Motivation News

Google Casts a Big Shadow on Smaller Web Sites

Label: Business

Annie Tritt for The New York Times

Jeffrey G. Katz, the chief executive of Wize Commerce, seen with employees. He says that about 60 percent of the traffic for the company’s Nextag comparison-shopping site comes from Google.

In a geeky fire drill, engineers and outside consultants at Nextag scrambled to see if the problem was its own fault. Maybe some inadvertent change had prompted Google’s algorithm to demote Nextag when a person typed in shopping-related search terms like “kitchen table” or “lawn mower.”

But no, the engineers determined. And traffic from Google’s search engine continued to decline, by half.

Nextag’s response? It doubled its spending on Google paid search advertising in the last five months.

The move was costly but necessary to retain shoppers, Mr. Katz says, because an estimated 60 percent of Nextag’s traffic comes from Google, both from free search and paid search ads, which are ads that are related to search results and appear next to them. “We had to do it,” says Mr. Katz, chief executive of Wize Commerce, owner of Nextag. “We’re living in Google’s world.”

Regulators in the United States and Europe are conducting sweeping inquiries of Google, the dominant Internet search and advertising company. Google rose by technological innovation and business acumen; in the United States, it has 67 percent of the search market and collects 75 percent of search ad dollars. Being big is no crime, but if a powerful company uses market muscle to stifle competition, that is an antitrust violation.

So the government is focusing on life in Google’s world for the sprawling economic ecosystem of Web sites that depend on their ranking in search results. What is it like to live this way, in a giant’s shadow? The experience of its inhabitants is nuanced and complex, a blend of admiration and fear.

The relationship between Google and Web sites, publishers and advertisers often seems lopsided, if not unfair. Yet Google has also provided and nurtured a landscape of opportunity. Its ecosystem generates $80 billion a year in revenue for 1.8 million businesses, Web sites and nonprofit organizations in the United States alone, it estimates.

The government’s scrutiny of Google is the most exhaustive investigation of a major corporation since the pursuit of Microsoft in the late 1990s.

The staff of the Federal Trade Commission has recommended preparing an antitrust suit against Google, according to people briefed on the inquiry, who spoke on the condition they not be identified. But the commissioners must vote to proceed. Even if they do, the government and Google could settle.

Google has drawn the attention of antitrust officials as it has moved aggressively beyond its dominant product — search and search advertising — into fields like online commerce and local reviews. The antitrust issue is whether Google uses its search engine to favor its offerings like Google Shopping and Google Plus Local over rivals.

For policy makers, Google is a tough call.

“What to do with an attractive monopolist, like Google, is a really challenging issue for antitrust,” says Tim Wu, a professor at Columbia Law School and a former senior adviser to the F.T.C. “The goal is to encourage them to stay in power by continuing to innovate instead of excluding competitors.”

SPEAKING at a Google Zeitgeist conference in Arizona last month, Larry Page, the company’s co-founder and chief executive, said he understood the government scrutiny of his company, given Google’s size and reach. “There’s very many decisions we make that really impact a lot of people,” he acknowledged.

The main reason is that Google is continually adjusting its search algorithm — the smart software that determines the relevance, ranking and presentation of search results, typically links to other Web sites.

Google says it makes the changes to improve its service, and has long maintained that its algorithm weeds out low-quality sites and shows the most useful results, whether or not they link to Google products.

“Our first and highest goal has to be to get the user the information they want as quickly and easily as possible,” says Matt Cutts, leader of the Web spam team at Google.

But Google’s algorithm is secret, and changes can leave Web sites scrambling.

Consider Vote-USA.org, a nonprofit group started in 2003. It provides online information for voters to avoid the frustration of arriving at a polling booth and barely recognizing half the names on the ballot. The site posts free sample ballots for federal, state and local elections with candidates’ pictures, biographies and views on issues.

In the 2004 and 2006 elections, users created tens of thousands of sample ballots. By 2008, traffic had fallen sharply, says Ron Kahlow, who runs Vote-USA.org, because “we dropped off the face of the map on Google.”

As founder of a search-engine optimization company and a recipient of grants that Google gives nonprofits to advertise free, Mr. Kahlow knows a thing or two about how to operate in Google’s world. He pored over Google’s guidelines for Web sites, made changes and e-mailed Google. Yet he received no response.

“I lost all donations to support the operation,” he said. “It was very, very painful.”

A breakthrough came through a personal connection. A friend of Mr. Kahlow knew Ed Black, chief executive of the Computer & Communications Industry Association, whose members include Google. Mr. Black made an inquiry on Mr. Kahlow’s behalf, and a Google engineer investigated.

Second Illness Infects Meningitis Sufferers

Label: Health

Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.

The new problem, called an epidural abscess, is an infection near the spine at the site where the drug — contaminated by a fungus — was injected to treat back or neck pain. The abscesses are a localized infection, different from meningitis, which affects the membranes covering the brain and spinal cord. But in some cases, an untreated abscess can cause meningitis. The abscesses have formed even while patients were taking powerful antifungal medicines, putting them back in the hospital for more treatment, often with surgery.

The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.

“We’re hearing about it in Michigan and other locations as well,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the Centers for Disease Control and Prevention. “We don’t have a good handle on how many people are coming back.”

He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”

In the last few days, about a third of the 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, Mich., have returned with abscesses, said Dr. Lakshmi K. Halasyamani, the chief medical officer.

“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”

She and other experts said they were especially puzzled that the infections could occur even though patients were taking drugs that, at least in tests, appeared to work against the fungus causing the infection, a type of black mold called Exserohilum.

The main symptom is severe pain near the injection site. But the abscesses are internal, with no visible signs on the skin, so it takes an M.R.I. scan to make the diagnosis. Some patients have more than one abscess. In some cases, the infection can be drained or cleaned out by a neurosurgeon.

But sometimes fungal strands and abnormal tissue are wrapped around nerves and cannot be surgically removed, said Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan. In such cases, all doctors can do is give a combination of antifungal drugs and hope for the best. They have very little experience with this type of infection.

Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.

A spokesman for the health department in Tennessee, which has had 78 meningitis cases, said that a few cases of epidural abscess had also occurred there, and that the state was trying to assess the extent of the problem.

Dr. Chiller said doctors were also reporting that some patients exposed to the tainted drug had arachnoiditis, a nerve inflammation near the spine that can cause intense pain, bladder problems and numbness.

“Unfortunately, we know from the rare cases of fungal meningitis that occur, that you can have complicated courses for this disease, and it requires prolonged therapy and can have some devastating consequences,” he said.

The meningitis outbreak, first recognized in late September, is one of the worst public health disasters ever caused by a contaminated drug. So far, 29 people have died, often from strokes caused by the infection. The case count is continuing to rise. The drug was a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. Three contaminated lots of the drug, more than 17,000 vials, were shipped around the country, and about 14,000 people were injected with the drug, mostly for neck and back pain. But some received injections for arthritic joints and have developed joint infections.

Inspections of the compounding center have revealed extensive contamination. It has been shut down, as has another Massachusetts company, Ameridose, with some of the same owners. Both companies have had their products recalled.

Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.

Second Illness Infects Meningitis Sufferers

Label: Lifestyle

Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.

The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.

He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”

“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”

Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.

Bits Blog: One on One: Google Android Director on Nexus Strategy

Label: Technology

Google on Monday introduced new Android devices in small, medium and large: a phone, the Nexus 4; an upgraded seven-inch tablet, the Nexus 7; and a 10-inch tablet, the Nexus 10. That puts Google in even more direct competition with Apple, which offers a similar family of three: the iPhone, the iPad Mini and the iPad.

In an interview, John Lagerling, director of business development for Android, talked about the company’s strategy with the Nexus brand, one that revolves around lower prices. An edited transcript of the interview follows.

What do you think are the highlights of the new Nexus devices?

My personal favorites are the 360-degree panoramic photo, Photo Sphere, and the fact that you can do inductive charging so you don’t need to fiddle with a plug — you can just put it on a surface to charge. On a Nexus 10 it’s the fact that it’s so thin and light, and the resolution is 2.5 K, so it has very crisp text and pictures.

And the price. I negotiated the prices and I’m very pleased with being able to deliver these things at these prices; $299 for an unlocked Nexus 4 — I think that’s pretty revolutionary.

How did you get the prices lower?

Basically we felt that we wanted to prove you don’t have to charge $600 to deliver a phone that has the latest-generation technologies. Simply that level of margin is sometimes even unreasonable, and we believed that we could do this. For Nexus 7, we were able to ramp those new memory SKUs at the same price. These move so fast that we knew after a few months, from an economical perspective, it was doable. Between us and our partners we have a very good understanding of supply chains. We’ve all done the best we can to really reach these prices — $399, $299 is pretty amazing, if I may say so.

I noticed each Nexus device is made by a different manufacturer. Is this to keep the playing field fair for Android partners?

It’s not so much fairness as it is to sort of work with partners who happen to be in good “phase match” with us in what we’re trying to do. So Samsung just happens to be in a good phase match on a high-end display, which is exactly what we wanted to do at a low cost. LG had a good phase match with the hardware they were working on. Asus as well. It’s just more about the timing being right.

We’ve always done that with our lead devices. Even before the Nexus One we did the lead device with HTC. We did the Xoom, which was a lead device with Motorola. And now we’ve sort of streamlined what the Nexus program is. We did really well with the Nexus 7, I feel, because nobody really pushed the envelope with seven-inch in terms of price and performance. It really proved that category. We felt the 10-inch category was overpriced and underpowered, and we wanted to see what we could do for that from our perspective.

Where does Motorola stand in all this? You haven’t used them yet for the Nexus program.

They stand where Sharp would stand, or Sony would stand or Huawei would stand. From my perspective as a partnership director, they are another partner. We are really walled between the Motorola team and the Android team. They would bid on doing a Nexus device just like any other company.

So how does Google take advantage of the Motorola acquisition?

The way I understand it is, it’s mostly about the patents, the way you can sort of disarm this huge attack against Android. We talked about prices. There are players in the industry who were unhappy about more competitive pricing for the consumers. They want to keep the prices high, they want to force the price to be so high that operators have to subsidize the devices very highly. That’s not only the Cupertino guys but also for the guys up in Seattle. They want higher margins, they want to charge more for software.

We simply believe there’s a better way of doing it without extracting that much payment from end users, because there are other ways to drive revenues. Patents were used as a weapon to try to stop that evolution and scare people away from lower-cost alternatives. And I think with the Motorola acquisition we’ve shown we’re able to put skin in the game and push back.

With Nexus phones, the lack of carrier support is the big roadblock. Only having the marketing and retail support of one carrier — T-Mobile, in the case of the Nexus 4 — isn’t as good as having the Big Four. In the past you’ve sold Nexus phones through the Google online store, and it was a failure.

Nexus One was very early. People didn’t know what Nexus was or what Android phones were. I feel we’re in a very different environment now and I feel the Nexus 7 has set the stage for the Nexus program at a new level, so we feel the time is right.

Approaching one million sales a month for the Nexus 7, right? According to Asus.

We haven’t announced numbers. We typically don’t allow our partners to announce numbers. All I can say is it has sold way above expectations. That could mean one of two things: Either we have very low expectations or we’ve done amazing well. But we’re very pleased with how we’ve done with the Nexus 7.

Most of the apps in the Google Play store are for phones, not for tablets. How many are there for tablets?

I don’t have a number for how many apps are properly adding those APIs that you need to put fully to use the extra screen real estate. What I can say is that the Nexus 7 has been a superstrong catalyst to kick off developers’ attention to making those expansions, so we’ve seen tremendous growth in apps for the larger screen size. The trending is very positive because of the Nexus 7.

But before, I’ll be honest and say, yes, there was a lack of tablet apps that supported bigger screen real estate. But I’ll add that, I know we talked about the Cupertino guys, but obviously people who have smartphones are a huge target for us. If you look globally that’s something we worry more about, not so much about competing with other smartphones, but more about, how can we get more people onto the Internet on mobile phones? And that’s a big deal. That’s why low cost is so important.

Android software has gotten to the point where it’s more respectable. There used to be these two very polarized camps, where a lot of people would say iOS was the greatest and Android was ugly. But the lines are blurring as Android has gotten polished. What happened?

We had such a long laundry list of things we wanted to do, and the fact we had to roll it out so it would work on a multitude of devices, it simply took a bit more time for us to get here. But the structure we’ve had for an operating system from day one including widgets, actual multitasking, notifications, it’s finally coming to its true form right as the software has come into final polish. Project Butter for Jelly Bean, to get every pixel to move really beautifully, it’s finally showing off those capabilities we’ve always planned to have. We have the right teams and maturity to deliver what we’ve always wanted to do. I’ll admit we’re finally much more closer to our actual vision in the past year than we have ever been.

Gays in Pakistan Move Cautiously to Gain Acceptance

Label: World

Max Becherer for the International Herald Tribune

HIDING IN PLAIN SIGHT Ali, a gay man who lives in Lahore, is in a support group for lesbian, gay, bisexual and transgender Pakistanis. “The gay scene here is very hush-hush,” he says.

LAHORE, Pakistan — The group meets irregularly in a simple building among a row of shops here that close in the evening. Drapes cover the windows. Sometimes members watch movies or read poetry. Occasionally, they give a party, dance and drink and let off steam.

The group is invitation only, by word of mouth. Members communicate through an e-mail list and are careful not to jeopardize the location of their meetings. One room is reserved for “crisis situations,” when someone may need a place to hide, most often from her own family. This is their safe space — a support group for lesbian, gay, bisexual and transgender Pakistanis.

“The gay scene here is very hush-hush,” said Ali, a member who did not want his full name used. “I wish it was a bit more open, but you make do with what you have.”

That is slowly changing as a relative handful of younger gays and lesbians, many educated in the West, seek to foster more acceptance of their sexuality and to carve out an identity, even in a climate of religious conservatism.

Homosexual acts remain illegal in Pakistan, based on laws constructed by the British during colonial rule. No civil rights legislation exists to protect gays and lesbians from discrimination.

But the reality is far more complex, more akin to “don’t ask, don’t tell” than a state-sponsored witch hunt. For a long time, the state’s willful blindness has provided space enough for gays and lesbians. They socialize, organize, date and even live together as couples, though discreetly.

One journalist, in his early 40s, has been living as a gay man in Pakistan for almost two decades. “It’s very easy being gay here, to be honest,” he said, though he and several others interviewed did not want their names used for fear of the social and legal repercussions. “You can live without being hassled about it,” he said, “as long as you are not wearing a pink tutu and running down the street carrying a rainbow flag.”

The reason is that while the notion of homosexuality may be taboo, homosocial, and even homosexual, behavior is common enough. Pakistani society is sharply segregated on gender lines, with taboos about extramarital sex that make it almost harder to conduct a secret heterosexual romance than a homosexual one. Displays of affection between men in public, like hugging and holding hands, are common. “A guy can be with a guy anytime, anywhere, and no one will raise an eyebrow,” the journalist said.

For many in his and previous generations, he said, same-sex attraction was not necessarily an issue because it did not involve questions of identity. Many Pakistani men who have sex with men do not think of themselves as gay. Some do it regularly, when they need a break from their wives, they say, and some for money.

But all the examples of homosexual relations — in Sufi poetry, Urdu literature or discreet sexual conduct — occur within the private sphere, said Hina Jilani, a human rights lawyer and activist for women’s and minority rights. Homoeroticism can be expressed but not named.

“The biggest hurdle,” Ms. Jilani said, “is finding the proper context in which to bring this issue out into the open.”

That is what the gay and lesbian support group in Lahore is slowly seeking to do, even if it still meets in what amounts to near secrecy.

The driving force behind the group comes from two women, ages 30 and 33. They are keenly aware of the oddity that two women, partners no less, have become architects of the modern gay scene in Lahore; if gay and bisexual men barely register in the collective societal consciousness of Pakistan, their female counterparts are even less visible.

“The organizing came from my personal experience of extreme isolation, the sense of being alone and different,” the 30-year-old said.

She decided that she needed to find others like her in Pakistan. Eight people, mostly the couple’s friends, attended the first meeting in January 2009.

For Hourly Workers After the Storm, No Work, No Pay

Label: Business

Chantal Sainvilus, a home health aide in Brooklyn who makes $10 an hour, does not get paid if she does not show up. So it is no wonder that she joined the thousands of people taking extreme measures to get to work this week, even, in her case, hiking over the Williamsburg Bridge.

While salaried employees worked if they could, often from home after Hurricane Sandy, many of the poorest New Yorkers faced the prospect of losing days, even a crucial week, of pay on top of the economic ground they have lost since the recession.

Low-wage workers, more likely to be paid hourly and work at the whim of their employers, have fared worse in the recovery than those at the top of the income scale — in New York City the bottom 20 percent lost $463 in annual income from 2010 to 2011, in contrast to a gain of almost $2,000 for the top quintile. And there are an increasing number of part-time and hourly workers, the type that safety net programs like unemployment are not designed to serve. Since 2009, when the recovery began, 86 percent of the jobs added nationally have been hourly. Over all, about 60 percent of the nation’s jobs are hourly.

Even as the sluggish economy has accentuated this divide, Hurricane Sandy has acted as a further wedge, threatening to take a far greater toll on the have-littles who live from paycheck to paycheck.

“There’s a lot of people in our society that are living in a very precarious situation in terms of low wages or very insecure work,” said Arne L. Kalleberg, a sociologist at the University of North Carolina at Chapel Hill and author of “Good Jobs, Bad Jobs.” “That’s why it’s important to have a safety net that’s based on the idea of people working insecure jobs like this.”

On Friday, Gov. Andrew M. Cuomo announced that New York City and four suburban counties were eligible for disaster unemployment relief, which covers a broader spectrum of workers than regular unemployment benefits, including the self-employed like taxi drivers and street vendors as well as those who were unable to get to work.

New Jersey has also declared people in 10 counties eligible for disaster unemployment assistance. In Connecticut, residents of four counties and the Mashantucket Pequot Indian Reservation are eligible.

A New York Department of Labor spokesman emphasized that workers who lost wages should call to apply because the program is flexible and many eligibility issues would be determined on a case-by-case basis.

But the program might not help people whose commute simply lasted longer or cost more, like Ibezim Oki, a cabdriver who spent $50 on a cab to get from his Brooklyn home to Manhattan on Friday, rather than risk long bus delays, and “now I don’t know how long I’m going to have to wait for gas.”

The commute alone represented a hardship for workers whose jobs require a physical presence, while neighborhood coffee shops in the boroughs and suburbs overflowed with those who needed nothing more than a laptop and Wi-Fi to stay connected to work.

Ms. Sainvilus estimated that on Thursday, she had traveled eight hours to work for five, making her effective pay less than $4 an hour.

Others could not work because their place of business was closed. At a food distribution center in Chelsea, Mike Samuel, 55, a delivery man for a florist, was feeling the pain of five days of lost income. “We don’t work, we don’t get no tips, we don’t get no pay,” he said.

Muta Prather said the chemical company where he works in Newark was flooded, causing him to miss three days of work. He worked part of the day on Thursday helping to clean up, but worried about how he would pay for damage to his own roof.

“It hurts, you know,” said Mr. Prather, who is 49 and lives in West Orange, N.J. “I looked up at my roof, and it’s going to cost me like seven grand. I don’t make that kind of money.”

But at a playground in the Clinton Hill section of Brooklyn, Damien Carney stood with his baby daughter strapped to his chest and his toddler on a nearby swing, enjoying a surprise week off. For Mr. Carney, a salaried portfolio manager for a wine distributor that was closed because it had no power, the storm was amounting to something like a paid vacation with time for cooking and rearranging the living room. “They basically said, ‘Don’t worry about it,’ ” Mr. Carney said of his employers.

Federal labor laws include more protections for salaried workers than hourly workers when a disaster hits. Employers must continue to pay salaries if the worksite is closed for less than a week, even though they are allowed to require employees to use vacation or paid leave for the duration of the closure. Hourly workers, on the other hand, do not have to be paid if the worksite closes. If the workplace is open but salaried workers cannot get there, their pay may be reduced.

Of course, policies vary from workplace to workplace, and some hourly workers were luckier than others. Cassandra Williams, 54, waiting for the bus from Brooklyn to Manhattan with her 6-year-old granddaughter, said the family for whom she keeps house would pay her full wages despite her missing three days of work. Tinash Makots, a 24-year-old salesman at the Nike store in Midtown Manhattan, said he would be paid for the days missed as well.

One nanny in the bus line said she would be paid her regular wages, while another said she would not be compensated for hours missed.

A financial district worker who would identify himself only as William S. said he did not strictly need to go into Manhattan to do his job, but felt that he should make an appearance after one of his staff members showed up every day at 6 a.m. and another paid $40 a day to get to a distant office in Queens.

But Anthony Howell, a 42-year-old hair stylist in Chelsea, said he hadn’t worked all week because his salon, like his high-rise apartment, has no electricity.

“That’s the brutal part,” he said. “The hair industry is like that. You don’t do the work, you don’t get the money.”

A Promising Drug With a Flaw

Label: Health

Dr. Bryan A. Cotton, a trauma surgeon in Houston, had not heard much about the new anticlotting drug Pradaxa other than the commercials he had seen during Sunday football games.

Then people using Pradaxa started showing up in his emergency room. One man in his 70s fell at home and arrived at the hospital alert and talking. But he rapidly declined. “We pretty much threw the whole kitchen sink at him,” recalled Dr. Cotton, who works at Memorial Hermann-Texas Medical Center. “But he still bled to death on the table.”

Unlike warfarin, an older drug, there is no antidote to reverse the blood-thinning effects of Pradaxa.

“You feel helpless,” Dr. Cotton said. The drug has contributed to the bleeding deaths of at least eight patients at the hospital. “And that’s a very bad feeling for us.”

Pradaxa has become a blockbuster drug in its two years on the market, bringing in more than $1 billion in sales for its maker, the privately held German drug maker Boehringer Ingelheim.

But Pradaxa has been linked to more than 500 deaths in the United States, and a chorus of complaints has risen from doctors, victims’ families and others in the medical community, who worry that the approval process was not sufficiently rigorous because it allowed a potentially dangerous drug to be sold without an option for reversing its effects.

Pradaxa is an example, some critics say, of what can happen when a drug that performs well in tightly controlled trials is released into the messy world of real-life medicine. Boehringer Ingelheim said it was working on developing an antidote but that even without one, patients in a large clinical trial died at roughly the same rate as those who were taking warfarin.

The Food and Drug Administration released a report on Friday that found that the drug did not show a higher risk of bleeding than for patients taking warfarin. The report did not address the lack of an antidote for Pradaxa.

“The evolving spontaneous reporting patterns do not indicate a change in the favorable benefit-risk profile of Pradaxa, when used correctly according to the approved label,” Boehringer Ingelheim said in a statement. In other words, the drug is still safe. But some reports have indicated that doctors are not sufficiently cautious when prescribing Pradaxa, giving the drug to older people or those with kidney problems even though there is evidence that the bleeding risks are higher in those groups. The company recommends testing patients’ kidney function before prescribing Pradaxa and notes that the risk of bleeding increases with age.

“The problem is that the people that prescribe this, as a general rule, are cardiologists and family practitioners,” said Dr. Mark L. Mosley, director of the emergency room at Wesley Medical Center in Wichita, Kan. “The people that see the harm are your E.R. docs and your trauma docs.”

Critics say that at least until an antidote is found, better disclosure or more limited use of Pradaxa may be preferable. Patients’ lawyers have begun turning their attention to the drug. More than 100 lawsuits have been filed in federal courts and lawyers say thousands more are expected.

When the F.D.A. approved Pradaxa in October 2010, the drug was hailed as the first in a new category of replacements for warfarin, the nearly 60-year-old drug used to prevent strokes in people with a heart-rhythm disorder known as atrial fibrillation.

Warfarin requires careful monitoring of a patient’s diet and drug regimen, and frequent blood tests to ensure that it is working. Pradaxa required no such monitoring and, compared with warfarin, appeared to be better at preventing strokes.

Sales of the drug took off. By the end of 2011, after just over a year on the market, 17 percent of patients with atrial fibrillation were being prescribed Pradaxa, compared with 44 percent for warfarin, according to a study released in September. About 725,000 patients in the United States have used the drug, according to the F.D.A.

But almost as soon as doctors started prescribing Pradaxa, concerns surfaced about its safety. Pradaxa was identified as the primary suspect in 542 patient deaths reported to the F.D.A. in 2011, and was linked to more reports of injury or death than any of the more than 800 drugs regularly monitored by the Institute for Safe Medication Practices, a nonprofit based in Pennsylvania that monitors medicine safety.

Dr. Mosley said he found it “shocking, just shocking” that the F.D.A. approved Pradaxa, which is also called dabigatran, even though no antidote was available.

In a statement, the F.D.A. said, “the lack of an antidote notwithstanding, dabigatran was superior to warfarin in preventing strokes in a large clinical trial. The rates of bleeding were similar.” In the study it released on Friday, the F.D.A. examined health insurance claims and hospital data and reached a similar conclusion.

Warfarin, which is also known by the brand name Coumadin, can often be reversed by giving a patient vitamin K or other substances. Warfarin, too, can be deadly but, doctors said, they at least have options.

“The practical experience is that once hemorrhagic complications occur in this drug, it is much more likely to be a catastrophe than with Coumadin,” said Dr. Richard H. Schmidt, an associate professor of neurosurgery at the University of Utah, who treated an 83-year-old man who died from bleeding and was using Pradaxa.

Boehringer Ingelheim recommends treating bleeding patients with dialysis to help flush the drug from the body, although it notes that “the amount of data supporting this approach is limited.”

Several doctors said that option was not realistic. “People that are bleeding to death aren’t going to tolerate being put on dialysis,” Dr. Cotton said.

Two other new drugs intended as warfarin replacements also lack antidotes. Doctors said they had not seen as many bleeding deaths associated with Xarelto, which was approved in 2011 and is sold by Bayer and Johnson & Johnson. On Friday, the F.D.A. approved Xarelto to also treat deep vein thrombosis and pulmonary embolism, two kinds of blood clots. Pradaxa is approved in the United States only to prevent stroke in patients with atrial fibrillation. A third drug, Eliquis, by Bristol-Myers Squibb and Pfizer, has not yet been approved by the F.D.A. Representatives for both drugs said trials showed their products were safe, adding that the companies were investigating different antidotes. Boehringer Ingelheim is expected to present several new studies of Pradaxa’s safety and efficacy — including one that examines potential antidotes — at the American Heart Association scientific conference next week in Los Angeles.

Some cardiologists have said that Pradaxa and the other new drugs represent real advances over warfarin. Around 40 percent of people with atrial fibrillation do not take any drugs for it, a recent study showed, putting them at risk for strokes.

“I think the benefit of the drug clearly exceeds the risk because to me, a disabling stroke has a greater weight than a bleeding complication,” said Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles and a member of the F.D.A. committee that voted to approve Pradaxa.

But those calculations make little sense to Walter Daumler, who said he watched his 78-year-old sister, Doris, bleed to death in May. Mr. Daumler, who lives in Wisconsin, has hired a lawyer and is considering suing. He said the doctors told him that because she was on Pradaxa, there was nothing they could do.

“My No. 1 goal is to stop this insidious drug,” Mr. Daumler said. “To get this off the market, so others will not undergo or witness what I saw.”