Noteworthy News Articles on Mental Health Topics, February
16-21, 2006
Prozac Battles Dark Dreams That Khmer Rouge Left
Seth Mydans, New York Times- 2/16/2006
PHNOM PENH, Cambodia — Mao Irang is an evangelist for the new magic in Cambodia, a treatment that can cure everything from headaches to blackouts to nightmares to bursts of violence. "I ask my friends, 'What is your problem?' " she said. " 'Does your food get stuck in your throat? Do you have pain here, and here, and here? Do you have problems with your sleep?' I say, 'O.K., try this doctor.' " Her doctor is Ka Sunbunaut, one of only 26 psychiatrists in this nation of 12 million traumatized people, the survivors and the children of survivors of one of the past century's most horrifying episodes of mass killing.
After therapy with him, said Ms. Mao Irang, 35, a social worker tormented by her memories, "I felt like I was another person; I was not a prisoner anymore." She was liberated through a combination of talk therapy and psychiatric drugs — treatments that are largely alien to Cambodians, who often turn to faith healers and herbalists. But the word is spreading now among a relatively small circle of educated people: your ailments have a cause, and there are treatments that can help you.
It is a quarter century since the Khmer Rouge was driven from power after causing the deaths of 1.7 million people from 1975 to 1979 through execution, starvation or overwork. "Until today, most people don't realize they have psychological problems," Dr. Ka Sunbunaut said in an interview. "They don't understand about trauma. Mostly, they believe it is all related to karma."
Now, though, people here are increasingly turning to drugs like Prozac and Valium, which are expensive but available without a prescription. Dr. Ka Sunbunaut said most of the medicines he prescribed were generic drugs manufactured in Asia. "He gave me holy medicine," said Preap Phal Theary, 52, a wholesale rice dealer and former French teacher. "It is a holy medicine. It has changed my life. I've become a normal person instead of a sick person." She said that before being treated, she had blackouts and intestinal problems. She had convulsions, and passed out whenever she went to the bathroom, she said. "For 15 years I tried all kinds of medication, modern and ancient, with herbs and Chinese cures and spiritual cures and monks' blessings and praying at my home altar," she said. "For 15 years I had two jobs. One was to feed my children and the other was to be ready to fall into a coma at any moment, so I always needed an escort."
Psychiatrists now are considering the possible effects on traumatized people like Ms. Preap Phal Theary of plans to hold a trial for surviving leaders of the Khmer Rouge. Preliminary work is being done to set up a tribunal, although it will be many months before any defendants are put in the dock. Convictions of the former Khmer Rouge leaders could bring some clarity and relief to people who still do not understand the causes of their suffering, doctors say. But for many the trial could revive traumas that have been suppressed over the years. "At the moment I'm not sure whether a tribunal can bring peace or problems in our society," said Dr. Sotheara Chhim, a psychiatrist who is managing director of the Transcultural Psychosocial Organization, which is preparing for the trial. He said his concerns were "retraumatization" of survivors who will come face to face with the past; new trauma on young people who did not experience the Khmer Rouge era; and renewed anger and hostility among victims. "I believe everybody has suffered," he said in an interview. "Everybody has inside some memory, some past trauma. But their abilities to cope are different."
The Khmer Rouge era itself could be seen as an episode of madness. In a utopian frenzy these radical Communists sought to erase the modern world and systematically killed off most of the country's educated and skilled people. Few doctors survived. Cambodia has no in-patient clinics for mental patients, the doctor said, and only 40 psychiatric nurses (and another 40 in training). He is only now organizing a committee for mental health, with its own budget, in the Ministry of Health.
No reliable data exist on the traumatic effects of the past, partly because people are not generally aware of the lasting impact of their experiences, said Dr. Sotheara Chhim. "People think their past problems have been buried and don't realize that the present is connected to the past," he said. A study of Cambodian refugees in the United States, published last August in The Journal of the American Medical Association, found that 62 percent had suffered from posttraumatic stress disorder in the previous year, compared with a rate of 3.6 percent in the general United States population. It found that 51 percent had suffered from major depression, compared with 9.5 percent of the general population. According to the study, 99 percent of the survivors of the Khmer Rouge years reported almost starving to death, 96 percent said they had been forced into slave labor, 90 percent said that a family member or friend had been killed and 54 percent said they had been tortured. Even if they learn to cope, their memories remain to torment them, the doctors said.
Ms. Preap Phal Theary, the rice seller, closed her eyes for a moment. "I see a man running, and I see a man shooting," she said. "I hear gunfire. You don't just have a picture of people running in a field, you have sound, too. I can hear the people saying, 'Oh, they killed him.' It is like a snapshot in my mind." Until she was treated, she said, loud noises, gunshots and the sight of people arguing caused her to pass out.
For Ms. Mao Irang, who was orphaned in the Khmer Rouge years, the most vivid memory almost seems to have been a nightmare. "When I heard my parents were killed I fainted," she said. "I did not wake up for a week. In the hospital they thought I was dead. They put me in a pile of bodies. "When I woke up I thought, 'What is that smell?' And I crawl, crawl, crawl to the door. And then I realize I am in the dead people's room." She was 7 or 8 years old at the time. She pressed the palms of her hands against her eyes. "Today, I feel much better," she said.
New Yorker, Suffering Memory Loss, Is Found in Chicago
Lisa Foderaro, New York Times- 2/16/2006
Raymond Power Jr. stepped out of his life some time on Aug. 1, 2005, the last day he awoke in Westchester County as a lawyer and New Rochelle resident, a 57-year-old husband and father of two, a Boy Scout leader and churchgoer. Within two days, he had stumbled into a new, uncertain and evidently unwanted life: as a homeless man in Chicago who could remember nothing of his former existence but for a semblance of his name: Jay Tower.
Earlier this week, Mr. Power, who is apparently suffering from a severe case of amnesia, was found after a homeless friend discovered his picture on "America's Most Wanted" Web site. His wife, Jane, and the couple's two children, 11 and 17, were overjoyed. But as he undergoes tests at a Chicago hospital before his return, they are bracing for what comes next. "He doesn't know who we are," said Mrs. Power, his wife of 30 years, who has spoken with him on the phone. "He said, 'Do I have children?' and I said, 'Yes, you have two children.' Our prayers have been answered but yet they are very sad that he doesn't know who they are and also very scared."
In a telephone interview, Mrs. Power said that her husband, a Vietnam War veteran, had been treated for depression since the terror attacks of Sept. 11, both with medication and counseling. Mr. Power walked between the two towers 15 minutes before the first plane hit, she said, but was on board a subway bound for the Bronx when the attack took place. She believes that Sept. 11 dredged up painful memories of Vietnam.
Still, she said, Mr. Power was functioning perfectly well until his disappearance. Indeed, a partner at his law firm said that there was no inkling. "This whole thing came out of left field," said Bruce M. Young of Babchik & Young. "The guy was a hard worker, he was well regarded and well liked by his colleagues. He manifested no signs of anything."
For months, his family and the New Rochelle Police Department — for whom Mr. Power worked as a sergeant before going to law school — searched in earnest. The police had videotape that showed Mr. Power's car pulling into a White Plains parking garage near his law office at 4:10 a.m.. on Aug. 1 and then right out again. They followed his credit card expenses as he bought gas over the next 12 hours in Pennsylvania and Ohio. Then the trail went dead.
During all those months, Mr. Power struggled to discover his identity while living at a homeless shelter in Chicago, conducting research at the local library and visiting the Chicago police, said the Rev. Phil Kwiatkowski, vice president of the Pacific Garden Mission. "He had no recollection," he said. "He was very, very frustrated. He broke down and cried on the shoulder of one of our security guys."
That a person can so totally and suddenly misplace his identity — much as one might lose car keys — is the stuff of thrillers and nightmares. It is rare, but it happens, according to Dr. Rocco F. Marotta, chief of the medical psychiatric service at the New York Medical College at Westchester Medical Center in Valhalla, N.Y. Dr. Marotta, who said he has no knowledge of Mr. Power's case, said that doctors would first want to rule out any physical causes like seizures. He said amnesia can result from extreme stress, typically affecting patients who have had post-traumatic stress disorder. "They often have depression," he said, "and a lot have had head injuries and periods of severe stress." But he said the prognosis for such patients was generally excellent. "When they get better, it's pretty abrupt," he said. "If it isn't due to some physical problem, they do very well."
Mrs. Power, who oversees a Web site for a medical publication, said her husband had not exhibited any memory loss before he vanished. "I really thought he might have just snapped," she said. "In my heart I knew that he would never intentionally leave us." She said that a sister of Mr. Power had met him in Chicago and that he would fly home to Westchester County within a day or two. She plans to meet them at the airport, and she is looking for a center where he can go for treatment. He will not live at home, at least at first. "It would be very hard," she said.
Friends and business associates were embracing the news of his discovery rather than focusing on the difficult consequences of his situation. Detective Lt. William B. Allison of the New Rochelle Police Department was a colleague of Mr. Power years ago. "I was elated he was found alive," Lieutenant Allison said. "He was a wonderful guy."
The police said Mr. Power arrived at the shelter on Aug. 3, without his car, a 1994 Ford Taurus. "What we don't know is if something happened along the way," Lieutenant Allison said. Jon Leiberman, a producer for "America's Most Wanted," said an anonymous caller provided a tip about Mr. Power's whereabouts on Monday afternoon. The caller was a friend of Mr. Power at the homeless shelter, Mr. Kwiatkowski said. "The police came here and at first he didn't want to go because now we are the only people he knew," Mr. Kwiatkowski said. "He was well liked. He gave one of our security personnel a Christmas card."
Staff At Connecticut Psychiatric Hospital Want Secure Unit
Associated Press, 2/16/2006
Workers at Connecticut's only psychiatric hospital for children are calling on the state to immediately establish a separate unit there for juvenile delinquent girls. The employees of the Riverview Hospital for Children and Youth told a legislative committee Thursday that the lack of a separate, secure unit for delinquent girls creates a volatile atmosphere in which patients and staff members have been assaulted and intimidated. "It appears that we're almost at the end of the match before the explosion takes place," said state Rep. Michael Cardin, D-Tolland, a member of the Select Committee on Children.
The state has had no secure facility for girls in the juvenile justice system since the coed Long Lane School closed three years ago because of concerns about safety. Some are sent to privately run group homes or adult prison, but others go to Riverview because they have mental health problems or have nowhere else to go.
Employees told legislators that the delinquent girls have different behavioral problems than other patients. One girl assaulted 12 patients and staff, sneaking up on lower-functioning girls and hitting them. She also threatened to kill patients at night when they were sleeping, said Susan Ritz, a clinical psychologist. Last year, a 14-year-old girl attacked another girl with a ball point pen, she said. "We urge you to do all you can to help curb the violence sooner rather than later before a death occurs," said Richard Liburdi, a children's services worker at Riverview, adding that the girls "create a culture in which others start to adopt some of the same violent, coercive behaviors."
Gov. M. Jodi Rell's proposed budget sets aside $1 million in bond money to build a small, secure facility with four to six beds for the most troubled girls. A location has not yet been chosen. Riverview employees say they can't wait until legislators pass the budget. They want the Department of Children and Families to immediately establish a separate unit within the 98-bed hospital for delinquent girls until a separate facility can be built. They're also concerned the four to six beds proposed for the facility will not be enough. They estimate about a dozen girls in the state are troubled enough to need spots.
Department of Children and Families Commissioner Darlene Dunbar acknowledged the problem posed by the lack of a secure facility but said a hospital reorganization that is already underway should help. "As the sole state hospital for children and youth in Connecticut, Riverview cannot ethically refuse admission to any child or youth who is in need of our services," said Melodie Peet, the hospital's superintendent. "Patient mix, then, is not always within our control." DCF also has added positions and training at the hospital, she said.
State Child Advocate Jeanne Milstein told legislators Thursday that her office has launched an investigation of problems at Riverview. "The hospital is in crisis right now, the level of tension is extraordinary, and it has never been more important for DCF to provide strong leadership and clear direction to staff," Milstein said. But she said most of the violent incidents cannot be attributed to delinquent girls. Of 130 children involved in violence against staff or other patients, only five were girls in the juvenile justice system, she said. About 40 percent of the reported incidents involved patients with developmental or cognitive disabilities, leading to concerns that staff may not be properly equipped to deal with those patients, she said.
Sen. Edward Meyer, D-Guilford and co-chairman of the Select Committee on Children, said he was astounded to learn children are languishing at the hospital even though the state spends $1,256 per child per day. "This is unacceptable to say the least," he said. Meyer said he would consider introducing bills to close the hospital or terminate its state appropriation, projected at $27. 5 million for fiscal year 2006, if staff and management can't resolve their differences.
Psychiatric Hospital `In A State Of Crisis'
Colin Poitras, Hartford Courant- 2/17/2006
Staff from the state's Riverview psychiatric hospital for adolescents Thursday pleaded to state legislators for a new, secure treatment unit for juvenile delinquent girls, saying it will do much to improve hospital safety and quell recent unrest. But several prominent children's advocates said the move won't be enough to resolve the hospital's mounting problems, which include a lack of beds for a growing list of suicidal, depressed and traumatized children being held in high-security detention centers.
Speaking before the legislature's select committee on children, Riverview employees said the hospital's current patient mix of potentially violent delinquent girls and seriously disturbed children has created a volatile environment in which both children and staff have been hurt. The employees cautioned that more serious injuries cannot be ruled out. The tension has been exacerbated by a new treatment regimen that prohibits staff from using mechanical restraints or seclusion to maintain control, the workers said.
"Riverview is in a state of crisis," said Susan Ritz, a clinical psychologist. Ritz said one young girl assaulted 12 patients and staff during an eight-month stay at the Middletown hospital, frequently punching lower-functioning girls from behind. The girl also threatened to kill patients at night while they slept, Ritz said. "You can imagine the sense of insecurity that creates," Ritz said. In another recent incident, a teenage boy involved in a planned uprising and escape later admitted that the plot included possibly killing a staff member, according to Rich Liburdi, a veteran children's service worker. Liburdi said the Department of Children and Families' decision to mix the patient populations - driven primarily by a lack of secure treatment beds for delinquent girls - has created a culture where "status and power is gained through intimidation and violence."
Gov. M. Jodi Rell has set aside $1 million in her 2007 budget proposal to create a small, secure facility for delinquent girls. The state has not had one since Long Lane School closed in February of 2003. Sources said Thursday that DCF is considering establishing a four- to six-bed secure unit for girls in one of the existing cottages at Connecticut Children's Place in East Windsor. DCF Commissioner Darlene Dunbar, however, said that the agency is still weighing its options and that no decisions have been made.
While acknowledging the need for a small, secure treatment center for girls, two leading children's advocates Thursday said that much more must be done to stabilize Riverview and restore it to the national acclaim it once enjoyed. DCF must work harder to open more specialized group homes and treatment-based foster homes to reduce overly long stays for children at Riverview, said attorney Martha Stone, director of the Center for Children's Advocacy at the University of Connecticut School of Law. "When you have a crisis, you need to act like it's a crisis," said Stone, who plans to discuss the backlog with a federal court judge next week as part of her ongoing class-action lawsuit on behalf of children in Connecticut detention centers.
The agency also must move faster in adopting plans for trauma-based treatment programs and gender-specific counseling needed by boys and girls at Riverview, Connecticut Child Advocate Jeanne Milstein said. Milstein said the current crisis has resulted from DCF's failure to implement services for girls that have been talked about since Long Lane closed. A 100-page plan for improving girls' services was released a year ago, yet most of it hasn't been acted on, she said. With Riverview costing state taxpayers $1,256 a day and $458,440 a year per child, it is vital for the legislature to demand more accountability from DCF and to push agency leaders to enact these reforms, Milstein said. "We should expect nothing less," she said.
DCF spokesman Gary Kleeblatt said the agency has already opened 12 of 24 planned group homes this year, which is part of the 100-page plan. But a proposal to have 95 special treatment foster homes to help ease the backup at Riverview has been less successful. Of the 95 new foster homes scheduled to open by July 1, 2006, only 24 have been created to date, Kleeblatt said. However, he said the agency is funding more family support teams to help traditional foster parents handle children in crisis until the new homes open.
Sen. Edward Meyer, D-Guilford, the select committee's Senate chairman, Thursday threatened to propose a bill calling for the closing of Riverview or a revocation of its approximately $28 million in annual state funding if the situation there doesn't rapidly improve. Meyer said he was `astounded" by the high cost of treating children at Riverview and the fact that the hospital is in such a state of crisis. State Rep. Michael J. Cardin, D-Tolland, the committee's co-chairman, said that whatever happens must happen soon. "It appears that we're almost at the end of the match before the explosion takes place," Cardin said.
Gov. Granholm Demands More Child Caseworkers
David Eggert, Associated Press- 2/17/2006
LANSING - Gov. Jennifer Granhohn on Thursday pledged to thoroughly investigate how a 7-year-old boy beaten to death last summer was left with an 'adoptive family despite repeated reports of abuse. She also said she won't sign any state Department of Human Services budget bills that don't include the 51 additional caseworkers she has asked for in the budget year that starts Oct. I. But she had to backtrack Thursday afternoon after first implying the Republican-controlled Legislature had denied her earlier requests for more caseworkers. The governor's office said in a statement that Granhohn had not asked for any more caseworkers before her latest budget proposal. Granholm spokeswoman Liz Boyd said the governor was not trying to point fingers at the Legislature. "The governor would not use this for political gain," Boyd said. "It should not be used for political gain by anyone. It's much too tragic."
Granholm's earlier comments didn't sit well with Senate Majority Leader Ken Sikkema. "To use the horrible tragedy of Ricky Holland's death to score some kind of leverage in budget negotiations is in poor taste and unacceptable," the Wyoming Republican said in a statement. "The governor has never asked for additional funding for that division in any budget requests until this year Despite the lack of a request, the Legislature did increase funding two years ago to provide for 14 additional caseworkers."
Ricky Holland disappeared last July 2 from his home in Williamston about 20 miles east of Lansing. His adoptive parents said he'd run away, and a massive hunt was undertaken to try to find him. Police located the boy's remains last month in a rural part of Ingham County His adoptive parents are now in jail charged with open counts of murder. They have pleaded not guilty and face a preliminary examination Feb. 28. Court documents show the parents accuse each other of killing Ricky.
Granholm said she plans to look into whether state officials could have done more to protect the boy. "Believe me, there will be an investigation of what happened," Granhohn told reporters Thursday.. "If there needs to be corrections, those will be made. And we will get additional resources to make sure all children are protected." Gianhohn said the child protective services section is understaffed, one reason she has requested money to hire 51 additional caseworkers in the budget year that starts Oct. 1. She added that a lot of child protective services caseworkers left state government in the late 1990s when Republican John Engler was governor to take advantage of an early retirement offer. "Consequently the Department of Human Services personnel have been understaffed for a long period of time," Granholm said. "This year, no budget gets signed unless those resources are there" to hire additional caseworkers. Figures from the Department of Human Services shows the state currently has 693 child protection caseworkers. It had 705 in the previous budget year.
Also Thursday, the independent state Office of Children's Ombudsman said it has started investigating the Ricky Holland case. The agency will determine whether the Department of Human Services or other child placing agencies violated any laws, rules or policies. It could make recommendations for changes. Granholm last month appointed Verlie Ruffin as the children's ombudsman to fill a vacancy. Human Services director Marianne Udow issued a statement Tuesday saying the department is "committed to doing whatever needs to be done to keep children like Ricky and his siblings safe."
Depression Device Won Approval Though F.D.A. Staff Objected
Gardiner Harris, New York Times- 2/17/2006
WASHINGTON— A top federal medical official overruled the unanimous opinion of his scientific staff when he decided last year to approve a pacemaker-like device to treat persistent depression, a Senate committee reported Thursday. The device, the surgically implanted vagus nerve stimulator, had not proved effective against depression in its only clinical trial for treatment of that illness. As a result, scientists at the Food and Drug Administration repeatedly and unanimously recommended rejecting the application of its maker, Cyberonics Inc., to sell it as such a treatment, said the report, written by the staff of the Senate Finance Committee. But Dr. Daniel G. Schultz, director of the Center for Devices and Radiological Health at the agency, kept moving the application along and eventually decided to approve it, the report said. That approval did follow the backing of a divided F.D.A. advisory committee. Still, the Senate committee, which for two years has been investigating the decision-making processes at the F.D.A., could find no previous instance in which the director of the center had approved a device in the face of unanimous opposition from staff scientists and administrators beneath him, the report said.
Dr. Schultz could not be reached for comment on Thursday, but Susan Bro, an F.D.A. spokeswoman, said the device had been approved because many people with persistent depression "are otherwise on their way to institutionalization, because of the seriousness of their illness." Ms. Bro said top officials did "occasionally overrule staff recommendations after assessing all data, expert opinion and medical need." Jill Gerber, a spokeswoman for Senator Charles E. Grassley, the Iowa Republican who heads the Senate committee, said, "The report speaks for itself, and Chairman Grassley has no additional comment."
In a 1,900-word written response issued Thursday night, Robert P. Cummins, Cyberonics's chairman and chief executive, said the investigators had failed to interview many experts on serious depression. Mr. Cummins said his company's device was "the only safe and effective treatment option ever specifically developed, studied, F.D.A.-approved and fully informatively labeled for the treatment of chronic or recurrent treatment-resistant depression."
The vagus nerve stimulator is surgically implanted in the upper chest, and its wires are threaded into the neck. Batteries in the device stimulate a nerve leading to the brain. The nerve stimulator has been approved since 1997 for the treatment of epilepsy in some patients. Common side effects include voice alteration, increased cough, shortness of breath, neck pain and difficulty swallowing. The device has also been linked to rare reports of death, heart problems and vocal cord paralysis.
When some epilepsy patients reported that their moods had changed after receiving the devices, Cyberonics, based in Houston, implanted them in 235 depressed patients and turned the machines on in half of them. After three months, the two groups were equally depressed. The trial had failed. Cyberonics then turned the devices on in all 235 patients and determined that 30 percent showed significant improvement after six months or more. Without a control group, however, it was impossible to determine if the device had caused the improvement.
Internal correspondence among F.D.A. reviewers shows that some were bewildered by Dr. Schultz's support for the device, the Senate report said. "In my opinion, they do not have adequate data, and I don't understand how this can move forward," one reviewer wrote in an e-mail message to a colleague, the report said. Another wrote, "As an M.D. interested in science, it seems to me that such an approval would be akin to approving an experimental product."
Smokers Facing New Pressure
Lisa Cornwell, Associated Press- 2/17/2006
CINCINNATI -- Smokers already feeling pressure from increasing cigarette costs and workplace smoking bans are now feeling squeezed from another direction - health insurance premiums. A growing number of employers - private and public - are charging employees who use tobacco more money for their health insurance coverage. Employers hope that the higher charges will motivate more employees to stop smoking, resulting in improved health and lower health care costs for the companies and their workers. Meijer Inc., Gannett Co., American Financial Group Inc., PepsiCo Inc. and Northwest Airlines are among the companies already charging or planning to charge smokers higher premiums. The amounts range from about $20 to $50 a month.
"With health care costs increasing by double digits in the last few years, employers are desperate to rein in costs to themselves and their employees," said Linda Cushman, senior health care strategist with Hewitt Associates, a human resources consulting and services firm. She said the practice of smoker surcharges is becoming such a significant trend that this year, it will be part of Hewitt's annual survey of companies' current and future health care plans. Cushman said a general benefits survey of 950 U.S.-based employers last year showed that at least 41 percent used some form of financial incentives or penalties in their health care plans. She estimates that at least 8 percent to 10 percent of the businesses probably aimed some of the incentives or penalties at smokers, and says that percentage is growing. "With smokers costing companies about 25 percent more than nonsmokers in the area of health care, it just makes good business sense," she said. The companies imposing the surcharges are mostly self-insured, with employers and employees sharing the insurance premium costs. Other companies or insurance plans have offered workers financial rewards for exercising, dieting or other healthy behaviors. Some have started onsite fitness programs and are paying for gym memberships.
The Centers for Disease Control and Prevention estimates $92 billion in lost wages annually in the United States from smokers who die prematurely. In addition, the economic cost of smoking includes $75.5 billion a year in direct health care costs. "In addition to employers having to pay out more in health care costs, public opinion is now solidly on the side of eliminating smoking and workers are realizing increasingly that they are having to pay for others' lifestyle choices," said Helen Darling, president of the National Business Group on Health, a nonprofit agency representing more than 200 of the nation's large employers.
Gannett Co., the nation's largest newspaper publisher, this year began charging its employees who smoke an extra $50 a month for the company's insurance coverage. "We have some strong feelings that smoking is really bad for employees, and a healthier employee is better for us," said Tara Connell, a spokeswoman for the McLean, Va.-based company. PepsiCo Inc., based in Purchase, N.Y., has been charging employees who use tobacco $100 annually for a couple of years, and Grand Rapids, Mich.-based Meijer Inc. started charging smokers $25 a month this year. That fee is dropped if smokers complete a smoking-cessation program, Meijer spokeswoman Judith Clark said. Public employers also are requiring smokers to pay for their habit. The state of Alabama on Oct. 1 began charging $20 a month extra per employee insurance contract. The charge applies if anyone covered under a contract - such as a spouse - smokes. Georgia charges $40 a month for smokers covered under the state's health plan. Employees caught lying on their insurance form about whether they smoke could lose their insurance for a year.
Trial Opens in Priest Sex-Abuse Case
Josh Noel, Chicago Tribune- 2/18/2006
ELKHORN, Wis. -- Two graying men looked on Friday as a jury was told that Rev. Donald McGuire, an internationally respected Jesuit priest, molested the two nearly 40 years ago when they were teenagers referred to him for counseling at Wilmette's Loyola Academy. During opening statements of a trial expected to last a week, Walworth County District Attorney Phil Koss said the men were victimized while struggling to fit in at the school, and their families thought they would benefit from a priest's attention. Though Koss told the jury McGuire molested the men repeatedly while they lived with him in his room on campus, the priest is formally accused only of five instances of abuse in Fontana, a resort community near Lake Geneva, between 1966 and 1968.
McGuire, 75, who nodded off several times in court due to what his lawyer called sleep apnea, has pleaded not guilty. Though the priest had few supporters on hand, his defense indicated that far more backers will turn out when testimony begins Monday. "On Monday we're going to turn this thing upside down," McGuire said after the proceedings, as he moved slowly to a waiting van with the aid of a cane. "You'll hear the truth."
Koss told the jury the boys were abused at separate times, both beginning when they were freshmen. The first alleged victim, a 53-year-old oceanographer from Massachusetts, was molested both at the school and four separate times at his uncle's home in Fontana after McGuire had befriended the boy's family, Koss said. "His mother thought it was great that this fine Jesuit was taking him under his wing," he told the jury. The other boy, now 52 and living in Arizona, was first abused at the school in 1968, Koss said. He said the boy once was taken by the priest to Milwaukee for dinner and then to the home in Fontana, where he was molested. The younger man approached a lawyer in 2003 after reading about McGuire on the Internet, Koss said. Loyola Academy responded to the accusations with a letter to alumni, which led the older alleged victim to also contact the lawyer.
Among his witnesses, Koss said, is a priest who said he reported the allegations to the school after the younger man told him about the abuse in 1969. In his opening, McGuire's attorney, Gerald P. Boyle, pledged to get to "the truth of the matter" and said no one would testify to seeing either boy in the priest's room.
Sobriety Saved Actor's Life
Chicago Tribune, 2/18/2006
Philip Seymour Hoffman, the favorite to take home the best actor Oscar next month, says he never would have reached such heights if he didn't get sober 16 years ago. Hoffman, the star of "Capote," tells "60 Minutes" on Sunday about nearly succumbing to substance abuse; after graduating from New York University's drama school, he fell into a fast-paced city social life.
"It was all that [drugs and alcohol], yeah. It was anything I could get my hands on. ... I liked it all," Hoffman says. He's glad fame didn't come until he cleaned himself up. "I have so much empathy for these young actors that are 19 and all of a sudden they're beautiful and famous and rich," he says. "I'm like, `Oh my God, I'd be dead.'"
A Bid to Toughen Stance on Sex Offenses
Jordan Rau, Los Angeles Times- 2/19/2006
SACRAMENTO — A proposal to severely restrict and monitor the movement of released sex offenders has led to a bitter deadlock in the Legislature and appears headed for the California ballot this fall. The initiative would bar convicted offenders from living in many neighborhoods in California — including most urban areas — and require them to wear electronic tracking devices for life. Supporters plan to submit more than 600,000 signatures to elections officials Tuesday for verification, well more than the 373,816 needed. All sides expect the initiative to qualify for the November ballot, giving California voters their first chance to weigh in on how to handle sex offenders.
If approved, the Sexual Predator Punishment and Control Act, also known as Jessica's Law, would increase prison terms for many crimes, including possession of child pornography and Internet luring, and ensure that child rapists spend at least 25 years behind bars. "It's the broadest change of sexual predatory laws in the nation," said Sen. George Runner (R-Lancaster), who sponsored the initiative with his wife Sharon, a Republican assemblywoman.
But the efficacy of several provisions is doubted by Democratic legislators, rape victim advocates, prosecutors in Iowa and therapists who treat offenders. That state banned sex offenders from living within 2,000 feet of schools, a central element of the California initiative. "It didn't take us very long in attempting to enforce the law to learn that it has nothing to do with the safety of children," said Corwin Ritchie, executive director of the Iowa County Attorneys Assn., which represents the state's prosecutors.
California critics complain that the broad changes would fail to differentiate between the worst offenders and ones who, though their crimes were heinous, are unlikely to molest again. These critics say it would be a reckless diversion of police time and taxpayer money to treat all sex offenders as if they were roaming insatiable predators preying on strangers. According to the state attorney general's office, most molesters know their victims, and in half the cases molester and victim are related. "There's public hysteria around sex offenders and children, but it doesn't acknowledge the fact that many of the sex offenders have never perpetrated violence against children," said Robert Coombs, a spokesman for the California Coalition Against Sexual Assault, which represents 66 rape crisis centers. Coombs said the initiative "also fails to acknowledge that the majority of sexual violence against children occurs in the home, in which case electronic tracking] doesn't help."
But many law enforcement officials say dramatic new laws are needed to respond to atrocious crimes such as the rape and murder of 9-year-old Jessica Lunsford by a registered sex offender in Florida in 2005. Her death prompted tougher laws in that state and spurred California's campaign. "I know just in the city I work in, we have a big problem with kids walking back and forth to school and people trying to drive up alongside of them and poach them in some way and say, 'Hey, get in the car,' " said Scott Currie, a Corona police detective and a past president of the California Sexual Assault Investigators' Assn., which supports Jessica's Law.
Republican efforts in the California Legislature to pass a law similar to Florida's have failed, done in by partisanship, accusations and jockeying prompted by the possible political stakes in the fall elections, when Gov. Arnold Schwarzenegger and 100 of 120 legislators are up for reelection. Republicans believe — and Democrats fear — that the initiative's presence on the fall ballot could be a boon to the GOP. "I think there's certain issues that Republicans have interest in, like public safety," Schwarzenegger said in August when he endorsed the legislative version of Jessica's Law and said that if it did not pass, he would support the initiative. "Then there's other issues that the Democrats have more interest in."
With more than a dozen states considering variations of the law, the issue has received attention on conservative talk radio and television's Fox News Channel for weeks. One Fox host, Bill O'Reilly, has devoted several shows to it and is selling pro-Jessica's Law window decals and bumper stickers. Nonetheless, California's Democratic-dominated Legislature rejected the GOP bills last month. They are in the process of passing alternatives that toughen some punishments and parole rules but, they say, do not treat all sex offenders as deserving equal vigilance.
Republicans, frustrated that the Democrats resisted changes until the initiative became a political threat, have refused to endorse the Democratic alternatives.
Politics have been particularly personal during the fights. In the longest floor battle in the Assembly all year, two lawmakers spoke of their own molestations and legislators debated extensively over how much pornography warranted prosecution and how much smut could fit on a computer disk. Republicans repeatedly called Democratic lawmakers "pro-criminal." That led one Democrat, Juan Arambula of Fresno, to invite critics to "meet me outside," presumably not for conversation.
Perhaps the most contested provision in the initiative would ban offenders from living within 2,000 feet of a school or park. Local governments would be able to add additional prohibited sites, such as child-care centers. In Iowa, many sex offenders, banned from entire communities through a similar law, ultimately ended up in isolated motels outside of towns, far from their probation and parole supervisors and treatment, said Ritchie of the prosecutors group. He said that because residency was defined as where a person sleeps, some registered offenders would not move, but would simply drive to highway rest stops at night to sleep in order to comply with the law. Still others stopped reporting where they lived to the state's sex offender registry. Prosecutors are now trying to repeal the law. "Our members run for election," Ritchie said. "They're prosecutors. They're not sympathetic to sex offenders. But we also understand that we're wasting resources." Starting this year, California barred high-risk sex offenders from living within half a mile of schools. But that applies to fewer than 1,000 convicts; the initiative would apply to all 85,000 registered sex offenders.
Even some supporters of Jessica's Law, such as Currie, say it may not work as planned. Currie, who emphasized that he was speaking only on behalf of the sexual investigators group, said, "Is the distance so far that it excludes the offenders from most cities and towns? If the answer is yes, where do they go? Do they go out in the middle of the Southern California desert, where there's less law enforcement manpower to keep track of them?"
Another contentious component of the initiative would require all sex offenders to wear global positioning tracking devices from the time of their release until death. San Diego County Dist. Atty. Bonnie Dumanis said 80 high-risk offenders in her county have been outfitted with such devices as part of a pilot program. She said law enforcement officials have been alerted eight times that the convicts were venturing into prohibited areas. "In one case, he was moments away from the victim he had victimized before when the police were able to rearrest him because of the GPS monitor," she said.
But the cost of applying such devices statewide to all released offenders is unclear, in large part because there is a legal disagreement about whether sex offenders who have already concluded parole would have to comply under the initiative. The nonpartisan legislative analyst's office estimates that within 10 years the initiative could cost an extra $200 million annually for electronic monitoring devices and extra parole officers needed to follow up on alerts. "It costs an awful lot of money and it's going to have virtually no effect," said Ron Kokish, spokesman for the California Coalition on Sexual Offending, a group of treatment providers, public defenders and probation officers.
Despite what the attention to the issue might seem to indicate, sex crimes in California are on the decline. Although all adult felony arrests increased by nearly 16% between 1999 and 2004, forcible rape arrests dropped by nearly 23% and the number of all other sex felonies remained relatively flat, according to the attorney general's office.
Although there is strong evidence that the worst sex offenders are likely to molest again, sex offenders overall are slightly less likely than other offenders to violate their parole and be returned to prison, according to California Department of Corrections records. Fifty percent of sex offenders released from prison in 2001 were returned within three years, while 59.2% of all offenders returned.
But advocates of the initiative say child molestation is too odious to be reduced to statistics. "If you've ever sat across the table from a child and listened as they tell their stories of what someone has done to them, it becomes extremely important," Currie said. "I think we should do whatever we can to protect kids."
Dreams Deferred
A. Roger Ekirch, New York Times- 2/19/2006
BED is a medicine," instructs an Italian proverb. Increasingly, Americans are inverting that counsel by ingesting sleeping pills to speed their slumber. With complaints of insomnia mounting, and marketing by drug companies becoming ever more ubiquitous, we are turning in increasing numbers to drugs like Ambien and Lunesta. According to a recent report from the research company IMS Health, pharmacists in the United States filled some 42 million prescriptions for sleeping pills last year, a rise of nearly 60 percent since 2000.
Are we running too quickly to the medicine cabinet? Or is insomnia genuinely reaching epidemic proportions, a consequence perhaps of the frenetic pace of modern life? In all likelihood, we have never slept so soundly. Yes, the length of a single night's sleep has decreased over the years (upward of 30 percent of adults average six or fewer hours), but the quality of our sleep has improved significantly. And quality, not quantity, sleep researchers tell us, is more important to feeling well rested.
This is not to minimize the torment of insomnia over the course of a restless night. But for most of us, slumber is reasonably tranquil — especially when compared with what passed for a night's rest before the modern era. Despite nostalgic notions about sleep in past centuries, threats to peaceful slumber lurked everywhere, from lice and noxious chamber pots to tempestuous weather. Worst in this pre-penicillin age was sickness, especially such respiratory tract illnesses as influenza, pulmonary tuberculosis and asthma, all aggravated by bedding rife with mites. One 18th-century diarist recounts that asthma forced her husband to sleep in a chair for months, with "watchers" required to hold his head upright. Among the laboring poor, whose living conditions were horrendous, sleep deprivation was probably chronic, prompting many to nap at midday, much to the annoyance of their masters.
As if these maladies were not enough, we now also know that pre-industrial families commonly experienced a "broken" pattern of sleep, though few contemporaries regarded it in a pejorative light. Until the modern age, most households had two distinct intervals of slumber, known as "first" and "second" sleep, bridged by an hour or more of quiet wakefulness. Usually, people would retire between 9 and 10 o'clock only to stir past midnight to smoke a pipe, brew a tub of ale or even converse with a neighbor. Others remained in bed to pray or make love. This time after the first sleep was praised as uniquely suited for sexual intimacy; rested couples have "more enjoyment" and "do it better," as one 16th-century French doctor wrote. Often, people might simply have lain in bed ruminating on the meaning of a fresh dream, thereby permitting the conscious mind a window onto the human psyche that remains shuttered for those in the modern day too quick to awake and arise.
The principal explanation for this enigmatic pattern of slumber probably lies in the nocturnal darkness that enveloped pre-industrial households — in short, the absence of artificial lighting. There is a growing consensus on the impact of modern lighting on sleep. The Harvard chronobiologist Charles A. Czeisler has aptly likened lighting to a drug in its physiological effects, producing, among other changes, altered levels of melatonin, the brain hormone that helps to regulate our circadian clock.
In fact, during clinical experiments at the National Institute of Mental Health, human subjects deprived of light at night for weeks at a time exhibited a segmented pattern of sleep closely resembling that related in historical sources (as well as that still exhibited by many wild mammals). The subjects also experienced, during intervals of wakefulness, measurably higher levels of prolactin, the hormone that allows hens to sit happily upon their eggs for long periods. These elevations of prolactin reinforce historical descriptions of complacent feelings at "first waking" and, back then, probably helped calm people's worries about the night's perils. Prolactin is also what differentiates segmented sleep, with its interval of "non-anxious wakefulness" that nearly resembles a meditative state, from the tossing-and-turning insomnia we medicate against. "Let the end of thy first sleep raise thee from thy repose: then hath the body the best temper; then hath thy soul the least encumbrance," wrote the moralist Francis Quarles.
Remarkably, then, our pattern of consolidated sleep has been a relatively recent development, another product of the industrial age, while segmented sleep was long the natural form of our slumber, having a provenance as old as humankind. (Homer even invoked the term "first sleep" in "The Odyssey.") For experts like Dr. Thomas Wehr, who conducted the experiments at the National Institute of Mental Health, some common sleep disorders may be nothing more than sleep's older, primal pattern trying to reassert itself — "breaking through," as Dr. Wehr has put it, into today's "artificial world." That theory, of course, remains to be proved. In the meantime, rather than resort to excessive medication, Americans might try to remember that though they're sleeping less, they're sleeping better and more seamlessly than humans ever have in the past. We might, on occasion, even choose to emulate our ancestors, for whom the dead of night, rather than being a source of dread, often afforded a welcome refuge from the regimen of daily life.
The Unconscious Mind: A Great Decision Maker
Benedict Carey, New York Times- 2/21/2006
Snap judgments about people and places can be remarkably accurate, and there is no substitute for simple logic and reflection in determining questions like which alarm clock or cellphone is the best value. But many more important decisions — choosing the right apartment, the optimal house, the best vacation — turn on such a bewildering swarm of facts that people often throw up their hands and put the whole thing temporarily out of mind. And new research suggests that this may be a rewarding strategy.
In a series of experiments reported last week in the journal Science, a team of Dutch psychologists found that people struggling to make complex decisions did best when they were distracted and were not able to think consciously about the choice at all. The research not only backs up the common advice to "sleep on it" when facing difficult choices, but it also suggests that the unconscious brain can actively reason as well as produce weird dreams and Freudian slips. "This is very elegant work, and like any great work, it opens up as many questions as it answers" about the unconscious, said Timothy D. Wilson, a psychologist at the University of Virginia and the author of the book "Strangers to Ourselves: Discovering the Adaptive Unconscious." He was not involved in the research.
Psychologists have known for years that people process an enormous amount of information unconsciously — for example, when they hear their names pop up in a conversation across the room that they were not consciously listening to. But the new report suggests that people take this wealth of under-the-radar information, combine it with deliberately studied facts and impressions and then make astute judgments that they would not otherwise form.
In the study, the research team, led by Ap Dijksterhuis of the University of Amsterdam, had 80 students choose among four cars based on a list of attributes for each, like age, gasoline mileage, transmission and handling. After presenting the attributes in quick succession, the researchers instructed some students to think carefully about the decision for four minutes and distracted others by asking them to solve anagrams. When the list of characteristics was four items, students were more likely to pick the best functioning vehicles if they reasoned through the decision, rather than if they were distracted. But with 12 attributes, the distracted anagram solvers tended to make wiser choices, the study found.
The unconscious brain has a far greater capacity for information than conscious working memory, the authors write, and it may be less susceptible to certain biases. "One example is people who like a house for its space but don't properly weigh in the effect of commuting distance until they're spending two hours on the train every day," said Dr. Dijksterhuis. The unconscious brain might give the commuting more weight, he said.
The researchers developed a "complexity score" for 40 products and assets based on how many of each item's attributes people took into account. Cars, computers and apartments were at the top, dresses and shirts in the middle and oven mitts and umbrellas at the bottom. Using that scale, the psychologists surveyed students who had recently bought some of those items and found that the more the buyers thought about their purchases of simple objects, the more satisfied they were. But the opposite was the case for complex purchases, where the more time spent in conscious deliberation, the less satisfied the students were.
In a survey of shoppers outside furniture and department stores, the researchers found a similar relationship between the amount of time shoppers spent thinking about simple and more involved decisions and their later satisfaction with their purchases. The research is only a stab at characterizing a process that is mostly unknown, psychologists say. For example, the studies did not take into account the effect of emotion or memory on the unconscious, both of which can sway decisions. Nor is it clear exactly which kinds of decisions are best handled by letting go. "Are we saying that an executive who has just read an important report should not think about it?" said Jonathan Schooler, a psychologist at the University of British Columbia. "The research helps us work toward an answer, but I don't think we're quite there yet."
Evidence Is Slight for Melatonin as Sleeping Aid
Nicholas Bakalar, New York Times- 2/21/2006
Although melatonin is widely used as a sleep aid, a review of the research says there is little evidence that it works, either for jet lag, shift work or sleep difficulty caused by other medical or psychiatric problems. The review, published online Feb. 9 in BMJ — Online First, analyzed 25 controlled trials that tested melatonin against placebos for various kinds of sleep disorders. The researchers performed a statistical analysis to combine the results.
In six trials reporting on the amount of time spent asleep as a proportion of time spent in bed, they found a small but clinically insignificant effect: melatonin increased the amount of time people slept by about 10 minutes for eight hours spent in bed.
In studies of those who had sleep problems caused by jet lag or shift work, the researchers found no difference at all in the effectiveness of melatonin compared to a placebo. Still, there was some good news for proponents of melatonin. The side effects it caused — most commonly headaches, dizziness, nausea and drowsiness — were no different from those caused by a placebo.
The researchers concluded that, at least with short-term use, melatonin is safe, even if it is ineffective. They stress, however, that they found very little information about long-term safety. Nina Buscemi, the lead author of the study and a research associate at the University of Alberta, made no specific treatment recommendations. "What I hope will come out of this," Dr. Buscemi said, "is for people to look at the evidence when they're making decisions about whether or not to use melatonin."
The Dilemma of Depression for Mothers-to-Be
Jane E. Brody, New York Times- 2/21/2006
Pregnancy has long been assumed to be a time of expectant joy, at least for women whose pregnancies are planned and who look forward to motherhood. And indeed, it is a happy time for most. But not all. A significant minority — 10 to 20 percent, depending on who is counting — suffer moderate to severe depression during pregnancy, which translates to 80,000 women a year in the United States. All too often the problem goes unrecognized by the women and their doctors.
Some depression symptoms — fatigue, change in appetite and lack of energy — overlap normal signs of pregnancy, prompting some women to ignore them. Others are embarrassed to mention their depressed feelings to their doctors since they're supposed to be thrilled to be pregnant. But even when pregnancy-related depression is recognized and acknowledged, women and their doctors can find themselves in a dilemma. After decades of warnings to avoid all manner of drugs, alcohol, nicotine and caffeine, pregnant women are often reluctant to take antidepressants even if their doctors will prescribe them.
Weighing the Risks
New studies examining possible effects of antidepressants on the fetus as well as the risks involved in failing to treat depression during pregnancy are likely to make decisions even harder. The decision to treat or not to treat must involve a careful assessment of known risks and benefits based on the best medical information available.
A depressed woman is more likely to be delinquent about prenatal care. She may miss doctor appointments, eat and sleep poorly, fail to take vitamins, have difficulty forming a healthy attachment to her unborn child, and experience stress that can expose the fetus to harmful levels of hormones and neurotransmitters. To alleviate depressed feelings, some women may turn to alcohol or cigarettes, which themselves can harm an unborn child.
Untreated depression during pregnancy has been linked to higher rates of miscarriage, stillbirths, premature deliveries, intrauterine growth restriction and low-birth-weight babies. Though they often catch up early in life, babies born smaller than they should be for their gestational age face higher than average rates of high blood pressure and heart disease as adults. The untreated depression can also damage a woman's relationship with her spouse and other children. The inability of a depressed person to cope well with stresses, however small, can result in undue irritability and impatience.
Finally, depression is unlikely to end once the baby is born. As Dr. Shaila Kulkarni Misri noted in her recent book, "Pregnancy Blues" (Delacorte Press, $23), "If depression goes untreated during pregnancy, it will worsen and more than likely continue postpartum." Postpartum depression not only robs a woman of the joy of having a new baby, it can seriously impair her ability to nurse and care for the infant, and it prompts some women to harm the baby.
A woman taking antidepressants before becoming pregnant may assume that the safest course is to stop the medication until the baby is born or after she stops nursing. But a study published Feb. 1 in The Journal of the American Medical Association found that such an interruption greatly increased the chance that major depression would recur during the pregnancy. Even stopping treatment only for the first 12 weeks, when the baby's organs are forming, increased the chance of a relapse, the researchers, headed by Dr. Lee S. Cohen, perinatal psychiatrist at Massachusetts General Hospital, found.
Dr. Misri emphasizes that pregnancy, "far from being protective against psychiatric illness, as many continue to believe, can actually trigger depression for the first time, exacerbate an already existing condition, or cause the relapse of a depression that had previously been under control." She calls pregnancy-related depression "an equal-opportunity illness" that can strike any woman, rich or poor, socially well-connected or isolated, previously healthy or suffering from years of recurrent depressions.
Are Antidepressants Safe?
Two new studies have raised questions about the safety of leading antidepressants during pregnancy, the selective serotonin reuptake inhibitors, or S.S.R.I.'s, like Prozac and Zoloft. One study, published in February in The Archives of Pediatric & Adolescent Medicine, examined 60 newborns who had been exposed in utero to S.S.R.I.'s. Eighteen of them showed mild to severe signs of "neonatal abstinence syndrome" — withdrawal from the drugs at birth. Symptoms included high-pitched crying, disturbed sleep, feeding difficulties, tremor and muscular stiffness that lasted a week or two. The effects were dose-related, and the drug Paxil, a longer-acting S.S.R.I., was linked to the most severe symptoms. The researchers, headed by Dr. Rachel Levinson-Castiel of the Schneider Children's Medical Center of Israel, recommended that infants exposed in utero to S.S.R.I.'s be kept in the hospital for observation for at least 48 hours or until symptoms subside.
The second study, published Feb. 9 in The New England Journal of Medicine, highlighted a rarer though more serious risk: the development of persistent pulmonary hypertension of the newborn, or P.P.H.N. With it, the baby fails to convert from fetal circulation, when oxygen and nutrients are supplied by the mother through the placenta. A baby with the disorder breathes normally but the blood supply bypasses the lungs because pressure there is too high. The researchers, headed by Christina D. Chambers of the University of California, San Diego, examined 377 women whose infants had the disorder and 836 matched control women and their healthy babies. Fourteen infants with the disorder had been exposed to S.S.R.I.'s after the 20th week of gestation, compared with six infants in the control group. This meant that exposure to an S.S.R.I. after the midpoint of pregnancy raised the chances that the baby would develop the disorder by a factor of six. An earlier study by the University of Pittsburgh found that about 1 percent of babies exposed to antidepressants in the last third of pregnancy developed serious respiratory problems.
The California researchers emphasized that the "absolute risk" that a baby exposed to S.S.R.I.'s would develop the hypertension disorder was extremely low: "about 99 percent of women exposed to one of these medications late in pregnancy will deliver an infant unaffected." Still, they urged that this risk be factored in when deciding to take an S.S.R.I. late in pregnancy. The risk has to be weighed against a possibility of a relapse of depression and postpartum depression if the drug is stopped in the third trimester .
There are, of course, other drugs to alleviate depression, and the safest are the tricyclic antidepressants. Although these drugs have more discomforting side effects, neither they nor the S.S.R.I.'s cause birth defects or lasting developmental harm to children exposed in utero, long-term studies show. These studies found no significant effect of in-utero exposure to the trycyclics S.S.R.I.'s on I.Q., language development or behavioral development among children followed to age 7.
Expert Witness: Suspect Unaware Killing Baby Wrong
Julia Glick,
Associated Press- 2/21/2006
McKINNEY, Texas -- Dena Schlosser didn't know right from wrong when she killed her 10-month-old baby by cutting off the child's arms, and she wasn't given the medical help she needed before the killing, a psychiatrist testified Tuesday at her murder trial. Schlosser, 37, was arrested in November 2004 when police found her soaked in blood, holding a knife and listening to a hymn as her baby, Margaret, known as Maggie, lay dying in her crib. Schlosser also had cut herself deeply in one shoulder.
People close to Schlosser had missed obvious signs of severe mental illness, Dr. William Reid testified. ''Everything I've seen indicates to me that she did not know what she was doing was wrong and she did not know right from wrong,'' said Reid, the final defense witness. The defense argues that Schlosser was insane when Maggie was killed and needs hospitalization. The prosecution holds that while she may have mental illness, she knew what she was doing was wrong and should be sent to prison for life.
Another psychiatrist testified Monday that Schlosser said she was commanded by God to cut Maggie's arms off, as well as her own arms, legs and head. ''What had happened did not have meaning for her like it did for others,'' said that witness, Dr. David Self.
Reid said Schlosser's husband and church were partly responsible for her not receiving the care she needed. The pastor of Water of Life Church in Plano, which the Schlosser family attended several times a week, has testified that God is the only cure for mental illness. Reid also questioned why a hospital had earlier released Schlosser less than 24 hours after she abandoned Maggie by running away from the family's apartment. Police found her two miles away. ''Ms. Schlosser was kept from adequate treatment, both in terms of getting and taking her medication, and seeing doctors and psychiatrists, both when she needed it and I believe when she wanted it,'' Reid testified.
Schlosser's husband, John, has testified that he thought she was getting better and it didn't occur to him to get treatment for her. Schlosser was diagnosed with postpartum psychosis not long after Maggie was born and with manic depression after Maggie's death. She had stopped taking anti-psychotic medication about four months before Maggie was killed.
Heart Risks With Stimulant Use? Maybe. Worry? For Some.
Benedict Carey, New York Times- 2/21/2006
Psychiatrists say they have been getting panicked phone calls from patients worried by a government advisory panel's recommendation this month that drugs for attention-deficit disorder carry a prominent warning about heart risks. The calls are coming not just from parents of children who take the drugs but from adult users, who the panel warned might be at the highest risk for heart problems. "Every single adult patient I saw today, the first thing out of their mouth was, 'Am I going to drop dead on this?' Every single one of them," said Dr. Timothy Wilens, a psychiatrist at Massachusetts General Hospital in Boston. Dr. James McGough, a professor of clinical psychiatry at the University of California, Los Angeles, said he had received several calls from parents "who were very upset and nervous" about potential risks.
The panel, convened to consider ways the drugs' effects on the heart could be investigated, made its recommendation on Feb. 9 based on a Food and Drug Administration analysis of more than 300 people who died while they were taking stimulant medications. The agency concluded that in 25 of the cases — 19 children and 6 adults — the stimulant appeared to be strongly related to the deaths, many apparently from heart problems. The Food and Drug Administration will soon decide whether to accept the advisory panel's advice and require a strong warning on the drugs' labels.
Doctors who treat adults and children with stimulants like Ritalin and Adderall say the risk is remote, given that an estimated 2.5 million children and 1.5 million adults are taking the medications, and a handful of them will die suddenly each year, whether taking drugs or not. But psychiatrists and cardiologists say that people with high blood pressure, heart murmurs or other cardiovascular problems should talk to their doctors to determine whether they need to be more closely monitored or should taper off the drugs altogether. "Ideally, doctors should be screening patients for these things up front, before prescribing the drugs," said Dr. James Waxmonsky, a psychiatrist at the University at Buffalo, part of the State University of New York.
Some panel members expressed concerns about children with structural heart abnormalities who might be given stimulants. Perhaps the most common abnormality is hypertrophic obstructive cardiomyopathy, a thickening of the muscle that can cause a blockage — and death — when under stress. Such problems are often not diagnosed before drug treatment begins, but a good pediatrician who is aware a child is being considered for stimulant treatment will often pick up a soft heart murmur that might reflect an abnormality, said Dr. Steven Nissen, chief of cardiology at the Cleveland Clinic and a panel member. "This seemingly small step could save a life," he said.
Norine Eaton, 50, of Williamsville, N.Y., who has been on stimulants for attention problems for six years and who has two teenage sons on the medications, said she read about the panel's warning in a newspaper article. "If I had any family history of heart disease, I would absolutely have stood up and called my doctor," she said in a telephone interview, "but I have not noticed any heart problems in myself or my sons."
The biggest worry for adults is high blood pressure. Stimulants usually prompt slight increases in heart rate and raise blood pressure, and even these changes can increase the risk of heart problems in someone who is vulnerable, Dr. Nissen said. Adults with hypertension who are considering the drugs should have their blood pressure stabilized first, doctors say. "A smoker with high cholesterol and a family history of heart disease: that's a person I would be very concerned about taking stimulants," Dr. Nissen said.
Lew Mills, 49, a therapist in San Francisco who takes a stimulant for attention-deficit disorder, said he first worried about the drugs' effect about a year and a half ago, when he was moving after a divorce and felt overwhelmed by stress. He said he went to a doctor and found that his blood pressure was elevated. "I was concerned that the medicine was adding to the blood pressure problem," he said. But Dr. Mills said that he stayed on the stimulants and resumed exercising, and that once the divorce was complete, his blood pressure soon returned to normal.
Dr. Wilens of Massachusetts General has just completed a study of 13 men and women, ages 20 to 55, being treated for high blood pressure who were also taking Adderall, a strong stimulant. The patients spent six weeks on Adderall and two weeks off, while doctors monitored their blood pressure. Two of them had mild increases in blood pressure, one while taking the stimulant and the other while not. "It's a small study, but we found the same rate of symptoms" whether people were on the stimulants or not, said Dr. Wilens, who consults widely with drug makers.
Where Sex Meets Crystal Meth
Andrew Jacobs, New York Times- 2/21/2006
Terry Evans turned on the computer, punched in his password and set out on the prowl. It was a Saturday night, and with more than 900 men logged onto the sex site Adam4Adam.com, he had no problem finding his quarry: a 25-year-old man nicknamed "Bronxplayer" who was looking to "party-n-play," cyberspace lingo for engaging in a sexual encounter enhanced with crystal methamphetamine. "Wanna play?" Mr. Evans wrote. "Let's talk and make it happen." But Mr. Evans, an outreach worker for Positive Health Project, an advocacy group that strives to reduce the spread of H.I.V., was not looking to do drugs. He was trying to lure Bronxplayer into his support group for black and Latino men whose lives have been hijacked by crystal meth, an illegal stimulant known to melt away inhibitions. After a few minutes of back-and-forth banter, Mr. Evans revealed his hand and the man begged off. "Not everyone's happy with the bait-and-switch, but there aren't many ways to get people's attention," Mr. Evans said as he scrolled down, searching for his next prospect. "Sometimes a guy will get hostile, but then he'll come back later to ask me questions." But he has succeeded, via the Internet, in persuading some men to join his group.
Mr. Evans, a recovering crystal meth addict, is among a handful of drug abuse counselors trying to stanch the powerful amphetamine's increasing popularity among black and Hispanic gay men, a trend that has alarmed city health officials who link the drug to the spread of H.I.V. and other sexually-transmitted diseases. Over the past decade, as crystal meth has made its way into New York, it has led to a steadily rising number of arrests, hospitalizations and health problems. A recent study of 19,000 men in Los Angles showed that new H.I.V. infections were three times higher among methamphetamine users than among nonusers. Further, drug abuse experts and some law enforcement officials in New York say they fear that the drug could follow the trajectory of another stimulant that spread violent crime, death and the dissolution of communities across New York City a generation ago: crack cocaine. "From our point of view," said Dr. Ronald O. Valdiserri, deputy director of the National Center for H.I.V., S.T.D. and TB Prevention at the Centers for Disease Control, "crystal meth is a very serious public health issue." Like AIDS itself, which was once largely confined to the world of white gay men, the abuse of crystal meth is beginning to find favor among those who live far from Chelsea.
In a recent New York University study of 312 crystal meth users, 32 percent were white, 23 percent were Latino and 22 percent were black. At a methamphetamine support group run by Gay Men's Health Crisis, blacks now make up more than 10 percent of the participants, up from fewer than two percent in 2001. Dr. Perry N. Halkitis, an applied psychologist at New York University who led the study, said that "the problem has been brewing for the past year, but now it's beginning to boil."
Dr. Richard Rawson, a researcher at University of California, Los Angeles, who has been studying the drug for two decades. says the appeal of meth is even greater than crack: methamphetamine, which can be smoked, snorted or injected, is just as cheap but packs a more potent and prolonged high. And unlike crack cocaine, whose raw materials are imported from South America, methamphetamine can be made locally from widely available ingredients. "From a pure marketing point of view, meth really gives you a bigger bang for your buck," Dr. Rawson said.
The drug's route from gay enclaves to a heterosexual population, experts say, could come about via gay men of color, especially those who lead double sex lives, similar to the path of AIDS over the last decade.
Just as homosexuality is more stigmatized among some minority groups, so, too, is the use of a drug associated with gay sex. And just as AIDS is now firmly entrenched among black and Latinos — black women make up 34 percent of all new cases — crystal meth abuse may soon follow the same course.
Although meth's distribution remains limited in the city, some drug abuse experts say it is only a matter of time before it makes its way into communities that were once ravaged by crack. "Ten years ago, if I had told people in Iowa that they would be coping with a meth crisis in Des Moines, they would have laughed at me," Dr. Rawson said. "Now they're drowning in meth. The Hudson River is not going to stop it from coming to New York."
Keith, a 39-year-old office assistant and a client at the AIDS organization Harlem United, took his first drag on a crystal meth pipe last April at a sex party where almost everyone was black. The next morning, he says he was hooked. Ashamed, depressed and on the brink of homelessness, he would not give his last name. "It used to be the only people I knew who did crystal hung out with Caucasians," he said. "Now there are plenty of black guys doing it on their own."
Public health campaigns that take aim at meth use among minorities are just getting under way, although it is widely acknowledged that earlier efforts that targeted recreational drug users in Manhattan's gay neighborhoods will not necessarily work in Washington Heights or the Bronx.
Donald Suggs, outreach coordinator at Harlem United, said such campaigns, which relied on scare tactics, have helped stigmatized crystal meth among whites but have made its use among black and Latino men more secretive. "It might be O.K. to talk about party drugs in Chelsea, but there's very little room for discussion in the black and Latino community, where the stigma is much stronger," he said. With money provided by the New York City Department of Health and Mental Hygiene, the organization has been placing Spanish-language ads on the Internet, and it is preparing to send volunteers into bars and clubs where Latino men congregate. Organizations like Harlem United are starting support groups that focus on black men.
Mr. Evans has gone one step further. In addition to the Saturday afternoon drop-in center he runs near the Port Authority Bus Terminal, Mr. Evans heads out after midnight each weekend to private sex parties where crystal meth use is the norm. It can be an awkward job, one that often requires Mr. Evans to strip down to his underwear, the better to blend in. Sometimes he does condom demonstrations; other times he just answers questions about meth. Often, he is just ignored. "I don't judge people," said Mr. Evans, 32, who said he has been sober for three years. "I know I can't stop them from doing drugs, but at least I can make sure they're safe when they're doing them."
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