Noteworthy News Articles on Mental Health Topics, December 18- , 2007



Brought on by Darkness, Disorder Needs Light
Richard Friedman, M.D., New York Times- 12/18/2007

In a few days, the winter solstice will plunge us into the longest and darkest night of the year. Is it any surprise that we humans respond with a holiday season of relentless cheer and partying? It doesn’t work for everyone, though. As daylight wanes, millions begin to feel depressed, sluggish and socially withdrawn. They also tend to sleep more, eat more and have less sex. By spring or summer the symptoms abate, only to return the next autumn.
     Once regarded skeptically by the experts, seasonal affective disorder, SAD for short, is now well established. Epidemiological studies estimate that its prevalence in the adult population ranges from 1.4 percent (Florida) to 9.7 percent (New Hampshire).
     Researchers have noted a similarity between SAD symptoms and seasonal changes in other mammals, particularly those that sensibly pass the dark winter hibernating in a warm hole. Animals have brain circuits that sense day length and control the timing of seasonal behavior. Do humans do the same?
     In 2001, Dr. Thomas A. Wehr and Dr. Norman E. Rosenthal, psychiatrists at the National Institute of Mental Health, ran an intriguing experiment. They studied two patient groups for 24 hours in winter and summer, one group with seasonal depression and one without. A major biological signal tracking seasonal sunlight changes is melatonin, a brain chemical turned on by darkness and off by light. Dr. Wehr and Dr. Rosenthal found that the patients with seasonal depression had a longer duration of nocturnal melatonin secretion in the winter than in the summer, just as with other mammals with seasonal behavior.
      Why did the normal patients show no seasonal change in melatonin secretion? One possibility is exposure to industrial light, which can suppress melatonin. Perhaps by keeping artificial light constant during the year, we can suppress the “natural” variation in melatonin experienced by SAD patients. There might have been a survival advantage, a few hundred thousand years back, to slowing down and conserving energy — sleeping and eating more — in winter. Could people with seasonal depression be the unlucky descendants of those well-adapted hominids?
     Regardless, no one with SAD has to wait for spring and summer to feel better. “Bright light in the early morning is a powerful, fast and effective treatment for seasonal depression,” said Dr. Rosenthal, now a professor of clinical psychiatry at the Georgetown Medical School and author of “Winter Blues” (Guilford, 1998). “Light is a nutrient of sorts for these patients.” The timing of phototherapy is critical. “To determine the best time for light therapy, you need to know about a person’s individual circadian rhythm,” said Michael Terman, director of the Center for Light Treatment and Biological Rhythms at the Columbia University Medical Center. People are most responsive to light therapy early in the morning, just when melatonin secretion begins to wane, about eight to nine hours after the nighttime surge begins.
     How can the average person figure that out without a blood test? By a simple questionnaire that assesses “morningness” or “eveningness” and that strongly correlates with plasma melatonin levels, according to Dr. Terman. The nonprofit Center for Environmental Therapeutics has a questionnaire on its Web site (www.cet.org). Once you know the optimal time, the standard course is 30 minutes of fluorescent soft-white light at 10,000 lux a day. You may discover that you are most photoresponsive very early, depending on whether you are a lark (early to bed and early to rise) or an owl. The effects of light therapy are fast, usually four to seven days, compared with antidepressants, which can take four to six weeks to work.
     For treatment while sleeping, there is dawn simulation. You get your own 90-minute sunrise from a light on a timer that starts with starlight intensity and ends with the equivalent of shaded sun. This is less effective than bright light.
     It may sound suspiciously close to snake oil, but the newest promising therapy for SAD is negative air ionization. Dr. Terman found it serendipitously when he used a negative ion generator as a placebo control for bright light, only to discover that high-flow negative ions had positive effects on mood. Heated and air-conditioned environments are low in negative ion content. Humid places, forests and the shore are loaded with them. It makes you wonder whether there is something, after all, to those tales about the mistral and all those hot dry winds, full of bad positive ions, that supposedly drive people mad.
     Of course, you might decide to drop the light and ions and head for a sunny, tropical vacation. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.



Programs Let Addicted Docs Practice
Associated Press, 12/18/2007

SAN FRANCISCO -- Troubling cases in which doctors were accused of botching operations while undergoing treatment for drugs or alcohol have led to criticism of rehab programs that allow thousands of U.S. physicians to keep their addictions hidden from their patients. Nearly all states have confidential rehab programs that let doctors continue practicing as long as they stick with the treatment regimen. Nationwide, as many as 8,000 doctors may be in such programs, by one estimate.
     These arrangements largely escaped public scrutiny until last summer, when California's medical board outraged physicians across the country by abolishing its 27-year-old program. A review concluded that the system failed to protect patients or help addicted doctors get better. Opponents of such programs say the medical establishment uses confidential treatment to protect dangerous physicians. ''Patients have no way to protect themselves from these doctors,'' said Julie Fellmeth, who heads the University of San Diego's Center for Public Interest Law and led the opposition to California's so-called diversion program.
     Most addiction specialists favor allowing doctors to continue practicing while in confidential treatment, as does the American Medical Association. Supporters of such programs say that cases in which patients are harmed by doctors in treatment are extremely rare, and would pale next to the havoc that could result if physicians had no such option. ''If you don't have confidential participation, you don't get people into the program,'' said Sandra Bressler, the California Medical Association's senior director for medical board affairs.
     California's program ends June 30. If no alternative program is adopted, the rules could revert back to the zero-tolerance policy in place before 1980, when doctors who were found by the medical board to have drug or alcohol problems were immediately stripped of their licenses. No other state has followed California's lead. But the president of California's medical board, Dr. Richard Fantozzi, said that behind the scenes, regulators nationwide share his ambivalence toward such programs. ''To hide something from consumers, something so blatant ... it's unconscionable today,'' Fantozzi said.
     Between 10 percent and 15 percent of physicians nationwide will have a substance abuse problem at some point in their lives, a rate similar to that of the general population, according to widespread estimates. An estimated 7,500 to 8,000 practicing doctors are probably in confidential treatment, or about 1 percent of all physicians practicing in the U.S., said Dr. Greg Skipper, head of Alabama's program and a leader of an upcoming study on the issue.
     Opponents of such programs are unable to cite any documented cases in which doctors who were confidentially undergoing treatment botched operations while drunk or high. But they say the very secrecy of the programs makes it hard to assess the risks. Nevertheless, some doctors have been accused of harming patients while they were in treatment.
     In Montana, a patient accused a doctor enrolled in the state's treatment program of not following up on her abnormal test results, delaying her cancer diagnosis by more than a year. Montana revoked Dr. Robert Schure's license last year after he flunked out of treatment six times since 1994, according to board documents. The patient's suit was settled for an undisclosed sum.
     A North Carolina surgeon enrolled in the state's program for alcoholism charged patients for one type of gastric bypass and then performed a shortcut procedure that led to serious complications, including stomach ulcers and vomiting, according to patients and a medical board investigation. It wasn't until Dr. Steven Olchowski lost his license in 2005, years after many of the incidents occurred, that his participation in North Carolina's program became publicly known.
     Opponents of California's program have focused on the case of Dr. Brian West, a Long Beach plastic surgeon who has been accused of negligence by the state medical board and is fighting to keep his license. In 1999, West performed a double mastectomy and breast reconstruction surgery on Becky Anderson. The procedure left her with gaping, infected wounds that wouldn't close and, ultimately, a grotesque lump the size of a melon caused by organs spilling through an unhealed hole in her abdomen. Weeks before performing his final, futile procedure on her, West was arrested for a drunken-driving accident.
     After his conviction, West entered the diversion program for alcoholism. A year later he performed a tummy tuck on a 37-year-old woman that also healed poorly. West ultimately flunked out of the treatment program after investigators uncovered a pattern of relapses, binge drinking and doctored urine tests that ''demonstrate that he is a physician who has been long and chronically impaired by alcohol,'' according to a 2005 medical board complaint.
     West's supporters say he has been made a scapegoat, asserting that he is not to blame for his patients' complications and that the severity of his drinking problem has been exaggerated by investigators. ''I have no information from any of my investigations that Dr. West has ever cared for patients while under the influence of alcohol,'' said his attorney, Dominique Pollara. West admitted no fault in settling Anderson's malpractice lawsuit for $250,000, Pollara said. The tummy-tuck patient lost her malpractice case.
     Without the assurance of confidentiality, some say, addicted doctors will go underground and continue to practice without getting any treatment at all. Jim Conway, a Venice, Calif., drug and alcohol counselor, said that before confidential treatment programs, doctors would do whatever they could to hide their addiction for fear they would lose their licenses. At a Pomona hospital where Conway worked, an alcoholic obstetrician came to work and delivered a baby while ''dead drunk,'' he said. In the process, the doctor severed the newborn's spine. ''And that's how it will be if they just do a punitive approach,'' Conway said.
     Dr. Jason Giles, a Malibu physician, completed California's program in 2004 after five years in treatment for alcoholism and addiction to prescription drugs. ''I was never intoxicated taking care of patients. It didn't get to that -- but would have if I didn't avail myself of that rope dropped from the helicopter,'' he said. His experience in rehab was so transformative, he said, that he quit practicing anesthesiology and opened the drug treatment center he now runs. Giles said allowing physicians to continue to practice while in rehabilitation is crucial to the success of the treatment. ''Working actually helps them get better,'' he said.

Michiko Kakutani, New York Times- 12/21/2007

When Susanna Sonnenberg was 10 years old, her mother bought her a copy of Penthouse magazine and told her to read one of the letters aloud. When she was 12, her mother gave her some cocaine and told her how to tell “the difference between the dealers you could trust and those who were just cokeheads.” When she was 14, her mother seduced — or pretended to seduce — the older brother of one of her friends.
      “Her Last Death” recounts “the true calamity of being daughter to this mother,” and the wonder of this memoir is that the author survived her traumatic childhood and found a way of turning her memories into a fiercely observed, fluently written book that captures the chaos and confusions of her youth, the daughter of an unpredictable pill-and-coke addicted mother and a brilliant, self-absorbed father, neither of whom had the faintest idea of how to be a parent.
     Writing in sharp, crystalline prose, Ms. Sonnenberg describes the glamorous but highly treacherous Manhattan world she grew up in, while limning her parents’ penchant for the theatrical gesture. Her maternal grandfather was a famous musician who played Carnegie Hall; her maternal grandmother, a dead ringer for Carole Lombard, lived in a hotel in New York, had an apartment in Monte Carlo and presided over a grand estate in Barbados. Her paternal grandparents lived in an ornate town house on Gramercy Park and maintained two summer houses in Provincetown.
     When Susy was born, her father arrived at the hospital with a Victorian pram completely filled with lilies of the valley, so she would remember their scent forever. He took her to movies like “Freaks” and “Tommy” when she was a young child, and when a stranger in a movie theater tried to grope her, she recalls, her father acted utterly blasé, telling her that the next time such a thing happened, she should simply say “Take your hands off me!” in a very loud voice.
     Susy’s parents divorced when she was in the second grade, and her mentally unstable mother loomed over her childhood like a frightening mythological creature — part Fury, part predator, part companion and guide. Her mother, whom she calls Daphne — Ms. Sonnenberg says she’s changed all names except her own in the book “to emphasize that this story could only be mine” — possessed a magical charm and a contagious, manic enthusiasm, especially in her “Big Everything” frenzies, her “Let’s-Take-Over-Central Park” moods.
     And Susy cherished her mother’s soul-searching talks. “No one else made me feel really interesting, different, magical,” she writes, no one else wanted to know all her “thoughts & feelings.” But she also recalls that Daphne was capable of turning from conspiratorial affection to accusatory rage in a flash, hurling insults, punches and undermining invective at her daughter, while lying, seemingly reflexively, about everything from the men she dated to her imminent death from a fatal illness.
     The worst, however, were Daphne’s falling-down, passing-out drug binges and her relentless obsession with sex, which she shockingly shared with her young daughter. According to Ms. Sonnenberg, her mother told her about orgasms when she was 8, and years later would quiz her voyeuristically about the sexual details of her relationships with boyfriends. Daphne flaunted her string of lovers — including a New York Giants quarterback, a BBC executive, a Broadway actor, a Sotheby’s executive, a movie theater owner and a famous lyricist — in front of Susy and her younger sister. And when Susy started dating, she says, her mother would routinely try to seduce her boyfriends.
     Daphne, who suffered from chronic back pain, was equally promiscuous with drugs, Ms. Sonnenberg recalls, downing Demerol, Percodan, Valium and sleeping pills with wild abandon, even as she cultivated a serious cocaine habit. As a young girl, the author says, she was forced to help her mother inject herself with Demerol, watched her mother pass out time and again, and became accustomed to visiting her in the hospital.
     Throughout these episodes Susy behaved as the resident grown-up, alert to her mother’s disasters and intent on trying to shield her younger sister from Daphne’s worst catastrophes. She got herself and her sister ready for school every morning, scheduled their dental checkups, thawed peas, scrambled eggs, turned off the television when they had watched enough. She resisted taking peyote with the grown-ups — “Susy’s our straight one!” her mother would say with a laugh — and resisted her mother’s efforts to push her early into sexual relationships.
     But Daphne, with her penchant for lying and sexual manipulation, would also become a kind of role model for her older daughter, a siren call to the dark side. After an intense affair with her high school English teacher and a series of serious college-era boyfriends, Susy embarked on an extended interlude of promiscuity, going “to bed with everybody,” using sex “to court oblivion” and becoming “a virtuoso of the lie.”
     It was meeting her future husband, Christopher, a man as earnest as she was ironic, as plain-spoken and straightforward as she was sophisticated, that put a punctuation point to this phase in her life and helped her begin a new chapter in which she could start to exorcise her mother’s spirit. Susy would move to Montana with Christopher, marry him, have two sons and begin a no-frills life of blessedly ordinary pleasures, frustrations and rewards. She would also distance herself from her mother, out of self-preservation. When Daphne was injured in a car accident, and Susy was summoned to Barbados, she declined to go.
     Throughout this book Ms. Sonnenberg refrains from analyzing her mother’s behavior — there is no speculation in these pages about mental illness or chemical imbalances or emotional damage — and she refrains as well from speculating about the psychological fallout of growing up with such a parent. The reader suspects that this aspect of “Her Last Death” was by design, perhaps from an inability (or unwillingness) to deconstruct her mother’s behavior, perhaps from a desire to avoid committing the sort of dime-store psychoanalysis so popular on daytime talk shows.
     This approach makes, at times, for a curiously opaque narrative, but it also intensifies the immediacy of Ms. Sonnenberg’s story, plunging readers into a sort of perpetual present tense in which we are made to experience, almost firsthand, the inexplicable and perverse behavior of an impossible woman from the point of view of her aghast, bedazzled — and immensely gifted — daughter.

A Life of Helping Becomes One in Need of Help
Jim Dwyer, New York Times- 12/22/2007

This was life, until Susan Barron crossed Second Avenue on a Saturday morning two and a half months ago: an apartment on the East Side of Manhattan, where she has lived for decades. A fat Scottish terrier that she doted on. A psychology practice treating people with physical disabilities, offering “scholarships” to patients who could not pay full fees. And she was a fixer — the friend who hunted down a kidney for someone in need of a transplant, mentor to a man starting his own therapy practice, regular volunteer on winter coat drives and at holiday soup kitchens. “That Jimmy Stewart character in ‘It’s a Wonderful Life’ had nothing on her,” said one friend, a self-described cynic.
      Then came the morning of Oct. 6. A few minutes before 11, a deranged man stole five knives from a restaurant on Second Avenue, stabbed the cook, then ran into the street. Ms. Barron, on a walk with the dog, happened into his path at 35th Street. Screaming at her, the man chopped, hacked and stabbed her head and arms, straddling her after she fell to the street, picking up a new knife when he lost one from the force of his blows. The man, identified as Lee Coleman, was stopped only when an off-duty police officer shot him. To those who witnessed it, the violence seemed to be a crime of toxic passion; they could not fathom the truth, that one total stranger had simply and suddenly set upon killing another. They also could not imagine that Ms. Barron would live. She did.
     And now this is her life: 11 weeks in hospital beds under an assumed name; perhaps 13 separate surgeries, but she has lost exact count, because a few were repeats; a cellphone she uses only at night to save the minutes; a discreet session or two in the hospital lounge with one of her patients; instructions for friends to send the thank-you notes she cannot write herself; a 15-minute visit in an office with her dog, Velvet. One scar runs from her lip to her right ear, along a strikingly youthful face. She is 67.
     Sitting in a hospital lounge, she calmly takes inventory of what has been fixed, a finger tracing her lower lip, one of the lesser injuries. “I can’t smile,” Ms. Barron said. “I can’t make a kiss.” These are not matters for pity, but the backdrop, she says, to the singular wonder of her life. “The most amazing thing of all is my brain is working,” she said. “The rest of it — it’s all baby stuff.”
     In fact, her psychic resilience may actually be working against Ms. Barron as she gets ready to go home, where she will need help. Although the state provides some compensation to crime victims, they must prove that their lost earnings and expenses are a result of crimes in which they are entirely innocent. They must also show that they have no other way to pay for them. “The only allowance under statute for someone else to file the claim is incompetency,” said John Watson, the general counsel for the State Crime Victims Board, which administers compensation.
     For Ms. Barron — self-employed, living alone and hospitalized with grave injuries for three months — the paper chase has been daunting, though friends are helping. It could be months before any compensation reaches Ms. Barron, a discovery that galls her friends. She expects to be discharged in a few weeks, but is far from being ready to take care of herself. The services of a part-time aide could cost $1,500 to $2,000 a week, with little covered by insurance. She ran through a nest egg while fighting invasive breast cancer seven years ago, her friends said.
     At home, her food may have to be puréed, at least for a while: all her teeth were knocked out, and her gums so damaged that they had to be rebuilt with skin grafted from her thigh. She cannot cook or clean — her arms and hands were slashed, right shoulder broken, rotator cuff and tendons torn. Nor can she get around safely, because a blow to the right ear broke a crystal that threw off her sense of balance.
     “What’s the whole point of the crime victims board?” said Rhoda Beckman, a friend of Ms. Barron’s since childhood in Brooklyn. “To have this happen, after all this, seems so cruel and unfair.” Mr. Watson said he could not comment about individual cases, but said the requirements were set by state and federal laws. The pace, he said, depended on how “cooperative” the victims are.
     Valerie Angeli, a neighbor who was with Ms. Barron when she was attacked, has set up a Web site, www.FriendsofSusanB.com. Early in Ms. Barron’s hospital stay, she fretted that her patients would be upset by news pictures of the knives, Ms. Angeli said. She asked after the Jersey City firefighters who saw the attack and pressed aprons — snatched from the same restaurant where the knives had been taken — around the wounds that were pulsing with blood. “You’re always thinking about other people,” Ms. Angeli told Ms. Barron this week. “Sometimes I think about other people,” Ms. Barron corrected. “But I always think about myself.”
     Her determination, she says, is a matter of temperament, as much as professional training. “Part of wanting to stay alive is I want to do more,” Ms. Barron said. “I love being alive. I wanted very much to stay alive. I didn’t think I would. What my training taught me is that I have to talk about this, that it’s the only way you can heal from anything.” Once a day, maybe, she cries for five minutes. “Then I say, ‘I have to make this phone call,’ ‘I have to get someone to write this thank-you,’” she said. She misses her patients. She ran a support group for the parents of blind children all over the country, which met by teleconference. “One night,” she said, “I couldn’t take it anymore. I had to call in.”
     Won’t the complaints of her therapy patients seem trivial? “Why make a comparison?” she said. “Yes, I feel what happened to me is pretty terrible. People can complain about the smallest things, but that is their pain. Hopefully, they will never have something terrible happen to give them context.”

Virginia Considering New Rules To Commit The Mentally Ill
Chris Jenkins & Tom Jackson, Washington Post- 12/22/2007

A Virginia Supreme Court commission on mental health laws yesterday proposed loosening the state's standard for when mentally ill people should be committed to hospitals, an issue that has come to the fore since the Virginia Tech shootings last spring.
      Virginia has one of the nation's toughest standards for involuntary commitment. Under state law, a mentally ill person can be committed only if the person poses an "imminent danger to self or others." The proposal would allow a magistrate or special justice to commit a person to treatment if there is "a substantial likelihood" that the person would cause "serious physical harm to himself or herself" in the near future or could "suffer serious harm due to substantial deterioration."
     The 30-member Virginia Commission on Mental Health Law Reform was appointed in October 2006 by state Chief Justice Leroy Rountree Hassell Sr. Its work gained urgency and momentum after a student with a history of psychiatric problems shot and killed 32 people and himself April 16 at Virginia Tech. The preliminary report, which also called for expanded intervention services and other steps, largely mirrored a plan Gov. Timothy M. Kaine (D) offered last week.
     With the commission's action, all three branches of government have weighed in on fixing the state's troubled mental health system. Many of the commission's recommendations are likely to become legislative proposals when the General Assembly convenes next month, several state officials said. "This is a pivotal moment," said Sen. Janet D. Howell (D-Fairfax), a commission member. "What's unprecedented is that all three branches of government are moving in the same direction at the same time."
     Among its recommendations, the commission called for more crisis stabilization beds and expanded availability of basic mental health services for a variety of people with disorders. Many mental health advocates, lawmakers and state officials have worried for years that Virginia has provided too little funding for community mental health services.
     The commission also called for better monitoring of mentally ill people in the community. Often there is confusion over how a person who is ordered by a court to receive services should be monitored. In the case of Virginia Tech gunman Seung Hui Cho, there was confusion over who was to monitor him after he was ordered into treatment in December 2005. As a result, he never received it. The commission recommended that specific guidelines be adopted, such as listing consequences of not complying, when mentally ill people are ordered into treatment. The commission accelerated its work after the shootings. "The compelling need for change -- long recognized by people within the mental health system . . . became evident," commission Chairman Richard J. Bonnie, a University of Virginia professor of law and psychiatry, wrote in the report. "Fixing this system became imperative."
     Ensuring access to services for the mentally ill was the most important recommendation, said Mark Bodner, a special justice in Fairfax County and a member of the commission. "Without having complete access to services, most of the reforms will not be effective." The commission also proposed extending the time used to evaluate a mental patient. Virginia law allows four hours for a person to be evaluated under an emergency custody order. The commission said the period should be eight hours. If a magistrate thinks someone should be temporarily detained, the time allowed to prepare for a civil commitment hearing should be extended to four or five days, from the current period of two days, the report said. Special justices in Virginia can order someone into inpatient treatment for up to 180 days. But the commission said that period is too long. A first commitment order should not exceed 30 days, the commission said, although subsequent orders could run to 180 days.

Crack Vs. Powder Disparity Is Questioned
Associated Press, 12/24/2007

BOSTON -- During some of the bloodiest years of the drug wars of the 1980s, crack was seen as far more dangerous than powdered cocaine, and that perception was written into the sentencing laws. But now that notion is under attack like never before. Criminologists, doctors and other experts say the differences between the two forms of the drug were largely exaggerated and do not justify the way the law comes down 100 times harder on crack.
      A push to shrink the disparity in punishments got a boost last month when reduced federal sentencing guidelines went into effect for crack offenses. Then, earlier this month, the U.S. Sentencing Commission, which sets guidelines for federal cases, voted to make the reductions retroactive, allowing some 19,500 inmates, mostly black, to seek reductions in their crack sentences. Many think the changes are long overdue.
     Crack, because it is smoked and gets into the bloodstream faster than snorted cocaine, produces a more intense high and is generally considered more addictive than powdered cocaine. But experts say that difference does not warrant the 100-to-1 disparity that was written into a 1986 law that set a mandatory minimum prison term of five years for trafficking in 5 grams of crack, or less than the amount in two packets of sugar. It would take 100 times as much cocaine to get the same sentence. ''There's no scientific justification to support the current laws,'' said Dr. Nora Volkow, director of the National Institute on Drug Abuse.
     Many defense lawyers and civil rights advocates say the lopsided perception of crack versus cocaine is rooted in racism. Four out of every five crack defendants are black, while most powdered-cocaine defendants are white. While powdered cocaine became the drug of choice for middle- and upper-income Americans in the 1970s, crack emerged in the early 1980s as a much cheaper version of the same drug. In the mid-1980s, powdered cocaine was typically sold by the half-gram or gram for $50 to $100, while crack was sold as small rocks that cost as little as $5 to $10. Crack became popular in poor, largely minority urban areas, and it developed an image as a drug used mostly by violent, inner-city youths.
     ''You had politicians manipulating fear, and instead of being seen as a more direct mode of ingestion of a very old drug, it became a demonic new substance,'' said Craig Reinarman, a sociology and legal-studies professor at the University of California at Santa Cruz who edited the 1997 book ''Crack in America: Demon Drugs and Social Justice'' about the rise of crack in the 1980s.
     When crack first became popular, there was an increase in murders and other crimes associated with the drug. But the bloodshed was not necessarily the result of something inherent in crack. Instead, most of that violence was typical for what happens when any illegal drug is introduced and drug dealers with guns compete for new markets, said Dr. Alfred Blumstein, a professor of urban systems and operations research at Carnegie-Mellon University.
     Although there was already a great deal of concern about crack by 1986, the death of basketball star Len Bias in June of that year is seen as the pivotal event that spurred Congress to enact the much tougher sentences for crack offenses. Bias was a star at the University of Maryland and had just been drafted by the Boston Celtics when he died. Initial news reports incorrectly said Bias died after using crack. It wasn't until months later that one of Bias' teammates testified that he had actually snorted cocaine the night be died.
     By that time, the harsh penalties for crack crimes had already been passed by Congress, with a push from House Speaker Tip O'Neill of Massachusetts, whose Celtic-fan constituents were up in arms about Bias' death. ''Len Bias' death symbolized just how terrible this drug was,'' said Marc Mauer, executive director of The Sentencing Project, a criminal justice research and advocacy group based in Washington. ''Here you had this promising young man on the verge of a very great basketball career and his life is taken away by the evils of crack cocaine.''
     The crack scare was also fueled by medical professionals who worried that pregnant women who used the drug would give birth to a generation of babies with severe neurological damage. But the ''crack babies'' theory has been largely debunked. Dr. Harolyn Belcher, an associate professor of pediatrics at John Hopkins University School of Medicine, said there is no evidence that crack is biologically more harmful than powdered cocaine to the fetus or developing child. ''If I had a well-to-do family whose wife was at home snorting coke versus someone who is a mother who is out on the street using crack, the babies would look very similar,'' Belcher said. Belcher said children who were exposed to crack or powdered cocaine in the uterus may be at slightly higher risks for language delays and attention deficits, but she said recent studies have shown that alcohol is far more devastating to the fetus.
     John Steer, a member of the U.S. Sentencing Commission, said the commission first said in 1995 that the disparate punishments for crack and powdered cocaine defendants were not justified. ''The bottom-line conclusion is that for punishment purposes, they should be treated much more similarly than they are now. That's based upon the fact that in the real world, they are not as different overall as was initially thought,'' Steer said. The reductions in the recommended sentences for crack offenses went into effect Nov. 1, but the guidelines do not affect the minimum mandatory sentences, which only Congress can change.