David Sternberg

BALTIMORE — Acknowledging that “flu has a huge news factor,” Bruce Gellin, M.D., spelled out the federal influenza pandemic preparedness plan at a biodefense research meeting sponsored by the American Society for Microbiology.

The Department of Health and Human Services' draft Pandemic Influenza Response and Preparedness Plan, developed in August 2004, includes influenza control, stockpiling vaccines, developing antiviral drugs and prophylaxis, providing quality medical care, and maintaining community services, said Dr. Gellin, director of the National Vaccine Program Office, a division of HHS. The World Health Organization originally developed pandemic preparedness guidelines in 1999 for other organizations to follow.

“There are a lot of unknowns,” said Dr. Gellin. “When will a pandemic occur? How bad will it be? And will there be major social and economic fallout? We need to continue to identify unmet questions.”

Improving vaccine preparedness is a major focus of the HHS plan. To that end, Dr. Gellin said the United States must enhance annual influenza vaccine use, ensure a year-round egg supply, increase and diversify U.S. manufacturing capacity, and improve the ability to rapidly develop reference strains.

As for antiviral drugs, the U.S. government currently stockpiles 2 million doses of Tamiflu (oseltamivir) and 4 million doses of Flumadine (rimantadine). He acknowledged the need for a greater stockpile of these drugs, as well as a push for other therapies besides antivirals.

Even in the case of a mild pandemic, Dr. Gellin emphasized the heightened need for inpatient medical services and effective triaging of patients, noting that there would be an estimated 25% increase in demand for inpatient beds, ICU beds, and ventilators.

A few key issues remain unresolved, according to Dr. Gellin, including determining priority groups for early vaccine and antiviral use in the event of a pandemic; purchase and distribution of public- and private-sector vaccinations; and legal issues, including indemnification, liability protection, and compensation.

Two other significant issues addressed in the pandemic plan are development of new vaccines and therapeutics.

Richard J. Webby, Ph.D., of St. Jude Children's Hospital in Memphis, pointed out the many considerations for creating a vaccine in response to an emerging influenza pandemic.

“There is no way of accurately predicting what strain it might be; there is enormous diversity of viruses in animal reservoirs, and some viruses are highly pathogenic,” he said.

But a procedure called reverse genetics has been significant in Dr. Webby's work at St. Jude's in accelerating the development of vaccines. Reverse genetics begins with a cloned segment of DNA and introduces programmed mutations back into the genome to investigate gene and protein function.

“Reverse genetics is likely to play a key role in future inactivated and attenuated vaccine strategies,” said Dr. Webby.

As for antivirals, the existing therapeutics are M2 ion channel inhibitors and neuraminidase inhibitors (NAIs), said Simon P. Tucker, Ph.D., of Biota Holdings Ltd., in Melbourne, Australia.

The M2s are Symmetrel (amantadine) and Flumadine, both of which are dosed at 100 mg twice a day. The NAIs are Relenza (zanamivir) and Tamiflu. Relenza is dosed at 10 mg twice daily and Tamiflu at 75 mg twice daily, said Dr. Tucker.

There are some basic differences between the two drug classes, Dr. Tucker said. M2s are used only for influenza A and have a high clinical resistance; NAIs are effective against both influenza A and B and have a low clinical resistance. For these reasons, NAIs, particularly Tamiflu, are prescribed more often than M2s. Most prescriptions are written by family physicians; most of the patients are aged 20-59 years.

Dr. Tucker noted that another drug class is under development—long-acting neuraminidase inhibitors (LANIs)—and has exhibited some early success.

One LANI monomer (R-118958) has shown to be more potent and more effective than Relenza, said Dr. Tucker. He noted a few of the advantages to LANIs: one-time-only therapy, once-weekly prophylaxis, and an optimal use for interpandemic cases.

Biota Holdings Ltd. was involved in the development of Relenza and is currently developing LANIs under a contract from the National Institutes of Health.

BALTIMORE — Acknowledging that “flu has a huge news factor,” Bruce Gellin, M.D., spelled out the federal influenza pandemic preparedness plan at a biodefense research meeting sponsored by the American Society for Microbiology.

The Department of Health and Human Services' draft Pandemic Influenza Response and Preparedness Plan, developed in August 2004, includes influenza control, stockpiling vaccines, developing antiviral drugs and prophylaxis, providing quality medical care, and maintaining community services, said Dr. Gellin, director of the National Vaccine Program Office, a division of HHS. The World Health Organization originally developed pandemic preparedness guidelines in 1999 for other organizations to follow.

“There are a lot of unknowns,” said Dr. Gellin. “When will a pandemic occur? How bad will it be? And will there be major social and economic fallout? We need to continue to identify unmet questions.”

Improving vaccine preparedness is a major focus of the HHS plan. To that end, Dr. Gellin said the United States must enhance annual influenza vaccine use, ensure a year-round egg supply, increase and diversify U.S. manufacturing capacity, and improve the ability to rapidly develop reference strains.

As for antiviral drugs, the U.S. government currently stockpiles 2 million doses of Tamiflu (oseltamivir) and 4 million doses of Flumadine (rimantadine). He acknowledged the need for a greater stockpile of these drugs, as well as a push for other therapies besides antivirals.

Even in the case of a mild pandemic, Dr. Gellin emphasized the heightened need for inpatient medical services and effective triaging of patients, noting that there would be an estimated 25% increase in demand for inpatient beds, ICU beds, and ventilators.

A few key issues remain unresolved, according to Dr. Gellin, including determining priority groups for early vaccine and antiviral use in the event of a pandemic; purchase and distribution of public- and private-sector vaccinations; and legal issues, including indemnification, liability protection, and compensation.

Two other significant issues addressed in the pandemic plan are development of new vaccines and therapeutics.

Richard J. Webby, Ph.D., of St. Jude Children's Hospital in Memphis, pointed out the many considerations for creating a vaccine in response to an emerging influenza pandemic.

“There is no way of accurately predicting what strain it might be; there is enormous diversity of viruses in animal reservoirs, and some viruses are highly pathogenic,” he said.

But a procedure called reverse genetics has been significant in Dr. Webby's work at St. Jude's in accelerating the development of vaccines. Reverse genetics begins with a cloned segment of DNA and introduces programmed mutations back into the genome to investigate gene and protein function.

“Reverse genetics is likely to play a key role in future inactivated and attenuated vaccine strategies,” said Dr. Webby.

As for antivirals, the existing therapeutics are M2 ion channel inhibitors and neuraminidase inhibitors (NAIs), said Simon P. Tucker, Ph.D., of Biota Holdings Ltd., in Melbourne, Australia.

The M2s are Symmetrel (amantadine) and Flumadine, both of which are dosed at 100 mg twice a day. The NAIs are Relenza (zanamivir) and Tamiflu. Relenza is dosed at 10 mg twice daily and Tamiflu at 75 mg twice daily, said Dr. Tucker.

There are some basic differences between the two drug classes, Dr. Tucker said. M2s are used only for influenza A and have a high clinical resistance; NAIs are effective against both influenza A and B and have a low clinical resistance. For these reasons, NAIs, particularly Tamiflu, are prescribed more often than M2s. Most prescriptions are written by family physicians; most of the patients are aged 20-59 years.

Dr. Tucker noted that another drug class is under development—long-acting neuraminidase inhibitors (LANIs)—and has exhibited some early success.

One LANI monomer (R-118958) has shown to be more potent and more effective than Relenza, said Dr. Tucker. He noted a few of the advantages to LANIs: one-time-only therapy, once-weekly prophylaxis, and an optimal use for interpandemic cases.

Biota Holdings Ltd. was involved in the development of Relenza and is currently developing LANIs under a contract from the National Institutes of Health.

BALTIMORE — Acknowledging that “flu has a huge news factor,” Bruce Gellin, M.D., spelled out the federal influenza pandemic preparedness plan at a biodefense research meeting sponsored by the American Society for Microbiology.

The Department of Health and Human Services' draft Pandemic Influenza Response and Preparedness Plan, developed in August 2004, includes influenza control, stockpiling vaccines, developing antiviral drugs and prophylaxis, providing quality medical care, and maintaining community services, said Dr. Gellin, director of the National Vaccine Program Office, a division of HHS. The World Health Organization originally developed pandemic preparedness guidelines in 1999 for other organizations to follow.

“There are a lot of unknowns,” said Dr. Gellin. “When will a pandemic occur? How bad will it be? And will there be major social and economic fallout? We need to continue to identify unmet questions.”

Improving vaccine preparedness is a major focus of the HHS plan. To that end, Dr. Gellin said the United States must enhance annual influenza vaccine use, ensure a year-round egg supply, increase and diversify U.S. manufacturing capacity, and improve the ability to rapidly develop reference strains.

As for antiviral drugs, the U.S. government currently stockpiles 2 million doses of Tamiflu (oseltamivir) and 4 million doses of Flumadine (rimantadine). He acknowledged the need for a greater stockpile of these drugs, as well as a push for other therapies besides antivirals.

Even in the case of a mild pandemic, Dr. Gellin emphasized the heightened need for inpatient medical services and effective triaging of patients, noting that there would be an estimated 25% increase in demand for inpatient beds, ICU beds, and ventilators.

A few key issues remain unresolved, according to Dr. Gellin, including determining priority groups for early vaccine and antiviral use in the event of a pandemic; purchase and distribution of public- and private-sector vaccinations; and legal issues, including indemnification, liability protection, and compensation.

Two other significant issues addressed in the pandemic plan are development of new vaccines and therapeutics.

Richard J. Webby, Ph.D., of St. Jude Children's Hospital in Memphis, pointed out the many considerations for creating a vaccine in response to an emerging influenza pandemic.

“There is no way of accurately predicting what strain it might be; there is enormous diversity of viruses in animal reservoirs, and some viruses are highly pathogenic,” he said.

But a procedure called reverse genetics has been significant in Dr. Webby's work at St. Jude's in accelerating the development of vaccines. Reverse genetics begins with a cloned segment of DNA and introduces programmed mutations back into the genome to investigate gene and protein function.

“Reverse genetics is likely to play a key role in future inactivated and attenuated vaccine strategies,” said Dr. Webby.

As for antivirals, the existing therapeutics are M2 ion channel inhibitors and neuraminidase inhibitors (NAIs), said Simon P. Tucker, Ph.D., of Biota Holdings Ltd., in Melbourne, Australia.

The M2s are Symmetrel (amantadine) and Flumadine, both of which are dosed at 100 mg twice a day. The NAIs are Relenza (zanamivir) and Tamiflu. Relenza is dosed at 10 mg twice daily and Tamiflu at 75 mg twice daily, said Dr. Tucker.

There are some basic differences between the two drug classes, Dr. Tucker said. M2s are used only for influenza A and have a high clinical resistance; NAIs are effective against both influenza A and B and have a low clinical resistance. For these reasons, NAIs, particularly Tamiflu, are prescribed more often than M2s. Most prescriptions are written by family physicians; most of the patients are aged 20-59 years.

Dr. Tucker noted that another drug class is under development—long-acting neuraminidase inhibitors (LANIs)—and has exhibited some early success.

One LANI monomer (R-118958) has shown to be more potent and more effective than Relenza, said Dr. Tucker. He noted a few of the advantages to LANIs: one-time-only therapy, once-weekly prophylaxis, and an optimal use for interpandemic cases.

Biota Holdings Ltd. was involved in the development of Relenza and is currently developing LANIs under a contract from the National Institutes of Health.

BALTIMORE — Acknowledging that “flu has a huge news factor,” Bruce Gellin, M.D., spelled out the federal influenza pandemic preparedness plan at a biodefense research meeting sponsored by the American Society for Microbiology.

The Department of Health and Human Services' draft Pandemic Influenza Response and Preparedness Plan, developed in August 2004, includes influenza control, stockpiling vaccines, developing antiviral drugs and prophylaxis, providing quality medical care, and maintaining community services, said Dr. Gellin, director of the National Vaccine Program Office, a division of HHS. The World Health Organization originally developed pandemic preparedness guidelines in 1999 for other organizations to follow.

“There are a lot of unknowns,” said Dr. Gellin. “When will a pandemic occur? How bad will it be? And will there be major social and economic fallout? We need to continue to identify unmet questions.”

Improving vaccine preparedness is a major focus of the HHS plan. To that end, Dr. Gellin said the United States must enhance annual influenza vaccine use, ensure a year-round egg supply, increase and diversify U.S. manufacturing capacity, and improve the ability to rapidly develop reference strains.

As for antiviral drugs, the U.S. government currently stockpiles 2 million doses of Tamiflu (oseltamivir) and 4 million doses of Flumadine (rimantadine). He acknowledged the need for a greater stockpile of these drugs, as well as a push for other therapies besides antivirals.

Even in the case of a mild pandemic, Dr. Gellin emphasized the heightened need for inpatient medical services and effective triaging of patients, noting that there would be about a 25% increase in demand for inpatient and ICU beds, and ventilators.

A few key issues remain unresolved, according to Dr. Gellin, including determining priority groups for early vaccine and antiviral use in the event of a pandemic; purchase and distribution of public- and private-sector vaccinations; and legal issues, including indemnification, liability protection, and compensation.

Two other significant issues addressed in the pandemic plan are development of new vaccines and therapeutics.

Richard J. Webby, Ph.D., of St. Jude Children's Hospital in Memphis, pointed out the many considerations for creating a vaccine in response to an emerging influenza pandemic.

“There is no way of accurately predicting what strain it might be; there is enormous diversity of viruses in animal reservoirs, and some viruses are highly pathogenic,” he said.

But a procedure called reverse genetics has been significant in Dr. Webby's work at St. Jude's in accelerating the development of vaccines. Reverse genetics begins with a cloned segment of DNA and introduces programmed mutations back into the genome to investigate gene and protein function.

“Reverse genetics is likely to play a key role in future inactivated and attenuated vaccine strategies,” said Dr. Webby.

As for antivirals, the existing therapeutics are M2 ion channel inhibitors and neuraminidase inhibitors (NAIs), said Simon P. Tucker, Ph.D., of Biota Holdings Ltd., in Melbourne, Australia.

The M2s are Symmetrel (amantadine) and Flumadine, both of which are dosed at 100 mg twice a day. The NAIs are Relenza (zanamivir) and Tamiflu. Relenza is dosed at 10 mg twice daily and Tamiflu at 75 mg twice daily, said Dr. Tucker.

There are some basic differences between the two drug classes, Dr. Tucker said. M2s are used only for influenza A and have a high clinical resistance; NAIs are effective against both influenza A and B and have a low clinical resistance.

For these reasons, NAIs, particularly Tamiflu, are prescribed more often than M2s, he said. Most prescriptions are written by family physicians; most of the patients are aged 20-59 years, he said.

Dr. Tucker noted that another drug class is under development—long-acting neuraminidase inhibitors (LANIs)—and has exhibited some early success.

One LANI monomer (R-118958) has been shown to be more potent and more effective than Relenza, said Dr. Tucker. He noted a few of the advantages to LANIs: one-time-only therapy, once-weekly prophylaxis, and an optimal use for interpandemic cases.

Biota Holdings Ltd. was involved in the development of Relenza and is currently developing LANIs under a contract from the National Institutes of Health.

BALTIMORE — Acknowledging that “flu has a huge news factor,” Bruce Gellin, M.D., spelled out the federal influenza pandemic preparedness plan at a biodefense research meeting sponsored by the American Society for Microbiology.

The Department of Health and Human Services' draft Pandemic Influenza Response and Preparedness Plan, developed in August 2004, includes influenza control, stockpiling vaccines, developing antiviral drugs and prophylaxis, providing quality medical care, and maintaining community services, said Dr. Gellin, director of the National Vaccine Program Office, a division of HHS. The World Health Organization originally developed pandemic preparedness guidelines in 1999 for other organizations to follow.

“There are a lot of unknowns,” said Dr. Gellin. “When will a pandemic occur? How bad will it be? And will there be major social and economic fallout? We need to continue to identify unmet questions.”

Improving vaccine preparedness is a major focus of the HHS plan. To that end, Dr. Gellin said the United States must enhance annual influenza vaccine use, ensure a year-round egg supply, increase and diversify U.S. manufacturing capacity, and improve the ability to rapidly develop reference strains.

As for antiviral drugs, the U.S. government currently stockpiles 2 million doses of Tamiflu (oseltamivir) and 4 million doses of Flumadine (rimantadine). He acknowledged the need for a greater stockpile of these drugs, as well as a push for other therapies besides antivirals.

Even in the case of a mild pandemic, Dr. Gellin emphasized the heightened need for inpatient medical services and effective triaging of patients, noting that there would be about a 25% increase in demand for inpatient and ICU beds, and ventilators.

A few key issues remain unresolved, according to Dr. Gellin, including determining priority groups for early vaccine and antiviral use in the event of a pandemic; purchase and distribution of public- and private-sector vaccinations; and legal issues, including indemnification, liability protection, and compensation.

Two other significant issues addressed in the pandemic plan are development of new vaccines and therapeutics.

Richard J. Webby, Ph.D., of St. Jude Children's Hospital in Memphis, pointed out the many considerations for creating a vaccine in response to an emerging influenza pandemic.

“There is no way of accurately predicting what strain it might be; there is enormous diversity of viruses in animal reservoirs, and some viruses are highly pathogenic,” he said.

But a procedure called reverse genetics has been significant in Dr. Webby's work at St. Jude's in accelerating the development of vaccines. Reverse genetics begins with a cloned segment of DNA and introduces programmed mutations back into the genome to investigate gene and protein function.

“Reverse genetics is likely to play a key role in future inactivated and attenuated vaccine strategies,” said Dr. Webby.

As for antivirals, the existing therapeutics are M2 ion channel inhibitors and neuraminidase inhibitors (NAIs), said Simon P. Tucker, Ph.D., of Biota Holdings Ltd., in Melbourne, Australia.

The M2s are Symmetrel (amantadine) and Flumadine, both of which are dosed at 100 mg twice a day. The NAIs are Relenza (zanamivir) and Tamiflu. Relenza is dosed at 10 mg twice daily and Tamiflu at 75 mg twice daily, said Dr. Tucker.

There are some basic differences between the two drug classes, Dr. Tucker said. M2s are used only for influenza A and have a high clinical resistance; NAIs are effective against both influenza A and B and have a low clinical resistance.

For these reasons, NAIs, particularly Tamiflu, are prescribed more often than M2s, he said. Most prescriptions are written by family physicians; most of the patients are aged 20-59 years, he said.

Dr. Tucker noted that another drug class is under development—long-acting neuraminidase inhibitors (LANIs)—and has exhibited some early success.

One LANI monomer (R-118958) has been shown to be more potent and more effective than Relenza, said Dr. Tucker. He noted a few of the advantages to LANIs: one-time-only therapy, once-weekly prophylaxis, and an optimal use for interpandemic cases.

Biota Holdings Ltd. was involved in the development of Relenza and is currently developing LANIs under a contract from the National Institutes of Health.

BALTIMORE — Acknowledging that “flu has a huge news factor,” Bruce Gellin, M.D., spelled out the federal influenza pandemic preparedness plan at a biodefense research meeting sponsored by the American Society for Microbiology.

The Department of Health and Human Services' draft Pandemic Influenza Response and Preparedness Plan, developed in August 2004, includes influenza control, stockpiling vaccines, developing antiviral drugs and prophylaxis, providing quality medical care, and maintaining community services, said Dr. Gellin, director of the National Vaccine Program Office, a division of HHS. The World Health Organization originally developed pandemic preparedness guidelines in 1999 for other organizations to follow.

“There are a lot of unknowns,” said Dr. Gellin. “When will a pandemic occur? How bad will it be? And will there be major social and economic fallout? We need to continue to identify unmet questions.”

Improving vaccine preparedness is a major focus of the HHS plan. To that end, Dr. Gellin said the United States must enhance annual influenza vaccine use, ensure a year-round egg supply, increase and diversify U.S. manufacturing capacity, and improve the ability to rapidly develop reference strains.

As for antiviral drugs, the U.S. government currently stockpiles 2 million doses of Tamiflu (oseltamivir) and 4 million doses of Flumadine (rimantadine). He acknowledged the need for a greater stockpile of these drugs, as well as a push for other therapies besides antivirals.

Even in the case of a mild pandemic, Dr. Gellin emphasized the heightened need for inpatient medical services and effective triaging of patients, noting that there would be about a 25% increase in demand for inpatient and ICU beds, and ventilators.

A few key issues remain unresolved, according to Dr. Gellin, including determining priority groups for early vaccine and antiviral use in the event of a pandemic; purchase and distribution of public- and private-sector vaccinations; and legal issues, including indemnification, liability protection, and compensation.

Two other significant issues addressed in the pandemic plan are development of new vaccines and therapeutics.

Richard J. Webby, Ph.D., of St. Jude Children's Hospital in Memphis, pointed out the many considerations for creating a vaccine in response to an emerging influenza pandemic.

“There is no way of accurately predicting what strain it might be; there is enormous diversity of viruses in animal reservoirs, and some viruses are highly pathogenic,” he said.

But a procedure called reverse genetics has been significant in Dr. Webby's work at St. Jude's in accelerating the development of vaccines. Reverse genetics begins with a cloned segment of DNA and introduces programmed mutations back into the genome to investigate gene and protein function.

“Reverse genetics is likely to play a key role in future inactivated and attenuated vaccine strategies,” said Dr. Webby.

As for antivirals, the existing therapeutics are M2 ion channel inhibitors and neuraminidase inhibitors (NAIs), said Simon P. Tucker, Ph.D., of Biota Holdings Ltd., in Melbourne, Australia.

The M2s are Symmetrel (amantadine) and Flumadine, both of which are dosed at 100 mg twice a day. The NAIs are Relenza (zanamivir) and Tamiflu. Relenza is dosed at 10 mg twice daily and Tamiflu at 75 mg twice daily, said Dr. Tucker.

There are some basic differences between the two drug classes, Dr. Tucker said. M2s are used only for influenza A and have a high clinical resistance; NAIs are effective against both influenza A and B and have a low clinical resistance.

For these reasons, NAIs, particularly Tamiflu, are prescribed more often than M2s, he said. Most prescriptions are written by family physicians; most of the patients are aged 20-59 years, he said.

Dr. Tucker noted that another drug class is under development—long-acting neuraminidase inhibitors (LANIs)—and has exhibited some early success.

One LANI monomer (R-118958) has been shown to be more potent and more effective than Relenza, said Dr. Tucker. He noted a few of the advantages to LANIs: one-time-only therapy, once-weekly prophylaxis, and an optimal use for interpandemic cases.

Biota Holdings Ltd. was involved in the development of Relenza and is currently developing LANIs under a contract from the National Institutes of Health.

Psychiatrists across the country, having argued for years that adolescents' brains function differently from those of adults, applauded last month's Supreme Court ruling that abolished juvenile executions.

In a 5-4 vote, the court concluded that the death penalty for minors—those under 18 at the time they committed the crime—was unconstitutional and represented cruel and unusual punishment.

“I am pleased and quite happy with the court's decision,” said David Fassler, M.D., a child and adolescent psychiatrist in Burlington, Vt. “The decision is a reinforcement of what we all know in the psychiatric community—that the brains of adolescents function differently [from those of] adults.”

Cynthia Pfeffer, M.D., a child psychiatrist at New York-Presbyterian Hospital, agreed.

“I think the court took a developmental view, which was very appropriate. From the perspective of development, children and adolescents are not the same as adults regarding neurobiological development,” she said.

Brain-development differences between adolescents and adults, say many child and adolescent psychiatrists, affect judgment, behavior, impulse control, and decision-making ability. Teens, with their still-maturing brains, rely more on impulsivity than rational and goal-oriented thought.

“Adolescents are still capable of change; their future behaviors are not yet fixed,” Dr. Fassler said. “It's important to remember that adolescents know the difference between right and wrong. But when it comes to capital punishment, it should be reserved for fully functioning and developed adults with a greater capacity to control and modify their behavior.”

Dr. Fassler, also of the University of Vermont, said he was pleased the medical community spoke with a unified voice on the issue.

Last October, Dr. Fassler was one of many attending the oral arguments on this case in front of the Supreme Court.

Several organizations, including the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Society of Adolescent Psychiatry, and the National Mental Health Association, have long opposed the death penalty for juvenile offenders.

The United States had been one of only three countries to maintain the practice of executing juvenile offenders; Iran and the Democratic Republic of the Congo are the others.

Last month's decision means 72 juvenile offenders on death rows in 12 states will be resentenced. Prior to last month, 20 states allowed executions of juvenile offenders. Since 1973, 22 juvenile offenders have been executed.

The ruling will also prohibit execution of defendants in pending cases, including then-17-year-old Lee Boyd Malvo, who, along with John Allen Muhammad, is responsible for killing 10 people in the Washington, D.C., area in October 2002. He will spend the remainder of his life in prison.

The high court decision overturned a 1989 ruling upholding the death penalty for 16- and 17-year-old offenders.

The impetus for the Supreme Court's new ruling was the case of Roper v. Simmons. In 1993, Christopher Simmons, then 17, and two younger accomplices broke into a neighbor's home, intending to burglarize it. When the neighbor, Shirley Crook, awoke and recognized him, Mr. Simmons tied her up, put duct tape over her eyes and mouth, put her in a minivan and threw her off a railroad bridge south of St. Louis. Crook drowned in the waters below.

Prosecutors described the crime as “wantonly vile, horrible, and inhuman,” and the jury sentenced Mr. Simmons to die. Two years ago, Missouri's highest court overturned that sentence because of Mr. Simmons' age at the time of the crime, forcing the Supreme Court to revisit the issue.

“From a moral standpoint, it would be misguided to equate the failings of a minor with those of an adult, for a greater possibility exists that a minor's character deficiencies will be reformed,” wrote Justice Anthony A. Kennedy.

Justices John Paul Stevens, David H. Souter, Ruth Bader Ginsburg, and Stephen G. Breyer joined Justice Anthony A. Kennedy's opinion setting 18 years as the minimum age for capital punishment. In addition to their arguments about brain development, they noted that in nearly every state, 18 is the minimum age for voting, serving on juries, and obtaining marriage licenses without parental permission.

Texas' juvenile offenders may be the biggest beneficiary of the court's ruling. Of the 72 juvenile defenders on death row, by far the largest number (29) is in Texas, a fact not lost on Christopher R. Thomas, M.D., professor of child and adolescent psychiatry at the University of Texas, Galveston. He said a lot of people think the ruling will spark an increase in juvenile violence. But states that have decided to abolish juvenile executions have not seen an increase in violent crimes among juveniles, said Dr. Thomas, who is also the chair of the rights and legal matters committee at the American Academy of Child and Adolescent Psychiatrists.

Lee Haller, M.D., who teaches forensic psychiatry at Children's Hospital in Washington and maintains a private practice in Potomac, Md., noted that “there is simply no evidence that executing juveniles does anything to act as a deterrent to crime.”

Early intervention and greater access to mental health services, not the death penalty, say psychiatrists, are what's needed for juvenile offenders.

Dr. Haller suggests comprehensive or “wraparound” services—psychotropic medication, behavioral therapy, and case management—as an early intervention for children and adolescents. Specifically, he noted the importance of groups that teach social skills, anger management, and impulse control. Dr. Thomas acknowledged the importance of gang prevention and substance abuse counseling.

Psychiatrists across the country, having argued for years that adolescents' brains function differently from those of adults, applauded last month's Supreme Court ruling that abolished juvenile executions.

In a 5-4 vote, the court concluded that the death penalty for minors—those under 18 at the time they committed the crime—was unconstitutional and represented cruel and unusual punishment.

“I am pleased and quite happy with the court's decision,” said David Fassler, M.D., a child and adolescent psychiatrist in Burlington, Vt. “The decision is a reinforcement of what we all know in the psychiatric community—that the brains of adolescents function differently [from those of] adults.”

Cynthia Pfeffer, M.D., a child psychiatrist at New York-Presbyterian Hospital, agreed.

“I think the court took a developmental view, which was very appropriate. From the perspective of development, children and adolescents are not the same as adults regarding neurobiological development,” she said.

Brain-development differences between adolescents and adults, say many child and adolescent psychiatrists, affect judgment, behavior, impulse control, and decision-making ability. Teens, with their still-maturing brains, rely more on impulsivity than rational and goal-oriented thought.

“Adolescents are still capable of change; their future behaviors are not yet fixed,” Dr. Fassler said. “It's important to remember that adolescents know the difference between right and wrong. But when it comes to capital punishment, it should be reserved for fully functioning and developed adults with a greater capacity to control and modify their behavior.”

Dr. Fassler, also of the University of Vermont, said he was pleased the medical community spoke with a unified voice on the issue.

Last October, Dr. Fassler was one of many attending the oral arguments on this case in front of the Supreme Court.

Several organizations, including the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Society of Adolescent Psychiatry, and the National Mental Health Association, have long opposed the death penalty for juvenile offenders.

The United States had been one of only three countries to maintain the practice of executing juvenile offenders; Iran and the Democratic Republic of the Congo are the others.

Last month's decision means 72 juvenile offenders on death rows in 12 states will be resentenced. Prior to last month, 20 states allowed executions of juvenile offenders. Since 1973, 22 juvenile offenders have been executed.

The ruling will also prohibit execution of defendants in pending cases, including then-17-year-old Lee Boyd Malvo, who, along with John Allen Muhammad, is responsible for killing 10 people in the Washington, D.C., area in October 2002. He will spend the remainder of his life in prison.

The high court decision overturned a 1989 ruling upholding the death penalty for 16- and 17-year-old offenders.

The impetus for the Supreme Court's new ruling was the case of Roper v. Simmons. In 1993, Christopher Simmons, then 17, and two younger accomplices broke into a neighbor's home, intending to burglarize it. When the neighbor, Shirley Crook, awoke and recognized him, Mr. Simmons tied her up, put duct tape over her eyes and mouth, put her in a minivan and threw her off a railroad bridge south of St. Louis. Crook drowned in the waters below.

Prosecutors described the crime as “wantonly vile, horrible, and inhuman,” and the jury sentenced Mr. Simmons to die. Two years ago, Missouri's highest court overturned that sentence because of Mr. Simmons' age at the time of the crime, forcing the Supreme Court to revisit the issue.

“From a moral standpoint, it would be misguided to equate the failings of a minor with those of an adult, for a greater possibility exists that a minor's character deficiencies will be reformed,” wrote Justice Anthony A. Kennedy.

Justices John Paul Stevens, David H. Souter, Ruth Bader Ginsburg, and Stephen G. Breyer joined Justice Anthony A. Kennedy's opinion setting 18 years as the minimum age for capital punishment. In addition to their arguments about brain development, they noted that in nearly every state, 18 is the minimum age for voting, serving on juries, and obtaining marriage licenses without parental permission.

Texas' juvenile offenders may be the biggest beneficiary of the court's ruling. Of the 72 juvenile defenders on death row, by far the largest number (29) is in Texas, a fact not lost on Christopher R. Thomas, M.D., professor of child and adolescent psychiatry at the University of Texas, Galveston. He said a lot of people think the ruling will spark an increase in juvenile violence. But states that have decided to abolish juvenile executions have not seen an increase in violent crimes among juveniles, said Dr. Thomas, who is also the chair of the rights and legal matters committee at the American Academy of Child and Adolescent Psychiatrists.

Lee Haller, M.D., who teaches forensic psychiatry at Children's Hospital in Washington and maintains a private practice in Potomac, Md., noted that “there is simply no evidence that executing juveniles does anything to act as a deterrent to crime.”

Early intervention and greater access to mental health services, not the death penalty, say psychiatrists, are what's needed for juvenile offenders.

Dr. Haller suggests comprehensive or “wraparound” services—psychotropic medication, behavioral therapy, and case management—as an early intervention for children and adolescents. Specifically, he noted the importance of groups that teach social skills, anger management, and impulse control. Dr. Thomas acknowledged the importance of gang prevention and substance abuse counseling.

Psychiatrists across the country, having argued for years that adolescents' brains function differently from those of adults, applauded last month's Supreme Court ruling that abolished juvenile executions.

In a 5-4 vote, the court concluded that the death penalty for minors—those under 18 at the time they committed the crime—was unconstitutional and represented cruel and unusual punishment.

“I am pleased and quite happy with the court's decision,” said David Fassler, M.D., a child and adolescent psychiatrist in Burlington, Vt. “The decision is a reinforcement of what we all know in the psychiatric community—that the brains of adolescents function differently [from those of] adults.”

Cynthia Pfeffer, M.D., a child psychiatrist at New York-Presbyterian Hospital, agreed.

“I think the court took a developmental view, which was very appropriate. From the perspective of development, children and adolescents are not the same as adults regarding neurobiological development,” she said.

Brain-development differences between adolescents and adults, say many child and adolescent psychiatrists, affect judgment, behavior, impulse control, and decision-making ability. Teens, with their still-maturing brains, rely more on impulsivity than rational and goal-oriented thought.

“Adolescents are still capable of change; their future behaviors are not yet fixed,” Dr. Fassler said. “It's important to remember that adolescents know the difference between right and wrong. But when it comes to capital punishment, it should be reserved for fully functioning and developed adults with a greater capacity to control and modify their behavior.”

Dr. Fassler, also of the University of Vermont, said he was pleased the medical community spoke with a unified voice on the issue.

Last October, Dr. Fassler was one of many attending the oral arguments on this case in front of the Supreme Court.

Several organizations, including the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Society of Adolescent Psychiatry, and the National Mental Health Association, have long opposed the death penalty for juvenile offenders.

The United States had been one of only three countries to maintain the practice of executing juvenile offenders; Iran and the Democratic Republic of the Congo are the others.

Last month's decision means 72 juvenile offenders on death rows in 12 states will be resentenced. Prior to last month, 20 states allowed executions of juvenile offenders. Since 1973, 22 juvenile offenders have been executed.

The ruling will also prohibit execution of defendants in pending cases, including then-17-year-old Lee Boyd Malvo, who, along with John Allen Muhammad, is responsible for killing 10 people in the Washington, D.C., area in October 2002. He will spend the remainder of his life in prison.

The high court decision overturned a 1989 ruling upholding the death penalty for 16- and 17-year-old offenders.

The impetus for the Supreme Court's new ruling was the case of Roper v. Simmons. In 1993, Christopher Simmons, then 17, and two younger accomplices broke into a neighbor's home, intending to burglarize it. When the neighbor, Shirley Crook, awoke and recognized him, Mr. Simmons tied her up, put duct tape over her eyes and mouth, put her in a minivan and threw her off a railroad bridge south of St. Louis. Crook drowned in the waters below.

Prosecutors described the crime as “wantonly vile, horrible, and inhuman,” and the jury sentenced Mr. Simmons to die. Two years ago, Missouri's highest court overturned that sentence because of Mr. Simmons' age at the time of the crime, forcing the Supreme Court to revisit the issue.

“From a moral standpoint, it would be misguided to equate the failings of a minor with those of an adult, for a greater possibility exists that a minor's character deficiencies will be reformed,” wrote Justice Anthony A. Kennedy.

Justices John Paul Stevens, David H. Souter, Ruth Bader Ginsburg, and Stephen G. Breyer joined Justice Anthony A. Kennedy's opinion setting 18 years as the minimum age for capital punishment. In addition to their arguments about brain development, they noted that in nearly every state, 18 is the minimum age for voting, serving on juries, and obtaining marriage licenses without parental permission.

Texas' juvenile offenders may be the biggest beneficiary of the court's ruling. Of the 72 juvenile defenders on death row, by far the largest number (29) is in Texas, a fact not lost on Christopher R. Thomas, M.D., professor of child and adolescent psychiatry at the University of Texas, Galveston. He said a lot of people think the ruling will spark an increase in juvenile violence. But states that have decided to abolish juvenile executions have not seen an increase in violent crimes among juveniles, said Dr. Thomas, who is also the chair of the rights and legal matters committee at the American Academy of Child and Adolescent Psychiatrists.

Lee Haller, M.D., who teaches forensic psychiatry at Children's Hospital in Washington and maintains a private practice in Potomac, Md., noted that “there is simply no evidence that executing juveniles does anything to act as a deterrent to crime.”

Early intervention and greater access to mental health services, not the death penalty, say psychiatrists, are what's needed for juvenile offenders.

Dr. Haller suggests comprehensive or “wraparound” services—psychotropic medication, behavioral therapy, and case management—as an early intervention for children and adolescents. Specifically, he noted the importance of groups that teach social skills, anger management, and impulse control. Dr. Thomas acknowledged the importance of gang prevention and substance abuse counseling.