Noteworthy News Articles on Mental Health Topics, April 19- , 2005

Despite widespread belief in its usefulness, vitamin E supplements are no more effective than sugar pills for delaying the onset of Alzheimer's disease in people with mild memory changes, a study published this week in The New England Journal of Medicine suggests. The research also suggests that for certain patients the drug Aricept, previously shown to moderate the symptoms of Alzheimer's disease after it is diagnosed, may also work to delay its onset.
      The researchers studied 769 patients with mild cognitive impairment, or M.C.I., the mental deterioration that is often the precursor of full-blown Alzheimer's. Patients were randomly assigned to groups receiving Aricept, vitamin E and placebo versions of those substances, and then observed over a three-year period ended in January 2004. Half of the financing for the work was provided by the National Institute on Aging, and half by Eisai and Pfizer, the companies that manufacture and market Aricept. DSM Nutritional Products donated the vitamin E. Six of the 14 authors of the study have received grants or consulting fees from either Esai or Pfizer or both.
     At the end of one year, significant differences appeared: 38 patients in the placebo group and 33 in the vitamin E group had Alzheimer's, compared with only 16 in the Aricept group. But among the 214 patients who progressed to Alzheimer's over the entire three-year course of the study, there was no significant difference among the three test groups. Aricept appeared to work only in the first year. For one large subgroup, however, Aricept was more effective: those who had a genetic risk factor for the illness called the apolipoprotein 4 allele, or Apo E4. At the end of three years, among carriers of Apo E4 who took Aricept, the risk of progression to Alzheimer's was reduced by one-third. More than three-quarters of the patients in the study who eventually developed Alzheimer's carried this genetic marker.
     Dr. Ronald C. Petersen, director of the Mayo Clinic Alzheimer's Disease Research Center and the study's lead author, does not urge anyone to undergo genetic testing for Apo E4. Rather, he views the marker as a useful guide to research. "It's an imperfect predictor on an individual basis," he said. He added that genetic testing could become a permanent part of a patient's health record and that insurance companies and employers might have access to it and use it as they wish. "For me," Dr. Petersen said, "the primary message is that we are now able to delay the clinical appearance of Alzheimer's disease." Any slowing of the progress from the moderate impairment to Alzheimer's has a significant effect in reducing the total number of cases of the disease.
     Aricept is not approved for the prevention or delay of Alzheimer's, and Dr. Petersen is not recommending its use based on his findings, but he said he believed that it might help in some cases. He stressed that ordinary forgetfulness was not the same as the moderate impairment. "We don't want to frighten everyone in the world who sometimes forgets his keys," he said. "That's normal aging. With M.C.I., we're talking about serious forgetfulness - forgetting important information that you really want to remember." For these people, he added, "the data do open the door for a discussion between patient and doctor" about the prophylactic use of Aricept.
     Dr. Deborah Blacker, associate professor of psychiatry at Harvard, wrote in an editorial with the article that the study had enormous importance for primary care medicine and public health. While the findings for Aricept are less than definitive, she said, the study provides clear-cut evidence that vitamin E is ineffective in the prevention of Alzheimer's. "The field is moving toward the detection of Alzheimer's at earlier and earlier stages," Dr. Petersen said. "What we need now is a drug that gets at the cause."

Exposure to bright artificial light can relieve some cases of depression as effectively as psychotherapy or antidepressant medication, new research suggests. In a statistical review of 20 rigorously designed studies, researchers found strong evidence that exposure to artificial broad-spectrum light was a good treatment not only for seasonal affective disorder, in which people become more depressed in the darker days of winter, but for the more common nonseasonal depression. The review appears in the April issue of The American Journal of Psychiatry.
      Dr. Robert N. Golden, professor and chairman of psychiatry at the University of North Carolina School of Medicine and the lead author, said he was once skeptical of such treatments. "I noticed that there were a lot of really bad studies being published" that claimed good results based on weak evidence, Dr. Golden said. "But when you throw out the bad studies and look at the good ones, the data are actually very impressive."
     Light therapy usually involves sitting in front of white fluorescent lights with eyes open but not looking directly at the light source. Treatment time varies from 15 minutes to 90 minutes a day. Dawn simulation, a variation of the treatment, recreates the timing and intensity of a normal sunrise each morning. Symptoms can start to diminish within weeks. Dr. Golden warns that the studies have not been large and that the standards for what constitutes exactly the right exposure have not yet been established.

How many American marriages end in divorce? One in two, if you believe the statistic endlessly repeated in news media reports, academic papers and campaign speeches. The figure is based on a simple -- and flawed -- calculation: the annual marriage rate per 1,000 people compared with the annual divorce rate. In 2003, for example, the most recent year for which data is available, there were 7.5 marriages per 1,000 people and 3.8 divorces, according to the National Center for Health Statistics.
      But researchers say that this is misleading because the people who are divorcing in any given year are not the same as those who are marrying, and that the statistic is virtually useless in understanding divorce rates. In fact, they say, studies find that the divorce rate in the United States has never reached one in every two marriages, and new research suggests that, with rates now declining, it probably never will.
     The method preferred by social scientists in determining the divorce rate is to calculate how many people who have ever married subsequently divorced. Counted that way, the rate has never exceeded about 41 percent, researchers say. Although sharply rising rates in the 1970's led some to project that the number would keep increasing, the rate has instead begun to inch downward. "At this point, unless there's some kind of turnaround, I wouldn't expect any cohort to reach 50 percent, since none already has," said Dr. Rose M. Kreider, a demographer in the Fertility and Family Statistics Branch of the Census Bureau.
     Two years ago, based on a 1996 survey, she and another demographer at the bureau predicted that if trends then in place held steady, the divorce rate for some age groups might eventually hit the 50 percent mark. But in February, the bureau issued a new report, based on 2001 data and written by Dr. Kreider. According to the report, for people born in 1955 or later, "the proportion ever divorced had actually declined," compared with those among people born earlier. And, compared with women married before 1975, those married since 1975 had slightly better odds of reaching their 10th and 15th wedding anniversaries with their marriages still intact. The highest rate of divorce in the 2001 survey was 41 percent for men who were then between the ages of 50 to 59, and 39 percent for women in the same age group.
     Researchers say that the small drop in the overall divorce rate is caused by a steep decline in the rate among college graduates. As a result, a "divorce divide" has opened up between those with and without college degrees, said Dr. Steven P. Martin, an assistant professor of sociology at the University of Maryland. "Families with highly educated mothers and families with less educated mothers are clearly moving in opposite directions," Dr. Martin wrote in a paper that has not yet been published but has been presented and widely discussed at scientific meetings.
     As the overall divorce rates shot up from the early 1960's through the late 1970's, Dr. Martin found, the divorce rate for women with college degrees and those without moved in lockstep, with graduates consistently having about one-third to one-fourth the divorce rate of nongraduates. But since 1980, the two groups have taken diverging paths. Women without undergraduate degrees have remained at about the same rate, their risk of divorce or separation within the first 10 years of marriage hovering at around 35 percent. But for college graduates, the divorce rate in the first 10 years of marriage has plummeted to just over 16 percent of those married between 1990 and 1994 from 27 percent of those married between 1975 and 1979.
     About 60 percent of all marriages that eventually end in divorce do so within the first 10 years, researchers say. If that continues to hold true, the divorce rate for college graduates who married between 1990 and 1994 would end up at only about 25 percent, compared to well over 50 percent for those without a four-year college degree. "It's a big wow sort of story," Dr. Martin said. "I've been looking for two years at other data sets to see if it's wrong, but it really looks like it's happening."
     Still, some researchers remain skeptical about the significance of the small drop in overall divorce rates. "The crude divorce rate has been going down," said Dr. Andrew J. Cherlin, professor of public policy in the sociology department at Johns Hopkins. "But whether the rates will ultimately reach 45 percent or 50 percent over the next few decades are just projections. None of them are ironclad." Dr. Larry Bumpass, an emeritus professor of sociology at the University of Wisconsin's Center for Demography and Ecology, has long held that divorce rates will eventually reach or exceed 50 percent. In an interview, he said that it was "probably right" that the official divorce statistics might fall below 50 percent, but that the rate would still be close. "About half is still a very sensible statement," he said.
     What all experts do agree on is that, after more than a century of rising divorce rates in the United States, the rates abruptly stopped going up around 1980. Part of the uncertainty about the most recent trends derives from the fact that no detailed annual figures have been available since 1996, when the National Center for Health Statistics stopped collecting detailed data from states on the age, income, education and race of people who divorced. As a result, estimates from surveys have had to fill in the gaps. "The government has dropped the ball on data collection," said Dr. David Popenoe, professor of sociology and co-director of the National Marriage Project at Rutgers University.
     Joshua R. Goldstein, associate professor of sociology and public affairs at Princeton's Office of Population Research, said the loss of detailed government data, coming at a time when divorce rates were at their highest, might have distorted not only public perception, but people's behavior. "Expectations of high divorce are in some ways self-fulfilling," he said. "That's a partial explanation for why rates went up in the 1970's." As word gets out that rates have tempered or actually begun to fall, Dr. Goldstein added, "It could lead to a self-fulfilling prophecy in the other direction."

COPENHAGEN, Denmark -- Denmark's highest court on Tuesday ruled that a 15-year-old girl did not develop an autistic disorder because of childhood vaccination. It was the first time in Denmark that a judicial instance ruled in a case involving the triple measles-mumps-rubella (MMR) vaccine.
      The Supreme Court upheld a 2003 ruling by a lower court that had rejected claims that Anne Matthiesen had been harmed by the immunizations she received when she was 2 years old. Her parents went to the courts after Denmark's Medico-Legal Council said the girl was healthy before she got the MMR vaccine.
     Following a controversial British study in 1998 that raised the possibility of a connection between the vaccine and developmental problems, immunization rates in Europe began to fall, even though the study was later widely discredited. Most of the scientists involved in the original 1998 study later renounced their findings after discovering that the main author had been paid separately by lawyers for parents who claimed their children were harmed by the immunizations.
     Several authoritative groups, including the World Health Organization, the U.S. Institute of Medicine and Britain's Medical Research Council, have reviewed evidence investigating a possible link between the vaccine and autism and all came to the conclusion that the two are not connected.



Rethinking Moderate Drinking
Associated Press, 4/19/2005

ATLANTA — The government warned Monday that a few drinks a day might not protect against strokes and heart attacks after all. Some studies in recent years have touted the health benefits of moderate drinking. Some have even said that as many as four drinks a day can significantly reduce the risk of heart disease in people 40 and older.
      But researchers at the Centers for Disease Control and Prevention analyzed data from 250,000 Americans who participated in a 2003 telephone survey. They found that the nondrinkers had many more risks for heart disease — such as being overweight and inactive, or having high blood pressure or diabetes — than the moderate drinkers. Based on those results, the agency could not say that moderate drinking was a factor in reducing the risk of heart disease. The findings were published in the May issue of the American Journal of Preventive Medicine.
     "We're feeling the pendulum has swung way too far and Americans are getting sort of the wrong idea" on alcohol, said the study's lead author, Dr. Tim Naimi of the CDC's chronic diseases division. "The science around moderate drinking is very murky."
     Moderate drinkers tended to be in better health, better educated, wealthier and more active than their nondrinking counterparts, and that might have contributed to their lower risk of heart disease, the study said. "It appears that moderate drinkers have many social and lifestyle characteristics that favor their survival over nondrinkers and few of these differences are likely due to alcohol consumption itself," the study said.
      The CDC has long worried about alcohol abuse in the United States. Studies have shown that drinking excessively — five or more drinks daily — can increase the risk of heart disease. The CDC says nearly one in three Americans drinks too much. The agency said that Americans should follow dietary guidelines that limit daily consumption to two drinks for men and a single drink for women.

WILKES-BARRE, Pa. -- Krystal began using heroin when she was 14 years old, and it didn't take long for her to become hooked. The teen dropped out of school, lost a ton of weight and hocked her belongings to support a $200 a day habit. Now 18, Krystal said she is drug-free, holds down a job, attends beauty school and cares for her toddler son. She credits a relatively new medication called buprenorphine with plucking her from heroin's grasp. ''Amazing,'' ''incredible'' and ''lifesaving'' are a few of the words addicts use to describe buprenorphine, which blocks heroin cravings. The problem is that relatively few can get it, and health professionals are pressuring the government to expand access.
      Available in this country since late 2002, buprenorphine is an alternative to methadone, long the primary treatment for heroin addiction. It is also used to treat addictions to prescription painkillers like OxyContin, Percocet and Vicodin. Doctors say buprenorphine has many advantages over methadone, including that it is longer acting, more difficult to overdose on and easier to withdraw from. ''It has been extraordinarily effective in the patients we have given it to,'' said psychiatrist Herbert Kleber of Columbia University, who started one of the first buprenorphine programs in the nation. Addicts, meanwhile, say ''bupe'' gives them a feeling of clearheadedness they don't get with methadone. They can be treated in the privacy of their doctor's office, enabling them to avoid the stigma associated with public methadone clinics.
     But federal law limits individual doctors and medical practices to prescribing buprenorphine to 30 patients at a time, making the drug very hard to get in areas where heroin and prescription opiate abuse is high. For example, Krystal's doctor, J. Charles Lentini, says he has a waiting list of 185 addicts -- many of whom are continuing to abuse drugs while they wait. Even more problematic is the restriction on large medical practices, which means that a health plan like Kaiser Permanente, the nation's largest not-for-profit health maintenance organization with 8.2 million members, can treat just a few hundred addicts at any one time nationwide.
     Bills pending in the House and Senate would eliminate the 30-patient restriction for group medical practices while retaining it for individual doctors. The Senate passed similar legislation last year, but it died in the House. ''It clearly was not our intention'' that addicts have less access to buprenorphine because they happen to go to a group practice, said Sen. Carl Levin, D-Mich., co-author of the Drug Addiction Treatment Act of 2000. The law paved the way for doctors to prescribe buprenorphine but also established the 30-patient limit. Levin introduced the bill now pending. Meanwhile, the U.S. Substance Abuse and Mental Health Services Administration said it is working on a regulatory fix to expand access to buprenorphine. ''The group practice issue we see very much as a critical barrier,'' said Robert Lubran, the agency's director of pharmacologic therapies.
     Krystal said she spent eight agonizing months on Lentini's waiting list before finally getting her buprenorphine prescription last month. She entered detox two or three times while she waited, but returned to heroin each time she was discharged. ''It was torture,'' said Krystal, whose boyfriend is on the waiting list. ''I just wanted to feel normal again.'' Another of Lentini's patients, David, took heroin for six years and has been on buprenorphine for 13 months. The 43-year-old day trader said he ''thanks God'' that he got the drug when he did. David, who spent time in prison for accidentally killing a woman with his car while high, was among Lentini's first patients when he got out. ''If there was a waiting list, I'd be in jail now, because my urine would be hot,'' he said. Both Krystal and David spoke on the condition that their last names not be used.
     The 30-patient limit is not the only barrier to access. Less than 1 percent of the nation's doctors -- 4,850 out of 600,000 -- have received federal Drug Enforcement Administration certification to prescribe buprenorphine, which comes in a pill and is sold under the brand names Suboxone and Subutex. The number of doctors actually prescribing the drug might be even smaller. Kleber said the manufacturer, Reckitt Benckiser, told him last year that only 1,500 had written a buprenorphine prescription. Reckitt Benckiser officials did not return a phone call.
     Many doctors shy away from treating heroin addicts because they believe those patients will be disruptive, Kleber and other experts said. ''Most practicing physicians carry the baggage that much of society carries around the treatment of addictive disorders,'' said Dr. David Fiellin, chairman of the buprenorphine department at the American Society of Addiction Medicine. Also, buprenorphine is expensive, typically costing around $300 to $350 a month, and is not always covered by private insurance or by Medicare or Medicaid.
     On the Net: SAMHSA's buprenorphine site: http://buprenorphine.samhsa.gov/

WASHINGTON -- Twenty people in the United States and abroad were arrested on charges they ran Internet pharmacies that illegally shipped narcotics, steroids and amphetamines to teenagers and other buyers around the world, federal authorities announced Wednesday. The arrests were the result of a yearlong investigation by six federal agencies of online pharmacies that often operate in the shadows of the Internet, with no fixed address and no way to track where they are located, Drug Enforcement Administrator Karen Tandy said. The drugs were shipped to buyers with little or no effort to verify ages or medical need, allowing teenagers or drug abusers easy access to addictive and dangerous drugs, officials said. Tandy and officials from the FBI, Customs, the Internal Revenue Service, Food and Drug Administration and the Postal Service were to formally announce details of Operation Cyber Chase at a news conference Wednesday.
      Among the organizations targeted was a Philadelphia-based Internet pharmacy that allegedly smuggled prescription painkillers, steroids and amphetamines into the United States from India, Germany, Hungary and elsewhere, repackaged them and sold them throughout the world, Tandy said. U.S. arrests took place in Fort Lauderdale and Sarasota, Fla.; Abilene and Tyler, Texas; New York City and Rochester, N.Y.; Philadelphia; and Greenville, S.C. Authorities also made arrests in Australia, Costa Rica and India.
     A study by the Government Accountability Office last year found it was easy to order drugs online. Some drugs received from foreign pharmacies were counterfeit and many came with no instructions or warnings, the GAO said. Others arrived in damaged or unconventional packaging. The FDA has led the government's enforcement efforts against Internet pharmacies as part of its strenuous opposition to the legalization of imported prescription drugs.
     On the Net: Drug Enforcement Administration: http://www.dea.gov

NEW YORK -- About one in five teenagers have tried prescription painkillers such as Vicodin and OxyContin to get high, with the pill-popping members of ''Generation Rx'' often raiding their parents' medicine cabinets, according to a study by the Partnership for a Drug-Free America. The 17th annual study on teen drug abuse, released Thursday, found that more teens had abused a prescription painkiller in 2004 than Ecstasy, cocaine, crack or LSD. One in 11 teens had abused over-the-counter products such as cough medicine, the study reported. ''For the first time, our national study finds that today's teens are more likely to have abused a prescription painkiller to get high than they are to have experimented with a variety of illegal drugs,'' said Partnership Chairman Roy Bostock. ''In other words, Generation Rx has arrived.''
      According to the study, the most popular prescription drug abused by teens was Vicodin, with 18 percent -- or about 4.3 million youths -- reporting they had used it to get high. OxyContin and drugs for attention-deficit disorder such as Ritalin/Adderall followed with one in 10 teens reporting they had tried them. Fewer than half the teens -- 48 percent -- said they saw ''great risk'' in experimenting with prescription medicines. ''Ease of access'' was cited as a major factor in trying the medications, with medicine cabinets at home or at friends' homes a likely source, the survey found.
     It was only the second year that the survey had studied abuse of legal drugs. In 2003, the Partnership grouped together three prescription pain relievers: Vicodin, OxyContin and Tylox, and found that 20 percent of teens had tried them.
     The 2004 study looked at Vicodin and OxyContin separately but excluded Tylox, and found that 18 percent had tried Vicodin and 10 percent had used OxyContin. The 2004 figures indicated the same or a slight increase in use compared with 2003, said Barbara Delaney, director of research at the Partnership. For the first time, the 2004 survey included a question about the use of over-the-counter products to get high. Nine percent, or about 2.2 million teens, had experimented with cough syrup and other such products, the survey reported. It also found that the number of teens reporting marijuana use declined to 37 percent last year, compared with 42 percent a half-dozen years earlier. Over the same amount of time, Ecstasy use declined from 12 percent to 9 percent, while methamphetamine use dropped from 12 percent to 8 percent.
     A University of Michigan study released in December also noted the apparent growing popularity of OyxContin among teens. Dr. Mitchell Rosenthal, head of the Phoenix House drug treatment facility, said his agency has watched the use of painkillers by adolescents rise in recent years. ''Adolescents find the line between drugs that do good for you and drugs that make you feel good becoming fuzzier every year,'' said Rosenthal, whose non-profit organization treats 6,000 patients in nine states. ''This is a wake-up call to parents.'' The 2004 Partnership Attitude Tracking Study surveyed more than 7,300 teens, the largest ongoing analysis of teen drug-related attitudes toward drugs in the country. Its margin of error is plus or minus 1.5 percentage points. The nonprofit Partnership for a Drug-Free America was launched in 1987.
     On the Net: Partnership for Drug Free America: http://www.drugfree.org

Crystal meth, a highly potent, dangerously addictive drug that swept the West Coast and spawned crime waves in the nation's heartland, is slowly establishing a foothold in New England, prompting campaigns by public health authorities and medical specialists to stop small outbreaks of use from raging into wildfires.
      Doctors and social workers who specialize in treating gay men report seeing an increase in patients hooked on meth, fueling fears that a drug capable of lowering inhibitions will result in risky sexual behavior and a flood of HIV infections. A survey of nearly 1,000 gay men conducted by Massachusetts health authorities in 2004 and obtained by the Globe indicated that one in 10 had tried crystal methamphetamine at least once in the preceding year and that 2 percent acknowledged smoking, snorting, or injecting the drug at least once a week.
     The drug gained notoriety on the East Coast earlier this year, when New York doctors sounded a health alert after discovering that a man with dozens of sexual liaisons while high on meth had contracted an especially virulent strain of HIV. Even before that case landed in the spotlight, local, state, and federal authorities had begun meeting with greater urgency to examine the potential link between meth and the spread of sexually transmitted illnesses.
     In January, drug and disease specialists converged on the Atlanta headquarters of the Centers for Disease Control and Prevention to develop better methods for tracking and combating meth and the behaviors it causes. In February, the CDC chief, Dr. Julie Gerberding, briefed President Bush's advisory council on AIDS regarding her concerns about a crisis in the making. In March, representatives from local and state governments huddled in Washington to consider how public health agencies should respond. That same month, a CDC official visited a bathhouse in Providence to learn more about a campaign there to discourage use of the drug.
     The growing use of meth in gay communities in New England, HIV specialists said, threatens the advances made in combating the AIDS epidemic. After enduring years of burying friends and viewing HIV as a death sentence, gay men now regard it as more of a chronic, treatable disease, with ads for powerful drug regimens portraying robust men celebrating newfound health.''The intersection of this drug with HIV is obviously a major concern for controlling the epidemic," said Dr. Stephen Boswell, executive director of Fenway Community Health, a major Boston provider of AIDS treatment. ''I've had tons of patients telling me they've wound up doing things they never would have done if they weren't on the drug."  New England stands on a precipice, said Gordon Mansergh, senior behavioral scientist in the CDC's Division of HIV/AIDS Prevention. ''Your community," he said, ''is in a really good position to prevent something from happening with meth that you might not see happening really clearly now." 
     It is a drug wrecking the lives of men in their prime -- men like Jeff Epperly, who, starting at age 38, took one hit and then another and another, until he lost his partner, squandered his savings, and abandoned, as he put it, his moral compass. Over four years, meth came to define his identity. ''By the end, I was high every single day," Epperly said. ''My entire life revolved around doing the drug, finding more of it." His was a life in full descent when one day, out of cash, his downstairs dealer dead, Epperly took a vacuum cleaner to the carpet in the room of his Kendall Square apartment where he had most often smoked or snorted meth. He emptied the contents of the vacuum bag and tried to smoke them. ''At the time, it seemed perfectly logical there might be crystal in the carpet," Epperly recalled, his face turning weary at the memory. ''It's funny and it's horrifying."
     Shortly after that episode, like a man waking from a deep slumber, Epperly freed himself from the manacles of meth, the rare example of an addict succeeding in shunning the drug without benefit of medical help or a support group. He returned to his hometown, Omaha, in 2002 before finally returning to Boston, where he had been editor of Bay Windows, a newspaper reporting on the gay and lesbian community. ''I feel very lucky," Epperly said. ''I'm alive, and I have all my friends."
     Crystal meth, like most narcotics, has ridden cycles of popularity. In the 1950s, amphetamine was renowned as the drug of choice among suburbanites desperate to shed pounds. Meth induces a state of hyper- alertness. To understand the effect, said Dr. Stephen Traub, a toxicologist at Beth Israel Deaconess Medical Center, think of that first cup of morning coffee and the jolt it unleashes. Now, imagine that amplified many times over. The drug works by increasing the availability of a chemical messenger in the brain called dopamine. And that substance is a prime mover in the cerebral pathways that engender pleasure and excitement.
     Meth began making a resurgence in the late 1980s and early '90s on the West Coast. Carrie Blake recalls snorting the drug as a teenager in Southern California. ''When you're really taking a significant amount of meth, you can go without sleep for three, four days," said Blake, now coordinator of Rhode Island CARES, an advocacy organization for substance abusers. ''I'd be flying for days. ''But when you come off? It's really a major crash," she said.
     From the West Coast, where the drug insinuated itself most prominently in gay communities, meth migrated to the Midwest. There, in Missouri, Iowa, Indiana, and other states, the drug took root in rural towns, disrupting the lives of heterosexuals and sometimes resulting in crime rampages. By 2002, the telltale markings of meth's arrival had become evident in Boston and New York, where clinics began treating men whose losses were mounting: lost jobs, lost homes, and lost teeth, a consequence of taking a drug that is cut with toxic substances and that causes the mouth to turn dry, saliva replaced by tooth-rotting acids. ''So many of us know people whose lives have been destroyed by crystal meth, people whose lives have just crumbled in a short period of time," said Sophie Godley, prevention director at AIDS Action Committee of Massachusetts, New England's largest provider of HIV prevention and education services.
     But quantifying the precise scope of the problem in New England is a tricky proposition, substance abuse and disease specialists acknowledge. From February through December 2004, an acupuncture detox program at Fenway provided treatment to about 140 gay and bisexual men addicted to crystal meth. And for the first three months of this year, state-run substance abuse programs recorded 268 admissions related to meth. If admissions continue at that pace for the remainder of the year, the number would substantially exceed the 680 admissions of 2004, although Michael Botticelli, director of substance abuse services for the state, cautioned against making assumptions about trends in use.
     Kevin Cranston, chief of the state's HIV/AIDS Bureau, also warned that a slight increase in HIV cases among gay and bisexual men in 2003 and 2004 should not be interpreted as a trend, nor, he said, can it necessarily be linked to meth use. ''We have ample anecdotal data that crystal meth appears to be increasingly prevalent," Cranston said. ''But we need to be careful before we extrapolate from individual reports to a pattern of use and abuse in the community." Representatives of the New England branch of the US Drug Enforcement Administration and the Boston Police Department said their narcotics agents have uncovered meth labs and seized the drug but in volumes lower than elsewhere in the country.
     Nationally, concerns about meth and its potential for introducing a new generation of HIV infections led representatives from health departments, along with AIDS and substance abuse specialists, to gather last month in the Washington offices of the National Alliance of State and Territorial AIDS Directors. A Globe reporter was allowed to observe the private meeting. Discussions focused on the course of meth use in different cities, the link between meth and risky sexual behavior, and prevention strategies that worked in one place but not another. For instance, a campaign built around the tagline ''Meth=Death" was a hit in Miami but a dud elsewhere. The health officials also reviewed research associating meth with sexually transmitted diseases. One San Francisco study, for example, documented that gay meth users were twice as likely to be infected with HIV as men who had not used the drug. The same study discovered that the meth users were nearly five times more likely to have syphilis.
     The CDC's Mansergh described the Washington conference and the Atlanta meeting two months earlier as evidence that meth and its role in HIV infections had become an issue of national importance. ''Certainly, there's been regional attention for many years on the West Coast," Mansergh said. ''Now, there's a critical mass that calls for national attention."
     Which is why representatives of AIDS Action, clad in red T-shirts, found themselves one Friday night inside a pulsating gay nightspot called Machine. They were there to distribute condoms and to answer questions about meth or other drugs. Machine's manager, Mike Fabiano, said his club aggressively discourages drug use and thus welcomes the AIDS Action squad. The motivation, he acknowledged, is equal parts altruism and self- interest: Crystal meth can lead to isolation, to men staying cloistered in their homes. The past few years have been tough for gay clubs across the nation, and some club owners say meth is partly to blame. ''There used to be people who would come to the clubs, and then you wouldn't see them for months," Fabiano said. ''The next time you see them, they're emaciated figures."
     Bob Braunewell saw himself eroding into one of those figures. He had his first meth six years ago, dabbling briefly. It was only after a relationship soured, three years later, that he and meth became reacquainted. His use, he said, escalated but never stretched beyond weekend binges. For Braunewell, 38, the drug proved acutely isolating: He would smoke it alone while holed up in his Boston apartment. It was one weekend morning less than two months ago when Braunewell, who works with social service agencies and sings and writes music, hit a physical and emotional trip line. Something, somewhere deep inside, told him to seek help. Now. He drove himself to Faulkner Hospital's emergency room. He is recovering now, writing music to explain the pain. His eyes glisten with an intensity suggesting that, all at once, he is looking behind and looking ahead. Late on a sunny afternoon, crouching at a baby grand piano at Boston University, Braunewell practices a song he penned during his recovery. He calls the song ''How Much." Tell me tell me how/How much is enough?/Do you have to see the inside of heaven/To know you're done?



Study a Positive Sign on Alzheimer's
Associated Press, 4/24/2005

WASHINGTON -- The first attempt at gene therapy for Alzheimer's patients appeared to significantly delay worsening of the disease in a few people who have tested it so far, scientists reported Sunday. Far more research is needed to see if the experimental treatment, which requires a form of brain surgery, really helps. But if the approach pans out, researchers say delivering protective substances, called growth factors, into a diseased brain holds the potential to rescue some dying brain cells.
      In one patient, the brain tissue showed new growth, which was a first, according to a study published in Sunday's edition of the journal Nature Medicine. ''It won't cure the disease,'' said the lead researcher, Dr. Mark Tuszynski of the University of California, San Diego. That is because Alzheimer's destroys different types of cells in different areas of the brain; the new gene therapy targets just one of those. The preliminary success indicates that similar approaches might help other neurodegenerative diseases, such as Parkinson's, Tuszynski said. ''This is in a sense proof of principle for the potential use of growth factors,'' he said.
     Doctors at Chicago's Rush University Medical Center have begun a second small study of the approach in Alzheimer's patients. Tuszynski, who co-founded a biotechnology company that is funding the Chicago work, hopes larger studies will begin within another year. Tuszynski and colleagues took skin cells from eight patients in the early stages of Alzheimer's and modified the genes to secrete a protein found in healthy brains called nerve growth factor, or NGF.
     Earlier studies had shown that injecting NGF-producing tissue into the brains of aging monkeys could reverse deterioration. Simply injecting NGF into people would not work. If it goes into the wrong part of the brain, it can cause serious side effects. So, doctors drilled holes into the patients' skulls and implanted the NGF-producing skin cells directly onto Alzheimer's-injured spots.
     Six patients were tracked for almost two years. Tests involving memory and other skills found their rate of cognitive decline slowed by 36 percent to 51 percent, better than is usually seen with medication, Tuszynski reported. The first two patients were awake and moved during the cell implantation, causing bleeding in their brains; one patient died five weeks later. Remaining patients received the implants under general anesthesia to keep them still, and the researchers reported no further problems.
     The brain tissue of the study participant who died had new growth protruding from Alzheimer's-injured cells at the implant site, the first time that sort of recovery has been seen from a human brain treatment, Tuszynski said. Additionally, PET scans of the other participants showed a measurable increase in their brains' metabolic activity. ''These results need to be interpreted with cautious optimism,'' said William Thies of the Alzheimer's Association. With so few patients in the study, ''it's really impossible to tell whether the benefit was due to the treatment or natural fluctuation in symptoms,'' he said. Moreover, he said, it would never be practical to perform brain surgery on millions of patients. Already, 4.5 million Americans have Alzheimer's, and with the country's population aging, a staggering 14 million may have it by 2050. But if the gene-therapy approach ultimately works, it could revive interest in finding easier methods, he said.
     As for the next step, instead of genetically modifying skin cells, Dr. David Bennett of the Rush University Medical Center has begun injecting the brains of up to 12 Alzheimer's patients with an NGF-bearing virus. Animal studies suggest the virus may penetrate injured brain cells better, producing more of the protective growth factor for longer periods, he said. ''It's cautious optimism with a big C,'' Bennett stressed. ''It can't be a cure, obviously ... but maybe it'll do something.''