A Promising Drug With a Flaw

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.”

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A Promising Drug With a Flaw

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.”

Read More..

Cellphone Users Steaming at Hit-or-Miss Service

To wireless customers, cellphone networks might seem to be made out of thin air. But they are plenty vulnerable to catastrophic storms — and bringing service back can take an excruciatingly long time.

On Friday, four days after Hurricane Sandy, the major carriers — AT&T, Verizon Wireless, T-Mobile USA and Sprint — were still busily rebuilding their networks in the hardest-hit areas.

One-quarter of the cell towers in the storm zone were knocked out, according to the Federal Communications Commission. Many had no power, and their backup battery systems soon drained. The lines connecting those towers to the rest of the phone network were ripped out. Carriers deployed generators to provide power, but eventually those required more fuel — another limited resource.

In an emergency, a lack of cellphone reception can be dangerous, especially as more people have chosen to snip landlines out of their budgets. About 60 percent of American households have landlines, down from 78 percent four years ago, according to Chetan Sharma, an independent mobile analyst.

The carriers say they are trying their best to deal with an unusual disaster. But in the past, they have steadfastly objected to recommendations from regulators that they spend more money on robust emergency equipment, like longer-lasting backup batteries.

Neville Ray, chief technology officer of T-Mobile USA, said Hurricane Sandy was the biggest natural disaster he had ever dealt with and that service failures were inevitable.

“There’s an amount of preparation you can do, but depending on the size and scale and impact of the storm, it’s tough to anticipate every circumstance,” Mr. Ray said in an interview. “No degree of preparation can prevent some of those outages from happening.”

When networks fail, carriers deploy trucks, called C.O.W.’s, for cell on wheels, that act as temporary cell towers. But the companies say the challenge with deploying these trucks poststorm is connecting to power and to the wider phone network, which requires a microwave radio link to a working tower. Because of the density of the buildings in New York City, the trucks could serve only a small area, according to Mr. Ray.

The carriers have made other efforts to provide services while restoring their networks. AT&T wheeled out R.V.’s where customers could charge their phones. And it made an agreement to share networks with T-Mobile USA in the affected areas of New York and New Jersey. When customers of both companies place calls, they are carried by whichever network is available in the area.

But ultimately all of the carriers’ preparations and responses were not enough to get services running again in a hurry. Over the week the carriers reported gradual progress, and they declined to offer timelines indicating when customers could expect to have service again.

The unreliability of wireless networks may point to a bigger problem. Over the years, the phone companies have fought off regulators who want to treat them as utilities, arguing that if they are going to stay innovative, they cannot be burdened with the old rules that phone companies dealt with in the landline era. But as a consequence, there are almost no rules about what carriers have to do in an emergency, said Harold Feld, senior vice president for Public Knowledge, a nonprofit that focuses on information policy.

“With the new networks we’ve prized keeping costs down, we’ve prized flexibility and we’ve prized innovation,” said Mr. Feld, who wrote a blog post on Monday anticipating cell tower problems. “But we have not put stability as a value when we have been pushing to have these networks built out.”

Mr. Feld noted that after Hurricane Katrina in 2005, the F.C.C. recommended that carriers install backup batteries on their transmission towers that would last 24 hours, among other measures. But the carriers objected, presumably because they did not want to spend the money, he said. (Of course, 24 hours would not have been enough in many areas hit by the latest storm.)

In general, the carriers say it is in their own interest to fortify their networks for emergency situations, but Mr. Feld said this incentive was not enough.

“We ought to actually be doing this in the mind-set that there need to be actual rules, so that everybody knows how to behave when the crisis hits,” he said. “When I drive I have the best incentive in the world not to hit a telephone pole and not to slam into another car. But I still need speed limits, stop signs and stop lights.”

Debra Lewis, a spokeswoman for Verizon Wireless, said no amount of rules could have prepared carriers for the outcome of a storm like Hurricane Sandy.

“The fact is, regulation cannot anticipate the varied challenges that can arise in such situations, but we do learn from them and adapt accordingly to ensure we meet consumers’ needs,” Ms. Lewis said. She said the company prepared for natural disasters with generators and batteries that provided at least eight hours of power to cell sites.

Verizon Wireless said Friday evening that less than 3 percent of its network in the Northeast was still down. “In severely impacted areas, such as Lower Manhattan, while wireless service has yet to return to normal levels, coverage is good,” it said.

AT&T was the only major carrier that would not go into specifics about how much of its network was down. Anecdotally it seemed that in Manhattan at least, AT&T’s coverage was not as good as Verizon’s after the storm. One Twitter user directed this message at AT&T on Tuesday: “I live in lower manhattan. Vz has service u do not. You are ruining lives. I had to come midtown 2 call mom. Switching.”

Mark Siegel, a spokesman for AT&T, said the company would not comment because it was working on restoring its network.

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Petraeus’s Lower C.I.A. Profile Leaves Benghazi Void

WASHINGTON — In 14 months as C.I.A. director, David H. Petraeus has shunned the spotlight he once courted as America’s most famous general. His low-profile style has won the loyalty of the White House, easing old tensions with President Obama, and he has overcome some of the skepticism he faced from the agency’s work force, which is always wary of the military brass.

Brendan Smialowski/Getty Images

The low-profile style of David H. Petraeus, right, has won the loyalty of the White House, easing old tensions with President Obama.

Win Mcnamee/Getty Images

C.I.A. director, David H. Petraeus, right, appeared before the Senate Select Committee on Intelligence in Washington in January.

But since an attack killed four Americans seven weeks ago in Benghazi, Libya, his deliberately low profile, and the C.I.A.’s penchant for secrecy, have left a void that has been filled by a news media and Congressional furor over whether it could have been prevented. Rather than acknowledge the C.I.A.’s presence in Benghazi, Mr. Petraeus and other agency officials fought a losing battle to keep it secret, even as the events there became a point of contention in the presidential campaign.

Finally, on Thursday, with Mr. Petraeus away on a visit to the Middle East, pressure from critics prompted intelligence officials to give their own account of the chaotic night when two security officers died along with the American ambassador, J. Christopher Stevens, and another diplomat. The officials acknowledged for the first time that the security officers, both former members of the Navy SEALs, worked on contract for the C.I.A., which occupied one of the buildings that were attacked.

The Benghazi crisis is the biggest challenge so far in the first civilian job held by Mr. Petraeus, who retired from the Army and dropped the “General” when he went to the C.I.A. He gets mostly high marks from government colleagues and outside experts for his overall performance. But the transition has meant learning a markedly different culture, at an agency famously resistant to outsiders.

“I think he’s a brilliant man, but he’s also a four-star general,” said Senator Dianne Feinstein, the chairwoman of the Senate Intelligence Committee. “Four-stars are saluted, not questioned. He’s now running an agency where everything is questioned, whether you’re a four-star or a senator. It’s a culture change.”

Mr. Petraeus, who turns 60 next week, has had to learn that C.I.A. officers will not automatically defer to his judgments, as military subordinates often did. “The attitude at the agency is, ‘You may be the director, but I’m the Thailand analyst,’ ” said one C.I.A. veteran.

Long a media star as the most prominent military leader of his generation, Mr. Petraeus abruptly abandoned that style at the C.I.A. Operating amid widespread complaints about leaks of classified information, he has stopped giving interviews, speaks to Congress in closed sessions and travels the globe to consult with foreign spy services with little news media notice.

“He thinks he has to be very discreet and let others in the government do the talking,” said Michael E. O’Hanlon, a Brookings Institution scholar who is a friend of Mr. Petraeus’s and a member of the C.I.A.’s advisory board.

Mr. Petraeus’s no-news, no-nonsense style stands out especially starkly against that of his effusive predecessor, Leon E. Panetta, who is now the defense secretary.

Mr. Panetta, a gregarious politician by profession, was unusually open with Congress and sometimes with the public — to a fault, some might say, when he spoke candidly after leaving the C.I.A. about a Pakistani doctor’s role in helping hunt for Osama bin Laden, or about the agency’s drone operations.

Mr. Petraeus’s discretion and relentless work ethic have had a positive side for him: old tensions with Mr. Obama, which grew out of differing views on the wars in Iraq and Afghanistan, appear to be gone. Mr. Petraeus is at the White House several times a week, attending National Security Council sessions and meeting weekly with James R. Clapper Jr., the director of national intelligence, and Thomas E. Donilon, Mr. Obama’s national security adviser. Mr. Donilon said recently that the C.I.A. director “has done an exceptional job,” bringing “deep experience, intellectual rigor and enthusiasm” to his work.

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Estimate of Economic Losses Now Up to $50 Billion

Economic damages inflicted by Hurricane Sandy could reach $50 billion, according to new estimates that are more than double a previous forecast. Some economists warned on Thursday that the storm could shave a half percentage point off the nation’s economic growth in the current quarter.

Losses from the storm could total $30 billion to $50 billion, according to Eqecat, which tracks hurricanes and analyzes the damage they cause. On Monday, before the storm hit the East Coast, the firm estimated $10 billion to $20 billion in total economic damages.

The flooding of New York’s subways and roadway tunnels and the extensive loss of business as a result of utility failures across the region were behind the sharp increase in the estimate, the firm said.

“The geographic scope of the storm was unprecedented, and the impacts on individuals and on commerce are far larger,” said Tom Larsen, Eqecat’s senior vice president and product architect. “Lost power is going to contribute to higher insurance losses.”

Eqecat predicted that New York would bear 34 percent of the total economic losses, with New Jersey suffering 30 percent, Pennsylvania 20 percent and other states 16 percent. That includes all estimated losses, whether covered by insurance or not. The estimates and the share that will be covered by insurers are far from certain at this point, as government officials, property owners and insurance adjusters struggle to assess the destruction.

While the stock market, banks and other financial institutions regained some of their stride on Thursday, other sectors like retailing, transportation and leisure and hospitality face a much longer and more difficult recovery. With fuel in short supply in many areas and utilities warning that power may not be back for a week or more in some areas, businesses found themselves preparing for the equivalent of a long siege.

FedEx, for example, was trying to rent fuel tankers for its trucks in New York and New Jersey as commercial gas stations ran dry.

“We’re reaching out to everyone who has a gasoline tanker that we can move to these areas,” said Shea Leordeanu, a spokeswoman for the company. While FedEx had stocks of oil in advance of the storm for generators, it was not prepared for the gas shortages that caused long lines at stations on Wednesday and Thursday.

“There has not been an impact yet, but this is something we can see as an issue and we’re concerned,” she said.

As logistical problems mounted, and damage estimates surged, economists raised their estimates of the storm’s impact.

“I think the effect will be quite big,” said Julia Lynn Coronado, chief economist for North America at BNP Paribas. “In the fourth quarter, we’re probably looking at an impact of half a percentage point.”

She said some of those losses would be made up in the first quarter of 2013, as insurance reimbursements were distributed and homeowners and businesses rebuilt.

Hurricane Sandy will rank high among disasters in terms of economic impact but will not be at the top of the list, said Mark Zandi of Moody’s Analytics. He estimated that the losses would be less than half of those suffered because of the 9/11 terrorist attacks and from Hurricane Katrina.

Moody’s Analytics also put the impact in the $50 billion range, with about $12 billion in losses falling in the New York City metropolitan area.

About $20 billion of that total is from lost economic activity like meals not served in restaurants, canceled plane flights and bets not placed in casinos, Mr. Zandi estimated. The rest, about $30 billion, will be from property destruction, including damage to homes, cars and businesses, Mr. Zandi said.

Eqecat said it believed that various forms of insurance would cover $10 billion to $20 billion of the total cost. Other losses will be borne by individuals and businesses, or covered by federal government programs like the National Flood Insurance Program. Much of the federal spending will be used to repair damaged public infrastructure, rather than for private property.

Eqecat said that if insured costs remained at the lower end of its predicted range, at $10 billion, then about 60 percent of the losses would be covered by homeowners’ and, to a lesser extent, auto insurers. The remainder would be covered by commercial and industrial insurance.

The firm’s officials said that if total insured losses rose to the higher end of its predicted range, it would be because of costs like business-interruption losses — and in that case, commercial insurers pay more.

They said this possibility would depend to a great extent on how long power failures continued. They said there were no solid data yet on the number of transformers and power lines that had been knocked out. They added that in some cases, power might not be restored until well into December.

Moody’s issued a report on Thursday stating that the large nationwide insurers had “diversified exposures and strong capital bases to withstand” payouts related to the storm. It added, however, that the costs could disrupt the capital bases of smaller regional insurers.

State Farm, the largest writer of home and auto insurance in the region, reported having received nearly 25,000 homeowners’ claims and 4,000 auto claims as of Wednesday. Those numbers are probably a fraction of the eventual totals. Some of the losses will not be recouped. Lost Halloween sales will be especially painful for some retailers, according to a separate analysis by Moody’s.

“As shoppers in the affected regions focus on the storm, other discretionary spending will fall and not be recouped,” Moody’s said.

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Arthur R. Jensen, Who Set Off Debate on I.Q., Dies

Arthur R. Jensen, an educational psychologist who ignited an international firestorm with a 1969 article suggesting that the gap in intelligence-test scores between black and white students might be rooted in genetic differences between the races, died on Oct. 22 at his home in Kelseyville, Calif. He was 89.

His death was confirmed by the University of California, Berkeley, where he was an emeritus professor in the Graduate School of Education.

Professor Jensen was deeply interested in differential psychology, a field whose central question — What makes people behave and think differently from one another? — strikes at the heart of the age-old nature-nurture debate.

Because of his empirical work in the field on the quantification of general intelligence (a subject that had long invited a more diffuse, impressionistic approach), he was regarded by many colleagues as one of the most important psychologists of his day.

But a wider public remembered him almost exclusively for his 1969 article “How Much Can We Boost I.Q. and Achievement?” Published in The Harvard Educational Review, a scholarly journal, the article quickly became — and remains even now — one of the most controversial in psychology.

In the article, Professor Jensen posited two types of learning ability. Level I, associative ability, entailed the rote retention of facts. Level II, conceptual ability, involved abstract thinking and problem-solving. This type, he argued, was roughly equivalent to general intelligence, denoted in psychology by the letter “g.”

In administering I.Q. tests to diverse groups of students, Professor Jensen found Level I ability to be fairly consistent across races. When he examined Level II ability, by contrast, he found it more prevalent among whites than blacks, and still more prevalent among Asians than whites.

Drawing on these findings, Professor Jensen argued that general intelligence is largely genetically determined, with cultural forces shaping it only to a small extent. For this reason, he wrote in 1969, compensatory education programs like Head Start are doomed to fail.

While some observers praised Professor Jensen as a scientist unafraid to go where the data led him, others called him a racist. He continued to be heckled at speaking engagements throughout his career. He was burned in effigy on some college campuses and received death threats; for a time, he was accompanied by bodyguards.

The idea that intelligence cleaved along racial lines quickly became known as Jensenism, and its merits were the subject of heated public discussion for years afterward. The evolutionary biologist Stephen Jay Gould, for instance, devoted much of his 1981 book, “The Mismeasure of Man,” to criticizing Professor Jensen’s claims.

More recently, Professor Jensen’s ideas about race and the heritability of intelligence were cited approvingly in “The Bell Curve,” the 1994 book by Richard J. Herrnstein and Charles Murray that engendered renewed debate on the subject.

Today, some psychologists say that Professor Jensen’s work has been misunderstood. In a telephone interview on Wednesday, Douglas Detterman, a psychologist at Case Western Reserve University who edits the journal Intelligence, said: “If you look at the Harvard Educational Review paper, he discusses race very little in that paper, but he did say that it’s a possibility that there are genetic differences among racial groups. And that was not a very popular idea when that paper came out.”

Professor Detterman, who in 1998 devoted a special issue of Intelligence to Professor Jensen’s work, added: “When he wrote that paper, probably a large portion of psychologists wouldn’t have believed that there was a hereditary basis for intellectual ability. Now, there’s very little argument about that in the field. Whether there are differences between races is another thing altogether.”

Arthur Robert Jensen was born in San Diego on Aug. 24, 1923. An accomplished clarinetist, he considered pursuing a career as an orchestra conductor before taking a bachelor’s degree in psychology from Berkeley, followed by a master’s in the field from San Diego State College and a Ph.D. from Columbia. He joined the Berkeley faculty in 1958.

Professor Jensen’s wife, Barbara, died before him. Survivors include a daughter, Bobbi Morey.

Among his books are “Genetics and Education” (1972), “Educability and Group Differences” (1973), “The g Factor: The Science of Mental Ability” (1998) and “Clocking the Mind: Mental Chronometry and Individual Differences” (2006).

Even psychologists who disagree with Professor Jensen’s conclusions defend him against charges of racism.

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Arthur R. Jensen, Who Set Off Debate on I.Q., Dies

Arthur R. Jensen, an educational psychologist who ignited an international firestorm with a 1969 article suggesting that the gap in intelligence-test scores between black and white students might be rooted in genetic differences between the races, died on Oct. 22 at his home in Kelseyville, Calif. He was 89.

His death was confirmed by the University of California, Berkeley, where he was an emeritus professor in the Graduate School of Education.

Professor Jensen was deeply interested in differential psychology, a field whose central question — What makes people behave and think differently from one another? — strikes at the heart of the age-old nature-nurture debate.

Because of his empirical work in the field on the quantification of general intelligence (a subject that had long invited a more diffuse, impressionistic approach), he was regarded by many colleagues as one of the most important psychologists of his day.

But a wider public remembered him almost exclusively for his 1969 article “How Much Can We Boost I.Q. and Achievement?” Published in The Harvard Educational Review, a scholarly journal, the article quickly became — and remains even now — one of the most controversial in psychology.

In the article, Professor Jensen posited two types of learning ability. Level I, associative ability, entailed the rote retention of facts. Level II, conceptual ability, involved abstract thinking and problem-solving. This type, he argued, was roughly equivalent to general intelligence, denoted in psychology by the letter “g.”

In administering I.Q. tests to diverse groups of students, Professor Jensen found Level I ability to be fairly consistent across races. When he examined Level II ability, by contrast, he found it more prevalent among whites than blacks, and still more prevalent among Asians than whites.

Drawing on these findings, Professor Jensen argued that general intelligence is largely genetically determined, with cultural forces shaping it only to a small extent. For this reason, he wrote in 1969, compensatory education programs like Head Start are doomed to fail.

While some observers praised Professor Jensen as a scientist unafraid to go where the data led him, others called him a racist. He continued to be heckled at speaking engagements throughout his career. He was burned in effigy on some college campuses and received death threats; for a time, he was accompanied by bodyguards.

The idea that intelligence cleaved along racial lines quickly became known as Jensenism, and its merits were the subject of heated public discussion for years afterward. The evolutionary biologist Stephen Jay Gould, for instance, devoted much of his 1981 book, “The Mismeasure of Man,” to criticizing Professor Jensen’s claims.

More recently, Professor Jensen’s ideas about race and the heritability of intelligence were cited approvingly in “The Bell Curve,” the 1994 book by Richard J. Herrnstein and Charles Murray that engendered renewed debate on the subject.

Today, some psychologists say that Professor Jensen’s work has been misunderstood. In a telephone interview on Wednesday, Douglas Detterman, a psychologist at Case Western Reserve University who edits the journal Intelligence, said: “If you look at the Harvard Educational Review paper, he discusses race very little in that paper, but he did say that it’s a possibility that there are genetic differences among racial groups. And that was not a very popular idea when that paper came out.”

Professor Detterman, who in 1998 devoted a special issue of Intelligence to Professor Jensen’s work, added: “When he wrote that paper, probably a large portion of psychologists wouldn’t have believed that there was a hereditary basis for intellectual ability. Now, there’s very little argument about that in the field. Whether there are differences between races is another thing altogether.”

Arthur Robert Jensen was born in San Diego on Aug. 24, 1923. An accomplished clarinetist, he considered pursuing a career as an orchestra conductor before taking a bachelor’s degree in psychology from Berkeley, followed by a master’s in the field from San Diego State College and a Ph.D. from Columbia. He joined the Berkeley faculty in 1958.

Professor Jensen’s wife, Barbara, died before him. Survivors include a daughter, Bobbi Morey.

Among his books are “Genetics and Education” (1972), “Educability and Group Differences” (1973), “The g Factor: The Science of Mental Ability” (1998) and “Clocking the Mind: Mental Chronometry and Individual Differences” (2006).

Even psychologists who disagree with Professor Jensen’s conclusions defend him against charges of racism.

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When Floodwaters Rise, Web Sites May Fall

Here is a lesson every Web site manager may be taking away from Hurricane Sandy: It is probably not a good idea to put the backup power generators where it floods.

As computer centers in Lower Manhattan and New Jersey shut down or went to emergency operations after power failures and water damage Monday night, companies scrambled to move the engines of modern communication to other parts of the country. Others rushed to find fuel for backup power generation. In some cases, things just stopped.

“Suddenly, nobody could get online,” said Arianna Huffington, president and chief executive of The Huffington Post, which went offline about 7 p.m. Monday when the computer servers of Datagram, which distribute its work on the Internet, stopped working because of rising water in Lower Manhattan.

About six hours later, Huffington Post was online, but it crashed again several hours later. It was running again at 8 a.m. Tuesday.

As more of life moves online, damage to critical Internet systems affect more of the economy, and disasters like Hurricane Sandy reveal vulnerabilities from the sometimes ad hoc organization of computer networks. In places like Manhattan, advanced technology comes up against aging infrastructure and space constraints, forcing servers and generators to use whatever space is available.

Power is the primary worry, since an abrupt network shutdown can destroy data, but problems can also stem from something as simple as not keeping a crisis plan updated.

“If you have an e-commerce system taking an order from the Web, it may touch 17 servers, all in different locations,” said James Staten, an analyst with Forrester Research. One server might contain customer information, he said, while others work with logistics, product availability or billing. “If you don’t list them all as mission critical, you’re in trouble when disaster occurs.”

Big nationwide providers of Internet service, like Google and Amazon Web Services, were for the most part unaffected by the storm. Their cavernous facilities, holding more than 100,000 computer servers each, were located out of the storm’s path, and had extensive backup power generation. Amazon’s facilities in Virginia, which had been affected in a storm last summer, had no problems.

The largest telecommunications company affected by the storm appeared to be Verizon, which lost a considerable amount of old-fashioned wired phone service to the flooding. Bill Kula, a Verizon spokesman, said the storm surge from the hurricane flooded its central offices in Lower Manhattan, Queens and Long Island, causing power failures. Cellphone service at both AT&T and Verizon Wireless appeared to be less affected.

In the days leading to the hurricane, the carriers staged fleets of emergency response vehicles — trucks that act as temporary cell towers — in strategic locations along the storm’s edge. They also took safety measures, like installing backup batteries on cell sites and moving important equipment to less vulnerable areas. They advised customers to use text messaging instead of placing phone calls to use fewer network resources.

Large companies avoided problems by moving data and people out of town before the hurricane hit, using specialized nationwide service providers.

“They fan out across the U.S.,” said Nick Magliato, chief operations officer of SunGuard. “They move data from New York to Philadelphia, Philadelphia to Phoenix.” His company also provides offices for workers across the country, with computers that replicate their office systems and phones that have their personal numbers.

Peer 1 Hosting, like many other service providers, updated customers via its blog Tuesday. Robert Miggins, senior vice president for business development, said the main options for customers were to shut down in an orderly way, preserving data, risk staying online, or consider moving data to Peer 1’s computers in other parts of the country. “We’re telling them to back up everything,” he said, “sometimes they are dealing with us with nothing but a smartphone.”

Quentin Hardy reported from San Francisco and Jenna Wortham from New York. Brian X. Chen contributed reporting from New York.

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Live Coverage: Increments of Progress, and New Struggles, After Storm

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A look at the devastation caused in the aftermath of Hurricane Sandy from North Carolina to New England.

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Apple Shake-Up Could End Real-World Images

Whether they realize it or not, all of those who swipe a finger down from the top of the iPhone’s screen to check for notifications are bearing witness to a big sore point within Apple.

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Jonathan Ive, second from left, who will oversee the look of Apple’s software, is said to have criticized the images in the company’s mobile software. More Photos »

There, behind a list of text messages, missed phone calls and other updates, is a gray background with the unmistakable texture of fine linen.

Steven P. Jobs, the Apple chief executive who died a year ago, pushed the company’s software designers to use the linen texture liberally in the software for the company’s mobile devices. He did the same with many other virtual doodads that mimic the appearance and behavior of real-world things, like wooden shelves for organizing newspapers and the page-flipping motion of a book, according to people who worked with him but declined to be named to avoid Apple’s ire.

The management shake-up that Apple announced on Monday is likely to mean that Apple will shift away from such visual tricks, which many people within the company look down upon. As part of the changes, the company fired Scott Forstall, the leader of Apple’s mobile software development and a disciple of Mr. Jobs. While Mr. Forstall’s abrasive style and resistance to collaboration with other parts of the company were the main factors in his undoing, the change also represents the departure of the most vocal and high-ranking proponent of the visual design style favored by Mr. Jobs.

The executive who will now set the direction for the look of Apple’s software is Jonathan Ive, who has long been responsible for Apple’s minimalist hardware designs. Mr. Ive, despite his close relationship with Mr. Jobs, has made his distaste for the visual ornamentation in Apple’s mobile software known within the company, according to current and former Apple employees who asked not to be named discussing internal matters.

This may seem like little more than an internal disagreement over taste. But Apple venerates design like few other companies of its size, and its customers have rewarded it handsomely as a result. Apple’s decisions can influence how millions of people use and think about digital devices — not only its own but those made by other companies that look to Apple as a standard-setter in design.

Axel Roesler, associate professor and chairman of the interaction design program at the University of Washington, says Apple’s software designs had become larded with nostalgia, unnecessary visual references to the past that he compared to Greek columns in modern-day architecture. He said he would like to see Mr. Ive take a fresh approach.

“Apple, as a design leader, is not only capable of doing this, they have a responsibility for doing it,” he said. “People expect great things from them.”

Steve Dowling, an Apple spokesman, declined to comment.

Apple’s customers do not seem to have serious qualms about the design choices the company has made as they continue to buy iPhones and iPads at a healthy clip. But within the circles of designers and technology executives outside Apple who obsess over the details of how products look and work, there has been a growing amount of grumbling in the last year that Apple’s approach is starting to look dated.

The style favored by Mr. Forstall and Mr. Jobs is known in this crowd as skeuomorphism, in which certain images and metaphors, like a spiral-bound notebook or stitched leather, are used in software to give people a reassuring real-world reference.

In contrast, Microsoft, not known as a big risk-taker, has been praised recently for taking greater creative risks in the design of its software than Apple has. It has come up with a visual style that is now used throughout its computer, mobile and game products. It relies heavily on typography and sheets of tiles that provide access to programs and are updated with photos and other online information. It is not yet clear whether this approach will be a hit with people who do not spend time thinking about design.

Bill Flora, a former Microsoft designer who created the earliest prototypes of its new visual style, said Apple had not been innovative enough in the design of its software. “I have found their hardware to be amazing and sophisticated, and I have found their software to be kind of old school,” said Mr. Flora, who now has his own design firm, Tectonic, in Seattle. “Their approach really wasn’t what I was taught as a designer in design school.”

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