Noteworthy News Articles on Mental Health Topics, February 22-31, 2008



Suspect Found Fit to Stand Trial in Therapist’s Killing
Anemona Hartocollis, New York Times- 2/23/2008

A man with a history of schizophrenia who was charged with killing an Upper East Side therapist with a meat cleaver and knives has been found mentally competent to stand trial. That finding — by two experts who had examined the suspect, David Tarloff — was announced at a court hearing on Friday a few hours before the presentation of his indictment on a first-degree murder charge in the death of the therapist, Kathryn Faughey. “Both of them have concluded that the defendant is not incapacitated — in other words, is competent to assist in his own defense,” Judge James D. Gibbons of Manhattan Criminal Court said, as Mr. Tarloff stood by with his court-appointed lawyer, Bryan Konoski.
      Mr. Tarloff, 39, was also indicted on charges of attempted murder, first-degree assault and attempted robbery in the attack on the therapist’s colleague, Dr. Kent D. Shinbach, a psychiatrist in the same suite of offices. Dr. Shinbach was attacked when he heard Dr. Faughey’s screams and tried to help. If convicted of first-degree murder, Mr. Tarloff could face life in prison.
     Mr. Tarloff stumbled Friday afternoon as he walked into court. He was dressed in blue jeans, black high-top sneakers and a bright orange jacket with “DOC,” for Department of Correction, printed on the back. But he seemed alert, focused and responsive to questions — which required yes or no answers — in court. His calm behavior contrasted with that during a court appearance on Sunday, when he denigrated his previous court-appointed lawyer and asked to be taken to a vending machine for snacks.
     After Judge Gibbons announced the findings of the two experts who had examined Mr. Tarloff, Mr. Konoski asked the court to appoint a psychiatrist to conduct a more complete mental examination. He said he would use that examination to decide whether to contest the finding that his client was fit to stand trial and to explore whether to mount an insanity defense at trial.
     Mr. Konoski said later that Mr. Tarloff had been medicated before being examined for mental competency and before coming to court. Competence to stand trial is a minimal standard, meaning only that the defendant understands the charges against him and can assist in his own defense. Mr. Konoski said he talked to Mr. Tarloff on Friday and found him “able to hold a coherent conversation.” He declined to say whether Mr. Tarloff had acknowledged any role in Dr. Faughey’s death. “I am certainly not a psychiatrist and I am not going to make any evaluation whether I believe he was fit or unfit,” Mr. Konoski said. “I’m going to leave that to my psychiatrist.”
    Dr. Faughey, 56, was stabbed in the head, face and chest on Feb. 12 by a man who entered her building, at 79th Street and York Avenue. When Dr. Shinbach rushed in, the attacker turned on him. After Mr. Tarloff was arrested, based on several bloody palm prints, the police said that Dr. Shinbach had played a part in diagnosing schizophrenia in him 17 years ago, and that Dr. Shinbach was the main target of the attack.
     This week, Mr. Tarloff’s father, Leonard, said his son did not seem to realize that he had killed anyone. He quoted Mr. Tarloff saying, “Dad, they say I killed some lady,” and then adding, “What are they talking about?” Mr. Tarloff’s father and his brother, Robert, a special education teacher, were not in court on Friday. Mr. Konoski said he had asked the family to stay away. But during the hearing, Mr. Konoski told Judge Gibbons that his client had authorized him to speak with his family, and Mr. Tarloff nodded his agreement.


Why Wasn't He Stopped?
Hilary Waldman & Daniel Jones, Hartford Courant- 2/24/2008

During the same stretch of time that Dr. George Reardon was allegedly fondling youngsters in his office at St. Francis Hospital and Medical Center in Hartford, a psychologist across town at the Institute of Living reached this conclusion: "Dr. Reardon is not a pedophile." Sparked by complaints, the state Department of Public Health — which has the authority to lodge formal charges against doctors and initiate disciplinary hearings — had asked the prestigious institute to examine Reardon to determine whether he was a child molester. A psychiatrist and a psychologist conducted three separate evaluations of Reardon between 1988 and 1993, with each examination spanning several weeks.
     During the examinations, Reardon "categorically and absolutely denied" allegations that he abused young boys and girls during his work as an endocrinologist specializing in childhood growth and development at St. Francis, according to copies of written psychological reports submitted to the health department and obtained by The Courant. The mental health experts also interviewed some of Reardon's alleged victims — one of whom provided a detailed description of Reardon's genitalia. But while the institute's experts conceded it was difficult to determine who was telling the truth — the doctor or his accusers — they said they could not diagnose Reardon as a pedophile. In both 1988 and 1991 the experts concluded that Reardon was able to continue practicing medicine with "skill and safety."
      Now, 20 years later, it's clear just how wrong the experts were. Reardon died in 1998, but last November, a cache of thousands of pornographic photos and videos was found hidden in the basement of Reardon's former West Hartford home, prompting dozens of men and women to come forward and tell horror stories. Under the guise of research, they say, Reardon would have them undress, fondle them to the point of sexual arousal and photograph them in suggestive poses — at times with other children.
      Since that discovery, more than 60 adults have filed lawsuits, accusing St. Francis of negligence for not preventing the alleged abuse — including six who say they were abused after the first complaints were filed with the state in 1987. "One of the tragedies is the decision of officials at the health department not to proceed [with disciplinary action in 1987]," said Susan Smith, an Avon lawyer who represents about half of Reardon's alleged victims. "They allowed the doctors at the [Institute of Living] to be the judges in the case."
     With the psychiatric reports in hand, public health officials declined to pursue disciplinary action against Reardon, although department officials refuse to say how much the reports influenced their decision. Six years passed from the time the first complaint was filed before the institute reversed its opinion in 1993 and the department moved to revoke Reardon's license.
     One alleged victim who is suing the hospital and says he was abused by Reardon numerous times from 1987 to 1993 called the inaction by the hospital and state regulators "an outrage." "It's like adding salt in the wounds — another six years," said the man, who now lives in West Hartford and like other accusers is identified only as John or Jane Roe or John or Jane Doe in court documents. "Who knows how many other kids could have been saved?"
     In a written statement, the institute's psychiatrist in chief, Dr. Harold I. Schwartz, said last week that Reardon had managed to "deceive" the two forensic experts who examined him. Schwartz repeated disclaimers in the institute's reports to the health department that said it was impossible to sort fact from fiction in the alleged victims' accusations and Reardon's denials.
     But one of the experts, Dr. Peter M. Zeman, said that if he knew then what he knows now, he would have tried to shut down Reardon in 1991 — two years before Reardon resigned from St. Francis and stopped practicing. "In the past 17 years the psychiatric profession has become much more knowledgeable and sophisticated concerning the deceptive behavior practiced by individuals with pedophilia," Zeman wrote in response to written questions posed by The Courant. "Were I to evaluate Dr. Reardon from my present vantage point would I have found him in 1991 to show no evidence of pedophilia? "I think not."

For Darryle D. Schoepp, that moment came one evening in October 2006, while he was seated at his desk in Indianapolis. At the time, he was overseeing early-stage neuroscience research at Eli Lilly & Company and colleagues had just given him the results from a human trial of a new schizophrenia drug that worked differently than all other treatments. From the start, their work had been a long shot. Schizophrenia is notoriously difficult to treat, and Lilly’s drug — known only as LY2140023 — relied on a promising but unproved theory about how to combat the disorder.

When Dr. Schoepp saw the results, he leapt up in excitement. The drug had reduced schizophrenic symptoms, validating the efforts of hundreds of scientists, inside and outside of Lilly, who had labored together for almost two decades trying to unravel the disorder’s biological underpinnings.

The trial results were a major breakthrough in neuroscience, says Dr. Thomas R. Insel, director of the National Institute of Mental Health. For 50 years, all medicines for the disease had worked the same way — until Dr. Schoepp and other scientists took a different path. “This drug really looks like it’s quite a different animal,” Dr. Insel says. “This is actually pretty innovative.”

Dr. Schoepp and other scientists had focused their attention on the way that glutamate, a powerful neurotransmitter, tied together the brain’s most complex circuits. Every other schizophrenia drug now on the market aims at a different neurotransmitter, dopamine.

The Lilly results have fueled a wave of pharmaceutical industry research into glutamate. Companies are searching for new treatments, not just for schizophrenia, but also for depression and Alzheimer’s disease and other unseen demons of the brain that torment tens of millions of people worldwide.

Driving the industry’s interest is the huge market for drugs for brain and psychiatric diseases. Worldwide sales total almost $50 billion annually, even though existing medicines have moderate efficacy and have side effects that range from reduced libido to diabetes.

The glutamate researchers warn that their quest for new treatments for schizophrenia is far from complete. The results of the Lilly trial covered only 196 patients and must be validated by much larger trials, the last of which may not be finished until at least 2011. Other glutamate drugs are even further away from approval. And even if the drugs win that approval, they may be viewed skeptically by doctors who have been disappointed by side effects in other drugs that were once been hailed as breakthroughs.

Still, for Dr. Schoepp, the drug’s progress so far is cause for celebration — and relief. “I don’t think people appreciate how much money, time and good technical research goes into what we do,” he says. “Sometimes, people think the idea is the thing. I think the idea can be the easy part.”

Lilly continues to develop LY2140023 and has begun a trial of 870 patients that is scheduled to be completed in January 2009. But Dr. Schoepp is no longer involved in its development. He left Lilly in April to become senior vice president and head of neuroscience research at Merck, where he oversees a division of 300 researchers and support staff members.

Dr. Schoepp’s new base is a modest office on the top floor of a four-story Merck building here in North Wales, north of Philadelphia. He has a view of the building’s big front lawn and a busy two-lane road called the Sumneytown Pike. The huge Merck research complex called West Point, where 4,000 scientists and support staff members work, is less than a mile to the north.

For Dr. Schoepp, 52, the Merck job is the latest stop in a research career that began at Osco Drug’s store No. 807 in downtown Bismarck, N.D. He grew up in Bismarck in a working-class family; at 16, he started working at the Osco, which has since closed. He quickly decided to become a scientist.

“I just found it fascinating,” he says. “I was hungry for science.” While reading a magazine for pharmacists, he noticed an ad for a free pamphlet published by Merck called “Pharmacists in Industry.” He wrote away for the pamphlet, which convinced him that he could have a career developing medicines.

He applied to North Dakota State University, where he focused on psychopharmacology, a discipline that studies the way chemicals affect the brain. “I was really interested in psychiatric disorders,” he says. “I fell in love with dopamine.” His love affair was so consuming that his wife joked that “dopamine” would be his daughter’s first word.

Although scientists sometimes decide to study a disease because of problems it has caused among family members, Dr. Schoepp says his fascination with mental illness has been purely academic. “My family has more heart disease than anything else,” he says.

After graduating from North Dakota State, he received a scholarship to a doctoral program in pharmacology and toxicology at West Virginia University. He graduated in 1982. Nearly five years later, he joined Lilly, which was about to introduce Prozac, the first modern antidepressant — a drug that changed both psychiatry and the public perception of depression and mental illness.

Prozac became a blockbuster almost instantly after Lilly introduced it in 1987, making the company one of the most visible players in Big Pharma and giving it room to invest in long-shot scientific research. Ray Fuller, a Lilly scientist who was a co-discoverer of Prozac, encouraged Dr. Schoepp to focus his attention on glutamate.

Glutamate is a pivotal transmitter in the brain, the crucial link in circuits involved in memory, learning and perception. Too much glutamate leads to seizures and the death of brain cells. Excessive glutamate release is also one of the main reasons that people have brain damage after strokes. Too little glutamate can cause psychosis, coma and death. “The main thoroughfare of communication in the brain is glutamate,” says Dr. John Krystal, a psychiatry professor at Yale and a research scientist with the VA Connecticut Health Care System.

Along with Bita Moghaddam, a neuroscientist who was at Yale and is now at the University of Pittsburgh, Dr. Krystal has been responsible for some of the fundamental research into how glutamate works in the brain and how it may be implicated in schizophrenia.Schizophrenia affects about 2.5 million Americans, about 1 percent of the adult population, and it usually develops in the late teens or early to mid-20s. It is believed to result from a mix of causes, including genetic and environmental triggers that cause the brain to develop abnormally.

The first schizophrenia medicines were developed accidentally about a half-century ago, when Henri Laborit, a French military surgeon, noticed that an antinausea drug called chlorpromazine helped to control hallucinations in psychotic patients. Chlorpromazine, sold under the brand name Thorazine, blocks the brain’s dopamine receptors. That led the way in the 1960s for drug companies to introduce other medicines that worked the same way.

The medicines, called antipsychotics, gave many patients relief from the worst of their hallucinations and delusions. But they also can cause shaking, stiffness and facial tics, and did not help the cognitive problems or the so-called negative symptoms like social withdrawal associated with schizophrenia.

In the 1980s, drug companies looked for new ways to treat the disease with fewer side effects. By the mid-1990s, they had introduced several new schizophrenia medicines, including Zyprexa, from Lilly, and Risperdal, from Johnson & Johnson. At the time, the new medicines were hailed as a major advance — and the companies marketed them that way to doctors and patients.

In fact, the new medicines, called second-generation antipsychotics, had much in common with the older drugs. Both worked mainly by blocking dopamine and had little effect on negative or cognitive symptoms. The newer medicines caused fewer movement disorders, but had side effects of their own, including huge weight gain for many patients. Many doctors now complain that the companies oversold the second-generation compounds and that new treatments are badly needed.

“People say that there are drugs to treat schizophrenia,” says Dr. Carol A. Tamminga, professor of psychiatry at the University of Texas Southwestern, in Dallas. “In fact, the treatment for schizophrenia is at best partial and inadequate. You have a cadre of cognitively impaired people who can’t fit in.”

While most of the industry focused on second-generation medicines during the 1980s and 1990s, a handful of academic and industry researchers found intriguing hints that glutamate might provide an alternative treatment pathway.

Psychiatrists and neuroscientists have wondered about a possible connection between glutamate and schizophrenia since the early ’80s, when they first learned that phencyclidine, the street drug commonly called PCP, blocks the release of glutamate.

People who use PCP often have the hallucinations, delusions, cognitive problems and emotional flatness that are characteristic of schizophrenia. Psychiatrists noted PCP’s side effects as early as the late 1950s. But they lacked the tools to determine how PCP affected the brain until 1979, when they found that it blocked a glutamate receptor, called the NMDA receptor, that is at the center of the transmission of nerve impulses in the brain.

The PCP finding led a few scientists to begin researching glutamate’s role in psychosis and other brain disorders. By the early 1990s, they discovered that besides triggering the primary glutamate receptors — NMDA and AMPA — glutamate also triggered several other receptors.

They called these newly found receptors “metabotropic,” because the receptors modified the amount of glutamate that cells released rather than simply turning circuits on or off. Because glutamate is so central to the brain’s activity, directly blocking or triggering the NMDA and AMPA receptors can be very dangerous. The metabotropic receptors appeared to be better targets for drug treatment.

“Rather than acting as an all-or-nothing signal, they fine-tune that signal and modulate that signal,” said P. Jeffrey Conn, director of a Vanderbilt University drug research program. “It’s really an attempt to be very subtle in the way that you regulate the system.”

During the 1990s, molecular biologists discovered genes for eight metabotropic glutamate receptors, which were located at different places inside nerve cells and had different structures. The finding allowed for the possibility that drug companies could create chemicals to turn them on and off selectively, rather than hitting all of them at once.

For Dr. Schoepp and others, finding the receptors was only the first part of the struggle. They also had to find chemicals that would either block or trigger the receptors selectively. At the same time, the chemicals had to be relatively easy to formulate and capable of crossing the blood-brain barrier, which protects the brain from being easily penetrated by outside agents.

The work was arduous, but the Lilly scientists made slow progress. In 1999, Dr. Schoepp and two other scientists published a 46-page research paper that detailed scores of different chemicals that produced reactions at the glutamate sites.

At about the same time, scientists at Yale, led by Dr. Moghaddam, were demonstrating that activating metabotropic glutamate receptors in rats could reverse the effects of PCP — a seminal finding, providing the first proof that altering the path of glutamate transmission in the brain might help relieve the symptoms of psychosis.

Although the finding in rats was promising, developing animal models for schizophrenia and other brain diseases is extremely difficult, said Paul Greengard, professor of molecular and cellular neuroscience at Rockefeller University.Even when compared with diseases like cancer, brain disorders are notoriously complex. Scientists have only a limited understanding of the chemistry of consciousness, or of how problems in the brain’s electrical circuitry affect the ability to form memories, learn or think.

“We do not know with any of these neuropsychiatric disorders what the ultimate basis is,” Dr. Greengard says. “Let’s say you could find that too much of protein X was involved in schizophrenia. Would you then know what schizophrenia is? You would not.”

Nonetheless, the findings in rats were promising. Those studies, as well as Dr. Krystal’s tests in 2001 of volunteers given ketamine, a drug that has effects similar to PCP, hinted that the glutamate drugs might help to treat the cognitive and negative symptoms of schizophrenia. Drugs currently on the market do little to treat those symptoms.

Even before the findings at Yale, Lilly had put its first metabotropic glutamate receptor compound into human testing. Researchers initially tested the drug on patients with panic disorder, and it showed some positive results. But Lilly stopped human testing of the drug in 2001 when long-term testing in animals showed that it caused seizures.

Even so, Lilly decided that it had enough evidence to justify tests of another chemical compound, LY404039, that affected the same receptors. “They had to take a risk on letting these drugs be tested on models or for disorders that were justified purely on pretty basic science,” Dr. Krystal says. “There is nothing with these drugs that is straightforward or makes developing them a basic path.”

When it tried to test LY404039 in humans, the company ran into yet another hurdle. The human body didn’t easily absorb it. So Lilly created a drug that the body could absorb, LY2140023, which is metabolized into LY404039 in the body.

Bingo. LY2140023 was the drug that got Dr. Schoepp jumping out of his office chair in 2006, nearly three years after the first trials in humans began. In the Lilly test, the drug was slightly less effective over all than Zyprexa, which is considered the most effective among the widely used schizophrenia treatments.

But LY2140023 also appeared to have fewer side effects than Zyprexa, which can cause severe weight gain and diabetes. The new drug also appeared to improve cognition, something that existing treatments don’t do, said Dr. Insel of the National Institute of Mental Health.

IF Lilly’s new round of tests confirms the drug’s efficacy by early next year, the company is likely to move ahead to an even larger clinical trial, involving thousands of patients, that could lead to federal approval for the compound. Still, approval is at least three to four years away, and other big drug makers are already scrambling to compete with Lilly.

In January, Pfizer agreed to pay Taisho Pharmaceutical, a Japanese company, $22 million for the rights to develop Taisho’s glutamate drug for schizophrenia. Taisho will receive more payments if the drug moves forward in development.

Since it hired Dr. Schoepp, Merck has also been moving aggressively. It has struck two deals since December to work with Addex Pharmaceuticals, a Swiss company, to develop glutamate drugs for schizophrenia, Parkinson’s and other diseases. Merck has paid Addex $25 million so far, with more payments to come if the drugs move forward. Another glutamate drug, meanwhile, has been shown in preclinical studies to reverse mental retardation in adult rats, a finding that previously appeared impossible, Dr. Insel said.

Dr. Steven M. Paul, the president of Lilly Research Laboratories, says Lilly expects competition in glutamate research to intensify. “We’d like to believe we have a head start here, and hopefully a good head start,” he says. “But this area will heat up here; this will be an area where there will be a lot of investment.”

For Dr. Schoepp, the sudden interest in glutamate is exciting, and he acknowledges that he eagerly awaits the results of the large Lilly trial early next year. And what if the drug fails in that trial, after all the work that he and scientists around the world have put in? “I would probably go out and have a beer,” he says. “You have to define failure. If you collect information and it tells you what you need to know, you’re not a failure.”

Anti Smoking Pill's Dark Side
Robert Cohen, Newhouse News- 2/25/2008

WASHINGTON - When Pfizer's anti-smoking pill Chantix came on the market 18 months ago, it was touted as more effective than existing treat­ments at helping break the deadly nicotine addiction. Propelled by a multimillion- dollar advertising campaign and aggressive marketing to doctors, the drug already has been used by 5.5 million patients, helped an estimated 1 million people quit smoking, and brought in $883 million in sales last year. But the widespread use of the drug has led to unexpected side effects, possibly including suicidal behavior, raising concerns at the Food and Drug Administration and within the medical and smoking treat­ment communities.
      Chantix is the latest example of the pitfalls associated with promising new medicines that are tested on a small number of carefully screened patients in a controlled environment, then mass-marketed to a much broader and potentially more vulnerable population. "The drug companies go from zero to a hundred miles an hour promoting their new drugs," said Arthur Levin, director of the nonprofit Center for Medical Consumers. "They rush to expose so many people to a drug based on results from a very few people, and that is why surprises occur all the time." Chantix is a new kind of treatment, one that contains no nicotine but interacts with the same brain receptors as nicotine, reducing the cravings and symptoms of withdrawal.
     Prior to Chantix, smokers who wanted to quit had limited options, including products containing nicotine such as patches; chewing gums and sprays, as well as the antidepressant Zyban, which is sold as a smoking-cessation treat­ment. The nicotine products are designed to replace the nicotine in cigarettes, curbing the desire to smoke and minimizing the effects of withdrawal as doses are gradually reduced over time.
     Earlier this month, the FDA said it had received reports of serious psychiatric symptoms among Chantix users, such as suicide and suicidal behavior, agitation and depression, which required new safety warnings on the label. Martina Flammer, a senior medical director for Pfizer, said the company takes the reports seriously and changed its labeling as a precaution, but in­sisted there has been no demonstrated link between use of Chantix and suicide or suicidal behavior.
     The FDA said it is not clear whether Chantix is responsible for these side effects because smoking cessation, with or without treatment is associated with nicotine withdrawal symptoms and the worsening of underlying psychiatric illness. "However, not all patients described in these cases had pre-existing psychiatric illness, and not all had discontinued smoking," the FDA said.
     The FDA got involved after the death of folk-rock musician Carter Albrecht, who was shot by a neighbor in Dallas after a night of uncharacteristically violent behavior. Family members said Chantix may have caused the rage that ultimately led to Albrecht's death, although his blood-alcohol level was highly elevated. New York magazine recently published a story titled "My Brain on Chantix" by Derek de Koh who chronicled his experience on the medication, including strange dreams, intense paranoia and self-destructive fantasies.
      Robert Klesges, a professor of preventive medicine at the University of Tennessee Health Sciences Center, said the clinical evidence shows Chantix improves the chances of stopping smoking. But he said the FDA alert "raises a bit of a red flag," and reinforces his belief that the first line of treatment should be the nicotine-replacement products, which have a long safety record. Ponni Subbiah, Pfizer's vice president of medical affairs, said Chantix has risks like all medications, but emphasized it has proven effective in helping people stop smoking and in helping control "a huge public health epidemic" that causes death and sickness.
     More than 44 million adult Americans smoke cigarettes, with 8.6 million suffering from at least one serious smoking-related illness, including cancer and heart disease. Some 438,000 Americans die annually because of tobacco use.

A Twice-Told Tale of Addiction: By Father, by Son
Charles McGrath, New York Times- 2/26/2008

David Sheff and his 25-year-old son, Nic, are so close these days, so much on the same wavelength, that they sometimes finish each other’s sentences. There was a time when they weren’t even speaking. Both Sheffs have books just out — each, coincidentally, beginning with an epigram from John Lennon — and over breakfast in New York recently they described in almost exactly the same terms the experience of reading the other’s work. “It was very, very painful,” Nic Sheff said. “It was excruciating,” his father said.
      Nic’s book, “Tweak: Growing Up on Methamphetamines,” is a first-person account of his drug addiction, which began while he was still in high school (where he learned to shoot up from studying a diagram on the Internet) and lasted for more than a decade. For much of that time he was living on the street, prostituting himself, selling drugs occasionally (though he was never very good at it) and eating food salvaged from Dumpsters; he would turn up in his parents’ lives occasionally, sometimes to steal from them. (David Sheff and Nic’s mother divorced when Nic was 4; she moved to Los Angeles, and Nic grew up with his father in Northern California.)
    In and out of treatment numerous times, Nic had several brushes with the law and once nearly died of an overdose. Another time he almost lost an arm when an infected needle puncture grew to the size of a baseball. In the first half of the book, especially, he writes about these experiences with harrowing vividness and detachment, as if he were watching someone else. He says that the first time he took meth, it felt like a gift, and he thought, “My God, this is what I’ve been missing my entire life.”
     David’s book, “Beautiful Boy: A Father’s Journey Through His Son’s Addiction,” which goes on sale on Tuesday and has been selected by Starbucks as its next featured book, is the same story seen through the father’s eyes. He describes how a seemingly gilded youth (Nic was an honor student and co-captain of the high school water polo team) went almost overnight from casual marijuana use — just a phase, one of his teachers said — to full-blown addiction. In the beginning, David writes, he was in denial, then he was hurt and angry, and ultimately, in his worry and preoccupation and efforts to understand what happened, he became, in effect, addicted to his son’s addiction, unable to stop torturing himself. What had he done wrong?
     “Reading Dad’s book, the thing that popped out that I hadn’t fully understood was how much I hurt people,” Nic said. “I had this idea that if I wanted to kill myself, it was my own business — no one had a right to me. And the thing I saw from the book is that killing yourself is such a selfish act that affects so many people. But when you’re in the middle of addiction, you don’t see that. All you see is your own pain. Part of my recovery is knowing that all these people are depending on me.”
     David said: “For me, the hardest part about reading Nic’s book is that, bad as I imagined things were, they were even worse. The volume of drugs he was taking, the dangerous situations he was in over and over again. I never knew that he almost let his arm fall off. I was in pretty bad shape for a while after reading all this, even as I respected his truth-telling.”
     David Sheff’s book, published by Houghton Mifflin, grew out of an article he wrote for The New York Times Magazine in 2005. The same article prompted an editor at Atheneum to get in touch with Nic. Roughly halfway through, each book was temporarily derailed. David suffered a brain hemorrhage, and Nic, who had been clean for 18 months, relapsed. He writes about the setback, which involved resuming a destructive romantic relationship, in such a way that the reader can feel it coming almost before the author does.
     The experience and his subsequent effort to straighten himself out yet again accounts, Nic said, for the change in his book’s tone in the second half. “I started feeling and making connections,” he said. “Before, I was tending to invent myself as a kind of fictional character and not really owning the things that were happening to me.”
     For David’s part, he had to learn how to write all over again, starting with very short sentences and then linking them together. The hemorrhage, he recalls in “Beautiful Boy,” had left him with a brain that was like a broken suitcase, full of scrambled items that he had to fit together. “That’s what writing is,” he said. “Putting the pieces of the puzzle back together in your head.”
     His son’s last relapse was devastating, he added, and he almost gave up the idea of intervening once more. Nic, who had been discovered breaking into his mother’s garage, was resisting the idea of treatment, and his parents gave him an ultimatum: a return to rehab or jail. “I’m so super-grateful he didn’t give up on me,” Nic said at breakfast. “I’d be dead.”
     Nic has been straight now for two and a half years — a significant milestone, his father says, since it typically takes two years before the brain scans of former meth addicts resemble normal scans. What makes the drug so pernicious is that it seems to rewire the addict’s neural circuits. Nic lives now in Savannah, Ga., with his girlfriend and is working on a second book, a novel about homeless teenagers and the end of the world. He also works as a model at a local art school. “Taking your clothes off in front of people, that’s nothing compared to writing the book,” he said, and added, “The whole point of my recovery is not to hide who I am, but to embrace it.” David Sheff has meanwhile resumed his career as a magazine journalist. (He is a longtime contributing editor to Playboy magazine, for which he did the last interview with John Lennon.) “Much as I love my son, I had to learn to separate myself from him,” he said. “We were really entangled,” David explained. “It’s a baffling thing. People of my generation, we were going to be different. It’s a fantasy of not growing up ourselves, I suppose, and there’s a danger in not knowing whether to be a parent or a friend.”
     He added that he still thought all the time about what he might have done differently. “I think I could have intervened sooner,” he said. “Before Nic turned 18, I could have forced him into a program. I could have dragged him in, and at least it would have gotten him off the streets.” Nic said: “I think maybe I’m a little bit stupid. I’m super-flawed, I know that, and I really benefit from knowing that I’m an addict. If I had a glass of wine now, I wouldn’t be capable of not going out and buying a bottle of vodka. My brain is such that I could not not do that. And I don’t know that I could have learned that any quicker. I had to go through the trial-and-error process. But on the other hand, I’m lucky to be alive, so it’s a hard thing to say to parents, ‘Just let them learn on their own.’”

Why All The Drug Alerts?
Francesca Kritz, Washington Post- 2/26/2008

If it seems as though the Food and Drug Administration has been issuing a new drug safety warning almost every week, that's because, for the past three months, it has. Since early November, the agency has sent out 14 advisories, more than it has issued in some entire years. Wall Street health-care analyst Les Funtleyder recently quipped that the agency should have a color coding system, as the Department of Homeland Security does, so consumers could determine the severity of the risk.

The uptick in advisories doesn't mean that drugs are more dangerous, says Paul Seligman, director of the FDA's Office of Drug Safety; it simply marks the fulfillment of a 2005 promise by Secretary of Health and Human Services Mike Leavitt to notify the public sooner when the agency learns of adverse reactions to approved drugs. "We are trying to act in a responsible way," Seligman says.

FDA critics, including Rep. John Dingell (D-Mich.), head of the House Energy and Commerce Committee, have complained that the agency's responses are too few and too late. As a case in point, they cite the recall of the pain reliever Vioxx four years ago. Some critics said the FDA had long known of concerns about Vioxx and delayed taking any action on the drug, including requesting that the company add information on heart disease risk to the label.

Dingell calls the recent increase in public communications "a quantum improvement." Marc J. Scheineson, a former FDA deputy commissioner, agrees. "There was certainly too little information back then,'' he says. Now, the problem is the opposite, he says, "so patients and their doctors will need to filter the news.''

Since the fall, the agency has begun issuing three new types of advisories: an "early communication" that indicates a recently reported problem with a drug; a "public health advisory" that advises consumers to speak with their doctors because a drug may pose a serious risk; and a Q and A for physicians to help them answer patient questions.

In November, an early communication advised that patients on Chantix, a smoking-cessation drug, had reported side effects including depression and suicidal behavior. Two months later, a public health advisory noted that drugmaker Pfizer would add safety warnings to its label, at the agency's request. The FDA also issued a fact sheet for doctors, identifying factors (such as a history of psychiatric illness) that would make someone a poor candidate for Chantix and listing symptoms that users should report promptly.

Some advisories hold good news for patients, Scheineson says. He cites a December advisory that found no link between two acid reflux drugs and heart problems -- a concern previously reported. "That shows the system is working'' says the FDA's Seligman.

While the advisories are meant primarily for physicians, consumers have easy access to them: on the FDA Web site ( http://www.fda.gov), via e-mail alerts ( http://www.fda.gov/emaillist.html) and in a new quarterly newsletter ( http://www.fda.gov/cder/dsn/default.htm).

Arthur Levin, head of the Center for Medical Consumers in New York, and other patient advocates welcome the information but worry that patients will simply stop taking a drug cited in an advisory. That's what many users of the diabetes drug Avandia did, according to Levin, after a well-publicized study several months ago warned that the drug might be tied to an increased risk of heart disease.

No patient should stop taking prescribed medication without first consulting his or her doctor, warns Richard Platt, a professor of medicine at Harvard Medical School and chairman of the FDA's new Drug Safety and Risk Management Advisory Committee. In most cases, failing to take prescribed drugs "poses a far higher risk of complications and death than staying on a drug about which a question has been posed," Platt says. Advice on whether to continue a cited drug will vary by patient.

The FDA is also working with medical oganizations to help physicians understand the nuances of its advisories and pass along that information to patients. For example, the agency is sending weekly e-mails to members of the American Medical Association, said Edward Langston, who chairs the AMA's board of trustees.

He Listens. He Cares. He Isn’t Real.
Ruth La Ferla, New York Times- 2/28/2008

Compassion is an aphrodisiac. It is a potent elixir for sure to those who tune in to HBO five nights a week to watch Gabriel Byrne play Dr. Paul Weston, the rumpled, world-weary shrink of “In Treatment.” Taking in the world from the depths of his leather armchair, Paul is all ears. And eyes. And hands. Steepled, clasped in contemplation or lingering at his cheek, those hands, especially, express empathy better than words. “They are like an artist’s hands: I watch them all the time,” said Nian Fish, a fashion publicist in New York. In her mind, Mr. Byrne and Paul, the 50-ish psychotherapist he plays, are fused.
      It is hard to say whether it is a fantasy of those fingers trailing across their skin, or the promise of an emotional deliverance that so rivets fans of the show, women in particular. But in recent weeks, the viewers’ ardor has transformed Mr. Byrne and his character into the latest Dr. McDreamy, a television healer-as-lust-object, a flash point for audience passions ranging from fluttery crush to full-on erotic fixation. “He’s a hunk, totally,” said Elizabeth Easton, an art curator in New York who is among the smitten. “He’s hot.” His sympathetic response to patients “makes him even hotter.”
     Some male viewers are also susceptible. Reactions to Mr. Byrne/Paul are “almost visceral,” said Vincent Gagliostro, an American filmmaker who lives in Paris. “When I first watched the show, I thought, ‘Oh, I don’t really like Gabriel Byrne,’ ” he said. “Now I’m totally infatuated with him. I want to watch his every move.”
     Similar responses are posted on the Web, where chatter about the show and its brooding protagonist is mostly of the uncensored kind. “I could lick Gabriel Byrne all over,” a fan calling herself Therealzenobia confided on an HBO message board. Another viewer, Kleds, seemed to hang on the actor’s every gesture. “I love, love, love when he licks his lips,” Kleds wrote, “or when he simply sticks his tongue in the front of his mouth near his lips for a second. Sooo sexy.”
     On the show, which began on Jan. 29, Paul conducts four sessions a week, seeing a different patient (and in one case a couple) Monday through Thursday. The therapist’s fraught encounters with his patients — including Alex, the guilt-racked aviator; Sophie, the teenage gymnast bent on self-destruction; and Jake and Amy, bickering young marrieds — attract intensely devoted viewers. (On Monday night at 9:30 Eastern, 302,000 people tuned in, according to Nielsen.)
     Some of the most passionate identify with Laura, a sullen 30-year-old anesthesiologist who chases Paul with a fervor bordering on the predatory. Early in the series, when Laura confesses during treatment that she loves Paul, he replies, “I am not an option.” The audience knows better. Paul’s attraction to Laura provokes the crisis of conscience that is a central conflict in the series.
     The Paul-Laura relationship (not to mention that between Paul and the viewer) is a case study in erotic transference, during which the patient develops feelings of love and sexual attraction for the therapist. But “transference can be a two-way street,” said Peter S. Kanaris, a clinical psychologist in private practice in Smithtown, N.Y. “The common term is counter-transference, in which the intimacy of the therapy may have triggered feelings of attraction and connection toward the patient.” “At this point in the series,” Dr. Kanaris added, “I have to say Paul’s counter-transference is not going very well. It makes for good television but bad therapy.”
      But transference may be just a fancy name for gratitude. Patients in therapy are often effusively thankful just to have someone pay attention to them. Diane O’Rourke, a medical writer in Chicago, is reminded of this each time she watches. “There is an old saying,” Ms. O’Rourke said, “that most men would rather have you hear their story than grant their wish.” That truism applies even when the sexes are reversed. In or out of therapy, Ms. O’Rourke added, “you fall in love with anyone who will listen to your story.”
     Paul is good at listening. But there are times when his book-jammed study is more battlefield than confessional. His patients often taunt him and pick at his scabs, while he, in turn, provokes in them a tumult of responses. Amy flirts. Sophie threatens suicide. Alex hurls insults that open old wounds. A master of confrontation, Alex chides the doctor, reminding him that he is no saint. Paul, in fact, is estranged from his wife, at odds with his children and patently unhinged by the depth of his feelings for Laura.
     “I was first annoyed that he was falling in love with a 30-year-old patient,” said Ms. O’Rourke, who is closer to Paul’s age than Laura’s. “But I realized that he is pained by his own imperfections and learning to cope.” “Paul is attractive not because he has youthful great biceps,” she added, “but because he’s vulnerable — a real person who wakes up in the middle of the night in a cold sweat, worrying, ‘What the hell am I doing here?’ “What could be sexier than that, somebody who knows how fragile you are because he’s so fragile himself?”
     Richard Nahem, an American living in Paris and the author of a Web guide about the city, watches the series with a mixture of zeal and unease. “Paul is almost too expressive,” Mr. Nahem said. “A psychologist is supposed to be neutral. But I like that his personal life is in turmoil. You just want to say ‘I’ll take care of you.’ ”
     And then you don’t. Part of the drama’s compulsive fascination, viewers say, is that when Paul’s frailties are exposed, he can be off-putting. Snappish and shaken by feelings he can barely express, the psychotherapist is so flummoxed he sometimes turns on Gina, his own therapist and former mentor, played with a mix of compassion and censure by Dianne Wiest. On such occasions, Mr. Byrne’s sympathetic hands seem repellently waxen. “To me they look like instruments of manipulation,” Ms. Fish said. “Physically, Paul gets disgusting. But I’m still rooting for him to have a victory over his weaknesses.”
     A publicist for Mr. Byrne, who was born in Dublin and who earlier in his career starred in “The Usual Suspects” and was married to Ellen Barkin, declined to make him available to comment about the unusually personal feelings some audience members have developed for him and his character. Rodrigo Garcia, the writer and director of the drama, which is adapted from a hit television series in Israel, predicted that as the series continues, through March 29, viewers with a crush on Paul might find the spell broken. “Sure, Paul is a sex symbol,” he said. “But he makes mistakes along the way. And now that we’re seeing his real problem, maybe he’s not a god after all. It’s like my mother used to say: Being that close to someone, you are seeing his dirty underwear.”

Study: Spanking Affects Adult Sex Lives
Associated Press, 2/29/2008

DURHAM, N.H. -- New research by a University of New Hampshire domestic abuse expert says spanking children affects their sex lives as adults. Professor Murray Straus concludes that children who are spanked are more likely as adults to coerce partners to have sex, to have unprotected sex and to have masochistic sex.

Other studies have shown the link between spanking and physical violence, but Straus said his research is the first to show a link between corporal punishment and sexual behavior. ''My underlying motive was to bring this to the attention of parents and of more people,'' Straus said, ''in the hope it will help continue the decrease in the use of corporal punishment.''

Straus, co-director of UNH's Family Research Laboratory, conducted a study in the mid-1990s in which he asked 207 students at three colleges whether they'd ever been aroused by masochistic sex. He also asked them if they'd been spanked as children. He found that students who were spanked were nearly twice as likely to like masochistic sex.

He has bundled that study with three new ones that explore the connections between corporal punishment, coerced sex and risky sex. He presented all four studies this week at the American Psychological Association's Summit on Violence and Abuse in Relationships in Bethesda, Md.

Straus said his study found adults who were spanked as children are more likely to coerce their partners to have sex.

Straus asked 14,000 college students in 32 different countries whether they strongly disagreed, disagreed, agreed or strongly agreed with this statement: ''I was spanked or hit a lot before age 12.'' He also asked whether they had ever verbally or physically coerced an uninterested partner to have sex.

He found a big difference between students who said they'd been hit a lot before age 12 and those who said they hadn't. For every increased step on Straus's four-step scale of agreement, men were 10 percent more likely to have verbally coerced sex from a partner by insisting on sex or threatening to end the relationship if the partner refused. Women were 12 percent more likely to have done that.

Previous studies have shown that 90 percent of parents strike their toddlers, a statistic that's held steady throughout the 30 years Straus has researched corporal punishment. Meanwhile, the number of parents who hit older children has drastically decreased. Straus said it's unclear why, though he has some theories. One is that 2- and 3-year-olds are less likely to respond to repeated verbal warnings.

Straus said he would like more pediatricians and child-rearing experts to warn against spanking. He'd also like lawmakers to take a stand by dedicating state money to teaching parents about the dangers of corporal punishment. ''The best-kept secret in child psychology is that children who were never spanked are among the best behaved,'' Straus said.

Information from: Concord Monitor, http://www.cmonitor.com