Noteworthy News Articles on Mental Health Topics, January 1-8, 2008



Researchers Work on Cocaine Vaccine
Associated Press, 1/1/2008

HOUSTON -- Two Baylor College of Medicine researchers in Houston are working on a cocaine vaccine they hope will become the first-ever medication to treat people hooked on the drug. ''For people who have a desire to stop using, the vaccine should be very useful,'' said Dr. Tom Kosten, a psychiatry professor who is being assisted in the research by his wife, Therese, a psychologist and neuroscientist. ''At some point, most users will give in to temptation and relapse, but those for whom the vaccine is effective won't get high and will lose interest.''
      The vaccine, currently in clinical trials, stimulates the immune system to attack the real thing when it's taken. The immune system -- unable to recognize cocaine and other drug molecules because they are so small -- can't make antibodies to attack them. To help the immune system distinguish the drug, Kosten attached inactivated cocaine to the outside of inactivated cholera proteins. In response, the immune system not only makes antibodies to the combination, which is harmless, but also recognizes the potent naked drug when it's ingested. The antibodies bind to the cocaine and prevent it from reaching the brain, where it normally would generate the highs that are so addictive.
     ''It's a very clever idea,'' says David Eagleman, a Baylor neuroscientist. ''Scientists have spent the last few decades figuring out reward pathways in the brain and how drugs like cocaine hijack the system. It turns out those pathways are difficult to rewire once they've seen the drug. But the vaccine just circumvents all that.''
     Kosten asked the Food and Drug Administration in December to green-light a multi-institutional trial to begin in the spring and is awaiting a response. Approval would mark a breakthrough in the treatment of cocaine addiction, which now mostly involves psychiatric counseling and 12-step programs. It presumably would be the final clinical hurdle before the vaccine -- more than a decade in the making -- might be approved for treatment. But one expert warns against expecting too much.
     ''Addiction vaccines are a promising advance, but it's unlikely any treatment in this field will work for everyone,'' said Dr. David Gorelick, a senior investigator at the National Institute on Drug Abuse. ''Still, if they prove successful, they will give those working in drug addiction an important option.''

A Clutter Too Deep for Mere Bins and Shelves
Tara Parker-Pope, New York Times- 1/2/2008

After the holidays, many shoppers load up their carts with storage bins, shelving systems and color-coded containers, all in a resolute quest to get organized for the new year. The country’s collective desire to clean up is evident in the proliferation of organization-oriented businesses like the Container Store and California Closets. Reality shows like “Mission Organization” on HGTV and “How Clean is Your House?” on Lifetime feed a national obsession to declutter. The magazine Real Simple has even created a $13 special issue on cleaning house.
      Getting organized is unquestionably good for both mind and body — reducing risks for falls, helping eliminate germs and making it easier to find things like medicine and exercise gear. “If you can’t find your sneakers, you aren’t taking a walk,” said Dr. Pamela Peeke, assistant clinical professor of medicine at the University of Maryland and the author of “Fit to Live” (Rodale, 2007), which devotes a section to the link between health and organization. “How are you going to shoot a couple of hoops with your son if you can’t even find the basketball?”
     But experts say the problem with all this is that many people are going about it in the wrong way. Too often they approach clutter and disorganization as a space problem that can be solved by acquiring bins and organizers. Measures like these “are based on the concept that this is a house problem,” said David F. Tolin, director of the anxiety disorders center at the Institute of Living in Hartford and an adjunct associate professor of psychiatry at Yale. “It isn’t a house problem,” he went on. “It’s a person problem. The person needs to fundamentally change their behavior.”
     Excessive clutter and disorganization are often symptoms of a bigger health problem. People who have suffered an emotional trauma or a brain injury often find housecleaning an insurmountable task. Attention deficit disorder, depression, chronic pain and grief can prevent people from getting organized or lead to a buildup of clutter. At its most extreme, chronic disorganization is called hoarding, a condition many experts believe is a mental illness in its own right, although psychiatrists have yet to formally recognize it.
     Compulsive hoarding is defined, in part, by clutter that so overtakes living, dining and sleeping spaces that it harms the person’s quality of life. A compulsive hoarder finds it impossible, even painful, to part with possessions. It’s not clear how many people suffer from compulsive hoarding, but estimates start at about 1.5 million Americans.
     Dr. Tolin recently studied compulsive hoarders using brain-scan technology. While in the scanner, hoarders looked at various possessions and made decisions about whether to keep them or throw them away. The items were shredded in front of them, so they knew the decision was irreversible. When a hoarder was making decisions about throwing away items, the researchers saw increased activity in the orbitofrontal cortex, a part of the brain involved in decision-making and planning. “That part of the brain seemed to be stressed to the max,” Dr. Tolin said. By comparison, people who didn’t hoard showed no extra brain activity.
     While hoarders are a minority, many psychologists and organization experts say the rest of us can learn from them. The spectrum from cleanliness to messiness includes large numbers of people who are chronically disorganized and suffering either emotionally, physically or socially. Cognitive behavioral therapy may help: a recent study of hoarders showed that six months’ therapy resulted in a marked decline in clutter in the patient’s living space.
     Although chronic disorganization is not a medical diagnosis, therapists and doctors sometimes call on professional organizers to help patients. One of them is Lynne Johnson, a professional organizer from Quincy, Mass., who is president of the National Study Group on Chronic Disorganization. Ms. Johnson explains that some people look at a shelf stacked with coffee mugs and see only mugs. But people with serious disorganization problems might see each one as a unique item — a souvenir from Yellowstone or a treasured gift from Grandma. Many clients have already accumulated numerous storage bins and other such items in a futile attempt to get organized. Usually the home space is adequate, she says, but the challenge is in teaching them how to group, sort, set priorities and discard.
     Ms. Johnson says she often sees a link between her client’s efforts to get organized and weight loss. “I think someone decides, ‘I’m not going to live like this anymore. I’m not going to hold onto my stuff, I’m not going to hold onto my weight,’” she said. “I don’t know that one comes before the other. It’s part of that same life-change decision.”
     On its Web site, www.nsgcd.org, the group offers a scale to help people gauge the seriousness of their clutter problem. It also includes a referral tool for finding a professional organizer. But since the hourly fees can range from $60 to $100 or more, it may be worth consulting a new book by Dr. Tolin, “Buried in Treasures” (Oxford, 2007), which offers self-assessments and advice for people with hoarding tendencies.
     Dr. Peeke says she often instructs patients trying to lose weight to at least create one clean and uncluttered place in their home. She also suggests keeping a gym bag with workout clothes and sneakers in an uncluttered area to make it easier to exercise. She recalls one patient whose garage was “a solid cube of clutter.” The woman cleaned up her home and also lost about 50 pounds. “It wasn’t, at the end of the day, about her weight,” Dr. Peeke said. “It was about uncluttering at multiple levels of her life.”

Same-Sex Divorce Challenges the Legal System
Dafna Linzer, Washington Post- 1/4/2008

When her three-year-old marriage broke up, the 44-year-old doctor assumed she and her ex would split their property and jointly parent their two children. Her stay-at-home spouse wanted sole custody and the right to move the children out of Massachusetts. In pretrial motions, both parents made the same argument to a judge: The children should be with me; I'm their mother.
      For years, family court judges leaned toward a maternal preference when it came to custody disputes. But what to do when both parents are women, or neither is? Judges in Massachusetts have been grappling with that question since gay and lesbian couples began filing for divorce in 2004, seven months after the state Supreme Court legalized same-sex marriage.
     Nearly 10,000 gay and lesbian couples married after the ruling. Massachusetts does not keep records on the number who have divorced, but lawyers who specialize in family cases say it is in the dozens. Those who choose to end their marriages soon discover that the trauma of divorce is compounded by legal and financial difficulties that heterosexual couples generally are spared. "One of the benefits of marriage is divorce," said Joyce Kauffman, a Boston divorce lawyer who has handled a dozen same-sex divorce cases. "But for a lot of couples, that benefit is very complicated and very costly in ways that heterosexual couples would never have to experience."
     In the case of the doctor, she and her spouse each gave birth to a boy fathered by the same sperm donor. They then adopted one another's sons. Biologically, their children are half-siblings; legally, they are full brothers. "Up to now, I've been lucky with the court," said the doctor, who spoke on the condition of anonymity so as not to prejudice her court case. "Giving birth to one of our children has given me leeway because judges often show a preference toward a biological mother. I've spoken to other lesbian women who were in a similar situation, except that they were not the biological mothers of their children, and, in my opinion, they were not treated as fairly by the court." While the parties are litigating, a family court in Boston has come up with a Solomonic ruling, saying that each of the women can spend half the week alone in the family home with the children.
     For same-sex couples, divorce can be financially ruinous. Heterosexual couples claim a tax deduction for alimony payments, but that benefit is not available to gay and lesbian spouses because the Internal Revenue Service does not recognize their marriages. Divorce lawyers say that, while gay people making alimony payments are hurt the most by the IRS policy, their ex-spouses are also affected, because a tax deduction often provides an incentive for larger payments. "In a straight context, alimony is an income stream from one person to another and tax-deductible to the person who is paying it," said David W. Eppley, a divorce lawyer with lesbian clients. "But in a gay divorce, there aren't two parties, there are three, and that third party is Uncle Sam."
     Michael, a 42-year-old Bostonian whose divorce settlement precludes him from speaking publicly about its details, met his older and far wealthier spouse 17 years before they were able to marry. He came to the relationship fresh out of college, with no assets and little means of independent support. His partner bought and sold companies and owned homes around the world where they vacationed with friends and family. When the relationship foundered, two years after they married, the men imagined splitting personal possessions they had amassed. "I wasn't aware of how messy things were going to get," Michael said in an interview. "The legal maneuvering we had to go through was enormous, and it was difficult to find attorneys who were willing to handle the issue because there just aren't that many lawyers familiar enough with the law and how it affects a gay divorce."
     Retirement savings and pension plans, easily split for heterosexual couples divorcing, would have to be cashed out and would be heavily taxed for gay couples. Current tax law allows only $12,000 to be transferred from one gay spouse to another without being subject to a gift tax. "Federal law looks at gay divorcees as strangers," Eppley said. "Bob can't transfer property to Steve without it counting as a taxable transfer, whether in capital gains or a gift and potentially both."
     Lawyers have found no shortage of creative solutions around the tax codes by swapping assets, setting up irrevocable trusts and parceling out years' worth of payments in amounts that meet the tax threshold. Barbara J. Macy, a divorce lawyer with a number of lesbian clients, recalled a recent case in which the tax implications for a simple health insurance benefit led to weeks of negotiations in order to avoid one party being saddled with thousands of extra dollars a year in taxes. "The emotional issues and personal issues in gay divorce are similar to straight divorce. But the legal issues, the tax issues and complications make your mind feel like it's going to break," she said.
     To ease the financial losses arising from his divorce, Michael's former spouse employed a $1 million lifetime tax exemption often reserved for estate planning. He gave money from his estate to Michael, who would not have to pay taxes on it. But when the ex-spouse dies, the amount he can bequeath to his heirs tax-free will be reduced by the amount he gave to Michael. "You can pass $1 million free and clear of tax, so a portion of what was passed between us had to come from my partner's death tax. When he dies and his estate is worth $10 million, his heirs will not have the $1 million tax cushion, so the government even then will get its money," Michael said.
     Massachusetts is an equitable-distribution state, and a major factor in determining the distribution of assets is the duration of the marriage. But gay couples are fighting that in court, contending they would have been married longer if it had been allowed. The argument is gaining ground with judges who have been willing in same-sex divorce cases to take account of the entire length of the relationship in deciding on division of assets. "If a couple has been together for 25 years in Massachusetts, their assets would be divided 50-50," said Elizabeth Zeldin, who has handled several same-sex divorces. "But a same-sex couple has only been married a maximum of three years, so do you treat it as a three-year marriage or a 25-year marriage? A lot of judges are now saying: Treat it as a long-term marriage."
     Where the courts have not always responded is on the status of children. In Massachusetts, a child born into a heterosexual marriage is a child of the marriage, regardless of whether both spouses are the biological or legal parents. That is not necessarily the case for same-sex couples. Kauffman represented a woman who unsuccessfully sued her departing spouse for child support. Since the spouse was not the biological parent, she had no legal obligation to the child, whom she had not co-adopted. "A lot of couples ran out to get married when they should have run out to co-adopt," Kauffman said. "I tell all my clients: 'Adopt, adopt, adopt. It is the only way to protect your child.' "
     In 1996, Congress passed, and President Bill Clinton signed, the Defense of Marriage Act, which says that no state is required to recognize a same-sex marriage that occurred in another state. States that do not recognize those marriages "would probably not divorce a same-sex couple from Massachusetts," said a 2004 handbook on marriage produced by the Massachusetts Lesbian and Gay Bar Association.
     Under Massachusetts law, both people seeking a divorce must reside in the state. That left Cassandra Ormiston and Margaret Chambers of Rhode Island in a bind. The two were wed in Massachusetts in 2004, soon after the state legalized same-sex marriages. But in 2006, they filed for divorce in their home state, where the law is silent on whether such marriages are legal. The divorce issue then fell to the Rhode Island Supreme Court, which ruled in December that the state's family court lacks the authority to grant a divorce for same-sex couples because the state legislature has not defined marriage as anything other than a union between a man and a woman. "There is now no way for me to get divorced unless I move back to Massachusetts, establish residency and then wait a year before I file, and I simply will not do that," a bitter Ormiston said after the ruling.
     Andrew Koppelman, a law professor at Northwestern University, published a book in 2006, "Same Sex, Different States: When Same-Sex Marriages Cross State Lines." Koppelman urged states that oppose same-sex marriage to agree at least to perform divorces. "You have to have a way for people to get out of these things -- otherwise, you have multiple claims on the same property and no protections for people entering into new marriages. I think states that try to adopt these rules refusing to recognize the marriages just haven't thought it through."

Kicking the Habit in '08 Won't Be Easy
Mary Beckman, Los Angeles Times- 1/4/2008

It's the time of year when people resolve to make changes in their lives. And we probably all know someone -- it might even be ourselves -- who vowed to quit that nasty, cancer-mongering habit: smoking. We also all know someone who stopped for a few days then lighted back up. Here's a closer look at one of the most difficult resolutions to keep: "I vow to quit smoking."
     According to a 2006 report by the Centers for Disease Control and Prevention, 41% of smokers try to quit at least once during the year. But only about 10% actually succeed. "For some people, quitting is one of the hardest things they will ever do in their lives," says Dr. Marc Manley, medical director for population health at Blue Cross and Blue Shield of Minnesota, in Minneapolis.
     Smokers trying to quit are up against one of the most addictive substances around. An example of nicotine's powers: In 2007, researchers conducted an experiment in which they first allowed squirrel monkeys to give themselves a nicotine injection by pressing a lever. As time went on, the monkeys had to press the lever more times to get the drug. The animals would slap the lever for hours to get their fix, the researchers found, and some were willing to hit the lever as many as 600 times for a burst of the drug.
     Manley says quitting is possible, but "it is not to be taken lightly. It takes work, planning and persistence." Many people quit a few times before it sticks, he adds. A statistic often quoted is that it takes seven times to quit before a person succeeds, but, in fact, researchers don't know the average number of attempts people make before kicking the habit for good.
     People trying to quit do better when they have some sort of medication. Of those going cold turkey with no medical assistance, studies suggest, about 5% will succeed, Manley says, whereas the number of successful quitters who use an antismoking drug averages around 30%. (Depending on the study design, "quitting" might be defined as staying smoke-free for months or years.)
     Drugs that help people quit are of two varieties: One replaces the nicotine that smokers get from cigarettes. This comes in the form of gum, a lozenge, patch, nasal spray or inhaler. The others are drugs that mimic nicotine's actions in the brain such as Chantix (varenicline) and Zyban (bupropion). These usually require a prescription. "There isn't a real clear winner which is best," Manley says. Nicotine replacers and medications help stave off withdrawal symptoms that quitters inevitably feel. "The worst symptoms usually last one to two weeks," Manley says. "But . . . former smokers have to think of themselves as a nicotine addict for life."
     Recent research suggests that a person's genes may influence how easy it is to quit and what therapy works best. A study published in September in the journal Biological Psychiatry reported that people with a certain form of a gene called CYP2B6 don't benefit from bupropion as much as people with a different variation of that gene.
      Researchers also have found that the precise message the smokers hear when they're urged to quit appears to be important. Benjamin Toll, a researcher at Yale University School of Medicine found that when smokers who are trying to quit using medications are presented with encouraging mottoes such as "When you quit smoking, you save your money, you look healthy, " they are more likely to abstain from smoking than people who are told, "If you continue smoking, you waste your money, you look unhealthy."
     Toll's study tracked 170 quitters on bupropion. People watched stop-smoking videos and got handouts, water bottles and air fresheners with reminders on them to not smoke. Reminders were either positive or negative. Six months later, 32% of the group given positive messages were not smoking compared with 25% of the other group.
     Counseling is also important for a quitter. "You're about to break up with your best friend: your cigarettes," Manley says. Many states have telephone counseling available for people who want someone to talk to or want to get some encouragement. In California, the state health department mans the phones [(800) NO-BUTTS/662-8887]. Non-English speakers can find other phone numbers at www.dhs.ca.gov/tobacco/html/quit.htm).
     A supportive environment -- being unable to smoke at work, a home in which no smoking is allowed -- " goes a long long way in helping people succeed," Manley says. Finally, he says, if a quitter doesn't succeed the first time, "Keep at it. Be persistent. You can do it."

Varying punishments
The case before Zatkoff involved Robert Michael Boyden, 60, the 2002 teacher of the year in Wyandotte, who pleaded guilty in 2006 to possession of child pornography after U.S. Immigration and Customs Enforcement agents found nearly 1,400 images on his home computer. Boyden became a target after agents discovered he had subscribed to a child porn Web site. After his arrest, he retired from his $79,000-a-year special education job and agreed in a plea deal to serve 4 to 5 years in prison.
     But Zatkoff balked after Boyden's lawyer, Jerome Sabbota of Royal Oak, said three doctors had concluded Boyden, who had no criminal record, wasn't a threat to children. A government doctor agreed. So Zatkoff sentenced Boyden last June to 12 months in a federal halfway house, three years of supervised release and continued therapy. "Judge Zatkoff imposed a sentence that was reasonable and proper," Sabbota said. Federal prosecutors have appealed that sentence and another one Zatkoff imposed.
     Under different circumstances, Zatkoff has meted out harsh sentences in child pornography cases. In January 2007, he sentenced Robert Kent, 57, of Royal Oak to 10 years in prison for possessing more than 12,000 images of child pornography, which federal agents found during a 2004 raid of his home. Unlike Boyden, Kent had previously served time for molesting a girlfriend's daughters.

Nabbed at the airport
Experts don't know how many people who view child porn eventually assault children. A 2000 study by a prison psychologist of 54 federal prisoners convicted of child pornography offenses found that 79% admitted to molesting kids. But Dan O'Neil, a psychologist who treats sex offenders and victims at the Maple Clinic in Troy, said other studies put the number as low as 10%. Many of the men charged in the federal crackdown in metro Detroit possessed child porn and had or tried to have sex with children.
     Like Karl Kaechele, 65, a retired truck driver from St. Petersburg, Fla., who was busted at Detroit Metro Airport in April 2005 after returning from a three-month trip to Thailand, Vietnam, Cambodia and the Philippines. Suspecting that he might be a sex tourist -- someone who travels abroad for sex -- customs officers checked his luggage and found photos of naked Asian females and journals describing his sexual exploits with dozens of children, some as young as 7. They also found his packing list that included Viagra, KY brand lubricant and penicillin. Agents searched his home and found evidence that he had subscribed to child pornography Web sites.
     Kaechele, a twice-divorced Army veteran, pleaded guilty in August to traveling overseas for illicit sex. "I would like to apologize to the United States and this court for being a very bad example of a U.S. citizen in a foreign country," he told U.S. District Judge Gerald Rosen in a letter two months later. "The pain of what I've done to my family can never heal or be fixed or go away," added Kaechele, who has been shunned by his children, court documents said. Rosen sentenced him in November to 9 years in prison -- a possible death sentence because of his declining health, his lawyer said.

Caught on the Net
Many of the people charged under federal law in eastern Michigan were caught because they subscribed to child pornography Web sites, which agents infiltrated. Others were caught after e-mailing or receiving child porn from someone whose computer was seized. "The Internet has really provided a vehicle for these guys," said Assistant U.S. Attorney John O'Brien, who heads the team of federal prosecutors in Detroit. "You can't go out in public and announce your interests. But online, you can find someone who thinks like you, who shares your interests and who validates you."
     Others were caught because they trolled Internet chat rooms looking for underage sex and set up dates with undercover cops -- like an undercover Macomb County sheriff's detective who poses online as a single mother offering her children for sex. The detective, who spoke on condition her name not be used because she works undercover, collared several people who are being prosecuted federally.
     The most surprising catch was J.D. Roy Atchison, 53, an assistant U.S. attorney from Gulf Breeze, Fla., who flew to Michigan in September to have sex with the detective's fictitious 5-year-old daughter. Atchison, one of three suspects to kill themselves after being charged in the federal crackdown, was jailed pending trial. He was charged with traveling interstate to have sex with a minor. A married father of three, he hanged himself Oct. 5 at a federal prison in Milan, and the charges against him were dropped. "It's sad to realize that there are people out there who will go to these lengths to abuse a child," the detective said.
     Her other arrests last year include a Los Angeles County paramedic, a Los Angeles zoo consultant and a professor from Connecticut who allegedly flew to Detroit to have sex with the detective's make-believe daughter. All three pleaded not guilty. The men allegedly contacted the detective online after reading personal profiles she posted at various locations on the Web.

What drives pedophiles
Psychologists who treat or study pedophiles -- anyone fixated on having sex with children -- say pedophiles sometimes ignore their better judgment and walk into law enforcement traps because they're driven by powerful sexual fantasies that often develop in childhood. Many grew up in seriously dysfunctional households, the victims of sexual abuse or poor sexual boundaries -- such as sleeping with or being bathed by their parents well into their teens. Others experience trauma that causes them to act out sexually with children, or got hooked on adult pornography and switched to child porn. "These guys develop a bubble, and they believe the bubble is impenetrable," said O'Neil, the psychologist in Troy. "They can see out of the bubble, but don't think anyone can see in," he added. "They convince themselves that their fantasies are real and that what they're doing is OK."
     Many federal prosecutions in Detroit involve local men, like Lee Edwin Garling, 66, a retired Dearborn real estate agent who was charged after U.S. Immigration and Customs Enforcement agents raided his home in November 2006 and found more than 150,000 child porn images. They also found a DVD of him repeatedly molesting a 4-year-old girl. Federal agents found Garling by charging a membership to a child porn Web site and tracking down the company that processed it and then tracking down its members. Garling, who lived with his mother, admitted collecting child porn for more than 20 years. He pleaded guilty to sexual exploitation of children and receiving child pornography and was sentenced last July to nearly 22 years in prison.

Families in the fray
Many of the men prosecuted for acts involving children are married and fathers. In some cases, family members have stuck by them, as in the case of the Wyandotte teacher. Boyden's wife, Sherry, urged Zatkoff to be lenient in sentencing her husband. "As his wife of almost 30 years I can tell you with utmost confidence that it is simply not in my husband to intentionally hurt anyone, least of all a child. ... The incarceration of my husband will serve absolutely no useful purpose" to society or the justice system.
     In another case, Julie Flaherty, wife of Brian Flaherty, 38, a Los Angeles County fire paramedic arrested in February on charges he flew to Detroit to have sex with what he thought was a 5-year-old girl, said his arrest has been an ordeal. "You can't even begin to imagine," she told the Free Press, adding that the media attention has made matters worse. "It puts the family through hell."

Mercury's Removal Doesn't Stop Autism's Rise, Study Shows
Jia-Rui Chong, Los Angeles Times- 1/8/2008

The prevalence of autism in California children continued to rise after most vaccine manufacturers started to remove the mercury-based preservative thimerosal in 1999, suggesting that the chemical was not a primary cause of the disorder, according to a study released Monday.
The analysis found that from 2004 to 2007, when exposure to thimerosal dropped significantly for 3 to 5 year olds, the autism rate continued to increase in that group from 3.0 to 4.1 per 1,000 children. "If mercury exposure in vaccines was a major cause of autism, then the number of . . . affected kids should have diminished once they were no longer exposed to thimerosal," said Dr. Robert Schechter, lead author of the study and a medical officer at the state Department of Public Health. "That is not what we found."
      The study, published in the Archives of General Psychiatry, is the latest in a series that has investigated the connection between thimerosal and autism. The vast majority have found no association. The latest findings failed to convince some parents and advocacy groups, which have long blamed mercury, a neurotoxin, for the disorder. "This study presents a greatly oversimplified explanation of a very complex problem," said Claire Bothwell, chairwoman of the board at the National Autism Assn., which works on behalf of families with autism. "Rising numbers do not confirm that thimerosal never had a role."
      Autism is a severe developmental disorder in which children seem isolated from the world around them. There is a broad spectrum of symptoms, marked by poor language skills and an inability to handle social relations. Over the last two decades, the number of cases has boomed across the country for still-unexplained reasons. Psychiatrists estimated that 20 years ago there were 0.2 to 0.5 cases for every 1,000 children. Last year, the national Centers for Disease Control and Prevention estimated that there were 6.6 cases per 1,000 schoolchildren, based on a study of 8-year-olds.
      The latest study was based on data from the state Department of Developmental Services, which provides services to about 36,000 people with autism and has one of the best reporting systems in the country. The researchers looked at all reported cases in the state starting with children born in 1989. They found the number of cases per 1,000 children has been steadily increasing from that point to March 2007, the end point of the study.
     In a commentary accompanying the study, Dr. Eric Fombonne called the data "a clear and unambiguous test." "Parents of autistic children should be reassured that autism in their child did not occur through immunizations," wrote Fombonne, a psychiatrist at Montreal Children's Hospital who was not involved in this study. He has provided advice to vaccine manufacturers in the past but has received no research funding from them, he said.
     Steve M. Edelson, an experimental psychologist who is director of the Autism Research Institute, a nonprofit organization in San Diego, said the study, along with evidence from previous research, argued against thimerosal as the major culprit in autism. But he added that thimerosal may still play some role. Edelson said such large-scale analysis could overlook smaller groups of children, who for whatever reason have a particular vulnerability to mercury. He said more solid evidence can only come from laboratory studies, such as postmortem analyses of the brains of autistic children.
     The National Autism Assn. criticized the study, saying that some children may still be exposed to mercury through either flu shots or trace amounts in other vaccines. The group also said that some vaccines containing thimerosal had expiration dates as late as 2005 and may have been used up to that point.

Navigating Life With Humor and Bewilderment
Felicia R. Lee, New York Times- 1/8/2008

“I think the wind created me,” says Nicky Gottlieb, the subject of “Today’s Man,” a documentary that has its television premiere on Tuesday night on most PBS stations. Mr. Gottlieb, who in the film offers his theory of how the world was formed, has Asperger’s syndrome, a form of autism, and his sister, Lizzie Gottlieb, spent six years committing his life to film. She depicts a highly intelligent man addicted to television, socially inappropriate, self-aware about his condition and negotiating the world with both humor and bewilderment. “Physically, I’m a man,” Mr. Gottlieb says at the beginning of “Today’s Man,” which tracks his quest, beginning at 21, to hold a job, get an apartment, make friends. “But mentally and emotionally, I’m a boy; I’m still a child.”
      His mother, the actress Maria Tucci, has to remind Mr. Gottlieb to shower, for example. We see his father, Robert Gottlieb, a dance critic for The New York Observer and a former editor in chief of The New Yorker, lovingly shaving a son who is often too distracted for that task. In another scene the younger Mr. Gottlieb, now 29, confides to his sister that he likes “the perks” of living at home. “What is our future going to be like?” Ms. Gottlieb, 36, asks him, her only sibling. “I mean, what are you and I going to do when Mommy and Daddy aren’t around? What do you want your life to be like?” Ms. Gottlieb and her parents are haunted by that question about her brother’s future, she said in a recent interview. His life and the intensity of their family journey pushed her to make the film, casting light on an adult with Asperger’s, a neurobiological condition.
     People with the syndrome show a wide range of intelligence — some are brilliant — but characteristically have intense, narrow interests; odd speech patterns; and few social skills, among other symptoms. Often they seem to lack the ability to bond with others. Mr. Gottlieb is high-functioning, bright enough to give Italian lessons and tutor students in math. He was a late talker, but at around 4 or 5 he would ask people their birth dates and instantly tell each of them the day of the week on which the date fell. “As a child, I thought I had this magical brother,” Ms. Gottlieb said. “We assumed there was no one else in the world like him. It’s harder now, as it became clearer that there is no magical answer to Nicky’s problems.” He still lives at home, she said, but is now seeing a young woman with Asperger’s.
     Ms. Gottlieb, a theater and film director who was a founder and producer of Pure Orange Productions, a theater company for new Off Broadway plays, has taken “Today’s Man” to several film festivals (Margaret Mead, Nantucket, Mendocino). Mr. Gottlieb has accompanied her to about 20 screenings. “Today’s Man,” part of the “Independent Lens” series on PBS, can be seen in New York on Friday. PBS’s Web site pbs.org/todaysman has information about the film and links to resources.
     The Gottlieb family coped without such help. Asperger’s syndrome was not diagnosed until Mr. Gottlieb was about 20, following years of various therapies, schooling arrangements and medication. His parents, sophisticated people in a sophisticated city, did not even hear the word Asperger’s until he was 20, Ms. Tucci says in “Today’s Man.”
     Still, she says, she knew within days of his birth that her son was different. He nursed oddly, she says, could not bond, had facial tics and later developed seizures. “The doctor calls and says, ‘Mrs. Gottlieb, it’s the worst; it’s very bad,’” she recalls in the film. “He may never talk, he may never walk. He may become blind, deaf and dumb.”
     None of the worst came to pass. Mr. Gottlieb’s parents watched as he began hitting developmental milestones. And when his sister was making the documentary (stopping for the birth of twins and a bout of now vanquished thyroid cancer), she even found an old film of Nicky saying his first word, bread, a piece of history relegated to a cupboard in her parents’ Manhattan home.
     Lynda Geller, the clinical director of the Asperger Institute at the New York University Child Study Center, said that “Today’s Man” called much needed attention to the problems of adults with the syndrome. The institute treats children and adults with Asperger’s, and Dr. Geller said she received calls frequently from adults with the syndrome who have not yet received a diagnosis. “We need a lot more creative solutions for independence,” she said. “To me, looking at the job world and independence later in life are critical.”
     Asperger’s syndrome was added to the American Psychiatric Association’s diagnostic reference in 1994. And although the Centers for Disease Control estimate that there are 560,000 people under age 21 with autism in this country, there is no good data on adults.
     A few weeks ago Tina Brown, another former editor in chief of The New Yorker, was host of a screening of “Today’s Man” in Midtown Manhattan. The audience included journalists and parents of people with Asperger’s. Ms. Brown introduced Lizzie Gottlieb and Nicky Gottlieb. Mr. Gottlieb said jokingly that he was bored from seeing the film over and over but was proud of his sister for making it. Ms. Brown fielded questions from the audience members, who wanted to know what Mr. Gottlieb did for a living and if he was aware of his limitations. Ms. Brown asked Mr. Gottlieb if he declared his disability in social situations. “Most of the people I meet have been warned about me,” he said in his tongue-in-cheek way, making the audience laugh.
     Ms. Gottlieb ends her film with Mr. Gottlieb singing, off-key and unselfconsciously:

Poor wand’ring one
If such true love as mine
Can help thee find
True peace of mind
Why, take it, it is thine.