Noteworthy News Articles on Mental Health Topics, September 1-12, 2006



Some Co-Eds Evicted for Suicide Attempts
Associated Press, 9/1/2006

NEW YORK -- A depressed Hunter College student who swallowed handfuls of Tylenol, then saved her own life by calling 911, was in for a surprise when she returned to her dorm room after the ordeal. The lock had been changed on the door. She was being expelled from the residence, the school informed her, because she violated her housing contract by attempting suicide. The 19-year-old was allowed to retrieve her belongings in the presence of a security guard.
     Policies barring potentially suicidal students from campus dorms have popped up across the country in recent years as colleges have struggled to decide how to best curb an estimated 1,100 suicides a year. But just as quickly, some of those rules have come under attack. Hunter College announced last week that it was abandoning its 3-year-old suicide policy as part of a legal settlement with the student, who sued claiming her 2004 ouster from the dorms violated federal law protecting disabled people from discrimination. The school, part of the City University of New York system, also agreed to pay her $65,000. Hunter spokeswoman Meredith Halpern said the college may still consider temporary removal from residence halls a future option for troubled students, but such evictions will no longer be automatic.
     Karen Bower, a senior attorney with the Bazelon Center for Mental Health Law, which helped litigate the case, said she hoped the settlement would prompt other schools to rethink their policies. ''The real danger of these policies is that they discourage students from getting the help that they really need,'' Bower said. Young students might be scared away from speaking out about suicidal thoughts if they believed it would mean an abrupt eviction, she said.
     Similar lawsuits are already in the works. George Washington University is being sued by a former student who was barred from campus and threatened with expulsion after checking himself in to a hospital for depression. The student, Jordan Nott, said he never tried to kill himself, but had been thinking about it because of the suicide death of a close friend, also a George Washington student. The Bazelon Center is also representing a student at a Connecticut boarding school who was placed on a mandatory leave after seeking treatment for depression.
     Schools and the courts have grappled with the issue of depressed students for years. The prevailing legal theory had long been that adult students were responsible for their own behavior, but that philosophy was undermined by a pair of court rulings involving the Massachusetts Institute of Technology and Ferrum College in Virginia. In both cases, judges ruled prior to out-of-court settlements that colleges might have a duty to prevent suicide if the risk was foreseeable. The cases prompted some schools to be more aggressive about sending troubled pupils home.
     George Washington University spokeswoman Tracy Schario said the school's treatment of Nott wasn't an attempt to limit legal liability. ''The intention was to protect a life,'' she said. She added that Nott's case was an unusual one. More than 200 students seek help for depression or suicidal thoughts each year at George Washington, and a majority are not asked to leave. ''It is always a case-by-case assessment of what is best for that particular student,'' Schario said. She acknowledged, however, that the university's current practice of using its disciplinary system to handle some students with psychological problems ''does appear insensitive'' and said alternate procedures were being considered.
     Joanna Locke of the Jed Foundation, a program aimed at preventing college suicides, said schools should have enough flexibility in their mandatory-leave policies to allow for individual circumstances. Some schools, she said, may feel a need to send a student home if they lack the resources to offer help, or if their behavior has become disruptive. ''There is no right answer, except that (the decision) should be made carefully, and the decision should be made kindly,'' she said.
     Colleges may wind up in court no matter which approach they take. A jury in Pennsylvania decided Thursday that Allegheny College was not liable for the 2002 suicide of a student who was allowed to stay in class for years while he battled severe depression. Lawyers for the parents of Charles Mahoney, 20, said the school should have contacted his family and put him on a mandatory leave of absence. The jury also cleared a college counselor and consulting psychiatrist of any liability in the death. Allegheny said in a written statement after the verdict that the case was ''a tragedy for all involved.''



Boredom in the West Fuels Binge Drinking
Timothy Egan, New York Times- 9/2/2006

CODY, Wyo. — Barely five people per square mile live on the high, wind-raked ground of Wyoming; the entire state is a small town with long streets, as they say. The open space means room to roam and a sense of frontier freedom. It also means that on any given night, an unusually high percentage of young people here are drinking alcohol until they vomit, pass out or do something that lands them in jail or nearly gets them killed. “Had a kid, drunk, flipped his car going 80 miles an hour, and that killed him; and another kid, drunk, smashed his boat up against the rock just a couple months ago, killing two; and then there was this beating after a kegger — they clubbed this kid to death,” said Scott Steward, the sheriff here in Park County, recounting casualties that followed long nights of hard drinking by high school students.
      A federal government survey recently confirmed what residents of Wyoming, Montana and the Dakotas already knew: people there drink to excess, at very early ages, well above the national average. The survey, conducted over three years by the federal Substance Abuse and Mental Health Services Administration, said south-central Wyoming led the nation with the highest rate of alcohol abuse by people age 12 and older. In Albany and Carbon counties, more than 30 percent of people under age 20 binge drink — 50 percent above the national average. In examining behavior in 340 regions of the country, the survey found that 7 of the top 10 areas for under-age binge drinking — defined as five or more drinks at a time — were in Wyoming, Montana and North and South Dakota.
      At the other end of the scale, some of the lowest areas for under-age binge drinking were in the nation’s most densely packed cities — parts of Washington, D.C., Detroit and Los Angeles. An earlier federal study found that rural youths ages 12 and 13 were twice as likely as urban youths to abuse alcohol.
     With methamphetamine ravaging small towns, Wyoming and other rural states have also been fighting a persistent drug problem. And while it may be a mystery to some why the least-populated part of the country leads the nation in the percentage of young people drinking to excess, it is no surprise to many people in Wyoming or Montana. Teenagers, police officers and counselors offer the same reason: the boredom of the big empty.
     “After living in the city, it’s obvious to me that kids just get bored here,” said Karen Grimm, who moved here from Seattle 10 years ago. “There is this feeling of isolation, especially in the wintertime.” Ms. Grimm’s daughter, Risa, a freshman at Cody High School, estimated that about half the students at her school regularly drank alcohol. Friday nights in Cody can mean football and a movie, but after 11 o’clock, with nothing else to do, teenagers say they head to somebody’s ranch or into the mountains toward Yellowstone National Park to drink. “I think so many kids drink because the state is barren, desolate and boring to some people, and there is not really anything to do,” said Isaiah Spigner, a recent high school graduate from Cheyenne who is headed for the University of Wyoming.
     But geography alone does not fully explain why there is such a drinking problem among young people. “We’re a frontier culture, and people say, ‘I work hard and I’ll be damned if I’m not going to have a beer or two on the way home,’ ” said Rosie Buzzas, a Montana state legislator who also oversees alcohol counseling services in the western part of the state. “There’s a church, a school, and 10 bars in every town.”
     It has never been hard for young people to get alcohol in Montana, Ms. Buzzas said, in part because many parents think it is a rite of passage for children to drink. “There are plenty of adults who tell me, ‘What’s the big deal? Kids just have to learn to drink,’ ” she said. Not long ago, three children, ages 9, 11 and 12, died of alcohol poisoning in an isolated town in Montana, but the deaths did little to change attitudes, she said. “Something like that has a sobering effect, but it doesn’t last,” Ms. Buzzas said. “Kids aren’t listening to what we say; they’re watching what we do.”
     This year, Montana made it an offense to drink while driving, one of the last states to do so. But there was heavy opposition. Wyoming still allows passengers in a vehicle to drink, as long as the driver is not holding the container. A bill that would have made that illegal was defeated. A minor in possession of alcohol can be fined, but will typically not lose a driver’s license for a first offense.
     At the nightly rodeo in Cody, beer signs are ubiquitous, and on the town’s main commercial strip, a giant beer banner welcomes tourists.
     Some say a legacy of forcing children to grow up early in the empty West may contribute to the problem. From 1854 to 1929, about 200,000 orphan children arrived by train from the East and were offered to families for adoption. The orphan trains, as they were called, left a psychic print, some counselors and historians say. “The idea that life is harsh and you learn it at an early age is part of our history,” said Ralph Boerner, who counsels alcoholics of all ages in Butte, Mont. “I asked everyone in my group the other night when they started drinking,” Mr. Boerner said. “The latest was 15. The earliest was age 5.” Binge drinking, he said, is a way for young people to prove themselves in the West. “You get validation by saying, ‘Boy, did I get hammered,’ ” Mr. Boerner said.
     Here in Park County, where the sheriff has four deputies to patrol an area much larger than Connecticut, parents can be as much a problem as their children, Sheriff Steward said. “We’ll bust a party where every kid is drinking, call the parents, and they’re mad at us for getting them out of bed,” he said.
     The recent surveys show that girls, starting in middle school, are much more likely to drink than earlier studies found. In part, some say, that is because of flavored drinks that hide the taste of alcohol, so-called alcopops. “People who want to get wasted but don’t like the taste of beer, they’re drinking something like Mike’s Hard Lemonade,” said Sienna White, a sophomore at Cody High School who says she does not drink. Sienna estimated that half the students at her school drank. “Living in a cowboy town,” she said, “it’s really hard to find a party without drinking.”
     But Sienna and other students are part of a program at the school where students pledge not to drink or take drugs. The program has had a fair amount of success drawing athletes and cheerleaders, offering positive role models, school officials say. Sheriff Steward, however, is skeptical. Like other adults who now preach against what they once practiced, the sheriff remembers his own high school days of beer. “Obviously we’ve all been there,” said Sheriff Steward, who went to Cody High School 20 years ago, and said 60 to 65 percent of his fellow students drank. “The problem, then and now, was that there was nothing to do in Cody after a certain time.”



Autism Risk Rises With Age Of Father
Shankar Vedantam, Washington Post- 9/4/2006

Children born to fathers of advancing age are at significantly higher risk of developing autism compared with children born to younger fathers, according a comprehensive study published yesterday that offers surprising new insight into one of the most feared disorders of the brain. The finding comes at a time of great controversy over autism in the United States, as a recent surge in diagnoses has fueled speculations about various possible causes of the disorder. For scientists, both the origins of and potential treatments for the disorder remain a mystery.
     With every decade of advancing age starting with men in their teens and twenties, the new study found, older fathers pose a growing risk to their children when it comes to autism -- unhappy evidence that the medical risks associated with late parenthood are not just the province of older mothers, as much previous research has suggested.
     Of special concern is the finding that the risk for autism not only increases with paternal age but also appears to accelerate. When fathers are in their thirties, children have about 1 1/2 times the risk of developing autism of children of fathers in their teens and twenties. Compared with the offspring of the youngest fathers, children of fathers in their forties have more than five times the risk of developing autism, and children of fathers in their fifties have more than nine times the risk.
     Autism is a developmental disorder that is often characterized by social and verbal problems. It becomes manifest early in childhood and is associated with learning deficits and other problems. Many cases are diagnosed shortly after children enter school, where differences among kids become too obvious to ignore. A wide variety of interventions are increasingly available for autistic children, and early behavioral interventions have been said to help with outcomes and functioning. There is, however, no cure for the disorder, and scientists are not sure about its biological roots.
     The new study suggests an intriguing new avenue for research, because it suggests that genetic traits passed along by fathers, as opposed to mothers, may play some significant role in creating susceptibility to autism. Several other studies have suggested that older parents of both sexes are at greater risk of having children with developmental disorders. Three earlier studies looking at the relationship between paternal age and autism have produced mixed results; the new study is the most rigorous analysis conducted to date.
     The study was based on an enormous sample of 17-year-olds -- nearly all the men and three-quarters of the women of that age found over a six-year period in Israel, as they came of draft age. In all, data from 378,891 men and women were analyzed. Since all Israeli citizens have a unique identification number, and the draft process routinely calls for listing the identification numbers of parents, researchers were able to develop a large-scale map that allowed them to determine the age of both parents for 132,271 draft candidates. They then compared that information against medical evaluations conducted by the draft board for autism and other disorders for those same candidates.
     Abraham Reichenberg at the Mount Sinai School of Medicine in New York, along with several others at research institutions in the United States and Israel, found a significant relationship between paternal age and autism, even after accounting for other factors, such as mothers' age and socioeconomic status. Children of fathers who were 15 to 29 years of age had a risk of about 6 in 10,000 of developing autism. Children of fathers in their thirties had a risk of 9 in 10,000. Children of fathers in their forties had a risk of 32 in 10,000, and children of fathers who were older than 50 had a risk of 52 in 10,000.
     In a paper published yesterday in the Archives of General Psychiatry, the researchers said that the number of cases of autism among families with the oldest dads was too small to lead to definitive conclusions about that group, but there was little doubt about the overall trend. The only question they said is whether the risk accumulates at an accelerating rate with advancing paternal age, as the numbers in this study suggest.
      Scientists in the United States are increasingly thinking about autism in terms of a spectrum of problems, which is why they have coined the term "autism spectrum disorders." The federal government estimates that the risk for autism spectrum disorders in the United States is around 3.4 for every 1,000 children between the ages of 3 and 10. Whether that number is on the rise or not has been hotly contested; better outreach and diagnostic efforts may be finding children who would previously have gone undetected. Enduring disparities in access to health care complicate the picture. While the medical complexities of autism are present in Israel, concern over disparities is mitigated to some extent because Israel has universal health insurance, which guarantees equal access to care.
     The Israeli military draft board's medical diagnostic system does not differentiate among conditions on the autism spectrum, which includes autism, Asperger's syndrome, Rett syndrome and what are known as pervasive developmental disorders. Autistic people can be unresponsive in social situations, or focused intently on a single task or object for long periods. While some parents recognize that their babies seem different from a very young age, U.S. government researchers also say that sometimes engaging and babbling babies can suddenly turn "silent, withdrawn, self-abusive, or indifferent to social overtures."
     In recent years, concern and controversy have grown -- despite a lack of conclusive evidence -- that mercury in children's vaccines produces toxicity that leads to autism. While the link between older fathers and autistic children is likely to be genetic, the researchers who conducted the new study also acknowledged the possibility that unknown other factors could simultaneously be causing men to delay parenthood while independently increasing autism rates.



Patient Admits Killing Psychiatrist, Police Say
Dan Morse, Washington Post- 9/5/2006

A 19-year-old North Potomac man told detectives that he killed a psychiatrist with his fists during a hastily arranged appointment Sunday in which they discussed the man's treatment for schizophrenia, according to Montgomery County police. Police charged the patient, Vitali A. Davydov, with first-degree murder yesterday in the killing of Wayne S. Fenton, 53, a prominent psychiatrist who served as associate director of the National Institute of Mental Health. He maintained a private practice in Bethesda, treating severely mentally ill patients mostly on weekday evenings and weekends.
      Near Fenton's house yesterday on Parkedge Drive in Rockville, small groups of neighbors gathered and remembered their friend. "This is a tremendous loss for his family and his colleagues and his patients," said Roger Rothman, who lives next door. He said neighbors liked walking by Fenton's house and listening to him sing as he played old-time Southern blues on his guitar. He played songs from the greats, like Robert Johnson. "He was very good," Rothman said. Tim Moran, Fenton's brother-in-law, said Fenton was trying to help out another doctor in treating Davydov. "This young man was not a regular patient of his," Moran said. "He was having an episode of some sort."
     Fenton developed research programs at NIMH that were designed to help schizophrenics deal with day-to-day life. William T. Carpenter, a colleague of Fenton's who knew him for two decades, said Fenton worked to make changes at Chestnut Lodge, a now-closed psychiatric hospital in Rockville, when he was a director there. "His studies clarified the unmeet needs for schizophrenia," said Carpenter, director of the Maryland Psychiatric Research Center at the University of Maryland School of Medicine in Baltimore. "His leadership at the lodge helped transform that institution into a modern, therapeutic facility." A woman who answered the door at Davydov's home in the Dufief Mill Estates development in North Potomac said the family would not comment. "We're just in shock, and we don't know how it happened," she said.
     Barry H. Helfand, a lawyer who represents Davydov, said his client is "a very, very sick young man who suffers from really serious mental illnesses." Helfand represented Davydov after a 2005 arrest for possession of marijuana and drug paraphernalia. Prosecutors dropped that case in June after Helfand told them a psychiatrist had concluded that Davydov was "incapable of coming to court." Davydov is a 2005 graduate of Wootton High School in Rockville, where he and his twin brother tried out for junior varsity ice hockey. "They played the game a little rough, but nothing out of the ordinary," said David Evans, the varsity head coach. "They were hard-nosed kids."
     Vitali Davydov saw Fenton on Saturday and had an appointment scheduled for the following week, according to a charging document prepared by Montgomery County Detective Patrick J. McNerney. The document says that after the reading of his rights, Davydov "elected to make a statement of admission to the crime." "Davydov told his father . . . that he needed to speak with Dr. Fenton [Sunday] about his continuing to take medications for his schizophrenia/bi-polar disorder," McNerney wrote. "According to the suspect's father, discussions with the suspect about his need to take his medications caused an angry reaction from the suspect." Fenton agreed to see Davydov at 4 p.m. at his office on Old Georgetown Road in Bethesda. Davydov's father, Joseph, spoke with Fenton when the father and son arrived at the psychiatrist's office. Fenton told the father "that he was going to encourage Davydov that it was important to take his medication," McNerney wrote. "Additionally, he said that if given the chance he would suggest that Davydov accept an injection of the medication rather than take it orally."
     It was not clear what medication Davydov was being prescribed or whether he stopped taking it. "During this meeting, Davydov became agitated and beat Dr. Fenton with his fists," McNerney wrote. "When he left the office Dr. Fenton was on the ground bleeding from the face." When Joseph Davydov returned to the doctor's office to pick up his son, he found him outside the building. The father called 911 after noticing blood on his son's hands, pants and shirt, police said. Paramedics found Fenton lying unresponsive inside a rear office in the private practice medical building. He was declared dead at the scene.
     Vitali Davydov's work number, which is in his charging documents, corresponds to American Pool Enterprises Inc., an Owings Mills, Md.-based company that trains lifeguards who are stationed at thousands of pools across the country. A man who answered the phone at the company yesterday said Davydov has been employed there for about two years. Officials at the company declined to comment further.
     The Davydov twins last year sought restraining orders against two brothers after a fight in Gaithersburg, according to Freddy Garcia, who went to school with the twins and was one of the men involved in the fight. Garcia, 19, of Gaithersburg, said he was not surprised to hear of the arrest of Vitali Davydov, a former friend with whom he had a falling out after the fight. Garcia said Davydov had a volatile temper that worsened during his last couple of years in high school. "It's sad," Garcia said yesterday during an interview at his home. "He was doing so good. He was a bright kid. He was going to college."



Suspect Wasn't Violent, Father Says
Ernesto Londorio, Washnigton Post- 9/6/2006

The 19-year-old North Potomac man accused of fatally beating a prominent doctor had been under psychiatric care for about six months but had not acted violently before, his father said yesterday. Albert Davydov said his family has "huge gratitude" for slain psychiatrist Wayne S. Fenton, who had agreed to treat his son, Vitali. Fenton went "above and beyond what he was supposed to do," Davydov said, adding that he wished there was something he could do to help the psychiatrist's mourning family.
     Vitali A. Davydov is charged with first-degree murder in the killing of Fenton, 53, who was beaten to death Sunday during a hastily arranged appointment at which he tried to persuade the teenager to take his medication for schizophrenia. The teenager, dressed in a green prison jumpsuit, appeared yesterday via closed-circuit camera from the county's main jail before Montgomery County District Court Judge Gary L. Crawford, who ordered Davydov held without bond. Toward the end of the bond hearing, while talking to his attorney over the phone, Vitali Davydov was overheard saying, "My father did it." Barry Helfand, the teenager's attorney, dismissed that claim. He said his client is severely mentally ill and is "unable to appreciate where he is and what's going on."
    Authorities have provided few details about what might have triggered the assault. Douglas Olson, 64, who lives near the crime scene, said Albert Davydov, to whom he spoke at length while the two waited to give statements to police, told him that his son had irrational delusions of being raped. Helfand confirmed last night that the threat of rape "has been one of his delusions" and that Davydov brought it up after being arrested. Albert Davydov and his wife, Natalia, sat quietly in the front row of the courtroom.
     Helfand agreed with prosecutors that Davydov needs to be screened by mental health experts. He will likely be evaluated at Clifton T. Perkins Hospital Center, a state facility in Jessup where inmates are examined to determine whether they are competent to stand trial. That could take a few weeks. If Davydov is found competent to stand trial, Helfand said, he intends to enter a plea of not criminally responsible due to mental illness. Helfand said he is also assessing the possibility of finding a private psychiatric facility where Davydov could be held while he is evaluated. Helfand said the county jail might not be the most suitable place to provide Davydov with the treatment he needs.
      Assistant State's Attorney Constantine Lizas said Montgomery prosecutors would oppose that option because releasing Davydov from jail would pose a threat to the community.Davydov allegedly told detectives that he killed Fenton on Sunday afternoon by beating him with his fists at the doctor's office in Bethesda. Police said Davydov had argued with his father over the medication he had been prescribed for what police described as "schizophrenia/bipolar disorder" in a charging document. Albert Davydov said yesterday that his son had seen "quite a few" psychiatrists in recent months but had not behaved aggressively.
     Vitali Davydov was charged in December with possession of marijuana and carrying a concealed dangerous weapon after a traffic stop in Montgomery Village. Those charges were dropped.

SHERRYBABY
Written and directed by Laurie Collyer; director of photography, Russell Lee Fine; edited by Curtiss Clayton and Joe Landauer; music by Jack Livesey; production designer, Stephen Beatrice; produced by Marc Turtletaub and Lemore Syvan; released by IFC Films. Running time: 96 minutes. This film is not rated.
WITH: Maggie Gyllenhaal (Sherry Swanson), Brad William Henke (Bobby Swanson), Giancarlo Esposito (Parole Officer Hernandez), Sam Bottoms (Bob Swanson Sr.), Bridget Barkan (Lynette Swanson), Ryan Simpkins (Alexis Parks), Kate Burton (Marcia Swanson), Rio Hackford (Andy Kelly) and Danny Trejo (Dean Walker).



Slamming the Door on Problem Gamblers
Crystal Yednak, Chicago Tribune- 9/8/2006

After Linda Ruder sold her house, cashed out her pension and lost all the money playing slot machines at Illinois casinos, her children staged an intervention and persuaded her to sign up for a state program in which she essentially banned herself from entering the state's casinos. Despite placing herself on the state's "self-exclusion" list last year, Ruder, 67, returned to the casinos during a relapse and lost another $35,000. "I'm not blaming the casino," said Ruder, who came out of retirement to work as a nurse to pay off her debts. "It was my own doing, but if they would check people's IDs when they went in, then people who had self-excluded couldn't get back in and that would definitely save us from relapses."
     In a step that could lead to carding all gamblers, the Illinois Gaming Board has begun to demand identification of all players who appear to be under the age of 30. If their names appear on the state list, they will be turned over to local police for trespassing. If the new procedure keeps problem gamblers from the under-30 set out of casinos, Illinois Gaming Board Chairman Aaron Jaffe said, the board may expand it to all age groups.
     There are now nearly 3,800 people on the self-exclusion list. Since the carding policy was enacted Aug. 15, Illinois casinos have arrested at least five people after the new ID checks showed they were on the list, Gaming Board officials said. At least another 16 people have been arrested after casino employees learned through other ways that they were on the list. "This should not be seen as a last step, this is merely a first step," Jaffe said. "It might be that everyone in the state is carded," he said.
     Since 2002, problem gamblers in Illinois have been able to sign themselves up for the self-exclusion program, adding their name and photo to a database that identifies individuals who should not be allowed onboard. But, if a casino employee did not recognize the problem gambler, or the person avoided transactions or jackpots that may require an ID, no one was likely to know the person had made an illicit visit. As Ruder's story illustrates, gamblers who wanted to get around the system found ways to do so. She steered clear of situations where she might be carded and slot machines with high jackpots that would require her to show an ID in order to collect her winnings.
     But the gaming industry says carding everyone who walks in the door isn't the answer. Gamblers struggling with addiction must also take responsibility and seek out the help they need, said Tom Swoik, executive director of the Illinois Casino Gaming Association. "If somebody comes on the boat every day for 300 days, we can arrest them 300 times, but that doesn't help them. It's the next step they need," he said. Carding everyone would also lead to long lines and force players to casinos over the borders where rules are more relaxed, Swoik said.
     Indiana, Iowa and Wisconsin don't card all players upon entry. Missouri requires everyone to have a player's card to enter, and patrons must show their ID to obtain a player's card. Swoik said some casinos had already been carding those under 30 on their own, but the new policies make the rules uniform across the state. Besides the new carding effort, the casinos sent a letter out to all individuals on the self-exclusion list reminding them of the possibility of arrest if they try to enter a casino. Swoik said people often don't want to present identification when they enter casinos. They either prefer the anonymity or have privacy concerns, he said.
     As for the next step in helping problem gamblers, Michael W. Crider, general manager of Harrah's Metropolis Casino, said the focus should be on linking them with clinical assistance. Concerns about problem gamblers must also be balanced with concerns for people who gamble responsibly, he said. "This is a legal choice, people have a right to do this activity," Crider said.
     In Missouri, when people on the self-exclusion list try to enter, their players' cards are flagged and they are arrested, said Melissa Stephens, problem gambling program administrator for the Missouri Gaming Commission. Stephens said the threat of arrest often keeps some people away.
      Indiana has discussed the new carding procedures being instituted in Illinois, said Ernest Yelton, executive director of the Indiana Gaming Commission. But Yelton said he doesn't foresee the commission following suit.

“She was in as dark and low a place as you can ever imagine a person living,” said Don Knight, her husband. So Ms. Knight drove to a drugstore in her hometown of Columbus, Ga., bought two large bottles of extra-strength Excedrin and two boxes of sleeping pills. She said she swallowed as many of the pills as she could before she passed out.

Katherine V. Coram, another depression sufferer with a history of attempted suicide, was in relatively better shape that same summer. She had managed to cling to a job at the National Archives in Washington, where an understanding boss gave her a light workload. But Ms. Coram felt defeated. Her three years in a clinical trial to see if an implanted nerve stimulator could control her illness had ended with hellish results.

“I was hospitalized three times in the year after I got it for anxiety, panic and other problems — after having gone 15 years without hospitalization,” said Ms. Coram, who lives alone in Silver Spring, Md. “Once I even hit a stranger in a restaurant after I got mad. It was totally out of character for me.”

The summer of 2004 was also trying for Cyberonics, a small Houston company that made Ms. Coram’s stimulator, and Robert P. Cummins, known as Skip, the company’s combative chief executive. A Food and Drug Administration panel recommended in June that the agency approve the device — a pocket-watch-sized generator implanted in the chest that transmits electronic pulses to a major nerve pathway in the neck — for treating the most intractable forms of depression. But about two months later, the F.D.A. ignored its own panel’s recommendation and decided to withhold approval after weighing criticisms from groups opposed to the controversial treatment.

Since 2004, Ms. Knight and Ms. Coram have continued their struggles with depression, their fates intersecting with Cyberonics’ own battles with the F.D.A. and insurers, as well as medical skeptics and public interest groups who argue that the company is peddling false hopes built on a still unproved technology.

The struggle over the future of the $15,000 device, which costs another $10,000 or more to implant, is being played out against that most tender of landscapes: the human psyche and the unpredictable and poorly mapped fault lines that cause depression and separate people from themselves and the world around them.

IT is a very promising avenue of research, and the long-term data they are pushing are encouraging,” said Dr. Christopher Gorton, chief medical officer of APS Healthcare, a consulting firm that was hired by the state of South Carolina to review Cyberonics’ research results. “But people have a legitimate need to be cautious. Even the sponsors admit they don’t know exactly how it works. The psychiatric literature is full of people clutching at straws.”

Some 21 million American adults suffer from depression, according to the National Institute of Mental Health, a federal research agency. While doctors as far back as the Renaissance speculated that mood disorders had medical roots, it was not until the end of the 19th century that such views were widely accepted. Since then, mental health care has seen innovations in talk therapy, electroshock, surgical procedures, drugs and, most recently, implanted devices.

Along the way, there have been notorious examples of misplaced medical enthusiasm, including adoption of lobotomies to treat depression. Currently, critics complain about frequent misuse of electroshock therapy and the virtually unregulated mixing of potent antidepression and antipsychotic drugs.

Cyberonics, which finally secured F.D.A. approval to market its implant last year, has ventured into the most difficult corner of depression treatment. It says its stimulator can provide relief for many of the four million or so people who suffer from “treatment resistant depression,” or T.R.D., a form so severe that patients fail to respond to drugs and traditional shock therapy. No other product has ever been designed for — and tested exclusively on — such a severely depressed population.

During the last month, some 1,300 doctors, patients and Cyberonics employees have written to the Centers for Medicare and Medicaid Services, asking that the agency grant Cyberonics’ recent petition for Medicare coverage. Public Citizen, a consumer advocacy group in Washington, filed a competing request on Wednesday, asking the agency to deny coverage. The group contends that Cyberonics has relied on misleading advertising and clinical trial write-ups, among other tactics, to secure federal approvals.

“With substantial constraints on the Medicare budget and so many clear needs going unmet, it seems absurd to flush away millions of dollars on this unproven device,” wrote Dr. Peter Lurie, deputy director of health research for Public Citizen, in the group’s petition. Other problems loom over the company. Federal prosecutors and regulators are investigating its pay practices, according to recent securities filings. Earnings disappointments over the last year have also caused Cyberonics’ stock to drop to $17.30 from a 52-week high of $40.69. Mr. Cummins declined to comment on the investigations, which are continuing.

But in an e-mail message last week, he scornfully dismissed Public Citizen’s criticisms as “shrill” and questioned Dr. Lurie’s expertise. “I look forward to the day when T.R.D. patients and fully qualified psychiatrists have the right to make treatment decisions regarding the ONLY treatment ever studied, proven safe and effective and F.D.A. approved for the long-term treatment of T.R.D!” he wrote.

The Cyberonics implant, like so many modern medical devices born of recent technological advances, would have been unimaginable only a generation ago. After being implanted in a patient’s chest, the device is surgically wired to the neck’s left vagus nerve, a major pathway for nerve signals to the brain from the heart and torso. Research suggests that repeated electronic stimulation of the vagus nerve can help treat severe depression by altering chemical and electrical functions in areas of the brain linked to mood disorders.

Cyberonics, which was founded in 1987, initially developed the stimulator to help epileptics control seizures. The F.D.A. approved that use in 1997. In 1998, based on animal tests and reports that many epileptics with the implant experienced mood improvements, Mr. Cummins gambled Cyberonics’ future on the idea that the device could also help treat patients with T.R.D. — people like Ms. Knight and Ms. Coram.

Mr. Cummins forecast, to Wall Street’s delight, that the T.R.D. market might be 10 times bigger than the epilepsy market. But his zeal also reflected his own family’s experience with depression, an affliction he says drove his mother and his grandfather to suicide. “My mother was my object lesson in wasted potential,” he said.

A squarely built, 6-foot-2-inch former college linebacker, Mr. Cummins, 52, says his mantra is, “Maybe wrong but never in doubt.” His shaved head and nonstop intensity seem well suited to someone whose idea of relaxation is competing in Nascar-affiliated car racing events. He now owns a Daytona Prototype race car — named Cyberspeed in honor of his company.

A native of Grove City, Pa., Mr. Cummins is the youngest of three children born into a dysfunctional family that he said was ripped apart by the periodic absences of his father, a steelworker, and his mother’s depression, alcohol and drug addictions. A decent student and a star athlete, he won a scholarship to Dartmouth, where he majored in government affairs.

After earning an M.B.A. at the University of Illinois at Urbana-Champaign Mr. Cummins eventually became a venture capitalist, joining Cyberonics’ board in 1988. Cyberonics was the brainchild of Reese S. Terry Jr., a veteran of the medical device industry, who set up the company to develop nerve-stimulation technology invented by Dr. Jacob Zabara at Temple University.

Dr. Zabara was one of many researchers exploring how electrical stimulation of the nervous system and the brain could affect a range of mental and physical ailments. The neurostimulation market as a whole now generates $1 billion annually in revenue, according to Wall Street analysts, and includes devices like spinal-cord stimulators that mask pain and deep brain implants that control some symptoms of Parkinson’s disease.

Wall Street and leading device companies see neurostimulation growing into a $10 billion business in the next decade, thanks to rapid advances in microchips and sensors. Executives at Cyberonics say that focusing on the vagus nerve makes its implants as effective but less risky and invasive than those that stimulate the brain and spinal cord.

Mr. Cummins became Cyberonics’ chief executive in 1995, when the company was struggling to stay afloat financially while seeking regulatory approval of its epilepsy therapy. He took over about the same time that Tamara Knight began a seemingly irreversible slide into severe depression.

Ms. Knight began suffering from depression as a teenager, a struggle that led to an early suicide attempt. Several years ago, drugs that had helped her recover stopped working. She began to neglect housework and her three children. In the fall of 1998, after several incidents in which she became outraged with co-workers, she lost her job. That winter, she began electroshock therapy.

What followed, she said, were more than 30 such treatments and more hospitalizations than she can recall. The number of drugs she took kept increasing, along with her weight. At one point, Ms. Knight, who is 5-foot-6 and had struggled with anorexia as a teenager, weighed more than 200 pounds. By 2004, she was depressed and was suffering from a common side effect of the electroshock therapy required to control her suicidal impulses: a steady erosion of her memory.

“Moneywise, insurance and Medicare paid for them,” Ms. Knight said of her treatments. “But it cost 30 years of my life in memory loss.”

As often happens in cases of severe depression, the family says it also lost the support of outsiders, including its local church. “If Tamara had had cancer, our church would have had people visiting all the time,” Mr. Knight said. “One older man visited us as long as he was able. That was it. It was a real blow to our faith.”

When Ms. Knight’s psychiatrist recommended a Cyberonics implant shortly after the F.D.A. approved the device in 2005, she became enthusiastic. Mr. Knight, who said he thought that V.N.S. therapy — Cyberonics’ trademarked name for “vagus nerve stimulation” — sounded far-fetched when he heard about it a few years earlier, now agreed that it was a chance they had to take.

He was worried, though, that public information about V.N.S. came largely from Cyberonics and highlighted favorable aspects of clinical data. Negative experiences of clinical-study patients like Katherine Coram were not readily available, outside of commentaries that epilepsy patients posted on a Cyberonics Web site.

Ms. Coram recalls feeling better in the first six months after her Cyberonics stimulator first turned on in 2001.

But when researchers ramped up her implant’s power to enhance its long-term performance, Ms. Coram began suffering nausea, sleeplessness and panic attacks that sent her to the hospital. She lost track of her finances. Like many victims of severe depression, she also began to experience distressingly peculiar setbacks, including an inability to load her dishwasher. Ms. Coram said doctors raised and lowered the implant’s power level several times before she asked them to turn it off temporarily.

“I was trusting the people in the study to figure out how to use the device but they didn’t have a clue,” Ms. Coram said.

The experiences of individuals like Ms. Coram and inconclusive data were not enough, though, for the F.D.A. to shut its doors to Cyberonics. In June 2004, an advisory panel recommended that the agency allow Cyberonics to market its stimulator.

That same night, Cyberonics’ board granted Mr. Cummins a bonus of 150,000 stock options. The next day, as the stock market reacted to the F.D.A. panel’s recommendation, Cyberonics shares leapt 77 percent, laying the groundwork for what, two years later, would become inquiries by the Securities and Exchange Commission and the Justice Department into whether Mr. Cummins’s options grant was legal.

But in 2004, Mr. Cummins had more immediate problems. By early August, critics inside and outside the F.D.A. had talked the agency into the unusual step of disagreeing with its advisory panel. True, there were success stories from patients who achieved almost complete recoveries (nearly 20 percent, according to Cyberonics). Data also suggested that patients who benefited — over 50 percent to one degree or another — were more likely to avoid relapses, expensive hospitalizations and suicide than a similar group of patients who received conventional therapy.

Still, in the most carefully controlled trial, a group that had the device implanted but not turned on fared nearly as well as the group being stimulated. Critics also pointed out that long-term results indicated that 30 percent of the patients reported worsening depression similar to Ms. Coram’s, creating unanswered questions about potential harm.

Mr. Cummins said in a press release that Cyberonics was “shocked” by the agency’s rejection. He denigrated the F.D.A. request for more randomized testing, arguing that other antidepression therapies had been subjected to far less challenging scrutiny. And he suggested to analysts that the agency’s decision would leave many patients feeling that they had no option other than suicide. In September, the F.D.A. accepted an amended application from Cyberonics that contained more long-term performance data and comparisons to other therapies.

Still, it came as something of a surprise on Wall Street and in the medical device industry when the F.D.A. decided early in February 2005 to approve V.N.S. as a depression treatment if Cyberonics met certain conditions. Most of the new requirements dealt with follow-up studies aimed at figuring out how the device could be used most effectively. Mr. Cummins forecast that all of the conditions could be met by the end of May. Shares of Cyberonics soared, and the company went on a hiring spree.

Mr. Cummins cast the decision as a victory for patients but also heralded the financial upside, projecting that Cyberonics’ sales could reach $1 billion by 2010. In the weeks after the F.D.A.’s announcement, he responded to Cyberonics’ stock run-up by exercising options on 350,000 shares, which netted him about $10.75 million. (The sales left him holding just over 36,000 Cyberonics shares, a stake he has since raised to 173,750 shares, according to federal filings.)

The long-awaited marketing approval from the F.D.A. came in July, but new problems emerged. A prominent board member resigned, citing disagreements with other directors over compensation policies and lack of a succession plan for Mr. Cummins.

The Senate Finance Committee, which began investigating the F.D.A.’s handling of the implant that spring, issued a staffreport in February of this year criticizing Dr. Daniel G. Schultz, a senior F.D.A. official, for overruling agency experts opposed to the device. An F.D.A. spokeswoman said that the agency acted carefully and that for “the small number of patients with severe depression who have failed all other treatments, data shows this may be the difference between being able to live a more productive life or suffer from debilitating illness.”

The Senate report also put Medicare officials on notice that decisions to cover V.N.S. would invite further scrutiny.

Continued uncertainty surrounding V.N.S. and Mr. Cummins’s us-against-the-world attitude have taken their toll on Cyberonics’ stock price and on Wall Street’s faith in the company. “There are institutional investors who won’t touch the company as long as Skip is at the helm,” said Jan Wald, an analyst at A. G. Edwards & Sons.

To hear Mr. Cummins tell it, what really matters is that a growing number of depression patients now credit the device with saving their lives. They include Ms. Knight, who got her Cyberonics implant last October, and quickly proved to be the kind of patient the company treasures.

“My family could see subtle differences right away,” Ms. Knight recalled in the letter of support for V.N.S. she sent to Medicare regulators last month. “I was out of bed more often and started taking an interest in how the house looked.”

While Ms. Knight, now 47, talks about “having my life back,” the legacy of severe depression remains with her. After spending so much time for so many years in bed, her body cannot keep up with all the things she now wants to do around the house, often leaving her in pain. She continues to lose her way around her hometown and mourns the loss of so much of her long-term memory. But she has been able to cut back to using just three medications, a change she credits with helping her shed 40 pounds.

MS. CORAM is also on the mend, but not because of V.N.S. or Cyberonics. After enduring numerous futile adjustments to her implant and having it temporarily turned off, she asked her doctors to try one last time in March 2004. Three months later, she stopped using the implant for good and then had it removed from her chest. Her doctors left the metal leads wrapped around her vagus nerve, saying it was too risky to try to remove them.

She said she is slowly regaining the ability to do household tasks — like paying bills — that had been impossible during her V.N.S. treatment. “I feel like I’m just beginning to get my life back,” she said recently.

Mr. Cummins remains as driven as ever. Cyberonics says 1,810 patients have received the implants since the product was approved, out of 13,313 identified candidates. Thousands have been caught up in lengthy and often unsuccessful appeals for insurance coverage, since only a few small insurers routinely pay for the device.

Seeking the traction it desperately needs with insurers, Cyberonics decided in May to narrow the company’s focus to the subset of T.R.D. patients whose problems are the most costly for health care providers. Cyberonics contends that V.N.S. treatment for that group would save hospitals $4,800 to $8,200 a patient annually, based on an estimate of the implant’s cost and follow-up visits over eight years. But Cyberonics’ calculation is based on optimistic presumptions, including aggressive estimates about the pace and nature of patients’ recovery.

Because the presumptions are also based primarily on results from earlier trials, critics like Public Citizen say the new focus has all the flaws of the old one.

However the controversy is resolved, depression victims who finally get an implant will find themselves entering a medical lottery. Many, like Joe Marhefka, 49, of Colchester, Conn., are too depressed to be optimistic about the procedure.

Mr. Marhefka, who ended up in the hospital last fall after attempting suicide, said that he masked his depression most of his life by drinking. When he gave up alcohol eight years ago, the depression seemed to intensify. He said electroshock therapy two years ago destroyed most of his memories of his adolescence, and younger adult years. He lost his job as a high school math teacher shortly before his suicide attempt.

“When I had the implant last month, I was hoping I wouldn’t wake up,” Mr. Marhefka said in July, before entering the New London, Conn., office of Dr. Kathleen R. Degen to have his stimulator activated. “I don’t have any hopes this is going to work. I’m doing this because my wife deserves a husband and my two daughters deserve a Dad. They have hope. I’m just going along with the doctors.”

Dr. Degen used a hand-held computer to program a wand that Mr. Marhefka held over the spot on his chest where his implant was located. A 30-second-long pulse surged into his vagus nerve, reducing Mr. Marhefka’s voice to a barely audible rasp. When the pulse stopped, his voice returned to normal and he conversed briefly with Dr. Degen. He asked about reducing his medications; Dr. Degen said the request was common, but that it was too early to consider it.

Five minutes later, just as Mr. Marhefka asked whether his implant was still on, it delivered its second pulse — again taking away his voice and leaving him with what he said was a mild strangling feeling. Dr. Degen let the pulse pass and explained how she would gauge his future progress.

But Mr. Marhefka plans to measure his progress with his own yardstick.

“If I start smiling again, maybe even laughing sometimes, that’s how I’ll know,” he had said just before entering Dr. Degen’s office. So far, Mr. Marhefka said in a phone call last week, he is still waiting.



To Fight Stuttering, Doctors Look at the Brain
Andrew Pollock, New York Times- 9/12/2006

When called upon in class, he would sometimes answer in the voice of Elmer Fudd or Donald Duck because he didn’t stutter when imitating someone. He found easier-to-say synonyms for words that stymied him. And he almost never made phone calls because he stumbled over a phrase for which there was no substitute: his own name.

Now Dr. Maguire, a psychiatrist at the University of California, Irvine, wants to cure the ailment that afflicts him and an estimated three million Americans. He is searching for a drug to treat stuttering, organizing clinical trials and even testing treatments on himself.

He could be getting closer. In May, Indevus Pharmaceuticals announced what it called encouraging results from the largest clinical trial ever of a drug for stuttering. Even larger trials are still needed, which could take two or three years. But if they succeed, the drug, pagoclone, could become the first medical treatment approved for stuttering.

That is just part of a transformation of stuttering — in the medical view — from what was once widely considered a nervous or emotional condition to a neurological one that is at least partly genetic. Using brain scans, DNA studies and other modern techniques, scientists — many of whom stutter themselves — are slowly shedding light on a condition that has flustered its victims as far back as Moses, who some scholars believe was a stutterer because he told the Lord that he was “slow of speech and of a slow tongue” and had his brother Aaron speak for him.

“This is a total paradigm shift in the last 10 years,” said Dr. Maguire, who helped design the Indevus trial and was an investigator in it. “When I was in medical school, I learned nothing about stuttering.”

Still, much remains to be learned about the causes of stuttering and how to treat it. It is estimated that about 1 percent of the population worldwide stutters, though that figure may be high. Men who stutter outnumber women by a ratio of about 4 to 1, for reasons not known.

In most cases, stuttering begins between ages 2 and 6, when a child is just learning to speak. But three quarters of such children will stop stuttering within a few years without any intervention, said Ehud Yairi, emeritus professor of speech and hearing science at the University of Illinois, who stutters himself. Other children benefit from speech therapy.

Those who stutter say the condition — marked by repetitions of syllables, long silences and the contortion of the face as a person seems to try to force the words out — can exact a terrible emotional toll. Many talk of jobs or promotions not received, of relationships broken or not pursued. Some structure their entire lives to avoid having to speak unnecessarily or to avoid being teased.

“Stuttering is one of the last diseases it’s still O.K. to make fun of,” said Ernie Canadeo, an advertising executive from Oyster Bay, N.Y., who stutters.

Alan Rabinowitz, a noted wildlife conservationist, has told of how when called upon by a teacher in elementary school, he once avoided answering by stabbing his hand with a pencil so he would be taken to the hospital.

Still, many people overcome — if not totally cure — their stuttering, either through therapy or just the passage of time. Winston Churchill stuttered. So did Marilyn Monroe. Others who have coped with the problem include the author John Updike, Senator Joseph R. Biden Jr. of Delaware, the actor James Earl Jones, the newsman John Stossel, the singer Carly Simon and the sportscaster Bill Walton. Throughout history, various theories have been advanced for stuttering, including sexual fixations, emotional disorders, nervousness, and persistence into adult life of infantile nursing activities, according to the book “Knotted Tongues: Stuttering in History and the Quest for a Cure” by Benson Bobrick (Simon & Schuster, 1995).

One of the more popular theories from a few decades ago was that parents caused stuttering by reacting negatively to the repetitions that normally occur when children first learn to talk.

But a consensus is growing that stuttering is a neurological condition, though its exact nature is not clear. Emotional stress can make stuttering worse, however.

Brain imaging studies have shown that the brains of people who stammer behave differently from those of people who don’t when it comes to processing speech.

Luc De Nil, chairman of the department of speech and language pathology at the University of Toronto, said that in people who don’t stutter, speech processing is largely handled in the brain’s left hemisphere. With stutterers, there is an unusually large amount of activity in the right hemisphere.

Dr. Maguire said studies that he and others had done also suggest there is an excess of the neurotransmitter dopamine in the brains of those who stutter.

Stuttering also appears to be at least partly genetic. About half of the people who get treatment for stuttering have an immediate family member who also stutters, said Dennis Drayna, a geneticist at the National Institute on Deafness and Other Communication Disorders.

Scientists believe there are many genes that can contribute to stuttering, each one perhaps having a small effect. That has made it more difficult to find the genes.

But Dr. Drayna and his colleagues got a big break when a man from Cameroon wrote to an online forum on stuttering a few years ago. The man was part of a prominent family in which 48 of 106 adults stuttered, suggesting that the gene responsible for the family’s stuttering was inherited by changes in one gene.

Studying the DNA from that family, Dr. Drayna and his colleagues have narrowed the search to a stretch of Chromosome 1 containing 50 to 60 genes. Another study using families from Pakistan with large numbers of stutterers found a region on Chromosome 12, and that specific gene is close to being identified, Dr. Drayna said. Other studies have found other chromosomal regions.

If the cause of stuttering has baffled scientists, so has its treatment. A 16th-century Italian physician prescribed nosedrops to “dehumidify” the brain, according to Mr. Bobrick’s book. An American Indian tribe made stutterers spit through a hole in a board to drive the devil from their throats.

Most people who are treated for stuttering nowadays undergo various types of speech therapy. Some therapies teach speech techniques, like elongating vowels or speaking slowly. Others emphasize reducing the anxiety and fear of speaking.

“Adults can be significantly helped,” said Peter Ramig, a professor of speech language pathology at the University of Colorado, who stutters. “But it would be very unusual to see documented cases of adults who stutter being cured.”

Some stutterers have been helped by devices. The best known is the SpeechEasy, which fits in the ear like a hearing aid and feeds the voice back to the speaker with a tiny delay and at a slightly different pitch. This is said to simulate the choral effect, in which people don’t stutter when speaking or singing in unison with others. The device costs about $5,000, and 6,000 have been sold since 2001, according to the manufacturer, the Janus Development Group of Greenville, N.C.

Specialists say that the device helps some people but not others and that the effects can wear off.

As for drugs, there have been some studies over the years using medications developed to treat other conditions. Dr. Maguire ran small trials of two schizophrenia drugs, Risperdal, from Johnson & Johnson, and Zyprexa, from Eli Lilly. Both drugs showed some effectiveness, but neither company took the drug into larger trials.

That has frustrated Dr. Maguire, who said pharmaceutical companies could be missing a big market. In the past, some critics have accused pharmaceutical companies of taking conditions like anxiety or inattentiveness, which the critics say are not clearly illnesses, and turning them into medical problems so they could sell drugs. But stuttering, Dr. Maguire said, is clear cut.

One obstacle is that stuttering has been primarily treated by speech therapists, who can’t prescribe drugs and might object to the condition being treated as a medical one. “There are many people who simply have a bias against it and don’t think it’s a good idea,’’ said J. Scott Yaruss, a speech therapist at the University of Pittsburgh.

Another is that side effects might be worth risking for a serious disease like schizophrenia but not for stuttering.

Zyprexa has been linked to weight gain and diabetes. Dr. Maguire himself has taken Zyprexa for seven years and says it has greatly helped his fluency. He has gained 20 pounds in that time but believes he would have gained some of it anyway because he was approaching middle age.

Pagoclone, the newest candidate, was initially tested as a treatment for panic disorder and anxiety. Results were mixed, and Pfizer, which had the rights to the drug, returned them to Indevus.

But in those trials a few people who stuttered said their speech improved during the trial. So Indevus got a patent covering the use of the drug for stuttering and began the clinical trial, in which 88 patients got the drug and 44 a placebo.

The participants were videotaped in conversation and reading, both before starting on the drug or a placebo and four and eight weeks afterward. Evaluators, blinded to whether the patient was on the drug or the placebo when the video was made, counted the proportion of syllables stuttered and the duration of the three longest stutters. In a separate measure, clinicians evaluated the speech of their patients.

In most cases, those who got the drug did better than those who got the placebo by a statistically significant amount. As evaluated by the clinicians, 55 percent of those who got the drug improved after eight weeks, compared with 36 percent on the placebo. The most common side effects were headache and fatigue.

Still, until the results are published in a journal the company will not reveal how big the improvement was for people, or whether it was enough to make a real difference in their lives.

It’s also not quite clear how the drug is working, whether it is merely reducing anxiety or has some other effect on speech. The drug activates a receptor in the brain called GABA that is associated with a calming effect.

Indevus has not said whether it will continue to pursue pagoclone for stuttering because it is outside its focus of urology and gynecology. It is also testing pagoclone as a treatment for premature ejaculation. The company, under a previous name, Interneuron Pharmaceuticals, developed Redux, a diet drug that became part of the fen-phen combination. Wyeth, which sold the drug, withdrew it from the market after it was linked to heart valve problems.

Claire Byrne of Fountain Valley, Calif., who is taking pagoclone as part of an extension of the clinical trial, said, “I definitely think it’s helping me.” Another woman taking it said, “It’s left me feeling a little bit more free, and I engaged in more speaking situations.”

Dr. Maguire is more enthusiastic. On a conference call for securities analysts held by Indevus, he said some patients taking the drug had finally gotten jobs they wanted or were able to approach others and go out on a date. “It’s almost an awakening, people coming out of their shells, so to speak.”



For Some, Acceptance or Support Is Answer
Andrew Pollock, New York Times- 9/12/2006

LONG BEACH, Calif. — Ken Koroll, a 32-year-old compliance officer for the Occupational Safety and Health Administration, stutters so badly that he often writes his questions to the companies he inspects rather than speaking them. But Mr. Koroll, who lives in Peoria, Ill., said he had come to terms with his inability to speak fluently.

“When I was 27 or 28, I actually stopped fighting it and started embracing it,” he said. “This is who I am and what I am, and I accept it. If anyone else can’t, that’s their problem, not mine.”

Such an attitude appears to be rare among people who stutter. Many become “covert stutterers,” avoiding jobs and social situations in which they have to talk.

Mr. Koroll’s attitude of what might be called stutterers’ lib is fostered by the National Stuttering Association, which runs support groups around the nation. The group’s three-day annual meeting, which took place in a hotel here at the end of June, attracted about 525 children and adults.

“A lot of people who stutter don’t want to be viewed as a person with a disability,” said Michael Sugarman, a social worker from Oakland who co-founded the organization in 1977.

The older and more established group for stutterers is the Stuttering Foundation, based in Memphis, which provides help and advice through a toll-free number (800-992-9392) and Web sites (www.stutteringhelp.org and www.tartamudez.org) but does not run support groups.

The foundation was started in 1947 by Malcolm H. Fraser, the co-founder of Genuine Parts Company, a major automobile parts company, who stuttered badly. Mr. Fraser, who died in 1994, endowed the organization with $20 million, and it is now run by Jane Fraser, his daughter.

The National Stuttering Association (www.nsastutter.org, 800-937-8888), by contrast, has had financial difficulties. It now operates out of the office of Tzell Travel in New York. The travel agency’s owner, Barry Liben, said he was supporting the association because it instilled self-confidence in his son Michael, who stutters.

“It’s hard raising money for stuttering,” Mr. Liben said at the meeting here. “People say it never kills you. People who don’t stutter or don’t have someone who stutters in their life don’t understand how powerfully it affects your life. I’ve met children here who literally never talk — never.”

Some members of the association say that acceptance of one’s stuttering can veer into antagonism toward efforts to improve fluency. Gregg Benedikt, a New York-area advertising executive, recalled that at his first meeting, in 1997, half of a small group talking in the hotel lobby said they would not take a pill to cure their stuttering if one were available.

But he and others say such attitudes have moderated. The keynote speech at this year’s meeting was about the development of drugs to treat stuttering.l

Lady Macbeth Not Alone in Her Quest for Spotlessness
Benedict Carey, New York Times- 9/12/2006

Liars, cheats, philanderers and murderers are not renowned for exquisite personal hygiene, but then no one has studied their showering habits.

They may scrub extra hard after a con job, use $40 hyacinth shampoo after a secret tryst or book a weekend at a spa after a particularly ugly hit. They are human beings, after all, and if a study published last week is any guide, they feel a strong urge to wash their hands — literally — after a despicable act in an unconscious effort to ease their consciences.

And it works, at least for minor guilt stains. People who washed their hands after contemplating an unethical act were less troubled by their thoughts than those who didn’t, the study found.

“The association between moral and physical purity has been taken for granted for so long that it was startling that no one had ever shown empirical evidence of it,” said Chen-Bo Zhong, an author of the new research and a behavioral researcher at the University of Toronto. The study, which he wrote with Katie Liljenquist, a graduate student at Northwestern University, appeared in the journal Science.

The researchers call this urge to clean up the “Macbeth effect,” after the scene in Shakespeare’s tragedy in which Lady Macbeth moans, “Out, damned spot! Out, I say!” after bloodying her hands when her husband, at her urging, murders King Duncan.

In one of several experiments among Northwestern undergraduates, the researchers had one group of students recall an unethical act from their past, like betraying a friend, and another group reflect on an ethical deed, like returning lost money. Afterward, the students had their choice of a gift, either a pencil or an antiseptic wipe. Those who had reflected on a shameful act were twice as likely as the others to take the wipe.

In another experiment, the researchers found that students who had been contemplating an unethical deed rated the value of cleaning products significantly higher than peers who had been thinking about an ethical act.

Psychologists have known for years that when people betray their values, they feel a need to compensate. Christians who have read a blasphemous story about Jesus express a desire to go to church more frequently; social liberals who feel they have discriminated express an increased desire to volunteer for civil rights work. “It’s sometimes called symbolic cleansing, or moral cleansing, and it’s an attempt to repair moral identity,” said Dr. Philip Tetlock, a professor of organizational behavior at the University of California, Berkeley.

Sure enough, Mr. Zhong and Ms. Liljenquist found that students who had been thinking about past sins were very likely to agree to volunteer their time to help with a graduate school project — unless they had been allowed to wash their hands, which cut their willingness to volunteer roughly in half.

Several people known to have expressed guilt over spreading rumors were asked to comment for the record on the findings, but all declined. And efforts to contact hit men to inquire about personal hygiene were deemed unwise; none had publicists.

But Macbeth was available for comment. Liev Schreiber, who played Macbeth to critical acclaim this summer at the Delacorte Theater in Central Park, said the moral weight of the murder in the play was exhausting. And he said that cast members lined up to shower at the theater, rather than waiting until they got home.

“That was unusual — usually no one uses those theater showers,” Mr. Schreiber said in an interview. “I had to shower. I was covered in eight gallons of fake blood by the end.” He said he had no idea how much the cast’s cleansing was because of to the moral horror of the play and how much was because of the muggy summer weather.

Either way, the Macbeths, by the last act, have fallen to pieces, physically and mentally, despite compulsive efforts to purge their sins. Mr. Zhong said in an interview that for this couple at least, all the kingdom’s washbasins were not enough to ease their consciences.

But the murder of a king, he acknowledged, falls into a different category from the confessed sins of the undergraduates, which included shoplifting, lying and “kissing a married man.”

“We do believe there might be limits to how well simple hand washing can clean your slate,” he said, “but it remains to be seen where that limit is.”