutors, defense attorneys, judges, mental health professionals and others -- is aimed at recognizing the disability for what it is: brain damage that makes people more likely to end up in court and less able to navigate the system when they do. "Unless we understand what their needs are and learn how to meet them, we're going to be operating on a hit-and-miss basis," said retired King County Superior Court Judge Anthony Wartnik, who is involved as a liaison between the court and the University of Washington. "We've never really tackled the side we're looking at now."
     Project leaders say the criminal justice system needs to be improved on all levels to better deal with the disability, which affects an estimated one in 100 babies and is a lifelong, irreversible and preventable problem. They say a better understanding would help police be careful not to ask leading questions of people who suffer from it and make defense attorneys aware of a disability that may never have been diagnosed -- one that might help explain a crime or justify a less-lengthy sentence. They say judges should be aware that imposing a long prison term might be less effective than making sure the person gets such help as job training, medication, substance-abuse treatment or a more structured living situation. Wartnik said people with the disability often need more attention to make sure they meet their court obligations, something a community corrections officer might do by giving needed reminders to come to court, make appointments or pay fines.
      The project is in its first year, a planning stage for what leaders hope will become a five-year effort and expand from King County Superior Court to misdemeanor courts. A grant of about $100,000 from the federal Substance Abuse and Mental Health Services Administration will help cover the first stage. A similar project in Skagit County focuses on juveniles. The ultimate goals are to reduce the number of court cases involving fetal-alcohol-affected people and keep the community safe, said Ann Streissguth, director of the university's fetal alcohol and drug unit and professor of psychiatry and behavioral sciences at the School of Medicine. "We want to use the initial criminal act to build a network of support around the person," Streissguth said. "Incarcerating them alone is not going to prevent them from doing the same thing over again."

Sexual Offender Issues Debated
Ofelia Casillas, Chicago Tribune- 4/7/2005

Study on Foster Care 'Alumni' Troubling
Claudia Rowe, Seattle Post-Intelligencer- 4/7/2005

Before he was 14, Adam Cornell had been in and out of a dozen schools and six foster homes. Even as an adult, he still replays the day his mother gave him up to the state for good. Shay Randolph sank into a depression so deep at the prospect of growing up and out of foster care that during her final year of high school, she could hardly rouse herself from bed.
     The term is emancipation -- the moment when foster children turn 18 and are severed from the child welfare bureaucracy. But the reality is more like a free fall, according to findings from a study released yesterday by Casey Family Programs, a Seattle-based foundation that aims to improve foster care.
      After reviewing records for 659 Washington and Oregon youths who had lived at least one year in foster care, the authors conducted exhaustive interviews and found that a vast majority spent their early adulthood struggling with poverty, homelessness and bouts of major depression far exceeding rates for the general population. Specifically, one-third of the foster care alumni, who were between 20 and 33 when the study was conducted, had incomes at or below the federal poverty level; one-third were without health insurance and nearly a quarter had experienced homelessness. Perhaps most striking, the rate of post-traumatic stress disorder was almost twice that afflicting U.S. war veterans.

Medical Boards Let Physicians Practice Despite Drug Abuse
Cheryl W. Thompson, Washington Post- 4/9/2005

Over the past 20 years, John F. Pholeric Jr. struggled on and off with cocaine addiction, cycled in and out of rehab and was convicted of a felony. During that time, he also practiced medicine. Pholeric, 55, an ear, nose and throat specialist in Fairfax and Loudoun counties, admitted snorting cocaine "three to four times per week" in his office in 1999. He stole drugs from hospitals where he worked and wrote more than 40 fraudulent prescriptions for his own use, according to Virginia and District medical board records. Several times, the Virginia Board of Medicine took up Pholeric's case. But it never took away his license to practice.
      Pholeric, who retired last month after he was questioned by a Washington Post reporter about his substance abuse, is not alone. Virginia Board of Medicine records show that an Arlington ophthalmologist who performed cataract surgery under the influence, his hands shaking and his speech slurred, still has his license. So does a Loudoun County gastroenterologist who deprived his colonoscopy patients of painkillers and injected himself with the drugs between operations.
     Scores of physicians in the area and across the country have been given repeated chances to practice, despite well-documented drug and alcohol problems, a Post investigation has found. They have stayed in business with the permission of state medical boards and hospitals, even when many have relapsed multiple times and posed a danger to patients, records show.
     When physicians were disciplined, the process sometimes was so slow that they moved to another state and became licensed before a paper trail surfaced detailing their transgressions. According to a review of medical board records, 74 doctors in the District, Maryland and Virginia were disciplined for substance abuse from 1999 through 2004. In five other cases, the boards found that doctors violated the law by abusing drugs or alcohol but took no action despite the doctors' repeated substance abuse. In nine other cases, the physicians surrendered their licenses for the time being to avoid investigation and possible punishment, according to board records.
     In the 74 cases in which doctors were disciplined, most had their licenses suspended temporarily. Ten doctors were reprimanded and five others were placed on probation, but their licenses were not suspended. Seven of the disciplined doctors have been convicted of felony drug crimes. One doctor who was convicted in Virginia and served time in prison once again has a license to practice in the state. Of the 74 physicians, 53 percent have been disciplined more than once for alcohol or drug use during their medical careers. Nine were sanctioned at least three times by the same board. The District and Maryland boards do not permanently revoke doctors' licenses. In Virginia, where a license can be permanently taken away only with a doctor's agreement, just one was revoked for substance abuse from 1999 to 2004, records show.
     Critics say lenient treatment of substance-abusing physicians flows from a seriously flawed national system of disciplining doctors. At its heart is a network of state medical boards made up primarily of physicians who, critics argue, are unwilling to exact strict punishment on their colleagues. A federal data bank designed to track problem doctors has critical loopholes and is closed to the public. Malpractice lawsuits often end in sealed settlements, adding to a cloak of secrecy that keeps patients from learning a doctor's full history.
     Patient advocacy groups say bad doctors are also coddled by hospitals and other employers as part of a culture of clemency and second chances. "Medicine tolerates behavior that in any other industry would be unacceptable," said Lucian Leape, a physician and expert on patient safety who teaches at the Harvard School of Public Health. "There are patients' lives at stake . . . and that's more important than a doctor's career."
     Charles B. Inlander, president of the People's Medical Society, an Allentown, Pa.-based nonprofit consumer health advocacy group, said doctors who are drug addicts are often given too much leeway. "If a pilot gets caught, they're out. If an engineer gets caught, they're out," Inlander said. "Why does a doctor get special treatment?"
     Hospitals and other employers can discipline physicians. But when it comes to a doctor's license, the authority rests with state boards of medicine, which usually are appointed by governors. In the District, board members are mayoral appointees. The panels also grant licenses and investigate complaints. Although their meetings are usually open to the public, physician discipline is typically discussed behind closed doors. Many boards prefer not to take away a doctor's license to practice. "Regulators believe that many problems can be resolved with probation and by putting restrictions on a physician's license," according to a release from the Federation of State Medical Boards.
      William L. Harp, a physician and executive director of the Virginia Board of Medicine, said he could not comment on specific cases but defended his panel's record. If the Virginia board is aware of an impaired doctor, he said, it moves swiftly to take action. "The practice of medicine is on the honor system," he said. "Once you get your license . . . the board assumes that you're out there taking good care of patients until we hear otherwise." But Harp acknowledged that the system has flaws. "You can't catch every single thing." He said medical boards should become more proactive in assessing doctors and patient safety instead of using the current system, which primarily reacts to complaints.
     The Virginia board did not discipline Herman A. Garrett, an anesthesiologist licensed in Virginia. Garrett has struggled with drugs and alcohol off and on since he was a resident at Georgetown University, according to Kentucky medical board records. In 1991, Georgetown officials placed him on leave for his "chemical dependency," the records show. In 1992, he pleaded guilty to driving under the influence in Georgia and received a suspended sentence and fine, according to the records. "Physicians are no different than any other individual," Garrett said in an interview. "I was just a person who liked to change the way I feel through using chemicals. It may be illegal, but I didn't perceive it as wrong."
     Garrett, who injected himself with drugs up to 10 times a day, admitted stealing drugs while working at a Kentucky hospital, medical board records show. His abuse of fentanyl, a synthetic morphine, was the "crescendo" that prompted him in 2001 to surrender his Kentucky license in lieu of revocation, he said in the interview. He has been in rehab twice. The Virginia board stated in a 2003 order that he was in a "well established recovery monitoring program."
     Garrett, 42, argued that he and other physicians have a right to return to medicine despite relapses. "Do we as a society want to say that because you've had this problem, you're no longer eligible to participate in the capacity that you're trained in?" he asked. "There are some stunningly good professionals in recovery."

Suit Over Drugs
Nancy Rodriguez, a Loudoun County mother of four, claimed in a 2001 lawsuit that gastroenterologist Joseph Shaw Jones used drugs meant for her. Rodriguez had gone to Jones for a colonoscopy in 1998 on the recommendation of her doctor. When she arrived at Loudoun Hospital Center for the procedure, Jones asked the nurse to go and change the music piped into the room, Rodriguez recalled in an interview. "That's when he changed the drugs," she said. "That was the only time I was alone with him. That was the only time he could have done it." Rodriguez was awake during the procedure and told Jones she felt sharp pain, she said. "He said, 'We're almost finished.' I told him it hurt."
      She later found out through media reports that Jones had tampered with drugs meant for patients. Nurses reported that "they heard a number of his patients screaming during procedures," according to Virginia medical board records. Hospital staff members also reported that Jones had glassy eyes on one occasion and slurred speech on another.
     The Virginia medical board gave Jones several chances. Even though he was battling drug and alcohol addiction in 1989, the board gave him a license to practice. In 1993, the board found that he had violated specific terms of a 1992 order to abstain from drugs and alcohol. And in 1999, after he used drugs meant for patients while performing colonoscopies and endoscopies, board members reprimanded him and fined him $10,000. Still, they let him keep practicing. "It never even occurred to me that a doctor would be allowed to continue practicing if he had any drug history," Rodriguez said. "If a more serious penalty or punishment would have come down on him sooner, perhaps he wouldn't have continued" practicing. Jones, 51, settled the case with Rodriguez for an undisclosed amount. The Virginia medical board suspended him only after he pleaded guilty to drug possession charges in federal court in Virginia, was sentenced in July 2001 to 30 months in federal prison and ordered by the court to surrender his medical license for three years.
     But in September 2003 -- two years and two months after he was sentenced -- the Virginia board gave Jones his license back. After the incidents at Loudoun Hospital Center, Jones received support from the group that oversees physicians with substance abuse problems and from a hospital official, records show. In an Oct. 4, 1999, letter to the medical board, Walter M. O'Brien, president of the hospital's medical staff, said he was "familiar with the current events involving Dr. Jones' drug use . . . and he fully supports his return to practice," according to Virginia board records. "My natural instinct is to use your forum to set the record straight," Jones wrote in an e-mail. "As you know, the events that led to my last meeting with the Virginia Board of Medicine occurred . . . six years ago. Since then, my family and I have moved past the painful fallout of those times and do not wish to revisit them in a public forum." Jones declined to say whether he is practicing medicine, and the Virginia medical board does not keep track of who is actively practicing, said Karen W. Perrine, the board's deputy executive director of discipline.
     In the case of Arlington ophthalmologist Kenneth D. Hansen, 58, Virginia medical board records say that in January 1997, he showed up at Arlington Hospital, now Virginia Hospital Center, late for surgery, "unshaven, his hair was uncombed . . . his eyes were glassy, his speech was slurred and his face and hands appeared swollen." His hands trembled while performing cataract surgery, and "Patient A," according to the board records, "incurred excessive bleeding," prompting the hospital to suspend Hansen's privileges. The hospital reinstated him less than a month later. A year earlier, he had been suspended from performing surgery at the hospital until he completed treatment for a prescription drug problem. Then in March 1997, after the cataract surgery, he was back in rehab, according to board records. His Virginia license was suspended, then reinstated on probation in 1998. He currently has an unrestricted license. Hansen, who has a private practice in Arlington, declined to discuss his history. "I've done everything I can to the satisfaction of the board," he said in a brief phone conversation. "Sometimes you have to move on."

Incident in Loudoun
Kim Gardiner, a former patient of physician John Pholeric, said state medical boards and hospitals should bar drug-abusing doctors from the medical field. "That just angers me," she said. "Nothing is really done about it." Gardiner knew nothing of Pholeric's history when she went to his Loudoun County office in 1995 on the recommendation of her HMO. She needed surgery for hearing loss in her left ear, a procedure that involved wiring a tiny hammer into her ear drum. "He had performed it before -- not once or twice, but several times," said Gardiner, now 42 and a mother of three in suburban Atlanta. But she emerged from the surgery at Reston Hospital Center with a dislocated jaw. "My face hurt, and I had an excruciating headache, like a migraine, and it kept getting worse," she recalled in an interview. She said she was unable to chew and had to sip liquids through a straw for three weeks.
      Gardiner sued Pholeric and the hospital, but it was the hospital that settled with her for an undisclosed amount, she said. When Gardiner went to Pholeric, he was already known to the Virginia medical board for stealing and using drugs in the 1980s. He went to a residential treatment program in 1984 and the next year was convicted in federal court in the District for writing 42 false prescriptions for his personal use. The court placed him on probation and banned him from prescribing certain drugs for two years but did not order him to stop practicing.

Relapses
Paul H. Earley, medical director of the Impaired Professionals Program at the Ridgeview Institute in Smyrna, Ga., said it is common for doctors with substance abuse problems to relapse. One in 10 doctors do so within two years, he said. Others, he said, are in and out of rehab for years. "There are people who can't stay sober . . . and they shouldn't practice medicine," he said.
      From 1999 to 2004, nearly 1,400 physicians across the country were disciplined for substance abuse and reported to the National Practitioner Data Bank, a federal clearinghouse for disciplinary action and medical malpractice payments against doctors. Of those, many were repeat offenders: 259 physicians were reported twice; 58 had three reports; and two physicians had six reports, according to data bank records.
     The controversy over whether medical boards should treat prolonged substance abuse as a career-ending offense is partially rooted in a much broader debate over whether addiction is an illness or a crime. The same question has come up in other arenas, from the judicial system to disability policy.
     Arthur Caplan, chairman of the Department of Medical Ethics at the University of Pennsylvania School of Medicine, said it is common for the medical community to let doctors with a history of substance abuse continue to care for patients. "Treating impaired doctors with kid gloves has been true since I was on the New York state licensing board in the '70s, and it hasn't changed," Caplan said. "I'm all for rehabilitation, but when you have multiple violations of drug abuse, you can't be near a prescription pad."
     James T. Birch Jr., 50, a family practitioner who practiced for years in Norfolk, contends that a doctor with a drug or alcohol problem should be given as many chances as a doctor who is physically ill. "Suppose you have a diabetic surgeon whose blood sugar drops and he's in the middle of a procedure," he said in an interview. "How many chances do you give him?"
     From 1990 to 2001, Birch tested positive for alcohol, marijuana or cocaine seven times and went to four drug treatment centers, one financed by taxpayer dollars, according to Birch and state records. The Virginia medical board suspended his license four times but each time gave it back. "I think the board was very fair to me," said Birch, who said he has been drug free for nearly four years. "I was given five chances. I think the board understands and recognizes addiction as a disease and not some type of moral turpitude."
     Drug use, he said, "never prevented me from staying focused on my work." But he said he became reckless with money, stayed up all night and was always "bone-dead tired." Still, no one at Norfolk Community Hospital knew about his drug use, and "nothing was ever documented" that he harmed a patient, he said.
     After he tested positive for drugs in 1990, the Virginia medical board suspended his license for the first time. But it immediately set aside the order, allowing him to keep practicing. If he relapsed, the board could enforce the suspension. In 1993, a medical board inspector approached him during his 12-hour shift at Norfolk Community Hospital's emergency room and ordered him to stop practicing medicine immediately, Birch said. His license was suspended, she told him, because he had tested positive for cocaine. "There were people around," Birch recalled. "That was the most humiliating experience of my life." The cycle continued, with Birch testing positive, losing his license and then regaining it. Birch obtained a Missouri license in 2003 and is on a medical fellowship in the state.

One Chance in Ohio
Some states are less tolerant than others. In Ohio, for example, "everybody has one chance to screw up," said Lauren Lubow, the senior executive staff attorney for the Ohio Medical Board. If doctors are impaired, they are evaluated, offered treatment and then allowed to return to practice "without interference from the board," she said. If a relapse occurs, the board takes action, usually a consent agreement immediately removing the doctor from practice, she said. The doctor must meet certain guidelines, including 28 days of treatment, before applying for license reinstatement. "There is an end to the board's patience," Lubow said. "It comes at a point where they are convinced this is not a person who will be able to recover and safely return to practice."
      In Massachusetts, an impaired doctor who relapses twice or more must demonstrate at least a year of sobriety before being allowed to return to medicine, according to Nancy Achin Audesse, executive director of the Massachusetts Board of Registration in Medicine. "We give people a couple of chances to get themselves together," she said. "But our primary goal is patient protection."
     Maryland, Virginia and the District are more tolerant. Alexandria psychiatrist Luanne Ruona has been hospitalized for alcohol dependency and been in drug rehab at least nine times since 1991, records show. By her own admission, Ruona relapsed at least 12 times during that period and once tampered with her urine sample so that those who monitored her couldn't detect alcohol, according to Virginia medical board records.
     She also has treated patients while under the influence, records show. In March 1999, a patient arrived appearing "distressed" for an afternoon appointment at her home office and was greeted by Ruona at the door, according to records. She suggested that he lie on her couch, then she sat beside him on the floor and held his hands near her face to relax him. At one point, Ruona excused herself and told him she was going upstairs to phone in a prescription. When she didn't return, the man said, he went upstairs and found her in "lounging attire" asleep across the bed, according to records. He left and reported the incident to another doctor the next day. Five months passed before the board acted, suspending her license for two years, records show. It was the first time the Virginia medical board took away her license, even though it knew about her alcohol abuse for more than a decade, medical board records show.
     In 2001, a physician familiar with her history recommended that the Virginia board allow her to practice again. Another doctor said he "very strongly" recommended reinstatement because "this time, she surrendered to her illness," records show. The board reinstated her license in October 2001. She has relapsed at least three times since then, according to board records. "I probably over-drank," Ruona, 63, said in an interview. "But I didn't feel like it interfered with my work that much. And it wasn't like I would get up and drink."
     After 11 relapses, she was put out of Virginia's Health Practitioners' Intervention Program, which oversees impaired doctors, in March 2004. She surrendered her license in the fall after another relapse and said the board told her that it would return her license in 2006 if she does not drink again. "They said the ball was in my court this time and told me to come up with a good treatment plan, and if I stayed clean I could get my license back in 18 months," Ruona said. "It's a big relief. I was satisfied and I think the board was, and we all shook hands."