Well: Embracing Children for Who They Are

Contrary to what some parents might believe or hope for, children are not born a blank slate. Rather, they come into the world with predetermined abilities, proclivities and temperaments that nurturing parents may be able to foster or modify, but can rarely reverse.

Perhaps no one knows this better than Jeanne and John Schwartz, parents of three children, the youngest of whom — Joseph — is completely different from the other two.

Offered a bin of toys, their daughter, Elizabeth, picked out the Barbies and their son Sam the trucks. But Joseph, like his sister, ignored the trucks and chose the dolls, which he dressed with great care. He begged for pink light-up shoes with rhinestones and, at 3, asked to be “a disco yady” for Halloween.

Joseph loved words and books, but “our attempts to get him into sports, which Sam had loved so much, were frustrating bordering on the disastrous,” Mr. Schwartz, a national correspondent for The New York Times, wrote in a caring and instructive new memoir, “Oddly Normal: One Family’s Struggle to Help Their Teenage Son Come to Terms with his Sexuality” (Gotham Books).

“This is not just a book about raising a gay child,” Mr. Schwartz said in an interview. “It’s about raising children who are different,” both recognizing and adapting to those differences and being advocates for the children who possess them. Citing the novel “The Martian Child,” about an adopted son, he said, “We’ve got to take care of our little Martians.”

Adjust Expectations

The goal of parenting should be to raise children with a healthy self-image and self-esteem, ingredients vital to success in school and life. That means accepting children the way they are born — gay or straight, athletic or cerebral, gentle or tough, highly intelligent or less so, scrawny or chubby, shy or outgoing, good eaters or picky ones.

Of course, to the best of their ability, parents should give children opportunities to learn and enjoy activities that might be outside their natural bent. But, as attested to in many a memoir, forcing children to follow a prescribed formula almost always backfires.

For example, everyone in my family is a jock, with a strong belief in the importance of physical activity. Everyone, that is, except one of my four grandsons. Now 10, he is an intellectual, and has been since age 3, when he learned the entire world’s atlas of animals. He absorbs scientific information like a sponge and retains it. He can tell you about deep-sea creatures, planets and stars, chemical reactions, exotic caterpillars, geological formations — you name it — and he’s a whiz at the computer. But he has no athletic interest or apparent ability. His parents have introduced him to a variety of team and individual sports, but so far none has clicked.

Rather than try to remake him into someone he is not, the challenge for all of us is to appreciate and adapt to his differences, love him for who he is and not disparage him for what he is not. While the other three boys get basketballs, bicycles and tennis rackets as gifts, for his 10th birthday I gave him a huge book on the universe, which became his bedtime reading. Lives Enriched

One persuasive voice for differences in children and how families must adapt better is Andrew Solomon, author of an ambitious new book, “Far From the Tree: Parents, Children and the Search for Identity,” published this month by Scribner. Mr. Solomon, a gay man who has fathered four children, one of whom he is raising with his husband, has explored in depth the challenges and rewards of family diversity.

Mr. Solomon, who has written articles for The Times, interviewed more than 300 families, most of whom have successfully raised children who are deaf, dwarfs, autistic, schizophrenic, transgender, are prodigies or have Down syndrome, as well as those who were conceived in rape or became criminals.

He makes a strong case for accepting one’s children for who they are and, at the same time, helping them become the best they can be. Especially poignant is his account of a family with a high-functioning son with Down syndrome. For years, the boy progressed academically on pace with his peers and was a poster child for what a person with Down syndrome could do. But when the son could go no further, his mother recognized that he needed to be in a group home.

“We had worked so hard to make him the Down syndrome guy who didn’t need it,” the mother told Mr. Solomon. “But I had to look at what was best for him, and not some ideal we had built up for ourselves.”

Most of the parents interviewed found a lot of meaning and many rewards in dealing with a child who was different. “They told me it has given them a so much richer life that they wouldn’t have given it up for all the world,” Mr. Solomon said. “There are many ways to exist in this world and many different ways to be happy.”

As Mr. Schwartz described Joseph: “He’s a delightful guy, a joy. I couldn’t have made that mold. You can’t expect your kids to turn out as you planned, but you can be thrilled by how they turn out.”

He added: “You want your children to achieve and be comfortable with who they are. You should advocate for them and help them develop the skills to advocate for themselves. But parents shouldn’t try to mold their children. When you expect your kids to fit into a mold, especially a mold of your own making, you’ll be disappointed.”

Schools, too, should know how to accommodate children who are different, said Mr. Schwartz, whose book details the struggles his son faced even in a town with great schools.

It’s not just a matter of schools dealing effectively with bullying, he said. “Jeanne and I believe schools can do a lot with the resources they have to embrace differences in kids and recognize when they are unduly stressed,” he said.

Even with accepting and encouraging parents, Joseph Schwartz was unable for years to acknowledge his gay identity, which resulted in serious academic, social and psychological problems. Each of Mr. Solomon’s families also faced identity struggles, and many were helped greatly by finding peers with similar challenges, a task made so much easier by the Internet.

For many parents, he said, raising children who were different was “an occasion for growth that introduced them to social networks they never imagined.”

He said, “It added richness to the lives of those who said they could see a positive side to having a child who was different.”

Read More..

Well: Embracing Children for Who They Are

Contrary to what some parents might believe or hope for, children are not born a blank slate. Rather, they come into the world with predetermined abilities, proclivities and temperaments that nurturing parents may be able to foster or modify, but can rarely reverse.

Perhaps no one knows this better than Jeanne and John Schwartz, parents of three children, the youngest of whom — Joseph — is completely different from the other two.

Offered a bin of toys, their daughter, Elizabeth, picked out the Barbies and their son Sam the trucks. But Joseph, like his sister, ignored the trucks and chose the dolls, which he dressed with great care. He begged for pink light-up shoes with rhinestones and, at 3, asked to be “a disco yady” for Halloween.

Joseph loved words and books, but “our attempts to get him into sports, which Sam had loved so much, were frustrating bordering on the disastrous,” Mr. Schwartz, a national correspondent for The New York Times, wrote in a caring and instructive new memoir, “Oddly Normal: One Family’s Struggle to Help Their Teenage Son Come to Terms with his Sexuality” (Gotham Books).

“This is not just a book about raising a gay child,” Mr. Schwartz said in an interview. “It’s about raising children who are different,” both recognizing and adapting to those differences and being advocates for the children who possess them. Citing the novel “The Martian Child,” about an adopted son, he said, “We’ve got to take care of our little Martians.”

Adjust Expectations

The goal of parenting should be to raise children with a healthy self-image and self-esteem, ingredients vital to success in school and life. That means accepting children the way they are born — gay or straight, athletic or cerebral, gentle or tough, highly intelligent or less so, scrawny or chubby, shy or outgoing, good eaters or picky ones.

Of course, to the best of their ability, parents should give children opportunities to learn and enjoy activities that might be outside their natural bent. But, as attested to in many a memoir, forcing children to follow a prescribed formula almost always backfires.

For example, everyone in my family is a jock, with a strong belief in the importance of physical activity. Everyone, that is, except one of my four grandsons. Now 10, he is an intellectual, and has been since age 3, when he learned the entire world’s atlas of animals. He absorbs scientific information like a sponge and retains it. He can tell you about deep-sea creatures, planets and stars, chemical reactions, exotic caterpillars, geological formations — you name it — and he’s a whiz at the computer. But he has no athletic interest or apparent ability. His parents have introduced him to a variety of team and individual sports, but so far none has clicked.

Rather than try to remake him into someone he is not, the challenge for all of us is to appreciate and adapt to his differences, love him for who he is and not disparage him for what he is not. While the other three boys get basketballs, bicycles and tennis rackets as gifts, for his 10th birthday I gave him a huge book on the universe, which became his bedtime reading. Lives Enriched

One persuasive voice for differences in children and how families must adapt better is Andrew Solomon, author of an ambitious new book, “Far From the Tree: Parents, Children and the Search for Identity,” published this month by Scribner. Mr. Solomon, a gay man who has fathered four children, one of whom he is raising with his husband, has explored in depth the challenges and rewards of family diversity.

Mr. Solomon, who has written articles for The Times, interviewed more than 300 families, most of whom have successfully raised children who are deaf, dwarfs, autistic, schizophrenic, transgender, are prodigies or have Down syndrome, as well as those who were conceived in rape or became criminals.

He makes a strong case for accepting one’s children for who they are and, at the same time, helping them become the best they can be. Especially poignant is his account of a family with a high-functioning son with Down syndrome. For years, the boy progressed academically on pace with his peers and was a poster child for what a person with Down syndrome could do. But when the son could go no further, his mother recognized that he needed to be in a group home.

“We had worked so hard to make him the Down syndrome guy who didn’t need it,” the mother told Mr. Solomon. “But I had to look at what was best for him, and not some ideal we had built up for ourselves.”

Most of the parents interviewed found a lot of meaning and many rewards in dealing with a child who was different. “They told me it has given them a so much richer life that they wouldn’t have given it up for all the world,” Mr. Solomon said. “There are many ways to exist in this world and many different ways to be happy.”

As Mr. Schwartz described Joseph: “He’s a delightful guy, a joy. I couldn’t have made that mold. You can’t expect your kids to turn out as you planned, but you can be thrilled by how they turn out.”

He added: “You want your children to achieve and be comfortable with who they are. You should advocate for them and help them develop the skills to advocate for themselves. But parents shouldn’t try to mold their children. When you expect your kids to fit into a mold, especially a mold of your own making, you’ll be disappointed.”

Schools, too, should know how to accommodate children who are different, said Mr. Schwartz, whose book details the struggles his son faced even in a town with great schools.

It’s not just a matter of schools dealing effectively with bullying, he said. “Jeanne and I believe schools can do a lot with the resources they have to embrace differences in kids and recognize when they are unduly stressed,” he said.

Even with accepting and encouraging parents, Joseph Schwartz was unable for years to acknowledge his gay identity, which resulted in serious academic, social and psychological problems. Each of Mr. Solomon’s families also faced identity struggles, and many were helped greatly by finding peers with similar challenges, a task made so much easier by the Internet.

For many parents, he said, raising children who were different was “an occasion for growth that introduced them to social networks they never imagined.”

He said, “It added richness to the lives of those who said they could see a positive side to having a child who was different.”

Read More..

Shunning Amazon, Booksellers Resist a Transformation

SAN FRANCISCO — Amazon prides itself on unraveling the established order. This fall, signs of Amazon-inspired disruption are everywhere.

There is the slow-motion crackup of electronics showroom Best Buy. There is Amazon’s rumored entry into the wine business, which is already agitating competitors. And there is the merger of Random House and Penguin, an effort to create a mega-publisher sufficiently hefty to negotiate with the retailer on equal terms.

Amazon inspires anxiety just about everywhere, but its publishing arm is getting pushback from all sorts of booksellers, who are scorning the imprint’s most prominent title, Timothy Ferriss’s “The 4-Hour Chef.” That book is coming out just before Thanksgiving into a fragmented book-selling landscape that Amazon has done much to create but that eludes its control.

Mr. Ferriss’s first book, “The 4-Hour Workweek,” sold nearly a half-million copies in its original print edition, according to Nielsen BookScan. A follow-up devoted to the body did nearly as well. Those books about finding success without trying too hard were a particular hit with young men, who identified with their quasi-scientific entrepreneurial spirit.

Signing Mr. Ferriss was seen as a smart choice by Amazon, which wanted books that would make a splash in both the digital and physical worlds. When the seven-figure deal was announced in August 2011, Mr. Ferriss, a former nutritional supplements marketer, said this was “a chance to really show what the future of books looks like.”

Now that publication is at hand, that future looks messy and angry. Barnes & Noble, struggling to remain relevant in Amazon’s shadow, has been emphatic that it will not carry its competitor’s books. Other large physical and digital stores seem to be uninterested or even opposed to the book. Many independent stores feel betrayed by Mr. Ferriss, whom they had championed. They will do nothing to help him if it involves helping a company they feel is hellbent on their destruction.

“At a certain point you have to decide how far you want to nail your own coffin shut,” said Michael Tucker, owner of the Books Inc. chain here. “Amazon wants to completely control the entire book trade. You’re crazy if you want to play that game with them.”

Bill Petrocelli, co-owner of Book Passage, a large store in suburban Marin County, expressed similar reservations. “We don’t think it’s in our best interests to do business with Amazon,” he said.

Crown, a division of Random House, took on Mr. Ferriss in 2007, after more than two dozen publishers said no to him. “Crown put in a lot of effort to promote those books,” Mr. Petrocelli said. “He decided to walk away. That’s his decision to make but I can’t say I applaud it. I think writers should be supportive of publishers that are supportive of them.”

This isn’t a full-fledged boycott. Books Inc. and Book Passage said they would special order “The 4-Hour Chef” for anyone who wanted one. And some independent stores will even display it, if not enthusiastically.

Green Apple, another big independent San Francisco store, said it would stock the book, figuring that if there was money to be made on its sale, better Green Apple make it than Amazon. But Kevin Ryan, the store’s buyer, said there were limits. “We’re not going to go out of our way to promote something from Amazon,” he said. “We’re not going to stretch.”

When Mr. Ferriss signed with Amazon, he celebrated the new at the expense of the old. “I don’t feel like I’m giving up anything, financially or otherwise,” he said.

He has a somewhat different view these days. “By signing with Amazon, I expected this type of blowback,” he said. “I’ve been girding my loins.”

Read More..

Coptic Church Chooses Pope Who Rejects Politics

Tara Todras-Whitehill for The New York Times

Coptic clergymen at a ceremony on Sunday for choosing a pope.

CAIRO — A blindfolded 6-year-old reached into a glass bowl on Sunday to pick the first new Coptic pope in more than 40 years, a patriarch who promises a new era of integration for Egypt’s Christian minority as it grapples with a wave of sectarian violence, new Islamist domination of politics, and internal pressures for reform.

Tara Todras-Whitehill for The New York Times

The acting Coptic pope, before a banner of Bishop Tawadros, held up the names of other candidates to show that the selection was fair.

Speaking to the television cameras that surrounded him at his monastery in a desert town, the pope-designate, Bishop Tawadros, indicated that he planned to reverse the explicitly political role of his predecessor, Pope Shenouda III, who died in March. For four decades, Shenouda acted as the Copts’ chief representative in public life, won special favors for his flock by publicly endorsing President Hosni Mubarak, and last year urged in vain that Copts stay away from the protests that ultimately toppled the strongman.

“The most important thing is for the church to go back and live consistently within the spiritual boundaries because this is its main work, spiritual work,” the bishop said, and he promised to begin a process of “rearranging the house from the inside” and “pushing new blood” after his installation later this month as Pope Tawadros II. Interviewed on Coptic television recently, he struck a new tone by including as his priorities “living with our brothers, the Muslims” and “the responsibility of preserving our shared life.”

“Integrating in the society is a fundamental scriptural Christian trait,” Bishop Tawadros said then. “This integration is a must — moderate constructive integration,” he added. “All of us, as Egyptians, have to participate.”

Coptic activists and intellectuals said the turn away from politics signaled a sweeping transformation in the Christian minority’s relationship to the Egyptian state but also addressed a firm demand by the Christian laity to claim a voice in a more democratic Egypt.

“It can’t continue the way it used to be,” said Youssef Sidhom, editor of the Coptic newspaper Watani. “It is not in the interests of the Copts, if they are trying to speak for themselves as full and equal citizens, to have an intermediary speaking for them, and especially if he is a religious authority. I think the church has gotten this message loud and clear.”

In Egypt’s first free elections for Parliament and president, Christians voted overwhelmingly along sectarian lines, seeking to pool their votes around the most secular candidates — only to see their favorites fall under the Islamist tide. After the Muslim Brotherhood’s political party won parliamentary leadership and then the presidency, many Egyptians joked that the group put a candidate up for Coptic pope, too.

In recent interviews, intellectuals and activists, and churchgoers leaving Mass after the selection of the pope, all said they had concluded that Christians would have to build alliances with Muslims who shared their goal of nonsectarian citizenship.

“We are not the Muslim Brotherhood,” said Tarek Samir, a sales manager leaving the cathedral after the selection of Bishop Tawadros. “Politics is a dirty word to us, and we do not think it should be mixed with religion. But there are moderate Muslims who live the same life we do, who go to work with us, who live together with us, and if I am in trouble they will help me.”

Copts, often estimated to make up about 10 percent of Egypt’s 80 million people, trace their roots here to centuries before the birth of the Prophet Muhammad. They consider St. Mark their first pope; Tawadros II will be the 118th. In some ways, they are now at the spearhead of a challenge confronting Christian minorities across the region amid the tumult of the Arab Spring. In Iraq, Lebanon, Syria and elsewhere, Christian minorities had made peace with authoritarian rulers in the hope of protection from the Muslim majorities. But now the old bargains have broken, leaving Christians to fend for themselves.

In Egypt, the revolution last year coincided with by far the deadliest 12 months of sectarian violence in decades, including the bombing of an Alexandria church weeks before the revolt, the destruction of at least three churches in sectarian feuds, and the killing of about two dozen Coptic demonstrators by Egyptian soldiers squashing a protest — the single bloodiest episode of sectarian violence in at least half a century.

Known as the Maspero massacre after a nearby television building, the slaughter elicited attempts by top generals to blame the Copts and scant sympathy from the main Islamist groups, crystallizing Coptic anxieties.

Mayy El Sheikh and Mai Ayyad contributed reporting.

Read More..

Google Casts a Big Shadow on Smaller Web Sites

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.

Read More..

Second Illness Infects Meningitis Sufferers

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.

Read More..

Second Illness Infects Meningitis Sufferers

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.

Read More..

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

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.

Q.

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

A

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.

Q.

How did you get the prices lower?

A

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.

Q.

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

A.

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.

Q.

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

A.

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.

Q.

So how does Google take advantage of the Motorola acquisition?

A.

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.

Q.

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.

A.

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.

Q.

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

A.

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.

Q.

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

A.

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.

Q.

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?

A.

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.

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Gays in Pakistan Move Cautiously to Gain Acceptance

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.

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

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.”

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