Noteworthy News Articles on Mental Health Topics, January 1-4, 2007



Virginia Seeking Ways to Prevent Sexual Assaults
Candace Rondeaux, Washington Post- 1/1/2006

It happens in Virginia practically every day. Hundreds of thousands of women and men across the state have been sexually assaulted, according to a panel of experts recently appointed by Gov. Timothy M. Kaine (D) to lead a new statewide commission on sexual violence. Commission co-chairs John W. Marshall, the secretary of public safety, and Marilyn B. Tavenner, secretary of health and human resources, said that after several years of passing laws aimed at cracking down on sexual predators, it's time for the state to turn its attention to victims of sexual crimes. "It sounds good to have a place to send those that commit these crimes, but wouldn't it be better if we could prevent these crimes from happening and also help get treatment for the victims?" Tavenner said at the commission's first meeting in Richmond last month.
      Commission members include sexual assault survivors, law enforcement officials, legislators, advocates and clergy. The group's goal is to identify holes in the state's services for sex assault victims and review possible legislative fixes that could fill gaps in treatment and provide other assistance to victims. The commission will meet several times over the coming months and issue a report next year.
      Although a 2003 survey conducted by Virginia Commonwealth University found that one in four women and one in eight men in Virginia have been victims of sexual violence, sexual assaults are vastly underreported in the state. The survey found that only 12 percent of female victims and 7 percent of male victims reported their assaults to police, said Rebecca K. Odor, director of sexual and domestic violence prevention for the Virginia Department of Health.
     Sexual assault counselors, prosecutors and others agreed that one way to increase reporting is to expand and enhance overburdened resources and services for victims. Virginia has 37 sexual crisis centers, so some rape victims in rural areas have to drive 50 to 60 miles to reach one. Such obstacles can deter victims from filing a police report, and that needs to change, Marshall said. "I think it's important to make a very difficult process less complex and prevent obstacles from getting in the way of what victims need," Marshall said.
     Several speakers at the meeting said a shortage of forensic nurse examiners also hampers reporting and prosecution of sex crimes. Forensic nurses specialize in dealing with victims of sexual assault, comforting patients, collecting valuable physical evidence in rape kits and providing information about injuries and a victim's status immediately after a sexual assault. Bonnie Price, a sexual assault nurse at St. Mary's Hospital in Richmond and president of the Virginia chapter of the International Association of Forensic Nurses, said she has seen terrible injuries from sex assault cases and understands why victims often are afraid to seek the prosecution of their abusers. "I've seen everything. I've seen horrific assaults. I've seen terrible dog bites. I've seen stabbings, burns," Price said. "Many times it's a domestic situation, too, where a husband or a boyfriend is involved, and if you have a woman that's involved in a sexual violence case, you can bet they're not real gentle with the kids." Price said repeated exposure to accounts of such violence, plus long and often unpredictable hours, can make for a high burnout rate among forensic nurses.
     Many younger nurses are initially attracted to the specialty, but they soon leave when they learn that certification requires hundreds of hours of training. The shortage of nurses is also acute because it can be costly to keep them on staff full time, Price said. "If you have a small rural hospital, they only have one or two sexual assaults a year, so it's hard to convince administrators to spend the money to put a nurse on staff," Price said. "Yet, you would never consider not having a fireman available 24 hours a day even though in a lot of places you don't get a fire every day. So we should be thinking that way about forensic nurses." An interim report on the commission's work is expected in September.



Free Will: Now You Have It, Now You Don’t
Dennis Overbye, New York Times- 1/2/2007

I was a free man until they brought the dessert menu around. There was one of those molten chocolate cakes, and I was suddenly being dragged into a vortex, swirling helplessly toward caloric doom, sucked toward the edge of a black (chocolate) hole. Visions of my father’s heart attack danced before my glazed eyes. My wife, Nancy, had a resigned look on her face. The outcome, endlessly replayed whenever we go out, is never in doubt, though I often cover my tracks by offering to split my dessert with the table. O.K., I can imagine what you’re thinking. There but for the grace of God.
       Having just lived through another New Year’s Eve, many of you have just resolved to be better, wiser, stronger and richer in the coming months and years. After all, we’re free humans, not slaves, robots or animals doomed to repeat the same boring mistakes over and over again. As William James wrote in 1890, the whole “sting and excitement” of life comes from “our sense that in it things are really being decided from one moment to another, and that it is not the dull rattling off of a chain that was forged innumerable ages ago.” Get over it, Dr. James. Go get yourself fitted for a new chain-mail vest. A bevy of experiments in recent years suggest that the conscious mind is like a monkey riding a tiger of subconscious decisions and actions in progress, frantically making up stories about being in control.
     As a result, physicists, neuroscientists and computer scientists have joined the heirs of Plato and Aristotle in arguing about what free will is, whether we have it, and if not, why we ever thought we did in the first place. “Is it an illusion? That’s the question,” said Michael Silberstein, a science philosopher at Elizabethtown College in Maryland. Another question, he added, is whether talking about this in public will fan the culture wars. “If people freak at evolution, etc.,” he wrote in an e-mail message, “how much more will they freak if scientists and philosophers tell them they are nothing more than sophisticated meat machines, and is that conclusion now clearly warranted or is it premature?”
     Daniel C. Dennett, a philosopher and cognitive scientist at Tufts University who has written extensively about free will, said that “when we consider whether free will is an illusion or reality, we are looking into an abyss. What seems to confront us is a plunge into nihilism and despair.” Mark Hallett, a researcher with the National Institute of Neurological Disorders and Stroke, said, “Free will does exist, but it’s a perception, not a power or a driving force. People experience free will. They have the sense they are free. “The more you scrutinize it, the more you realize you don’t have it,” he said.
     That is hardly a new thought. The German philosopher Arthur Schopenhauer said, as Einstein paraphrased it, that “a human can very well do what he wants, but cannot will what he wants.” Einstein, among others, found that a comforting idea. “This knowledge of the non-freedom of the will protects me from losing my good humor and taking much too seriously myself and my fellow humans as acting and judging individuals,” he said.
     How comforted or depressed this makes you might depend on what you mean by free will. The traditional definition is called “libertarian” or “deep” free will. It holds that humans are free moral agents whose actions are not predetermined. This school of thought says in effect that the whole chain of cause and effect in the history of the universe stops dead in its tracks as you ponder the dessert menu. At that point, anything is possible. Whatever choice you make is unforced and could have been otherwise, but it is not random. You are responsible for any damage to your pocketbook and your arteries.
     “That strikes many people as incoherent,” said Dr. Silberstein, who noted that every physical system that has been investigated has turned out to be either deterministic or random. “Both are bad news for free will,” he said. So if human actions can’t be caused and aren’t random, he said, “It must be — what — some weird magical power?” People who believe already that humans are magic will have no problem with that. But whatever that power is — call it soul or the spirit — those people have to explain how it could stand independent of the physical universe and yet reach from the immaterial world and meddle in our own, jiggling brain cells that lead us to say the words “molten chocolate.”
     A vote in favor of free will comes from some physicists, who say it is a prerequisite for inventing theories and planning experiments. That is especially true when it comes to quantum mechanics, the strange paradoxical theory that ascribes a microscopic randomness to the foundation of reality. Anton Zeilinger, a quantum physicist at the University of Vienna, said recently that quantum randomness was “not a proof, just a hint, telling us we have free will.” Is there any evidence beyond our own intuitions and introspections that humans work that way?

Two Tips of the Iceberg
In the 1970s, Benjamin Libet, a physiologist at the University of California, San Francisco, wired up the brains of volunteers to an electroencephalogram and told the volunteers to make random motions, like pressing a button or flicking a finger, while he noted the time on a clock. Dr. Libet found that brain signals associated with these actions occurred half a second before the subject was conscious of deciding to make them. The order of brain activities seemed to be perception of motion, and then decision, rather than the other way around. In short, the conscious brain was only playing catch-up to what the unconscious brain was already doing. The decision to act was an illusion, the monkey making up a story about what the tiger had already done.
      Dr. Libet’s results have been reproduced again and again over the years, along with other experiments that suggest that people can be easily fooled when it comes to assuming ownership of their actions. Patients with tics or certain diseases, like chorea, cannot say whether their movements are voluntary or involuntary, Dr. Hallett said. In some experiments, subjects have been tricked into believing they are responding to stimuli they couldn’t have seen in time to respond to, or into taking credit or blame for things they couldn’t have done.
     Take, for example, the “voodoo experiment” by Dan Wegner, a psychologist at Harvard, and Emily Pronin of Princeton. In the experiment, two people are invited to play witch doctor. One person, the subject, puts a curse on the other by sticking pins into a doll. The second person, however, is in on the experiment, and by prior arrangement with the doctors, acts either obnoxious, so that the pin-sticker dislikes him, or nice. After a while, the ostensible victim complains of a headache. In cases in which he or she was unlikable, the subject tended to claim responsibility for causing the headache, an example of the “magical thinking” that makes baseball fans put on their rally caps. “We made it happen in a lab,” Dr. Wegner said. Is a similar sort of magical thinking responsible for the experience of free will? “We see two tips of the iceberg, the thought and the action,” Dr. Wegner said, “and we draw a connection.”
      But most of the action is going on beneath the surface. Indeed, the conscious mind is often a drag on many activities. Too much thinking can give a golfer the yips. Drivers perform better on automatic pilot. Fiction writers report writing in a kind of trance in which they simply take dictation from the voices and characters in their head, a grace that is, alas, rarely if ever granted nonfiction writers. Naturally, almost everyone has a slant on such experiments and whether or not the word “illusion” should be used in describing free will. Dr. Libet said his results left room for a limited version of free will in the form of a veto power over what we sense ourselves doing. In effect, the unconscious brain proposes and the mind disposes. In a 1999 essay, he wrote that although this might not seem like much, it was enough to satisfy ethical standards. “Most of the Ten Commandments are ‘do not’ orders,” he wrote. But that might seem a pinched and diminished form of free will.

Good Intentions
Dr. Dennett, the Tufts professor, is one of many who have tried to redefine free will in a way that involves no escape from the materialist world while still offering enough autonomy for moral responsibility, which seems to be what everyone cares about. The belief that the traditional intuitive notion of a free will divorced from causality is inflated, metaphysical nonsense, Dr. Dennett says reflecting an outdated dualistic view of the world.
      Rather, Dr. Dennett argues, it is precisely our immersion in causality and the material world that frees us. Evolution, history and culture, he explains, have endowed us with feedback systems that give us the unique ability to reflect and think things over and to imagine the future. Free will and determinism can co-exist. “All the varieties of free will worth having, we have,” Dr. Dennett said. “We have the power to veto our urges and then to veto our vetoes,” he said. “We have the power of imagination, to see and imagine futures.” In this regard, causality is not our enemy but our friend, giving us the ability to look ahead and plan. “That’s what makes us moral agents,” Dr. Dennett said. “You don’t need a miracle to have responsibility.”
     Other philosophers disagree on the degree and nature of such “freedom.” Their arguments partly turn on the extent to which collections of things, whether electrons or people, can transcend their origins and produce novel phenomena. These so-called emergent phenomena, like brains and stock markets, or the idea of democracy, grow naturally in accordance with the laws of physics, so the story goes. But once they are here, they play by new rules, and can even act on their constituents, as when an artist envisions a teapot and then sculpts it — a concept sometimes known as “downward causation.” A knowledge of quarks is no help in predicting hurricanes — it’s physics all the way down. But does the same apply to the stock market or to the brain? Are the rules elusive just because we can’t solve the equations or because something fundamentally new happens when we increase numbers and levels of complexity?
     Opinions vary about whether it will ultimately prove to be physics all the way down, total independence from physics, or some shade in between, and thus how free we are. Dr. Silberstein, the Elizabethtown College professor, said, “There’s nothing in fundamental physics by itself that tells us we can’t have such emergent properties when we get to different levels of complexities.” He waxed poetically as he imagined how the universe would evolve, with more and more complicated forms emerging from primordial quantum muck as from an elaborate computer game, in accordance with a few simple rules: “If you understand, you ought to be awestruck, you ought to be bowled over.”
     George R. F. Ellis, a cosmologist at the University of Cape Town, said that freedom could emerge from this framework as well. “A nuclear bomb, for example, proceeds to detonate according to the laws of nuclear physics,” he explained in an e-mail message. “Whether it does indeed detonate is determined by political and ethical considerations, which are of a completely different order.”
     I have to admit that I find these kind of ideas inspiring, if not liberating. But I worry that I am being sold a sort of psychic perpetual motion machine. Free wills, ideas, phenomena created by physics but not accountable to it. Do they offer a release from the chains of determinism or just a prescription for a very intricate weave of the links?And so I sought clarity from mathematicians and computer scientists. According to deep mathematical principles, they say, even machines can become too complicated to predict their own behavior and would labor under the delusion of free will.
      If by free will we mean the ability to choose, even a simple laptop computer has some kind of free will, said Seth Lloyd, an expert on quantum computing and professor of mechanical engineering at the Massachusetts Institute of Technology. Every time you click on an icon, he explained, the computer’s operating system decides how to allocate memory space, based on some deterministic instructions. But, Dr. Lloyd said, “If I ask how long will it take to boot up five minutes from now, the operating system will say ‘I don’t know, wait and see, and I’ll make decisions and let you know.’ ”
     Why can’t computers say what they’re going to do? In 1930, the Austrian philosopher Kurt Gödel proved that in any formal system of logic, which includes mathematics and a kind of idealized computer called a Turing machine, there are statements that cannot be proven either true or false. Among them are self-referential statements like the famous paradox stated by the Cretan philosopher Epimenides, who said that all Cretans are liars: if he is telling the truth, then, as a Cretan, he is lying.
     One implication is that no system can contain a complete representation of itself, or as Janna Levin, a cosmologist at Barnard College of Columbia University and author of the 2006 novel about Gödel, “A Madman Dreams of Turing Machines,” said: “Gödel says you can’t program intelligence as complex as yourself. But you can let it evolve. A complex machine would still suffer from the illusion of free will.”
     Another implication is there is no algorithm, or recipe for computation, to determine when or if any given computer program will finish some calculation. The only way to find out is to set it computing and see what happens. Any way to find out would be tantamount to doing the calculation itself. “There are no shortcuts in computation,” Dr. Lloyd said. That means that the more reasonably you try to act, the more unpredictable you are, at least to yourself, Dr. Lloyd said. Even if your wife knows you will order the chile rellenos, you have to live your life to find out. To him that sounds like free will of a sort, for machines as well as for us. Our actions are determined, but so what? We still don’t know what they will be until the waiter brings the tray. That works for me, because I am comfortable with so-called physicalist reasoning, and I’m always happy to leverage concepts of higher mathematics to cut through philosophical knots.

The Magician’s Spell
So what about Hitler? The death of free will, or its exposure as a convenient illusion, some worry, could wreak havoc on our sense of moral and legal responsibility. According to those who believe that free will and determinism are incompatible, Dr. Silberstein said in an e-mail message, it would mean that “people are no more responsible for their actions than asteroids or planets.” Anything would go.
      Dr. Wegner of Harvard said: “We worry that explaining evil condones it. We have to maintain our outrage at Hitler. But wouldn’t it be nice to have a theory of evil in advance that could keep him from coming to power?” He added, “A system a bit more focused on helping people change rather than paying them back for what they’ve done might be a good thing.” Dr. Wegner said he thought that exposing free will as an illusion would have little effect on people’s lives or on their feelings of self-worth. Most of them would remain in denial. “It’s an illusion, but it’s a very persistent illusion; it keeps coming back,” he said, comparing it to a magician’s trick that has been seen again and again. “Even though you know it’s a trick, you get fooled every time.The feelings just don’t go away.”
     In an essay about free will in 1999, Dr. Libet wound up quoting the writer Isaac Bashevis Singer, who once said in an interview with the Paris Review, “The greatest gift which humanity has received is free choice. It is true that we are limited in our use of free choice. But the little free choice we have is such a great gift and is potentially worth so much that for this itself, life is worthwhile living.” I could skip the chocolate cake, I really could, but why bother? Waiter!

Advocates for rape victims are blasting a decision by the state's highest court that they say will make it easier for defense lawyers to review confidential mental health records of alleged victims of sexual assault. Susan Vickers , executive director of the Victim Rights Law Center, said yesterday that guidelines announced Friday by the Supreme Judicial Court will discourage rape victims from getting counseling for fear that their assailants' lawyers will seek records of therapy sessions to discredit them. The unanimous ruling is "virtually an open door for the defense into rape victims' private counseling records," said Vickers, whose group provides free legal help to victims of sexual assault.
      But defense lawyers praised the ruling, saying the new guidelines better balance the rights of crime victims with those of defendants seeking evidence to establish innocence. "We know that there are false allegations of rape," said Carlene A. Pennell , a Boston appellate lawyer who challenged the current access. As a result of the ruling, she said, "defense attorneys are going to be able to pick up on things in records that they might never have seen before and that will potentially free their clients."
     The SJC issued the new guidelines in a decision that reversed the January 2004 conviction of Sean Dwyer, of Bellingham. Dwyer, now 26, was convicted of rape of a child by force and indecent assault and battery on a child under 14 after a female cousin accused him and another male cousin of repeatedly sexually assaulting her over several years. He was serving four to six years in prison, where he is still being held because the court did not order him released . Pennell said she will seek to have him released on his own recognizance this week.
     The high court cited a variety of reasons Dwyer deserves a new trial, including ineffective assistance by his counsel and errors by the trial judge. But Pennell also convinced the SJC that Dwyer, who maintains he is innocent, should have been able to review the victim's therapy records, which, Pennell argued, contradicted some of her allegations. Norfolk District Attorney William R. Keating said that his office is reviewing the Dwyer case.
     The SJC used the case to revise its guidelines for providing defense lawyers with access to confidential records kept by therapists and rape crisis counselors after a rape has been alleged -- an issue the court has examined before. In 1993 and in 1996, the SJC established protocols that advocates for rape victims said provided protections that were desperately needed. But several defense lawyers protested that the pendulum had swung too far.
     Under the new guidelines, defense lawyers, rather than judges, will review subpoenaed therapy records to determine if they might help their clients. Defense lawyers said this makes more sense because judges may not recognize the significance of details in records, something the court itself acknowledged in its decision. However, the guidelines forbid defense lawyers from copying the records or distributing them, even to their clients, without the court's permission. Still, Gina Scaramella , executive director for the Boston Area Rape Crisis Center, said she feared the guidelines would discourage rape victims from seeking counseling. As it is, she said, only about one in five rape victims who come to her center have reported the crime to police. Vickers said advocates for rape victims will consider asking the Legislature to pass a law tightening access to such records.



Drinking Risks Lurk for Women
Tara Parker-Pope, Wall Street Journal- 1/3/2007

Toasting the new year with an alcoholic beverage is probably good for your health--if you're a man. If you're a woman, the impact of that glass of alcohol is far more confusing. Overall, science shows that for both men and women, drinking a small amount of alcohol each day is better for you than never drinking at all, and it likely lowers your risk of heart attack, diabetes and mental decline. But for women, moderate alcohol consumption also carries risks you may not know about.
Even small amounts of alcohol consumption are linked with higher risk for breast cancer. Women who drive after drinking are at higher risk than men of dying in a car accident, even at similar bloodalcohol concentrations. And women are at higher risk than men for serious health problems related to alcohol abuse, including liver, brain and heart damage.
     The reasons alcohol appears to affect men and women so differently are complex. Women achieve higher concentrations of alcohol in the blood and become more impaired than men after drinking equivalent amounts of alcohol, even when taking into account differences in height and weight. This is likely due to the fact that a woman's stomach empties more slowly than a man's, giving the body more time to absorb the same amount of alcohol, many doctors say.
     Lab studies suggest there may be gender differences in how alcohol affects the response to visual cues and other tasks related to driving performance, which may explain why it's more risky for a woman. to drink and drive. And alcohol also may alter a woman's natural estrogen levels, which can influence her risk for a number of health concerns.
     One of the most troubling effects of alcohol is that even small amounts increase a woman's risk for breast cancer. A pooled analysis by Harvard researchers of all the data on alcohol and breast cancer shows that a woman's risk increases by about 9 percent for every 10 grams of alcohol a day that she drinks. In the U.S., the typical serving of 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor delivers about 12 grams to 14 grams of alcohol, according to the Harvard School of Public Health. That means a woman who consumes just two drinks a day has about a 27 percent higher risk of getting breast cancer than a woman who doesn't drink alcohol.
It's worth noting that the absolute risk of alcohol consumption to an individual woman is slight.      Consider that the typical 50-year-old woman has a five-year breastcancer risk of about 2.1 percent--so two drinks a day would boost her risk to only about 2.7 percent. "It's not a huge difference to an individual woman, but it could translate into many thousands of breast cancers in a year that would not have otherwise occurred," says Walter Willett, epidemiology and nutrition professor at the Harvard School for Public Health. The alcohol-health equation "is definitely more complicated in women because of the relationship with breast cancer," Willett says.
     For many women, similar risks from other choices have proved unacceptable. For instance, recent studies have shown a woman's risk of breast cancer increases 9 percent to 24 percent if she uses the menopause hormones estrogen and progestin, a concern that has prompted millions of women to abandon hormone treatments for menopause.
     Exactly why alcohol consumption alters a woman's breast-cancer risk isn't entirely clear. Several studies have shown that alcohol can, raise a woman's natural estrogen levels, and high natural estrogen is linked with higher breast-cancer risk Alcohol may enhance the negative effects of natural estrogen on the breast.
     While the breast-cancer risk sounds scary, it has to be weighed against other health benefits of alcohol. Women who consume about one drink a day have a 40 percent lower risk for heart attack, and a 70 percent lower risk of stroke. In the wellknown Nurses Health Study, which now follows more than 120,000 women, those with diabetes who drank at least a halfserving of alcohol a day had a 52 percent lower risk for heart attack than nondrinkers.
     Studies also show that moderate alcohol use might protect against osteoporosis, a serious health problem that leads to brittle bones and risky fractures and affects far more women than men. Women who drink six to seven servings of alcohol a week typically have higher bone density than nondrinkers. The higher bone density is likely explained by the estrogen-enhancing effects of alcohol, doctors say. As a result, women need to take into account family history and personal concerns. A woman with a strong family history of breast cancer or someone with a family history of alcoholism might decide to forgo alcohol altogether. But someone without those added risk factors who is worried about. heart attack, diabetes or osteoporosis might consider drinking small amounts of alcohol daily.
     While there's disagreement about whether any level of alcohol is good for a woman, most authorities agree that women should limit themselves to one-half to one drink a day to get the maximum health benefits of drinking and minimize the risks. For men, the maximum health benefit comes with one to two drinks a day. And women who do choose to drink should also take a multivitamin that contains folic acid. Recent studies show folic acid seems to blunt the harmful effects of alcohol on the breast and lowers risk of breast cancer to near that of a woman who doesn't drink alcohol. "It's all about deciding what's best for you as an individual," says Sherry Marts, vice president for scientific affairs for the Society for Women's Health Research in Washington. "For women, whether to drink alcohol is another one of those risk benefit decisions we make every day."


This Is Your Brain on Drugs, Dad
Mike Males, New York Times- 1/3/2007

When releasing last week’s Monitoring the Future survey on drug use, John P. Walters, the director of the Office of National Drug Control Policy, boasted that “broad” declines in teenage drug use promise “enormous beneficial consequences not only for our children now, but for the rest of their lives.” Actually, anybody who has looked carefully at the report and other recent federal studies would see a dramatically different picture: skyrocketing illicit drug abuse and related deaths among teenagers and adults alike.
      While Monitoring the Future, an annual study that depends on teenagers to self-report on their behavior, showed that drug use dropped sharply in the last decade, the National Center for Health Statistics has reported that teenage deaths from illicit drug abuse have tripled over the same period. This reverses 25 years of declining overdose fatalities among youths, suggesting that teenagers are now joining older generations in increased drug use.
     What the Monitoring the Future report does have right is that teenagers remain the least part of America’s burgeoning drug abuse crisis. Today, after 20 years, hundreds of billions of dollars, and millions of arrests and imprisonments in the war on drugs, America’s rate of drug-related deaths, hospital emergencies, crime and social ills stand at record highs. According to the Centers for Disease Control and Prevention, the number of Americans dying from the abuse of illegal drugs has leaped by 400 percent in the last two decades, reaching a record 28,000 in 2004. The F.B.I. reported that drug arrests reached an all-time high of 1.8 million in 2005. The Drug Abuse Warning Network, a federal agency that compiles statistics on hospital emergency cases caused by illicit drug abuse, says that number rose to 940,000 in 2004 — a huge increase over the last quarter century.
     Why are so few Americans aware of these troubling trends? One reason is that today’s drug abusers are simply the “wrong” group. As David Musto, a psychiatry professor at Yale and historian of drug abuse, points out, wars on drugs have traditionally depended on “linkage between a drug and a feared or rejected group within society.” Today, however, the fastest-growing population of drug abusers is white, middle-aged Americans. This is a powerful mainstream constituency, and unlike with teenagers or urban minorities, it is hard for the government or the news media to present these drug users as a grave threat to the nation.
     Among Americans in their 40s and 50s, deaths from illicit-drug overdoses have risen by 800 percent since 1980, including 300 percent in the last decade. In 2004, American hospital emergency rooms treated 400,000 patients between the ages 35 and 64 for abusing heroin, cocaine, methamphetamine, marijuana, hallucinogens and “club drugs” like ecstasy. Equally surprising, graying baby boomers have become America’s fastest-growing crime scourge. The F.B.I. reports that last year the number of Americans over the age of 40 arrested for violent and property felonies rose to 420,000, up from 170,000 in 1980. Arrests for drug offenses among those over 40 rose to 360,000 last year, up from 22,000 in 1980. The Bureau of Justice Statistics found that 440,000 Americans ages 40 and older were incarcerated in 2005, triple the number in 1990.
     Yet drug officials seem fixated on paper-and-pencil surveys of drug use by teens. In releasing its survey last week, the Office of Drug Control Policy trumpeted that “America’s balanced strategy to reduce drug use is working.” Representative Mark Souder, an Indiana Republican who has been a top supporter of federal antidrug efforts, says “the Bush administration is doing very well” on this front because “drug use, particularly among young people, is down.” But, some may say, don’t teenage drug use rates predict future drug problems? To the contrary: 30 years of experience shows that fluctuations in the percentage of youths who report using drugs on surveys has almost nothing to do with the harm that drug abuse causes (addiction, disease, injury, death, crime, family and community distress), either in adolescence or later in life.
     I compared teenage drug use trends reported annually by Monitoring the Future since the 1970s with trends for other behaviors and with federal crime, health and education statistics. In years in which a higher percentage of high school seniors told the survey takers they used illicit drugs, teenagers consistently reported and experienced lower rates of crime, murder, drug-related hospital emergencies and deaths, suicides, H.I.V. infection, school dropouts, delinquency, pregnancy, violence, theft in and outside of school, and fights with parents, employers and teachers. The data also contradict Mr. Walters’s claim that generations reporting lower rates of drug use enjoy “less addiction, less suffering, less crime, lower health costs and higher achievement.” For example, baby boomers rarely used illegal drugs as youths.
     In 1972, the University of Michigan researchers who carry out Monitoring the Future found that just 22 percent of high school seniors had ever used illegal drugs, compared to 48 percent of the class of 2005. Yet as that generation has aged, it has been afflicted by drug abuse and its related ills — overdoses, hospitalizations, drug-related crime — at far higher rates than those experienced by later generations at the same ages.
     It’s time to end the obsession with hyping teenage drug use. The meaningless surveys that policy makers now rely on should be replaced with a comprehensive “drug abuse index” that pulls together largely ignored data on drug-related deaths, hospital emergencies, crime, diseases and similar practical measures. A good model is the California Department of Alcohol and Drug Programs’ fledgling drug abuse index, which I helped compile and which aims to pinpoint which populations and areas are most harmed by drugs, both legal and illicit.
     Few experts would have suspected that the biggest contributors to California’s drug abuse, death and injury toll are educated, middle-aged women living in the Central Valley and rural areas, while the fastest-declining, lowest-risk populations are urban black and Latino teenagers. Yet the index found exactly that. These are the sorts of trends we need to understand if we are to design effective policies. The United States’ drug abuse crisis has exploded out of control. Scientifically designed strategies are urgently needed to target the manifest drug-caused damage that current policies are failing miserably to address.
     Mike Males is a senior researcher at the Center on Juvenile and Criminal Justice.

Mother Wonders if Drug Helped Kill Son
Alex Berenson, New York Times- 1/4/2007

At first, the psychiatric drug Zyprexa may have saved John Eric Kauffman’s life, rescuing him from his hallucinations and other symptoms of acute psychosis. But while taking Zyprexa for five years, Mr. Kauffman, who had been a soccer player in high school and had maintained a normal weight into his mid-30s, gained about 80 pounds. He was found dead on March 27 at his apartment in Decatur, Ga., just outside Atlanta. An autopsy showed that the 41-year-old Mr. Kauffman, who was 5 feet 10 inches, weighed 259 pounds when he died. His mother believes that the weight he gained while on Zyprexa contributed to the heart disease that killed him. Eli Lilly, which makes Zyprexa, said in a statement that Mr. Kauffman had other medical conditions that could have led to his death and that “Zyprexa is a lifesaving drug.” The company said it was saddened by Mr. Kauffman’s death.
      No one would say Mr. Kauffman had an easy life. Like millions of other Americans, he suffered from bipolar disorder, a mental illness characterized by periods of depression and mania that can end with psychotic hallucinations and delusions. After his final breakdown, in 2000, a hospital in Georgia put Mr. Kauffman on Zyprexa, a powerful antipsychotic drug. Like other medicines Mr. Kauffman had taken, the Zyprexa stabilized his moods. For the next five and a half years, his illness remained relatively controlled. But his weight ballooned — a common side effect of Zyprexa. His mother, Millie Beik, provided information about Mr. Kauffman, including medical records, to The New York Times.
     For many patients, the side effects of Zyprexa are severe. Connecting them to specific deaths can be difficult, because people with mental illness develop diabetes and heart disease more frequently than other adults. But in 2002, a statistical analysis conducted for Eli Lilly found that compared with an older antipsychotic drug, Haldol, patients taking Zyprexa would be significantly more likely to develop heart disease, based on the results of a clinical trial comparing the two drugs. Exactly how many people have died as a result of Zyprexa’s side effects, and whether Lilly adequately disclosed those risks, are central issues in the thousands of product-liability lawsuits pending against the company, and in state and federal investigations. Because Mr. Kauffman also smoked heavily for much of his life, and led a sedentary existence in his last years, no one can be sure that the weight he gained while on Zyprexa caused his heart attack.
     Zyprexa, taken by about two million people worldwide last year, is approved to treat schizophrenia and bipolar disorder. Besides causing severe weight gain, it increases blood sugar and cholesterol in many people who take it, all risk factors for heart disease. In a statement responding to questions for this article, Lilly said it had reported the death of Mr. Kauffman to federal regulators, as it is legally required to do. The company said it could not comment on the specific causes of his death but noted that the report it submitted to regulators showed that he had “a complicated medical history that may have led to this unfortunate outcome.” “Zyprexa,” Lilly’s statement said, “is a lifesaving drug and it has helped millions of people worldwide with schizophrenia and bipolar disorder regain control of their lives.”
     Documents provided to The Times by a lawyer who represents mentally ill patients show that Eli Lilly, which makes Zyprexa, has sought for a decade to play down those side effects — even though its own clinical trials show the drug causes 16 percent of the patients who take Zyprexa to gain more than 66 pounds after a year. Eli Lilly now faces federal and state investigations about the way it marketed Zyprexa. Last week — after articles in The Times about the Zyprexa documents — Australian drug regulators ordered Lilly to provide more information about what it knew, and when, about Zyprexa’s side effects.
     Lilly says side effects from Zyprexa must be measured against the potentially devastating consequences of uncontrolled mental illness. But some leading psychiatrists say that because of its physical side effects Zyprexa should be used only by patients who are acutely psychotic and that patients should take other medicines for long-term treatment. “Lilly always downplayed the side effects,” said Dr. S. Nassir Ghaemi, a specialist on bipolar disorder at Emory University in Atlanta. “They’ve tended to admit weight gain, but in various ways they’ve minimized its relevance.” Dr. Ghaemi said Lilly had also encouraged an overly positive view of its studies on the effectiveness of Zyprexa as a long-term treatment for bipolar disorder. There is more data to support the use of older and far cheaper drugs like lithium, he said. Last year, Lilly paid $700 million to settle 8,000 lawsuits from people who said they had developed diabetes or other diseases after taking Zyprexa. Thousands more suits are still pending.
     But Ms. Beik is not suing Lilly. She simply wants her son’s case to be known, she said, because she considers it a cautionary tale about Zyprexa’s tendency to cause severe weight gain. “I don’t think that price should be paid,” she said. Mr. Kauffman’s story, like that of many people with severe mental illness, is one of a slow and steady decline. Growing up in DeKalb, Ill., west of Chicago, he acted in school plays and was a goalie on the soccer team. A photograph taken at his prom in 1982 shows a handsome young man with a messy mop of dark brown hair.
     But in 1984, in his freshman year at Beloit College in Wisconsin, Mr. Kauffman suffered a breakdown and was found to have the most severe form of bipolar disorder. He returned home and, after medication stabilized his condition, enrolled in Northern Illinois University. He graduated from there in 1989 with a degree in political science. For the next year, he worked as a bus driver ferrying senior citizens around DeKalb. In a short local newspaper profile of him in 1990, he listed his favorite book as “Catch-22,” his favorite musician as Elvis Costello, and his favorite moment in life as a soccer game in which he had made 47 saves. A few months later, he followed his mother and stepfather to Atlanta and enrolled in Georgia State University, hoping to earn a master’s degree in political science. “He wanted so much to become a political science professor,” Ms. Beik said.
     But trying to work while attending school proved to be more stress than Mr. Kauffman could handle, Ms. Beik said. In 1992, he suffered his most severe psychotic breakdown. He traveled around the country, telling his parents he intended to work on a political campaign. Instead, he spent much of the year homeless, and his medical records show that he was repeatedly admitted to hospitals. Mr. Kauffman returned home at the end of 1992, but he never completely recovered, Ms. Beik said. He never worked again, and he rarely dated. In 1994, the Social Security Administration deemed him permanently disabled and he began to receive disability payments. He filed for bankruptcy that year. According to the filing, he had $110 in assets — $50 in cash, a $10 radio and $50 in clothes — and about $10,000 in debts.
     From 1992 to 2000, Mr. Kauffman did not suffer any psychotic breakdowns, according to his mother. During that period, he took lithium, a mood stabilizer commonly prescribed for people with bipolar disorder, and Stelazine, an older antipsychotic drug. With the help of his parents, he moved to an apartment complex that offered subsidized housing. But in late 1999, a psychiatrist switched him from lithium, which can cause kidney damage, to Depakote, another mood stabilizer. In early 2000, Mr. Kauffman stopped taking the Depakote, according to his mother.
     As the year went on, he began to give away his possessions, as he had in previous manic episodes, and became paranoid. During 2000, he was repeatedly hospitalized, once after throwing cans of food out of the window of his sixth-floor apartment. In August, he was institutionalized for a month at a public hospital in Georgia. There he was put on 20 milligrams a day of Zyprexa, a relatively high dose. The Zyprexa, along with the Depakote, which he was still taking, stabilized his illness. But the drugs also left him severely sedated, hardly able to talk, his mother said. “He was so tired and he slept so much,” Ms. Beik said. “He loved Shakespeare, and he was an avid reader in high school. At the end of his life, it was so sad, he couldn’t read a page.” In addition, his health and hygiene deteriorated. In the 1990 newspaper profile, Mr. Kauffman had called himself extremely well-organized. But after 2000, he became slovenly, his mother said. He spent most days in his apartment smoking.
     A therapist who treated Mr. Kauffman while he was taking Zyprexa recalls him as seeming shy and sad. “He was intelligent enough to have the sense that his life hadn’t panned out in a normal fashion,” the therapist said in an interview. “He always reminded me of a person standing outside a house with a party going on, looking at it.” The therapist spoke on the condition that her name not be used because of rules covering the confidentiality of discussions with psychiatric patients.
     As late as 2004, Mr. Kauffman prepared a simple one-page résumé of his spotty work history — evidence that he perhaps hoped to re-enter the work force. He never did. As Mr. Kauffman’s weight increased from 2000 to 2006, he began to suffer from other health problems, including high blood pressure. In December 2005, a doctor ordered him to stop smoking, and he did. But in early 2006, he began to tell his parents that he was having hallucinations of people appearing in his apartment.
     On March 16, a psychiatrist increased his dose of Zyprexa to 30 milligrams, a very high level. That decision may have been a mistake, doctors say. Ending smoking causes the body to metabolize Zyprexa more slowly, and so Mr. Kauffman might have actually needed a lower rather than higher dose. A few days later, Mr. Kauffman spoke to his mother for the last time. By March 26, they had been out of contact for several days. That was unusual, and she feared he might be in trouble. She drove to his apartment building in Decatur the next day and convinced the building’s manager to check Mr. Kauffman’s apartment. He was dead, his body already beginning to decompose. An autopsy paid for by his mother and conducted by a private forensic pathologist showed he had died of an irregular heartbeat — probably, the report said, as the result of an enlarged heart caused by his history of high blood pressure.
     Ms. Beik acknowledged she cannot be certain that Zyprexa caused her son’s death. But the weight gain it produced was most likely a contributing factor, she said. And she is angry that Eli Lilly played down the risks of Zyprexa. The company should have been more honest with doctors, as well as the millions of people who take Zyprexa, she said. Instead Lilly has marketed Zyprexa as safer and more effective than older drugs, despite scant evidence, psychiatrists say. Ms. Beik notes that Stelazine — an older drug that is no longer widely used even though a federally financed clinical trial showed it works about as well as Zyprexa — stabilized Mr. Kauffman’s illness for eight years without causing him to gain weight. “He was on other drugs that worked,” she said.



Medication Mistakes Far Too Common
Jane Brody, New York Times- 1/4/2006

The elderly aunt of a colleague was sharp as a tack, living on her own and busy doing everything a healthy woman in her 80s might want to do. That is, until she went to the pharmacy to pick up a refill of methazolamide, the pills she took to control her glaucoma, and instead was given methotrexate, a potent chemotherapy drug that suppresses immunity. The woman noticed that the color of the new pills was different from her previous pills and questioned the pharmacist, who told her they were fine. She even counted them, noting that she was short six pills. But on the pharmacist’s reassurance, she took them for a month, by which time the drug had seriously suppressed her body’s immune system. The woman developed a painful attack of shingles that she couldn’t shake off. She lapsed into a coma, and when she finally emerged, she was no longer able to care for herself.
      A similar error befell my father at a leading New York hospital. After weeks of intensive care following a massive heart attack, he was sent home with medication from the hospital pharmacy to prevent his body from rejecting his damaged heart. He was about to take the first pill when my mother noticed that the name on the vial was Mrs. Rosenberg, not Sidney Brody, and that it contained estrogen, not the prednisone my father needed.
     Medication errors are among the most common medical mistakes, injuring or killing at least 1.5 million people a year and incurring at least $3.5 billion a year in extra hospital costs alone, according to a report issued in July by the Institute of Medicine of the National Academy of Sciences. This was the institute’s second report on the subject, and the committee that compiled it stated that insufficient progress had been made since its first report, “To Err Is Human,” was issued in 1999. “We need a comprehensive approach to reducing these errors that involves not just health care organizations and federal agencies, but the industry and consumers as well,” said Linda R. Cronenwett, dean of the School of Nursing at the University of North Carolina in Chapel Hill and co-chairwoman of the institute committee.
     While consumers can do little to improve drug-prescribing procedures in organizations, they can do a lot more to protect themselves.

Know What You Are Taking
Preventing medication mishaps starts with knowing what medications you are taking — or supposed to be taking — and how they might interact with other drugs, supplements or herbal remedies you take and even the foods you eat. Far too many patients leave the doctor’s office or medical clinic with a prescription that borders on the illegible. They may have been told the category of the drug — antibiotic, for example, or painkiller — but not its name. And they may have at best a vague memory of how to take it — how much, when and with what. Rarely are they warned of possible adverse effects and what to do if they notice no improvement or a downturn in their health.
      You can help protect yourself by maintaining a list of all the drugs you take — prescription and nonprescription, vitamin-mineral supplements and herbal remedies, including the dosing schedule and amount. Bring this list with you whenever you visit the doctor and make sure it is reviewed by the health care provider. If you have ever experienced an allergic reaction to a medication, or have a food allergy, be sure to tell your health care provider before any medication is prescribed.
     When you are given a prescription, ask the name of the drug, what it is supposed to do for your condition, how much to take and how often it should be taken, whether it should be taken with food or on an empty stomach, what side effects are possible and what effects warrant a prompt call to the doctor. Also ask how the medication might interact with other remedies you take or foods you eat. And, of course, write down the answers while you are still in the doctor’s office.
     When picking up the prescription, check the name and dosing schedule against what the doctor told you. If the labels are too small to read, bring a magnifying glass or ask the pharmacist or someone with better vision to read it to you. If you have any questions, ask. It is the pharmacist’s responsibility to explain how to take the drug properly, its side effects and what to do if you experience them. The pharmacist can also provide written information about the drug. Many consumers sign a book when they pick up a prescription, not realizing that their signature means they have received needed information about the drug or that they are waiving their right to such information. When patients are too ill to obtain adequate information about their medications, a surrogate — family member, friend, or, in a hospital, a nurse, social worker or patient advocate — should obtain it for them.
     The Institute of Medicine committee noted that hospitalized patients have a right to have a surrogate with them whenever they receive medication and are unable to monitor the process themselves. Many mistakes are made when hospital personnel administer the wrong drug or the wrong dose, give the drug by the wrong means (intravenously instead of intramuscularly, for instance) or to the wrong patient. The administering nurse should always check the patient’s hospital bracelet against the name on the medication before giving it and should tell the patient the purpose for a drug each time it is administered.
     If you are scheduled for surgery or an invasive exam like a colonoscopy, make sure you ask what drugs you can or should take preoperatively and which you should stop taking. Aspirin and its over-the-counter relatives, as well as prescribed blood thinners, can result in uncontrolled bleeding during such procedures. Before leaving the hospital, ask for a list of the medications you should be taking at home. Have the provider go over the list with you and be sure you understand how much of each to take and how to take it. Again, write it down or have your surrogate write it for you.

Follow Directions
Failure to take medications according to the prescribed directions is one of the most common reasons for bad outcomes. Sometimes this results from a misunderstanding of dosage schedules. The label may say “Take one capsule every six hours” but the patient assumes, incorrectly, that this does not include the hours during sleep. Or the patient, whose native language is Spanish, may read “once” as 11 o’clock, as it could be interpreted in Spanish, instead of as one time. It is vitally important to follow warnings about possible drug or food interactions or hazards operating motorized equipment, including cars, while taking the medication. Most pharmacies now routinely place yellow warning stickers on medicine vials, and many include patient information leaflets with the drugs they dispense. It is the consumer’s job to read these and follow directions like “take with food” or “do not drink alcohol while on this drug.”
      Many consumers now check out prescription and alternative remedies on the Internet. This can be risky because most of this information is posted by lay or commercial sources, not medical experts. If you use the Web, make sure the information is provided by an official government source, such as the National Library of Medicine’s MedlinePlus program (www.medlineplus.gov), which provides easy-to-read drug information and interactive tutorials.

Saying 'No' Can Give You New Freedom
Meredith Moss, Cox News Service- 1/4/2007

Have you resolved to ditch the New Year's resolutions this time around? Perhaps it's time to consider a different approach. Instead of the typical - lose weight, get organized, exercise - maybe you deserve to think about your mental health and the emotional baggage that's weighing you down. Like the friend or relative who turns to you for solutions to every problem, and always has a problem. She calls six times a day and is a definite drain on your psyche. Perhaps this is the time to tell her you love her, but you're not a therapist.
     "You can use the New Year as a time to change your role within relationships," says psychologist Susan Newman, author of "The Book of NO: 250 Ways to Say It and Mean It and Stop People-Pleasing Forever" (McGraw-Hill, $14.95). "It could be your scatterbrained friend who can never get it together and for whom you always end up picking up the pieces. Or it could be the friend who borrows your CDs or sweaters or books and never returns them."
     While you don't want friends or family members to think you're uncaring, this may be the time to say what's on your mind And ask for what you want. Newman says other people aren't mind readers. "The next time she asks to borrow something, you might want to tell her you're sorry, but that you have a new policy and have decided not to lend your things anymore.
     It isn't necessary to be confrontational. "You don't need to have a blow-up that will sever the relationship permanently" she says. "It can be more subtle. You can just pull back, not be available. After you've said `no' a number of times, your friend will get the message."
     What about your spouse? Perhaps his idea of cleaning up the kitchen and yours are totally different. Maybe he never thinks about wiping down the counters. You'll have to spell it out. Maybe he doesn't understand that you don't mix the white clothes with the dark in the washer. You may have to demonstrate. If it's your kids, perhaps this is the time to tell them you're tired of picking up after them. Close the bedroom door, and let them know they can't drop their things all over the house. Tell them you don't want to walk in the door every day and be upset.
     Changing a relationship is freeing, Newman says, and you'll like the other person better once you've asserted yourself. Once you've rid yourself of what's draining, you'll also have more time for yourself and can begin to think about what might make you happy and give you an emotional lift.
It may be something small -- getting your nails done, changing a hair style, learning to ballroom dance, starting a book club. Laughing will make you feel better, too. Maybe you'll want to take a course at a community college. Or make a new friend who shares your interest in gardening or photography. Either will give you a new perspective. "The new year marks the beginning of a clean slate, and we feel hopeful," Newman says. "We have a whole 12 months where we can change and fix. things."

Detoxing tips
Psychologist Susan Newman offers these tips on emotional detoxing and adding personal fulfillment to your life in the New Year:
• Don't date men or women you know are trouble or with whom there is no obvious future or advantage.
• Be kinder to yourself by eliminating or scaling back time spent with people who get your adrenaline pumping, such as friends who take advantage of your good nature.
• Determine who is in your inner circle of friends, the supportive people you enjoy and who nurture you.
• Carve out time that's just for you to relax. Make that time sacred, with no exceptions unless there is an emergency.
• Plan a trip or start a fund for something you've always wanted.
• Add the word "no" to your vocabulary -- vowing to use it at least once a day.
• Recognize that guilt is a waste of time and emotional energy. People aren't thinking about you as much as you worry about what they think.