Labor Relations Board Rulings Could Be Undone

By ruling that Mr. Obama’s three recess appointments last January were illegal, the federal appeals court ruling, if upheld, would leave the board with just one member, short of the quorum needed to issue any rulings. The Obama administration could appeal the court ruling, but no announcement was made on Friday.

If the Supreme Court were to uphold Friday’s ruling, issued by the United States Court of Appeals for the District of Columbia Circuit, it would mean that the labor board did not have a quorum since last January and that all its rulings since then should be nullified.

Many Republicans and business groups applauded Friday’s ruling. They often assert that the appointments Mr. Obama made to the board have transformed it into a tool of organized labor. But many Democrats and labor unions say Mr. Obama’s appointments restored ideological balance to the board after it was tipped in favor of business interests under President George W. Bush

Mark G. Pearce, the board’s chairman, issued a statement saying the board disagreed with the ruling and suggested that other appeals courts hearing cases about the constitutionality of Mr. Obama’s appointments could reach a different conclusion.

“In the meantime, the board has important work to do,” said Mr. Pearce, whose agency oversees enforcement of the laws governing strikes and unionization drives. “We will continue to perform our statutory duties and issue decisions.”

Unless the Senate confirms future nominees to the board — Senate Republicans have blocked several of Mr. Obama’s board nominees — Mr. Pearce will be the only member left if Friday’s ruling is upheld. The board has five seats.

Representative Darrell Issa, a California Republican who is the chairman of the Oversight and Government Reform Committee, issued a statement that urged the recess appointees to “do the right thing and step down.” He added, “To avoid further damage to the economy, the N.L.R.B. must take the responsible course and cease issuing any further opinions until a constitutionally sound quorum can be established.”

The three disputed recess appointees included two Democrats, Sharon Block, deputy labor secretary, and Richard Griffin, general counsel to the operating engineers’ union; and one Republican, Terence Flynn, a counsel to a board member. Mr. Flynn resigned last May after being accused of leaking materials about the group’s deliberations. Another Republican member, Brian Hayes, stepped down when his term expired last month.

Read More..

40 Years After Roe v. Wade, Thousands March to Oppose Abortion

Drew Angerer/The New York Times

Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.

WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.

On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.

Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.

“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”

Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.

“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”

Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”

The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.

Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.

“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”

Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”

“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.

The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”

Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.

Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.

“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”

This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.

Read More..

40 Years After Roe v. Wade, Thousands March to Oppose Abortion

Drew Angerer/The New York Times

Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.

WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.

On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.

Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.

“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”

Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.

“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”

Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”

The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.

Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.

“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”

Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”

“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.

The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”

Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.

Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.

“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”

This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.

Read More..

Bits Blog: Apple Takes Aim at Providers of Under-Age Laborers

Labor recruiters in China last year knowingly provided underage workers to a supplier that built parts for products from Apple and other companies.

That finding was included in Apple’s 2013 report on labor conditions at its suppliers, where more than 1.5 million workers make or assemble the ingredients that go into the iPhone, iPad and other products. The report, posted late Thursday night, is the latest installment in the company’s annual assessment of how well its suppliers are complying with Apple’s code of conduct, which dictates standards for workplace safety and other labor conditions. The 2013 report is the result of 393 audits at Apple suppliers, the company said.

Apple said it found no cases of underage workers at its final assembly suppliers in 2012 — including big companies like Foxconn — but it discovered such violations deeper within its network of suppliers at subcontractors. Apple described in the report how “dishonest third-party labor agents” in China work to skirt Apple’s policy against underage laborers. In January of last year, Apple said it audited a company that makes circuit board components found in Apple’s and other companies’ products, Guangdong Real Faith Pingzhou Electronics Co., and discovered 74 cases of workers who were under the age of 16.

As part of the investigation, it found that Shenzhen Quanshun Human Resources Co., a large labor agency in China’s Shenzhen and Henan provinces, had provided the children to the maker of circuit board parts, conspiring with their families to forge documents to represent them as older than they were. Apple said it reported the labor agency to the provincial governments, which fined the agency and revoked its license. The children were returned to their families, Apple said in the report.

The report said Apple’s audits showed 92 percent compliance with its policy of a 60-hour maximum workweek.

Read More..

India Ink: Jeet Thayil's Novel of Opium and Bombay Takes DSC Prize

Jeet Thayil, an Indian poet and author, won the DSC Prize for South Asian Literature at the Jaipur Literature Festival on Friday for his debut novel “Narcopolis.”

“Finally!” Mr. Thayil exclaimed when he was presented the award. His book, about the narcotic underbelly of Bombay 30 years ago, had been short-listed for four awards, but never won any.

The award is special because it is an Indian prize, he said. “How you are perceived at home does matter,” he said.

The Kerala-born author will take home a $50,000 prize purse. Mr. Thayil noted that it was a substantial amount of money, and part of the reason that the award was taken seriously.

“Writers like money,” he said. “We don’t have a job, but we have bills to pay.”

Mr. Thayil is the first Indian to win the award since its introduction by the infrastructure company DSC Limited in 2010. The first winner was a Pakistani writer, H.M. Naqvi, for his debut novel the “Home Boy.” Last year the Sri Lankan author Shehan Karunatilake’ s novel “Chinaman” won the prize.

A five-member jury received more than 80 entries for the prize, including translations of non-English writing. The contest is open to any writing about South Asia, not just to South Asian writers. The Indian poet and literary critic K. Satchidanandan, who led the jury, said, the award is significant because it is the first award that honors literary works about South Asia.

Other finalists included two Indians, two Pakistanis and a Bangladeshi writer.

Jamil Ahmed, a Pakistani author whose book, “The Wandering Falcon,” was a finalist, said that it took 40 years to publish the book. The retired bureaucrat wrote about the tribal population living along the Pakistan-Afghanistan border. He was born in pre-partition India and during his childhood he traveled across India with his family. That was when he said he first came in contact with tribes, which led him to “romanticize the tribes.”

“I want people to understand that tribes are not savage,” he said.

A work by the Indian author Uday Prakash, “The Walls of Delhi,” was also a finalist. The book, actually three novellas, was originally written in Hindi. The stories highlight the flaws of the state, including bureaucracy and the deep entrenchment of corruption, and it is narrated by three characters, a weaver, sweeper and a baby in a slum suffering from an undiagnosed disease. Mr. Prakash said these narratives symbolized the lives led by 70 percent Indians.

Other finalists included the Indian writer Amitav Ghosh for his book “River of Smoke,” the Pakistani writer Mohammed Hanif, for “Our Lady of Alice Bhatti” and Tahmima Anam, the author of “The Good Muslim,” from Bangladesh.

Read More..

Storm-Damaged Homes Mean Lower Property Tax Revenues in New York Region

Localities across the New York region, already reeling from the cost of cleaning up from Hurricane Sandy, are confronting the prospect of an even bigger blow to their finances: a precipitous decline in property tax revenues.

The storm damaged tens of billions of dollars’ worth of real estate, especially in coastal areas of Long Island and New Jersey. As a result, localities can no longer expect to reap the same taxes from properties that have lost much of their value — in some cases, permanently.

Without new revenues, state and local officials and Wall Street analysts said, these areas may have to make deep cuts in spending on schools, police and fire departments and other services. They also may be hard-pressed to finance rebuilding.

“Absolutely, this is going to be devastating for several years,” said Ester Bivona, former president of the New York State Receivers and Collectors Association, which represents local tax officials.

The Division of Local Government Services in New Jersey estimated this month that more than a dozen municipalities in the state could lose at least 10 percent of their tax bases. About another 10 face a drop between 5 percent and 10 percent, state and local officials said.

Among the worst hit is Toms River, one of New Jersey’s largest municipalities, with 90,000 people. It recently warned Wall Street that property tax receipts could drop 10 percent to 15 percent, according to its financial disclosure documents.

Down the coast, the tiny borough of Tuckerton lost close to 20 percent of its property tax base. In Sea Bright, nearly half the homes are uninhabitable.

The situation is similar on Long Island, according to interviews with officials there.

The village of Freeport in Nassau County expects that many of its 15,000 homeowners will qualify for reductions in property tax bills, erasing at least 5 percent of property tax revenues and probably far more.

Experts said the looming revenue crisis for localities in the region underscores how natural disasters can have a profound effect long after the debris is gone.

If localities try to raise overall tax rates to make up for looming deficits, they may touch off a backlash from homeowners with undamaged properties.

“My thing is to encourage property owners to not seek reassessments because you’re going to pay on one end or the other,” said Andrew Hardwick, Freeport’s mayor. “If too many people seek reassessment and are successful with it, that means, how do you pay the bills on the other end? You raise the taxes again? It doesn’t make sense.”

Some localities, like Long Beach, on Long Island, had shaky finances before the storm and are now in deeper trouble, according to local budget records. But many others had been on solid financial ground.

Two major bond-rating agencies, Moody’s Investors Service and Standard & Poor’s, have expressed concerns in recent weeks about the fiscal stability of numerous municipalities in the region.

New York City and county governments in New York are far less reliant on property taxes than localities, so they are expected to have an easier time weathering a drop in the value of the tax base caused by storm damage. The city, for example, has its own income and business taxes.

What’s more, the city and county governments in both states have a much broader property tax base than small localities.

The $50.7 billion Hurricane Sandy relief bill approved this month by the House of Representatives provides up to $300 million in low-interest loans for localities facing shortfalls. The Senate has supported a similar provision in its own relief package.

But some local officials said such financing was not nearly enough. States themselves have not yet sent aid, and senior state officials said they were not inclined to do so until federal money was exhausted.

“It’s a pretty inescapable conclusion that there will be an impact on the tax base,” said Michael Drewniak, chief spokesman for Gov. Chris Christie of New Jersey.

“In many instances, we had homes completely wiped out or severely damaged to the point they were rendered uninhabitable,” Mr. Drewniak said. “That left behind rebuildable land but, in the meantime, no ‘improvements’ to tax. In other cases, people may find it cost prohibitive to rebuild at all, depending on their individual circumstances.”

It could be a year or two before the aftereffects are fully understood, given that localities will have to assess damaged properties before lowering property taxes on them.

Griff Palmer contributed reporting.

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The New Old Age Blog: Time to Recognize Mild Cognitive Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by.

It can make it easier or harder to get an insurance company or Medicare to cover treatments, for example. It factors into a variety of legal and governmental decisions.

And on a personal basis, a psychiatric diagnosis may be welcome (having a name and a treatment plan for what’s bothering us can be comforting) or not (are we really suffering from a mental disorder if we seem depressed after a family member dies?).

That last question refers to a change in the new DSM5, to be published in May, that has generated considerable controversy and that I discussed in an earlier post: the removal of the “bereavement exclusion,” once part of the diagnosis of Major Depressive Disorder.

Another element of the revised DSM could also affect readers: It will include something called Mild Neurocognitive Disorder. The task force revising the manual wanted to align psychiatry with the rest of medicine, which has already begun to distinguish between levels of impairment, said its chairman, David Kupfer, a University of Pittsburgh psychiatrist.

True enough, as we have reported before. Neurologists call it Mild Cognitive Impairment, a stage where cognitive decline becomes noticeable enough to affect daily functioning, yet people can still live independently and have not progressed to dementia.

In fact, a large proportion of people with mild cognitive problems never will develop dementia — but doctors and researchers cannot yet determine who will and who won’t. Biomarkers that could identify the biological brain changes that presage dementia are still years away.

Will it be helpful, then, for health professionals using the DSM5 — most of them not psychiatrists, but primary care doctors — to begin diagnosing Mild Neurocognitive Disorder? Particularly as there is no treatment that can reverse it or reliably slow its progression, if it would progress?

Dr. Ronald Petersen, director of the Mayo Clinic’s Alzheimer’s Disease Research Center and a member of the working group that developed the new DSM5 criteria, said he thought the newly recognized disorder would be useful. “The predementia phase is becoming increasingly important,” he told me in an interview.

Counseling could help people compensate for the memory loss and other deficits they are experiencing, for example. With a DSM-recognized diagnosis, those approaches are more likely to be covered by insurers.

Besides, “one argument against Alzheimer’s therapies is that we wait too late, when there’s too much damage to the central nervous system to repair,” Dr. Petersen said, referring to several recent disappointing drug trials. In the future, with earlier diagnoses, “you may be able to intervene, stop the process and forestall the dementia.”

But as we have seen with screening tests for other diseases, early detection does not always lead to better health or longer lives. It can, however, lead to unnecessary treatments and procedures involving risks of their own. Could that happen with Mild Neurocognitive Disorder?

“It will lead to wild overdiagnosis,” predicted Allen Frances, an emeritus professor of psychiatry at Duke and the chairman of the task force that developed the previous DSM edition. Indeed, about a quarter of people initially diagnosed with mild cognitive impairment are later determined to be normal, a prominent researcher told my colleague Judy Graham last year.

“People will get unnecessary tests and start getting weird treatments that have no proven efficacy,” said Dr. Frances, who has criticized a number of DSM5 changes. “They’re going to worry like crazy about being demented.”

Dr. Petersen agreed that it was a legitimate concern, but “by and large, we’re becoming better at distinguishing between the normal cognitive effects of aging and disease.” (The American Psychiatric Association will publish a specialized DSM for primary care physicians, Dr. Kupfer pointed out, to help guide them through diagnoses.)

It is hard for patients and families to know how to react when experts disagree. But keep in mind that contemporary health care aims for what is called shared decision-making. That means patients and professionals discuss options and weigh the risks and benefits of treatments and procedures, their likely outcomes, patients’ preferences, and come to agreement on how to proceed. This essay in the New England Journal of Medicine calls shared decision-making “the pinnacle of patient-centered care.”

So when Dr. Frances refers to the DSM5 as “a guide, not a bible,” and urges skepticism about some of its diagnoses, he is advocating an approach that patients and families should probably bring to any medical decision.

Seeking further information, asking questions, assessing options — those are reasonable responses if, a few weeks after a loved one’s death, a doctor says you may have major depression. Or if she thinks your memory loss could mean Mild Neurocognitive Disorder.

“The shorter the evaluation, the less the person knows you, the less he or she can explain and justify the diagnosis, the more tests and treatments that will result, the more a person should be cautious and get a second opinion,” Dr. Frances said.

Whatever the DSM5 says, it’s hard to argue with that.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

The New Old Age Blog: Time to Recognize Mild Cognitive Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by.

It can make it easier or harder to get an insurance company or Medicare to cover treatments, for example. It factors into a variety of legal and governmental decisions.

And on a personal basis, a psychiatric diagnosis may be welcome (having a name and a treatment plan for what’s bothering us can be comforting) or not (are we really suffering from a mental disorder if we seem depressed after a family member dies?).

That last question refers to a change in the new DSM5, to be published in May, that has generated considerable controversy and that I discussed in an earlier post: the removal of the “bereavement exclusion,” once part of the diagnosis of Major Depressive Disorder.

Another element of the revised DSM could also affect readers: It will include something called Mild Neurocognitive Disorder. The task force revising the manual wanted to align psychiatry with the rest of medicine, which has already begun to distinguish between levels of impairment, said its chairman, David Kupfer, a University of Pittsburgh psychiatrist.

True enough, as we have reported before. Neurologists call it Mild Cognitive Impairment, a stage where cognitive decline becomes noticeable enough to affect daily functioning, yet people can still live independently and have not progressed to dementia.

In fact, a large proportion of people with mild cognitive problems never will develop dementia — but doctors and researchers cannot yet determine who will and who won’t. Biomarkers that could identify the biological brain changes that presage dementia are still years away.

Will it be helpful, then, for health professionals using the DSM5 — most of them not psychiatrists, but primary care doctors — to begin diagnosing Mild Neurocognitive Disorder? Particularly as there is no treatment that can reverse it or reliably slow its progression, if it would progress?

Dr. Ronald Petersen, director of the Mayo Clinic’s Alzheimer’s Disease Research Center and a member of the working group that developed the new DSM5 criteria, said he thought the newly recognized disorder would be useful. “The predementia phase is becoming increasingly important,” he told me in an interview.

Counseling could help people compensate for the memory loss and other deficits they are experiencing, for example. With a DSM-recognized diagnosis, those approaches are more likely to be covered by insurers.

Besides, “one argument against Alzheimer’s therapies is that we wait too late, when there’s too much damage to the central nervous system to repair,” Dr. Petersen said, referring to several recent disappointing drug trials. In the future, with earlier diagnoses, “you may be able to intervene, stop the process and forestall the dementia.”

But as we have seen with screening tests for other diseases, early detection does not always lead to better health or longer lives. It can, however, lead to unnecessary treatments and procedures involving risks of their own. Could that happen with Mild Neurocognitive Disorder?

“It will lead to wild overdiagnosis,” predicted Allen Frances, an emeritus professor of psychiatry at Duke and the chairman of the task force that developed the previous DSM edition. Indeed, about a quarter of people initially diagnosed with mild cognitive impairment are later determined to be normal, a prominent researcher told my colleague Judy Graham last year.

“People will get unnecessary tests and start getting weird treatments that have no proven efficacy,” said Dr. Frances, who has criticized a number of DSM5 changes. “They’re going to worry like crazy about being demented.”

Dr. Petersen agreed that it was a legitimate concern, but “by and large, we’re becoming better at distinguishing between the normal cognitive effects of aging and disease.” (The American Psychiatric Association will publish a specialized DSM for primary care physicians, Dr. Kupfer pointed out, to help guide them through diagnoses.)

It is hard for patients and families to know how to react when experts disagree. But keep in mind that contemporary health care aims for what is called shared decision-making. That means patients and professionals discuss options and weigh the risks and benefits of treatments and procedures, their likely outcomes, patients’ preferences, and come to agreement on how to proceed. This essay in the New England Journal of Medicine calls shared decision-making “the pinnacle of patient-centered care.”

So when Dr. Frances refers to the DSM5 as “a guide, not a bible,” and urges skepticism about some of its diagnoses, he is advocating an approach that patients and families should probably bring to any medical decision.

Seeking further information, asking questions, assessing options — those are reasonable responses if, a few weeks after a loved one’s death, a doctor says you may have major depression. Or if she thinks your memory loss could mean Mild Neurocognitive Disorder.

“The shorter the evaluation, the less the person knows you, the less he or she can explain and justify the diagnosis, the more tests and treatments that will result, the more a person should be cautious and get a second opinion,” Dr. Frances said.

Whatever the DSM5 says, it’s hard to argue with that.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

Mark Zuckerberg Plans Fund-Raiser for Gov. Christie

Mel Evans/Associated Press

Gov. Chris Christie of New Jersey has found an unlikely ally in Mark Zuckerberg.

So much that Mr. Zuckerberg, a co-founder of Facebook, and his wife will hold a fund-raiser for him next month at their home in Palo Alto, Calif.

The fund-raiser is another reminder of the hurdles Democrats face in attempting to defeat Mr. Christie, who faces re-election in November and is often mentioned as a leading contender for the Republican presidential nomination in 2016.

Mr. Christie has increasingly tried to position himself as a kind of crossbreed politician, apart from the partisan politics that plague Washington, and able to appeal to a constituency beyond the Republican Party regulars. He took leaders of his own party to task this month when they failed to call a vote on a relief package for victims of Hurricane Sandy. His popularity has soared since the storm, even among Democrats — and apparently among at least some tech donors in Silicon Valley, where political contributions tend to flow toward more liberal causes.

A spokeswoman for Mr. Zuckerberg, who is the company’s chief executive, said he and his wife admired the governor’s work on education policy — Mr. Christie has pushed for vouchers, championed a new state law weakening tenure in public schools, and signed a contract with the teachers union in the state-run Newark schools that will allow performance bonuses. He also signed a law requiring teachers, among other public employees, to pay more toward their pension and benefits.

Mr. Zuckerberg showed his interest in education with a $100 million donation to the Newark schools in 2010. But he stood alongside a Democrat, Mayor Cory A. Booker of Newark, as well as Mr. Christie to make that announcement. And he has made few political contributions — federal records show only a $10,000 donation to Facebook’s political action committee.

Mike DuHaime, Mr. Christie’s chief political consultant, said the two men met in 2010, before Mr. Zuckerberg’s pledge to the Newark schools, became fast friends and have kept in touch. “Governor Christie was instrumental in giving Mark the confidence that the money in Newark was going to be used wisely,” Mr. DuHaime said.

“I think it demonstrates the kind of broad appeal that he has and support that he has, and part of it is taking on education reform. People took notice that the governor stood up and did the right thing.”

The Democratic Governors’ Association, which might be expected to dispute that characterization of some of Mr. Christie’s education policies, started an online petition Thursday calling on Mr. Zuckerberg to cancel the fund-raiser for “right-wing Republican darling Chris Christie.”

Mr. Christie has raised more than $2 million for his re-election, and announced that he would opt not to take public matching money for the primary, which would have required him to limit spending in the early stage of the race to $5 million. Some Democrats have said they need to raise close to $50 million to beat him. The only declared Democratic challenger so far, State Senator Barbara Buono, has raised about $250,000. (Mr. Booker, who was considered a favorite to challenge Mr. Christie, announced his interest in running for Senate in 2014 instead.)

Read More..

North Korea Turns Its Ire on the South

SEOUL, South Korea — North Korea threatened on Friday to take “physical countermeasures” against South Korea if it helps enforce sanctions against the besieged North, calling the United Nations-endorsed penalties a “declaration of war” and warning of a prolonged chill in the relations between the two Koreas.

North Korea’s confrontational posture was likely to significantly limit room for the South’s incoming conservative president, Park Geun-hye, to make overtures for reconciliation with the North; like the outgoing President Lee Myung-bak and President Obama in the United States, Mr. Park considers the dismantling of the North’s nuclear program the premise in all South Korea’s diplomacy toward the North. Since her December election, she has said she would not tolerate the North’s nuclear program and would deal sternly with North Korean provocations.

In a statement issued in the name of its Committee for the Peaceful Reunification of the Fatherland, which manages relations with South Korea, North Korea gave no hint of what those countermeasures might be. While its earlier pronouncements more often than not turned out to be bluster, North Korea does have a history of following up some with unexpected military attacks — most recently, its shelling of a border island in 2010 that left four South Koreans dead. It was also blamed for sinking a South Korean warship the same year, leaving 46 sailors dead.

Those two incidents brought the two Koreas closer to waging a full-scale war than ever in recent decades, dispelling Washington’s desire to engage North Korea in serious negotiation. While calling for a vigorous enforcement of U.N. sanctions, Glyn Davies, Washington’s special envoy on North Korea, also appealed to the North’s new leader, Kim Jong-un, not to miss the opportunities for a new beginning, stressing that Washington cannot improve ties with Pyongyang without progress in inter-Korean relations.

North Korea outburst against South Korea on Friday in the latest installment of a verbal barrage it has launched since the United Nations Security Council on Tuesday unanimously adopted a resolution condemning North Korea’s Dec. 12 rocket launching. The resolution called the rocket a violation of earlier U.N. resolutions banning it from testing ballistic missile technology, and called for tightening sanctions against the country.

“If the puppet group of traitors takes a direct part in the U.N. ‘sanctions,’ the D.P.R.K. will take strong physical countermeasures against it,” North Korea said, using the nickname it often uses for the South Korean government and the acronym of its official name, the Democratic People’s Republic of Korea. “‘Sanctions’ mean a war and a declaration of war against us.”

The U.N. resolution was the fifth to be slapped on the North for its rocket and nuclear programs since 1993. It calls for tightening existing sanctions, such as expanding a travel ban on North Korean officials and the freezing of assets of North Korean banks and other agencies accused of engaging in shipments and financing for the North’s missile and nuclear programs. It also broadened the means for U.N. member nations to intercept and confiscate cargo headed for the North.

Since the Security Council resolution, North Korea has said it would conduct a nuclear test and launch more long-range rockets and that there would be no more talks on the “denuclearization” of the Korean Peninsula, a main goal of Washington’s thus-far unsuccessful diplomacy on the Korean Peninsula for the last two decades.

With Friday’s threat against the South, North Korea, under the young Mr. Kim, appeared to be following a well-worn track established under his late father, Kim Jong-il, before his death in December 2011: a cycle of North Korean provocation such as a rocket launching, U.N. condemnation, North Korean warnings of “physical countermeasures,” which were sometimes followed by provocative actions, such a nuclear test.

While this familiar cycle repeated itself in recent years, North Korea also steadily boosted its nuclear and missile capabilities. The North Korean nuclear crisis began in the early 1990s with nothing but a tiny amount of fissile material North Korea was suspected of gleaning from its experimental research reactor. It has since accumulated enough plutonium for an estimated half dozen nuclear bombs, built a full-scale uranium-enrichment program, conducted two nuclear tests and made strides toward building intercontinental ballistic missiles that U.S. officials feared could one day be tipped with nuclear warheads.

On Thursday, North Korea said it felt no need to hide its intention of building rockets and nuclear weapons with the United States as a “target” because Washington had intensified its “hostile” policy of “stifling” the already impoverished country.

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Euro Watch: Data Point to Slow Recovery in Euro Zone

The euro zone economy took a step closer to recovery this month as the rate of decline in the bloc’s private sector eased more than expected, a business survey showed on Thursday.

But in an indication of the hurdles left to scale, Spain’s unemployment surged to 26 percent in the fourth quarter, a record high since measurements began in the 1970s, as a prolonged recession and deep spending cuts left almost 6 million people out of work at the end of last year.

The manufacturing survey published by Markit supports European Central Bank President Mario Draghi’s assertion that the 17-nation currency union is benefiting from “positive contagion” but still hints at an economic contraction in the first quarter of 2013.

Markit’s Flash Composite Eurozone Purchasing Managers’ Index, which surveys around 5,000 companies and is seen as a good growth indicator, jumped to 48.2 from December’s 47.2, beating expectations for a rise to 47.5.

While the index has now held below the 50 mark that separates growth from contraction in all but one of the last 17 months, Markit said the data suggested conditions in the bloc were improving.

“We shouldn’t get too gloomy about those numbers,” Chris Williamson, a data collator at Markit, said. “There is a turning point that took place towards the end of last year and the beginning of this year so things are picking up. Any downturn is looking likely to end in the first half.”

He added, however, that the manufacturing index was “still consistent” with gross domestic product in the 17-country bloc falling at a quarterly rate of about 0.2 percent to 0.3 percent.

The euro zone economy contracted in the second and third quarters of last year, meeting the technical definition of recession, and the downturn is expected to have deepened in the fourth quarter.

Earlier data from Germany, Europe’s largest economy and the bloc’s growth engine, showed its private sector expanded at its fastest pace in a year.

In neighboring France, data from Markit showed that business activity shrank in January at the fastest pace since the trough of the global financial crisis. The preliminary composite purchasing managers’ index, covering activity in the services and manufacturing sectors combined, came out at 42.7 for the month, slumping from 44.6 in December.

Spain’s unemployment rate rose to 26 percent in the fourth quarter of 2012, or 5.97 million people, the National Statistics Institute said on Thursday, up from 25 percent in the previous quarter and more than double the European Union average.

“We haven’t seen the bottom yet and employment will continue falling in the first quarter,” José Luis Martínez, a strategist with Citigroup, said.

Spain sank into its second recession since 2009 at the end of 2011 after a burst housing bubble left millions of low-skilled laborers out of work and sliding private and business sentiment gutted consumer spending and imports.

Efforts by Prime Minister Mariano Rajoy’s government to control one of the euro zone’s largest deficits through billions of euros of spending cuts and tax increases have fueled general malaise, further hampering demand.

Still, Mr. Draghi of the E.C.B. is taking an optimistic view, declaring earlier this month that the euro zone economy would recover later in 2013 and that there was now a “positive contagion” effect in play.

Europe’s top central banker cited falling bond yields, rising stock markets and historically low volatility as evidence for this, causing several forecasters to ditch expectations for an imminent cut in euro zone interest rates.

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Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

Read More..

Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

Read More..

Media Decoder Blog: A Resurgent Netflix Beats Projections, Even Its Own

9:12 p.m. | Updated For all those who have doubted its business acumen, Netflix had a resounding answer on Wednesday: 27.15 million.

That’s the number of American homes that were subscribers to the streaming service by the end of 2012, beating the company’s own projections for the fourth quarter after a couple of quarters of underwhelming results.

Netflix’s growth spurt in streaming — up by 2.05 million customers in the United States, from 25.1 million in the third quarter — was its biggest in nearly three years, and helped the company report net income of $7.9 million, surprising many analysts who had predicted a loss.

The results reflected just how far Netflix has come since the turbulence of mid-2011, when its botched execution of a new pricing plan for its services — streaming and DVDs by mail — resulted in an online flogging by angry customers. Investors battered its stock price, sending it from a high of around $300 in 2011 to as low as $53 last year.

“It’s risen from the ashes,” said Barton Crockett, a senior analyst at Lazard Capital Markets. “A lot of investors have been very skeptical that Netflix will work. With this earnings report, they’re making a strong argument that the business is real, that it will work.”

Investors, cheered by the results, sent Netflix shares soaring more than 35 percent in after-hours trading Wednesday. The stock had ended regular trading at $103.26.

Netflix’s fourth-quarter success was a convenient reminder to the entertainment and technology industries that consumers increasingly want on-demand access to television shows and movies. Streaming services by Amazon, Hulu and Redbox are all competing on the same playing field, but for now Netflix remains the biggest such service, and thus a pioneer for all the others.

“Our growth and our competitors’ growth shows just how large the opportunity is for Internet TV, where people get to control their viewing experience,” Netflix’s chief executive, Reed Hastings, said in a telephone interview Wednesday evening.

Questions persist, though, about whether Netflix will be able to attract enough subscribers to keep paying its ever-rising bills to content providers, which total billions of dollars in the years to come. The company said on Wednesday that it might take on more debt to finance more original programs, the first of which, the political thriller “House of Cards,” will have its premiere on the service on Feb. 1. Netflix committed about $100 million to make two seasons of “House of Cards,” one of five original programs scheduled to come out on the service this year.

“The virtuous cycle for us is to gain more subscribers, get more content, gain more subscribers, get more content,” Mr. Hastings said in an earnings conference call.

The company’s $7.9 million profit for the quarter represented 13 cents a share, surprising analysts who had expected a loss of 12 cents a share. The company said revenue of $945 million, up from $875 million in the quarter in 2011, was driven in part by holiday sales of new tablets and television sets.

Netflix added nearly two million new subscribers in other countries, though it continued to lose money overseas, as expected, and said it would slow its international expansion plans in the first part of this year.

The “flix” in Netflix, its largely forgotten DVD-by-mail business, fared a bit better than the company had projected, posting a loss of just 380,000 subscribers in the quarter, to 8.22 million. The losses have slowed for four consecutive quarters, indicating that the homes that still want DVDs really want DVDs.

On the streaming side, Netflix’s retention rate improved in the fourth quarter, suggesting growing customer satisfaction.

Asked whether the company’s reputation had fully recovered after its missteps in 2011, Mr. Hastings said, “We’re on probation at this point, but we’re not out of jail.”

He has emphasized subscriber happiness, even going so far as to say on Wednesday that “we really want to make it easy to quit” Netflix. If the exit door is well marked, he asserted, subscribers will be more likely to come back.

The hope is that original programs like “House of Cards” and “Arrested Development” will lure both old and new subscribers to the service. Those programs, plus the film output deal with the Walt Disney Company announced in December, affirm that Netflix cares more and more about being a gallery — with showy pieces that cannot be seen anywhere else — and less about being a library of every film and TV show ever made.

“They’re morphing into something that people understand,” said Mr. Crockett of Lazard Capital.

Mr. Hastings said this had been happening for years, but that it was becoming more apparent now to consumers and investors.

Mr. Hastings’s letter to investors brought up the elephant in the room, the activist investor Carl C. Icahn, who acquired nearly 10 percent of the company’s stock last October. Mr. Icahn, known for his campaigns for corporate sales and revampings, stated then that Netflix “may hold significant strategic value for a variety of significantly larger companies.”

Netflix subsequently put into place a shareholder rights plan, known as a poison pill, to protect itself against a forced sale by Mr. Icahn.

The company said on Wednesday, “We have no further news about his intentions, but have had constructive conversations with him about building a more valuable company.”

Factoring in the stock’s 30 percent rise since November and the after-hours action on Wednesday, Mr. Icahn’s stake has now more than doubled in value, to more than $700 million from roughly $320 million.

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IHT Rendezvous: IHT Quick Read: Jan. 24

NEWS In one of her final appearances as secretary of state, Hillary Rodham Clinton on Wednesday vigorously defended her handling of last September’s attack on the United States diplomatic compound in Benghazi, Libya, which killed four Americans and prompted a scathing review of State Department procedures. Michael R. Gordon reports from Washington.

North Korea vowed on Thursday to launch more long-range rockets and conduct its third nuclear test, ratcheting up tensions following the United Nations Security Council’s decision to tighten sanctions against the country for launching a rocket last month. Choe Sang-Hun reports from Seoul.

Prime Minister David Cameron of Britain has added to Europe’s malaise, vowing to reduce British entanglement with the European Union—or allow his people to vote in a referendum to leave the bloc altogether. Andrew Higgins reports from Brussels.

Defense Secretary Leon E. Panetta is lifting the U.S. military’s official ban on women in combat, which will open up hundreds of thousands of additional front-line jobs to them, senior defense officials said Wednesday. Elisabeth Bumiller and Thom Shanker report from Washington.

At the most recent count, there were 212,000 refugees in Lebanon, registered or awaiting registration with the United Nations refugee agency. A year ago, the agency had registered 5,000. The increase mirrors the intensification of a conflict across the border in Syria that the United Nations says has now killed 60,000. Josh Wood reports from Al-Minya, Lebanon.

Jamie Dimon, the chief executive of JPMorgan Chase, apologized again for the bank’s recent $6 billion trading loss, this time in front of an audience that included the elite of the financial world. But in keeping with his confident demeanor, it was a diet portion of humble pie. Jack Ewing reports from Davos, Switzerland.

ARTS Nearly 212,000 oil paintings in Britain have been photographed and put online in a comprehensive project designed to make the country a cultural pioneer of the digital age. Stephen Castle reports from London.

FASHION The garden in all its summer enchantment has blossomed as the big theme of the Paris couture season. Suzy Menkes reviews from Paris.

SPORTS Li Na, one of China’s biggest sports stars, played one of the best big matches of her career to defeat Maria Sharapova, 6-2, 6-2 and reach the Australian Open final. Christopher Clarey reports from Melbourne, Australia.

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DealBook: Allergan to Buy MAP Pharmaceuticals for $958 Million

Allergan has agreed to pay nearly $1 billion to acquire MAP Pharmaceuticals and gain full control of its experimental treatment for migraine headaches, the two companies announced Tuesday night.

The purchase price of $25 a share in cash is a 60 percent premium over MAP’s closing price on Tuesday of $15.58 a share. The deal, valued at $958 million in total, suggests that Allergan has considerable faith that MAP’s new migraine treatment will win regulatory approval from the Food and Drug Administration by the agency’s deadline of April 15.

The two companies said the deal had been unanimously approved by the boards of both companies and was expected to close in the second quarter.

Allergan already had the rights to help market the migraine drug, known as Levadex, in the United States and Canada, but after an acquisition it would have control of all the profits and costs globally.

Allergan is most known for Botox, a form of the botulinum toxin, which is used for cosmetic purposes as well as medical ones, including the treatment of chronic migraines with the goal of reducing the frequency of headaches. By contrast, Levadex is meant to treat migraines after they occur, making it complementary to Botox, Allergan said.

Levadex is actually a new form of an old drug, known as dihydroergotamine, or DHE, which has been used to treat severe migraine attacks for decades. DHE is typically given by intravenous infusion, requiring patients to get to a hospital at a time when many would rather remain in a dark quiet room.

Levadex, by contrast, is breathed into the lungs using an inhaler similar to one used for asthma, allowing people to use it at home.

The F.D.A. declined to approve Levadex last March, though MAP said the rejection was related to manufacturing and questions about use of the inhaler, not the safety and efficacy of the drug. It resubmitted its application, with additional data and answers to questions from the F.D.A., in October.

Levadex would be the first approved product for MAP, which is based in Mountain View, Calif.

Allergan said that if Levadex is approved by April, the transaction would dilute earnings by about 7 cents a share in 2013 and add to earnings in the second half of 2014.

Allergan was advised by Goldman Sachs and the law firm Gibson, Dunn & Crutcher. MAP was advised by Centerview Partners and the law firm Latham & Watkins.

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The New Old Age Blog: Study Links Cognitive Deficits, Hearing Loss

There’s another reason to be concerned about hearing loss — one of the most common health conditions in older adults and one of the most widely undertreated. A new study by researchers at Johns Hopkins Medicine suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact.

The study in JAMA Internal Medicine was led by Dr. Frank Lin, a hearing specialist and epidemiologist who over the past several years has documented the extent of hearing problems in older people and their association with falls and the onset of dementia.

The physician’s work is bringing fresh, and some would say much-needed, attention to the link between hearing difficulties and seniors’ health.

In his new report, Dr. Lin looked at 1,984 older adults who participated over many years in the Health ABC Study, a long-term study of older adults conducted in Pittsburgh and Memphis. Participants’ mean age was 77; none had evidence of cognitive impairment when the period covered by this research began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later.

The tests included the Modified Mini-Mental State exam, which is administered through an interview and yields an overall picture of cognitive status, and the Digit Symbol Substitution Test, a paper-only exercise that asks people to match symbols and numbers, which can reveal deficits in someone’s working memory and executive functioning.

Dr. Lin found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without, based on results from the Modified Mini-Mental State Exam. A five-point decline on that test is considered a “clinically significant” indicator of a change in cognition.

Using this information, Dr. Lin found that elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing.

Results from the Digit Symbol Substitution Test showed the same downward trend, though not quite as steep: older people with hearing loss recorded a yearly rate of cognitive decline 32 percent greater on it than those with intact hearing. In both cases, the results showed an association only, with no proof of causality.

Still, given the fact that nearly two-thirds of adults age 70 and older have hearing problems, it is an important finding.

For caregivers and older adults, the bottom line is “pay attention to hearing loss,” said Kathleen Pichora-Fuller, a professor of psychology at the University of Toronto who was not involved in the study.

Most people seek medical attention for hearing difficulties 10 to 20 years after they first notice a problem, she said, because “there’s a stigma about hearing loss and people really don’t want to wear a hearing aid.” That means years of struggling with the consequences of impairment, without interventions that can make a difference.

One consequence that may help explain Dr. Lin’s findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations to dinners or parties, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others.

A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged, and “now we have this intersection of hearing research and cognitive research lining up and showing us that hearing health is part of cognitive health,” said Dr. Pichora-Fuller, who originally trained as an audiologist.

Family physicians and internists, too, often dismiss older patients’ complaints about hearing, and should pay close attention to Dr. Lin’s research, she said.

“I hope this study will be a wake-up call to clinicians that auditory tests need to be part of the battery of tests they employ to look at an older person’s health,” agreed Patricia Tun, an adjunct associate professor of psychology at Brandeis University.

Although the tests are effective and cause no known harm, a panel of experts recently failed to recommend them for older adults because of a lack of supporting evidence, as I wrote last August.

Another potential explanation for Dr. Lin’s new finding lies in a concept known as “cognitive load” that Dr. Tun has explored through her research. Basically, this assumes that “we only have a certain amount of cognitive resources, and if we spend a lot of those resources of processing sensory input coming in — in this case, sound — it’s going to be processed more slowly and understand and remembered less well,” she explained.

In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, “you’ll have less mental energy for higher cognitive processing,” Dr. Tun said.

Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, she noted, indicating a deterioration in hearing mechanisms that process complex speech.

Also, as yet unidentified biological or neurological pathways may affect both speech and cognition. Or hearing loss may exacerbate frailty and other medical conditions that older people oftentimes have in ways that are as yet poorly understood, Dr. Lin’s paper notes.

A limitation to his study is its reliance, in part, on the Modified Mini-Mental State exam, which asks older adults to respond to questions posed by an interviewer, according to Barbara Weinstein, a professor and head of the audiology program at CUNY’s Graduate Center.

Her research has shown that hearing-compromised seniors may not understand questions and answer incorrectly, confounding results. Another limitation arises from the failure to test participants’ hearing over time, as happened with cognitive tests, making associations more difficult to tease out.

Dr. Lin hopes to address this through another research project that would follow older adults over time and test whether interventions such as hearing aides help prevent the onset or slow the progression of cognitive decline. In the meantime, older people and caregivers should arrange for hearing tests if they have concerns, and consider getting a hearing aid if problems are confirmed.

Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction, said Kelly Tremblay, a professor of speech and hearing science at the University of Washington.

Read More..

The New Old Age Blog: Study Links Cognitive Deficits, Hearing Loss

There’s another reason to be concerned about hearing loss — one of the most common health conditions in older adults and one of the most widely undertreated. A new study by researchers at Johns Hopkins Medicine suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact.

The study in JAMA Internal Medicine was led by Dr. Frank Lin, a hearing specialist and epidemiologist who over the past several years has documented the extent of hearing problems in older people and their association with falls and the onset of dementia.

The physician’s work is bringing fresh, and some would say much-needed, attention to the link between hearing difficulties and seniors’ health.

In his new report, Dr. Lin looked at 1,984 older adults who participated over many years in the Health ABC Study, a long-term study of older adults conducted in Pittsburgh and Memphis. Participants’ mean age was 77; none had evidence of cognitive impairment when the period covered by this research began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later.

The tests included the Modified Mini-Mental State exam, which is administered through an interview and yields an overall picture of cognitive status, and the Digit Symbol Substitution Test, a paper-only exercise that asks people to match symbols and numbers, which can reveal deficits in someone’s working memory and executive functioning.

Dr. Lin found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without, based on results from the Modified Mini-Mental State Exam. A five-point decline on that test is considered a “clinically significant” indicator of a change in cognition.

Using this information, Dr. Lin found that elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing.

Results from the Digit Symbol Substitution Test showed the same downward trend, though not quite as steep: older people with hearing loss recorded a yearly rate of cognitive decline 32 percent greater on it than those with intact hearing. In both cases, the results showed an association only, with no proof of causality.

Still, given the fact that nearly two-thirds of adults age 70 and older have hearing problems, it is an important finding.

For caregivers and older adults, the bottom line is “pay attention to hearing loss,” said Kathleen Pichora-Fuller, a professor of psychology at the University of Toronto who was not involved in the study.

Most people seek medical attention for hearing difficulties 10 to 20 years after they first notice a problem, she said, because “there’s a stigma about hearing loss and people really don’t want to wear a hearing aid.” That means years of struggling with the consequences of impairment, without interventions that can make a difference.

One consequence that may help explain Dr. Lin’s findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations to dinners or parties, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others.

A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged, and “now we have this intersection of hearing research and cognitive research lining up and showing us that hearing health is part of cognitive health,” said Dr. Pichora-Fuller, who originally trained as an audiologist.

Family physicians and internists, too, often dismiss older patients’ complaints about hearing, and should pay close attention to Dr. Lin’s research, she said.

“I hope this study will be a wake-up call to clinicians that auditory tests need to be part of the battery of tests they employ to look at an older person’s health,” agreed Patricia Tun, an adjunct associate professor of psychology at Brandeis University.

Although the tests are effective and cause no known harm, a panel of experts recently failed to recommend them for older adults because of a lack of supporting evidence, as I wrote last August.

Another potential explanation for Dr. Lin’s new finding lies in a concept known as “cognitive load” that Dr. Tun has explored through her research. Basically, this assumes that “we only have a certain amount of cognitive resources, and if we spend a lot of those resources of processing sensory input coming in — in this case, sound — it’s going to be processed more slowly and understand and remembered less well,” she explained.

In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, “you’ll have less mental energy for higher cognitive processing,” Dr. Tun said.

Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, she noted, indicating a deterioration in hearing mechanisms that process complex speech.

Also, as yet unidentified biological or neurological pathways may affect both speech and cognition. Or hearing loss may exacerbate frailty and other medical conditions that older people oftentimes have in ways that are as yet poorly understood, Dr. Lin’s paper notes.

A limitation to his study is its reliance, in part, on the Modified Mini-Mental State exam, which asks older adults to respond to questions posed by an interviewer, according to Barbara Weinstein, a professor and head of the audiology program at CUNY’s Graduate Center.

Her research has shown that hearing-compromised seniors may not understand questions and answer incorrectly, confounding results. Another limitation arises from the failure to test participants’ hearing over time, as happened with cognitive tests, making associations more difficult to tease out.

Dr. Lin hopes to address this through another research project that would follow older adults over time and test whether interventions such as hearing aides help prevent the onset or slow the progression of cognitive decline. In the meantime, older people and caregivers should arrange for hearing tests if they have concerns, and consider getting a hearing aid if problems are confirmed.

Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction, said Kelly Tremblay, a professor of speech and hearing science at the University of Washington.

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DealBook: Microsoft May Back Dell Buyout

The effort to take Dell private has gained a prominent, if unusual, backer: Microsoft.

The software giant is in talks to help finance a takeover bid for Dell that would exceed $20 billion, a person briefed on the matter said on Tuesday. Microsoft is expected to contribute up to several billion dollars.

An investment by Microsoft — if it comes to pass — could be enough to push a leveraged buyout of the struggling computer maker over the goal line. Silver Lake, the private equity firm spearheading the takeover talks, has been seeking a deep-pocketed investor to join the effort. And Microsoft, which has not yet made a commitment, has more than $66 billion in cash on hand.

Microsoft and Silver Lake, a prominent investor in technology companies, are no strangers. The private equity firm was part of a consortium that sold Skype, the online video-chatting pioneer, to Microsoft for $8.5 billion nearly two years ago. And the two companies had discussed teaming up to make an investment in Yahoo in late 2011, before Yahoo decided against selling a minority stake in itself.

A vibrant Dell is an important part of Microsoft’s plans to make Windows more relevant for the tablet era, when more and more devices come with touch screens. Dell has been one of the most visible supporters of Windows 8 in its products.

That has been crucial at a time when Microsoft’s relationships with many PC makers have grown strained because of the company’s move into making computer hardware with its Surface family of tablets.

Frank Shaw, a spokesman for Microsoft, declined to comment.

If completed, a buyout of Dell would be the largest leveraged buyout since the financial crisis, reaching levels unseen since the takeovers of Hilton Hotels and the Texas energy giant TXU. Such a deal is taking advantage of Dell’s still-low stock price and the abundance of investors willing to buy up the debt issued as part of a transaction to take the company private. And Silver Lake has been working with Dell’s founder, Michael S. Dell, who is expected to contribute his nearly 16 percent stake in the company to a takeover bid.

Yet while many aspects of the potential deal have fallen into place, including a potential price of up to around $14 a share, talks between Dell and its potential buyers may still fall apart.

Shares of Dell closed up 2.2 percent on Tuesday, at $13.12. They began rising after CNBC reported Microsoft’s potential involvement in a leveraged buyout. Microsoft shares slipped 0.4 percent, to $27.15.

Microsoft’s lending a hand to Dell could make sense at a time when the PC industry is facing some of the biggest challenges in its history. Dell is one of Microsoft’s most significant, longest-lasting partners in the PC business and among the most committed to creating machines that run Windows, the operating system that is the foundation of much of Microsoft’s profits.

But PC sales were in a slump for most of last year, as consumers diverted their spending to other types of devices like tablets and smartphones. Dell, the third-biggest maker of PCs in the world, recorded a 21 percent decline in shipments of PCs during the fourth quarter of last year from the same period in 2011, according to IDC.

In a joint interview in November, Mr. Dell and Steven A. Ballmer, Microsoft’s chief executive, exchanged friendly banter, as one would expect of two men who have been in business together for decades.

Mr. Dell said Mr. Ballmer had gone out of his way to reassure him that Microsoft’s Surface computers would not hurt Dell sales.

“We’ve never sold all the PCs in the world,” said Mr. Dell, sitting in a New York hotel room brimming with new Windows 8 computers made by his company. “As I’ve understood Steve’s plans here, if Surface helps Windows 8 succeed, that’s going to be good for Windows, good for Dell and good for our customers. We’re just fine with all that.”

Microsoft has been willing to open its purse strings in the past to help close partners. Last April, Microsoft committed to invest more than $600 million in Barnes & Noble’s electronic books subsidiary, in a deal that ensures a source of electronic books for Windows devices. Microsoft also agreed in 2011 to provide the Finnish cellphone maker Nokia billions of dollars’ worth of various forms of support, including marketing and research and development assistance, in exchange for Nokia’s adopting Microsoft’s Windows Phone operating system.

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North Korea Hints at New Nuclear Test

SEOUL, South Korea - North Korea said on Wednesday that its nuclear weapon program was no longer negotiable, and indicated that it might conduct its third nuclear test to retaliate against the United Nations Security Council’s tightening of sanctions against the isolated yet highly militarized country.

Although it was not the first time North Korea issued such strident rhetoric, its posture, coming under the new leadership of Kim Jong-un, threw a direct challenge to President Barack Obama as he starts his second term, and Park Geun-hye, who will be sworn in as president of South Korea next month. After years of tensions with North Korea, both Mr. Obama and Ms. Park have recently said they were keeping the door open for dialogue with North Korea on the premise that such engagement should lead to the eventual dismantling of its nuclear weapons program.

Simultaneously, Washington reaffirmed its policy of punishing North Korea for moving toward the development of long-range missiles tipped with a nuclear warhead when it spearheaded international backing for a unanimous Security Council resolution on Tuesday.

The resolution condemned North Korea’s Dec. 12 rocket launch as a violation of earlier resolutions banning the country from any tests involving ballistic missile technology, and added new sanctions.

In a swift rejection of the U.N. warnings, North Korea said on Wednesday that it will take “physical counteraction” to bolster its “nuclear deterrence both qualitatively and quantitatively.” It said, “There can be talks for peace and stability of the Korean Peninsula and the region in the future, but no talks for the denuclearization of the peninsula.”

By “physical counteraction,” analysts in Seoul said, North Korea most likely meant detonating another nuclear device to demonstrate advances in bomb-making. After analysing the debris of the rocket North Korea fired in December to put a satellite into orbit, South Korean officials said that North Korea indigenously built key components of a missile that can fly more than 6,200 miles.

The analysts said Washington would watch whether a new nuclear test involved a uranium device, as opposed to the previous two tests that used plutonium bombs. North Korea has recently revved up efforts to enrich uranium, ostensibly as fuel for its new nuclear reactor under construction but for practical purposes as a new and more stable source of fuel for nuclear bombs.

North Korea unveiled a brand-new uranium enrichment plant to a visiting American scholar in 2010. But U.S. and South Korean military intelligence officials, using satellite imagery, have since detected more facilities that they suspected could be part of a more expansive enrichment program, military officials here said.

“A nuclear test is the most likely option for the North,” said Choi Jin-wook, an analyst at the Korea Institute for National Unification in Seoul.

In recent months, international experts have detected what appeared to be new tunneling activities and efforts to fix flood damages in the Punggye-ri nuclear test site in northeastern North Korea. Kim Min-seok, spokesman for the Defense Ministry of South Korea, told reporters last month that North Korea could conduct a third nuclear in a short notice once its leadership decided to. North Korea conducted an underground nuclear test in Punggye-ri in 2006 and again in 2009.

Each of those tests came as North Korea was protesting a United Nations’ decision to impose more sanctions as punishment for rocket tests.

Washington and its allies “know better than any others about the fact that ballistic missile technology is the only means for launching satellite and they launch satellites more than any others,” the North Korean statement said on Wednesday. “This is self-deception and the height of double-standards. The essence of the matter is the U.S. brigandish logic that a satellite launch for peaceful purposes by a country which the U.S. antagonizes should not be allowed because any carrier rocket launched by it can be converted into long-range ballistic missile threatening the U.S.”

In recent years, North Korea has made it increasingly clear that it is determined to keep its nuclear weapons at whatever costs, undermining a once-popular belief that the Pyongyang regime’s brinkmanship was a mere bargaining ploy designed to get as many concessions as possible in exchange for nuclear weapons.

On Wednesday, blaming Washington’s “hostile policy,” the North said it “drew a final conclusion that denuclearization of the Korean Peninsula is impossible unless the denuclearization of the world is realized.” The 2005 deal in which North Korea and the United States agreed in principle upon the dismantling of the North’s nuclear weapons program in return for diplomatic incentives “has now become defunct,” it said.

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Bank of Japan Moves to Fight Deflation

TOKYO — The Bank of Japan set an ambitious 2 percent inflation target and pledged to ease monetary policy “decisively” by introducing open-ended asset purchases, following intense pressure from the country’s audacious new prime minister, Shinzo Abe, who has made beating deflation a national priority.

In a joint statement Tuesday with the government, the central bank said it was doubling its inflation target to 2 percent and said it would “pursue monetary easing and aim to achieve this target at the earliest possible time.”

The Bank of Japan also said that it intended to purchase assets indefinitely, promising to stick to a program that has allowed the bank to pump funds into the Japanese economy, even with interest rates at virtually zero. The bank’s board voted to keep its benchmark rate at a range of zero to 0.1 percent.

Mr. Abe immediately hailed the bank’s moves, telling the Bank of Japan governor, Masaaki Shirakawa, that the measures were “groundbreaking,” according to Kyodo News. Analysts, however, said the details of the bank’s policy were less impressive than the headlines and said they had expected more.

The central bank, for example, will only begin its open-ended asset purchases in 2014, and estimates that its asset purchase fund will increase by just 10 trillion yen in 2014, remaining unchanged after that. With such a paltry increase, it was unlikely Japan would achieve 2 percent inflation, analysts said. The consumer price index for 2012 fell 0.5 percent, according to government statistics.

The Bank of Japan’s announcement “will likely disappoint those who expected the policy board to answer Abe’s call for a ‘different kind of B.O.J. policy,’ or significantly ramp up its pace of easing,” Izumi Devalier, an economist with HSBC, said in a note to clients.

“This means pressure will remain in place for the B.O.J. to ease policy further, as the 2 percent inflation target remains ever out of reach,” Ms. Devalier and her colleagues said.

Masaaki Kanno, Japan economist for JPMorgan, also called the details of the asset purchase program disappointing. “That said, this is not the end of the game,” he said. “We should expect further easing” including an increase in asset purchases as well as purchases of longer-term assets, once Gov. Shirakawa’s term is up in April and a successor is appointed, Mr. Kanno said.

Since last year, when Mr. Abe was still opposition leader, he has urged the central bank to do more to end deflation, the all-around fall in prices, profit and incomes that has plagued Japan’s economy since the late 1990s. He stepped up the pressure on the bank after a landslide victory by his Liberal Democratic Party in parliamentary elections in December, which catapulted him to office for the second time since a short-lived stint in 2006-07.

Mr. Abe’s call for the Bank of Japan to increase the monetary supply, among other things, has weakened the yen, a boon to the competitiveness of exporters, which make up much of Japan’s growth. Earlier this month, Mr. Abe also announced a 12 trillion yen emergency stimulus, providing even more tailwind for the Japanese economy. That bright outlook has pushed the Nikkei stock index 20 percent higher since mid-November, when Mr. Abe first campaigned on his expansionary platform.

Mr. Abe’s critics, however, warn that the central bank, which will buy up more government bonds as part of its asset purchase program, will become a printing press for profligate government spending — spending that carries great risks for a country whose public debt is already twice the size of its economy. Critics also say that before flooding a broken system with money, Japan must first tackle structural problems that hurt economic efficiency.

Mr. Abe maintains that deflation will undermine any efforts to grow, and that the government and central bank must act together to get prices rising again. But in a nod to critics, the joint statement said the government would also promote “all possible decisive policy actions for reforming the economic structure” and establish “a sustainable fiscal structure.”

“I believe we are firmly on the path toward bold monetary easing,” Mr. Abe told reporters following the bank’s announcement.

Mr. Shirakawa, who has long argued that the bank alone cannot spark inflation or economic growth, called on the government to do its part to bolster the Japanese economy.

“Various actors need to put in considerable effort along with the Bank of Japan,” Mr. Shirakawa told a press conference late Tuesday. “Those efforts are going to have to be quite drastic,” he said.

Market reaction was mixed. The Nikkei index average rose 0.8 percent in anticipation of the bank’s announcement, before giving up its gains to end 0.4 percent lower, at 10,709.93. The index has risen over 20 percent, however, since Mr. Abe started his monetarist push. The dollar briefly rose above 90 yen, near the 2-year high of 90.25 it hit on Monday, but had slipped to 88.67 yen late afternoon in Tokyo.

Yields on 10-year Japanese government bonds were largely unchanged, with a benchmark issue ending trading at 0.730 percent, down 0.005 percentage points from Monday’s close.

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