That provoked an outcry from psychiatrists. Groups including Freudian societies, the World Association of Psychoanalysis and France’s Child Institute started a petition calling on the French government to recognize their clinical approach, focused on psychotherapy.

“The situation in France is sort of like the U.S. in the 1950s,” said Dr. Fred Volkmar, a U.S. expert who directs the Child Study Center at Yale University. “The French have a very idiosyncratic view of autism and, for some reason, they are not convinced by the evidence.”

Behavioral methods, which focus on helping autistic children communicate with others and develop social skills, are the norm in Britain, Canada, Japan, the U.S. and elsewhere in Europe. But they’re seldom used in France.

France has long been criticized for its approach to treating autism. In 2002, the charity Autism Europe lodged a complaint against France with the Council of Europe, charging the country was refusing to educate autistic children, as required under the European Social Charter.

The charge was upheld and the European Committee of Social Rights declared “France has failed to achieve sufficient progress” in educating autistic children. The committee also slammed France for making autistic people “an excluded group” and said there was a chronic shortage of care.

Volkmar said some forms of psychotherapy might be helpful for high-functioning autistic children to handle specific problems like anxiety, but should not be considered a first-line treatment. He said the vast majority of autistic children in the U.S. — more than 95 percent — attend school.

But French children with autism are lagging far behind. According to government data, fewer than 20 percent of autistic children attend school. Mostly they’re either kept at home or go to a day hospital for psychiatric sessions.

Many French experts insist psychotherapy is essential. “I would never say that psychoanalysis is ‘the best’ method, but it is invaluable,” said Marie Dominique Amy, president of CIPPA, a French association of psychotherapists and psychiatrists. She said even in autistic children who don’t speak, the therapy can be done through gestures and interpreting their body language.

Amy said she had nothing against behavioral methods, which could be included in a comprehensive treatment program. But she said it was impossible to accept the assessment from France’s top health authority that there was no consensus for the use of psychotherapy for treating autism.

Amy also said she had seen autistic children improve after being treated with a controversial therapy known as “packing.” That involves wrapping nearly naked children in wet, cold towels in an attempt to “reconnect” them with their bodies. The practice is rare, but is allowed in France as part of research projects. Amy said she had seen autistic children start talking, writing and drawing after the sessions. She said it was essential to get parents’ permission before trying packing.

According to the French Association of Psychiatrists, packing can sometimes produce “spectacular” results. The group said more autistic children in France could benefit from the method if authorities did not so tightly regulate its use.

Others condemn the practice as barbaric. “Not only is there no evidence that packing works, but it’s unthinkable something potentially dangerous and harmful would be performed on vulnerable children,” said Tony Charman, chair of autism at the Institute of Education in London.

Catherine Consel was horrified when she and her husband found out their autistic son Thomas, now 20, had been subjected to regular packing sessions for three years while he was treated in a Bordeaux hospital. “I was shocked,” Consel said. “We trusted the doctors to take care of him.” Consel and her husband found out about the packing sessions by chance years later, after Thomas’ hospital was featured in a television story about the technique.

She and her husband later demanded Thomas’ medical records, where psychiatrists wrote that his autism was the result of his parents’ mental problems. “It was very difficult to read what (Thomas) had been subjected to,” she said of the packing sessions. “They noted it all very precisely, how long it had taken and how he had screamed and cried,” she said.

Consel is convinced Thomas would have fared better had the family stayed in the U.S., where he was born. “There is only one way to do things in France,” she said. “And sometimes the government makes the wrong choice.”

Elsewhere in Europe, packing is unheard of and even psychotherapy is rare.

In Spain, for example, autism treatment guidelines published in 2006 lumped psychotherapy together with alternative therapies like chelation, which involves the injection of chemicals into the body to remove heavy metals. Spanish officials ruled there was no evidence such alternative treatments work.

Joaquin Fuentes, a psychiatrist and scientific adviser for a Spanish autism group, said that where he works in the Basque region, autistic children go to regular schools and none are sent to psychiatric hospitals. “To be exposed to psychoanalytic treatment is a painful and unethical way of treating children with autism,” he said.

Some French parents resort to sending their children abroad to get adequate treatment. When Andy Beverly’s son Guillaume was diagnosed as autistic at age 2, Guillaume began to receive treatment from psychiatrists in Paris.

“They said his autism was a psychosis and that Guillaume needed to figure out himself how to get over it,” Beverly said. After years of sporadic schooling in France, Beverly sent Guillaume to a school in Belgium that focuses on techniques to help him interact with others and do simple things like putting on his coat. He is convinced that Guillaume, now 15, would be more advanced if he’d gotten better treatment as a child.

“I started out having a lot of trust in the French doctors, but it was only later that I realized we were in the wrong country,” Beverly said. “The situation may finally be getting better, but for a lot of families with autistic children, that’s not enough.”

___

Online:

www.autismeurope.org

“Everyone’s first assumption is that Breivik must be insane because he’s done such terrible things,” said Dr. Simon Wessely, of the Institute of Psychiatry at King’s College London. “But it doesn’t automatically follow that he must be mad just because what he has done is inexplicable.”

In a commentary published Friday in the British medical journal Lancet, Wessely writes that explanation is too simplistic.

For the 33-year-old Norwegian to be schizophrenic — as some psychiatrists have suggested — his actions would have to be the result of delusions, or based on beliefs not shared by others.

“As ghastly as his views are, there are other people in society who believe countries are being destroyed by multiculturalism and Islam,” Wessely said.

Breivik’s extraordinarily well-organized and methodical massacre also undermines the idea that he was suffering from a serious mental illness.

“It doesn’t tally with the kinds of disorganized crimes usually committed by people with mental health problems,” Wessely said.

One Norwegian psychiatric report found Breivik to be insane, while a second concluded that he was sane. A panel of judges is hearing weeks of testimony to decide which is correct.

Breivik himself has slammed reports concluding that he is insane, describing them as based on “evil fabrications.” He said earlier this week the worst thing that could happen would be for officials to declare he has a mental illness, since that would “delegitimize” everything he stands for.

Breivik claims the attacks were “necessary” and that the victims — many of whom had some ties to the ruling Labor Party — had betrayed Norway by embracing immigration.

Breivik claims to belong to an anti-Muslim militant group inspired by medieval crusaders and working with two other cells in Norway. Investigators have said they don’t believe the group exists, and prosecutor Seven Holder noted that the second psychiatric report described it as a “fantasy.”

Some experts said the publicly known information about Breivik and his crimes suggest he has a personality disorder, like psychopathy and narcissism. That may also be apparent in Breivik’s complete lack of empathy for his victims or his tendency to remain emotionless in court.

“The way he perceives the world is probably within the bounds of normality,” said Dr. Paul Keedwell, a psychiatrist at Cardiff University, who has not examined him and was not linked to the Lancet commentary.

“But because of the personality disorder, he may be overwhelmed by a sense of strong anger and indignation when he believes people are not listening to his point of view,” he said.

Keedwell said it was difficult to know the cause of Breivik’s condition without knowing more about his personal history. He hypothesized the crimes could have been the result of a series of bad decisions after Breivik had his mind “warped” by far-right propaganda.

“The question society has to decide is what part mental illness played and at what point he will be held accountable for his vile actions.”

If found guilty and sane, Breivik will face 21 years in prison, though he could be held longer if deemed a danger to society. If declared insane, he would be committed to mandatory psychiatric care.

___

Online:

www.lancet.com

But the figures come with a big grain of salt; scientists only had solid data for 65 countries. For the 128 others, they used modeling to come up with their estimates.

Despite the major dent, the progress fails to meet a WHO target to cut measles deaths by 90 percent by 2010.

“This is still a huge success,” said Peter Strebel, a measles expert at WHO and one of the authors of the study. “You don’t reduce measles deaths by three quarters without significantly accelerating efforts.”

He noted that the global 85 percent vaccination coverage rate was the highest ever recorded.

The study was paid for by the U.S. Centers for Disease Control and Prevention and was published Tuesday in the journal, Lancet.

Measles is one of the most infectious diseases that exists and mostly affects children. It causes a fever, cough and a rash all over the body. The disease kills about one to two children for every 1,000 it infects and can also cause pregnant women to have a miscarriage or premature birth.

Past progress in reducing measles has led some health officials to consider whether they can eradicate it. Smallpox is the only human disease to have been wiped out. Other initiatives to rid the world of diseases including polio and guinea worm remain largely stalled.

“I am cautious about adopting too many eradication campaigns at once,” said Nancy Leys Stepan, author of a book on disease eradication and a professor at Columbia University. She was not linked to the study.

Stepan said problems like getting good data and the challenges of eradication make it more reasonable to stick to deadlines for reducing measles rather than trying to eliminate it.

In recent years, the disease has surged in Europe — the number of people infected since 2007 has tripled. Doctors say measles cases are rebounding in Europe because people don’t realize how serious the disease is and are skeptical of the vaccine.

The first measles shot was licensed in the U.S. in 1963 and is now widely included in routine childhood immunization programs in developed countries. Last year was the worst year for measles in the U.S. in 15 years, with 222 cases — mostly imported by foreign visitors or by U.S. residents infected overseas.

Daniel Berman, a vaccines expert at Medecins Sans Frontieres, noted there has been a massive increase in measles across Africa in the last two years, largely because of backsliding on immunization campaigns and declining funds.

“The challenge is to find ways to make measles campaigns happen in countries with weak systems,” he said.

Berman said it would be hard to dramatically improve the 74 percent drop in measles deaths and that it would probably plateau.

WHO’s Strebel said just maintaining the decline in measles still requires a major effort. He added experts are not ready to set any eradication deadlines.

“Let’s wait until we get a bit closer to the top of the mountain before we say if we can get there,” he said.

____

Online:

www.lancet.com

http://www.who.int/topics/measles/en/

“If women are suffering from serious menopause symptoms and have had a hysterectomy, then estrogen alone is a reasonable approach,” said Garnet Anderson, of the Fred Hutchinson Cancer Research Center in Seattle and the study’s lead author.

Doctors have long prescribed hormones for women after menopause to relieve symptoms like hot flashes and night sweats. The pills were also believed to be good for bones, the heart and have other health benefits.

In the 1990s, researchers began a large, U.S. funded study, known as the Women’s Health Initiative, looking at the effects of estrogen-progestin combination pills and estrogen-only therapies. The estrogen-progestin part of the study was stopped in 2002 when the combo pill was linked to higher risks for heart attacks and breast cancer. In 2004, the estrogen study was halted after researchers detected stroke and blood clot risks in that group.

Those results shook up conventional wisdom about hormone replacement therapies and led women to stop taking them in droves. Now the advice is to take the hormones to relieve symptoms at the lowest dose possible for the shortest amount of time because of the potential risks.

Estrogen-only pills are recommended for the approximately 25 percent of women in menopause who have had hysterectomies. Other women are prescribed the combo pill: estrogen alone can raise their risk of cancer of the uterus.

In the new analysis, Anderson and colleagues tracked more than 7,600 postmenopausal women aged 50 to 79 who had a hysterectomy. Roughly half took estrogen while the other half took placebo pills for about six years. Most women in both groups had yearly mammograms. The women were followed for about 12 years.

In the group that took estrogen, there were 151 cases of breast cancer versus 199 in those on fake pills. That amounted to a 23 percent lower risk of cancer, researchers said.

In women who developed breast cancer, there were six deaths among those who had taken estrogen compared to 16 in those who took placebos. The lower risk of breast cancer didn’t apply to women with a family history of the disease or those who previously had benign breast lumps.

Doctors said women should not take estrogen to lower their breast cancer risk since the hormone comes with slightly higher chances of stroke and blood clots. Research published last year found those problems appeared to fade after women stopped taking the pills.

“Estrogen on its own appears to be safe,” said Dr. Anthony Howell, professor of medical oncology at the University of Manchester, who co-authored a commentary in journal.

Scientists aren’t sure why estrogen appeared to lower the risk of breast cancer, but Howell said altering the amount of estrogen in the body might help stop tumor growth, since fluctuating levels could interfere with tumor development.

Other experts weren’t convinced. “It’s inconsistent with the totality of evidence that finds estrogen increases breast cancer risk,” said Valerie Beral, director of the cancer epidemiology unit at Oxford University. She said the analysis was a subset of a larger trial that wasn’t designed to specifically look at breast cancer.

“If you want to take hormone replacement therapy, estrogen-only has a much lesser effect on breast cancer than with progestin,” she said. “But to say it protects against breast cancer is wrong.”

Dr. Peter Bowen-Simpkins, medical director of the London Women’s Clinic and a spokesman for Britain’s Royal College of Obstetricians and Gynaecologists, said the study was still reassuring news for women who had hysterectomies seeking relief from menopausal symptoms.

“A lot of their suffering could be spared,” he said.

“If women are suffering from serious menopause symptoms and have had a hysterectomy, then estrogen alone is a reasonable approach,” said Garnet Anderson, of the Fred Hutchinson Cancer Research Center in Seattle and the study’s lead author.

Doctors have long prescribed hormones for women after menopause to relieve symptoms like hot flashes and night sweats. The pills were also believed to be good for bones, the heart and have other health benefits.

In the 1990s, researchers began a large, U.S. funded study, known as the Women’s Health Initiative, looking at the effects of estrogen-progestin combination pills and estrogen-only therapies. The estrogen-progestin part of the study was stopped in 2002 when the combo pill was linked to higher risks for heart attacks and breast cancer. In 2004, the estrogen study was halted after researchers detected stroke and blood clot risks in that group.

Those results shook up conventional wisdom about hormone replacement therapies and led women to stop taking them in droves. Now the advice is to take the hormones to relieve symptoms at the lowest dose possible for the shortest amount of time because of the potential risks.

Estrogen-only pills are recommended for the approximately 25 percent of women in menopause who have had hysterectomies. Other women are prescribed the combo pill: estrogen alone can raise their risk of cancer of the uterus.

In the new analysis, Anderson and colleagues tracked more than 7,600 postmenopausal women aged 50 to 79 who had a hysterectomy. Roughly half took estrogen while the other half took placebo pills for about six years. Most women in both groups had yearly mammograms. The women were followed for about 12 years.

In the group that took estrogen, there were 151 cases of breast cancer versus 199 in those on fake pills. That amounted to a 23 percent lower risk of cancer, researchers said.

In women who developed breast cancer, there were six deaths among those who had taken estrogen compared to 16 in those who took placebos. The lower risk of breast cancer didn’t apply to women with a family history of the disease or those who previously had benign breast lumps.

Doctors said women should not take estrogen to lower their breast cancer risk since the hormone comes with slightly higher chances of stroke and blood clots. Research published last year found those problems appeared to fade after women stopped taking the pills.

“Estrogen on its own appears to be safe,” said Dr. Anthony Howell, professor of medical oncology at the University of Manchester, who co-authored a commentary in journal.

Scientists aren’t sure why estrogen appeared to lower the risk of breast cancer, but Howell said altering the amount of estrogen in the body might help stop tumor growth, since fluctuating levels could interfere with tumor development.

Other experts weren’t convinced. “It’s inconsistent with the totality of evidence that finds estrogen increases breast cancer risk,” said Valerie Beral, director of the cancer epidemiology unit at Oxford University. She said the analysis was a subset of a larger trial that wasn’t designed to specifically look at breast cancer.

“If you want to take hormone replacement therapy, estrogen-only has a much lesser effect on breast cancer than with progestin,” she said. “But to say it protects against breast cancer is wrong.”

Dr. Peter Bowen-Simpkins, medical director of the London Women’s Clinic and a spokesman for Britain’s Royal College of Obstetricians and Gynaecologists, said the study was still reassuring news for women who had hysterectomies seeking relief from menopausal symptoms.

“A lot of their suffering could be spared,” he said.

___

Online:

Journal: www.lancet.com