Danger of Liver Problems Seen in ADD Drug
Associated Press, 12/17/2004

WASHINGTON -- Strattera, used to treat attention deficit hyperactivity disorder, is getting an updated label to highlight the risk the drug might contribute to severe liver problems in some patients. The government said Friday the new warning says the medication should be discontinued in patients who develop jaundice or laboratory evidence of liver injury. ``The labeling warns that severe liver injury may progress to liver failure resulting in death or the need for a liver transplant in a small percentage of patients,'' the Food and Drug Administration said.
      The updated labeling follows reports of liver problems in an adult and a teenager who had been treated with Strattera for several months. Both recovered, the FDA said, and it offered no other details of the cases. Strattera has been dispensed to more than 2 million patients since it went on the market in 2002. No sign of liver problems were seen in the drug's clinical trials, which involved 6,000 patients, the FDA said.
      Eli Lilly & Co., the manufacturer, agreed to alert doctors about the risk by sending them a letter, an updated insert for patients in the drug package and a boldface warning on the label, the FDA said. The company confirmed Friday it was taking those actions.
      Strattera is among a new generation of attention deficit drugs that require only a morning dose, a boon in schools where kids have had to take second doses of their medication in the afternoon. Normally, the main side effects are reduced appetite and growth. The FDA said the package insert explains some of the signs of possible liver problems, including jaundice, dark urine, unexplained flu-like symptoms, upper right-side abdominal tenderness and a form of itchy skin known as pruritus.
      On the Net: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01335.html

Link Between Ritalin, Depression Explored
Jamie Talan, Newsday- 12/17/2004

Pre-adolescent rats given the popular ADHD drug Ritalin are more likely to show signs of depression in adulthood, according to a Harvard study. The study suggests stimulants, at least in the normally developing brain, can have unsuspected effects in adulthood. The findings also underscore the importance of an accurate diagnosis for Attention Deficit Hyperactivity Disorder.
      William Carlezon, director of McLean Hospital's Behavioral Genetics Laboratory and associate professor of psychiatry at Harvard Medical School, presented the findings in Puerto Rico at the annual meeting of the American College of Neuropsychopharmacology. Carlezon said that because there are no animal models for ADHD, the young rats in the Harvard study were normal. "We know that depression occurs more often in adults with ADHD," said Dr. Peter Jensen, director of the Center for the Advancement of Children's Mental Health at Columbia University Medical Center. "What we don't know is whether it's because the disorder wasn't treated when it should have been, or was treated and the depression is a consequence of treatment, or it's a result of ADHD itself."
      The animals were exposed to Ritalin during the same developmental stage as a human between ages 4 and 12. In adulthood, the animals were given tests to tap the brain circuits thought to trigger ADHD symptoms — hyperactivity, impulsivity, difficulty focusing. The tests showed "the animal's brain reward system is altered" by drug treatment in pre-adolescence, Carlezon said.

Cruel Bargain: Parents Lose Custody to Aid Teens
Patricia Wen, Boston Globe- 12/19/2004

ARLINGTON -- Sharon Chossé could not bear to give up custody of her son. She saw herself as a good mother. And after her husband died four years ago, the secretary worked harder than ever to give their only child everything he needed. But on a chilly fall day in 2002, Chossé walked into court to sign papers authorizing the state to take legal custody of her son, Spencer. She wept, and when her 13-year-old son heard about it, he cried, too. School officials said the best place for Spencer, who was prone to angry outbursts, was a residential school for children with behavioral problems. They warned that teenagers like Spencer often end up in prison if they do not get help.
      Chossé was told that the state would pay for the school, but only if she temporarily gave up custody through a special law to curb juvenile delinquency. Then Chossé recognized the cruel bargain faced by many parents with troubled teenagers and limited incomes: They may receive state-funded services for their children only if they are willing to surrender authority over their child. Chossé remembers approaching the counter of the clerk's office on that October day, unable to control her anguish. She heard a court clerk ask, "Then why are you doing this?" to which the mother answered simply, "I need the funding."
      Chossé is among a growing number of parents, child-welfare advocates, and state officials calling for an overhaul of legislation that they say undermines the parent-child relationship. Known as the Child in Need of Services Law, it is designed to help troubled children from becoming criminals. Parents who have run out of solutions for children who skip school or run away from home, can petition the court for services they cannot afford.
      But critics say the system not only fails to deliver promised services, but imposes the unfair requirement that parents, who have not been proven unfit, give up legal custody to the state in return for help. One state lawmaker has filed a bill to repeal the law, saying it should be replaced by a system that emphasizes parental involvement, essential to rehabilitating these youngsters.
      In the past two decades, three blue-ribbon panels have concluded that the law does not achieve its stated purpose: Many teenagers who go through its programs still turn to a life of crime. One report found that of the 6,500 cases filed in 1994 under the law, more than 54 percent of the youngsters were arraigned for criminal offenses in adult or juvenile courts within three years of being brought into court under the Child in Need of Services Law. "It's something that desperately needs to be fixed," said Harry Spence, commissioner of the Department of Social Services. "We all have significant levels of frustration with the law." More than 9,000 children, typically in their early teens, were brought into the court system through this law last year.
     Chossé said she knew the agonizing deal she was striking when she filled out the legal paperwork to temporarily give up custody of Spencer. But many parents are unaware of the broad reach of the law and are often shocked to learn that their appeal for state-funded services might result in a court ordering their child to live in a foster home. "Parents are taking chances," said Lael Chester, executive director of Citizens for Juvenile Justice, a nonprofit advocacy group that has criticized the law. "They think they're going to court to get more authority over their child, but the result can be the opposite."
      Elizabeth Monteiro, 37, a Malden mother of four, came to court more than two years ago for help when her daughter, Shardey, ran away from home. A judge ordered Shardey placed in DSS custody. After that, Monteiro said, she lost control over where her daughter lived. She realized that she needed state permission to visit her daughter at the foster homes and a residential school in Lexington where state authorities placed her. She discovered that psychological and educational assessments that the state ordered for Shardey were delayed for many months, and she said no one ever explained reasons for the delay. Monteiro said she realized too late that she would be losing custody.
      "It's punitive," said Monteiro, who is starting a nonprofit group to help parents who face problems in the juvenile court system. "Why do I have to lose custody? I need services, and now I have to lose my God-given right to have custody of my child." She felt pushed away from her daughter's life, which she said has affected her relationship to her daughter to this day. Shardey has run away again, and Monteiro said she had been forced again to seek services from the courts.
      Critics of the law say parents in the system ought to have a greater voice in the choice of treatment for their children, or, at least, receive some kind of booklet telling them what powers they are surrendering. "I think parents should be warned," said R. Susan Dillard, codirector of the Children and Family Law Program in the Committee for Public Counsel Services. "Once you engage in this, you could lose custody of your child."
      The law was devised as a softer approach to dealing with hard-to-manage adolescents. Until 1973, children with specific behavioral problems could be charged criminally and sent to locked reform schools. Children could be sent to these schools, essentially prisons for young people, if the court deemed them truants, runaways, stubborn (for refusing to listen to their parents), or school offenders (for refusing to listen to their teachers.) But in 1973 lawmakers erased the criminal labels for these behaviors and decided that such youngsters were more likely to turn their lives around by receiving counseling than prisonlike sanctions. The court can arrange psychiatric and medical tests and treatment, appoint a tutor, transfer the child to a special school, or assign the child to afterschool programs, in short, make many of the important decisions a parent would normally make.
     Parents, school authorities, or police officers could file a petition against a child, triggering an investigation by the courts.The court's power in each case lasts for six months, but can be extended. If the judge finds enough evidence that the child needs help, the judge has the option of allowing the child to live at home, provided that he or she adheres to certain conditions, such as following curfews and attending therapy sessions. In those cases, the child remains at home under the court's authority. And, if the child fails to follow the rules, the judge can remove the youngster from home. "That's the ultimate threat," said Kathy Costello, assistant chief of probation in the Suffolk County juvenile court.
      Martha Grace, chief justice of the state's juvenile court, said that she agrees that the law needs an overhaul, but that she does not think the statute should be repealed before a good replacement is drafted. A majority of children benefit from informal meetings with juvenile probation officers, she said, adding that "for a huge number of kids, we make a difference." In those cases, the court does not take custody of the child. Judges often voluntarily ask for input from parents, but she added that some parents abandon their responsibilities, failing to show up for court meetings and leaving the problem of their troubled teenagers to the courts.
      State Representative Paul J. Donato, a Democrat from Medford, said the current law is deeply flawed. He filed a bill last month to repeal the statute, saying the current system undermines the parent-child bond that is essential to rehabilitating these youths. Donato's bill is backed by the Children's League of Massachusetts, one of the state's largest child advocacy groups.
      Sitting in her living room in her Arlington apartment last weekend, Chossé said she has been reunited this year with her son. Spencer, now 15, spent two years at a residential private school in Lowell. The 49-year-old mother said her son ultimately benefited from two years at that school, but she would never want to live through again the stress of surrendering legal custody. Her son said he would never forget sitting in the courtroom for the first time two years ago, worried that he would be sent to a foster home someday. "I didn't know what was going on," said Spencer, whose bedroom is adorned with an array of Red Sox memorabilia. "I wanted to go home." Chossé said she wants the law to be changed, so that other parents do not have to worry about being excluded from decision making about their children. She said the law should reflect not a "child in need of services," but a "family in need of services."

How About Not 'Curing' Us, Some Autistics Are Pleading
Amy Harmon, New York Times- 12/20/2004

BOICEVILLE, N.Y. - Jack Thomas, a 10th grader at a school for autistic teenagers and an expert on the nation's roadways, tore himself away from his satellite map one recent recess period to critique a television program about the search for a cure for autism. "We don't have a disease," said Jack, echoing the opinion of the other 15 boys at the experimental Aspie school here in the Catskills. "So we can't be 'cured.' This is just the way we are."
     From behind his GameBoy, Justin Mulvaney, another 10th grader, objected to the program's description of people "suffering" from Asperger's syndrome, the form of autism he has. "People don't suffer from Asperger's," Justin said. "They suffer because they're depressed from being left out and beat up all the time."
      That, at least, was what happened to these students at mainstream schools before they found refuge here. But unlike many programs for autistics, this school's program does not try to expunge the odd social behaviors that often make life so difficult for them. Its unconventional aim is to teach students that it is O.K. to "act autistic" and also how to get by in a world where it is not.
      Trained in self-advocacy, students proudly recite the positive traits autism can confer, like the ability to develop uncanny expertise in an area of interest. This year's class includes specialists on supervolcanoes and medieval weaponry. "Look at Jack," Justin pointed out. "He doesn't even need a map. He's like a living map."
      The new program, whose name stands for Autistic Strength, Purpose and Independence in Education -- and whose acronym is a short form of Asperger's -- is rooted in a view of autism as an alternative form of brain wiring, with its own benefits and drawbacks, rather than a devastating disorder in need of curing. It is a view supported by an increasingly vocal group of adult autistics, including some who cannot use speech to communicate and have been institutionalized because of their condition. But it is causing consternation among many parents whose greatest hope is to avoid that very future for their children. Many believe that intensive behavioral therapy offers the only rescue from the task of caring for unpredictable, sometimes aggressive children, whose condition can take a toll on the entire family.
      The autistic activists say they want help, too, but would be far better off learning to use their autistic strengths to cope with their autistic impairments rather than pretending that either can be removed. Some autistic tics, like repetitive rocking and violent outbursts, they say, could be modulated more easily if an effort were made to understand their underlying message, rather than trying to train them away. Other traits, like difficulty with eye contact, with grasping humor or with breaking from routines, might not require such huge corrective efforts on their part if people were simply more tolerant.
      Spurred by an elevated national focus on finding a cure for autism at a time when more Americans are receiving autism diagnoses than ever before - about one in 200 - a growing number of autistics are staging what they say amounts to an ad hoc human rights movement. They sell Autistic Liberation Front buttons and circulate petitions on Web sites like www.neurodiversity.com to "defend the dignity of autistic citizens." The Autistic Advocacy e-mail list, one of dozens that connect like-minded autistics, has attracted nearly 400 members since it started last year. "We need acceptance about who we are and the way we are," said Joe Mele, 36, who staged a protest at Jones Beach, on Long Island, while 10,000 people marched to raise money for autism research recently. "That means you have to get out of the cure mind-set."
      A neurological condition that can render standard forms of communication like tone of voice, facial expression and even spoken language unnatural and difficult to master, autism has traditionally been seen as a shell from which a normal child might one day emerge. But some advocates contend that autism is an integral part of their identities, much more like a skin than a shell, and not one they care to shed.
      The effort to cure autism, they say, is not like curing cancer, but like the efforts of a previous age to cure left-handedness. Some worry that in addition to troublesome interventions, the ultimate cure will be a genetic test to prevent autistic children from being born. That would be a loss, they say, not just for social tolerance but because autistics, with their obsessive attention to detail and eccentric perspective, can provide valuable insight and innovation. The neurologist Oliver Sacks, for instance, contends that Henry Cavendish, the 18th-century chemist who discovered hydrogen, was most likely autistic. "What they're saying is their goal is to create a world that has no people like us in it," said Jim Sinclair, who did not speak until he was 12 and whose 1993 essay "Don't Mourn for Us" serves as a touchstone for a fledgling movement.
      At this year's "Autreat," an annual spring gathering of autistics, attendees compared themselves to gay rights activists, or the deaf who prefer sign language over surgery that might allow them to hear. Some discussed plans to be more openly autistic in public, rather than take the usual elaborate measures to fit in. Others vowed to create more autistic-friendly events and spaces. Autreat participants, for instance, can wear color-coded badges that indicate whether they are willing to be approached for conversation. Common autistic mannerisms, like exceedingly literal conversation and hand-flapping, are to be expected. Common sources of autistic irritation, like casual hugs and fluorescent lighting, are not.
      For many parents, however, the autistic self-advocacy movement often sounds like a threat to the brighter future they envision for their children. In recent months, the long-simmering argument has erupted into an online brawl over the most humane way to handle an often crippling condition. On e-mail lists frequented by autistics, some parents are derided as "curebies" and portrayed as slaves to conformity, so anxious for their children to appear normal that they cannot respect their way of communicating. Parents argue that their antagonists are showing a typical autistic lack of empathy by suggesting that they should not try to help their children. It is only those whose diagnosis describes them as "high functioning" or having Asperger's syndrome, they say, who are opposed to a cure. "If those who raise their opposition to the so-called oppression of the autistic would simply substitute their usage of 'autism or autistic' with 'Asperger's,' their arguments might make some sense," Lenny Schafer, publisher of the widely circulated Schafer Autism Report, wrote in a recent e-mail message. "But I intend to cure, fix, repair, change over etc. my son and others like him of his profound and typical disabling autism into something better. Let us regain our common sense." But the autistic activists say it is not so easy to distinguish between high and low functioning, and their ranks include both.
      In an effort to refute parental skeptics, the three owners of www.autistics.org, a major Web hub of autistic advocacy, issued a statement listing their various impairments. None of them are fully toilet-trained, one of them cannot speak, and they have all injured themselves on multiple occasions, they wrote: "We flap, finger-flick, rock, twist, rub, clap, bounce, squeal, hum, scream, hiss and tic."
      The touchiest area of dispute is over Applied Behavior Analysis, or A.B.A., the therapy that many parents say is the only way their children were able to learn to make eye contact, talk and get through the day without throwing tantrums. Some autistic adults, including some who have had the therapy, say that at its best it trains children to repress their natural form of expression and at its worst borders on being abusive. If an autistic child who screams every time he is taken to the supermarket is trained not to, for example, he may still be experiencing pain from the fluorescent lights and crush of strangers. "Behaviors are so often attempts to communicate," said Jane Meyerding, an autistic woman who has a clerical job at the University of Washington and is a frequent contributor to the Autistic Advocacy e-mail discussion list. "When you snuff out the behaviors you snuff out the attempts to communicate."
      Perhaps the most public conflict between parents and adult autistics came in a lawsuit brought by several Canadian families who argued that the government should pay for their children's A.B.A. therapy because it is medically necessary. Michelle Dawson, an autistic woman in Montreal, submitted testimony questioning the ethics of the therapy, which the Canadian Supreme Court cited in its ruling against the families in November. Ms. Dawson's position infuriates many parents who are fighting their own battles to get governments and insurance companies to pay for the expensive therapy. "I'm afraid of this movement," said Kit Weintraub, the mother of two autistic children in Madison, Wis.
      Ms. Weintraub's son, Nicholas, has benefited greatly from A.B.A., she said, and she is unapologetic about wanting to remove his remaining quirks, like his stilted manner of speaking and his wanting to be Mickey Mouse for Halloween when other 8-year-olds want to be Frodo from "The Lord of the Rings." "I worry about when he gets into high school, somebody doesn't want to date him or be his friend," she said. "It's no fun being different."
      The dispute extends even to the basic terminology of autism. "I would appreciate it, if I end up in your article, if you describe me as 'an autistic' or 'an autistic person,' versus the 'person with...,' " Ms. Dawson wrote in an e-mail message. "Just like you would feel odd if people said you were a 'person with femaleness.' " Ms. Weintraub insists on the opposite. "My children have autism, they are not 'autistics,' " she wrote in her own widely circulated essay, "A Mother's Perspective." "It is no more normal to be autistic than it is to have spina bifida."
      Terry Walker, 37, who has Asperger's syndrome, said he was not opposed to the concept of a cure for autism but he suggested that there was a pragmatic reason to look for other options. "I don't think it's going to be easy to find," Mr. Walker said. "That's why I opt for changing the world around me; I think that does more long-term good."

Therapy? Or Pills? A Quandary in Britain
Lizette Alvarez, New York Times- 12/21/2004

LONDON -- One year after British drug regulators advised against prescribing a new generation of antidepressants, except Prozac, for depressed adolescents, British doctors say they are in a frustrating bind. Warned away from using the antidepressants, they are recommending psychotherapy for their young patients instead. But under the British health system, depressed teenagers face a six- to nine-month waiting list for psychotherapy, a situation unlikely to improve in the short term. "On the ground, we feel very much abandoned," said Dr. Dick Churchill, a general practitioner and senior lecturer at Nottingham University. "The advice seems to be these kids should be having psychological treatment. But we don't have ready access to trained services to give them. So we are stuck in a difficult position at the moment."
      Dr. Peter Hill, an independent child and adolescent psychiatrist and an honorary consultant to the Great Ormond Street Hospital for Children, said the advisory was at first greeted with deep concern and bewilderment by parents, patients and the general practitioners who are on the front line of medical care here. "The phone was red hot for days on end," Dr. Hill said. The situation has settled since then, he said, but a certain amount of confusion remains about antidepressants, particularly about those addressed by the regulators, most of which belong to the class known as selective serotonin reuptake inhibitors, or S.S.R.I.'s. "I have a letter on my desk at the moment from a G.P. who thinks he is unable to prescribe any S.S.R.I.'s for any children, and that included 17½-year-olds," Dr. Hill said.
      The government's warning, issued last December, came on the heels of an enormous rise in the use of antidepressants and stimulants among young people here. Prescriptions of the drugs to children in Britain jumped to 700,000 in 2002 from 400,000 in 2000, according to an international study by a research team from the University of London's School of Pharmacy, published in November in the journal Archives of Disease in Childhood. From January 1992 until December 2001, the use of antidepressants for children rose 70 percent, according to a second study published in the journal by the same team. The British government estimates that 40,000 children under 18, or about 1 child in 300, were taking antidepressants in 2003. Doctors here say the popularity of the drugs could be traced to several factors, including the availability of newer drugs, greater awareness about childhood depression and an increase in diagnoses of the illness by family doctors.
      In its 2003 advisory, the Medicines and Healthcare Products and Regulatory Agency, the British equivalent of the Food and Drug Administration in the United States, stopped short of an outright ban on prescribing antidepressants for children. But the recommendation was more sweeping than the action taken by the F.D.A., which in October toughened warning labels on antidepressants for children and adolescents but did not tell doctors not to use them. Under the British guidelines, general practitioners are advised not to prescribe any of six newer generation antidepressants for children and teenagers and to consult with a mental health specialist before prescribing Prozac, which was exempted from the warning. The regulators based their decision on data suggesting a link between the drugs and suicidal thinking and behavior among young people and a lack of evidence for their effectiveness in treating childhood depression.
      In December, the British drug agency weighed in again, this time for adults, recommending, on the basis of an 18-month review of 600 published and unpublished clinical trials, that antidepressants not be prescribed for mild depression. But the officials stressed that the benefits of antidepressants for more severe depression were well proved, and said that there was "no clear evidence" of an increased risk of self-harm and suicidal thoughts in adults.
     Psychiatrists in Britain say that for the most part, children and adolescents who were already taking the antidepressants continued to take them after the 2003 advisory was issued, but with greater vigilance by doctors. New patients who visited psychiatrists, as opposed to family doctors, were given Prozac if medication was required. "Specialists can still prescribe whatever S.S.R.I. is necessary, but we are using much more fluoxetine than before," said Dr. Mark Berelowitz, a child and adolescent psychiatrist who is a consultant at the Royal Free Hospital in Hampstead, referring to Prozac.
      General practitioners, on the other hand, have grown increasingly squeamish about prescribing any medication to depressed children. "The key thing that seems to be happening in my awareness is that most G.P.'s are fairly reluctant to prescribe any antidepressant to teenagers at the moment," Dr. Churchill said. "The guidance from the government has made everybody wary, even of Prozac."
      In theory, the national health system advocates a holistic approach to mental health. Troubled or depressed teenagers are referred to mental health teams that include counselors and psychiatrists, all of them working together in treating the patient. The problem is the scarcity in the number of child counselors and psychiatrists, a shortage that has led to long waiting lists once a referral is granted.
      Some experts believe the government's action was rashly taken. The evidence that the drugs cause suicidal thinking and behavior, they say, is not clear-cut, and they worry that some teenagers may not be getting the help they require. The regulators "may have been flatly overcautious," said Dr. David Coghill, a senior lecturer in child and adolescent psychiatry at the University of Dundee in Scotland and a clinician. "I did prefer the black-box warning that the U.S. came out with," Dr. Coghill said. "I think that was more considered. It addresses the concerns but does point out that the number of children and young people who will have these reactions are very small." But many family doctors say that they were never altogether comfortable dispensing medication for depressed teenagers, but that often they felt they had no choice.
      Still, the turmoil surrounding the use of antidepressants has had some positive repercussions. Psychiatrists say there is now a greater emphasis on consulting with child psychiatrists before prescribing medication. And for the first time in a long time, the government now is focusing on the need for psychotherapists and psychiatrists for young people, and promising to steer more money into psychotherapy, a critical component to mental well-being, doctors say. "The national guidelines, which are about to be published, are going to say that we should almost always be trying psychotherapy first, and medication should be in addition to that rather than something used on its own," Dr. Berelowitz said. He added, "If my child was depressed, I would be very unhappy if a family doctor started him on medication and didn't arrange for a specialist opinion and specialist psychotherapy." Dr. Sue Bailey, an adolescent forensic psychiatrist at the University of Lancashire in Manchester, said that "child psychology in the U.K. had been a Cinderella" for too long.

Pain Doctor 'Cavalier,' Jury Foreman Says
Jerry Markon, Washington Post- 12/21/2004

The foreman of the jury that convicted prominent pain doctor William E. Hurwitz on drug charges described him yesterday as a "sloppy" physician who prescribed enormous amounts of dangerous narcotics that went "beyond the bounds of reason.'' "The dosages were just astounding,'' foreman Ralph Craft said of testimony that Hurwitz prescribed 1,600 pills a day to one patient and that his dosages caused the deaths of several patients and seriously injured others. "I'm not an expert, but I do know that under the Hippocratic oath, the first duty of a doctor is do no harm, and it seemed a lot of Dr. Hurwitz's patients were harmed much more than they were helped," Craft said.
      Although Hurwitz struck jurors as intelligent and articulate and did try to help some patients, Craft said he seemed "a bit cavalier" toward many who were in chronic pain. "He ramped up and ramped up the prescriptions very quickly,'' Craft said. "This is stuff that can kill people. He should have been extra careful.''
      The 12-member jury convicted Hurwitz last week on 50 drug-trafficking counts, including conspiracy to distribute controlled substances and trafficking resulting in death and serious injury. Jurors acquitted him of nine counts and deadlocked on the final three in the 62-count indictment before the judge declared a mistrial on those three counts. Hurwitz, 59, who practiced in McLean until 2002 and was a major figure in a national movement to treat patients with chronic pain, faces up to life in prison. A sentencing date has not been set.
      Prosecutors accused Hurwitz of prescribing excessive amounts of OxyContin and other painkillers to addicts and drug dealers, some of whom then sold the medication on a lucrative black market. The verdicts culminated a three-year investigation into doctors, pharmacists and patients suspected of selling potent narcotics and fueling an epidemic that ravaged Appalachia and triggered scores of other crimes.
      Advocates for patients with chronic pain, many of whom attended the six-week trial in U.S. District Court in Alexandria, decried the verdict. They predicted, along with defense attorneys, that many of the estimated 30 percent of Americans suffering from chronic pain would now be left untreated by doctors afraid of going to jail. Craft expressed skepticism about that viewpoint yesterday. "Certainly, the legitimate doctors out there don't prescribe anywhere close to what Hurwitz did,'' he said. "I would guess that legitimate doctors would not be threatened by this case.''
      Other jurors declined to comment, did not return telephone calls or would not detail the reasons for the verdict. But several said the government put on a strong case. "The evidence was overwhelming, and the verdict speaks for itself," juror Carolyn Keller said.
      Siobhan Reynolds, president of the New York-based Pain Relief Network, said the jury's perspective was understandable because defense attorneys were not allowed to call as witnesses most of the several dozen patients who would have testified that Hurwitz's dosages saved their lives. "I believe this jury was duped,'' said Reynolds, who last week called Hurwitz "a hero and a medical pioneer.'' Defense attorney Marvin D. Miller echoed that point. "The government was allowed to present an overwhelming case, and we were not,'' said Miller, who plans to take up the issue on appeal.
      Craft did question one key premise of the government's case: that Hurwitz not only knew that some patients were selling the drugs he prescribed but that he orchestrated the operation. "No, he wasn't running a criminal enterprise,'' Craft said, adding that he felt that some of Hurwitz's patients played more important roles. "While I respect this juror's opinion,'' U.S. Attorney Paul J. McNulty said, "Dr. Hurwitz was convicted of multiple drug-trafficking violations because he knew that many of his patients were abusing or selling prescription drugs.''

U of M Study Surveys Teen Drug Use
Associated Press, 12/21/2004

WASHINGTON -- Fewer teenagers are smoking cigarettes or using illegal drugs, but a survey released Tuesday shows a troubling increase in the use of inhalants by younger adolescents. The smoking rate among younger teens is half what it was in the mid-1990s, and drug use by that group is down by one-third, according to the University of Michigan study, done for the National Institute on Drug Abuse. Less dramatic strides have been made among older teens.
      Health experts and government officials called the annual survey of eighth, 10th and 12th-graders a sign of continued progress in the effort to reduce youth drug use and said further declines would come only with a sustained public education campaign about the consequences of drug abuse. Overall, illicit drug use among teens declined by 7 percent over the past year, and 17 percent over the last four years. There are now 600,000 fewer teens using drugs than there were in 2001. "These are sustained, broad and deep declines," national drug policy director John Walters said at a news conference. "The challenge before us is to follow through."
      Altogether, gains in 2004 over 2003 were modest. Researchers are troubled by increases -- especially among eighth-graders -- in the use of inhalants such as glue and aerosols, and a rise in the use of the pain-control narcotic OxyContin. Use of most other drugs declined or held steady. Health officials said they are concerned that use of inhalants, which are easily accessible to children, may rebound unless children are warned about the grave dangers they pose. Inhalant use had been declining since 1995, when the Partnership for a Drug-Free America began an anti-inhalant media campaign. "Research has found that even a single session of repeated inhalant abuse can disrupt heart rhythms and cause death from cardiac arrest or lower oxygen levels enough to cause suffocation," said Nora Volkow, director of the National Institute on Drug Abuse.
      Researchers also noted the apparent growing popularity of OxyContin, a powerful and potentially addictive synthetic narcotic. Up to 5 percent of 12th-graders and smaller percentages of younger teens reported having tried it in the last year, the study showed. By contrast, 1 percent or less of teens had tried heroin in a year. The survey found 15 percent of eighth-graders, 31 percent of 10th-graders and 39 percent of 12th-graders had used drugs in the previous year -- down 1 percentage point or less from the year before.
      This was the eighth consecutive year that smoking rates among surveyed teens dropped, a turnaround that began in 1996 among students in grades eight and 10 and a year later among 12th-graders. Researchers credited higher cigarette prices, tighter marketing practices, anti-smoking ads and withdrawal of the Joe Camel logo among the reasons smoking has fallen out of favor with more teens. Close to three-quarters of surveyed 12th graders now say they'd rather not date a smoker, up from close to one-third in 1977. "When smoking makes a teen less attractive to the great majority of the opposite sex, as now appears to be the case, one of the long-imagined benefits for adolescent smoking is seriously undercut," said Lloyd Johnston, lead researcher for the Monitoring the Future study.
      Overall, the percentage of eighth-graders who had ever tried cigarettes declined to 28 percent this year, down half a percentage point from 2003 and from a peak of 49 percent in 1996. About 41 percent of 10th-graders had tried cigarettes, down 1 percentage point from a year earlier and from 61 percent in 1996. And 53 percent of high school seniors had smoked at least once in their lives, down 1 percentage point from 2003 and from more than 65 percent in 1997. Even so, cigarette use has hardly been stamped out among youth. The study reported that 25 percent of 12th-graders said they had smoked within 30 days of being surveyed, as did 16 percent of 10th-graders and 9 percent of eighth-graders.
      The study also found that progress in discouraging teen drinking in recent years held steady for the lower grades in 2004. Researchers said it would take another year to know whether a small increase in drinking by seniors was real or a statistical blip. The study questioned 50,000 students in about 400 schools nationwide as part of research that began three decades ago with high school seniors. Surveys of eighth-graders and 10th-graders were added in 1991.

Exercise Program Specially Fit to Mentally Ill People
Elizabeth Mehren, Los Angeles Times- 12/21/2004

KEENE, N.H. — Until her first breakdown, Pat was trim and active, even playing on the volleyball team in college. But deep scars on her forearms attest to a lifetime of self-abuse. Pat, 53, grew sedentary, obese and reclusive. She said she has been hospitalized 25 times. "The sicker I got, and the more doped up I became, the more I tended to become isolated," she said.
      This year, Pat enrolled in a program here called In Shape, designed to provide regular structured exercise for people with mental illness. The year-old project also includes education in nutrition, weight loss and behavior modification. Each participant works with a mentor, and all classes and training take place in mixed settings among people who are not mentally ill.
      The unusual, community-based effort targets a population that has been largely overlooked by a physical fitness boom that caters to an array of groups — from older people to babies to the physically disabled — but typically not to people with mental illness. Experts view In Shape as a model to improve the lives and life spans of millions of people with mental illness. "It is absolutely groundbreaking," said Dr. Stephen Bartels, a psychiatrist at Dartmouth Medical School. "This is a very important project."
      In Shape evolved after Kenneth Jue, a social worker who runs a large community services agency here, noticed that one after another, his mentally ill clients were dying in their 40s and 50s. After some investigating, Jue learned that the life span of mentally ill people tended to be 10 to 20 years shorter than that of people who were not mentally ill. The health problems that sometimes contribute to their early deaths — including diabetes and heart disease — often are related to obesity. Cigarette smoking also was a factor, Jue found, as was a general pattern of poor physical maintenance. So, Jue told his bosses at Monadnock Family Services: "It is our responsibility to extend the life span of someone with mental illness and to get to the same life-span expectations as anyone else in this country." His goal was to sign up 40 people. But as In Shape winds up its first year, about 130 people are enrolled in a free regimen that takes participants to the YMCA, yoga and dance studios, the local state college, an indoor pool at a motel and wooded trails for vigorous group walks.
      In Shape has been so successful in its first year that Monadnock Family Services has budgeted $830,000 to run and expand the program over the next four years. About half the money comes from the Robert Wood Johnson Foundation. In Shape also has received grants from the local United Way and the New Hampshire Endowment for Health, as well as smaller foundations. The mentors who work with the In Shape participants receive salaries. In Shape pays charges associated with stop-smoking programs, gym memberships, nutrition classes and other expenses.
      For participants, bodies are changing, old habits of isolation are shifting — and spirits are lifting. A 44-year-old In Shape client named Deborah said her cholesterol level dropped 35 points in three months. Deborah also has lost an inch and a half off her waist. Most important, she has been able to taper off some of the medication she takes for depression. "In Shape also has helped me with socialization," Deborah said at a recent In Shape awards luncheon. "A few months ago, I would not have been able to speak like this in front of a group." Peter, 63, took up water exercise — "a big change from what I used to do, which was sit home all day and cry." Pat — who, like all the In Shape participants, did not want her last name used — works out at the YMCA at least three times a week. Pat and her mentor, Pam Buffum, learned racquetball together. When Pat has an especially grueling psychotherapy session, she likes to go whack racquetballs with Pam. "This has done more for me than any psychotropic drug I have taken, and I have taken a lot," Pat said — so much medication, in fact, that she joked that the pile of pills she took each night was her version of dessert. Finishing up a 30-minute session on the treadmill, Pat said: "I feel like this has saved my life. I keep telling people that I am this 20-year-old, svelte athlete stuck in this 53-year-old, obese body."
      An In Shape mentor named Josh Royce, who began working as a personal trainer in high school and studied physical education in college, said: "People didn't talk about this special population. You talked about the obese or the elderly or little kids. But nothing about people with severe mental illness." Royce, 23, watched with satisfaction as the In Shape clients worked through their exercise routines alongside others in the busy gym. "I can't see any difference between the In Shape people and anyone else who's here," he said.
      But Kathryn McNulty, director of consumer affairs for the National Alliance for the Mentally Ill in Washington, said mental illness was surrounded by stigma. "There is an expectation that people with mental illness will be overweight, will smoke and will have a low activity level," she said. And the reality is that many also are poor: "It is hard enough to buy good quality food," McNulty said. "It is out of the question to join a gym." Although medication can convey "remarkable effects in terms of mental health," McNulty said, many of the drugs prescribed for mental illness cause people to gain weight. "Keene sounds like heaven," said McNulty, who said she knew of no other comprehensive program like In Shape. "They are doing the right things, helping people with lifestyle changes and using a buddy system. This is awesome. They are just not doing this in the rest of the country."
      In Shape has drawn inquiries from Britain and Canada. The U.S. federal government is sending a mental health specialist to Keene next month to observe the program. And doctors at the Dartmouth Medical Center, which has a branch in Keene, are providing free medical evaluations so they can track participants' progress.
      Jean Hoffman said she and her husband donated $50,000 from their family foundation because they had seen the benefits of exercise in their own lives after they began running together in their mid-40s. Hoffman, 70, said: "We are really hoping that we can move this program across the state. Then our idea is, if we have one state that is a pilot program and it shows improvements, we can take it across the country."

Safety Issue May Change Pill Culture
Michael S. Rosenwald, Washington Post-12/22/2004

Safety questions about popular pain-killing medications may give people pause over the nation's pill-popping culture, analysts say, and that would give the beleaguered drug industry something else to worry about. The tendency to take prescription pills for everyday aches and pains, shyness, allergies, impotence, and other "lifestyle" concerns have helped prop up pharmaceutical company revenue. Now analysts say safety concerns may prompt a consumer backlash. "We are entering a period of caution and concern, and a lot of people will take a second look at the excessive use of so-called lifestyle medicines," said Steven Findlay, a health care analyst at Consumers Union in Washington.
      In September, Merck & Co. pulled its painkiller Vioxx off the market after studies found it increased the risk of heart attacks and strokes. Last week, Pfizer Inc. said high doses of its painkiller Celebrex more than doubled the risk of heart attacks. And this week, federal health officials said naproxen, sold over the counter as Aleve, might increase the risk of heart attack or stroke. Some also worry that antidepressants pose an increased risk of suicide among children and teenagers . "When the average consumer sees the headlines and the news blitz on one drug after another, you would think that the average person is going to become more and more concerned," said Herman Saftlas, a pharmaceutical analyst for Standard & Poor's.
      Members of Congress have expressed concern over the safety problems, and pressure is mounting on the Food and Drug Administration to strengthen its safety examination of drugs. Analysts predicted that will lead to lengthier, more expensive testing of new drugs. Add to that the pharmaceutical companies' other problems -- including a dwindling pipeline of new drugs in development and a number of older drugs losing patent protection -- and the industry's growth prospects appear dim, analysts said. "I think it's a tough outlook for them going forward," said David Moskowitz, managing director of health care research at Friedman, Billings, Ramsey Group Inc.
      Gone are the days of 13 and 14 percent annual revenue growth that drug companies enjoyed in the 1990s. Revenue growth has fallen to 9 or 10 percent in recent years and is likely to fall further, to 7 or 8 percent annually, according to Saftlas of Standard & Poor's. "The growth engines have all slowed," Saftlas said.
      Instead of investing heavily in "me too" drugs that barely differ from existing products and marketing them with expensive TV commercials, Moskowitz said drug companies will be under pressure to develop drugs for unmet medical needs.
However, that approach won't mean big profits, Moskowitz said, unless the companies develop a variety of successful new medicines, not just one or two. Still, there may be some bright spots for the drug companies.
      Findlay thinks consumer caution over lifestyle drugs will subside after a time. "Americans understand taking pills," he said. "It's simple. It's an easy thing to do. And many pills over the years have been very effective. We've come to rely on many of our medicines because we are less willing to change our lifestyles in ways that would lower our risks to some diseases."
      Jerome L. Avorn, a Harvard Medical School professor and author of a book called "Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs," questioned whether there would really be changes in the way that drug companies and the FDA do business. For the pharmaceutical industry, Avorn said, "It may be a case of waiting things out and hoping there will be other crises and hoping that the public's attention span is short."

Report: Infanticide Suspect Slit Her Wrist
Associated Press, 12/23/2004

DALLAS -- A mother charged with killing her 10-month-old daughter by cutting off her arms tried to commit suicide the day after giving birth at home, according to a newspaper report citing medical records. The Dallas Morning News reported in Thursday editions that medical records it obtained showed Dena Schlosser, 35, cut her wrist Jan. 10 and was treated at an emergency room.
Schlosser was charged with capital murder Nov. 22 after she told a 911 operator that she had severed her baby Margaret's arms. Police and paramedics found Schlosser in her living room, covered in blood and still holding a knife.
      Five days after the January birth of Margaret, Schlosser's third daughter, police and paramedics were called to the home after Schlosser was seen running down the street "yelling at the top of her lungs" because she said there was a "spirit" in the apartment, the newspaper said records showed. Doctors at three hospitals determined over the next 24 hours that she was psychotic or suffering from psychosis in addition to postpartum depression, the records showed.
      Marissa Gonzales, a spokeswoman for the state Children Protective Services agency, declined to comment when asked by the News if her agency knew of the suicide attempt or the diagnosis of psychosis. She cited prosecutors' request for a gag order to prevent comment on child custody issues involved in the case. The state agency investigated Schlosser after the January incident. It closed the case in August after Schlosser received psychiatric treatment for postpartum depression and the agency determined she was stable. The Schlossers' two other daughters are in temporary state custody. Their father has said through his attorney that he wants his children returned to him. He has declined to comment.
      David Haynes, Dena Schlosser's attorney, said that although he has not seen all of her medical records, he thinks her diagnosis in January supports his belief that she is not competent to assist him with her defense.

Drug Courts Are Not a Right, Washington State Justices Rule
Christine Frey, Seattle Post-Intelligencer- 12/24/2004

The Washington State Supreme Court ruled yesterday that drug offenders do not have a constitutional right to go through a drug court program to avoid a felony conviction. Katharine Keithley and Melody Harner each sued the state after they were separately convicted of drug possession. The counties in which they were arrested did not offer a drug court, which would have allowed the women to receive treatment instead of jail time. King County has a drug court. Attorneys for the women argued that the lack of drug courts in the counties violated the women's rights to equal protection or due process, but the court unanimously rejected those arguments yesterday.
      In a decision written by Justice Charles Johnson, the court noted that the Legislature did not require all counties to establish drug courts. "Because establishment of a drug court could effectively promote frugal use of state and local resource in one county but drain local and state resource in another, the structure of (the law) achieves the Legislature's purpose of allowing each county the choice of establishing a drug court program and structuring any such program," the decision said. The court also noted that the Legislature did not establish the drug courts as an entitlement for defendants. So drug offenders have no constitutional rights to be tried in drug courts.