Noteworthy News Articles on Mental Health Topics, June 15-30, 2008 Gay Couples Find Marriage Is a Mixed Bag Pam Belluck, New York Times- 6/15/2008 BOSTON — Four years after Massachusetts became the first state to allow gay couples to marry, there have been blissful unions, painful divorces and everything in between. Some same-sex couples say being married has made a big difference, and some say it has made no difference at all. There are devoted couples who have decided marriage is not for them, couples whose lawyers or accountants advised them against marrying, and couples in which one partner wants to marry but the other does not. But as same-sex marriage begins in California, Massachusetts’s experience may offer hints of what is to come. For example, after an initial euphoric rush to the altar, the number of gay weddings here fell sharply and has declined each year since. Of the more than 10,500 same-sex couples married here since May 17, 2004, 6,121 wed in the first six months. There were 2,060 weddings in 2005; 1,442 in 2006; and 867 in the first eight months of 2007, the most recent data show. Gay men and lesbians say the early wave of weddings reflected “pent-up demand” from longstanding couples. The subsequent numbers indicate that “marriage isn’t for everybody,” said Mary L. Bonauto, a lawyer who argued the case that led to same-sex marriage being legalized here. And, Ms. Bonauto said, “there’s only so many gay people in Massachusetts.” The Census Bureau recorded 23,655 same-sex households in Massachusetts in 2006. Nearly two-thirds of the weddings have been lesbian marriages, including one between two women named Melissa McCarthy. And while nearly half of straight people marrying are under 30, more same-sex married couples of both sexes are older — nearly a third are in their 40s. Lawyers say same-sex couples are more likely to draw up prenuptial agreements than straight couples are. For some, the marriage learning curve is steep. “It’s been a mixed bag,” said Jacob Venter, a 44-year-old child psychiatrist who married Billy Boney, a 36-year-old hairdresser, a month after it became legal to do so. They have disagreements over money, the in-laws and whether to adopt children or have their own. “Nothing turns out the way you imagine,” Mr. Venter said. “There are no role models for gay marriage.” Unlike California, Massachusetts has a residency requirement for marriage. Some couples have moved here to marry, including Lisa Forest and Ann Marie Willer, who came from Texas. “Without having that legal recognition, we felt very vulnerable,” Ms. Forest said. “We wanted the psychological security of knowing that we’re protected if one of us were to become sick, that we would be able to transfer our assets, at least on the state level, without incurring taxes, that we’ll be able to stay together if we’re old and not able to care for ourselves.” For many, the biggest advantages are less quantifiable. “I feel totally different inside my skin,” said Linda Bailey-Davies, 62, who married her longtime partner, Gloria Bailey-Davies, 67. With marriage, she said, “I felt legitimate in the world.” Heather and Adrienne Walker believe people better understand the seriousness of their relationship, recognition that is especially valuable to them as mothers of four children in suburban Natick. “Before marriage was legal, if I called Adrienne my wife, people would say ‘Your what?’ ” Heather Walker said. “But if you say partner, they’re thinking business partner. The knowledge that we are legally married, that they can’t play a semantics game, is very freeing. There’s none of that, ‘but we really need to talk to the actual parents.’ ” Still, some couples find few significant advantages. Many employers offered health insurance to domestic partners. State taxes can be higher for some couples, and the lack of federal recognition of gay marriage makes lucrative benefits — Social Security, federal tax breaks — off limits. “I can’t say that anything has changed for us personally,” said David Eppley, who married Chad Garner in 2004. What has changed for gay couples is that marriage is part of the dating landscape, adding tension or romance, pressure or excitement. “It makes me completely think differently about the relationship,” said Lance Collins, 38, a colorist at a Boston hair salon. He envisions his perfect wedding (grooms in jeans and T-shirts), but his partner does not want to marry. “I know he cares about me quite a bit,” Mr. Collins said. “I just think he doesn’t want to.” Mr. Collins believes his partner is his ideal match because he “gets as excited about seeing me as I get about seeing him,” because “sometimes he’ll do my laundry and fold it the way I like it,” and because “he makes my coffee really well — one Equal with just a tablespoon of fat-free half-and-half.” But their marriage chasm worries him. “Maybe I should move out and maybe that will make him appreciate me,” Mr. Collins said. “I’ve gone so far as looking for an apartment.” While many couples want conventional marriages, some are drawing on a creative definition of family forged while living “outside mainstream society,” said Joyce Kauffman, a family lawyer and gay activist. “They’ve incorporated whatever’s outside the box into their marriage.” Eric Erbelding and his husband, Michael Peck, both 44, see each other only every other weekend because Mr. Peck works in Pittsburgh. So, Mr. Erbelding said, “Our rule is you can play around because, you know, you have to be practical.” Mr. Erbelding, a decorative painter in Boston, said: “I think men view sex very differently than women. Men are pigs, they know that each other are pigs, so they can operate accordingly. It doesn’t mean anything.” Still, Mr. Erbelding said, most married gay couples he knows are “for the most part monogamous, but for maybe a casual three-way.” Some same-sex spouses have split up, including Julie and Hillary Goodridge, the lead plaintiffs in the case that paved the way for same-sex marriage in the state. “Lesbian and gay couples get divorced for the same reasons that heterosexual couples do,” Ms. Kauffman said. “Honestly the only thing that is different is that some people rushed to get married without thinking it through just because they could. It was an incredibly heady historical moment, and some people probably made the decision hastily.” Rick Bettencourt, 41, married his partner of 12 years in July 2005, but by September they had broken up, and his partner is now married to another man, he said. “I knew there was an issue with us prior to the marriage,” Mr. Bettencourt said, “but we thought maybe this is the thing that will help us stay together. Stupid, obviously. It was almost like I needed the marriage in order to consummate the relationship in order to break it up.” Amy Bullock married in 2004 after her partner of nine years said “we’ve got to quick do it because maybe they’ll reverse” the law, Ms. Bullock recalled. They had a child and were considering having another. But five months after the wedding, “she decides she is straight,” Ms. Bullock said. “Maybe being married triggered those feelings,” she said. “I didn’t see it coming.” Chris Burgess, pregnant when she wed her partner in June 2004, severed the marriage in 2006 when past problems resurfaced, she said. Divorce was more complicated than “in most of our relationships, where you say, ‘O.K., you get these CDs,’ ” Ms. Burgess said. Her partner needed to adopt their son before divorcing to retain parental rights. Now, Ms. Burgess lives with another woman and they wear rings and want children, but she says she will not marry unless federal recognition makes it economically irresistible. “I’m kind of fine with the ‘Brad Pitt-Angelina Jolie, all right we’re committed, we don’t need to get married,’ ” she said. Ms. Bullock, who is dating another woman, is buying a duplex with her former wife so both can see their son daily. She is wary of remarrying in general, though she says marriage may have made separation more equitable. Mr. Bettencourt and his current partner, Chris Weaver, just bought a house, but he played down a ring he gave Mr. Weaver for Valentine’s Day, telling him, he says, “I don’t want you to get concerned that I’m pushing marriage or anything.” Some couples, including longtime partners and those with children, have rejected marriage for economic, philosophical or cultural reasons. “I just don’t really see the point in it,” said Michelle Smith, 51, of Truro, who has two children with Terri Humes, 51, her partner of 27 years. “I don’t need that paper for any type of validation. I know what her and I have.” Ms. Kauffman considers marriage a “patriarchal institution” that “politically, kind of makes me queasy.” To Clint Wolbert, 28, marriage is too “assimilative.” Being gay is like belonging to an “exclusive club,” Mr. Wolbert said. “I just worry that the drive to marry will end up kind of chipping away at the culture.” Some couples are advised not to marry for financial reasons or if they want to adopt children from foreign countries, most of which would not place children with a same-sex married couple. Bill Brandon, a doctor who will soon marry Tedd Elison, waited several years because Mr. Elison’s job as a disc jockey seemed too unstable until he also began running a hair salon. “I wasn’t going to go through this unless he was — I don’t want to say having a real job, but more of a profession,” Dr. Brandon said. Same-sex married couples report widespread acceptance in Massachusetts, but not necessarily out of state. At a Disney World hotel, “I got the third degree — who is Heather, is she your sister?” Adrienne Walker said. An Atlanta pharmacy argued when Mr. Boney, filling a prescription, said that as a husband, he was covered by Mr. Venter’s insurance. The Bailey-Davieses are so nervous about being separated if one gets sick that they rejected spending the winter in Florida. “I don’t feel safe,” Linda said. “I’d rather freeze my butt off and be with my honey.” Jodi Sperber, who moved with her wife, Pippa Shulman, to New Hampshire, said a handyman there “could not bring himself to talk about Pippa as anything other than my associate.” But over all, Ms. Sperber said, their religion probably draws “stranger questions: ‘Why don’t you have a Christmas tree? Is it the Jewish thing?’ ” Many couples said marriage had made relatives more comfortable with their relationships. Mr. Boney, who is black, was surprised that his “very conservative, very Bible Belt” family in North Carolina welcomed Mr. Venter, a white South African, so warmly. And when his nieces and nephews say “Uncle Jacob,” he said, it “almost brings a tear to my eye; and honey, it takes a lot to bring a tear to my eye.” Mr. Boney and Mr. Venter remain committed to marriage despite their conflicts. “It’s a hard commitment to make,” Mr. Venter said. But they try to settle their disagreements. “I’m more willing to figure it out,” he said. “In the past I might have just ended the relationship.” Mental Health and the Military Mind-Set Aamer Madhani, Chicago Tribune- 6/15/2008 BELLMORE, N.Y -- . -- Kristofer Goldsmith was so distressed about the prospect of returning to Iraq that he decided he was willing to kill himself to avoid serving a second tour. The Army had mandated an extension of his three-year contract, which had been set to expire, as his unit was set to deploy to Baghdad as part of the troop surge. The day before he was to ship out in May 2007, he washed down a dozen Percoset with more than a liter of vodka. Soon after he was admitted to the Winn Army Community Hospital at Ft. Stewart, Ga., a top noncommissioned officer from his brigade's rear detachment visited the young sergeant, along with an Army psychologist, to discuss discharging him from the military. "We all agreed that it was for the best that my Army career come to an end then," said Goldsmith, who added that he'd scrawled the words "stop-loss killed me" in marker on his body before his suicide attempt. "It was a few days later when they told me that they were going to come at me for faking a mental lapse." The rear commander of his unit, Maj. Douglas Wesner of the 2nd Brigade of the 3rd Infantry Division, quickly initiated an administrative punishment known as an Article 15 against Goldsmith for malingering -- that is, feigning a mental lapse or derangement or purposely injuring oneself -- in order to avoid being deployed to Iraq. Eventually, his commanders dropped the Article 15, but not before removing the 22-year-old from the service on a general discharge. Because he did not receive an honorable discharge, Goldsmith was stripped of his Montgomery GI Bill benefits, which he'd been counting on to help pay for his college education. Goldsmith's treatment is hardly unheard of. In fact, 21 Iraq soldiers have been punitively discharged since 2003 after being convicted of malingering, said U.S. Army spokesman Paul Boyce. Goldsmith's case illustrates the complex decisions facing the U.S. military, which says it is eager to address the mental health problems plaguing its troops but at the same time must maintain its warrior ethos and respect for the chain of command. Goldsmith remains adamant that he did not fake a mental illness. A Department of Veterans Affairs psychologist later diagnosed him with post-traumatic stress disorder. Wesner declined to comment. A 3rd Infantry Division spokesman said that Goldsmith was provided legal counsel and received a medical evaluation before his discharge, but he declined to speak further about the case. Sitting in his parents' home in this working-class suburb on Long Island, Goldsmith said his mental unraveling began when he returned from his first tour in Iraq in 2005. The collapse accelerated after he learned he would be subject to "stop-loss": The Army was involuntarily extending his three-year contract so that it could return him to Baghdad. Goldsmith, now an active member of Iraq Veterans Against the War, is part of a growing population of Iraq and Afghanistan war veterans who have suffered from PTSD. Pentagon officials recently disclosed that at least 40,000 U.S. troops had been diagnosed with PTSD after returning from Iraq or Afghanistan. But those figures accounted only for those who had sought help; a recent study by Rand Corp. put the number closer to 300,000. Last month, the Defense Department announced that 115 U.S. troops had committed suicide in 2007, the highest annual toll since the military began tracking the figures. And the Pentagon acknowledges that 12% to 15% of war-zone soldiers are taking antidepressants or sleep medication. Goldsmith served much of his yearlong deployment in the Shiite slums of Sadr City. On patrols, his unit took potshots from insurgents and was attacked by brick-throwing adolescents. Sadr City was plagued by sectarian fighting, and U.S. troops regularly found the tortured corpses of Sunni men. Goldsmith's duties included photographing them. When he got back to Ft. Stewart in late 2005, Goldsmith said, he suffered deep bouts of depression and drank so much that he would often black out. At first he refused to seek help. "Before we were heading back to Iraq, [a senior noncommissioned officer] said that if we tried to use mental stress as a way to get out of going, he would see to it that we'd become his personal IED kicker," Goldsmith said. "No one wanted to be stigmatized. . . . You also feared that there would be career consequences." One night Goldsmith became so irritated by a man at a party that he choked him until he was unconscious. He realized that he had to tell his commanders he needed help. Goldsmith is fighting for an upgrade to an honorable discharge so he can regain his eligibility for GI Bill benefits. Some of the soldiers who worked most closely with him have written letters to the 3rd Infantry Division brass on his behalf. His company commander and platoon leader had recommended him for a Bronze Star at the end of his tour. "If I were to go to war tomorrow, I would want Kris Goldsmith to go with me," Capt. Edward McMichael, who was Goldsmith's company commander in Iraq, said in an interview. "I don't think Kris would fake it."
Brains of Gay Men Show Similarities to Those of Heterosexual Women Denise Gellene, Los Angeles Times- 6/17/2008 The brains of gay men resemble those of straight women, according to research being published Tuesday that provides more evidence of the role of biology in sexual orientation. Using brain-scanning equipment, researchers said they discovered similarities in the brain circuits that deal with language, perhaps explaining why homosexual men tend to outperform straight men on verbal skills tests -- as do heterosexual women. The area of the brain that processes emotions also looked very much the same in gay men and straight women -- and both groups have higher rates of depressive disorders than heterosexual men, researchers said. The study in Proceedings of the National Academy of Sciences, however, found that the brain similarities were not as close in the case of gay women and straight men. Previous studies have found evidence that sexual orientation is influenced by biological factors. More than a decade ago, neurobiologist Simon LeVay reported that a key area of the hypothalamus, a brain structure linked to sexual behavior, was smaller in homosexual men than in heterosexual men. The latest study, led by Dr. Ivanka Savic of the Karolinska Institute in Stockholm, was significant in that it looked at areas of the brain that have nothing to do with sexual behavior, suggesting that there was a basic biological link between sexual orientation and a range of brain functions. "The question is, how far does it go?" said Dr. Eric Vilain, who studies human sexual development at UCLA and was not involved in the study. "In gay men, the brain is feminized. Is that limited to particular areas, or is the entire brain female-like?" Vilain said his hunch was that the entire brain was not feminized because "gay men have a number of masculine traits that are not present in women." For example, he said, men regardless of sexual orientation tend to be interested in casual sex and are stimulated by sexually suggestive images. Savic and her colleagues used magnetic resonance imaging to measure brain volumes of two groups, each divided evenly between men and women: 50 heterosexuals and 40 homosexuals. They knew going into the study that in men the right cerebral hemisphere is larger than the left, but in women the hemispheres are of equal size. The results showed that gay men had symmetrical brains like those of straight women, and homosexual women had slightly asymmetrical brains like those of heterosexual men. Symmetry is thought to favor verbal skills, the report said. The differences were pronounced. For example, the right cerebral hemisphere in heterosexual men was 624 cubic centimeters -- 12 cubic centimeters greater than the left side. In homosexual men, the right hemisphere was 608 cubic centimeters -- 1 cubic centimeter smaller than the left. In heterosexual women, there was no volume difference between right and left hemispheres. But in homosexual women, their right hemisphere was 5 cubic centimeters larger than the left. Next, researchers used positron emission topography to measure blood flow in the amygdala, a brain area involved in processing emotions. The circuitry of the amygdala in gay men more closely resembled that of straight women than straight men, researchers said. The amygdalas of gay women looked more like those of straight men, the report said. Savic said she thought the brain differences originated in the womb or infancy, probably as a result of genetic or hormonal factors. She said she could not explain why the differences were more pronounced in homosexual men than in homosexual women. S. Marc Breedlove, a Michigan State University neuroscientist who studies sexual development, said that in his studies with rats, changes in prenatal levels of testosterone caused the sort of brain alterations Savic observed in her study. Weighing Nondrug Options for A.D.H.D. Tara Parker-Pope, New York Times- 6/17/2008 About 2.5 million children in the United States take stimulant drugs for attention and hyperactivity problems. But concerns about side effects have prompted many parents to look elsewhere: as many as two-thirds of children with attention deficit hyperactivity disorder, or A.D.H.D., have used some form of alternative treatment. The most common strategy involves diet changes, like giving up processed foods, sugars and food additives. About 20 percent of children with the disorder have been given some form of herbal therapy; others have tried supplements like vitamins and fish oil or have used biofeedback, massage and yoga. While some studies of alternative treatments show promise, there is little solid research to guide parents. That is unfortunate, because for some children, prescription drugs aren’t an option. The drugs have been life-changing for many children. But nearly one-third experience worrisome side effects, and a 2001 report in The Canadian Medical Association Journal found that for more than 10 percent, the effects could be severe — including decreased appetite and weight loss, insomnia, abdominal pain and personality changes. Although the drugs are widely viewed as safe, many parents were alarmed when the Food and Drug Administration ordered in 2006 that stimulants like Adderall, Ritalin and Concerta carry warnings of risk for sudden death, heart attacks and hallucinations in some patients. What about the alternatives? Last week, The Journal of the American Medical Association reported that the first study of the herb St. John’s wort worked no better than a placebo to counter A.D.H.D. But the trial, of 54 children, lasted only eight weeks, and even prescription drugs can take up to three months to show a measurable effect. But the larger issue may be that in complementary medicine, one treatment is rarely used alone, making the range of alternative remedies difficult to study. Natural treatments may well be beneficial, said the report’s lead author, Wendy Weber, a research associate professor at the school of naturopathic medicine at Bastyr University in Kenmore, Wash. “We just need to do more studies and document the effect.” Other herbal treatments for the disorder include echinacea, ginkgo biloba and ginseng. There are no reliable data on echinacea; a 2001 study showed improvement after four weeks in children using ginkgo and ginseng, but there was no control group for comparison. There is more hope for omega-3 fatty acids, found in fish and fish-oil supplements. A review last year in the journal Pediatric Clinics of North America concluded that a “growing body of evidence” supported the use of such supplements for children with A.D.H.D. As for dietary changes, a 2007 study in The Lancet examined the effect of artificial coloring and preservatives on hyperactive behavior in children. After consuming an additive-free diet for six weeks, the children were given either a placebo beverage or one containing a mix of additives in two-week intervals. In the additive group, hyperactive behaviors increased. The study caused many pediatricians to rethink their skepticism about a link between diet and A.D.H.D. “The overall findings of the study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of their children, admit we might have been wrong,” reported a February issue of AAP Grand Rounds, a publication of the American Academy of Pediatrics. Data on sugar avoidance are less persuasive. Several studies suggest that any link between sugar and hyperactivity is one of parental perception, rather than reality. In one study, mothers who were told the child received sugar reported more hyperactive behavior, even when the food was in fact artificially sweetened. Mothers who were told the child received a low-sugar snack were less likely to report worse behavior. One interesting option is a form of biofeedback therapy in which children wear electrodes on their head and learn to control video games by exercising the parts of the brain related to attention and focus. Research has suggested that the method works just as well as medication, and many children report that they enjoy it. The challenge is finding a doctor who will help explore the range of options. For instance, the best way to tell whether dietary changes may help is to eliminate the foods and then reintroduce them, monitoring the child’s behavior all the while. The best evidence may come from a teacher who is unaware of any change in diet. The Integrative Pediatrics Council, at www.integrativepeds.org, offers a list of pediatricians who offer alternative treatments. Its chairman, Dr. Lawrence D. Rosen, chief of pediatric integrative medicine at Hackensack University Medical Center in New Jersey, says parents should seek a holistic approach. But he notes that that may well include prescription drugs. “I do prescribe medications in my practice, and there are kids whose lives have been saved by that,” he said. “But it’s a holistic approach that is very different than one pill, one symptom. We’re addressing not just the physical, chemical needs of kids, but their total emotional and mental health.” Court Limits Self-Representation for Mentally Ill Associated Press, 6/19/2008 WASHINGTON - Mentally ill criminal defendants don't have the same constitutional rights as everyone else, the Supreme Court said Thursday in carving out an exception to the right to represent yourself. The justices said that a mentally ill defendant can be judged competent to stand trial, yet incapable of acting as his own lawyer. The 7-2 decision said states can give a trial judge discretion to force someone to accept an attorney to represent him if the judge is concerned that the trial could turn into a farce. "The Constitution permits states to insist upon representation by counsel for those competent enough to stand trial ... but who still suffer from severe mental illness to the point where they are not competent to conduct trial proceedings by themselves," Justice Stephen Breyer wrote in the majority opinion. The court has previously declared that self-representation is a constitutional right, although it is not absolute. The decision on defendants acting as their own lawyers came in the case of an Indiana man who was convicted of attempted murder and other charges in 2005 for a shooting six years earlier at an Indianapolis department store. Ahmad Edwards was initially found to be schizophrenic and suffering from delusions and spent most of the five years after the shooting in state psychiatric facilities. But by 2005, he was judged competent to stand trial, which means a judge determined Edwards could understand the proceedings and was capable of assisting his lawyer. But Edwards asked to represent himself. A judge denied the request because he was concerned that Edwards' trial would not be fair. Edwards, represented by a lawyer, was convicted anyway and sentenced to 30 years in prison. He appealed, and Indiana courts agreed that his right to represent himself had been violated, citing a U.S. high court decision from 1993. The courts overturned his conviction and ordered a new trial. Thursday's ruling probably will lead to the reinstatement of the conviction. The court ratified Indiana's decision to impose a higher standard for measuring a defendant's competency to be his own lawyer than to stand trial. Justices Clarence Thomas dissented. "In my view, the Constitution does not permit a state to substitute its own perception of fairness for the defendant's right to make his own case before the jury," Scalia said. Last term, the high court saw what could happen in these kinds of cases in the proceedings against Scott Panetti, a mentally ill killer from Texas who was nonetheless judged competent to stand trial and allowed to represent himself. Panetti was convicted and sentenced to death after personally arguing that only an insane person could prove the insanity defense. He dressed in cowboy clothing and submitted an initial witness list that included Jesus Christ and John F. Kennedy. The court blocked his execution in June, in a ruling that did not address his role in his own defense. The case is Indiana v. Edwards, 07-208.
Eating Disorder Treatment May Be Covered by Insurance in Illinois
Bonnie Rubin & Ashley Wiehle, Chicago Tribune- 6/23/2008 Melissa Traub has struggled for a decade with an eating disorder, her weight sometimes dipping below 100 pounds, her hair falling out by the handful. Today, the 24-year-old Naperville woman appears to be healthy—a tribute to treatment, tenacity and financial means. The road to recovery, which included hospitalization and stints in residential treatment centers, cost her family more than $100,000, even with insurance. "I got to the point where I finally said, 'I don't want this for my life anymore.' But without the support and resources of my family, I wouldn't be where I am today," she explained. Illinois lawmakers can't do much about the physical and emotional toll, but they did move to ease the financial burden on families, recently approving legislation that would require insurance companies to pay for treatment of anorexia and bulimia. If Gov. Rod Blagojevich signs the bill, Illinois will become the 17th state to mandate such coverage. The measure is part of a larger national debate about addressing inequities in insurance coverage between psychiatric and physical ailments. Suicide seen as big risk More than 12 million Americans, mostly young women, have eating disorders in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders. The organization ranked risk of death as higher with anorexia than with any other mental illness. Among patients with anorexia, almost half of all deaths are suicides, according to ANAD. Yet many insurers balk at covering the tab, which can run as high as $2,500 a day. "I've met so many parents who have had to refinance their homes," said Rep. Fred Crespo (D-Hoffman Estates), one of the bill's sponsors. But others cite the financial cost of such a law. Richard Cauchi, health program director for the National Conference of State Legislatures, said Illinois has taken "an unusual action" for 2008, when the trend is to move away from mandates on business and governments. "There's more pressure now to repeal and restrict mandates than to enact new ones," he said. The cost of treatment, which often requires a team of clinicians, is one of the biggest obstacles to healing, said Mary Elsner, who fields several calls a week from desperate parents at the national anorexia association's Highland Park office. As with other serious illnesses, early intervention can save victims' lives and insurers' money, before patients end up in the intensive-care unit on a feeding tube, with heart and kidney failure, she and other advocates say. "With cancer, we don't wait until tumors spread throughout the body," Elsner said. For Traub, it took multiple attempts before she turned a corner, and things got worse before they got better. The fourth of five children, and the only one to have the disorder, Traub's troubles started as she started high school, a tough transition for many girls. She started eliminating one food, then another, until her daily consumption dwindled to little more than an apple and a granola bar. She would duck dinner and prying questions by assuring her parents she had already eaten. Baggy clothes helped conceal her gaunt frame. By the end of first semester, she couldn't keep her secret. She was self-injuring, which ultimately set off alarms. The next few years were a cycle of treatment, recovery and relapse. She learned how to game the system, lining her pockets with weights or chugging water before weigh-ins. She gave up soccer, which she had played since age 4. Despite the turmoil, Traub looked forward to attending Ball State University in Indiana. At college, she kept her compulsions under control at first. But when the stress became overwhelming and she returned to her old behavior, the school told her to leave. "If I had stayed, I may not be alive," Traub said. The Traubs are lucky—Melissa is a survivor, and Blue Cross Blue Shield covered most of her costs. Even so, the out-of-pocket expenses, including $400 a month for therapy and $300 for medications, have amounted to more than $100,000 since her diagnosis. "We ended up using her college fund," explained her mother, Jodi Traub, who is retired from the Environmental Protection Agency, where her husband still works. Without insurance, the disease would have run into the "hundreds of thousands of dollars," she estimated. The Illinois bill would require coverage for 45 days as an inpatient and 60 outpatient visits each calendar year, still not enough for the most severe cases, experts said. But if the bill had been in effect, more of the Traubs' expenses would have been covered. The measure is on the governor's desk, where it is "under review," his office said. At Timberline Knolls, a Lemont-based residential treatment center that charges about $1,000 a day, few families have the amount of coverage necessary, said Dr. Kimberly Dennis, medical director. "It's an incredible hardship. . . . A lot of kids, it takes two to three months before they're in recovery." Lawsuits filed Over the years, a number of lawsuits have been filed against insurers for refusing to pay. Aetna announced this month it will settle a class-action suit filed by 100 New Jersey families who said they were denied coverage. In addition to settling, the company agreed to cover eating disorders the way it treats other mental illnesses. Rep. Roger Eddy (R-Hutsonville), one of 20 lawmakers to vote against the bill, worried that expanding benefits would raise premiums. "Whenever you begin to mandate coverage, there is an increase in the cost of insurance because you're adding risk," he said. But Mark Heyrman, a University of Chicago law professor and head of Mental Health Summit, a coalition that aims to increase mental health spending, dismissed such concerns. "As we have passed these laws, the research overwhelmingly shows that the cost increases, if any, have been minimal," he said, citing a 2000 federal study. Traub finally connected with treatment at Arabella House, a group home in Naperville where she spent almost four months this year. Now she's maintaining a healthy weight, with the help of professionals. "I was ready to do the hard work," said Traub, now a junior at Lewis University in Romeoville majoring in psychology. "I realized that God had bigger plans for me . . . and I could do so much more with my life."
Decline in Teen Smoking Hits a Wall
Rob Stein, Washington Post- 6/29/2008 The campaign to reduce teenagers' smoking has stalled, new federal data show, dismaying federal health officials and anti-smoking advocates who said that one of the nation's most important public health priorities is faltering. Smoking by teenagers fell sharply and steadily between 1997 and 2003, but the latest data from a large federal survey tracking smoking and other risky behaviors among young people found the proportion of teens who smoke leveled off between 2003 and 2007. "This is the most dramatic indication that the great progress we're making has stalled," said Terry Pechacek of the federal Centers for Disease Control and Prevention in Atlanta, which released the new data last week. "This has very negative long-term implications." Anti-smoking advocates agreed. "More progress must be made to ensure youngsters at these critical age levels continue to turn away from smoking," Cheryl Healton of the American Legacy Foundation, a Washington-based anti-smoking group, said in a statement. "The lack of greater progress in recent years is a clear warning to elected officials to resist complacency and redouble efforts to reduce tobacco use. We know how to win the fight against tobacco use, but we will not win it -- and our progress could even reverse -- without the political leadership to implement proven solutions," Matthew L. Myers of the Campaign for Tobacco-Free Kids, a Washington advocacy group, said in a statement. The data released last week come from the Youth Risk Behavior Survey, a nationally representative survey that the federal government conducts of students in grades 9 through 12 every two years to track a variety of risk behaviors, including drug, alcohol and tobacco use. The proportion of students who smoke soared from 27.5 percent in 1991 to 36.4 percent in 1997 but then began to fall, hitting 21.9 percent in 2003. The 2005 survey, however, showed the rate had crept up to 23 percent. Because that change was not statistically significant, officials were waiting for the 2007 figures to determine whether the downward trend had actually stalled. The 2007 figure is slightly lower at 20 percent, but again, the figure is not statistically significant. "We had a dramatic increase from 1991 to 1997 and then a reversal of that problematic upward trend from 1997 to 2003. In 2005 it was not declining, but we hoped that was a short-term bump," Pechacek said. "We're always cautious about making long-term implications from one data point. We were hoping that we would be back on track this year. But we're not." While the survey did show continued declines in some groups, most notably African American girls, the overall downward trend stalled. "There have been fluctuations between subgroups, but the bottom line is we are not on the decline anymore. We are confident that is a scientifically defined fact," Pechacek said. "One in five kids is still smoking. Another generation is continuing on with a high rate of tobacco use into adulthood where the industry can prey on them and maintain this epidemic into another generation," he said. "This is a major public health concern." Pechacek blamed the trend in part on cuts on anti-smoking campaigns by states that had been funded by a nationwide 1998 settlement of a class-action lawsuit against the tobacco industry. "Many large states had very active campaigns that went off the air," he said, citing Massachusetts, Florida and Mississippi as examples of states that had cut their programs. At the same time, cigarette companies have continued to increase their spending on promotional activities, including heavily advertising brands that teenagers are most likely to smoke, working to feature smoking in movies and videos and offering pricing incentives that offset increases in cigarette prices. "The tobacco industry never stopped promoting its products," Pechacek said. "They have increased their effort and maintained a very active effort to promote tobacco while prevention efforts have lost funding." Bill Phelps, a spokesman for Altria Group, the parent company of Philip Morris USA, said his company has a variety of programs aimed at discouraging teen smoking, including punishing stores found selling cigarettes to children. "We believe kids should not use tobacco," Phelps said. "We have a pretty significant youth smoking prevention program.
Surprising Fact: Half of Gun Deaths Are Suicides
Associated Press, 6/30/2008 ATLANTA -- The Supreme Court's landmark ruling on gun ownership last week focused on citizens' ability to defend themselves from intruders in their homes. But research shows that surprisingly often, gun owners use the weapons on themselves. Suicides accounted for 55 percent of the nation's nearly 31,000 firearm deaths in 2005, the most recent year for which statistics are available from the Centers for Disease Control and Prevention. There was nothing unique about that year -- gun-related suicides have outnumbered firearm homicides and accidents for 20 of the last 25 years. In 2005, homicides accounted for 40 percent of gun deaths. Accidents accounted for 3 percent. The remaining 2 percent included legal killings, such as when police do the shooting, and cases that involve undetermined intent. Public-health researchers have concluded that in homes where guns are present, the likelihood that someone in the home will die from suicide or homicide is much greater. Studies have also shown that homes in which a suicide occurred were three to five times more likely to have a gun present than households that did not experience a suicide, even after accounting for other risk factors. In a 5-4 decision, the high court on Thursday struck down a handgun ban enacted in the District of Columbia in 1976 and rejected requirements that firearms have trigger locks or be kept disassembled. The ruling left intact the district's licensing restrictions for gun owners. One public-health study found that suicide and homicide rates in the district dropped after the ban was adopted. The district has allowed shotguns and rifles to be kept in homes if they are registered, kept unloaded and taken apart or equipped with trigger locks. The American Public Health Association, the American Association of Suicidology and two other groups filed a legal brief supporting the district's ban. The brief challenged arguments that if a gun is not available, suicidal people will just kill themselves using other means. More than 90 percent of suicide attempts using guns are successful, while the success rate for jumping from high places was 34 percent. The success rate for drug overdose was 2 percent, the brief said, citing studies. ''Other methods are not as lethal,'' said Jon Vernick, co-director of the Johns Hopkins Center for Gun Policy and Research in Baltimore. The high court's majority opinion made no mention of suicide. But in a dissenting opinion, Justice Stephen Breyer used the word 14 times in voicing concern about the impact of striking down the handgun ban. ''If a resident has a handgun in the home that he can use for self-defense, then he has a handgun in the home that he can use to commit suicide or engage in acts of domestic violence,'' Breyer wrote. Researchers in other fields have raised questions about the public-health findings on guns. Gary Kleck, a researcher at Florida State University's College of Criminology and Criminal Justice, estimates there are more than 1 million incidents each year in which firearms are used to prevent an actual or threatened criminal attack. Public-health experts have said the telephone survey methodology Kleck used likely resulted in an overestimate. Both sides agree there has been a significant decline in the last decade in public-health research into gun violence. The CDC traditionally was a primary funder of research on guns and gun-related injuries, allocating more than $2.1 million a year to such projects in the mid-1990s. But the agency cut back research on the subject after Congress in 1996 ordered that none of the CDC's appropriations be used to promote gun control. Vernick said the Supreme Court decision underscores the need for further study into what will happen to suicide and homicide rates in the district when the handgun ban is lifted. Today, the CDC budgets less than $900,000 for firearm-related projects, and most of it is spent to track statistics. The agency no longer funds gun-related policy analysis. On the Net: CDC gun injury statistics: http://www.cdc.gov/ncipc |