Noteworthy News Articles on Mental Health Topics, February 10-13, 2007

John Walters said that President Bush's anti-drug plan for 2007-08 is to reduce prescription drug abuse by 15 percent over three years. The administration ranks the problem second only to marijuana.

The plan singled out the pain reliever OxyContin as one of the prescription drugs most abused. It calls for more states to adopt prescription drug monitoring programs to prevent ''doctor-shopping'' to get prescriptions for more drugs.

Walters said overall use of illegal drugs among young people is down 23 percent from 2001, with 840,000 fewer teenagers using drugs now. He credited drug testing for much of the decline and urged its expansion in schools. He also said abuse among older people declined.

About 1,000 school districts carry out drug tests, which can trigger an intervention that keeps a young drug abuser from carrying the habit into adulthood, Walters said. Despite some concerns for invasion of privacy, he said, the United States will ''look stupid in five or ten years if we don't do this.''

Walters said the data came from a survey done at the University of Michigan for the National Institute For Substance Abuse. The report says about 19.7 million Americans reported using at least one illegal substance in the previous month.

In Washington, D.C, Bill Piper, director of affairs for the Drug Policy Alliance, called the strategy a ''spin on the failure of the war on drugs.''

He said in a statement that despite incarcerating millions of Americans, drugs are as available as ever and the related harms of addiction, overdose, and the spread of disease continue to mount.

Piper said drug use rates are less important than whether the death, disease, crime and other suffering associated with abuse go up or down.



Treatment Sought For Stress Disorder
Larry Gordon, Los Angeles Times- 2/10/2007

SAN DIEGO -- None of this is really happening, but the experience is almost overwhelming in "virtual Iraq": The Humvee plows along a desert road. The engine rumbles underfoot and Blackhawk choppers whirl overhead. A sandstorm blows in, and insurgents pop up and start to shoot with sickening blasts that shatter the windshield. Is that the smell of burning rubber?

Those sensations of war are being fed into a special helmet, goggles and earphones. They are conjured by a computerized virtual reality program developed in part by gaming engineers and psychologists at the University of Southern California and being tested, among other places, at the Naval Medical Center in San Diego. The goal is to treat post-traumatic stress disorder.

Universities, private firms and the federal government are pouring millions of dollars into creating and testing such virtual Iraqs to help ease the psychological disorder that, according to a 2004 study by the Walter Reed Army Institute of Research, affects more than 15 percent of combat units returning from Iraq and Afghanistan.

Sufferers may have anxiety, nightmares, flashbacks, emotional numbness, extreme jumpiness and physical pain. Unable to return to combat or civilian jobs, some receive disability payments for years or for life.

With a therapist's supervision, the virtual Iraqs are designed to vividly, yet safely, allow those veterans to confront war experiences in ways that go beyond traditional counseling and drug therapy. The computer programs, even with the somewhat cartoonish digital depictions of combat, seek to relieve trauma by repeatedly revisiting its origins and not letting fear fester.

The virtual program is being tried for Iraq veterans because the more typical form of what is called exposure therapy may require return visits to the actual locations. That's obviously not an alternative here, said Lt. Cmdr. Robert McLay, a Navy psychiatrist. "You don't want to send someone who is traumatized back to Iraq," he said.

And, he said, some PTSD sufferers are unable or unwilling to recall things in counseling sessions without stimuli, such as the digital images of a combat hospital, a recorded Muslim prayer melody or the smell of cordite explosives misted into a psychologist's office.

Early results "look very promising," said Cmdr. Russell Shilling, a program officer for the Office of Naval Research, which is funding tests of virtual reality treatments in San Diego.

The National Institute of Mental Health is funding a $2 million study at Emory University School of Medicine that uses a virtual Iraq along with a drug, D-cycloserine, that has been shown to reduce the fear of heights.

"The potential impact for men and women with stress adjustment problems is really substantial" and the possible impact on medical research "is extraordinarily important," said Farris Tuma, chief of the institute's traumatic stress disorders program.

But Tuma cautioned that no treatment is a panacea. "We want to be careful not to oversell it as a simple fix for very complex conditions," he said.

The treatment usually starts with a digital scene and no violence. But in subsequent sessions, the therapists - after giving warning - heighten the intensity and specifics of the re-created event. They can make the platform shake more violently. They can set off simulated explosions and gunfire and add fog, smoke and night-vision effects, along with the smells of body odor and Iraqi spices.

"Habituation occurs when they repeat their story over and over again," said Karen Perlman, a psychologist who uses a computer to tailor the experience to the patients. "They start to learn they can tolerate their distress, they can work through it."

Rebecca's psychiatric treatment by Dr. Kayoko Kifuji of Tufts-New England Medical Center was highly experimental and posed a potential threat to the girl's health, some pediatricians and psychiatrists said. All three drugs given to the girl were prescribed "off label," meaning they were for uses not approved by the US Food and Drug Administration.

Doctors in many specialties prescribe drugs off label; however, they run greater risks when they do so because the medication has not been rigorously tested for safety and efficacy for these additional uses. Doctors say prescribing multiple off-label drugs together can be particularly risky because their interactions have not been adequately studied.

About two years before Rebecca died Dec. 13 of an overdose, which police say was an act of child abuse by her troubled parents, Dr. Kifuji diagnosed the two-year old girl with bipolar disorder and attention deficit hyperactivity disorder, according to a police investigator's report. The psychiatrist had already diagnosed mental disorders for Rebecca's two older siblings, whom she met while practicing in Springfield. Dr. Kifuji's diagnosis of Rebecca was a result of knowing the family mental health history, as well as relying on Rebecca's mother's description of the girl's behavior and the doctor's own observations of Rebecca during office visits, records show.

Soon thereafter, Rebecca was put on three medications, which were designed to stabilize her moods and help her sleep, according to records. The decision to medicate a young child on those drugs, at potent doses, should have instantly alarmed pediatricians and social workers familiar with the girl's case, said some psychiatrists.

"Having a 4-year-old on those three medications and the intensity of the medications, I'd have big concerns," said Dr. Candida Fink, a child psychiatrist from New Rochelle, N.Y., who specializes in bipolar illness. "These are big-gun medications."

In the investigator's report, Rebecca's preschool teachers repeatedly cited the girl's extreme lethargy and said the girl seemed more energetic when the effects of the drugs wore off. A nurse also said that the girl did not exhibit the kind of aggressive behavior that sometimes warrants potent drugs.

Fink, who consults with government agencies nationwide and works with the American Psychiatric Association, said the medications all have serious potential medical side effects, including damage to organs and extreme sedation. Any psychiatrist is entering uncharted territory when prescribing these to young children, and should run regular blood tests to make sure a child is not suffering serious bodily damage. It remains unclear, based on public records so far, whether blood tests were conducted.

Carney said he questions the validity of anyone's criticisms of Kifuji's care when they have "never examined the child or her siblings and never reviewed her medical records or lab reports."

But Dr. Eli Newberger, a pediatrician and specialist on child abuse, joined some other physicians in questioning how a 4-year-old girl would be given such a powerful mix of drugs and receive a diagnosis of bipolar disorder at the age of 2.

Newberger said it is particularly shocking given that the psychiatrist had to know that the family had a history of domestic violence and other troubles and that the mother's account of a child's behavior in such circumstances cannot be relied upon. "It's not just a question of dosages; it's a question of the appropriateness of the initial diagnosis and treatment," he said.

The autopsy showed the girl died of the "combined effects" of clonidine and Depakote in her system, as well as two drugs contained in over-the-counter cough medication she was taking the night she died.

The autopsy also indicated that Rebecca's heart and lungs were damaged due to "prolonged abuse of these prescription drugs, rather than one incident." The manner of death was ruled a homicide due to "intentional overmedication with clonidine." Rebecca's parents were arraigned Tuesday on first-degree murder charges in her death.

The questions about Rebecca's daily drug exposure are being raised as the state's Department of Social Services commissioner says his agency is not equipped to oversee the complex psychiatric and medical decisions made for children under its care. He has called for the hiring of medical experts to be assigned to DSS, so that social workers can consult when they have questions about a child's care.

A Father Recalls a Day Now Far From Ordinary
Donna St. George, Washington Post- 2/10/2007

There is still no official ruling on when the two missing Rachels died. But, preparing for his daughter's funeral today, Troy Crites said he is certain of the date -- not from police or any science exactly, but from every detail he has absorbed and what his gut tells him. "There's no question in my mind they did it the 19th," he said. Jan. 19, the first day they were gone.

Crites, father of one of the Montgomery County teens who were found Feb. 2 in an apparent double suicide, remembers that morning as ordinary. He recalled that his Rachel, Rachel Lacy Crites, 18, and her best friend, Rachel Samantha Smith, 16, had a sleepover at his home. They were getting up as he was leaving for work at a defense contracting firm in Virginia.

Everything had seemed normal, he said. Although his daughter had suffered from depression, she had seemed much improved in recent months.

She called him later, about 10:30 a.m. He said they talked every day by phone about when they would have dinner -- they almost always had dinner together -- and who would walk their black Labrador retrievers, Lina and Zowie.

His daughter mentioned heading to a movie in Georgetown with her friend. "So what are we doing for the weekend?" he recalled asking her. "I don't know," she said. "We could go for a hike," he offered. "We could climb Old Rag . . . "

They agreed to figure it out in the morning.Today, Troy Crites and other relatives and friends will remember the dark-haired teen -- who sang in the church choir and used to run cross-country at Wootton High School -- at a memorial Mass at St. Martin of Tours Catholic Church in Gaithersburg. She and her friend were found in a car in Loudoun County at the West Virginia line, dead, police suspect, from carbon monoxide poisoning.

But even as Crites plans to take his daughter's ashes to their resting place -- inside a granite cemetery bench in the shade of an oak -- he said he does not fully understand how the moment arrived, how two teenage girls chose to take their lives.

The girls had been friends for a couple of years but were especially close during the past year. Rachel Smith had been his daughter's "guardian angel," he said, and helped her pull through after a suicide attempt in March. She had been cutting herself and underwent treatment and medication, he said.

Recently, she had made plans for the future, he said, looking to become a nurse or to work with animals. "That's why this seems so out of place," he said, his face appearing weary, in the three-story Gaithersburg townhouse he shared with the teenager. He said that even her psychiatrists were surprised by her death.

Yet, along with the promise of getting better, he said, was the weight of the past. At the time of his daughter's suicide attempt, Crites said, he was separating from her stepmother after more than eight years, which was difficult for the teen. Rachel's birth mother, Kathryn Cornelius, had lived in Italy for most of Rachel's life -- writing, calling, visiting -- but living on another continent. Everyone tried to come together to help, Crites said.

Two months later, Rachel received the Catholic sacraments of Communion and confirmation, a decision she had made for herself, her mother said in an interview yesterday. Two months after that, her mother treated her to a trip with her to Paris. Then there was a big family get-together in Florida.

The last time she talked to her daughter, Cornelius said, was five days before she disappeared. Her voice was upbeat during a two-hour conversation, she said, and "she was cuddly and sweet and talking about how she was going to sing the Mass."

The search for the missing Rachels started the next weekend -- and the longer they were gone, the greater the efforts. It was Feb. 2 when Troy Crites was told his Subaru station wagon, which the girls had been driving, was discovered on rugged terrain beyond a remote utility trail.

Crites found the goodbye letter from his daughter not long after he realized she was missing. It was on the desk, in her diary, on a page dated Jan. 19. She wrote of Rachel Smith, referring to her by her widely used nickname, Pi, the mathematical term.

"Wherever I end up laying, whether buried or cremated, I want to stay with my true love, Pi, buried next to her," the letter said. "This is my choice. I'm sorry."

Some of this diary entry was made public the week the teens vanished, setting off a quiet public debate among friends and strangers about whether the Rachels had a romantic relationship that their families did not condone.

Crites said this is not so: "A. It doesn't make any difference. B. There's no real evidence at all. . . . They were just two teenagers who did everything together. Is that all that uncommon?" Despite the wording of the letter, he said, "true love and sexuality are not the same things."

Rachel Smith was a junior at Wootton High School, and Rachel Crites had started attending classes at Montgomery College. But her father said his daughter was always " a little young for her age"; some days, he said, she returned to Wootton and sat through a class or two with her friend.

Both girls loved animals. Crites worked at PetSmart, and Smith worked at Potomac Kennels in Gaithersburg, where fellow employee Tracy Payne recalled her as responsible and in love with American Eskimo dogs. Often, Rachel Crites drove her friend to work. Sometimes she stayed to play with the puppies, Payne said. Rachel Smith "was so outgoing, and she never seemed like she had any problems," Payne said. "She was always smiling and always happy, and so was her friend."

Both families had supported the friendship. Rachel Crites once went with Rachel Smith on a family visit to New York, and Rachel Smith recently joined her friend and her mother, in from Italy, on a weeklong visit with relatives in Pennsylvania.

"I think Rachel and Pi had what they considered an undying friendship -- true friends forever," Cornelius said. "Pi had helped Rachel, and they had grown close." Rachel Crites even got a tattoo of a little guardian angel, her father said. He remembered that as the girls were heading back from Pennsylvania, they called him at home. It was New Year's Eve, and they asked if he would make dinner. "What would you like?" Crites asked. He said he heard the teens conferring. "Can you do something around tater tots?" they asked. For Troy Crites, the memory provides a touch of solace.

Marian Smith, Rachel Smith's mother, said that she and her family are waiting for answers about exactly when the girls died. But, she added, "our hearts go out to them, just as their hearts went out to us." Troy Crites has decided that Jan. 19, 2007, will mark his daughter's resting place. It is the last day he heard her voice.

A Volatile Mix: Obsessive Love and Abandonment
Kate Zernike, New York Times- 2/11/2007

In Margaret Atwood’s story “Hairball,” the protagonist has just had a benign ovarian tumor removed when her married lover-boss informs her that she has been fired. When she arrives home to an engraved cocktail party invitation from him and his wife, she knows exactly how to respond. She goes to a fancy food shop and buys a box of chocolate truffles, the kind he gave her after their first tryst. She takes the tumor she has kept as a souvenir, dusts it with cocoa powder, nestles it in the elaborately wrapped box, and sends it to her lover with a note expressing her regrets.

What novelist, after all, could have dreamed up the diaper that Lisa Nowak, the Navy captain, astronaut and married mother of three, put on so she would not have to stop to go to the bathroom as she drove 950 miles, the police said, to confront the woman she believed stood between her and the object of her affection?

Sure, Hollywood produced a runaway bride, but it took real life — a 32-year-old Georgia woman who fled west by bus in 2005 — to give us one who faked her own abduction. Then there’s the skydiver detained last month in Belgium after the police said she sabotaged another diver’s parachute, then watched her fall 13,000 feet to her death, all because she suspected the woman was having an affair with her boyfriend.

It’s a question for the ages, but hey, it’s almost Valentine’s Day: What is it about love that drives apparently rational people to such blindly irrational behavior? No question, love reigns supreme in human behavior. “There’s very little in life we desire as much as to be connected with someone we love,” said Arthur Aron, a professor of social psychology at the State University of New York at Stony Brook. “It trumps the desire for wealth, for power, even to live. People feel that if only this person would reciprocate, their lives would be just perfect.”

As science has become better able to analyze brain activity, some researchers argue it boils down to chemistry. Helen Fisher, an anthropologist at Rutgers who has written extensively on love and mating, described a recent experiment in which she and colleagues put 15 people who had been madly in love and freshly rejected through M.R.I. scans. Their scans showed decreased blood to the area of the brain associated with decision-making. But the brains showed increased activity in the dopamine reward system, or what Dr. Fisher called “the wanting-seeking system,” associated with craving and taking big risks, as well as in areas associated with physical pain and obsessive-compulsive disorder.

The overall picture was of what Dr. Fisher calls “abandonment rage.” “You’ve got a person who has enormous energy and intense motivation and craving, with focused attention, willing to take huge risks, in physical pain, trying to control their anger, and obsessively thinking about someone,” she said. “It’s a bad combination.” Love, in this interpretation, really is the drug. "If you really want cocaine and you don’t have it,” Dr. Aron said, “you’ll do the same sorts of things.”

Others caution against blaming nature for “crazy love.” When someone goes over the edge, it tends to be that they are missing some ability to make moral judgments, or suffering some mental disorder. Of course, “being in love is not a mental disorder, thank God,” said Pamela Regan, a professor of psychology at California State University, Los Angeles.

People suffering an obsession may have developed a faulty attachment style. They grew up with an emotionally distant parent and become preoccupied with securing a close bond with someone else, even if, and perhaps especially if, that person is unavailable.

The documentary film “Crazy Love” tells the story of Burt Pugach, who in 1959 became so obsessed with the woman he was dating that he hired thugs to throw lye in her eyes, permanently blinding her. Crazier yet, when he got out of prison, she married him.

Both Mr. Pugach and his wife had suffered distant or emotionally harsh mothers. And to Dan Klores, who made the film, it made sense that they wanted to be together; both were intensely afraid of being alone. He saw parallels in Captain Nowak’s behavior. “There was the same type of heightened fear, that skin-chilling fear of, ‘I’m going to lose him,’ ” he said.

There but for the grace of God go the rest of us. In 2003, when Clara Harris was on trial in Texas for running over her cheating husband with her Mercedes, lawyers had to strike several jurors from the pool because they told of similar experiences.

One woman recalled how she had nicked her husband with a truck after discovering him with another woman. A man recalled how he had been accused of assault after his wife cheated on him. But most of us don’t buy a steel mallet, drive 950 miles and pepper spray someone in an airport parking garage in the middle of the night, as the police say Captain Nowak did.

There is what Dr. Regan called “a gray area between normalcy and obsession.” “We don’t realize we’re being annoying when we e-mail or text-message someone, and oftentimes the objects are not clear in their refusal,” she said.

But when the rejection is clear, Dr. Regan continued, “the key thing is, people who have normal mental development realize that heartache happens, it’s painful, it’s going to hurt, but I’m going to be O.K.”

For Dr. Fisher, it comes down to better impulse control. “It is my guess that just about everybody on this planet has wanted to stalk somebody at some point, but we contain ourselves,” she said.

That doesn’t mean you can necessarily screen for some flaw that will expose stalking behavior. “For many people they simply won’t be in a situation that stresses them in such a fashion that their normal filtering process is overruled,” said James Hollis, the director of the Houston Jung Center and the author of “Why Good People Do Bad Things.” “They’re lucky, and they may be conscious of what they’re doing.” Dr. Hollis speculated that Captain Nowak “got caught in a moment of unconscious vulnerability.”

It is not unlike road rage, he said: “It’s not about someone driving badly, someone cut me off. It hits an old wound: ‘They always disrespected me.’ What we do is not crazy. It’s logical based on the emotional premise from which it’s coming. The emotional premise may not be rational. But it’s truthful to the person in the moment.”

People in highly competitive environments may not be used to asking for the help that might steer them away from drastic behavior, Dr. Hollis said. And the drive to excel may extend to every area of their lives. “This is someone who would go to outer space to reach a goal,” Dr. Aron said of Captain Nowak, who has been charged with attempted murder.

But no one knows for sure yet why Lisa Nowak behaved as she did. And highly accomplished people — men or women — are no more or less prone to such behavior. As Dr. Fisher said, “Any police blotter could tell you this isn’t just astronauts.”

Investigating Links Between Personality and Politics
Patricia Cohen, New York Times- 2/12/2007

Folk music and a collection of feminist poetry may well be dead giveaways that there is a liberal in the house. But what about an ironing board or postage stamps or a calendar? What seem to be ordinary, everyday objects to some people can carry a storehouse of information about the owner’s ideology, says a new wave of social scientists who are studying the subtle links between personality and politics.

Research into why someone leans left or right — a subject that stirred enormous interest in the aftermath of World War II before waning in the 1960s — has been revived in recent years, partly because of a shift in federal funds for politics and terrorism research, new technology like brain imaging and a sharper partisan divide in the nation’s political culture.

“I believe that recent developments in psychological research and the world of politics — including responses to 9/11, the Bush presidency, the Iraq War, polarizing Supreme Court nominations, Hurricane Katrina, and ongoing controversies over scientific and environmental policies — provide ample grounds for revisiting” the psychological basis of Americans’ opinions, party and voting patterns, John T. Jost, a psychologist at New York University, wrote in a recent issue of American Psychologist.

The newest work in the field, found in a growing number of papers, symposiums and college courses, touches on factors from genetics to home décor. Some people have greeted the results with fascination. Books by George Lakoff, a linguist and cognitive scientist at the University of California, Berkeley, who studies the psychological power of metaphors and the framing of issues, became required reading among Democrats after their defeat in the 2004 elections. Others have been decidedly less thrilled with studies they say portray conservatives as pinched and neurotic.

For anyone who assumes political choices rest on a rational analysis of issues and self-interest, the notion that preference for a candidate springs from the same source as the choice of a color scheme can be disturbing. But social psychologists assume that all beliefs, including political ones, partly arise from an individual’s deep psychological fears and needs: for stability, order and belonging, or for rebellion and novelty.

These needs and worries vary in degree, develop in childhood and probably have a temperamental and a genetic component, said Arie Kruglanski of the University of Maryland. A study of twins, for instance, has shown that a conservative or progressive orientation can be inherited, while a decades-long study has found that personality traits associated with liberalism or conservatism later in life show up in preschoolers.

No one is arguing that an embrace of universal national health care or tax cuts arises because of a chromosome or the unconscious residue from a schoolyard spat. What Mr. Jost and Mr. Kruglanski say is that years of research show that liberals and conservatives consistently match one of two personality types. Those who enjoy bending rules and embracing new experiences tend to turn left; those who value tradition and are more cautious about change tend to end up on the right.

What’s more, these traits are reflected in musical taste, hobbies and décor. Dana R. Carney, a postdoctoral fellow at Harvard University, who worked with Mr. Jost and Samuel D. Gosling of the University of Texas at Austin among others, found that the offices and bedrooms of conservatives tended to be neat and contain cleaning supplies, calendars, postage stamps and sports-related posters; conservatives also tended to favor country music and documentaries. Bold-colored, cluttered rooms with art supplies, lots of books, jazz CDs and travel documents tended to belong to liberals (providing sloppy Democrats with an excuse to refuse clean up on principle).

Jonathan Haidt, a social psychologist at the University of Virginia, said he found this work intriguing but was more inclined to see a person’s moral framework as a source of difference between liberals and conservatives. Most liberals, he said, think about morality in terms of two categories: how someone’s welfare is affected, and whether it is fair. Conservatives, by contrast, broaden that definition to include loyalty, respect for authority, and purity or sanctity. Conservatives have a richer, more elaborate moral horizon than liberals, Mr. Haidt said, because there is a “whole dimension to human experience best described as divinity or sacredness that conservatives are more attuned to.”

So how does he explain the red-blue divide? “Areas with less mobility and less diversity generally have the more traditional,” broadened definition of morality, “and therefore were more likely to vote for George W. Bush — and to tell pollsters that their reason was ‘moral values,’ ” he and his co-writer, Jesse Graham, say in a paper to be published this year by The Journal Social Justice Research.

Mr. Jost did his own research on the red-blue divide. Using the Internet he and his collaborators gave personality tests to hundreds of thousands of Americans. He found states with people who scored high on “openness” were significantly more likely to have voted for the Democratic candidate in the past three elections, even after adjustments were made for income, ethnicity and population density. States that scored high on “conscientiousness” went Republican in the past three elections. Some of these psychological studies have been dogged by charges of bias however. In 2003 a mammoth survey of more than 50 years of research on the psychology of conservatism that Mr. Jost and Mr. Kruglanski undertook with the help of Jack Glaser and Frank Sulloway at Berkeley concluded that conservatives tend to be “rigid,” “close-minded” and “fearful,” less tolerant of minorities and more tolerant of inequality. At the time the conservative columnist George F. Will ridiculed the results: “The professors have ideas; the rest of us have emanations of our psychological needs and neuroses.”

The authors insist they are not making value judgments; whether a particular trait is positive or negative depends on circumstance. “Fear of death has the highest correlation with being conservative,” Mr. Sulloway said. But he continued: “What’s wrong with fearing death? If you don’t fear death, evolution eliminates you from the population.”

Accusations of bias against conservatives go way back, to Theodor Adorno and other scholars who, after World War II, came up with the “authoritarian personality” to explain the link between the far right and fascist regimes.

As for the present research, John Zaller, a political scientist at Berkeley, said: “I am personally embarrassed by some of the leading work by psychologists on personality and conservatism. I take the data to be valid, but I feel the manner of describing it too often sets up conservatives to look bad.”

Mr. Haidt, who agrees liberals and conservatives have distinct dispositions, still thinks bias is a problem: “Our own biases as researchers — because we are almost all liberal — make it difficult for us to understand the psychology of conservatives.”

A slanted interpretation isn’t the only cause of skepticism. Definitions of liberal and conservative shift, critics say. How would you define a liberal or conservative in the former Soviet Union? And what about people who are conservative on economic policy but liberal on social issues?

What is important, said Larry Bartels, a political scientist at Princeton University, is how psychological tendencies are translated into views about specific political issues: “In 2000, George W. Bush ridiculed nation-building; now he seems pretty committed,” he wrote in an e-mail message. “Which of those positions (if either) represents rigidity, resistance to change, or discipline? On the other hand, how many flexible, curious, open-to-experience liberals do you know who want to experiment with restructuring the Social Security system?” Personality may have something to do with a particular political outlook, he said, but so do a lot of other things.

Doctors and Drug Makers: A Move to End Cozy Ties
Stephanie Saul, New York Times- 2/12/2007

More Hippocrates, less Hunan hot sauce. Free lunches for doctors are under attack yet again. Free lunch deliveries to medical offices, along with those ubiquitous drug company logo pens, have come to symbolize the extensive financial ties between doctors and the drug industry. And there is evidence they influence which drugs are prescribed.

But pressure is building against the widely reported gifts and other potential conflicts, an effort that took hold last year when a group of influential doctors condemned financial arrangements between doctors and drug companies in The Journal of the American Medical Association.

Tomorrow, a new push is scheduled to be announced by Community Catalyst, a health care consumer advocacy group based in Boston, and the Institute on Medicine as a Profession, a research group at Columbia University.

With a $6 million grant from the Pew Charitable Trusts, the organizations plan a national campaign calling for restrictions on the interactions between doctors and drug companies, and urging doctors to base their prescription writing more on medical evidence than on marketing.

“If you’ve been in the waiting room when these Chinese lunches are taken into the back office, it may raise the question whether the decisions are based on the best scientific evidence about medication or whether or not those Sichuan shrimp have something to do with the prescribing patterns,” said Jim O’Hara, the managing director of policy initiatives at Pew.

The pharmaceutical industry spends $12 billion a year marketing to doctors, and much of that money is in the form of free samples delivered to doctors’ offices, often accompanied by lunch for the entire staff. When the University of Michigan health systems banned such lunches in 2005, they calculated that the lunches had been worth $2.5 million a year.

The free drugs are samples of the newest and most expensive branded products. The drug industry hopes that by starting patients with free samples, they will remain on the more expensive medication rather than using a cheaper generic. And there is evidence that doctors who have relationships with the pharmaceutical industry prescribe more of the expensive drugs.

The new initiative, called the Prescription Project, is an outgrowth of an article published in January 2006 in The Journal of the American Medical Association in which a coalition of scholars and doctors proposed that academic medical centers across the country take the lead in restricting interactions between doctors and the health care industry. Several medical centers, including those at Yale, the University of Pennsylvania and Stanford, have announced such restrictions. The Prescription Project aims to spread those restrictions to other academic medical centers, doctors’ organizations and third-party payers.

Some medical school deans are reluctant to impose such restrictions, fearing that they will lose research money, according to David J. Rothman, an author of last year’s journal paper who is also president of the Institute on Medicine as a Profession.

“They say, ‘If we did this, we would lose a third of our faculty. They’ll go to places with less stringent requirements; if we did this, we’ll tick off the drug companies and there’ll be payback,’ ” said Professor Rothman. One of the group’s plans is to document the impact of changes at Yale, the University of Pennsylvania and Stanford. “Did the drug companies stop giving Penn research money?” he said. “I don’t for a minute believe that is going to happen.” The organization’s goal is not to prohibit research grants or consultancies, but to limit gifts, travel fees, speakers’ bureaus and ghostwriting while at the same time encouraging prescriptions based on a medical evidence. “Gifts bring with them the felt need to reciprocate,” said Professor Rothman, who teaches social medicine at Columbia. “We’re not saying you’re being bribed,” he added. “We’re saying you’re being gifted. Some of it could be raw monetary hustling. But some of it is this psychological — ‘Well, they just sent me out to Las Vegas, their drug is as good as anybody else’s, why not just say thank you.’ ”

We all know someone who has been there or in the neighborhood. Maybe not so far as Captain Nowak is accused of going, but making one phone call too many or taking a late-night cruise past the house to see whose car is in the driveway.

Captain Nowak’s situation might seem inexplicable to people who have bought into the media image of science and spaceflight as a robotic realm of light and reason inhabited by drones more interested in crossword puzzles and chess than in the latest exploits of Jack Bauer or the White Stripes.

In fact, the opposite is more often true. It takes guts and gumption, as well as no small amount of ego, to endure years of training and competition to ascend the ranks of military and government bureaucracies to the levels of test pilot or astronaut, or to survive the ego bashing at the blackboard during physics seminars and presume to crack the mysteries of the universe.

Not to mention vast reserves of talent and stubbornness. You’ve got to think you’re pretty special to fly in space or to engage, as an astronomer once described it to me, in a bar fight with God.

These are qualities that don’t get switched off going in or out of the lab door, and the results are often as messy as the lives of the rest of us who aren’t regularly weighted with cosmic destiny. It would not be surprising if their lives, like those of rock stars, were even messier.

Only three days before Captain Nowak was arrested, William French Anderson, a geneticist at the University of Southern California and a hero of the once-promising technique of gene therapy whose work has been described (among other places) on the front page of this newspaper, was sentenced to 14 years in prison for molesting a girl when she was 10 to 14 years old.

The girl’s mother worked for Dr. Anderson and had recruited him to teach her daughter martial arts.

Confronted by the girl years later, Dr. Anderson was recorded saying, “I will love you forever,” but also admitting, “Something inside me was evil.”

Last month Andrew Pakhomov, a physics professor at the University of Alabama in Huntsville, pleaded not guilty to the murder of his wife, Yelena Zakin. She was found dumped in the Tennessee River last summer, a week after she had caught him with another woman, a staff assistant, in his office and attacked them.

A successful merger of sex and science was engineered by Erwin Schrödinger, the Austrian quantum physicist, who gave us the parable of the cat that is both alive and dead. In 1925 Schrödinger invited a still-mysterious woman friend to join him over the year-end holidays in a lodge in Arosa, Switzerland. While he was there he invented a wave equation that won him the Nobel Prize. It now bears his name and has been the basis of quantum mechanics ever since.

At Oxford, where he fled the Nazis, Schrödinger lived openly in a threesome with his wife and a mistress (the wife of his assistant), who bore him a daughter in 1934. In Dublin, where Schrödinger and his two “wives” eventually landed in 1940 as he became the director of the School for Theoretical Physics, the quantum genius had more love affairs and fathered more children.

Captain Nowak’s humiliation brings to mind the plight of Marie Curie, who won the 1903 Nobel Prize in Physics with her husband, Pierre, for discovering radium and who has been a role model for female scientists ever since. As detailed in Susan Quinn’s biography, “Marie Curie: A Life,” she was nearly hounded out of Paris in 1911 when it was discovered that she was having an affair with Paul Langevin, one of Pierre’s students, who was married with four children.

Pierre was run over by a carriage in the street in 1906. Drawn together by mutual grief, Paul and Marie set up an apartment near the Sorbonne as a love nest. Langevin’s wife sent a man to break into the apartment, obtaining love letters, which his mother-in-law then shared with the newspapers.

“The fires of radium which beam so mysteriously have just lit a fire in the heart of one of the scientists who studies their action so devotedly; and the wife and children of this scientist are in tears,” read one article.

France was apparently more strait-laced then than now, and the press vilified the lovebirds. Langevin challenged the editor of one newspaper to a duel, but neither man could bring himself to fire his pistol. The only violence occurred when Langevin showed up for work bruised and beaten and said his wife had hit him with a chair.

In the midst of the brouhaha, Curie won another Nobel, for chemistry, but the Swedish academy suggested she stay away from the awards ceremony. She went anyway.

Albert Einstein, who met Curie for the first time at a meeting in Brussels that year, wrote home that he didn’t really see what the fuss was all about. “She has a sparkling intelligence, but despite her passionate nature, she is not attractive enough to represent a threat to anyone,” he wrote.

Einstein was soon to have his own problems with adultery. For most of the years that he was inventing his supreme achievement, the general theory of relativity, which predicted the bending of light, the expanding universe and black holes, he was having an affair with his cousin Elsa and fending off suspicions, accusations and emotional breakdowns from his wife, Mileva. His oldest son stopped speaking to him at various times.

In his divorce deposition, Einstein admitted that there had been physical violence in the marriage, but said his wife was the one who had started it.

Einstein continued to have affairs after he married Elsa in 1919. One of them, according to a letter in the Einstein archive at the Hebrew University in Jerusalem, commenced with the by-then-famous physicist sneaking into the house of his friend Hans Muhsam, to be with his niece Betty Neumann, whom he then hired as a secretary. With his wife’s explicit permission, Einstein carried on with Neumann for about a year.

Einstein broke off the affair in 1924, saying that he had to seek in the stars what had been denied him on the Earth.

But he was pursued by and involved with other women for the rest of his life. If you are an Einstein, the stars are never enough.



Survey Puts New Focus on Binge Eating as a Diagnosis
Nicholas Bakalar, New York Times- 2/13/2007

Binge eating is not yet officially classified as a psychiatric disorder. But it may be more common than the two eating disorders now recognized, anorexia nervosa and bulimia.

The first nationally representative study of eating disorders in the United States, a nationwide survey of more than 2,900 men and women, was published by Harvard researchers in the Feb. 1 issue of the journal Biological Psychiatry. It found a prevalence in the general population of 0.6 percent for anorexia, 1 percent for bulimia and 2.8 percent for binge-eating disorder.

Lifetime rates of the disorders, the researchers found, are higher in younger age groups, suggesting that the problem is increasingly common. Eating disorders are about twice as common among women as men, the study reports.

Experts not involved in the study called it significant. “This is probably the best study yet conducted of the frequencies of eating disorders in American households,” said Dr. B. Timothy Walsh, director of the eating disorders research unit of the New York State Psychiatric Institute at Columbia University Medical Center.

“It confirms that anorexia nervosa and bulimia are uncommon but serious illnesses, especially among women,” Dr. Walsh said. “It also finds that many more individuals, especially those with significant obesity, are troubled by binge eating, and underscores the need to better understand this problem.”

The survey, partly financed by two pharmaceutical companies, was carried out from 2001 to 2003 among adults 18 and older, and the diagnoses were established using face-to-face interviews.

While all three eating disorders appear in the American Psychiatric Association’s diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M.-IV, binge eating disorder is not considered a definitive diagnosis like anorexia and bulimia. Rather, it is one of a number of categories requiring further study.

Some suspect that establishing binge eating disorder as a psychiatric diagnosis is merely an attempt by psychiatrists or drug companies to “medicalize” what would otherwise be considered simply ordinary, if unfortunate, human behavior. Cynthia M. Bulik, director of the eating disorders program at the University of North Carolina, Chapel Hill, does not see it this way.

“It’s patients who want this in the D.S.M. so they can get treatment,” Dr. Bulik said. “I’ve gotten e-mails from people saying, ‘Thanks for putting a name on this binge-eating disorder.’

“The disorder has no diagnostic label that will get them insurance payments,” she continued. “They have a nasty syndrome with serious health implications, knowing that there is evidence-based treatment available and not being able to get it because it’s not officially recognized as a diagnosis.”

The diagnosis of binge eating disorder requires that a person eat an excessively large amount of food in a two-hour period at least twice a week for six months, feel a lack of control over the episodes, and experience marked distress regarding the practice.

Marlene B. Schwartz, the director of research and school programs at the Rudd Center for Food Policy and Obesity at Yale, who had no role in the study, said binge-eating disorders were “not a matter of just eating too much every now and then.”

“The diagnosis requires the feeling that you can’t stop,” Dr. Schwartz said. “And it’s that loss of control that makes it a psychiatric disorder different from someone just overindulging every now and then.”

Dr. James I. Hudson, the lead author of the new study, said binge eating was associated with obesity, particularly severe obesity. “This brings in a lot of medical consequences and suggests it’s a major health problem,” he said. “This information will help us make decisions on public health policy.” Dr. Hudson is director of the psychiatric epidemiology research program at McLean Hospital in Belmont, Mass., and a professor of psychiatry at Harvard.

A diagnosis of anorexia requires a refusal to maintain at least 85 percent of normal weight and a distinctly distorted view of one’s weight or body shape. Bulimia is characterized by recurrent episodes of binge eating at least twice a week for three months and then compensating for the behavior, usually by self-induced vomiting or abuse of laxatives and other medicines.

Eating disorders, the researchers found, are commonly accompanied by other psychiatric illnesses. In the survey, more than half of the people with bulimia had major depression, 50 percent had phobias and more than one-third had a substance abuse disorder. Over all, more than 94 percent of people with bulimia, 56 percent of those with anorexia and 79 percent of those with binge-eating disorder had at least one other psychiatric diagnosis.

Dr. Hudson said the most significant limitation of the study was its basis on self-reports, explaining that people tend to underreport their problems with eating disorders. So the true prevalence, he said, is probably higher than reported.

“Obesity is an endpoint, and there are many pathways in,” Dr. Bulik said. “One of the things I look for is modifiable behavioral factors. This study shows now that binge eating disorder is relatively prevalent. For a certain percentage of the population, this is a modifiable behavior.”