Activism: Great video!! Sarah Palin doesn't speak for me !!!

Rally protesting Sarah Palin for VP in Rochester, NY

CL psych's timely reminder about bipolar diagnosis and a SOLUTION

Bipolar Overawareness Week Starts on Monday

It appears that the massive bipolar awareness campaigns from NAMI and various drug companies have paid off big time. The conclusions of a new study by Mark Zimmerman and colleagues in the Journal of Clinical Psychiatry state, in part:

However, our results suggest that overdiagnosis of bipolar disorder is as much, if not more, of a problem than underdiagnosis.

Say what? Well, if you've been following the mental health world, you may have noted that bipolar disorder is the new plague -- it is apparently spreading like wildfire. David Healy wrote an excellent article in PLoS Medicine in 2006 which has been validated by Zimmerman et al.'s latest study. Healy wrote in part:

One of the most famous direct-to-consumer television adverts for a drug begins with a vibrant woman dancing late into the night. A background voice says, “Your doctor probably never sees you when you feel like this.” The advert cuts to a shrunken and glum figure, and the voiceover now says, “This is who your doctor usually sees.” Cutting again to the woman, in active shopping mode, clutching bags with the latest brand names, we hear: “That's why so many people with bipolar disorder are being treated for depression and not getting any better—because depression is only half the story.” We see the woman again depressed, looking at bills that have arrived in the post before switching to seeing her again energetically painting her apartment. “That fast- talking, energetic, quick tempered, overdoing it, up-all-night you,” says the voiceover, “probably never shows up at the doctor's office, right?”

No drugs are mentioned. But viewers are encouraged to log onto www.bipolarawareness.com, which takes them to a Web site called “Bipolar Help Center,” sponsored by Lilly Pharmaceuticals, the makers of olanzapine (Zyprexa). The Web site contains a “mood disorder questionnaire” (http:/​/​www.bipolarhelpcenter.com/​resources/​mdq.jsp). In the television advert, we see our heroine logging onto www.bipolarawareness.com and finding this questionnaire. The voice encourages the viewer to follow her example: “Take the test you can take to your doctor, it can change your life….getting a correct diagnosis is the first step in treating bipolar disorder. Help your doctor to help you.”

This advert markets bipolar disorder. The advert can be read as a genuine attempt to alert people who may be suffering from one of the most debilitating and serious psychiatric diseases—manic-depressive illness. Alternatively, the advert can be read as an example of what has been termed disease mongering. Whichever it is, it will reach beyond those suffering from a mood disorder to others who will as a consequence be more likely to see aspects of their personal experiences in a new way that will lead to medical consultations and in a way that will shape the outcome of those consultations. Adverts that encourage “mood watching” risk transforming variations from an emotional even keel into potential indicators of latent or actual bipolar disorder. This advert appeared in 2002 shortly after Lilly's antipsychotic olanzapine had received a license for treating mania. The company was also running trials aimed at establishing olanzapine as a “mood stabilizer,” one of which was recently published.

Here's part of an Abilify for bipolar ad...




Back to the Zimmerman study. The researchers interviewed 700 patients with the Structured Clinical Interview for DSM-IV (SCID). Keep in mind that the SCID is not a conservative measure. When patients receive an unstructured interview, they tend to receive fewer diagnoses than when they are interviewed with the SCID, which makes sense because the SCID sticks to asking detailed questions about DSM-IV symptoms, whereas most interviews ask questions about a variety of topics, and don't go into nearly as much depth regarding one's DSM-specific symptoms.

These 700 patients were also asked if they had been diagnosed as bipolar by a healthcare professional. 145 of the 700 patients included in the study indicated they had been diagnosed as bipolar. Then it gets interesting...

Of the 145 patients diagnosed as bipolar prior to being interviewed for the present study, only 63 (43.4%) were labeled as having bipolar disorder according to the SCID. Remember, the SCID tends to generate more diagnoses than a typical clinical interview, so it's not like the SCID is generally insensitive to picking up on DSM-IV disorders. The researchers even took the liberty of diagnosing many patients who did not officially meet bipolar I or bipolar II diagnostic standards as having bipolar NOS (not otherwise specified); about 25% of those diagnosed with bipolar according to the SCID were labeled as having bipolar NOS. In other words, the authors of the study went out of their way to be quite inclusive, to label some cases that did not quite meet DSM-IV criteria for bipolar as bipolar NOS. So one cannot reasonably state that they were being too restrictive with how they made their bipolar diagnoses.

To put it straight: Over half of the patients coming into the study with a bipolar diagnosis were not labeled as bipolar in the present study when given a thorough diagnostic interview.

Naysayers. Of course, the "bipolar spectrum" club will unite to say that this article is junky. I read an email from a psychiatrist who stated that the study was flawed because the DSM-IV model of diagnosing bipolar is wrong; it is too restrictive. But since the current researchers went past official DSM-IV criteria to make some of their bipolar diagnoses, I'm not sure that is a very valid concern. But similar points will be raised over and over again. Those in favor of expanding the boundaries of bipolar disorder will insist that all this study showed was that the DSM needs change; it needs to broaden its definition of bipolar disorder. Those who were diagnosed as having bipolar disorder but were not labeled as such according to a thorough interview based on the DSM -- those people had "subthreshold" bipolar disorder, which will be labeled as an "underdiagnosed and undertreated" condition that needs to be remedied through more Awareness Days and the like. Doubt me? A group of researchers recently stated that "subthreshold bipolar disorder" was not receiving the treatment it needed, a claim they later retracted when it was pointed out that there was not a single shred of evidence to suggest that such a "condition" received any benefit from treatment with mood stabilizers or antipsychotics.

Why did bipolar become so hip? Mark Zimmerman, lead author of the present study is no pharma hater. By that, I'm not suggesting that he's in bed with pharma either; I'm just saying that he has no axe to grind. So how did he interpret his team's findings?

The impact of marketing efforts and publicity probably also plays a role. Direct-to-consumer advertisements that refer individuals to screening questionnaires can result in patients suggesting to their treaters that they have bipolar disorder. We have seen evidence of this in our practice...

We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive. The bias is reinforced by the marketing message of pharmaceutical companies to physicians that has emphasized the literature on the delayed recognition and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder. The campaign against underrecognition, which is also illustrated in the titles of published articles in peer-reviewed journals, has probably resulted in some anxious, agitated, and/or irritable depressed patients who complain of insomnia and "racing thoughts" being misdiagnosed with bipolar disorder.

News flash, folks. Remember, documents seem to indicate that Lilly was pushing Zyprexa in primary care to treat watered down cases of... bipolar disorder. Cases that would not pass DSM-IV muster, but, if you stretched the diagnostic boundaries quite a bit, BAM, you've got bipolar disorder.

The Last Psychiatrist has also been duly keeping tabs on the bipolar epidemic (1, 2, 3) and I recommend reading his posts on the topic. To quote from one of them:

Yes, but even though the world agrees the symptoms are the same, the consequences of each label is very different, right? The epidemiology, the prognosis-- the meds?

But the real difference is the societal implications. Getting a diagnosis changes the way you relate to the world, and the world relates to you. The label changes your identity and how you think.

Don't agree? Try killing someone and using "pervasive ADHD" as a defense. Get it?

We pretend that psychiatry is an emerging science, and hide behind a feigned ignorance ("we don't know everything, but we're making progress!") And so no one has to take responsibility, or even admit, that psychiatry is changing the evolution of humanity, right in front of our eyes, with nothing more than words.

Right. We relabel conditions and act as if we just figured out the laws of relativity. It's not ADHD or conduct disorder or borderline personality or anger management issues or just, life sucks for you right now and you're having a difficult time adjusting to life's difficulties -- it's... bipolar disorder! Look at the progress we've made! But where is the data showing that these people who are being newly christened as bipolar are actually doing any better due to their new label and their new course of treatment? Doesn't giving someone a bipolar label impact that person? I'd probably feel differently about life if a medical authority labeled me as bipolar.

So I propose that we start a Bipolar Overawareness Week, complete with a website linking to a questionnaire that makes statements like:

• Do you know that your symptoms are probably not indicative of bipolar disorder?
• Ask your doctor if you've been misdiagnosed with bipolar.
• Find out if you are unnecessarily taking Zyprexa today.
  

Let's see if we can get the National Alliance for the Mentally Ill on board. Surely they want to make sure that patients receive the proper diagnosis. Surely drug companies, with their interest in good science and good medical practice, want to help out as well, since they want to make sure that their drugs are prescribed properly.

Daniel Goldberg said...

Good post. The jargon term for "disease mongering" is medicalization, which is such a large and influential area of study that it has even become a subdiscipline ("medicalization studies").

Peter Conrad, a sociologist at Brandeis, studied under Irving Zola, who was a pioneer in medicalization studies, and has a new book out on medicalization. Interestingly, he emphasizes that chalking medicalization up to so-called "medical imperialism" is short-sighted, because often times patients and advocates are at the forefront of urging medicalization (alcoholism and adult ADHD being two of the most prominent examples).
Wednesday, May 07, 2008 11:33:00 AM
by: PM, SN said...

This reminds me of a conversation I had with one of my older friends, a tradesman (jack-of-all) who lives on a boat in the river in my hometown. I forget the conversation that lead up to this, but he mentioned to me that for months out of the year he would feel depressed, and then for months he would feel happy. Sure, I thought, cyclic dysthymia! What I told him, though, was that his experience wasn't at all unusual, and that it's only the degree to which this experience interferes with his ability to live and work that makes the difference between a pathology and just the way we feel. He understands his own pattern, what kinds of things make him feel good and bad, and how to deal with the extremes of his existance gracefully. Some people need a little extra help with this and that's ok, but I think the emphasis on "preventative care" definately leads to overmedication and overdiagnosis.

I left my comments, which you may perhaps be able to read when/if they get posted.

There is so much SEXISM and refusal to understand TRAUMA it boggles my mind.

After 50 years of PTSD, they are STILL trying to label me bipolar and get me on addictive medications!!

I am the patient from HELL for these yuppie, uncaring
30-somethings who are still drinking
and think they can shove these pills on me!

Sure, I am not the easiest person to "deal with"
Tough.
But I'm not having anyone rot my brain!
I've paid dearly to keep it.

Helping Girls Navigate Sexualization in the Media

Young girls are inundated with sexist media images. How do we help them develop a healthy sense of their own sexuality?

By Joyce McFadden, Huffington Post.
Posted May 1, 2008.

Also in Sex and Relationships

What Are Bisexuals? Chopped Liver?
Greta Christina

Without Ceremony: How I've Managed to Avoid Getting Married for Forty Years
Lisa Gabriele

The Female Condom: Sexual Freedom Doesn't Come Free
Lauren Sisson

Cruising the Cubicles: The Do's and Don'ts of Office Romance

The Science of Sexuality
Greta Christina

It needs to start in the home. Our daughters' best defense against the skewed sexual saturation of our culture is for us to support them in the healthy development of their own sexuality.

As I wrote in "What Huff Post Women Had to Say" women still experience discomfort in educating their daughters about menstruation. If our own discomfort gets in the way of that, imagine the unspoken, often unconscious, fear of teaching them about their sexuality -- which would by extension also be teaching them about ours. How can we expect our daughters to hold their own against unrealistic images of sexuality in the media when they sense our own impairments to being sexually comfortable in our mother/daughter relationships?

Maybe we're so afraid of having to go into the "naughtiness" of sexual detail that we're missing the simplicity of what our daughters most need from us: our blessing of their sexuality as normal and healthy.

Esther Perel, sex therapist and author of Mating in Captivity, a book exploring the sexual complications within marriage, wrote in her Huffington Post blog that it isn't usually the mechanics of sex that bring couples to her for help, but rather their desire for "the poetics of sex." I think as Americans, our fixation with the taboo of sexuality causes us to overlook its poetry and its greater meaning in our lives, and then we pass this limited view of sex onto our children.

It's difficult for women to teach their girls how to celebrate being alive within their desire; but it's commonplace for women to teach girls how to devalue their bodies in the quest for physical perfection. A mother, over the years, even in the most seemingly innocuous statements like "I was good today; I skipped lunch." or "I was bad today; I had cake" erodes herself in front of her daughter, and in so doing, systematically erodes her daughter right along with her. This is the crisis. Why do we readily and consistently, consciously and unconsciously, dispense messages of self loathing that will harm them in every way by undermining their confidence, even as we shy away from teaching them how to protect, delight in, and express love with their bodies?

It will be harder for our girls if we only engage in seeing them as sexual once they're adults. We need to be there with them from the beginning of the journey.

Here are some questions we can ask ourselves to help us consider the possible impact of our reluctance to speak openly with our daughters.

We want our girls to grow into women who can be happy and experience love, but how do we imagine them arriving there? We want them to be in relationships, but do we really see our daughters as sexual? When we think of them being in love, do we stop at a love that's more to do with friendship and reliable companionship? How do we hope our daughters learn and measure what they find sexually arousing? Do we indirectly hope our daughters have unfulfilling sex? Do we feel too embarrassed to somehow give them, and ourselves, the support needed to lead full, open lives?

If the sexual lessons don't come from us girls will search elsewhere. This week it might be Vanity Fair's tutorial on Miley Cyrus. While it's healthy for girls to individuate from their mothers, does our fear of discussing sexuality push them even farther away than we intend? Do we inadvertently influence them to find other role models who unrealistically represent girls and women?

What of our sexuality do we allow them to know? Girls might come to learn through observation that "real" women can express their sexuality only through the smaller victories of erotic pleasure, such as finding it quite normal that women in restaurants or at the Thanksgiving table will openly tilt their heads back, close their eyes and moan unabashedly ... over a piece of chocolate ... with the full support and understanding of all onlookers.

It's hard to feel genuine and alive when we're taught to hide half of who we are. Being more open in revealing ourselves, mother to daughter, might offer our daughters a greater chance to feel more complete in an authentic sense of sexuality, as opposed to only donning the facade the media holds out to us.

Women of all ages in my study repeatedly reported wanting to know more about their sexuality, they just didn't know how to go about it because guilt, shame, discomfort and propriety precluded their taking the risk. There were important things about sexuality that they hadn't been taught by their mothers, and this gap in learning resulted in both a reluctance to confide in other women the sexual content of their lives, and an ambivalence about providing their daughters with a sexual contextualization of life.

What are we teaching our daughters about being female? And what are we withholding from them that might be useful for them to know?

If we choose not to ground their sexuality in a sense of home, they're more at risk of grounding it wherever the media directs them.

See more stories tagged with: sexuality, girls, media

Joyce McFadden is a certified psychoanalyst with an MSW from Columbia University and five years of postgraduate training. She's a faculty member, training analyst and clinical supervisor at the Training and Research Institute for Self Psychology, and author of the ongoing anonymous web-based Women's Realities Study.

On Deborah Palfrey's SUICIDE: Matt Janovic

Why the Suicide of Deborah Jeane Palfrey Was Not Unexpected

[Ed. note: When someone is convicted their record is wiped-clean, please do in regards to Jeane's fate. Her record is now clean, and the assets they took from her are no longer the government's legally. ]

J-7/Tarpon Springs, Florida--I would like to express my deepest condolences to the family of the deceased Ms. Palfrey. This writer never met Jeane--as she liked to be called by friends--and I only spoke with her a few times telephonically--our correspondence occurred through the Internet. That doesn't make this any easier to write.

Jeane claimed--she claimed a lot of things, most-of-which were accurate--that James Grady, author of "Three Days of the Condor" told her (paraphrased), "They've handed you a gun to blow their heads off with." He wasn't wrong, and this story opened a door into things that most of us assumed were going on in Washington D.C. It confirmed our suspicions. Expect it to keep delivering.

What's disturbing is what Jeane told myself and others on the defense team: that she had had contact with Brent Wilkes, the convicted Poway defense contractor who bribed GOP Rep. Randall Cunningham, and likely many-many other congressmen, primarily Republican ones.

Predictably, the comment boards are already flowing with a lot of ignorant speculation that Jeane was somehow "murdered" by a "conspiracy." This is not only disrespectful to the memory of a human being who felt compelled to kill herself by hanging, it's cracked and has no basis in reality whatsoever.

Here's why: being a researcher on her defense team gave me an inside-view of things. Just weeks before the trial, Jeane sent this e-mail out to Jason Leopold--formerly of Talkout, whose editors forced him from covering the story this year--and forwarded it to the rest of us on the legal defense team. It contains an entire exchange in it for context. From February 28th, 2008 (paragraph-breaks added):

Jason… let’s put it like this, the bastards aren’t going to take me alive. Of course, anytime that you want to do an interview – I will make myself available. However, I doubt that I will be doing any interviews once I am in D.C., for the trial. –Best, Jeane


-----Original Message-----
From: jasonleopold@hotmail.com [mailto:jasonleopold@hotmail.com]
Sent: Thursday, February 28, 2008 11:40 AM
To: jeanepalfrey@sprynet.com; 'Justice League'
Cc: myboigie@earthlink.net
Subject: Re: "D.C. Madam trial scheduled for April 7th" (Jeane Palfrey)...

Jeane

I have no doubt that you will prevail. Your fighting spirit is infectious. I am in the process of setting up my own shop. I will actually be in DC for your trial and would love to get you on camera theb for the new nesit if possible.

Best

Jason

Sent via BlackBerry from T-Mobile

-----Original Message-----

From: "Jeane Palfrey"

Date: Thu, 28 Feb 2008 11:25:30

To:"'Justice League'"

Cc:,

Subject: RE: "D.C. Madam trial scheduled for April 7th" (Jeane Palfrey)...

Bil… thanks for the kinds words. If USA’s can’t file racketeering charges, then who can? More specifically, who filed them in my case? -Jeane

-----Original Message-----

From: Justice League [mailto:spbiloxi00@gmail.com]

Sent: Thursday, February 28, 2008 11:11 AM

To: jeanepalfrey@sprynet.com

Cc: jason leopold

Subject: Re: "D.C. Madam trial scheduled for April 7th" (Jeane Palfrey)...

Good Morning Jeane:

Thanks for your update and concerns in your case. I am copying Jason. I will post your email on my blog and on the Newsinkling.org. Jason and I know that you are innocent. Just remember. This is a battle of a much corrupted justice system. And we are with you on the long haul no matter what happen. Keep in mind that your case is in the hands of 12 jurors. You are innocent until proven guilty.

Also, I wanted to bring this to you and Jason. I was watching a webcast of the House Judiciary Committee hearing that was held on Tuesday about the matter of the procedures of a Special Prosecutor. There were two panels of attorneys that were experinced attorneys that dealt with a Special Prosecutor or was a Special Prosecutor or Independent counsel. I watched carefully to the last person to testify in the second panel: USA and Special Counsel Patrick Fitzgerald. One the committee asked this question to Fitzgerald that was interesting:


Cannon: Distinction between special counsel and normal prosecutor.

Patrick Fitzgerald: One common misunderstanding is that we didn't follow DOJ guidelines. I was bound by those guidelines. Many of the procedures I was the decision maker. When you prosecute as USA, you have to follow the guidelines. In an ordinary case, USA has an awful lot of power. In many cases, the volume of our cases, we can bring charges that will imprison people with out possibility of parole. No wiretap without DOJ, no immunity for witnesses, no govt appeal or attorney or member of the media. USAs can't file racketeering charges.

I found the last part of Fitzgerald's statement about racketeering charges interesting. And I appreciate him explaining what the role of as an USA. His statement is a very clear indication on why certain USAs were fired, why certain USAs were selected as interims, and what role within the WH and AG played in allowing certain charges to stick on certain individuals for political and personal means, and finally the handpicking of certain judges in certain cases. It would be interesting on how much power [especially USA Taylor] the selected USA interims with the DOJ by the WH. Here is the link of the webcast. Fitzgerald's testimony is about 15 minutes toward the end: 2:20.52

http://judiciary.edgeboss.net/real/judiciary/commercial/comm022608.smi

Bil [Monique Rawlings]

On 2/28/08, Jeane Palfrey > wrote:

My and defense counsel's various efforts the past 17 months to resolve the charges levied against me by the Department of Justice have been unsuccessful. Therefore, a full-jury trial is scheduled to take place on April 7th, in Federal District Court, in Washington, D.C.

I intend to defend myself vigorously against the charges of racketeering, money laundering and conspiracy. I will call witnesses to testify on my behalf about the legal, sexual nature of my former business – Pamela Martin & Associates. These witnesses likely will be culled from the existing research – conducted over the past 8 months - by a variety of press/media, bloggers and interested third parties.

It should be noted ALL charges are predicated upon the seldom utilized Travel Act, which allows the Government to claim jurisdiction for ANY crime – including misdemeanor offenses such as prostitution – when state lines are crossed. In the course of regular business operation in the Washington, D.C. area, state lines are crossed routinely by any number of businesses, including escort services. In fact, all one has to do is quite literally cross the street in hundreds, if not thousands of locations in the vicinity to cross a state line.

The Travel Act is important here because – unlike the state misdemeanor crime of prostitution – the Travel Act can be used to satisfy the requirement of an SUA (specified unlawful activity), which must be in place in order for the Government, not only to claim jurisdiction, but to be able to charge racketeering, money laundering and conspiracy. Federal law recognizes dozens of SUAs. Normally, such activities involve murder, treason, rape, kidnapping, drug trafficking, white slavery, extortion, embezzlement, etc and subsequently are utilized to support broader crimes like racketeering and conspiracy.

Perhaps, it also should be stated (and clarified) the racketeering charge is based in part upon the belief my previous business – to this day - is an ongoing criminal enterprise. Pamela Martin & Associates ceased to exist the day phone service was disconnected by me, in August of 2006. Any/all affiliated parties went their separate ways, at this time. The money laundering charge has been built upon the fact that payment transaction was done through the U.S. Mail.

Since I did not live in the Washington, D.C. area, during the 13 year period, PM&A was a viable concern – there realistically was no other logistical way for the women in my employ to send agency revenue onto me. Lastly, conspiracy – from what I have been able to ascertain – ostensibly occurs when two minds agree to commit a crime. Strangely, a person also can conspire with himself/herself, without the inclusion of a second individual.

Without doubt, I am in the fight of my life.Unfortunately, the Government will not capitulate, nor will I in this extremely bizarre case; one,where no person other than myself–including all former clients and escorts-is being charged with any crime here. Technically the Government has been successful in making the charges against me work on paper.

As a result, I have no choice- nor have I ever had any alternative - but to fight on and clear my name via the facts of the case, particularly since - if convicted, federal sentencing guidelines allow for a maximum sentence of 55 years imprisonment. Realistically, it has been calculated I would receive 8 to 10 to 15 years. Nonetheless for me at age 51, such a harsh penalty would be tantamount to a virtual life sentence – stripping me of some of the most productive years remaining in my life.

Jeane Palfrey

There's an image I have of Blanche Palfrey finding her daughter's body, hanging in the shed outside of her residential trailer. It's an image that should stick in the minds of all the "Johns," the privileged ones, forever. This is the real face of our elected (and appointed) representatives, and Republican Senator David Vitter is hardly alone in all of this. This is the face of lawlessness, a profoundly sexist patriarchy...it is the face of a homegrown American Fascism.

This political and economic system uses women like Deborah Jeane Palfrey and her former escorts to facilitate government contracts. When things get uncovered, the press acts as gatekeepers, and they throw them away through prosecution. Jeane, I hardly knew you, but you didn't deserve this ending. I have to wonder what the dirty political prosecutors told you about sentencing, and whether it contributed to your decision to kill yourself. Your story will be told, and what I've learned in all of this will become public. This I vow.

Follow up information:

UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA : CRIMINAL NO. 07-046 (JR)

:

v. ::

DEBORAH JEANE PALFREY, :

:

Defendant. :

JOINT SUGGESTION OF DEATH AND ANTICIPATION

OF MOTION FOR ABATEMENT OF PROSECUTION

The United States of America, by and through its attorney, the United States Attorney for the

District of Columbia, in consultation with and with the concurrence of counsel for defendant, Preston

Burton, herewith files this joint suggestion of death. The parties file this suggestion on information

and belief that defendant, Deborah Jeane Palfrey, died on or about May 1, 2008. Once the certificate

of death is received, the parties will jointly move to abate the prosecution.

A defendant’s death is a basis for abatement of all prosecution proceedings from their

inception. Durham v. United States, 401 U.S. 481, 483 (1971); United States v, Asset, 990 F.2d 208,

211 (5

th Cir. 1992) (death of defendant before entry of judgment abates prosecution ab initio); United

States v. Oberlin, 718 F.2d 894, 896 (9

th Cir. 1983) (similar holding); cf. United States v. Pogue, 19

F.3d 663 (D.C. Cir. 1994) (death pending direct appeal abates prosecution); Howell v. United States,

445 A.2d 1371, 1373 (D.C. 1983) (quoting Howell).

In light of the apparent recent death of defendant and in anticipation of the resulting joint

motion for abatement of prosecution, the parties request that the Court stay the need for either party

to file any pleadings that are coming due for a response in the interim. Furthermore, defense counsel

requests that he be authorized to contact the defendant’s family and representatives of her Estate in

Case 1:07-cr-00046-JR Document 312 Filed 05/02/2008 Page 1 of 2

2

connection with matters related to the criminal and civil forfeiture proceedings before the Court. The

United States does not object to defense counsel’s request.

Respectfully submitted,

JEFFREY A. TAYLOR

UNITED STATES ATTORNEY

DC Bar No. 498610

/ s /

Daniel P. Butler

DC Bar No. 417178

Catherine K. Connelly

Mass. Bar No. 649430

William R. Cowden

DC Bar No. 426401

Assistant United States Attorneys

555 4th Street, N.W.

(202) 353-9431, 616-3384

Washington, D.C. 20530

Daniel.Butler@usdoj.gov

Catherine.Connelly2@usdoj.gov

William.Cowden@usdoj.gov

/ s /

______________________________________

Preston Burton, Esq., D.C. Bar No. 426378

ORRICK, HERRINGTON & SUTCLIFF, LLP

1152 15

th St., NW

Washington, D.C. 20005

(202) 339-8400

See also:

'D.C. Madam' apologized to mom, sister in suicide notes

By MITCH STACY – 2 hours ago

TAMPA, Fla. (AP) — The woman known as the "D.C. Madam" apologized to her mother and sister in suicide notes, saying she couldn't bear going to prison and saw killing herself as the only "exit strategy."

Deborah Jeane Palfrey, convicted last month of running an elite Washington prostitution ring, wrote to her mother that she could not "live the next 6-8 years behind bars for what you and I have come to regard as this 'modern day lynching,' only to come out of prison in my late '50s a broken, penniless and very much alone woman."

The notes were released by police Monday.

Palfrey, 52, hanged herself with a nylon rope Thursday in a shed outside her mother's mobile home in the Florida Gulf Coast community of Tarpon Springs, northwest of Tampa. Her mother, 76-year-old Blanche Palfrey, discovered the body.

Deborah Palfrey was convicted of running a prostitution service that catered to members of Washington's political elite, including Sen. David Vitter, a Louisiana Republican. She denied her escort service engaged in prostitution, saying that if any of the women engaged in sex acts for money, they did so without her knowledge.

She was free while she awaited sentencing on July 24 and had been staying with her mother.

Her suicide appeared to have been planned for days. The note to her mother was dated April 25, nearly a week before she killed herself. Police said the notes were found on a night stand in the bedroom where she'd been staying. One of the notes said, "Do not revive. Do not feed under any circumstances."

In the note to her younger sister, Bobbie, Palfrey expressed her love and told her to "be strong for mom."

"Also, you must comprehend that there was no other way out, i.e., 'exit strategy,' other than the one I have chosen here," she wrote. "Know I am at peace, with complete certainty, I believe Dad is standing watch — prepared to guide me into the light."

Also Monday, police announced that the medical examiner's office officially ruled Palfrey's death a suicide by hanging. A toxicology report is pending.

Her death last week had sparked widespread Internet chatter among those who speculated that someone killed her to keep her from identifying more prominent clients of the escort service.

"Tarpon Springs Police Department detectives, after following up on several investigative avenues have not discovered any new evidence which would indicate anything other than a suicide by hanging in this case," spokesman Capt. Jeffrey Young said.

Palfrey's mother and sister identified her handwriting in the suicide notes, Young said.

A federal jury convicted Palfrey on April 15 of money laundering, using the mail for illegal purposes and racketeering. Prosecutors said she ran the prostitution service for 13 years. The trial concluded without revealing many new details about the service or its clients. Vitter was among possible witnesses but did not take the stand.

Palfrey had vowed that she would not go to prison, even telling a Washington writer that she would commit suicide first.

Dallas compound case: more than meets the eye

First off - IF the person in charge had any obligation and sense of responsibility and knew what was happening at this "compound" - then why didn't she have one of her own relatives file a "referral" as that clearly would have been the RIGHT THING to do!!

With the provisions of the PATRIOT ACT, all suspicious activity is to be reported, so WHY NO REPORTS ??

The people in the "compound" OBVIOUSLY use many products - food is bought, kotex, just a whole host of products. Again, where are the suspicious activity reports that are filed?

This entire thing reeks from start to finish, and like WACO perhaps the entire story will never come out.

Any country that suffers under THEOCRATS is going to see plenty more of these in upcoming years. Score more points for The Patriarchy!! That which looks away from real harm done to anyone without POWER.

And like no one, no one at all, was watching Mr. Jeffs - and NO ONE filed a "referral"?

Oh, all of us who can read - we're just SO gullible.

Veeger

ps - ANYONE remember the Franklin Sex case? STILL covered up.




Update: Tensions Calmed At West Texas Polygamist Compound

Texas child welfare workers said Sunday they have now removed 219 women and children from a West Texas polygamous compound, but still have no positive identification of the 16-year-old girl whose abuse complaint led to the sweep.

“We didn’t know there would be this many [children], and we don’t know how many more there are,” said Marleigh Meisner, a spokeswoman for Child Protective Services.

On Saturday, officials had removed 183 women and children. So far, 18 juveniles are in state custody, meaning there was sufficient evidence of abuse or an immanent danger. The rest are being questioned to determine whether they will be placed in state care.

Tensions at a West Texas polygamous compound where investigators remain were calmed Sunday morning after law enforcement officials searched the retreat’s massive temple.

Authorities first entered the retreat, built by followers of polygamist leader Warren Jeffs, on Thursday night after a 16-year-old girl called to report that she had a child with a 50-year-old husband.

That girl, however, had not been found by Sunday afternoon. Ms. Meisner said the girls often go by different names and can be difficult to identify.

“We’re always concerned anytime we have a victim and we can’t find that victim,” said Ms. Meisner.

“I am confident this girl does indeed exist.”

In Eldorado, a ranching town with fewer than 2,000 residents, some struggled Sunday morning to help protect and care for the new faces in their midst, many of whom may have never left the retreat before. Of the 219 taken in, 159 are children.

“They seem very stoic, very strong,” pastor Andy Anderson of First Baptist Church said of the women. “Clearly this has been emotional, but they are great mothers.”

About 70 of the women and children, wearing old-fashioned dresses and uniform hair braids, were housed in the church’s fellowship hall until mid-day Sunday when they were whisked away in school buses flanked by state troopers. All of the women and children taken from the compound were being relocated to a San Angelo facility where they can receive therapy and medical attention, Ms. Meisner said. She said a state district judge recommended that all the children from the compound be relocated to better facilitate interviews and care.

“This has been a tense situation for all involved,” Ms. Meisner said.

“I think they’re doing remarkably well considering the circumstances.”

Mr. Anderson said cots were brought in from a nearby Air Force base and grocery store donations helped with other supplies. Buses had been taking the women and children from the church to the local high school for showers.

“That compound has put Eldorado on the map,” Mr. Anderson said. “We’re used to the scrutiny. Whenever we go out of town, that’s all that everybody seems to know about us.”

State troopers armed with a search warrant swept through the compound on Friday to look for evidence of a marriage between the 16-year-old girl, who allegedly had a baby at 15, and 50-year-old Dale Barlow. Under Texas law, girls younger than 16 cannot marry, even with parental approval.

Mr. Barlow’s probation officer told The Salt Lake Tribune that he was in Arizona.

“He said the authorities had called him [in Colorado City, Ariz.] and some girl had accused him of assaulting her and he didn’t even know who she was,” said Bill Loader, a probation officer in Arizona.

The retreat, part of the The Fundamentalist Church of Jesus Christ of Latter Day Saints, was taken over by Mr. Jeffs after his father’s death in 2002. It splintered from the Mormon church more than a century ago.

Mr. Jeffs is now jailed in Kingman, Ariz., awaiting trial for four counts each of incest and sexual conduct with a minor stemming from two arranged marriages between teenage girls and their older male relatives.

In November, he was sentenced to two consecutive sentences of five years to life in prison in Utah for being an accomplice to the rape of a 14-year-old girl who wed her cousin in an arranged marriage in 2001.

The West Texas compound, on a 1,700-acre ranch, sits down a narrow paved road and behind a hill that shields it almost entirely from view in town. Only the 80-foot-high, white temple can be seen from a distance. State troopers continued to block roads into and out of the compound on Sunday.

“CPS can only go in and do an investigation if we receive a referral,” Ms. Meisner said when asked why authorities had not acted sooner.

“This is the first referral that we’ve had.

Diabetes and other diseases of OPPRESSION

I realize that this is a very long post. The New York Times makes you enter a password to read it. So I decided, ho hum, I'll have to post it in its entirety here. This is a very upsetting scenario indeed. Twenty thousand hours watching TV ads for junk (read: crap) food. Meanwhile, fees are charged for exercise and athletic programs at schools.

I pointed out to the NYT that alot of this had to do with Big Pharma prescriptions. I think that they are SLOOOOOOOOOOOOOOWly catching on.

Diseases of oppression and the working poor must be ERADICATED.

January 9, 2006

Bad Blood
Diabetes and Its Awful Toll Quietly Emerge as a Crisis

By N. R. KLEINFIELD
Begin on the sixth floor, third room from the end, swathed in fluorescence: a 60-year-old woman was having two toes sawed off. One floor up, corner room: a middle-aged man sprawled, recuperating from a kidney transplant. Next door: nerve damage. Eighth floor, first room to the left: stroke. Two doors down: more toes being removed. Next room: a flawed heart.

As always, the beds at Montefiore Medical Center in the Bronx were filled with a universe of afflictions. In truth, these assorted burdens were all the work of a single illness: diabetes. Room after room, floor after floor, diabetes. On any given day, hospital officials say, nearly half the patients are there for some trouble precipitated by the disease.

An estimated 800,000 adult New Yorkers - more than one in every eight - now have diabetes, and city health officials describe the problem as a bona fide epidemic. Diabetes is the only major disease in the city that is growing, both in the number of new cases and the number of people it kills. And it is growing quickly, even as other scourges like heart disease and cancers are stable or in decline.

Already, diabetes has swept through families, entire neighborhoods in the Bronx and broad slices of Brooklyn, where it is such a fact of life that people describe it casually, almost comfortably, as "getting the sugar" or having "the sweet blood."

But as alarmed as health officials are about the present, they worry more about what is to come.
Within a generation or so, doctors fear, a huge wave of new cases could overwhelm the public health system and engulf growing numbers of the young, creating a city where hospitals are swamped by the disease's handiwork, schools scramble for resources as they accommodate diabetic children, and the work force abounds with the blind and the halt.

The prospect is frightening, but it has gone largely unnoticed outside public health circles. As epidemics go, diabetes has been a quiet one, provoking little of the fear or the prevention efforts inspired by AIDS or lung cancer.

In its most common form, diabetes, which allows excess sugar to build up in the blood and exact ferocious damage throughout the body, retains an outdated reputation as a relatively benign sickness of the old. Those who get it do not usually suffer any symptoms for years, and many have a hard time believing that they are truly ill.

Yet a close look at its surge in New York offers a disturbing glimpse of where the city, and the rest of the world, may be headed if diabetes remains unchecked.

The percentage of diabetics in the city is nearly a third higher than in the nation. New cases have been cropping up close to twice as fast as cases nationally. And of adults believed to have the illness, health officials estimate, nearly one-third do not know it.

One in three children born in the United States five years ago are expected to become diabetic in their lifetimes, according to a projection by the Centers for Disease Control and Prevention. The forecast is even bleaker for Latinos: one in every two.

New York, perhaps more than any other big city, harbors all the ingredients for a continued epidemic. It has large numbers of the poor and obese, who are at higher risk. It has a growing population of Latinos, who get the disease in disproportionate numbers, and of Asians, who can develop it at much lower weights than people of other races.

It is a city of immigrants, where newcomers eating American diets for the first time are especially vulnerable. It is also yielding to the same forces that have driven diabetes nationally: an aging population, a food supply spiked with sugars and fats, and a culture that promotes overeating and discourages exercise.

Diabetes has no cure. It is progressive and often fatal, and while the patient lives, the welter of medical complications it sets off can attack every major organ. As many war veterans lost lower limbs last year to the disease as American soldiers did to combat injuries in the entire Vietnam War. Diabetes is the principal reason adults go blind.

So-called Type 2 diabetes, the predominant form and the focus of this series, is creeping into children, something almost unheard of two decades ago. The American Diabetes Association says the disease could actually lower the average life expectancy of Americans for the first time in more than a century.

Even those who do not get diabetes will eventually feel it, experts say - in time spent caring for relatives, in higher taxes and insurance premiums, and in public spending diverted to this single illness.

"Either we fall apart or we stop this," said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene.

Yet he and other public health officials acknowledge that their ability to slow the disease is limited. Type 2 can often be postponed and possibly prevented by eating less and exercising more. But getting millions of people to change their behavior, he said, will require some kind of national crusade.

The disease can be controlled through careful monitoring, lifestyle changes and medication that is constantly improving, and plenty of people live with diabetes for years without serious symptoms. But managing it takes enormous effort. Even among Americans who know they have the disease, about two-thirds are not doing enough to treat it.

Nearly 21 million Americans are believed to be diabetic, according to the Centers for Disease Control, and 41 million more are prediabetic; their blood sugar is high, and could reach the diabetic level if they do not alter their living habits.

In this sedentary nation, New York is often seen as an island of thin people who walk everywhere. But as the ranks of American diabetics have swelled by a distressing 80 percent in the last decade, New York has seen an explosion of cases: 140 percent more, according to the city's health department. The proportion of diabetics in its adult population is higher than that of Los Angeles or Chicago, and more than double that of Boston.

There was a pronounced increase in diagnosed cases nationwide in 1997, part of which was undoubtedly due to changes in the definition of diabetes and in the way data was collected, though there has continued to be a marked rise ever since.

Yet for years, public health authorities around the country have all but ignored chronic illnesses like diabetes, focusing instead on communicable diseases, which kill far fewer people. New York, with its ambitious and highly praised public health system, has just three people and a $950,000 budget to outwit diabetes, a disease soon expected to afflict more than a million people in the city.

Tuberculosis, which infected about 1,000 New Yorkers last year, gets $27 million and a staff of almost 400.

Diabetes is "the Rodney Dangerfield of diseases," said Dr. James L. Rosenzweig, the director of disease management at the Joslin Diabetes Center in Boston. As fresh cases and their medical complications pile up, the health care system tinkers with new models of dispensing care and then forsakes them, unable to wring out profits. Insurers shun diabetics as too expensive. In Albany, bills aimed at the problem go nowhere.

"I will go out on a limb," said Dr. Frieden, the health commissioner, "and say, 20 years from now people will look back and say: 'What were they thinking? They're in the middle of an epidemic and kids are watching 20,000 hours of commercials for junk food.' "

Of course, revolutionary new treatments or a cure could change everything. Otherwise, the price will be steep. Nationwide, the disease's cost just for 2002 - from medical bills to disability payments and lost workdays - was conservatively put by the American Diabetes Association at $132 billion. All cancers, taken together, cost the country an estimated $171 billion a year.

"How bad is the diabetes epidemic?"

asked Frank Vinicor, associate director for public health practice at the Centers for Disease Control. "There are several ways of telling. One might be how many different occurrences in a 24-hour period of time, between when you wake up in the morning and when you go to sleep. So, 4,100 people diagnosed with diabetes, 230 amputations in people with diabetes, 120 people who enter end-stage kidney disease programs and 55 people who go blind.

"That's going to happen every day, on the weekends and on the Fourth of July," he said. "That's diabetes."

One Day in the Trenches

The rounds began on the seventh floor with Iris Robles. She was 26, young for this, supine in bed. She wore a pink "Chicks Rule" T-shirt; an IV line protruded from her arm. For more than a year, she had had a recurrent skin infection. The pain overwhelmed her. Then came extreme thirst and the loss of 50 pounds in six weeks. In the emergency room, she found out she had diabetes.

She was out of work, wanted to be an R & B singer, had no insurance. It was her fourth day in Montefiore Medical Center. Her grandmother, aunt and two cousins have diabetes.
"I'm scared," she said. "I'm still adjusting to it."

Next came Richard Dul, watching news chatter on a compact TV. Now 64, he has had diabetes since he was 22. A month before, he had a blockage in his heart and needed open-heart surgery. He was home a few days, but an infection arose and he was back. Postoperative infections are more common with diabetes. This was his 21st straight day in the hospital.

Here, then, was the price of diabetes, not just the dollars and cents but the high cost in quality of life.

Simply put, diabetes is a condition in which the body has trouble turning food into energy. All bodies break down digested food into a sugar called glucose, their main source of fuel. In a healthy person, the hormone insulin helps glucose enter the cells. But in a diabetic, the pancreas fails to produce enough insulin, or the body does not properly use it. Cells starve while glucose builds up in the blood.

There are two predominant types of diabetes. In Type 1, the immune system destroys the cells in the pancreas that make insulin. In Type 2, which accounts for an estimated 90 percent to 95 percent of all cases, the body's cells are not sufficiently receptive to insulin, or the pancreas makes too little of it, or both.

Type 1 used to be called "juvenile diabetes" and Type 2 "adult-onset diabetes." By 1997, so many children had developed Type 2 that the Diabetes Association changed the names.
What is especially disturbing about the rise of Type 2 is that it can be delayed and perhaps prevented with changes in diet and exercise. For although both types are believed to stem in part from genetic factors, Type 2 is also spurred by obesity and inactivity. This is particularly true in those prone to the illness. Plenty of fat, slothful people do not get diabetes. And some thin, vigorous people do.

The health care system is good at dispensing pills and opening up bodies, and with diabetes it had better be, because it has proved ineffectual at stopping the disease. People typically have it for 7 to 10 years before it is even diagnosed, and by that time it will often have begun to set off grievous consequences. Thus, most treatment is simply triage, doctors coping with the poisonous complications of patients who return again and again.

Diabetics are two to four times more likely than others to develop heart disease or have a stroke, and three times more likely to die of complications from flu or pneumonia, according to the Centers for Disease Control. Most diabetics suffer nervous-system damage and poor circulation, which can lead to amputations of toes, feet and entire legs; even a tiny cut on the foot can lead to gangrene because it will not be seen or felt.

Women with diabetes are at higher risk for complications in pregnancy, including miscarriages and birth defects. Men run a higher risk of impotence. Young adults have twice the chance of getting gum disease and losing teeth.

And people with Type 2 are often hounded by parallel problems - high blood pressure and high cholesterol, among others - brought on not by the diabetes, but by the behavior that led to it, or by genetics.

Dr. Monica Sweeney, medical director of the Bedford-Stuyvesant Family Health Center, offered an analogy: "It's like bad kids. If you have one bad kid, not so bad. Two bad kids, it's worse. Put five bad kids together and it's unmanageable. Diabetes is like five bad kids together. You want to scream."

The Caro Research Institute, a consulting firm that evaluates the burden of diseases, estimates that a diabetic without complications will incur medical costs of $1,600 a year - unpleasant, but not especially punishing. But the price tag ratchets up quickly as related ailments set in: an average $30,400 for a heart attack or amputation, $40,200 for a stroke, $37,000 for end-stage kidney disease.

One of the most horrific consequences is losing a leg. According to the federal Agency for Healthcare Research and Quality, some 70 percent of lower-limb amputations in 2003 were performed on diabetics. Sometimes, the subtraction is cumulative. One toe goes. Two more. The ankle. Everything to the knee. The other leg. Studies suggest that as many as 70 percent of amputees die within five years.

Yet medical experts believe that most diabetes-related amputations are preventable with scrupulous care, and that is why the offices of conscientious doctors post signs like this: "All patients with diabetes: Don't forget to bare your feet each visit."

To witness the pitiless course that diabetes can take, simply continue on the hospital tour. This one day will do. Dr. Rita Louard, an endocrinologist, and Anne Levine, a nurse diabetes educator, were making their way through the rooms at Montefiore.

Here was Julius Rivers, 58, on the sixth floor. Three years with diabetes. He had been at home in bed when he saw a light like a starburst and told his wife to take him to the emergency room. His blood sugar was 1,400, beyond the pale. (A fasting level of 126 milligrams per deciliter is the demarcation point of diabetes.)

This was his third trip to the hospital in seven months. At the moment, he had a blood clot in his left leg. He had a heart attack a few years ago. He was on dialysis. "Tuesday, Thursday and Saturday," he said.

On the sixth floor was Mauri Stein, 58, a guidance counselor, a diabetic for 20 years. She had been at a party recently and "zoned out." Her words slurred. Foam appeared on her mouth. She had had a mild stroke.

Now she tried to control her emotions, tried not to cry. She had had repeated laser surgery on her eyes, and was effectively blind in one. She had recovered from the stroke, but doctors had also found a tumor on her heart and said it would need surgery.

"My feet burn," she said. "My toes burn all the time. My days of wearing my pumps are over. I've gotten more cortisone shots in my feet than I'm sure are legal."

She mentioned her brother, who lived in California. Diabetes had ransacked his body - an amputation, kidney dialysis, heart disease, blindness in one eye. He now resided in an assisted-living center. He was 53.

Ms. Stein's husband walked in and sat on the bed. Six months ago, he found out the same truth: he had diabetes.

This was one day in one hospital.

Inside the Incubator

Little about diabetes is straightforward, and to comprehend why New York is such an incubator for the disease, it is necessary to grasp that diabetes is as much a sociological and anthropological story as a medical one. While it assaults all classes, ages and ethnic groups, it is inextricably bound up with race and money.

Diabetes bears an inverse relationship to income, for poverty usually means less access to fresh food, exercise and health care. New York's poverty rate, 20.3 percent, is much higher than the nation's, 12.7 percent.

African-Americans and Latinos, particularly Mexican-Americans and Puerto Ricans, incur diabetes at close to twice the rate of whites. More than half of all New Yorkers are black or Hispanic, and the Hispanic population is growing rapidly, as it is around the nation.

Some Asian-Americans and Pacific Islanders also appear more prone, and they can develop the disease at much lower weights. Asians constitute one-tenth of New York's population, more than twice their proportion nationwide.

The nature of these groups' susceptibility remains under study, but researchers generally blame an interplay of genetic and socioeconomic forces. Many researchers believe that higher proportions of these groups have a "thrifty gene" that enabled ancestors who farmed and hunted to stockpile fat during times of plenty so they would not starve during periods of want. In modern America, with food beckoning on every corner, the gene works perversely, causing them to accumulate unhealthy quantities of fat.

But the velocity of new cases among all races has accelerated significantly from just a few decades ago. Genetics cannot explain this surge, because the human gene pool does not change that fast. Instead, the culprit is thought to be behavior: faulty diet and inactivity. Dr. Vinicor, of the Centers for Disease Control, likes to use this expression: "Genetics may load the cannon, but human behavior pulls the trigger."

Of the country's spike in diabetes cases over the last two decades, C.D.C. studies suggest that about 60 percent stem from demographic changes: a population increasingly comprising older people and ethnic groups with a higher risk.

The studies ascribe the other 40 percent to lifestyle changes: the fundamental shift that has people eating jumbo meals and shunning exercise as if it were illegal. At every turn, technology has made physical activity unnecessary or unappealing. Gym class has largely been deleted from schools. Fewer than a third of junior high schools require physical education at all, the C.D.C. says.

On the whole, New York's corpulence is below the national average, with 20 percent of adults qualifying as obese, compared with 30 percent for the country, the C.D.C. says. But the figure is much higher in poor areas like the South Bronx and East Harlem.

When the health department studied diabetes in the city's 34 major neighborhoods, the distribution echoed demographic patterns: Diabetes left only a light imprint on more affluent, white areas like the Upper West Side and Brooklyn Heights. The prevalence was about average in working-class Ridgewood, Queens, and almost nil on the Upper East Side.

But that apparent immunity is weakening. Of those 34 neighborhoods, 22 already have diabetes rates above the national average, and the numbers are rising all over as the city continually remakes itself.

"New York is switching from a mom-and-pop type of environment to a chain-store type of environment, a proliferation of fast food, even in high-rent neighborhoods they haven't had access to before, like the East Village and Lower Manhattan," said Peter Muennig, an assistant professor of health policy and management at Columbia.

If changes in daily living can bring on diabetes, they can also delay it, though it is uncertain for how long.

A federal program studied people around the country at high risk of getting diabetes, and concluded that 58 percent of new cases could be postponed by shifts in behavior - most notably, shedding pounds.

But Dr. Frieden, New York's health commissioner, says meaningful prevention cannot be achieved at the city level. "I can urge people until I'm blue in the face to walk and take the stairs and eat less, and it won't make much difference," he said.

His emphasis is on trying to better treat those who already have diabetes, an ambitious goal in its own right. Most primary care doctors treat too many patients to provide the attention that diabetics need, or to check for the disease, he said. Specialists are scarce. And compliance among patients is notoriously poor.

Even the most basic step in controlling the disease - watching one's blood sugar - is too much for many diabetics. Doctors recommend that two to four times a year, patients take a so-called A1c test, which gauges the average sugar level over the prior 90 days and is more revealing than daily at-home measurements.

But in 2002 , the health department found that 89 percent of diabetics did not know their A1c levels. Of those who did, presumably the most conscientious, four out of five had readings over the level the American Diabetes Association says separates well-controlled from poorly controlled diabetes.

The patients in the survey were not much better at knowing their blood pressure and cholesterol, which are also crucial for diabetics to control.

"Diabetes is an interesting beast," said Dr. Diana K. Berger, who heads the diabetes division at the health department. "It's probably one of the easier conditions to diagnose but one of the hardest to manage."

Shortages and Shipwrecks

There is an underappreciated truth about disease: it will harm you even if you never get it.

Disease reverberates outward, and if the illness gets big enough, it brushes everyone. Diabetes is big enough.

Predicting the path of a disease is always speculative, but without bold intervention diabetes threatens to hamper some of society's most basic functions.

For instance, no one with diabetes can join the military, though service members whose disease is diagnosed after enlisting can sometimes stay. No insulin-dependent diabetic can become a commercial pilot.

Shereen Arent, director of legal advocacy for the American Diabetes Association, says she already fields 150 calls a month from diabetics who complain that they are being discriminated against in the workplace, double the number just a couple of years ago. She mentioned a typical case, a man rejected for a job at a baked-bean factory in Texas as a safety risk. "If this continues," she said, "we're in big trouble."

Dr. Daniel Lorber is an endocrinologist in Queens who thinks a lot about the disease's present and future. "The work force 50 years from now is going to look fat, one-legged, blind, a diminution of able-bodied workers at every level," he said, presuming that current trends persist.

As more women contract diabetes in their reproductive years, Dr. Lorber said, more babies will be born with birth defects. Those needy babies will be raised by parents increasingly crippled by their diabetes.

"At a time when we are trying to shift health care out of hospitals, with diabetics you don't have a choice," he said. "Nursing homes are going to be crammed to the gills with amputees in rehab. Kidney dialysis centers will multiply like rabbits. We will have a tremendous amount of people not blind but with low vision. And we have lousy facilities in this country for low-vision problems. These people will not be able to function in society without significant aid."

Cost pressures have been slashing the number of hospital beds, and some exasperated doctors are known to denigrate advanced diabetics as "shipwrecks," because they have so many health problems and virtually live in the hospital.

Not only will the future mean too few beds and unsupportable drains on Medicaid and Medicare, Mr. Muennig said, but if an emergency strikes - a terrorist attack, an earthquake - the city health system's ability to respond may be compromised because all the beds will be full of diabetics.

Most schools do not have full-time nurses. Some public schools, Ms. Arent said, try to turn away children with diabetes, even though that is illegal. Others ban them from field trips and sports teams. And this is now, when diabetes is still relatively rare among children.

If trends continue, people will live through years blighted by disability, then die too young. Diabetes is thought to shave 5 to 10 years off a life.

"Life expectancy usually decreases because there's a plague or there's a massive economic trauma," Mr. Muennig said.

"In this case, we will see a decline in life expectancy due to a chronic condition."

In 2003, diabetes vaulted past stroke and AIDS from the sixth-leading cause of death in New York to the fourth. It was fifth, slightly behind stroke, in 2004. But the health department says it believes the actual toll is much worse because doctors who fill out death certificates may ascribe the death to a complication rather than to the diabetes at its root. Lorna Thorpe, deputy health commissioner, combed through medical charts and concluded that diabetes should be third, trailing cardiovascular disease and cancer.

Laurie Raps is a claims representative for Social Security on Staten Island, 31 years on the job. From her perspective, interviewing people embarking on full-time disability, she has seen the disease's long tentacles. When she started, she saw people in their 50's and 60's, hobbled by the usual problems of age: arthritis, herniated discs, heart conditions. Now, every week, she gets diabetic after diabetic, people as young as 30.

In fact, a 2004 study by UnumProvident, a major provider of disability insurance, found that the number of workers filing claims for Type 2 diabetes doubled between 2001 and 2003.

"It's a double whammy," Ms. Raps said. "You don't have these people working and paying into the system, and then you have these people collecting from the system."

Ten years ago, Ms. Raps developed diabetes. Her husband has it. Both her parents have it, their lives being washed away.

"When I look at the people who sit before me with disability claims, I have to check the birth date in their records," she said. "They look 10 or 20 years older. Diabetes does that. It wears you down and wears you down. We're looking at a future of people 10 or 20 years older in sickness than they are. What kind of future is that?"

'A 15-Year-Old Is Immortal'

"I'm Linda and I've had diabetes for 13 years."
"I'm Dominique and I've had diabetes for seven years."
"I'm Joseph and I've had diabetes for two months."
The brisk introductions went on, the ritual start to the monthly meeting of a support group called Sugar Babes Place. All the members had diabetes. All were children.
Sugar Babes is the idea of Dr. Yolaine St. Louis, chief of pediatric endocrinology at Bronx-Lebanon Hospital Center. When she started practicing medicine 16 years ago, the only children she saw with diabetes had Type 1.
Now, of Sugar Babes' 90 official members, roughly 40 percent have Type 2. One is 8. Another is 7.

It scares Dr. St. Louis. It scares many doctors who see the same thing, because they know it does not have to be. Type 2 was supposed to be an old person's disease. Diabetes still increases with age in an almost linear fashion - today, one in five New Yorkers age 65 and older have it - but the starting point used to be mostly in their 50's.

Dr. Alan Shapiro, a pediatrician with the Children's Health Fund and Montefiore Medical Center who has spent 13 years ministering to children in the South Bronx, said there was an easy way to illustrate the change. When he began, there was a "failure-to-thrive" clinic, meant to address the undernourished, because so many children were dangerously thin and small.

"Now I don't think we hardly ever see a failure-to-thrive case," he said.

In the clinic's place is an obesity program. Dr. Shapiro never saw children with Type 2 diabetes in his early years in medicine. Now, the program has about 10 cases.

One concern he and fellow doctors have is the surge in children who take antipsychotic drugs for anxiety and conditions like autism. Some newer drugs can promote weight gain and thus elevate the risk of diabetes. Dr. Shapiro has an autistic patient who he feels needs the new medication. But since taking it, the young man has markedly put on weight and, at 18, developed diabetes.
This extension of the disease to the young is where health care professionals feel society and public policy have most glaringly failed. Diabetes, they say, should never have gotten there.
There has been little research into the long-term impact of Type 2 diabetes on children. But doctors have a rough idea. The harsh consequences that can accompany diabetes tend to arrive 10 to 15 years after onset.

If people contract diabetes when they are 15, 10 or even 5, they may well start developing complications, not on the cusp of retirement but in the prime of their lives.

There is a big difference between losing a limb at 21 and at 70. There is a big difference between going on dialysis at 30 and at 65.

"I heard a horror story a few weeks ago," Dr. Lorber said, "of a girl who was born deaf, got diabetes at 11 or 12 and went blind from diabetes at 30."

The C.D.C. has projected that a child found to have Type 2 diabetes at age 10 will see his life shortened by 19 years.

"Imagine if kids were showing up at emergency rooms in cardiac arrest," said Dr. David L. Katz, director of the Prevention Research Center at the Yale University School of Medicine. "Frankly, I think that's the next big thing. It's that dramatic. If diabetes doesn't respect age, why should coronary disease? Lord knows, I hope this never happens. But this is what keeps me up at night."

Yet children can be the most reluctant to accept the truths of their condition.

"A lot of them are in denial," Dr. St. Louis said. "They have blood sugars of 300, 400, and they tell me right to my face they don't have diabetes. 'You're wrong,' they say. 'I don't feel anything.' I tell them what can happen down the road, and they shrug. A 15-year-old doesn't care what's going to happen at 35 or 45. A 15-year-old is immortal."

The doctor was telling the Sugar Babes that everyone should have two compact blood-sugar meters, one for home and one for school. Then she warned them, "If your sugar is bad and you don't do anything, you're going to be dropping down all over the Bronx."

Interest was tepid. Some children couldn't keep their eyes off the waiting dinner arranged at a buffet table by the wall. No rapt attention from Joseph, 12, who had begged not to come, until his mother put her foot down. He moaned that he had schoolwork.

"Look at that," said Dorothy Morris-Swaby, a diabetes nurse educator who worked with Dr. St. Louis, nodding at a girl who was talking on her phone. "We're educating about diabetes, and she's on her cellphone. Typical teenager."

As time ran out, hula hoops were brought out. Dr. St. Louis was trying to identify activities other than video games and TV that the children might try. Last meeting, they held a jump-rope contest.

"They have 10,000 excuses why they can't do something," the doctor said. "So you have to give them ideas and then hope."

The meeting wound up. The hoops were stashed away. Some of the children stepped toward the buffet table and began to eat.

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