Report Faults Priorities in Breast Cancer Research

Too little of the money the federal government spends on breast cancer research goes toward finding environmental causes of the disease and ways to prevent it, according to a new report from a group of scientists, government officials and patient advocates established by Congress to examine the research.

The report, “Breast Cancer and the Environment — Prioritizing Prevention,” published on Tuesday, focuses on environmental factors, which it defines broadly to include behaviors, like alcohol intake and exercise; exposures to chemicals like pesticides, industrial pollutants, consumer products and drugs; radiation; and social and socioeconomic factors.

The 270-page report notes that scientists have long known that genetic and environmental factors contribute individually and also interact with one another to affect breast cancer risk. Studies of women who have moved from Japan to the United States, for instance, show that their breast cancer risk increases to match that of American women. Their genetics have not changed, so something in the environment must be having an effect. But what? Not much is known about exactly what the environmental factors are or how they affect the breast.

“We know things like radiation might cause breast cancer, but we don’t know much that we can say specifically causes breast cancer in terms of chemicals,” said Michael Gould, a professor of oncology at the University of Wisconsin, Madison, and a co-chairman of the 23-member committee that prepared the report.

At the two federal agencies that spend the most on breast cancer, only about 10 percent of the research in recent years involved environment and prevention. From 2008 to 2010, the National Institutes of Health spent $357 million on environmental and prevention-related research in breast cancer, about 16 percent of all the financing for the disease. From 2006 to 2010, the Department of Defense spent $52.2 million on prevention-oriented research, about 8.6 percent of the money devoted to breast cancer. Those proportions were too low, the group said, though it declined to say what the level should be.

“We’re hedging on that on purpose,” Dr. Gould said. “It wasn’t the role of the committee to suggest how much.”

He added, “We’re saying: ‘We’re not getting the job done. We don’t have the money to get the job done.’ The government will have to figure out what we need.”

Jeanne Rizzo, another member of the committee and a member of the Breast Cancer Fund, an advocacy group, said there was an urgent need to study and regulate chemical exposures and inform the public about potential risks. “We’re extending life with breast cancer, making it a chronic disease, but we’re not preventing it,” she said.

“We have to look at early life exposures, in utero, childhood, puberty, pregnancy and lactation,” Ms. Rizzo said. “Those are the periods when you get set up for breast cancer. How does a pregnant woman protect her child? How do we create policy so that she doesn’t have to be a toxicologist when she goes shopping?”

Michele Forman, a co-chairwoman of the committee and an epidemiologist and professor of nutritional sciences at the University of Texas, Austin, said the group found that breast cancer research at various government agencies was not well coordinated and that it was difficult to determine whether there was duplication of efforts.

She said that it was essential to study how environmental exposures at different times of life affected breast-cancer risk, and that certain animals were good models for human breast cancer and should be used more.

The report is the result of the Breast Cancer and Environmental Research Act, which was passed in 2008 and required the secretary of health and human services to create a committee to study breast cancer research. A third of the members were scientists, a third were from government and a third were from advocacy groups. The advocates, Dr. Forman said, brought a sense of urgency to the group

“People who are not survivors need to have that urgency there,” she said.

Pointing to the vaccine now being offered to girls to prevent cervical cancer, Dr. Forman said, “I look forward to the day when we have an early preventive strategy for breast cancer.”

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Bits: Where the Singles Are: A Dating Guide by ZIP Code

At Trulia, a residential real estate Web site, the analysts are constantly crunching data — home and apartment listings, prices, school ratings, crime rates and other numbers.

With Valentine’s Day coming this week, Jed Kolko, Trulia’s chief economist and head of analytics, decided to sift through household, gender, city and neighborhood data in America. If you’re looking for someone single of the opposite sex, where are your chances best and worst, statistically speaking?

He posted his findings on the Trulia Trends site on Monday.

According to Trulia’s analysis, men living alone most outnumber women living alone in Las Vegas; Honolulu; Palm Bay, Fla.; Gary, Ind.; and San Jose, Calif.

Women most outnumber men in Bethesda, Md.; Washington; Boston; New York; and Raleigh, N.C.

At the broader metropolitan level, Mr. Kolko said in an interview, labor markets are typically the determining factor. Men outnumber women in regions that have a higher proportion of technology, manufacturing and construction jobs. Women outnumber men most in places with more professional services jobs and in bigger cities.

The data sets for many thousands of ZIP codes, Mr. Kolko explained, all came from the 2010 census and were downloaded onto a laptop, then sliced, diced and manipulated using Stata data analysis and statistical software.

The data was massaged a bit. Only people living alone were counted; an earlier survey showed singles prefer to date someone who lives alone. And this time, Mr. Kolko factored out the gay and lesbian population, using the assumption that the share of gay or lesbian singles in neighborhoods would be roughly equal to same-sex couples living in those neighborhoods. (Last year, Mr. Kolko did an analysis of the ZIP code neighborhoods with the highest shares of gays and lesbians.)

Local industries may play a large role in gender populations for cities as a whole. But neighborhoods, Mr. Kolko said, are a more genuine reflection of where people want to live. So for each of the 10 largest metropolitan areas, he calculated the ZIP codes with the highest ratio of men to women, and women to men.

Men, Mr. Kolko observed, tend to settle near downtown or in recently redeveloped neighborhoods like the Waterfront in Boston or Long Island City in New York. Women are more likely to live in residential areas, including the Marina in San Francisco and Queen Anne in Seattle, and neighborhoods that are seen as safe and are more affluent, like the Upper East Side of New York and Upper Connecticut Avenue in Washington.

More women in high-income neighborhoods? Is this another sign of the much-discussed trend of women doing better than men? Mr. Kolko did not push the data that far. “It probably says more about where men and women choose to live in a given city rather than which gender is more successful,” he said.

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IHT Rendezvous: A Different Kind of Labyrinth in the London Underground

LONDON — The artist Mark Wallinger has a few strings to his bow: he spent 10 days in a bear suit in 2004 in the Neue Nationalgalerie in Berlin; he won the Turner Prize in 2007; he enjoyed a few days of media admiration/derision in 2009 when he proposed a 50-meter white horse as a public art project in Ebbsfleet in Kent.

On Thursday, Mr. Wallinger presented his newest work: a commission from the London Underground, for which he has created 270 individual panels — one for every Tube station — showing a labyrinth design in black on white square enamel panels. A small red cross marks a point of entry, and each panel is individually numbered, according to the order used by the winner of the Tube Challenge, an eccentric affair in which people compete to pass through every Tube stop on the network in the shortest possible time. (The current record is 16 hours, 29 minutes and 59 seconds.)

The Underground has long had a tradition of commissioning art. Its headquarters in St. James’s Park boasts reliefs by Henry Moore and Jacob Epstein among others, and its Art on the Underground program has shown admirable eclecticism in its choice of artists for commissioned posters, map brochures and in-station work. Mr. Wallinger’s Labyrinth project is part of Art on the Underground’s celebration, this year, of the Tube’s 150th anniversary.

“Something like 4 million people every day have an opportunity to encounter the art works,” said Tamsin Dillon, the head of Art on the Underground, in a statement marking the official opening of the project.

On the basis of visits, on Friday morning, to 4 of the 10 Tube stations at which the panels were displayed, and the remaining 260 stations will get theirs over the next few months, it seems clear that opportunity is one thing, actual encounters are another.

At Baker Street station (No. 58), my first stop, a friendly Tube employee went to find out where the panel was located and came to look at it with me. It was next to the Marylebone Road exit, near a few public phones. In and out streamed the passengers; no one except the two of us seemed to notice the new artwork. “Nice,” he said cautiously.

Similar indifference pertained at Oxford Circus (no. 60), Victoria (no. 103) and Green Park (no. 232), where a man stood consulting his cell phone right next to the panel without noticing it was there.

While this may be a bit discouraging for Mr. Wallinger and Ms. Dillon, there was something rather nice about seeking out the unobtrusively placed artworks, and a slightly Harry Potter-ish aspect to being the only person who could apparently see them as the rest of the world wandered by. Looking for the panels may not be the journey that Mr. Wallinger had in mind (unlike a maze, the labyrinth allows a straightforward passage between entrance and exit, and presumably symbolizes each passenger’s trajectory), but it’s a pleasant diversion in the hurly-burly of commuting. I see a Labyrinth Challenge coming up.

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Snedeker on the rise with Pebble win

PEBBLE BEACH, Calif. (AP) — Everything about Brandt Snedeker moves at warp speed, including his rapid rise into golf's elite.

He talks so fast that he always seems to be a few words short of a complete sentence. He plays fast, giving his hips a quick swivel to set his position before pulling the trigger. Even his putts go into the hole quickly, most of them struck with purpose instead of hope.

But when he reached the 18th tee box at Pebble Beach, he had to wait for the fairway to clear before taking a victory stroll up one of the prettiest closing holes in golf.

And that was OK with him.

"There's not much better place to be on the planet with a three-shot lead on that tee box," Snedeker said Sunday. "It felt pretty special there."

Indeed, Snedeker is in a special place.

With his 10th consecutive round in the 60s, Snedeker finally had a trophy to show for his astounding start to the 2013 season. He knew the opening seven holes were critical, and he made an eagle and three birdies to build a quick lead. He realized a late birdie would give him a cushion, and he fired at the flag on the par-3 17th to 10 feet below the cup and holed the putt. He closed with a 7-under 65 for a two-shot win over Chris Kirk in the Pebble Beach National Pro-Am.

It was the fifth win of his career, and his fourth in the last 22 months. But it's the last six months that have really turned heads.

He captured the $10 million FedEx Cup prize with a win at the Tour Championship, where he held off the likes of Rory McIlroy, Tiger Woods and Luke Donald going into the final round. He played in his first Ryder Cup. He started this year with a third-place at Kapalua, and runner-up finishes in consecutive weeks to Woods and Phil Mickelson, both of whom had big leads going into the final round.

Go back to the start of the FedEx Cup playoffs last August and Snedeker now has six top 3s in his last nine starts. Since missing the cut at the PGA Championship, he has broken par in 33 out of 37 rounds. No wonder he now is No. 4 in the world, the best ranking of his career.

"Just hard to put into words, to have a stretch of golf like I had the last couple of months," Snedeker said. "Something you dream about. Something you think that you can do, but you don't really know until you actually put it together. And I have.

"I'm really enjoying this, and hopefully can parlay this into the best year of my career."

Snedeker set the tournament record at 19-under 267, one shot better than Mickelson (2007) and Mark O'Meara (1997), who each had a 20-under 268 when Poppy Hills (par 72) was part of the rotation. It has been replaced by Monterey Peninsula, which is a par 70.

Chris Kirk closed with a 66 to finish alone in second, though he was never closer than two shots of the lead on the back nine and finished with a birdie. Kirk finished on 269, a score that would have been good enough to win all but four times at Pebble Beach since this tournament began in 1937.

"We've had a lot of tournaments like that on tour this year where somebody has really just kind of blitzed the field," Kirk said. "I felt like I played well enough to win a golf tournament and came up a little bit short."

Snedeker could have said the same thing — except for Woods at Torrey Pines, and Mickelson going obscenely low to win the Phoenix Open.

He wasn't about to take a back seat to anyone at Pebble Beach.

Snedeker started the final round tied with James Hahn, a 31-year-old rookie from the Bay Area, with Kirk one shot behind. He set the tone early with a 4-iron into the par-5 second hole that was on the edge of the left green. It hit the collar and kicked slightly to the right, rolling toward the pin until it settled 4 feet behind the cup.

"Kind of lucky, but it was a good shot, and to end up where it did was a great way to start the day," he said.

Hahn hit his approach high and pure, and it nearly hit Snedeker's ball before stopping 6 feet away. Hahn missed. Snedeker made. It was like that over the front nine.

Snedeker started to pull away with a 3-wood that came off the edge of the green, ran by the cup and stopped 20 feet away for a two-putt birdie. Then, he holed a 15-foot birdie putt on the seventh and was on his way.

Most impressive about Snedeker this week was bouncing back from bogey. He made five bogeys for the entire week, and four times made birdie on the next hole. On Sunday, his lone mistake was knocking an 18-foot birdie off the green and three-putting for bogey at No. 9.

The answer, like everything else about him, was fast and furious.

He knocked in a 25-foot birdie putt on the 10th, and then holed from 15 feet for birdie on the 12th. Right when it looked as though he would make another bogey on the par-3 12th, he made par from just short of 10 feet.

There's a reason Snedeker led the PGA Tour in putting last year, though it's his driving that has vastly improved. Snedeker studied some statistics last year that showed his odds of hitting the green go way up when he starts in the fairway. And once he's on the green, he's tough to beat.

Hahn, who shot 70 and tied for third, was looking forward to learning something from his debut in the final group, and he saw Snedeker put on a clinic.

"I learned that he is a better guy than he is a golfer. The dude is world class," Hahn said. "He's obviously one of the best, if not the best golfer right now, and possibly for the last year. But how he conducts himself as a person on an off the golf course, that's also world class. He deserved to win today. ... I'm sure if you ask him, it was never a doubt that he was going to win the golf tournament."

Snedeker concurred.

"I definitely didn't want to do anything but win today," he said. "I was out there for one purpose and one purpose only, and I was extremely focused all day. I did a great job of staying patient and I did a great job of playing the golf course the way you're supposed to play it."

And the outcome was just what he expected. The way he has been playing, it shouldn't have been any surprise to anyone.

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Well: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found here.

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Media Decoder Blog: NPR Campaign Seeks the Quirky Listener

Are you a sky diving algebra teacher? A Sudoku-playing barista? NPR has a new ad campaign aimed at you.

The pilot campaign, in four cities, is intended to bring new listeners to local public radio stations, and in turn NPR’s national programs, by matching a show to even the quirkiest interests.

The three-month campaign, financed with a $750,000 grant from the Ford Foundation and developed by Baltimore agency Planit, includes billboards, as well as television spots, social media outreach and rail, print and digital ads aimed at adults 25 to 54, with at least some college education. Ads point to a Web site, interestingradio.com, where visitors can take a poll, discover shows and click through to a live stream from a local station.

The ads will run in the Dallas/Fort Worth, San Diego, Indianapolis and Orlando, Fla., markets, chosen because they offer geographic diversity, as well as stations that are strong and growing, said Emma Carrasco, who joined NPR two months ago as chief marketing officer, a new position.

The campaign comes as listenership for “Morning Edition” and “All Things Considered” — NPR’s two top programs and the radio news programs that reach the most people nationwide each week — declined from spring 2011 to spring 2012, the last period for which national ratings are available.

Year-to-year, the cumulative weekday audience for “Morning Edition” declined 5 percent to 12.3 million listeners a week, from 13 million, NPR officials said, citing Arbitron ratings figures, while “All Things Considered” was off 4 percent, to 11.8 million weekly listeners, compared with 12.3 million in spring 2011.

Preliminary fall 2012 estimates showed year-to-year audience increases for those two shows, NPR said, but the figures were for major markets only.

Local public radio stations have undertaken similar efforts in recent years. WQXR’s modest 2011 “Obeythoven” campaign used TV spots to get audiences thinking about New York City classical music radio in a new way. Chicago’s WBEZ this month began a cheeky campaign called “2032 Membership Drive” encouraging audiences to procreate and raise a new generation of listeners.

If NPR’s new ads are deemed successful, NPR will seek additional funds to expand them to more markets, Ms. Carrasco said.

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IHT Rendezvous: Hungry Enough to Eat a Horse?

LONDON — As new revelations emerged in the great horse meat scandal gripping the European food industry, there was no indication it would dim the enthusiasm of Continental foodies for their favorite equine delicacies.

Aldi, a cut-price supermarket chain, was the latest retailer to take action, announcing late on Friday that it had removed spaghetti bolognese and beef lasagne from stores in Britain and Ireland after samples were found to contain up to 100 percent horse meat.

In France, meanwhile, fraud inspectors were attempting to track down the origin of the meat, supplied by Comigel, a French supplier, but possibly originating from as far afield as Romania.

Government officials in Britain, who were on Saturday meeting food retailers for crisis talks, have assured consumers there is nothing intrinsically unsafe about eating horse meat.

But, as my colleagues Stephen Castle and Douglas Dalby write, “Few things divide British eating habits from those of continental Europe as much as a distaste for consuming horse meat.”

In many parts of Europe, from Iceland to Italy, gourmets will happily tuck into horse and proclaim its superiority over the humble beef steak.

France’s C4N news Web site took a poke at the fastidious British by asking unwitting consumers of the contaminated products: “Well, was it good or not?”

Umberto Bacchi, writing at International Business Times of the joy of horse tartare, said the scandal would baffle food lovers in other parts of the world, from Italy to Japan.

“As my father comes from Parma, I have eaten my share of horse meat from an early age,” Mr. Bacchi told his readers. “My late grandmother’s fried horse meatballs were a huge hit with the family.”

He went on to extol the virtues of horse meat as high in iron and often recommended to pregnant women, children and the anemic.

“Above all else, however, it is tasty and tender, particularly when cooked for a short time. Hence, the preference for rare steaks or tartare preparations.”

In Belgium, discerning diners delight in having their fries cooked in horse fat, while some Austrians swear by the benefits of horse meat in their dumplings.

Despite the taboo on horse meat that exists in the English-speaking world, the more inquisitive Anglo foodies might at least be tempted to try it the next time they venture to the Continent.

But beware. The esoteric tastes of some Europeans don’t stop at horse. A Swiss newspaper revealed in December that many people in Switzerland still regularly eat dogs and cats.

Apparently it’s perfectly legal and the most popular breed of dog for eating is said to be a close relative of the Rottweiler.

“There’s nothing odd about it”, said one Swiss farmer. “Meat is meat.”

Is he right? The meat-eaters among us happily consume cows, sheep or pigs. So what’s wrong with horse, or even dog? Tell us what you think. And, if you’re a culinary adventurist, where would you draw the line?

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Michigan, Kansas go down as run continues

There goes another one, and another one.

No. 3 Michigan, fifth-ranked Kansas and No. 11 Louisville all lost on Saturday, continuing a perilous stretch for the Top 25.

The Wolverines became the third top-three team to fall this week when Ben Brust hit a tiebreaking 3-pointer with less than 40 seconds left in overtime, leading Wisconsin to a 65-62 victory. Brust also tied the game at the end of regulation with a heave from just inside halfcourt.

That's just the way it has gone lately for the top of the poll.

No. 2 Florida lost at Arkansas on Tuesday night, and No. 1 Indiana dropped a 74-72 decision at Illinois on Thursday. This should be the sixth straight week with a different No. 1 in The Associated Press' Top 25, which would be the second-longest streak since the first AP poll in 1949.

The Jayhawks have dropped three straight games for the first time in eight years after they lost 72-66 at Oklahoma.

"It hasn't been a good week for us by any stretch, but let's be real," Kansas coach Bill Self said. "We were ranked No. 2 in the country seven days ago, and you don't go from being a good team to a bad team overnight.

"We've had a couple of bad outings, but we're still a good team."

The current string of No. 1 swapping is the longest since 1994, when Arkansas, North Carolina, Kansas, UCLA and Duke alternated at the top seven straight weeks — the longest streak since Saint Louis debuted as No. 1 in the initial AP poll.

But it isn't just the teams at the top that are having trouble. Top 25 teams all over the country are getting knocked off by unranked opponents.

According to STATS LLC, Top 25 teams lost to unranked teams 36 times from Jan. 17 to Feb. 6 this season, most in at least 17 years.

Louisville lost 104-101 in five overtimes at No. 25 Notre Dame on Saturday night. It was the longest regular-season game in Big East history.

The Irish trailed by eight with 46 seconds left in regulation.

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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India Executes Man Tied to 2001 Attack on Parliament

MUMBAI - India on Saturday on Saturday hanged a man who was convicted of an attack on India’s Parliament in 2001 that killed nine people.

The hanging of Afzal Guru, a 43-year-old militant with the group Jaish-e-Mohammad, comes more than a decade after the Dec. 13, 2001, suicide attack on India’s parliament in which five gunmen opened fire, killing nine people, including security officials and one journalist. The execution drew protests from human rights groups concerned about the growing use of capital punishment in such cases.

Mr. Guru was convicted of conspiracy in the plot and sentenced to death by a special court in 2002. In 2004, the Supreme Court of India upheld the call for death sentence.

After the execution, clashes broke out in Mr. Guru’s hometown of Sopore, and police and paramilitary units were called to the scene to restore order.Days before the execution, President Pranab Mukherjee had rejected a mercy plea by Mr. Guru’s wife, according to reports from the Press Trust of India, paving the way for Mr. Guru’s hanging in the Tihar Jail complex, officials said.

Mr. Guru was originally from Sopore, in the northern part of the Kashmir. The clashes following his execution came despite the fact that in the hours following the hanging the Kashmir valley was placed under strict curfew in the anticipation of trouble from separatist leaders, according to reports. Authorities in the Srinagar asked citizens to remain indoors. They also closed the national highway for one day.

Omar Abdullah, the Jammu and Kashmir chief minister, appealed for peace and calm.

“I understand there is certain degree of angst and there are some people who would like to take advantage of the situation,” Mr. Abdullah said. “I appeal to the people to allow us to get through this with peace and not to restore to violent protests.”

Congress Party officials said that the execution was a sign that India would not tolerate acts of terror.

“We have sent a message to the world that we cannot tolerate terrorism at any cost. Anybody committing any acts of terror will be punished,” said Rashid Alvi, a Congress Party spokesman. “People of our country and government have zero tolerance for terrorism.”

But the opposition Bharatiya Janta Party criticized the government’s delay in carrying out the execution.

“The attack on the Indian Parliament happened in 2001, that is 12 years ago, which was an attack on India,” said Ravi Shankar Prasad, the Bharatiya Janta Party spokesman.

On Nov. 21, 2012, India hanged Ajmal Kasab, the sole surviving gunman from the November 2008 terror attacks in Mumbai, ending an eight-year moratorium on the death penalty and drawing criticism from rights groups, which they reiterated Saturday.

“The hanging of Afzal Guru, following closely behind the hanging of Ajmal Kasab in November, shows a very worrying trend by the Indian government,” said Meenakshi Ganguly, South Asia director for Human Rights Watch. “Human Rights Watch opposes the death penalty in all circumstances as an inherently irreversible, inhumane punishment.”

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