Noteworthy News Articles on Mental Health Topics, May 8-17, 2008



Medical Know - How Raises Suicide Risk for Doctors
Associated Press, 5/8/2008

CHICAGO -- There's a grim, rarely talked-about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own. An estimated 300 to 400 U.S. doctors kill themselves each year -- a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.

Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.

And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of both how the body works and the amount of a drug needed for an overdose to stop breathing and halt the heart.

''All physicians have access to neat, clean ways to commit suicide,'' said Dr. Robert Lehmberg, a Little Rock, Ark., surgeon who has battled depression and long considered suicide ''an exit strategy if absolutely necessary.''

The American Medical Association has called physician suicide ''an endemic catastrophe,'' and pledged two years ago to work to prevent the problem.

But the suicides have persisted. So the American Foundation for Suicide Prevention has launched an educational campaign in hopes of making troubled doctors more willing to seek help.

The foundation, the American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of antidepressant pills, paid for the program. It includes a documentary titled ''Struggling in Silence'' that begins airing on public television stations this week.

''It really has been swept under the carpet,'' said Dr. Paula Clayton, the suicide foundation's medical director.

The foundation says 300 to 400 doctors commit suicide each year, based on estimates from research, but that more studies are needed to get a more precise count.

Another estimate of 250 yearly comes from an online article by Dr. Louise Andrew and in American Medical News, an AMA publication. But a spokesman said the AMA doesn't track doctor suicides because accurate numbers aren't available.

Suicide figures in broader society are not completely reliable because suicide is often not given as the cause of death.

The overall U.S. suicide rate among men is four times higher than in women -- about 23 per 100,000 versus about 6 per 100,000 in women, according to the most recent government data.

But among doctors, suicide rates are about equal for men and women.

A 28-state study from 1984-95 found women doctors were more than twice as likely as women in the general population to kill themselves. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.

One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr. Erika Frank, who specializes in research on physician health.

Depression is often the problem.

Depressed doctors frequently decide to self-medicate but don't seek psychotherapy that could help them deal with underlying issues, said Dr. Glenn Siegel, who runs a suburban Chicago program that treats doctors with drug abuse, depression and other psychiatric problems.

''It's not a safe topic to be as open about in that profession because you're responsible for the well-being of others,'' Siegel said. ''If you're admitting something like that, you're saying maybe you're not fit to do your job.''

Adds Lehmberg, the Arkansas surgeon, who is featured in the documentary: ''You just would rather take a risk with your health than your career. It's not like you get a second chance with it.''

A psychiatrist in the New York area who asked to remain unidentified said he had suicidal thoughts every day for several years. But in medical school in the 1980s, he said he was so embarrassed about seeking help for depression that he went to a pay phone instead of his dorm to call a therapist.

Since then, some schools have begun teaching medical students about depression among doctors, but, he said in an interview, ''so much more needs to be done.''

Because the stigma persists, he said he didn't want his name used to avoid hurting his family and relationships with colleagues and patients.

Some studies have suggested depression is more common among doctors, especially women physicians, and that the high demands of a job dealing with life-and-death issues makes them prone.

But Frank questions that and said she worries that singling out physicians risks ''pathologizing'' a profession whose members generally ''have it awfully good.''

''I think the situation gets portrayed as far more grave than it really is for physicians compared to anyone else in the world,'' Frank said.

There could be reasons why the stigma would be worse for doctors, ''but you can come up with just as many reasons why physicians would be better equipped to acknowledge'' mental illness, she said.

''We've all done psychiatric training. We all know bad mental health outcomes happen to good people,'' she said.

A study in Denmark, published last year, found more suicides in doctors than among more than 20 other professions, including nurses, factory workers, elementary school teachers, corporate managers and architects.

But there are few comprehensive studies on suicides among U.S. doctors.

Some have been based on newspaper obituaries, which are ''flawed at best'' because suicide often isn't listed as a cause of death, said Dr. Morton Silverman, a University of Chicago suicide expert.

New Jersey physician Ron Brown suffered from depression and killed himself in 2002. His widow, Mumtaz Bari-Brown, said she believes the stigma kept her husband from getting help in time to save his life.

As a boy, Brown had been told his father died of a heart attack, not the real cause of suicide, the widow said.

''We have to stop the hiding and the ignorance and recognize it as a disease like high blood pressure or diabetes,'' said Bari-Brown, who also is featured in the new documentary.

Dr. G. Richard Smith, Lehmberg's doctor and director of the University of Arkansas for Medical Sciences' psychiatric research institute, said doctors need assurance they won't risk their jobs if they seek psychiatric help.

Smith succeeded in getting changes to questions on medical license applications in Arkansas that he believes will help. The old application asked doctors if they were being treated for mental illness or ever had been. A ''yes'' answer required a psychiatrist's note declaring they were fit to practice medicine. Now, they need only disclose mental health treatment that was advised or required by medical authorities.

The previous form didn't keep doctors with psychiatric problems from practicing, Smith said. But it did keep ''doctors who needed treatment from getting the treatment that they needed.''

On the Net:
American Foundation for Suicide Prevention: http://www.doctorswithdepression.org
AMA: http://www.ama-assn.org

Feds: Teen Use of Pot Can Lead to Dependency, Mental Illness
Associated Press, 5/9/2008

WASHINGTON -- Depression, teens and marijuana are a dangerous mix that can lead to dependency, mental illness or suicidal thoughts, according to a White House report being released Friday.

A teen who has been depressed at some point in the past year is more than twice as likely to have used marijuana as teens who have not reported being depressed -- 25 percent compared with 12 percent, said the report by the White House Office of National Drug Control Policy.

''Marijuana is a more consequential substance of abuse than our culture has treated it in the last 20 years,'' said John Walters, director of the office. ''This is not just youthful experimentation that they'll get over as we used to think in the past.''

Smoking marijuana can lead to more serious problems, Walters said in an interview.

For example, using marijuana increases the risk of developing mental disorders by 40 percent, the report said. And teens who smoke pot at least once a month over a yearlong period are three times more likely to have suicidal thoughts than nonusers, it said.

The report also cited research that showed that teens who smoke marijuana when feeling depressed were more than twice as likely as their peers to abuse or become addicted to pot -- 8 percent compared with 3 percent.

Experts who have worked with children say there's nothing harmless about marijuana.

''I've seen many, many kids' lives negatively impacted and taken off track because of marijuana,'' said Elizabeth Stanley-Salazar, director of adolescent services for Phoenix House treatment centers in California. ''It's somewhat Russian roulette. There are so many factors, emotional, psychological, biological. You can't predict the experimentation and how it will impact a kid.''

Bruce Mirken, communications director for the Marijuana Policy Project, an organization that advocates the decriminalization of marijuana, called the study ''an absolutely dishonest report, deliberately confusing correlation with causation.''

''This very week the British government's official scientific advisers on illegal drugs issued a report saying they are 'unconvinced that there is a causal relationship between the use of cannabis and any affective disorder,' such as depression, he said.

The drug control policy office analyzed about a dozen studies looking at marijuana use, including research by the federal Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration.

Overall, marijuana use among teens has decreased 25 percent since 2001, down to about 2.3 million kids who used pot at least once a month, the drug control office said.

While the drop is encouraging, Walters appealed to parents to recognize signs of possible drug use and depression.

''It's not something you look the other way about when your teen starts appearing careless about their grooming, withdrawing from the family, losing interest in daily activities,'' Walters said. ''Find out what's wrong.''

On the Net:
White House Office of National Drug Control Policy: http://www.whitehousedrugpolicy.gov


‘Mad Pride’ Fights a Stigma
Gabrielle Glaser, New York Times- 5/11/2008

In the YouTube video, Liz Spikol is smiling and animated, the light glinting off her large hoop earrings. Deadpan, she holds up a diaper. It is not, she explains, a hygienic item for a giantess, but rather a prop to illustrate how much control people lose when they undergo electroconvulsive therapy, or ECT, as she did 12 years ago.

In other videos and blog postings, Ms. Spikol, a 39-year-old writer in Philadelphia who has bipolar disorder, describes a period of psychosis so severe she jumped out of her mother’s car and ran away like a scared dog.

In lectures across the country, Elyn Saks, a law professor and associate dean at the University of Southern California, recounts the florid visions she has experienced during her lifelong battle with schizophrenia — dancing ashtrays, houses that spoke to her — and hospitalizations where she was strapped down with leather restraints and force-fed medications.

Like many Americans who have severe forms of mental illness such as schizophrenia and bipolar disorder, Ms. Saks and Ms. Spikol are speaking candidly and publicly about their demons. Their frank talk is part of a conversation about mental illness (or as some prefer to put it, “extreme mental states”) that stretches from college campuses to community health centers, from YouTube to online forums.

“Until now, the acceptance of mental illness has pretty much stopped at depression,” said Charles Barber, a lecturer in psychiatry at the Yale School of Medicine. “But a newer generation, fueled by the Internet and other sophisticated delivery systems, is saying, ‘We deserve to be heard, too.’ ”

About 5.7 million Americans over 18 have bipolar disorder, which is classified as a mood disorder, according to the National Institute of Mental Health. Another 2.4 million have schizophrenia, which is considered a thought disorder. The small slice of this disparate population who have chosen to share their experiences with the public liken their efforts to those of the gay-rights and similar movements of a generation ago.

Just as gay-rights activists reclaimed the word queer as a badge of honor rather than a slur, these advocates proudly call themselves mad; they say their conditions do not preclude them from productive lives.

Mad pride events, organized by loosely connected groups in at least seven countries including Australia, South Africa and the United States, draw thousands of participants, said David W. Oaks, the director of MindFreedom International, a nonprofit group in Eugene, Ore., that tracks the events and says it has 10,000 members.

RECENT mad pride activities include a Mad Pride Cabaret in Vancouver, British Columbia; a Mad Pride March in Accra, Ghana; and a Bonkersfest in London that drew 3,000 participants. (A follow-up Bonkersfest is planned next month at the site of the original Bedlam asylum.)

Members of the mad pride movement do not always agree on their aims and intentions. For some, the objective is to continue the destigmatization of mental illness. A vocal, controversial wing rejects the need to treat mental afflictions with psychotropic drugs and seeks alternatives to the shifting, often inconsistent care offered by the medical establishment. Many members of the movement say they are publicly discussing their own struggles to help those with similar conditions and to inform the general public.

“It used to be you were labeled with your diagnosis and that was it; you were marginalized,” said Molly Sprengelmeyer, an organizer for the Asheville Radical Mental Health Collective, a mad pride group in North Carolina. “If people found out, it was a death sentence, professionally and socially.”

She added, “We are hoping to change all that by talking."

The confessional mood encouraged by memoirs and blogs, as well as the self-help advocacy movement in mental health, have deepened the understanding of bipolar disorder and schizophrenia. Books such as Kay Redfield Jamison’s autobiography, “An Unquiet Mind: A Memoir of Moods and Madness,” have raised awareness of bipolar disorder, and movies like “Shine” and “A Beautiful Mind” have opened discussion on schizophrenia and related illnesses. In recent years, groups have started antistigma campaigns, and even the federal government embraces the message, with an ad campaign aimed at young adults to encourage them to support friends with mental illness.

Members of MindFreedom International, which Mr. Oaks founded in the 1980s, have protested drug companies and participated in hunger strikes to demand proof that drugs can manage chemical imbalances in the brain. Mr. Oaks, who was found to be schizophrenic and manic-depressive while an undergraduate at Harvard, says he maintains his mental health with exercise, diet, peer counseling and wilderness trips — strategies that are well outside the mainstream thinking of psychiatrists and many patients.

Other support groups include the Mad Tea Party in Chicago and the Freedom Center in Northampton, Mass., which provides education, acupuncture, yoga and peer discussions to about 100 participants.

The Icarus Project, a New York-based online forum and support network, says it attracts 5,000 unique visitors a month to its Web site, and it has inspired autonomous local chapters in Portland, Ore., St. Louis and Richmond, Va. Participants write and distribute publications, stage community talks, trade strategies for staying well and often share duties like cooking or shopping.

The Icarus Project says its participants are “navigating the space between brilliance and madness.” It began six years ago, after one of its founders, Sascha Altman DuBrul, now 33, wrote about his bipolar disorder in The San Francisco Bay Guardian, a weekly newspaper. Mr. DuBrul, who is known as Sascha Scatter, received an overwhelming response from readers who had experienced similar ordeals, but who felt they had no one to discuss them with.

“We wanted to create a new language that resonated with our actual experiences,” Mr. DuBrul said in a telephone interview.

Some Icarus Project members argue that their conditions are not illnesses, but rather, “dangerous gifts" that require attention, care and vigilance to contain. “I take drugs to control my superpowers,” Mr. DuBrul said.

While psychiatrists generally support the mad pride movement’s desire to speak openly, some have cautioned that a “pro choice” attitude toward medicine can have dire consequences.

“Would you be pro-choice with someone who has another brain disease, Alzheimer’s, who wants to walk outside in the snow without their shoes and socks?” said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute in Chevy Chase, Md.

Dr. Torrey, a research psychiatrist who specializes in schizophrenia and manic depression, said he understood the roots of the movement. “I suspect that not an insignificant number of people involved have had very lousy care and are still reacting to having been involuntarily treated,” he said.

Many psychiatrists now recognize that patients’ candid discussions of their experiences can help their recoveries. “Problems are created when people don’t talk to each other,” said Dr. Robert W. Buchanan, the chief of the Outpatient Research Program at the Maryland Psychiatric Research Center. “It’s critical to have an open conversation.”

Ms. Spikol writes about her experiences with bipolar disorder in The Philadelphia Weekly, and posts videos on her blog, the Trouble With Spikol (http://trouble.philadelphiaweekly.com/).

Thousands have watched her joke about her weight gain and loss of libido, and her giggle-punctuated portrayal of ECT. But another video shows her face pale and her eyes red-rimmed as she reflects on the dark period in which she couldn’t care for herself, or even shower. “I knew I was crazy but also sane enough to know that I couldn’t make myself sane,” she says in the video.

IN a telephone interview, she described one medication that made her salivate so profusely she needed towels to mop it up. “Of course it’s heartbreaking if you let it be,” she said. “But it’s also inherently funny. I’d sit there watching TV and drool so much, it would drip on the couch.”

Ms. Spikol said she has a kind doctor who treats her with respect, and she takes her pharmaceutical drugs to stabilize her mood. “I have asthma, and I use medications to maintain it, too,” she said.

Ms. Saks, the U.S.C. professor, who recently published a memoir, “The Center Cannot Hold: My Journey Through Madness,” has come to accept her illness. She manages her symptoms with a regimen that includes psychoanalysis and medication. But stigma, she said, is never far away.

She said she waited until she had tenure at U.S.C. before going public with her experience. When she was hospitalized for cancer some years ago, she was lavished with flowers. During periods of mental illness, though, only good friends have reached out to her.

Ms. Saks said she hopes to help others in her position, find tolerance, especially those with fewer resources. “I have the kind of life that anybody, mentally ill or not, would want: a good place to live, nice friends, loved ones,” she said.

“For an unlucky person,” Ms. Saks said, “I’m very lucky.”

Yes, against all odds, Mr. Tyson is still alive. A pudgy 41-year-old who is millions of dollars in debt to the Internal Revenue Servic, he has been living in the Las Vegas suburbs for about three months. And he is sober — 15 months now, he says — after years of drug and alcohol abuse. But this was not an envisioned outcome just a few years ago. In Mr. Tyson’s own words, “I never thought I’d live to this age.”

Now that he’s here, he finds himself on an unlikely and unpleasant path forward, although one that could prove cathartic. This week Mr. Tyson and his new advisers will fly to the south of France for the Cannes Film Festival, where a new documentary about his life, “Tyson,” will make its premiere. Directed by James Toback, the film, which interposes interviews of Mr. Tyson conducted last year while he was in rehab, with fight clips, has forced Mr. Tyson to relive and reconsider a life that shames him.

“I look at it now, and I’m embarrassed I did it,” he said in a recent interview. “There’s a lot of information people didn’t need to know.”

But exposing Mr. Tyson’s embattled and seemingly impossible relationship with his former self is central to new plans to reintroduce the former heavyweight. The film, along with a memoir that is still in its early stages — Mr. Tyson is collaborating with the author Larry Sloman, who has ghostwritten autobiographies for Howard Stern and Anthony Kiedis, the lead singer of the Red Hot Chili Peppers — are two parts of an effort that Mr. Tyson’s advisers hope will reintroduce him to the public and propel him to some semblance of a postboxing career.

Mr. Toback, who also directed “The Pick-up Artist” and “Two Girls and a Guy,” said he believed that the documentary, which is expected to be released in theaters this fall, would allow people to see the former fighter, known for his bursts of viciousness in the ring and a well-publicized rape conviction, in a more sympathetic context. “I just showed it to Warren and Annette, and it’s the first time I’ve ever seen him choke up over a movie,” Mr. Toback said in a telephone interview. “Her too.” (That would be Mr. Beatty and Ms. Bening.)

Still, Mr. Tyson seems ambivalent about being in the public eye again, partly because it raises questions that he himself can’t answer. “I don’t know who I am,” he said in an interview in his Las Vegas home, one of the few extensive interviews he’s given in the last few years. “That might sound stupid. I really have no idea. All my life I’ve been drinking and drugging and partying, and all of a sudden this comes to a stop.” He speaks in his familiar high-pitch voice with a trace of a lisp, but there is no menace as he frames his past as a series of mistakes. It is easy, sitting next to him as he speaks softly and contritely, to forget how feared he was.

But does the public have any appetite left for Mr. Tyson? Muhammad Ali, an Olympic hero with political cachet, has been feted in his postboxing life. Mr. Tyson, on the other hand, has been (unfairly perhaps) dismissed as a mere fighting machine.

Certainly there is very little that seems threatening about Mr. Tyson on this day. Not when he exits a black S.U.V. to greet a visitor in his driveway and trudges across a pathway over a rolling stream — the only noticeable nod to decadence in this home. Not when he is handed a submarine sandwich from a member of his now-small entourage and plops on the couch, the familiar bowler hat tilted sideways on his bald, tattooed head.

It was 22 years ago on a Saturday night at the Las Vegas Hilton, 16 miles from here, when the left hook from a 20-year-old Brooklyn kid full of fury landed on the temple of Trevor Berbick at 2:35 in the second round. “The day I won the title I got so drunk and high,” he said, lighting up a miniature cigar.

This was the point of demarcation in Mr. Tyson’s life because what had come before was poetic: 13-year-old black kid from the ghetto streets is taken in by Cus D’Amato, a legendary fight man in upstate New York who turns him into the heavyweight champion of the world. But what came after was vulgar: Bengal tigers in the backyard, prison and bankruptcy. It is well-trod territory that is covered in the documentary, but with a sober Mr. Tyson reflecting on his foibles. During the interview he becomes enamored with a program on E! about celebrities in rehab. He is quick to recognize his friends.

“I love addicts,” he said, nodding to the television screen. “I love these guys. That’s the people I want to be around. You know, former users. And I think that’s really crazy.”

He said he was born an addict and doesn’t blame his affliction on the trajectory of his life. He disdains talking about his own boxing career. Other than the man sitting on the couch there is no sign that the home is inhabited by the former heavyweight champ: no trophies, no pictures, no memorabilia. “I don’t need to remember that,” he said.

But Mr. Tyson showed he was still enraptured with boxing history, a love borne from watching old fight films at the home of his mentor, Mr. D’Amato in Catskill, N.Y., as a teenager. Mention one of the old-time boxers and he will launch into a monologue: “Gene Tunney, Jack Johnson, Jack Dempsey, look at those guys,” he said. “In the end they say Gene Tunney became an alcoholic, but he married well, he did well. He was erudite.”

The group of people Mr. Tyson is surrounded by now is an important part of the latest chapter in his story. Don King, the flamboyant fight promoter whom Mr. Tyson accused of bilking him out of millions of dollars, is long gone. The key people now are Harlan Werner, 40, who has worked with Muhammad Ali on licensing and marketing since he was 19, and Damon Bingham, who is Mr. Ali’s godson and the son of the photographer Howard Bingham, Mr. Ali’s best friend.

Both Mr. Werner and Mr. Bingham were heavily involved in the documentary, and both have producer credits.

As for Mr. Toback, he met Mr. Tyson met in 1985 on the set of “The Pick-up Artist” at the American Museum of Natural History in Manhattan. Mr. Tyson, not yet the champion, had been brought to the set to meet Robert Downey Jr., and “somehow the subject got on to madness,” Mr. Toback said. “I told him about an LSD experience I had as a sophomore at Harvard. We talked about losing the self, and the difference between dread and fear.”

Since that meeting, Mr. Toback cast Mr. Tyson in two of his previous films — “Black and White” in 1999 and “When Will I Be Loved” in 2004. At the end of the newest film — which was shot last year in a rented Beverly Hills home and on the beach in Malibu while Mr. Tyson got day passes from the Wonderland Center — Mr. Tyson “was talking about that empty void,” Mr. Toback said.

It was something Mr. Tyson reflected on deeply when he was doing prison time in the 1990s for a rape conviction, according to Mr. Toback, who said Mr. Tyson had spent long hours in solitary confinement reading works of great philosophers. His favorites these days are Machiavelli and Tolstoy. “Cool guys,” Mr. Tyson said. “All these guys, for some bizarre reason, all these guys are in some bizarre pain. Machiavelli just wanted power. He wanted power and control. His whole game was about manipulation.

“Tolstoy was all about helping the poor. He was a Communist, while his wife was a capitalist. And they had big fights over this.”

As Mr. Tyson flits from philosophy to addiction to the burdens of celebrity, his ease in moving across this catholic range of interests is less surprising the more time you spend in his presence. During his time at Wonderland, Mr. Tyson’s book project was also hatched. David Vigliano, the New York literary agent, visited him there, and the two agreed to work together.

But neither project — film nor movie — has been easy for Mr. Tyson.

“That’s very painful stuff.” He said of his past: “I didn’t know how to be any other way. I felt like one of those barbarian kings just coming to conquer the Roman Empire. I was crazy.”

Much of what Mr. Werner and Mr. Bingham are doing is trying to clean up that past. They have had to deploy lawyers to stop the selling of unlicensed products on the Internet, and there are still ongoing negotiations with the I.R.S. over back taxes. (Mr. Tyson, who reportedly earned $300 million to $400 million during his boxing career, filed for bankruptcy protection in 2003.)

“We have a job to do,” said Mr. Werner, who added that he has comic book and video-game deals in the works. “We’ve got to make the guy money. That’s our job. Our plan is to do high-profile projects and associate with companies who understand that this guy has generated billions around the world in ticket sales, pay-per-view and DVD sales.”

“The obvious challenge, in addition to Mike not wanting to be a sellout, is there’s the past legal issues,” Mr. Werner said. “There are times we don’t get a return phone call.”

But in his prime Mr. Tyson’s name was gold. “Those pay-per-view events were some of the biggest pay-per-view events in history,” said Matthew Blank, the chief executive of Showtime, which showed several of Mr. Tyson’s fights. “The ups and downs of Tyson were extreme. Mike brought a huge amount of drama both in the ring and out of the ring.”

Several months before Mr. Tyson captured the heavyweight title in 1986 he was visited in Catskill by a reporter for The Globe and Mail of Toronto who was looking to profile, in the words of Sports Illustrated, “the next great heavyweight.”

At 19, Mr. Tyson told the Canadian reporter, his life goals were “peace of mind, a lot of money and to be a well-respected person.”

Most of the money is long gone, but the longer he remains clean and sober the other two seem achievable. “I just say I’m not getting high today,” he said. “I’m not promising them I’m not getting high tomorrow. I’m trying to figure it out. I’m in an abysmal world trying to figure it out.”

Families Make Case for Vaccine Link to Autism
Associated Press, 5/12/2008

WASHINGTON -- Parents claiming that childhood vaccines cause autism should not be rewarded by the courts when the scientific community has already rejected any link, government lawyers argued Monday on the first day of a hearing in federal court.

Overall, nearly 4,900 families have filed claims with the U.S. Court of Claims alleging that vaccines caused autism and other neurological problems in their children. Lawyers for the families are presenting three different theories of how vaccines caused autism. The theory at issue Monday was whether vaccines containing the preservative thimerosal caused autism.

Lynn Ricciardella, a Justice Department lawyer, said that theory has not moved beyond the realm of speculation. She said that the Institute of Medicine and the Centers for Disease Control and Prevention have rejected any link between thimerosal and autism. ''There is no scientific debate,'' Ricciardella said. ''The debate is over.''

Autism is a developmental disability that typically appears during the first three years of life and affects a person's ability to communicate and interact with others. Medical experts don't have a comprehensive understanding of what causes autism, but they do know there is a strong hereditary component.

Thimerosal has been removed in recent years from standard childhood vaccines, except flu vaccines that are not packaged in single doses. The CDC says single-dose flu shots currently are available only in limited quantities.

Under a two-decades-old program, individuals claiming injury from a vaccine must file a petition for ''no-fault'' compensation with the U.S. Court of Federal Claims. The secretary of Health and Human Services replaces the vaccine manufacturer or vaccine administrator to defend the claim.

Two 10-year-old boys from Portland, Ore., will serve as test cases to determine whether thousands of families can be compensated. Attorneys for the boys will try to show they were happy, healthy and developing normally -- but, after being exposed to vaccines with thimerosal, they began to regress.

To win, the attorneys for the two boys, William Mead and Jordan King, will have to show that it's more likely than not that the vaccine actually caused the injury, which they described as regressive autism.

Tom Powers, one of the boys' attorneys, acknowledged that the evidence showing thimerosal led to regressive autism was indirect and circumstantial. Still, it's clear in the case of the two boys that they did not show any symptoms of autism until after they had received all their immunizations. ''Each of them had developed normally and typically well after their first year in life,'' Powers said.

The attorneys for the two boys said that a study in monkeys showed that mercury could ignite ''neuroinflammation'' in the brain, and such inflammation is the hallmark of somebody with autism. They also noted that previous studies of thimerosal were focused on autism, rather than on a more rare, specific form of the disorder that they described as regressive autism.

The first witness for the families, Sander Greenland, a professor at the UCLA School of Public Health, said published studies he reviewed failed to separate regressive autism from other types of autism when looking at thimerosal, thus they allow for a substantial association of the vaccines with clearly regressive autism.

Under the vaccine compensation program, officials titled special masters serve as the trial judges. The hearing that began Monday involved three special masters who will hear the evidence and determine whether thimerosal belongs on the list of causes for regressive autism. The rulings are appealable to the Court of Federal Claims.

If the families are successful, they could be entitled to damages that cover lost income after one turns 18 and up to $250,000 for pain and suffering.

Many members of the medical community are skeptical of the families' claims. They worry that the claims about the dangers of vaccines could cause some people to forgo vaccines that prevent illness.

Ricciardella argued that a marketing consultant fanned publicity about the supposed link between thimerosal and autism in a journal called Medical Hypothesis. She described the journal as willing to publish radical ideas, so long as they are coherent. She also said the authors pay to have the article published.

But Powers said those questioning conventional wisdom in the case cannot be easily dismissed. ''These are doctors who are willing to challenge the establishment on behalf of their patients,'' Powers said.

The court Web site says more than 12,500 claims have been filed since creation of the program in 1987, including more than 5,300 autism cases, and more than $1.7 billion has been paid in claims. It says there is now more than $2.7 billion in a trust fund supported by an excise tax on each dose of vaccine covered by the program.

On the Net: Background on thimerosal trial: http://www.uscfc.uscourts.gov/node/4428

In Delusions of Romance, Genuine Comfort
Elissa Ely, M.D., New York Times- 5/13/2008

She was never on time to clinic appointments. Leaving her apartment was not simple when it required pushing aside the furniture she had pushed against the front door the night before, and even the furniture was no protection against the threats she perceived. She said strange men burrowed into the apartment after dark, right through the door, the chest of drawers and the armchairs. They entered her body, and then they ate her up from the inside. It took years before she told us this. We might doubt her, but she knew it happened. Numerous expensive antipsychotics made no difference at all.
      She smoked heavily, partly from anxiety and partly because, like many chronically institutionalized patients, she had been bribed into placidity with cigarettes years earlier. Before her first psychotic break, she had been a singer. Smoking was not good for her voice, of course, but under these harrowing circumstances, quitting was impossible.
     A few days after an appointment at which she had looked even wearier than usual, she collapsed. In the emergency room, her blood sodium was low. The medical resident decided it was from her psychiatric medication; he discontinued some, decreased others and sent her home. Three months later, while defensively moving furniture, she had a seizure. Back in the hospital, she still had low sodium, but a scan showed diffuse lung cancer, metastatic to bones and brain. Her problem was not a result of psychiatric medications.
     She refused to acknowledge her cancer, but she demanded that everything reasonable and unreasonable be done for the illness she insisted did not exist. When she grew too weak from chemotherapy and radiation to live alone — much less move the furniture — she was transferred to a rehabilitation facility. The consultant there stopped all of her medications except for a low dose of a single antipsychotic. In his view, the drugs increased her fatigue from the medical therapies. In our view, he might as well have been treating a raging pneumonia with a vitamin.
     Two months before she died, she came to see us. She arrived in a wheelchair, unable to walk from metastatic fractures, wearing a stylish bandanna. She was hard to recognize physically, and almost impossible to recognize mentally. She was rational, brisk and organized. She told us she had decided to stop the chemotherapy and radiation. “It’s cancer; there’s no cure,” she said, as I recall. She was lucid as could be, on almost no medication at all, with not one molecule of paranoia or a single misconception. We were the ones confused. We were astounded.
     Then she told us something else astounding. Love had come into her life. During the last few M.R.I.’s that tracked the progress of her tumors, a radiology technician had given her headphones to pass the time. Jazz began to play, and then each time, in the M.R.I. tube, a famous singer appeared in the dark. She recognized him immediately. “I can’t tell you who he is,” she said, modestly, “because he’s married.” Still, she couldn’t keep good news to herself. “He was singing love songs to me,” she said, “and I sang them back to him.” She had a look of demure joy, recalling the married Frank or Dean (she couldn’t tell us who) crooning to her over the M.R.I. machine. Against all spatial reality, they lay together, singing. “It was very nice,” she said. We might doubt her, but she knew it had happened.
     She had underestimated us. We would not have dreamed of questioning her. If there is anything fair about psychosis (and there is not), this was the least schizophrenia owed her. Her delusions, unremittingly ugly, had suddenly grown beautiful. In the end, the psychosis was her friend.
     Elissa Ely is a psychiatrist in Boston.



Official Urged Fewer Diagnoses of PTSD
Christopher Lee, Washington Post- 5/16/2008

A psychologist who helps lead the post-traumatic stress disorder program at a medical facility for veterans in Texas told staff members to refrain from diagnosing PTSD because so many veterans were seeking government disability payments for the condition.

"Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out," Norma Perez wrote in a March 20 e-mail to mental-health specialists and social workers at the Department of Veterans Affairs' Olin E. Teague Veterans' Center in Temple, Tex. Instead, she recommended that they "consider a diagnosis of Adjustment Disorder."

VA staff members "really don't . . . have time to do the extensive testing that should be done to determine PTSD," Perez wrote.

Adjustment disorder is a less severe reaction to stress than PTSD and has a shorter duration, usually no longer than six months, said Anthony T. Ng, a psychiatrist and member of Mental Health America, a nonprofit professional association.

Veterans diagnosed with PTSD can be eligible for disability compensation of up to $2,527 a month, depending on the severity of the condition, said Alison Aikele, a VA spokeswoman. Those found to have adjustment disorder generally are not offered such payments, though veterans can receive medical treatment for either condition.

Perez's e-mail was obtained and released publicly yesterday by VoteVets.org, a veterans group that has been critical of the Bush administration's policies in Iraq and Afghanistan, and Citizens for Responsibility and Ethics in Washington (CREW), a nonprofit government watchdog group.

"Many veterans believe that the government just doesn't want to pay out the disability that comes along with a PTSD diagnosis, and this revelation will not allay their concerns," John Soltz, chairman of VoteVets.org and an Iraq war veteran, said in a statement.

Melanie Sloan, executive director of CREW, said in a statement: "It is outrageous that the VA is calling on its employees to deliberately misdiagnose returning veterans in an effort to cut costs. Those who have risked their lives serving our country deserve far better."

Veterans Affairs Secretary James B. Peake said in a statement that Perez's e-mail was "inappropriate" and does not reflect VA policy. It has been "repudiated at the highest level of our health care organization," he said.

"VA's leadership will strongly remind all medical staff that trust, accuracy and transparency is paramount to maintaining our relationships with our veteran patients," Peake said.

Peake said Perez has been "counseled" and is "extremely apologetic." Aikele said Perez remains in her job.

A Rand Corp. report released in April found that repeated exposure to combat stress in Iraq and Afghanistan is causing a disproportionately high psychological toll compared with physical injuries. About 300,000 U.S. military personnel who have served in Iraq or Afghanistan are suffering from PTSD or major depression, the study found. The economic cost to the United States -- including medical care, forgone productivity and lost lives through suicide -- is expected to reach $4 billion to $6 billion over two years.

Ng said diagnosing PTSD often requires observing a patient for weeks or months because the condition implies a long, lingering effect of stress.

"Most people exposed to trauma, in general, can get better," Ng said. "You don't want to over-diagnose people with PTSD. Whether it's adjustment disorder is one thing. It's usually a temporary disorder with severity that is not as bad as someone with full-blown PTSD."

Prescription Drug Trafficking Increases
Tim Reiterman, Los Angeles Times- 5/17/2008

A Riverside County psychiatrist who drove a Corvette and lived in a gated community allegedly wrote prescriptions in the lobby of his fitness club and outside restaurants for $100 each.

More than $1 million was stashed in luggage at the house of an Orange County physician who sold black plastic bags of narcotic painkillers.

And at one Los Angeles pharmacy, people peddled medications out front while others squeezed inside to buy more drugs.

Health professionals and dishonest patients are diverting powerful and potentially addictive prescription drugs from legitimate medical channels, helping to fuel a shift toward pharmaceuticals as drugs of choice, authorities say.

Pharmacy thefts, robberies and burglaries also are contributing to the problem, investigators say, along with prescription forgeries and Internet pharmacies that require little information before shipping drugs. Nationwide, 25 million doses of commonly abused drugs were reported stolen last year.

In California, where almost 34 million prescriptions for narcotics and other controlled substances were issued last year, the drug diversion problem has caught the attention of state Atty. Gen. Jerry Brown. He says he plans to upgrade the state's monitoring system to allow health practitioners to check patients' histories before prescribing potentially dangerous medications.

"Doctors and pharmacies can instantly check out if the patient before them is legitimate or an abuser," Brown said in an interview. "We will be in a better position to control illegal diversion."

Law enforcement officials say high-profile accidental overdoses, such as that of former Playboy Playmate Anna Nicole Smith, are symptomatic of entrenched abuse and misuse of prescription drugs. The federal government's most recent survey reported that 7 million Americans engaged in non-medical use of pharmaceuticals in 2006 -- up from 6 million two years earlier. And that usage was higher than for any illicit drug except marijuana.

"Unlike illicit drug use, which shows a continuing downward trend, prescription drug abuse . . . has seen a continual rise through the 1990s and has remained stubbornly steady . . . during recent years," Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, told a congressional hearing in March.

And local law enforcement officials cite a surge in the use of prescription drugs as street narcotics.

"What we are seeing is that prescription drugs . . . are quickly becoming the drug of choice and abuse," said Murrieta Police Lt. Dennis Vrooman.

In late 2006 and early 2007, Murrieta police were hearing complaints that psychiatrist Joel Stanley Dreyer -- a cowboy boot-wearing, extreme-fighting aficionado whose personalized license plates read FREUDMD -- was prescribing highly addictive drugs to apparently healthy young people.

Then an Orange County businessman showed up with a sad story that dovetailed with that information. On Christmas Day of 2005, he and his mother had found the body of his 35-year-old sister, Jessica Silva, in her Newport Beach condominium.

Silva seemed an unlikely overdose victim. The divorced saleswoman had about $900,000 in assets. But she had been arrested for drug possession years earlier and gone through rehab -- and the coroner found many drugs in her system. Her last prescription was for OxyContin, a painkiller Dreyer had prescribed a few weeks earlier.

Her brother conducted his own investigation. Posing as a new patient at Dreyer's office, he complained of pain and difficulty sleeping, the brother later told police. Without conducting an examination, Dreyer prescribed three drugs and charged $100, according to an FBI court affidavit.

In 2007, three undercover officers also obtained prescriptions for $100 each during tape-recorded visits, the affidavit says. "And that, my love," Dreyer quipped to a female Drug Enforcement Administration agent, "is the game."

Now Dreyer, whose medical license was suspended last summer, faces a 19-count federal indictment alleging illegal drug dispensing. His attorney, Wayne Gross, declined to comment. Dreyer has pleaded not guilty.

Police say they do not know how much money Dreyer made.

"His car was leased and his home was rented, so that would lead to speculation as to whether he spent all the money or it is hidden somewhere," said Murrieta Police Det. John Nelson.

In the case of Anaheim physician Peter A. Ahles, that question was answered in dramatic fashion. Three years ago, the state medical board was examining whether Ahles was prescribing drugs without a valid medical reason. It also was looking into the overdose death of his son's 39-year-old roommate, who received narcotics prescriptions from the doctor despite a history of addiction.

After undercover officers obtained pills for cash at his office, Ahles was arrested in mid-2005, and $1.35 million was seized at his home. The doctor pleaded guilty to illegally dispensing a controlled substance and was placed on six months' home detention and three years' probation. He surrendered his medical license.

Ahles is a Korean War veteran who walks with a limp and empathizes with people in pain because he has chronic pain, said his attorney, Stephen M. Tornay.

"Some in the drug-addict crowd got wind that he was an easy mark to get drugs, which he did become," Tornay said.

Records show the state medical board disciplines several dozen doctors a year for inappropriate prescribing and for abusing drugs and alcohol themselves, but drug diversion cases are not tallied separately.

Dr. Bob Wailes, a San Diego pain specialist who reviews cases for the board, said: "I have seen egregious overuse of narcotics without physical examination and a good diagnosis. Those are uncommon. . . . I have also seen examples where . . . the doctor has been challenged [by law enforcement] for what falls into acceptable levels of prescribing narcotics for chronic pain."

Drug diversion investigations can be complex and take many months.

Several years ago, a multiagency task force in Los Angeles began looking at SNG Pharmacy on West Pico Boulevard after complaints of open drug dealing outside.

"We . . . have video of people crushing pills and mixing them with cough syrup on the sidewalk," Los Angeles County Sheriff's Sgt. Steve Opferman said. "It was a mill for street addicts."

In 2005, an undercover deputy encountered about 30 people inside, calling out drug orders. After writing his name, address, birth date and phone number on a piece of paper, the deputy said, he bought an unlabeled bottle of Soma, a painkilling muscle relaxant.

State investigators found that the pharmacy had purchased several million doses of drugs over a two-year period but could not account for hundreds of thousands of them.

The owner, Siamak Davoodi, pleaded no contest to misdemeanor dispensing of medication without the proper labeling or container. His pharmacy board licenses were revoked in 2006 and he was ordered to pay nearly $100,000 in investigative costs.

Davoodi's attorney, Herb Weinberg, declined to comment on the case.

Other avenues for prescription diversion are forgery and fraud. In San Diego, for example, a nurse admitted in 2006 that she obtained narcotics by using forms stolen from a doctor, according to the attorney general's office.

Last year, a woman was caught four times phoning bogus prescriptions to pharmacies.

Officials at Medi-Cal, the state's health program for the poor, have conducted nearly 500 drug diversion investigations since 2003, resulting in 182 criminal complaints.

Doctor shopping, in which a patient seeks prescriptions from multiple physicians, is on the rise among Medi-Cal recipients, according to Bruce Edwards, the state health department's chief investigator.

"My section chief in Los Angeles just got 30 to 40 referrals of beneficiaries shopping and abusing," he said.

At White Memorial Medical Center in East L.A., Dr. Brian Johnston said prescription fraud is increasingly common. The emergency room chief said people used his prescriber identification to try to get at least six Vicodin prescriptions last year and one recently.

They call a pharmacy "and say, 'I am Suzie and I work for Dr. Johnston, and he wants a refill on this prescription,' " Johnston said.

 

Ted Kaczynski: A Brother Lost, a Brotherhood Found
Robert Elder, Chicago Tribune- 5/17/2008

The two brothers hiked high into the Montana wilderness, cooked beans beneath the stars and talked like they hadn't in years.

By a campfire outside his one-room cabin, Ted read to his younger brother from a book on Roman history. For a time, they were just kids again, Teddy and Davy Kaczynski from Evergreen Park.

Gone was Ted's long-festering animosity toward their parents, or at least any mention of it. He had sent venomous letters accusing them of not loving him, blaming them for his social awkwardness.

But his brother's visit had gone so well that Ted even considered traveling to Dave's own retreat in southwest Texas. On their last day together in the fall of 1986, though, Ted declined.