Noteworthy News Articles on Mental Health Topics, June 10-15, 2007

Nearly 5,000 families will seek to convince a special "vaccine court" in Washington that the vaccines can cause healthy and outgoing children to withdraw into uncommunicative, autistic shells -- even though a large body of evidence and expert opinion has found no link. The court has never heard a case of such magnitude.

The shift from laboratory to courtroom means the outcome will hinge not on scientific standards of evidence but on a legal standard of plausibility -- what one lawyer for the families called "50 percent and a feather." That may make it easier for the plaintiffs to sway the panel of three "special masters," which is why the decision could not only change the lives of thousands of American families but also have a profound effect on the decisions of parents around the world about whether to vaccinate their children.

A victory by the plaintiffs, public health officials say, could increase the number of children who are not given vaccines and fall sick or die from the diseases they prevent.

Economics and politics intersect in the case with questions of health and the deepening mystery of soaring autism rates. Advocates of the vaccine theory have argued that the increase in cases was triggered by a mercury-based preservative in vaccines that, they say, is toxic to children's brains.

Under pressure from the advocates and to keep the issue from disrupting vaccination programs, U.S. officials began phasing out the additive, thimerosal, in children's vaccines around 1999 while maintaining that there was no hard evidence that it was dangerous. But thimerosal is still used in vaccines across much of the developing world. If the vaccine court decides that the preservative caused autism, parents of children in poor countries are likely to protest its inclusion, but removing it would make vaccines much more expensive and potentially put them out of reach for many.

Gary Golkiewicz, chief special master in the U.S. Court of Federal Claims, where the case is to be heard, said he is aware of the larger ramifications. But the court's job, he said, is only to focus on whether plaintiffs show a plausible link between vaccines and autism.

About 20 experts are expected to testify in the case, which will involve a staggering amount of complicated epidemiology and biochemistry. Golkiewicz said a ruling could be a year off.

Experts for the government will argue that a range of epidemiological studies found no link between vaccines and autism, as the prestigious Institute of Medicine concluded in a 2004 report. The institute, part of the National Academies that was chartered by Congress to advise the government and the public on matters of science, dismissed the vaccine-autism theory, which is mostly based on biochemistry studies on the toxic effects of mercury.

Large international studies -- and preliminary evidence from the United States -- suggest that after thimerosal was removed from children's vaccines, autism rates continued to soar.

If thimerosal was the cause, removing it should have sharply lowered autism rates, scientists say. Although definitive national evidence is not in -- children vaccinated after 1999 are just beginning to enter school, which is the point at which many receive a diagnosis -- data from California suggest that autism rates are continuing to climb steeply.

The cases are rising, experts say, primarily because of better diagnosis and services: Parents and teachers are more attuned to the signs of autism, and doctors are better equipped to spot it than they were two decades ago. Also, the boundaries of the diagnosis have expanded to include a range of problems under an umbrella known as autism spectrum disorders.

The plaintiffs acknowledge that their case is far from airtight scientifically. But Kevin Conway, a Boston attorney representing the family of 12-year-old Michelle Cedillo of Yuma, Ariz., whose claim was designated the opening test case for more than 4,800 plaintiffs, said that even if the science is equivocal, he has a good legal argument, which is all he needs.

"There is a difference between scientific proof and legal proof," Conway said. "One is 95 percent certainty, and the other is . . . 50 percent and a feather."

Besides, Conway added, those who support the vaccine-autism theory did not put all their eggs in the thimerosal basket. They are also arguing that something else in vaccines might be making children sick.

Like many other advocates of the link, Conway said he believes that vaccines in general are a good thing and have saved many lives. In an age of bioterrorism, moreover, vaccines are not just a health priority but a national security priority. But Congress's efforts to shield vaccine makers from lawsuits over the rare but inevitable side effects of vaccines have given the companies no incentive to make vaccines as safe as possible, Conway said.

Congress set up the vaccine court to provide compensation for individuals harmed by those side effects, because lawsuits were threatening to put vaccine makers out of business.

The law requires people claiming they were harmed by a vaccine to bring the case in the special court first, but if they lose, they can still file suit in civil courts.

Scientific advocates for the vaccine-autism theory, such as the father-and-son team of Mark and David Geier of Silver Spring, say fears about damaging public health programs have prompted scientists and the government to hide evidence of a problem. Many of the families believe that the medical establishment and the U.S. Centers for Disease Control and Prevention have conspired in a massive coverup.

Peter Hotez, president of the Sabin Vaccine Institute and a biology professor at George Washington University, who has a 14-year-old autistic daughter, said the controversy has distracted from the real problem: finding services for rising numbers of autistic children and ramping up research to find a cure.

"We are absolutely confident Rachel's vaccines have nothing to do with her autism," he said. "If we could roll back the clock, we would give her all the vaccines again."

But the family of severely autistic Michelle Cedillo, who arrived in Washington on Friday for the trial, disagrees.

Michelle was a healthy 15-month-old when she was given the measles-mumps-rubella vaccine, said her mother, Theresa. The dozen or so words she had been able to speak -- including Mommy, Daddy, baby, kitty and juice -- vanished. She developed a high fever one week after the shot and went rapidly downhill. Today, she does not speak and is totally dependent on caregivers. She suffers from seizures, arthritis and inflammatory bowel disease and is nearly blind.

Cedillo said she is "not anti-vaccine" and not very interested in playing the blame game or weighing in on matters of public policy.

"I am not a scientist. I am not a doctor," she said in an interview. "We want to focus on Michelle and find out what happened and get the help for her that she needs."

The cheeky openness of these ads is hardly anomalous. While cocaine and drug abuse seem to have faded from the headlines, with coverage limited to the not-so-veiled references surrounding the exploits of waifish celebrities, it is still very much a part of the social scene, especially in New York.

Evidence of that is popping up in music, television and even theater. Indeed, for a generation that has not had its John Belushi to drive home the dangers of drug abuse, references and even use are open, casual, even blatant.

“You do see it,” said Noel Ashman, an owner of the Plumm, a hotspot near the meatpacking district. “We’re pretty tight at the club with drug use, whenever we see it we kick it right out. But it has popped up more than it did five years ago.”

And like the red flash of a Louboutin pump, it is easy to spot. “It’s definitely prevalent in clubs, bars, parties — everywhere, basically,” said Cristiano Andrade, 26, a Brooklynite who manages a wine shop and goes out in the city once or twice a week.

Drug-abuse experts say the blasé attitude toward cocaine use is a result of “generational amnesia.” “There seems to be less of a stigma about” cocaine, said Dr. Herbert Kleber, director of the division of substance abuse at the New York State Psychiatric Institute in Manhattan. As part of his oversight of research into cocaine addiction and treatment, and in his private clinical practice, Dr. Kleber hears stories about the drug’s use. “People don’t feel nearly as much the need to hide it,” he said. “They feel that they can use it in a more open fashion.”

The visibility of cultural markers — and the absence of cautionary tales — leads to the assumption that coke is not as harmful, say, as heroin (which was associated with the high-profile overdoses of River Phoenix and Kurt Cobain in the 90s), or methamphetamine, whose recent popularity in the gay community has led to a targeted campaign against it, said Perry N. Halkitis, a professor of applied psychology at New York University who studies behavior, the AIDS epidemic and drug abuse.

“If you’re a 19-year-old and you go out and party and you’re offered meth, you say no because you’ve heard these bad things,” he said. “But you’re offered coke, you say yes because you assume it’s safe.” And, he added, as the authorities crack down on meth, “people are going to tend to go to cocaine, which has similar, if not identical properties” as a stimulant.

Not to mention that the supply and the price of cocaine, about $25 to $30 on the street for a half-gram bag, have remained stable for several years, said John Galea, director of the street studies unit of the New York State Office of Alcohol and Substance Abuse Services. (In rare cases, a large bust can affect prices. Chief James P. O’Neill, the commanding officer of the New York Police Department Narcotics Division, said the authorities seized a record 20 tons of cocaine off the coast of Panama in March, and wholesale prices rose in the last few weeks.)

A prevalence among young people is not entirely borne out by national statistics. According to an annual survey by the federal Substance Abuse and Mental Health Services Administration, lifetime cocaine use remained stable between 2002 and 2005 among 18- to 25-year-olds. (Data before 2002 are noncomparable.) But the study — which estimates national rates based on a poll of 67,500 people — recorded a 20 percent increase in past-month use among that age group in 2005 from 2004, the last period for which data were available, said Joe Gfroerer, the group’s director of the division of population surveys. (There was no change in usage rates among people over 26.)

The Police Department has not recorded an increase in drug-related arrests at clubs recently, Chief O’Neill said. But, he added, “It doesn’t mean if you’re doing drugs in a club you won’t get caught.”

But in interviews over the last five months with people in the night-life, entertainment, media and finance industries, all said that cocaine is a prominent part of a night out. Teron Beal, 34, a songwriter and aspiring actor, said he encountered cocaine regularly and does it occasionally — and not only in clubs and bars. “When you’re in meetings and you’re in the studio, it’s offered like coffee,” he said. “If you say yeah, they’re cool with it and if you say no, they’re like O.K., and they just go and do it in front of you.” “Coke is the new weed,” he continued. “Everybody says that.”

Tom Sykes, a former night-life reporter for The New York Post who chronicled his alcohol- and drug-fueled life in the memoir “What Did I Do Last Night?” said that cocaine is more socially acceptable than smoking. “You could go into a swanky party in New York and do a line and nobody would notice,” said Mr. Sykes, who is now sober. “Pull out a cigarette and people would think you’d pulled out a gun.”

And cocaine is not only popular in New York. “When I go to travel somewhere else, people think I do it and they’re so eager to shove it up my nose,” said Roxy Summers, a party promoter and D.J. who goes by the name Oxy Cottontail.

Mr. Beal, who is old enough to remember the drug wars of the 80s, said the perception of the drug has changed. “When I was growing up, it was like a VH-1 ‘Behind the Music’ moment whenever anyone talked about their cocaine habit,” he said. “It was like rock bottom, coke is crazy.” Now, he said, it is merely flashy fun.

Dominic Streatfeild, the author of “Cocaine: An Unauthorized Biography,” who is based in London, where according to recent government studies, use among young people has tripled since the late 90s, had another theory. “In a culture obsessed with celebrity,” he said, “the fact that cocaine makes you feel rich and beautiful — it’s the perfect drug for our times.”

With Wall Street surging and a 24-hour global economy, young professionals have the money and the incentive to stay constantly wired.

“I do it every day,” said Kristoff, a European transplant to New York who works in finance and would not give his last name. He said he pays $150 for two grams of cocaine. “If I have to work at 6 in the morning and I have to be on top of the game, I’ll do it. I’ll take a gram of coke and make half a million dollars.”

That cavalier attitude carries over to pop culture, where references to cocaine are as prevalent as the 80s fashions that accompanied its previous heyday. Cocaine rap is a recognized genre in hip-hop, as Sasha Frere-Jones noted in a December 2006 article in the New Yorker; the platinum-selling rapper Young Jeezy made his name rhyming about his days as a dealer and adopted a menacing-looking snowman as his logo. In the last few years, the drug has been the subject of multiple anthologies, some of them flattering.

Recently the comic Todd Barry, a staple of the downtown comedy circuit, used a conversation he heard at a bar — when one man called a friend to remedy his “nose problem” — as the basis for a new joke in his act. And on a recent episode of NBC’s “30 Rock” when two go-getter writers attribute their success to cocaine, it was a laugh line, not a rebuke.

Even Broadway is not exempt: In “Talk Radio” and “Jack Goes Boating” (starring Liev Schreiber and Philip Seymour Hoffman, respectively), the characters do lines and carry on.

When Gridskipper, a travel blog, ran a post in March about the top bars in which to find cocaine in New York, the response was so overwhelming — the list of places named was like a taxonomy of “it” joints on the Lower East Side, the meatpacking district and Williamsburg — and the comment section so lively that the editors pursued the subject for several more days.

“Drug use tends to be cyclic,” Dr. Kleber said. “If you have a really dangerous drug, the generational remembering will come back quickly. If it takes time for the casualties to add up, the epidemic will last longer.” Referring to the drug’s last heyday, he added, “As some of my colleagues said, John Belushi had to die before people believed that these drugs were really dangerous.”

Besides its addictive potential, cocaine can cause elevated blood pressure, seizures, stroke, cardiac arrest or other heart problems, particularly in people with a pre-disposition. Combining it with alcohol, as many do, increases its toxicity, particularly in the liver, said Dr. Thomas Kosten, a professor of psychiatry and neuroscience and the director of the division of addictions at Baylor College of Medicine.

But these negative effects are overshadowed by the drug’s glamorous image, which is perhaps best personified by Kate Moss. After a brief furor when photographs of Ms. Moss apparently snorting cocaine appeared on the cover of a British tabloid in 2005, she entered rehab for a short time and emerged more successful than ever, with bigger advertising contracts and her own line of clothing at Topshop, the British retailer.

“You never hear about the addiction, you just hear about exclusive photos of wild parties with cocaine, ” Mr. Streatfeild said. “The dangers of cocaine are without a doubt very real, but it’s never dispelled that Champagne image.”

IT took the death last February of the skateboard star and downtown bon vivant Harold Hunter, who died at 31 of a heart attack and whose wake was attended by friends like Rosario Dawson, for Ms. Summers, the D.J. and promoter, to rethink her own behavior.

“Harold’s death really affected me; I know the ways in which he treated night life,” she said, adding that she “never touched” cocaine again. Likewise, she said, people in her community of downtown skateboarders, musicians, artists, and D.J.s went into hiding with their drug habits. “But,” she added, “that only lasted six months, if that.”

“Either you drink or you get it from me tomorrow,” the boss told her one evening. She drank, fearing that refusing to do so would hurt her career. But eventually, unable to take the drinking any longer, she quit and sued.

In May, in the first ruling of its kind, the Seoul High Court said that forcing a subordinate to drink alcohol was illegal, and it pronounced the manager guilty of a “violation of human dignity.” The court awarded the woman $32,000 in damages for the incidents, which occurred in 2004.

The ruling was as much a testament to women’s growing presence in corporate life here as a confirmation of changes already under way. As an increasing number of women have joined companies as professionals in the past half decade, corporate South Korea has struggled to change the country’s thoroughly male-centered corporate culture, starting with alcohol.

An evening out with colleagues here follows a predictable, alcohol-centered pattern: dinner, usually some grilled pork, washed down with soju, Korea’s national vodkalike drink; then a second round at a beer hall; then whiskey and singing at a “norae bang,” a Korean karaoke club. Exhorted by their bosses to drink, the corporate warriors bond, literally, so that the sight of dark-suited men holding hands, leaning on one another, staggering toward taxis, is part of this city’s nighttime streetscape. The next morning, back at the office, they are ready to fight, with reaffirmed unity, for more markets at home and abroad.

Many professional women manage to avoid much of the drinking by adopting well-known strategies. They slip away while their male colleagues indulge in a second or third round of drinking. They pour the drinks into potted plants. They rely on male colleagues, called “knights in shining armor,” to take their turns in drinking games.

Companies, too, have begun to respond. Since 2005, Posco, the steel manufacturer, has limited company outings to two hours at its mill in South Korea’s southwest. Employees can raise a red card if they do not want to drink or a yellow card if they want to go home early. At Woori Bank, one of South Korea’s largest, an alarm rings at 10 p.m. to encourage workers to stop drinking and go home using public transportation, which stops running before midnight.

“My boss used to be all about, ‘Let’s drink till we die!’ ” said Wi Su-jung, a 31-year-old woman employed at a small shipping company.

Ms. Wi, who was out enjoying the sun in downtown Seoul, said the atmosphere began changing as more women joined her company in the past couple of years. “The women got together and complained about the drinking and the pressure to drink,” she said. “So things changed last year. Now we sometimes go to musicals or movies instead.”

Kim Chil-jong, who was taking a walk on his lunch hour, said he owned a nine-person publishing company. In the last couple of years, he hired two women for the first time.

“We drink less because of their presence,” Mr. Kim, 47, said. “Before, I’d encourage my workers to drink whenever we went out, but I don’t do that anymore.”

Still, at least 90 percent of company outings — called “hoishik,” or coming together to eat — still center on alcohol, according to the Korean Alcohol Research Foundation. The percentage of women who drink has increased over all as they have joined companies.

Over all, South Koreans consume less alcohol than, say, most Europeans, according to the Organization for Economic Cooperation and Development, a research organization financed by industrialized nations.

But Cho Sung-gie, the alcohol foundation’s research director, estimates that South Koreans rank first in binge drinking: the goal is to drink as much as possible, as quickly as possible, so that co-workers loosen up.

Companies have awakened to the potential dangers of bingeing: health threats, decreased productivity and, with more women working, the risk of sexual harassment.

The foundation, though financed largely by the alcohol industry, is considered the authority on the country’s drinking culture. It runs programs on responsible drinking and abstinence, and assists companies to organize outings not centered on alcohol. Chang Kih-wung, a manager in the education team, has even joined company outings to the movies.

“Usually, a company decides to do something about drinking after a guest, often a foreigner, visits and makes a comment like, ‘Man, people drink like crazy here!’ ” Mr. Chang said. “So they’ll invite me for a lecture or organize a single activity — then they forget about it and go back to drinking.”

Traditionally, this corporate culture often began at the job interview itself. Asked whether they liked to drink, applicants knew that there was only one correct answer.

“If they said they didn’t drink, we’d think that we couldn’t work closely together,” said Lee Jai-ho, 40, an engineer at a paper mill that was bought by Norske Skog of Sweden in the late 1990s.

Mr. Lee said he was asked whether he was a good drinker during his job interview in 1992, and he asked the same question of job candidates later. The company’s hard-drinking culture changed, however, after it changed to foreign ownership.

It is this fear of not being accepted as full members of the team that has led many women to drink to excess. A 31-year-old lawyer for a telecommunications company, who asked that her name not be used, blacked out during a company outing shortly after she became the first Korean woman to serve as a lawyer in the legal division three years ago. “During my studies, I always competed against men,” she said. “So I didn’t want to lose to men at hoishik.”

She drank so much during dinner at a Chinese restaurant that she remembered nothing past 9 p.m., though the outing lasted until 1 a.m.

However, as more women have joined her division, she said, the emphasis on alcohol has decreased.

“Before it was always grilled pork with soju followed by mixed drinks,” she said. “Now, I can suggest that we go to a Thai or Italian restaurant.”

Not all men were so flexible, though. In the case of the 29-year-old graphic designer, when she was interviewed at the 240-employee online game company in 2004, she was also forced to submit to an “alcohol interview,” according to the court ruling. She could drink only two glasses of beer and no soju at all, she said.

Her boss, though, liked to go out with his 10-person marketing team — six men and four women — at least twice a week until the predawn hours and brooked no excuses.

One time, he told her that if she called upon a “knight in shining armor,” she would have to kiss him. So she drank two glasses of soju. Another time, after she slipped away early, he called her at home and ordered her to come back. She refused.

At the trial, the boss said he was so intent on having his subordinates bond that he sometimes used his own money to take them out drinking. He called the woman a weirdo and said of the lawsuit, “I’m the victim.”

Returning Soldiers Struggle to Get Mental Health Care
Kimberly Hefling, Associated Press- 6/11/2007

WASHINGTON - Soldiers returning from war are finding it more difficult to get mental health treatment because military insurance is cutting payments to therapists, on top of already low reimbursement rates and a tangle of red tape.
     Wait lists now extend for months to see a military doctor, and it can takes weeks to find a private therapist willing to take on members of the military.. The challenge appears great in rural areas, where many National Guard and Reserve troops and their families live.
     To avoid the hassles of Tricare, the military health insurance program, one frustrated therapist decided to provide an hour of therapy time a week to Iraq and Afghanistan veterans for free. Barbara Romberg, a clinical psychologist in the Washington area, has started a group that encourages other therapists to do the same.
     "They're not going to pay me much in terms of my regular rate anyway," Romberg said. "So I'm actually feeling positive that I've given, rather than feeling frustrated for what I'm going through to get payment."
Joyce Lindsey, 46, of Troutdale, Ore., sought grief counseling after her husband died in Afghanistan last September. The therapist recommended by her physician would not take Tricare. Lindsey eventually found one on a provider list, but the process took two months. "It was kind of frustrating," Lindsey said. "I thought, Am I ever going to find someone to take this?"'
     Roughly one-third of returning soldiers seek out mental health counseling in their first year home. They are among the 9.1 million people covered by Tricare, a number that grew by more than 1 million since 2001. Tricare's psychological health benefit is "hindered by fragmented rules and policies, . inadequate oversight and insufficient reimbursement," the Defense Department's mental health task force said last month after reviewing the military's psychological care system.
     The Tricare office that serves Fort Campbell, Ky., and Fort Bragg, N.C. -- Army posts with heavy war deployments -- told task force members that it routinely fields complaints about the difficulty in locating mental health specialists who accept Tricare. "Unfortunately, in some of our communities ... we are maxed out on the available providers," said Lois Krysa, the office's quality manager. "In other areas, the providers just are not willing to sign up to take Tricare assignment, and that is a problem."
     Tricare's reimbursement rate is tied to Medicare's, which pays less than civilian employer insurance. The rate for mental health care services fell bay 6.4 percent this year as part of an adjustment inn reimbursements to certain specialties.
     Since 2004, Tricare has sped up payments to encourage more doctors to participate, said Austin Camacho, a Tricare spokesman. In some locations, such as Idaho and Alaska, the Defense Department has also raised rates to attract physicians, he said. "We are working hard to overcome those challenges," Camacho said.
     Jack Wagoner is a retired military officer and psychologist and psychiatrist in private practice who also works for a Tricare contractor. He told defense mental health board members last December that in general, Tricare pays "considerably lower" than private health insurance plans.
According to data from Tricare's Medical Benefits and Reimbursement System office, Tricare pays mental health providers as much or more than a corporate plan would pay a therapist for treating a patient -- although in some cases it is lower.
     There are different coverage plans within Tricare, and the amount paid to providers varies by plan, location, specialty and services performed. Psychologists who treat active duty troops are paid 66 percent of what Tricare views as the customary rate. So a psychologist eligible for a customary rate of $120 per hour would be paid $79.20 for the hour by Tricare, even if the psychologist's- standard rate is $150 per hour.
     Active duty troops use Tricare Prime, a managed-care option maintained by private contractors. Their mental health care is free. Guard and Reserve troops and their families frequently use Tricare Standard, a fee-for-service plan. They pay an annual deductible and 20 percent of the amount Tricare pays the therapist.
     John Class, a retired Navy health care administrator who now advocates on health issues for the Military Officers Association of America, said Tricare Prime contractors insist that the lower reimbursement rates has made it tougher to maintain a network of providers. "We are already starting to see the pinch," Class said.
     In a limited study by Tricare released earlier this year, about two out of three civilian psychiatrists in 20 states were willing to accept Tricare Standard clients among their new patients, the lowest acceptance rate for any specialty.
     Any additional cuts in Tricare payouts could mean that "some really good psychologists who specialize in this treatment and are experienced will be seeing less of (military families)," said clinical psychologist Marion Frank, a widow who is president of the Philadelphia Chapter of the Gold Star Wives of America, a support group for military widows.

Nearly 5,000 parents claim that vaccinations caused their children to become autistic, and many of their claims have been pending for five years. The hearing was held at the “federal vaccine court,” set up by Congress 20 years ago when a series of vaccine scares nearly crippled the industry.

Every major study and scientific organization examining this issue has found no link between vaccination and autism, but the parents and their advocates have persisted. Their frustration was evident in the opening statement of the parents’ lawyer, Thomas Powers of Portland, Ore.

“Numerous obstacles have been placed in the path of the petitioners seeking that fair and generous compensation that they are entitled to,” Mr. Powers said.

Mr. Powers gave his statement with his back to the three judges who will decide the case, addressing instead a few dozen audience members, many of them lawyers.

“I felt it was important to address the families and the public,” he said during a break in the hearing.

The vaccine court has gone to unusual lengths to convince parents that it will fairly adjudicate their claims, even setting up a conference call where parents can listen in to the hearings, which are expected to run for three weeks.

At the opening of the hearing, Special Master George Hastings took pains to express his sympathy to the parents of autistic children.

He pointed to Michelle Cedillo and her parents, Theresa and Michael Cedillo, whose claim for compensation is serving as the first test case. Special Master Hastings said the Cedillos were “the most important people in the courtroom.”

“To all such family members, as to the Cedillo family, we special masters pledge to you that we will listen very carefully to the evidence presented at this hearing,” Special Master Hastings said. “We realize what an important task that has been assigned to us in this hearing.”

Michelle Cedillo, 12, was rolled into the courtroom in a wheelchair at the start of the hearing. She wore hearing protection similar to that worn by heavy-machinery operators. She hit herself repeatedly and made loud grunting noises. Her parents soon rolled her out.

Many parents who claim that vaccines gave their children autism are deeply suspicious of what they see as the government’s role in their children’s illness.

Most have dismissed the many government-sponsored studies and panels that found no link between vaccination and autism. A few have even physically threatened some government scientists.

Parents’ lawyers said this case would probably affect only a handful of the other claims. A test hearing for the other claims will be heard next year, said Mike Williams, chairman of a committee of parents’ lawyers.

In Monday’s hearing, lawyers argued that the measles, mumps and rubella vaccine gave Michelle a chronic measles infection that damaged her central nervous system. The lawyers also said that a once-common additive to pediatric vaccines, thimerosal, damaged her immune system, making it impossible for her to fight the infection.

“She had been interacting with her parents, with her cousins,” said Sylvia Chin-Caplan, who represents the Cedillos. “She was babbling. She suddenly became silent.”

The argument represents a patchwork of theories advanced for years, but the more common argument is that thimerosal directly damaged children’s brains.

In hopes of finding more evidence to support their claims, parents’ lawyers have for years delayed the cases based on that argument.

“I think we can win with what we’ve got,” Mr. Williams said. “But I think we’ll get better evidence” by waiting.

Vincent J. Matanoski, an assistant director in the civil division of the Department of Justice, opened with a brief statement in which he dismissed the parents’ cases as “junk science.”

“Unfortunately, after five years, you’ll find a signal lack of support for their contentions,” Mr. Matanoski said.

Thimerosal was almost entirely removed from pediatric vaccines in 2001 after some government scientists expressed concern about the amount of mercury that children who got routine vaccinations would be exposed to. Since then, autism rates in the United States have shown no signs of dropping.

“Poor parenting may be reflected in poor sibling relationships,” said Dr. Robert J. Waldinger, the lead author of the study and an associate professor of psychiatry at Harvard. “But once you’ve taken account of the quality of sibling relationships, knowing about the quality of parenting doesn’t add much information.”

The findings, published in the June issue of The American Journal of Psychiatry, are based on an analysis of data from 229 men who were followed for more than 30 years beginning at age 18 or 19. They were first assessed in the period 1939-42 by internists, psychiatrists, psychologists and anthropologists, and then they completed questionnaires every other year. Researchers also interviewed their parents.

The men were reinterviewed when they were about 25, 30 and 50, and the biennial questionnaires have continued to the present. This prospective design and long follow-up are major strengths of the study.

Using information from these questionnaires and interviews, experts rated the men’s relationships with siblings during childhood and adolescence, and how well they were raised by each parent. They also recorded whether a parent had died before the child was 18 and whether there was a family history of depression. The 26 only children in the sample were excluded from the rating of relationships with siblings.

None of the 21 men who had a parent die in childhood became depressed. The 15 percent who had a poor relationship with their mothers and the 16 percent who had a family history of depression suffered depression later in life. But among those who had poor or destructive relationships with siblings, 26 percent had episodes of major depression as adults.

The significantly increased rate for depression among this last group remained even after controlling for family history of the illness, which suggests that the poor relationship with brothers and sisters did not grow out of a genetic tendency for depression but was an independent predictor.

“This is a really important study,” said Myrna M. Weissman, a professor of psychiatry at Columbia University who was not involved in the work. “The one caveat is that these were all men, and sibling relationships may pertain more to men than to women.”

The researchers offered some other examples of how the risks interact. A man whose parents did an average job and who had no family history of depression, but who had a poor relationship with a sibling, would have a 9.9 percent chance of developing depression. But a similar man with a good relationship with at least one sibling would have only a 2.3 percent chance of becoming depressed. In a man with an average parental experience, a family history of depression and poor relationships with siblings, the risk for depression rises to 30 percent.

The authors acknowledged that they collected diagnostic information on depression before the appearance of the Diagnostic and Statistical Manual of Mental Disorders, which established strict psychiatric diagnostic criteria. Also, the small sample consisted only of white male college students who came of age in the World War II era, and who were selected specifically for excellent mental health.

The study offers no conclusions about whether depression causes destructive interactions between siblings, whether the destructive relationships are an early indication of depression, or whether the two factors act on each other to increase the risk.

“This is just one study, and we need more to see whether this finding will be confirmed,” Dr. Waldinger said. “Sibling relationships have been underemphasized in learning about child development.”

A contract finalized this week but not yet announced calls for spending $33 million to add about 200 mental health professionals to help soldiers with post-traumatic stress disorder and other mental health needs, officials told The Associated Press on Thursday.

''As the war has gone on, PTSD and other psychological effects of war have increased,'' said Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general.

''The number of (mental health workers) that was adequate for a peacetime military is not adequate for a nation that's been at war,'' she said in an interview.

The new hiring, which she said could begin immediately, is part of a wider plan of action the Army has laid out to improve health care to wounded or ill veterans and their families. It also comes as the Defense Department completes a wider mental health study -- the latest in a series over recent months that has found services for troops have been inadequate.

Ritchie said long and repeat deployments caused by extended wars in Iraq and Afghanistan are causing more mental strain on troops. ''At the time that the war began, I don't think anybody anticipated how long it would be going on,'' she said.

Surveys of troops in Iraq have shown that 15 percent to 20 percent of Army soldiers have signs and symptoms of post-traumatic stress, which can cause flashbacks of traumatic combat experiences and other severe reactions.

About 35 percent of soldiers are seeking some kind of mental health treatment a year after returning home under a program that screens returning troops for physical and mental health.

The military has seen a number of high-profile incidents of alleged abuse in the wars in Iraq and Afghanistan, including the killings of 24 civilians by Marines, the rape and killing of a 14-year-old girl and the slaying of her family and the sexual humiliation of detainees at Abu Ghraib prison. Officials and military analysts have blamed ethics lapses partly on the strain of combat and insufficient training troops got before being sent to the battlefront.

Ritchie said the 200 new medical health workers will be added to more than 600 uniformed and civilian mental health professionals now working at three dozen Army medical centers and hospitals.

The Army also is planning a number of other improvements, such as streamlining bureaucracy that vets must go through to get care and adding more lawyers and other workers to help them and their families.

A report from a Defense Department task force released Thursday also found ''current efforts fall significantly short'' in providing help for troops.

''The psychological health needs of America's military service members, their families and their survivors pose a daunting and growing challenge to the Department of Defense,'' it said.

The task force was required by Congress under in 2006 law.

Also on Thursday, a Senate panel voted to expand brain screenings and counseling for wounded veterans of the Iraq war and to reduce red tape for service members moving from Pentagon to Veterans Affairs care.

The bill, approved by the Senate Armed Services Committee, also would boost disability pay and provide more counseling for family members of tens of thousands of U.S. service members wounded in combat.

The action, which sends the bill to the Senate floor, capped a flurry of activity in recent weeks to reach broad agreement on a single measure that would improve health care following reports of shoddy outpatient treatment at Walter Reed Army Medical Center.

Separately, the VA said that it would bolster programs to prevent suicide among veterans by hiring additional counselors at each of its 153 medical centers after an internal review found that current VA programs were inadequate.

The unspecified number of new counselors would join 9,000 mental health professionals already employed by the VA to help veterans.

Meanwhile, the White House has backed away from earlier threats to veto a spending bill containing $4 billion more than President Bush sought for veterans' health care.

Just last month, White House budget director Rob Portman pledged that Bush would veto bills from Congress that would break through Bush's budget caps.

The House is slated on Friday to take up the $64.7 billion measure, which also funds military base construction. A companion Senate bill sailed through the Appropriations Committee Thursday afternoon.

Officials with the Virginia Tech Review Panel said the university handed over "a few files" late Wednesday pertaining to Cho's interaction with the school's counselors and its medical system. Panel members said they still would like to review his college records, high school records and any other documents the state's mental health system and courts have about Cho.

Virginia Tech was authorized to hand over the records by Cho's parents, who went into isolation after the shootings, after several days of negotiations with someone the university found who knew how to contact them.

The information had been protected under a federal privacy law known as the Health Insurance Portability and Accountability Act, which is designed prevent doctors from sharing a patient's medical history.

Because Cho is dead, attorneys for the university determined that only the executor of his estate, his parents, could authorize the release of the information.

"This is information we are pleased to get," said W. Gerald Massengill, chairman of the panel, which is investigating the shootings that killed 32 people and what might have triggered them. "There are a number of questions associated with the mental health process that occurred out there that hopefully these records will shed some light onto."

Although the information has been given to the taxpayer-funded panel, the documents will not be made public.

"Under medical privacy laws, the panel received those records by the family waiving their privacy rights and enabling Virginia Tech to share them with the panel so the panel can review those records and use them in its investigation as it prepares its report, but we are constrained from sharing them otherwise," said James M. Kudla, a spokesman for the panel.

The records were released after weeks of frustration among the eight panel members about not being able to analyze Cho's mental health in the years leading to the massacre, the worst mass shooting by an individual in U.S. history.

In December 2005, after a court declared him mentally ill, Cho was ordered to seek treatment at the school's Thomas E. Cook Counseling Center. Sources have told The Washington Post that Cho never received the treatment.

Panel members, who were brought together by Gov. Timothy M. Kaine (D) in the days after the shooting, had threatened to seek a court order if Cho's records were not voluntarily released.

Massengill and other panel officials said yesterday that they will continue to press to gain access to additional records, which also are protected under state and federal privacy laws.Those include Cho's records from Westfield High School in Chantilly and information about his interaction with state mental health and court officials after he was taken into emergency custody.

Fairfax County school officials said they have helped the panel connect with an administrator and a counselor who knew Cho when he attended Westfield. But they said they can't release Cho's records without a subpoena or permission from his family.

Virginia Tech spokesman Mark Owczarski said he didn't know whether the university would turn over Cho's academic records.

The panel released a statement that said it "is confident it will be able to obtain all the records and information that it needs from other sources . . . so that it can complete its important work and produce a thorough report and well-grounded recommendations."

At the same time, the panel is facing increasing scrutiny from some of the relatives of the victims.

Thomas J. Fadoul Jr., a Vienna attorney for 20 of the families, said a family member or their representative needs to be included on the panel so they can "steer" the investigation and guarantee that it is unbiased.

The release of the medical reports, Fadoul said, underscores why family members want to be on the panel. "They want to know what was in that guy's mind when he killed their kids and how his mind has developed over the years," he said.

If a family member or representative was not added to the panel, relatives would be inclined to sue, said Fadoul, whose cousin Centreville was killed by Cho.

J. Tucker Martin, a spokesman for Attorney General Robert F. McDonnell (R), declined to comment. McDonnell's office would represent Kaine, taxpayers and Virginia Tech in any legal proceeding.

Approximately 3.028 million Japanese were diagnosed with mental illness, according to a report on people with disabilities issued annually by the Cabinet Office. Mental illness data, tabulated only periodically, was last featured in 2002.

2005 was the first year the number exceeded 3 million, Cabinet Office official Toshiaki Nagato said. Japan's population in 2005 was 127 million.

The report does not explain why the numbers have increased, said Nagato, who helped compile the report.

But he said it likely reflected an increase in the number of mental health care facilities and other treatment options that allow more sufferers to come forward and be counted.

The government has recently started to ease restrictions on compensation allowing more people suffering from depression or stress-related illnesses to qualify for help.

The government has earmarked substantial funds for programs to help those with depression and other mental illnesses and is more actively involved in trying to get those affected to seek help through awareness programs.

Earlier this year, officials said more Japanese claimed and received compensation for work-related suicides and mental-health problems in 2006 than ever before.

Conditions regarded as mental illnesses in the report included addictions, Alzheimer's disease, depression, epilepsy and stress-related disabilities.

Mental Health Action Urged By Military
Lisa Chedekel & Matthew Kauffman, Hartford Courant- 6/15/2007

All troops should undergo annual psychological screenings, no veteran should wait more than seven days for a mental health appointment, and the military and Congress should act immediately to begin adding hundreds of mental health workers to a system now at the breaking point.

Those are among the key recommendations a Pentagon task force will announce today in calling for the Defense Department to correct "fundamental weaknesses" in its approach to mental health - or risk staggering social consequences.

"The time for action is now. The human and financial costs of un-addressed problems will rise dramatically over time," the report by the panel of military and civilian experts states. "Our nation learned this lesson, at a tragic cost, in the years following the Vietnam War."

The task force's report, prepared for Defense Secretary Robert M. Gates and Congress, calls for restructuring how the military oversees mental health care. It proposes creating in each service branch a director of psychological health who would report to the surgeons general.

The National Guard in each state also would appoint a chief of psychological health, who would leverage community mental health resources for Guard members and families.

The structural changes are among 95 recommendations to improve treatment of mental health for troops and their families. Some of the issues addressed in the report were the subject of a May 2006 series in The Courant, which found myriad lapses, sometimes with tragic consequences, in the military's screening and treatment of soldiers who have psychological problems.

The task force recommends that all service members undergo an "annual psychological health needs assessment," conducted by a trained professional who would promptly refer troubled troops to mental health clinicians. The military has no requirement for annual face-to-face psychological screenings, and relies on brief questionnaires filled out by service members before and after they deploy to war to gauge their mental fitness.

Although the task force acknowledged the questionnaires were inadequate, it did not recommend expanding those forms, opting for annual exams as the best way to gauge troops' mental health.

The 14-member panel, created by Congress, also urged the military to devise "reliable and valid measurement tools" for assessing new enlistees' psychological strengths and weaknesses. But the group stopped short of recommending that all recruits undergo a psychological assessment to determine their mental fitness to serve. The military does not screen enlistees for mental health, relying on them to self-report any psychological problems.

The task force said mental health problems had an "overwhelming" stigma in the military. Commanders and medical providers need better training to recognize and treat service members in psychological distress. The panel also called for changing military policies to make it easier for commanders to refer troops for mental health treatment, and to encourage those with alcohol problems to get help.

The task force found that the pool of mental health providers at U.S. bases and in Iraq was badly strained. Children of troops were especially hard-hit by the shortage, the task force found.

"It was not unusual for a parent to report waiting six to nine months for an initial child psychiatry outpatient appointment, or for providers to report that children had to be sent to another state for inpatient treatment," the report states.

The task force urges the Defense Department and Congress to "immediately correct the systemic funding and personnel shortfalls that are adversely impacting service members ... and their families." Noting that the military has "dramatically reduced" the number of active-duty mental health professionals in recent years, it recommends attracting clinicians through more incentives and recruiting.

On Thursday, military officials said they were finishing a $33 million plan to add about 200 new mental health workers, the Associated Press reported.

The task force report emphasized the importance of using mental health workers employed by the military. Uniformed specialists understand the military better and are more likely to be respected by service members. To improve the odds that service members receive mental health care, the task force also recommended "embedding" mental-health workers in primary-care medical offices.

For children and spouses, the task force recommended a boost in insurance reimbursements for non-military mental health care, saying payments by the military's huge insurance program were so low, many private psychiatrists refuse to treat the relatives of service members.

Sens. Barbara Boxer, D-Calif., and Joseph Lieberman, an independent from Connecticut, who sponsored legislation last year to improve mental health screening and treatment of troops, said they were pleased with the task force's findings, and would meet with Gates to urge him to act.

"It's a groundbreaking report," said Boxer, who wrote the legislation creating the task force. "I think if the intent of the authors is carried out here, that we are going to see enormous changes."

"This report is direct, honest and forward-looking," Lieberman said. "There's no blurriness here. To do what we ought to do is going to cost some money and require some resources."

Lieberman said he hoped the Defense Department would use some money from a $2 billion appropriation already received to expand mental-health services. He and Boxer also said they would urge Gates to heed the task force's request for the "rapid drafting of an action plan that includes immediate steps, timelines and firm deadlines."

Cynthia Smith, a Pentagon spokeswoman, said Thursday that Gates' office had received the report and begun reviewing it.

The report calls on the Defense Department and the Department of Veterans Affairs to establish policies requiring that active-duty troops and veterans wait no more than seven days for mental health appointments, with shorter waits for more acute mental health problems.

The task force expressed concerns about the military's practice of sending some troops diagnosed with post-traumatic stress disorder back into combat, but it did not call for the practice to be stopped, saying PTSD was "treatable" and that some soldiers want to go back into combat.

Boxer said the issue of redeploying troops with PTSD remained a concern for her, but she hoped that new deployment guidelines, issued late last year, would keep unstable soldiers from going back to war.

The guidelines - prompted by congressional action after The Courant's series - set limits on when troops diagnosed with a mental illness or taking psychiatric medications can be sent back into combat.

The task force also rapped poor communication between mental health workers in Iraq and those at home, citing incidents of therapists "shredding their mental health notes upon the individual's departure from the deployed environment."



PTSD Symptoms Follow Afghanistan Vet Daily
Hart Seeley, Newhouse News Service- 6/15/2007

Fallen comrades visit him in dreams. Some were close friends. Some, he barely knew. Some are whole again. Some, he cannot bear to see. He bolts awake in the night, then roams the house, checking locks on doors and windows. He doesn't get back to sleep. He just paces. "They say it will be over, but sometimes, I just can't see it," said Tom Gibson, 29, of Bridgeport, N.Y, who has a wife, a 2-year-old daughter and a carryover from his time in Afghanistan: post-traumatic stress disorder.
     As the U.S. Army strains under the pressure of two wars, the toll on its warriors is showing on its warriors. Lost limbs and wheelchairs make unforgettable images, but for many Iraq and Afghanistan veterans, some of the most troubling scars don't photograph. Atop the list is PTSD, a mix of anxiety, guilt and depression that gained public awareness during the Vietnam War. Since 2002, nearly 40,000 Iraq and Afghanistan veterans have been diagnosed with PTSD symptoms, according to the Department of Veterans Affairs.
     Though misunderstood, PTSD is treatable, as long as the person seeks help. For many ex-soldiers, that's not so easy. "It's the stigma of a warrior having to admit that something in his or her life is out of control, said Larry Lantinga, a psychologist and co-manager of behavioral health at the VA Medical ClinicCenter in Syracuse, NY. "At post-deployment or discharge, often they will deny everything and say, `I just want to go home.' By the time we see them, something in their lives is not right."
     That's how it went for Gibson. After returning in 2004 from nine months in Afghanistan, he downplayed his problems to counselors at Fort Drum, the Army's post near Watertown, N.Y. But after he received an honorable discharge in 2005, Gibson couldn't get his life back on course. In January 2006, he sought counseling at the Syracuse VA Center. He couldn't sleep at night. He couldn't relax. Weary and frustrated, he couldn't keep a job. For 11 months, he received medication and counseling, trying to rise from his doldrums. On Dec. 6, a letter arrived from the Army. He was to reenter the Army for up to 18 months and work anywhere from Arizona to Baghdad. The country was calling Gibson back, and he was falling apart.

'Panicked and scared'
Upon enlistment, every U.S. soldier commits to eight years of military service; regardless of how long he or she spends on active duty. After being discharged, veterans are placed on the Army's Individual Ready Reserve list, a pool that numbers 78,000. "Back in the 1980s, nobody, thought about the. IRR," said Fred Bush, coordinator of Returning Veterans Education Outreach at the Syracuse VA. "It'd be, `Hell, they're not going. to call me back.' Well, that's a real concern now."
      Since 2001, the Army has recalled 10,128 veterans from the Individual Ready Reserve list. To keep boots on the ground in Iraq and Afghanistan, it has also extended combat deployments to 15 months from 12, required soldiers to serve extra tours through the "stop loss" program and called up large numbers. of National Guard troops.
     The recall letter hit Gibson hard. "He reported being very panicked and scared, and did not know what to do," psychologist Louise Weller wrote Dec. 7 in an evaluation for the VA. Based on Gibson's phone call, Weller described him as "highly anxious and distressed." After talks with his counselors, Gibson requested an exemption to his call-up, based on health concerns. The Army pushed back his retorting date by a month, to Feb. 22.  The Army grants about half the requests for IRR exemptions according to the Pentagon. The most common reasons: health concerns of soldiers or hardship for their immediate families.
     As the war grind on, concerns are growing about what the Army traditionally has called "combat stress." A 2007 Pentagon study reports that 17 percent of the soldiers in Iraq show PTSD symptoms. The frequency rises among soldiers who serve multiple and longer deployments. PTSD has been around for as long as war. In earlier times; people called it "shell shock" or "war neurosis.." In 1980, after exhaustive stud of Vietnam veterans, the American Psychiatric Association gave it a name: PTSD.
     In 1988, a study estimated that 13 percent of Vietnam veterans suffered from PTSD. The war in Vietnam took place in jungle villages. Iraq is being waged in desert cities. But in both, U.S. troops could not outwardly tell the difference between friend and enemy. And buried explosives brought about the threat of instant death.
     In mid-December, after receiving his call-up orders, Gibson quit his job as a telemarketer. He gathered VA records for his arthritic knees and flat feet and sent his psychiatric assessments to the Army. On March 9, the answer arrived. He was ordered to report to Fort Benning, Ga., on April 22.

Survivor's guilt
Thomas G. Gibson graduated from the State University of New York College at Oneonta in 2000 with a degree in math and physics. He wanted to be a teacher. To pay college loans, Gibson enlisted for a four-year hitch in the Amy on Aug. 29, 2001. Two weeks later, the World Trade Center fell. In August 2003, as a specialist in the 10th Mountain Division's 2nd Brigade, Gibson deployed to Afghanlstan for six months; a .tour that was later. extended to nine. His job: driving Humvees around the city of Ghazni.
     In 2003, the Army was adjusting to the threat of IED5 -- improvised explosive devices -- buried along roads. This was the era of "soft-skinned" Humvees, without the reinforced armor of today's vehicles. As the death toll rose, soldiers began filling Humvees with sandbags. But when a soft-skin triggered a roadside bomb head-on, somebody likely died. Gibson lost several friends to IEDs. His convoys were hit only once, without casualties. He never saw a firefight. But he lost a friend in a helicopter crash, a flight he at one point was scheduled to make. Gibson said he doesn't believe he experienced the kinds of atrocities that justify a soldier having PTSD. "It's never seemed. right that I could be messed up," he said. "It's like I have no right to be complaining, no right to
be experiencing this,"
     In May 2004, his brigade returned to Fort Drum. Gibson saw a counselor about his anger and sleepless nights. Upon his 2005 discharge, he thought his nightmares would vanish. With his wife, Joann, and a baby daughter, Gibson bought a home in Bridgeport, near Oneida Lake. He planned to go back to school and get his teaching degree. But something wasn't right. "There was just no joy in things. I stayed in the house. I didn't get out. I didn't like driving. Everything just kind of hit me," he said.
     In November 2005, the Albany VA Medical Center diagnosed Gibson's PTSD symptoms, though an examiner there wrote that Gibson was downplaying his problems to avoid being "labeled." Two months later, Gibson sought help at the Syracuse VA. "He has recurring intrusive thoughts, memories, images and recollections of his time in Afghanistan," his VA evaluator would write later. "He cannot relax. He has trouble feeling safe for any sustained period of time." Gibson went through ups and downs. But as the wars continued, and the news reports kept coming, he couldn't climb out of the hole. And then in December; the Army called him back.

A decision
In February, Gibson appealed the Army's rejection of his exemption request The Army pushed his date to report back to June. Over the next month, Gibson put his life on hold, unsure of what to do. If he reported, he feared being unable to do his job, and maybe costing someone his or her life. If he didn't report, he'd lose his honorabe discharge and veteran status. He grew more angry, more frustrated, more numb. "He continues to procrastinate and then belittle himself for that," Weller, the psychologist, wrote in April.
     When Army caseworkers called his home, Gibson was too distraught to take the phone. He asked Bush, his VA counselor, to call back and help him. He sent a bundle of VA medical records to the Army, then waited. "His insight and judgment are good," wrote VA examining provider Michael Thompson on April 12. "He is in appropriate treatment for his needs." Thompson said Gibson showed a "full range" of PTSD symptoms. Thompson suggested Gibson spend time at the VA's residential PTSD program in Batavia, N.Y.
     On April 18, a letter arrived- from the Army Human Resources Command in St. Louis. "Your orders for mobilization have been revoked," it said. The decision brought feelings of relief and guilt. Gibson could not celebrate. "I feel that I'm letting the guys down." he said. Gibson said he hopes to get his fife back on course. But the anxieties will not end as long as the wars continue. "What it comes down to is, I'm back here now," he said, "but there are guys over there still. It's not over."

WEST SENECA, N.Y.— Mary Strzelczyk spoke to the computer screen as clearly as it was speaking to her. “Oh, Justin,” she said through sobs, “I’m so sorry.” The images on the screen were of magnified brain tissue from her son, the former Pittsburgh Steelers offensive lineman Justin Strzelczyk, who was killed in a fiery automobile crash three years ago at age 36. Four red splotches specked an otherwise tranquil sea — early signs of brain damage that experts said was most likely caused by the persistent head trauma of life in football’s trenches.
      Strzelczyk (pronounced STRELL-zick) is the fourth former National Football League player to have been found post-mortem to have had a condition similar to that generally found only in boxers with dementia or people in their 80s. The diagnosis was made by Dr. Bennet Omalu, a neuropathologist at the University of Pittsburgh School of Medicine. In the past five years, he has found similar damage in the brains of the former N.F.L. players Mike Webster, Terry Long and Andre Waters. The finding will add to the growing evidence that longtime football players, particularly linemen, might endure hidden brain trauma that is only now becoming recognized. “This is irreversible brain damage,” Omalu said. “It’s most likely caused by concussions sustained on the football field.”
     Dr. Ronald Hamilton of the University of Pittsburgh and Dr. Kenneth Fallon of West Virginia University confirmed Omalu’s findings of chronic traumatic encephalopathy, a condition evidenced by neurofibrillary tangles in the brain’s cortex, which can cause memory loss, depression and eventually Alzheimer’s disease-like dementia. “This is extremely abnormal in a 36-year-old,” Hamilton said. “If I didn’t know anything about this case and I looked at the slides, I would have asked, ‘Was this patient a boxer?’ ”
     The discovery of a fourth player with chronic traumatic encephalopathy will most likely be discussed when N.F.L. officials and medical personnel meet in Chicago on Tuesday for an unprecedented conference regarding concussion management. The league and its players association have consistently played down findings on individual players like Strzelczyk as anecdotal, and widespread survey research of retired players with depression and early Alzheimer’s disease as of insufficient scientific rigor. The N.F.L. spokesman Greg Aiello said that the league had no comment on the Strzelczyk findings. Gene Upshaw, executive director of the N.F.L. Players Association, did not respond to telephone messages seeking comment.
     Strzelczyk, 6 feet 6 inches and 300 pounds, was a monstrous presence on the Steelers’ offensive line from 1990-98. He was known for his friendly, banjo-playing spirit and gluttony for combat. He spiraled downward after retirement, however, enduring a divorce and dabbling with steroid-like substances, and soon before his death complained of depression and hearing voices from what he called “the evil ones.” He was experiencing an apparent breakdown the morning of Sept. 30, 2004, when, during a 40-mile high-speed police chase in central New York, his pickup truck collided with a tractor-trailer and exploded, killing him instantly.
     Largely forgotten, Strzelczyk’s case was recalled earlier this year by Dr. Julian Bailes, the chairman of the department of neurosurgery at West Virginia University and the Steelers’ team neurosurgeon during Strzelczyk’s career. (Bailes is also the medical director of the University of North Carolina’s Center for the Study of Retired Athletes and has co-authored several prominent papers identifying links between concussions and later-life emotional and cognitive problems.) Bailes suggested to Omalu that Strzelczyk’s brain tissue might be preserved at the local coroner’s office, a hunch that proved correct.
     Mary Strzelczyk granted permission to Omalu and his unlikely colleague, the former professional wrestler Christopher Nowinski, to examine her son’s brain for signs of chronic traumatic encephalopathy. Nowinski, a former Harvard football player who retired from wrestling because of repeated concussions in both sports, has become a prominent figure in the field after spearheading the discovery earlier this year of C.T.E. inside the brain of Andre Waters, the former Philadelphia Eagles defensive back who committed suicide last November at age 44.
     Tests for C.T.E., which cannot be performed on a living person other than through an intrusive tissue biopsy, confirmed the condition in Strzelczyk two weeks ago. Omalu and Nowinski visited Mary Strzelczyk’s home near Buffalo on Wednesday to discuss the family’s psychological history as well as any experiences Justin might have had with head trauma in and out of sports. Mary Strzelczyk did not recall her son’s having any concussions in high school, college or the N.F.L., and published Steelers injury reports indicated none as well. Omalu remained confident that the damage was caused by concussions Strzelczyk might not have reported because — like many players of that era — he did not know what a concussion was or did not want to appear weak. Omalu also said that it could have developed from what he called “subconcussive impacts,” more routine blows to the head that linemen repeatedly endure.
     “Could there be another cause? Not to my knowledge,” said Bailes, adding that Strzelczyk’s car crash could not have caused the C.T.E. tangles. Bailes also said that bipolar disorder, signs of which Strzelczyk appeared to be increasingly exhibiting in the months before his death, would not be caused, but perhaps could be exacerbated, by the encephalopathy. Omalu and Bailes said Strzelczyk’s diagnosis is particularly notable because the condition manifested itself when he was in his mid-30s. The other players were 44 to 50 — several decades younger than what would be considered normal for their conditions — when they died: Long and Waters by suicide and Webster of a heart attack amid significant psychological problems.
     Two months ago, Omalu examined the brain tissue of one other deceased player, the former Denver Broncos running back Damien Nash, who died in February at 24 after collapsing following a charity basketball game. (A Broncos spokesman said that the cause of death has yet to be identified.) Omalu said he was not surprised that Nash showed no evidence of C.T.E. because the condition could almost certainly not develop in someone that young. “This is a progressive disease,” he said. Omalu and Nowinski said they were investigating several other cases of N.F.L. players who have recently died. They said some requests to examine players’ brain tissue have been either denied by families or made impossible because samples were destroyed.
     Bailes, Nowinski and Omalu said that they were forming an organization, the Sports Legacy Institute, to help formalize the process of approaching families and conducting research. Nowinski said the nonprofit program, which will be housed at a university to be determined and will examine the overall safety of sports, would have an immediate emphasis on exploring brain trauma through cases like Strzelczyk’s. Published research has suggested that genetics can play a role in the effects of concussion on different people. “We want to get a idea of risks of concussions and how widespread chronic traumatic encephalopathy is in former football players,” Nowinski said. “We are confident there are more cases out there in more sports.”
     Mary Strzelczyk said she agreed to Omalu’s and Nowinski’s requests because she wanted to better understand the conditions under which her son died. Looking at the C.T.E. tangles on a computer screen on Wednesday, she said they would be “a piece of the puzzle” she is eager to complete for herself and perhaps others. “I’m interested for me and for other mothers,” she said. “If some good can come of this, that’s it. Maybe some young football player out there will see this and be saved the trouble.”