Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.

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Catherine Saint Louis speaks about using SimplyThick in premature infants.

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Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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State seeks back taxes from small-business shareholders

SACRAMENTO — For almost two decades, California has provided a hefty tax break for residents owning shares of small businesses that keep most of their workers and assets in the state.

Not anymore. A court has thrown out the incentive, and now, to the frustration and anger of about 2,000 taxpayers, the state tax collector wants the money back, plus interest.

The Franchise Tax Board is going after four years' worth of these tax breaks. It recalculated the back taxes of people who benefited and mailed out a holiday surprise.

"It's a surreal situation," said Brian Overstreet of Healdsburg in the Sonoma County wine country. He said investors learned they owed taxes only in late December when the board sent out letters telling them the so-called qualified small-business capital gains tax incentive had been deemed unconstitutional.

"California is not a banana republic," said one critic, state Sen. Ted Lieu (D-Torrance). "California government should not punish innocent, law-abiding taxpayers retroactively just because it may have the power to do so."

Lieu says the state's move is questionable. In a strongly worded letter to the board, he called a staff decision to ask for the back taxes "an incredibly dangerous precedent" that could discourage businesses from locating in California.

Lieu is demanding that the board reverse its decision. He buttresses his argument by citing a number of U.S. Supreme Court decisions as a legal basis for a reversal.

The board says it's owed about $120 million in taxes plus accrued interest for earnings from Californians who sold stock in such small companies from 2008 through 2011.

In contention is a 1993 state law, which created the tax break for investors in companies with gross assets of less than $50 million. The law cut the tax rate on capital gains — profits made on stock sales — in half, to 4.5% from 9%.

But to ensure the tax break would boost the California economy, lawmakers mandated that at least 80% of the companies' payroll costs and assets had to be located in the Golden State.

And that's how the statute fell afoul of the U.S. Constitution — 19 years after it became law. In August, a state appeals court, ruling on a lawsuit brought by an investor whose stock holdings didn't meet the 80%-in-California test, invalidated the law because it interfered with interstate commerce: granting a special benefit to stockholders in California small businesses that investors in similar out-of-state companies couldn't get.

Tax officials argue that the court's finding gave them no choice but to demand retroactive taxes.

"If the statute is invalid, it can't be enforced," said board spokeswoman Denise Azimi. "To cure discrimination we have to treat all taxpayers alike."

The only way to keep the tax break and still satisfy the court would be to drop the requirement that the small-business investment be primarily in California, making the incentive available to all investors, regardless of a company's location, she said.

Such a change can be done only by the state Legislature's passing a new version of the 1993 law, the board's attorneys insist.

That's the plan being put together by California Business Defense, a just-organized group, backed by the Bay Area Council, an alliance of large, high-tech companies from the San Francisco-Silicon Valley region.

"A lot of people are just waking up to the fact that this is happening," Overstreet said. "We want to recraft the issue and hand it back to the FTB to do what they do, which is to enforce the law."

So far, Overstreet and the business group have gained support from a couple of lawmakers. Assemblyman Bob Wieckowski (D-Fremont) has submitted draft legislation aimed at preserving the tax break to the Legislature's attorneys that could be introduced as a bill this month.

For his part, Lieu argues that the Franchise Tax Board could fix the problem without passage of new legislation.

"The FTB staff is wrong, wrong, wrong to say this issue requires action by the Legislature," he said. "The FTB staff is misleading the public."

The board, which comprises the state controller, the director of the Department of Finance and the chairman of the state Board of Equalization, has the authority to grant the tax break to all investors, Lieu asserted. It should reverse its demand for retroactive taxes, which Lieu says violates the due process requirement of the U.S. Constitution.

"It's wrong to sock it to these taxpayers," he said, "after they relied on the law the way it was written."

marc.lifsher@latimes.com

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Manson follower parole decision in Gov. Jerry Brown's hands

Bruce Davis, a former member of the Manson Family, moments before the start of his parole hearing in October. (Joe Johnston, The Tribune)

By Paige St. John

February 4, 2013, 2:58 p.m.

It is up to Gov. Jerry Brown whether to release a now-70 follower of murderer Charles Manson.

For at least the second time, the California Board of Parole Hearings has recommended the release of Bruce Davis, imprisoned since 1972 for his role in the murder of two men, a musician and a stuntman. Brown has 30 days to decide whether to allow Davis' release, refer it for a full parole board hearing or follow then-Gov. Arnold Schwarzenegger's example and deny parole.

Manson and his followers killed nine people in July and August 1969, including actress Sharon Tate, and attempted to blame the slaying on black militants. Manson was already standing trial in 1970 for the Tate murders when Davis turned himself in at the Los Angeles County courthouse. He was convicted in two slayings and sentenced to life in prison.

California corrections officials previously rejected Davis' bid for parole 25 times before recommending in 2010 and again in October that parole be granted.

On Friday, the Board of Parole Hearings determined that the recommendation contained no legal errors and forwarded it to Brown.

"I am sorry for who I was and what I did," Davis wrote in a letter submitted to the earlier parole board. "I am now focused on compensating for the lives I destroyed by promoting life-enriching and violence-preventing lifestyles at every opportunity."

L.A. County Dist. Atty. Jackie Lacey wrote a letter to the Board of Parole Hearings objecting to Davis' release.

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Joe Pesci settles dispute over 'Gotti' film payday

LOS ANGELES (AP) — Joe Pesci has settled a lawsuit filed against a company planning a biopic on the Gotti crime family.

The Oscar-winner sued Fiore Films in July 2011 claiming the filmmakers reneged on a deal for a $3 million role in the film and were offering him a lesser part in the project and a lower payday.

Pesci's attorney Jessica Trotter confirmed Monday that a settlement had been reached in the case but said she could not provide any details.

Michael Froch, an attorney for Fiore Films, said he could only confirm the case had been dismissed.

Pesci's lawsuit stated the actor gained 30 pounds in anticipation of playing a childhood friend and enforcer of crime boss John Gotti Sr.

The film, "Gotti: In the Shadow of My Father," has not started filming.

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Well: Gluten-Free for the Gluten Sensitive

Eat no wheat.

That is the core, draconian commandment of a gluten-free diet, a prohibition that excises wide swaths of American cuisine — cupcakes, pizza, bread and macaroni and cheese, to name a few things.

For the approximately one-in-a-hundred Americans who have a serious condition called celiac disease, that is an indisputably wise medical directive.

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Kenneth Chang speaks about gluten.

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Now medical experts largely agree that there is a condition related to gluten other than celiac. In 2011 a panel of celiac experts convened in Oslo and settled on a medical term for this malady: non-celiac gluten sensitivity.

What they still do not know: how many people have gluten sensitivity, what its long-term effects are, or even how to reliably identify it. Indeed, they do not really know what the illness is.

The definition is less a diagnosis than a description — someone who does not have celiac, but whose health improves on a gluten-free diet and worsens again if gluten is eaten. It could even be more than one illness.

“We have absolutely no clue at this point,” said Dr. Stefano Guandalini, medical director of the University of Chicago’s Celiac Disease Center.

Kristen Golden Testa could be one of the gluten-sensitive. Although she does not have celiac, she adopted a gluten-free diet last year. She says she has lost weight and her allergies have gone away. “It’s just so marked,” said Ms. Golden Testa, who is health program director in California for the Children’s Partnership, a national nonprofit advocacy group.

She did not consult a doctor before making the change, and she also does not know whether avoiding gluten has helped at all. “This is my speculation,” she said. She also gave up sugar at the same time and made an effort to eat more vegetables and nuts.

Many advocates of gluten-free diets warn that non-celiac gluten sensitivity is a wide, unseen epidemic undermining the health of millions of people. They believe that avoiding gluten — a composite of starch and proteins found in certain grassy grains like wheat, barley and rye — gives them added energy and alleviates chronic ills. Oats, while gluten-free, are also avoided, because they are often contaminated with gluten-containing grains.

Others see the popularity of gluten-free foods as just the latest fad, destined to fade like the Atkins diet and avoidance of carbohydrates a decade ago.

Indeed, Americans are buying billions of dollars of food labeled gluten-free each year. And celebrities like Miley Cyrus, the actress and singer, have urged fans to give up gluten. “The change in your skin, physical and mental health is amazing!” she posted on Twitter in April.

For celiac experts, the anti-gluten zeal is a dramatic turnaround; not many years ago, they were struggling to raise awareness among doctors that bread and pasta can make some people very sick. Now they are voicing caution, tamping down the wilder claims about gluten-free diets.

“It is not a healthier diet for those who don’t need it,” Dr. Guandalini said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.”

Nonetheless, Dr. Guandalini agrees that some people who do not have celiac receive a genuine health boost from a gluten-free diet. He just cannot say how many.

As with most nutrition controversies, most everyone agrees on the underlying facts. Wheat entered the human diet only about 10,000 years ago, with the advent of agriculture.

“For the previous 250,000 years, man had evolved without having this very strange protein in his gut,” Dr. Guandalini said. “And as a result, this is a really strange, different protein which the human intestine cannot fully digest. Many people did not adapt to these great environmental changes, so some adverse effects related to gluten ingestion developed around that time.”

The primary proteins in wheat gluten are glutenin and gliadin, and gliadin contains repeating patterns of amino acids that the human digestive system cannot break down. (Gluten is the only substance that contains these proteins.) People with celiac have one or two genetic mutations that somehow, when pieces of gliadin course through the gut, cause the immune system to attack the walls of the intestine in a case of mistaken identity. That, in turn, causes fingerlike structures called villi that absorb nutrients on the inside of the intestines to atrophy, and the intestines can become leaky, wreaking havoc. Symptoms, which vary widely among people with the disease, can include vomiting, chronic diarrhea or constipation and diminished growth rates in children.

The vast majority of people who have celiac do not know it. And not everyone who has the genetic mutations develops celiac.

What worries doctors is that the problem seems to be growing. After testing blood samples from a century ago, researchers discovered that the rate of celiac appears to be increasing. Why is another mystery. Some blame the wheat, as some varieties now grown contain higher levels of gluten, because gluten helps provide the springy inside and crusty outside desirable in bread. (Blame the artisanal bakers.)

There are also people who are allergic to wheat (not necessarily gluten), but until recently, most experts had thought that celiac and wheat allergy were the only problems caused by eating the grain.

For 99 out of 100 people who don’t have celiac — and those who don’t have a wheat allergy — the undigested gliadin fragments usually pass harmlessly through the gut, and the possible benefits of a gluten-free diet are nebulous, perhaps nonexistent for most. But not all.

Anecdotally, people like Ms. Golden Testa say that gluten-free diets have improved their health. Some people with diseases like irritable bowel syndrome and arthritis also report alleviation of their symptoms, and others are grasping at gluten as a source of a host of other conditions, though there is no scientific evidence to back most of the claims. Experts have been skeptical. It does not make obvious sense, for example, that someone would lose weight on a gluten-free diet. In fact, the opposite often happens for celiac patients as their malfunctioning intestines recover.

They also worried that people could end up eating less healthfully. A gluten-free muffin generally contains less fiber than a wheat-based one and still offers the same nutritional dangers — fat and sugar. Gluten-free foods are also less likely to be fortified with vitamins.

But those views have changed. Crucial in the evolving understanding of gluten were the findings, published in 2011, in The American Journal of Gastroenterology, of an experiment in Australia. In the double-blind study, people who suffered from irritable bowel syndrome, did not have celiac and were on a gluten-free diet were given bread and muffins to eat for up to six weeks. Some of them were given gluten-free baked goods; the others got muffins and bread with gluten. Thirty-four patients completed the study. Those who ate gluten reported they felt significantly worse.

That influenced many experts to acknowledge that the disease was not just in the heads of patients. “It’s not just a placebo effect,” said Dr. Marios Hadjivassiliou, a neurologist and celiac expert at the University of Sheffield in England.

Even though there was now convincing evidence that gluten sensitivity exists, that has not helped to establish what causes gluten sensitivity. The researchers of the Australian experiment noted, “No clues to the mechanism were elucidated.”

What is known is that gluten sensitivity does not correlate with the genetic mutations of celiac, so it appears to be something distinct from celiac.

How widespread gluten sensitivity may be is another point of controversy.

Dr. Thomas O’Bryan, a chiropractor turned anti-gluten crusader, said that when he tested his patients, 30 percent of them had antibodies targeting gliadin fragments in their blood. “If a person has a choice between eating wheat or not eating wheat,” he said, “then for most people, avoiding wheat would be ideal.”

Dr. O’Bryan has given himself a diagnosis of gluten sensitivity. “I had these blood sugar abnormalities and didn’t have a handle where they were coming from,” he said. He said a blood test showed gliadin antibodies, and he started avoiding gluten. “It took me a number of years to get completely gluten-free,” he said. “I’d still have a piece of pie once in a while. And I’d notice afterwards that I didn’t feel as good the next day or for two days. Subtle, nothing major, but I’d notice that.”

But Suzy Badaracco, president of Culinary Tides, Inc., a consulting firm, said fewer people these days were citing the benefits of gluten-free diets. She said a recent survey of people who bought gluten-free foods found that 35 percent said they thought gluten-free products were generally healthier, down from 46 percent in 2010. She predicted that the use of gluten-free products would decline.

Dr. Guandalini said finding out whether you are gluten sensitive is not as simple as Dr. O’Bryan’s antibody tests, because the tests only indicate the presence of the fragments in the blood, which can occur for a variety of reasons and do not necessarily indicate a chronic illness. For diagnosing gluten sensitivity, “There is no testing of the blood that can be helpful,” he said.

He also doubts that the occurrence of gluten sensitivity is nearly as high as Dr. O’Bryan asserts. “No more than 1 percent,” Dr. Guandalini said, although he agreed that at present all numbers were speculative.

He said his research group was working to identify biological tests that could determine gluten sensitivity. Some of the results are promising, he said, but they are too preliminary to discuss. Celiac experts urge people to not do what Ms. Golden Testa did — self-diagnose. Should they actually have celiac, tests to diagnose it become unreliable if one is not eating gluten. They also recommend visiting a doctor before starting on a gluten-free diet.

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This post has been revised to reflect the following correction:

Correction: February 4, 2013

An earlier version of this article misspelled the surname of Thomas O'Bryan. It is O'Bryan, not O'Brien.

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CVS' Medicare drug program causing headaches for enrollees

Deborah Shapiro decided a few months ago to switch her prescription drug coverage from her former employer's plan to Medicare. The Medicare literature made clear that she could save hundreds of dollars on the various drugs she and her husband required.

Shapiro, 76, of Woodland Hills, studied her options carefully and decided to enroll in SilverScript, the Medicare-approved drug program run by CVS Caremark.

That turned out to be not such a good decision after all.

Shapiro was one of many seniors who found themselves facing inexplicably large bills that CVS refused to negotiate. As a result of cases like hers, CVS was sanctioned last month by Medicare, which means the company can't enroll new people in SilverScript until it cleans up its act.

The federal Centers for Medicare and Medicaid Services said in a letter to CVS' SilverScript subsidiary that its inability to process prescriptions correctly "poses a serious threat to the health and safety of Medicare beneficiaries."

The federal agency blamed the problems on "widespread data system failures" that have "created disruptions in tens of thousands of Medicare beneficiaries' access to prescription medications."

SilverScript handles the drug requirements of about 4 million Medicare beneficiaries.

In Shapiro's case, she told me that she'd ordered a 90-day supply of an estrogen pill that was supposed to cost $85. Instead, SilverScript sent her a 30-day supply running $70.61.

Shapiro said she got the runaround from three separate CVS supervisors until a company representative finally insisted that she had to take what she was given and pay the amount CVS was demanding.

She said the company deemed the $70.61 bill a "transition fee" from her former drug insurer, which, as it happens, was also run by CVS.

"They need to charge me a transition fee from CVS to CVS?" Shapiro said. "That makes no sense."

CVS blamed its SilverScript troubles on "an enrollment system conversion" that "brought about an increase in call volume and issues related to claims processing."

"We take these issues very seriously and are committed to working swiftly with [Medicare] officials to address their areas of concern," said Jon Roberts, president of CVS' pharmacy benefit management business.

He also said the company will work to resolve any issues for patients that have come up as a result of the problem. Presumably that means Shapiro and others can expect their sky-high drug bills to be revisited in a more accommodating manner by CVS service reps.

Medicare says it received 2,340 complaints about SilverScript in just the first two weeks of January — a rate four times greater than for all other Medicare-approved drug programs combined.

The agency said in its letter to CVS that the sanction will remain in place until officials are "satisfied that the deficiencies upon which the determination was based have been corrected and are not likely to recur."

This isn't CVS' first brush with regulatory scrutiny. As I've reported, the company is now being investigated by federal and state authorities for having refilled prescriptions and billed insurers without patients' approval.

CVS has blamed such incidents on overzealous pharmacy managers and said the practice doesn't represent company policy. But internal emails and documents I've obtained suggest the unauthorized refills were more widespread than CVS would have customers believe.

The U.S. Justice Department also is looking into whether CVS violated a $17.5-million settlement reached with federal authorities in 2011 over allegedly falsified claims to Medicaid programs in California and nine other states.

The Justice Department is working with the U.S. Department of Health and Human Services. California and New Jersey regulators also are probing CVS' refill practices.

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Court urges charges be reinstated for paparazzo in Bieber chase

An appeals court has recommended that charges be reinstated for a photographer who chased singer Justin Bieber on the 101 Freeway in the first case involving a California anti-paparazzi law that was deemed unconstitutional by a Los Angeles County judge.

The conclusion of the court's preliminary analysis of the case means that the judge who invalidated the law as a violation of the 1st Amendment must reconsider his decision or stand by it and have the three-judge appeals panel conduct a full hearing.

Superior Court Judge Thomas Rubinson ruled in November that although Los Angeles city prosecutors could proceed with traffic-related charges against Paul Raef, the two other charges related to the anti-paparazzi driving law did not pass constitutional muster.

But City Atty. Carmen Trutanich appealed Rubinson's decision.

The appeals court indicated in its initial analysis last week that the special vehicle code for punishing photographers who drive dangerously to obtain images to sell does not violate the 1st Amendment.

"The statute is not constitutionally infirm because it is neither vague nor over-broad," the panel wrote.

The notice of intent is not an order or a ruling, but the trial judge can revisit the decision based on the preliminary conclusions.

"The city attorney continues to believe that the law is constitutional, protects public safety and welcomes the notice issued by the appellate division," the city attorney's office said in a statement. "We look forward to another opportunity to hear the matter in the trial court."

The appellate division gave Rubinson 15 days to vacate his ruling and hold a hearing. If the judge declines to vacate his decision, the appellate judges will proceed to a briefing and oral arguments.

"We are optimistic that the trial judge will stand by the ruling," Dmitry Gorin, one of Raef's lawyers, said.

In his November ruling, Rubinson said the law passed by the state Legislature violated 1st Amendment protections by overreaching and by potentially affecting such people as wedding photographers or photographers speeding to a location where a celebrity was present.

His ruling came less than six months after Bieber was pulled over by the California Highway Patrol on the 101 Freeway in the San Fernando Valley and cited for driving his Fisker sports car at high speed. The pop star said he was being chased by a freelance paparazzo later identified as Raef.

Los Angeles city prosecutors filed charges against the 30-year-old photographer for allegedly chasing Bieber and then speeding off when police tried to pull over both Bieber and Raef.

Raef was charged with reckless driving, failing to obey a peace officer, two counts of following another vehicle too closely and reckless driving with the intent to capture pictures for commercial gain.

richard.winton@latimes.com

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BlackBerry Z10 Smartphone Already Going for $1,500 on eBay

The new BlackBerry Z10 smartphone won’t be out for weeks, but you can already get your hands on it via eBay for about $ 1,500.

BlackBerry — the company formerly known as Research In Motion (RIM) — announced the new smartphone at an event earlier this week and handed out samples to guests and members of the press in attendance. It didn’t take long for the Z10, which could potentially turn around the struggling company, to pop up on eBay.

[More from Mashable: BlackBerry’s Secret Weapon: Women]

One page notes “this particular device was given to all attendees of the Jan. 30, 2013 product launch.”

[More from Mashable: Don’t Hold Your Breath for More BlackBerry Tablets]

BlackBerry didn’t tell attendees what they can or can’t do with the device, which comes unlocked, according to the listing, and without a SIM card.

Four units are currently being sold on eBay, with bids starting at $ 800 and rising quickly. The auction for the one going for $ 1,500, which has eight bids so far, will end this afternoon.

Images by Mashable and via eBay, eBay

Click here to view the gallery: BlackBerry Z10 Review

This story originally published on Mashable here.

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Keys sings national anthem on piano at Super Bowl

Alicia Keys performed a lounge-y, piano-tinged — and live — version of the national anthem ahead of the Super Bowl on Sunday.

The Grammy-winning singer played the piano as she sang "The Star Spangled Banner" with her eyes shut. Her publicist said the performance was live, days after halftime performer Beyonce admitted singing along to a prerecorded track at the Inauguration.

Keys' version was soft and featured additional lyrics: She added "living in the home" before belting "home of the brave" as she finished the song.

Before Keys hit the field, Jennifer Hudson performed "America the Beautiful" with the 26-member Sandy Hook Elementary School chorus.

The students and Hudson wore green ribbons on their shirts in honor of the 20 first-graders and six adults who were killed in a Dec. 14 shooting rampage.

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Concerns About A.D.H.D. Practices and Amphetamine Addiction

Before his addiction, Richard Fee was a popular college class president and aspiring medical student. "You keep giving Adderall to my son, you're going to kill him," said Rick Fee, Richard's father, to one of his son's doctors.

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

Matt Eich for The New York Times

MENTAL HEALTH CLINIC Dominion Psychiatric Associates in Virginia Beach, where Richard Fee was treated by Dr. Waldo M. Ellison. After observing Richard and hearing his complaints about concentration, Dr. Ellison diagnosed attention deficit hyperactivity disorder and prescribed the stimulant Adderall.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.

“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”

“...when he was in elementary school he fidgeted, daydreamed and got A’s. he has been an A-B student until mid college when he became scattered and he wandered while reading He never had to study. Presently without medication, his mind thinks most of the time, he procrastinated, he multitasks not finishing in a timely manner.”

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that he was taking Vyvanse for A.D.H.D.

Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year and that he had seen a doctor and received a diagnosis. His father reacted with surprise. Richard had never shown any A.D.H.D. symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Mr. Fee also expressed concerns about the safety of his son’s taking daily amphetamines for a condition he might not have.

“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”

This article has been revised to reflect the following correction:

Correction: February 3, 2013

An earlier version of a quote appearing with the home page presentation of this article misspelled the name of a medication. It is Adderall, not Aderall.

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