Another Look at a Drink Ingredient, Brominated Vegetable Oil

James Edward Bates for The New York Times

Sarah Kavanagh, 15, of Hattiesburg, Miss., started an online petition asking PepsiCo to change Gatorade’s formula.

Sarah Kavanagh and her little brother were looking forward to the bottles of Gatorade they had put in the refrigerator after playing outdoors one hot, humid afternoon last month in Hattiesburg, Miss.

But before she took a sip, Sarah, a dedicated vegetarian, did what she often does and checked the label to make sure no animal products were in the drink. One ingredient, brominated vegetable oil, caught her eye.

“I knew it probably wasn’t from an animal because it had vegetable in the name, but I still wanted to know what it was, so I Googled it,” Ms. Kavanagh said. “A page popped up with a long list of possible side effects, including neurological disorders and altered thyroid hormones. I didn’t expect that.”

She threw the product away and started a petition on Change.org, a nonprofit Web site, that has almost 200,000 signatures. Ms. Kavanagh, 15, hopes her campaign will persuade PepsiCo, Gatorade’s maker, to consider changing the drink’s formulation.

Jeff Dahncke, a spokesman for PepsiCo, noted that brominated vegetable oil had been deemed safe for consumption by federal regulators. “As standard practice, we constantly evaluate our formulas and ingredients to ensure they comply with federal regulations and meet the high quality standards our consumers and athletes expect — from functionality to great taste,” he said in an e-mail.

In fact, about 10 percent of drinks sold in the United States contain brominated vegetable oil, including Mountain Dew, also made by PepsiCo; Powerade, Fanta Orange and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

The ingredient is added often to citrus drinks to help keep the fruit flavoring evenly distributed; without it, the flavoring would separate.

Use of the substance in the United States has been debated for more than three decades, so Ms. Kavanagh’s campaign most likely is quixotic. But the European Union has long banned the substance from foods, requiring use of other ingredients. Japan recently moved to do the same.

“B.V.O. is banned other places in the world, so these companies already have a replacement for it,” Ms. Kavanagh said. “I don’t see why they don’t just make the switch.” To that, companies say the switch would be too costly.

The renewed debate, which has brought attention to the arcane world of additive regulation, comes as consumers show increasing interest in food ingredients and have new tools to learn about them. Walmart’s app, for instance, allows access to lists of ingredients in foods in its stores.

Brominated vegetable oil contains bromine, the element found in brominated flame retardants, used in things like upholstered furniture and children’s products. Research has found brominate flame retardants building up in the body and breast milk, and animal and some human studies have linked them to neurological impairment, reduced fertility, changes in thyroid hormones and puberty at an earlier age.

Limited studies of the effects of brominated vegetable oil in animals and in humans found buildups of bromine in fatty tissues. Rats that ingested large quantities of the substance in their diets developed heart lesions.

Its use in foods dates to the 1930s, well before Congress amended the Food, Drug and Cosmetic Act to add regulation of new food additives to the responsibilities of the Food and Drug Administration. But Congress exempted two groups of additives, those already sanctioned by the F.D.A. or the Department of Agriculture, or those experts deemed “generally recognized as safe.”

The second exemption created what Tom Neltner, director of the Pew Charitable Trusts’ food additives project, a three-year investigation into how food additives are regulated, calls “the loophole that swallowed the law.” A company can create a new additive, publish safety data about it on its Web site and pay a law firm or consulting firm to vet it to establish it as “generally recognized as safe” — without ever notifying the F.D.A., Mr. Neltner said.

Read More..

Google Releases Maps App for iPhone as Apple Regroups

The return of a Google-powered maps application to the iPhone may make it easier for Apple’s customers to find their way. But it will not relieve Apple of the pressure to bring its own maps service up to snuff.

The release of the new Google Maps app for the iPhone, expected in Apple’s App Store on Thursday, does put to rest most of the conspiracy theorizing that began when Apple stopped bundling Google’s mapping service with the latest operating system for the iPhone and iPad, released in September. Apple did that because it was determined to own an increasingly critical feature of its devices, but the move seemed premature, as flaws in the company’s new service led to unusual public embarrassment.

Mobile analysts wondered whether Google would create an app for the iPhone or allow Apple, its rival, to flail around without a service on its devices that so many people rely on. After all, any long-term fallout for the iPhone could, in theory, benefit Google by making its own Android mobile operating system, which includes Google Maps, more attractive to customers.

Analysts also questioned whether Apple would approve the distribution of a Google Maps app through its App Store or hold it up, as it has some previous Google apps, to help Apple Maps.

That speculation is over. By making a high-quality maps app for the iPhone, it appears Google has put creating the biggest possible audience for its maps service above trying to undermine Apple’s product. “They’re more interested in owning the relationship with customers in any way they can,” said Carolina Milanesi, an analyst at Gartner.

Apple and Google representatives declined to discuss the app.

Marc Prioleau, a consultant on strategy, mergers and acquisitions in the maps and location services fields, said the release of the Google Maps app did not lessen the daunting challenge for Apple of making a maps service that is competitive with Google’s, a process that could take years.

“I don’t think it helps them, except in the sense that the iPhone stops having the thorn in its side of lacking the best mobile map app out there,” he said. “The fact that it’s Google means they’re back to the same position.”

Because of the sheer volume of data contained in Apple Maps, it is hard to judge how much Apple has improved the service since releasing it, Mr. Prioleau said.

But the bar is very high. “You can get 98 percent of stuff on maps right, and people who use it will remember the 2 percent you got wrong until they die,” he said.

Ms. Milanesi, the Gartner analyst, said she did not think Apple had lost a significant number of sales as a result of the deficiencies in Apple Maps, because its customers had shown a willingness in the past to overlook shortcomings in maps. When Apple used to bundle the Google Maps service with the built-in maps app on the iPhone, for instance, the service lacked turn-by-turn navigation, a feature that was available on other mobile devices, including Google’s.

“People were putting up with something that wasn’t as good as Android,” Ms. Milanesi said.

While Google is often criticized by reviewers for producing software and devices that are less polished than Apple’s, the Apple Maps fiasco illustrated how Google has the upper hand in some Internet services. The company has a multiyear head start on Apple in maps, and a huge team of employees dedicated to correcting the errors that can plague location data for businesses and other points of interest.

When Apple Maps came out, iPhone users quickly began identifying misplaced landmarks, incorrect addresses and other problems. The problems led to an unusual public apology by Timothy D. Cook, Apple’s chief executive, in which he recommended that people use competing maps services while the company improved Apple Maps.

This week, local police in Australia issued a warning about Apple Maps after assisting several motorists who were led astray in hot, desolate areas without water. Apple corrected the error on its Australian map, and the police reportedly issued a separate warning about incorrect directions from Google Maps.

Read More..

OPEC Leaves Production Quotas in Place

Members of the Organization of Petroleum Exporting Countries left their 30 million-barrel-per-day quota for oil production intact Wednesday, indicating the cartel’s satisfaction with current crude prices and its reluctance to do anything to further weaken the world economy.

But even as it stuck with the status quo, OPEC may face serious tests in the near future, as rising production in the United States and elsewhere threatens the cartel’s market share and influence in the world.

So far, though, OPEC has had an easy year. Crude prices have been stable and within the range the organization favors. Although oil prices for U.S.-produced oil have fallen into the range of $80 to $90 a barrel, the price of a global benchmark, Brent crude, remains well above $100 per barrel.

The OPEC basket price, which members consider representative of what they receive for their oil, was $104.80 a barrel on Tuesday.

“At these prices no one wants to rock the boat,” said Bhushan Bahree, an OPEC analyst at IHS Cera , who was in the meeting, held in Vienna.

But the global oil market is undergoing significant change, led by the surge in U.S. oil production, which reached 6.5 million barrels a day in September. That was the highest since 1998 and a 900,000 barrels-per-day increase from a year earlier, according to the U.S. Energy Information Administration.

Meanwhile, Iraq, an OPEC member not subject to the organization’s quotas because the country is recovering from the ravages of war, is also rapidly increasing production, reaching levels last seen in the late 1990s.

OPEC probably cannot avoid being buffeted by these shifts and their impact on market share.

“More production in the U.S. means there is less available for OPEC,” said Jamie Webster, an analyst for Washington-based consultants PFCEnergy, who was in Vienna observing the meeting.

Approximately a third of global oil output is produced by the cartel’s 12 members: Algeria, Angola, Ecuador, Iran, Iraq, Kuwait, Libya, Nigeria, Qatar, Saudi Arabia, the United Arab Emirates and Venezuela.

The high oil prices of recent years have led oil companies to invest heavily in exploration and in techniques to extract hydrocarbons that until recently were off limits, including the shale formations in North Dakota in the United States. As a result, supply is increasing faster than just about anyone expected, while demand remains sluggish as a result of the tepid world economy.

IHS Cera, a market analysis firm, expects the global supply of oil from non-OPEC producers like the United States, Kazakhstan and Brazil to grow by 1.2 million barrels per day next year. That would be well ahead of world demand, which the firm expects to increase by only 800,000 barrels a day in 2013.

Should this prediction, which is in line with the cartel’s own forecast, prove to be on the mark, OPEC will probably need to trim its output, giving up market share, to buffer falling prices.

The signs are that — quota notwithstanding — it is already cutting back. An OPEC report published Tuesday showed that Saudi Arabia, the key decision maker in the group, had already reduced output by 200,000 barrels a day in November, to 9.5 million barrels per day, its lowest level since October 2011.

“If the world ends up with a lot more capacity to produce oil than appetite to consume it, then either OPEC countries have to figure out a way to cut back production or prices will crash,” said Michael Levi, an energy fellow at the Council on Foreign Relations. “Sometimes OPEC doesn’t make decisions, but individual countries do and then others follow.”

Abdalla Salem el-Badri, the OPEC secretary general, acknowledged the possibility of production cuts in Vienna on Wednesday. “Maybe in the coming months we will produce less,” he said.

Recently, OPEC has not revealed specific quotas for members. But the whole organization was supposed to observe a 30 million barrel-per-day ceiling, which it is now being exceeded by around 1 million barrels per day. This lack of specific targets allows the Saudis to try keeping the global system balanced by adjusting the amount of oil they sell, without the need to haggle over changes.

Read More..

Daily Stock Market Activity

Wall Street opened higher on Tuesday after unexpectedly cheery data out of Europe and as the Federal Reserve was set to begin its two-day policy meeting.

The Standard & Poor’s 500-stock index added 0.9 percent, the Dow Jones industrial average rose 0.7 percent and the Nasdaq composite index was up 1.3 percent in early trading.

The stock market has entered a traditionally quiet period heading into the end of the year, with thinner trading volumes and fewer large fluctuations likely.

Though the pace of talks quickened in Washington to avert impending tax increases and spending cuts, senior politicians on both sides cautioned that an agreement on all the outstanding issues remained uncertain.

The lack of progress in negotiations about the “fiscal cliff” has kept investors from making aggressive bets in recent weeks, though most expect a deal will eventually be reached.

In Germany, analyst and investor sentiment rose sharply in December, entering positive territory for the first time since May, a leading survey showed. The data helped drive European shares higher. The DAX in Frankfurt was up 0.6 percent in afternoon trading, while the FTSE 100 in London gained 0.2 percent.

“We’ve been getting a lot of the beginning of our day from seeing what Europe has been doing, and I think that’s going to hold true today,” said Kim Caughey Forrest, senior equity research analyst at Fort Pitt Capital Group in Pittsburgh.

The Fed begins its two-day Federal Open Market Committee meeting on Tuesday. The central bank was expected to announce a new round of Treasury securities purchases on Wednesday, according to a Reuters survey of analysts. The program would replace its so-called Operation Twist stimulus effort, which expires at the end of the year.

The Treasury Department sold its remaining stake in the American International Group, bringing an end to a government ownership role about four years after a $182 billion bailout. A.I.G.'s shares were up 4 percent in morning trading.

Two firms raised their price targets for Urban Outfitters, sending the retailer’s shares up 6 percent.

Read More..

Mind: A Compromise on Defining and Diagnosing Mental Disorders

They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations.

But the effort itself was a valuable guide for anyone who has received a psychiatric diagnosis, or anyone who might get one.

This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy.

The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. A few committee members quit in protest.

The final text, which won’t be fully available until publication this spring, has already gotten predictably mixed reviews. “Given the challenges in a field where objective lines are hard to draw, they did a solid job,” said Dr. Michael First, a psychiatrist at Columbia who edited a previous version of the manual and was a consultant on this one.

Others disagreed. “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry,” wrote Dr. Allen Frances, the chairman of a previous committee who has been one of the most vocal critics, in a blog post about the new manual, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM5.

Yet many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied. The status quo is hard to budge, for one. And when changes do happen, they are not necessarily the ones that were intended.

The new manual does extend the reach of psychiatry in some areas, as many critics feared it might. Hoarding is now a mental disorder (previously it was considered a symptom of obsessive-compulsive behavior). “Premenstrual dysphoric disorder,” a severe form of premenstrual syndrome, is also new (it was previously in the appendix).

And binge-eating disorder (also formerly in the appendix), a kind of severe, highly distressing gluttony, is now a full-blown diagnosis. This one by itself could tag millions of people considered healthy, if often overindulgent, with a psychiatric label, some experts said.

But the deeper story is one of compromise. It is most evident in how the committee handled three of the thorniest diagnoses in psychiatry: autism, depression and pediatric bipolar disorder.

The group working on depression declared early on that it wanted to eliminate the so-called bereavement exclusion, which stated that grieving the loss of a loved one should not be considered a clinical disorder, though it shares many of the same outward signs. Grief has always been a normal reaction to death, not a kind of depression.

Advocacy and support groups, such as those representing people who have lost a child, objected furiously to the idea that the bereaved might be given a diagnosis of depression.

“This was just astonishing, that they would eliminate the exclusion, and a distortion of the research on the subject,” said Jerome Wakefield, a professor of social work and psychiatry at New York University, who did not work on the manual.

In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated.

“It’s like they took it all back,” Dr. Wakefield said. “I don’t like the way it was done — in a footnote — but it’s there.”

The debate over autism was even more furious, and it resulted in a similar rapprochement.

From the outset, the committee intended to tighten the definition of autism and simplify it, eliminating related labels like Asperger syndrome and “pervasive developmental disorder not otherwise specified,” or PDD-NOS. The rate of diagnosis of such conditions has exploded over the past decade, in part due to the vagueness of the definitions, and the committee wanted to draw clearer boundaries.

It proposed a single “autism spectrum disorder” category, with stricter requirements.

Some outside researchers raised concerns. In January one of them, Dr. Fred Volkmar of the Yale School of Medicine, who had quit the committee in protest, presented research suggesting that 45 percent or more of people who currently had an autism or related diagnosis would not have one under the proposed revision.

Autism groups reacted immediately, fearing that the change in the diagnosis would deny services to children and families who need them.

The committee countered with its own study, suggesting that the new definition would exclude about 10 percent of people currently with a diagnosis. And again, the experts took a half step back.

The new, streamlined definition was approved, but with language that took into account a person’s diagnostic history. “It’s explicit that anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before is now included,” said Catherine Lord, a committee member who worked on the new definition and who is director of the Center for Autism and the Developing Brain in New York. “Essentially everyone gets in.”

Pediatric bipolar disorder posed a different challenge.

In the 1990s and 2000s, psychiatrists began giving aggressive, explosive children a diagnosis of bipolar disorder in increasing numbers. The trend appalled many patient advocates and doctors.

Bipolar disorder, which is characterized by episodes of depression and mania, had previously been an adult problem; now the diagnosis is given to children as young as 2 — along with powerful psychiatric drugs and tranquilizers that also cause rapid weight gain. The committee wanted to stop the trend in its tracks, said experts who were involved.

Most of the children treated for bipolar disorder did not have it, recent research found. The committee settled on an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

“They essentially wanted to have some place for these kids, and D.M.D.D. was all they had in their kit,” said Dr. Gabrielle Carlson, a child psychiatrist at Stony Brook University Medical Center, who provided some outside consultation. “These are mostly kids who have A.D.H.D. or what we would call oppositional defiant disorder, but with this explosive feature. They need help; you can’t wait forever. The question was what to call it, without pretending we know enough to saddle them with a lifelong diagnosis” like bipolar disorder.

D.M.D.D. has its own problems, as many experts were quick to point out. It could be a symptom of an underlying condition, as Dr. Carlson argues. It could “medicalize” frequent temper tantrums. It’s brand new, and no one knows how it will play out in practice.

But it is now in the book — because it was the best solution available, experts inside and outside of the revision process said.

From beginning to end, many experts said, the process of defining psychiatric diagnoses is very much like finding the right one for an individual: it’s a process of negotiation, in many cases.

“That’s one of the take-aways from all this, and I think it’s a good one,” Dr. Carlson said. “A diagnosis is a hypothesis. It’s a start, and you have to start somewhere. But that’s all it is.”

One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.

Read More..

Mind: A Compromise on Defining and Diagnosing Mental Disorders

They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations.

But the effort itself was a valuable guide for anyone who has received a psychiatric diagnosis, or anyone who might get one.

This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy.

The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. A few committee members quit in protest.

The final text, which won’t be fully available until publication this spring, has already gotten predictably mixed reviews. “Given the challenges in a field where objective lines are hard to draw, they did a solid job,” said Dr. Michael First, a psychiatrist at Columbia who edited a previous version of the manual and was a consultant on this one.

Others disagreed. “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry,” wrote Dr. Allen Frances, the chairman of a previous committee who has been one of the most vocal critics, in a blog post about the new manual, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM5.

Yet many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied. The status quo is hard to budge, for one. And when changes do happen, they are not necessarily the ones that were intended.

The new manual does extend the reach of psychiatry in some areas, as many critics feared it might. Hoarding is now a mental disorder (previously it was considered a symptom of obsessive-compulsive behavior). “Premenstrual dysphoric disorder,” a severe form of premenstrual syndrome, is also new (it was previously in the appendix).

And binge-eating disorder (also formerly in the appendix), a kind of severe, highly distressing gluttony, is now a full-blown diagnosis. This one by itself could tag millions of people considered healthy, if often overindulgent, with a psychiatric label, some experts said.

But the deeper story is one of compromise. It is most evident in how the committee handled three of the thorniest diagnoses in psychiatry: autism, depression and pediatric bipolar disorder.

The group working on depression declared early on that it wanted to eliminate the so-called bereavement exclusion, which stated that grieving the loss of a loved one should not be considered a clinical disorder, though it shares many of the same outward signs. Grief has always been a normal reaction to death, not a kind of depression.

Advocacy and support groups, such as those representing people who have lost a child, objected furiously to the idea that the bereaved might be given a diagnosis of depression.

“This was just astonishing, that they would eliminate the exclusion, and a distortion of the research on the subject,” said Jerome Wakefield, a professor of social work and psychiatry at New York University, who did not work on the manual.

In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated.

“It’s like they took it all back,” Dr. Wakefield said. “I don’t like the way it was done — in a footnote — but it’s there.”

The debate over autism was even more furious, and it resulted in a similar rapprochement.

From the outset, the committee intended to tighten the definition of autism and simplify it, eliminating related labels like Asperger syndrome and “pervasive developmental disorder not otherwise specified,” or PDD-NOS. The rate of diagnosis of such conditions has exploded over the past decade, in part due to the vagueness of the definitions, and the committee wanted to draw clearer boundaries.

It proposed a single “autism spectrum disorder” category, with stricter requirements.

Some outside researchers raised concerns. In January one of them, Dr. Fred Volkmar of the Yale School of Medicine, who had quit the committee in protest, presented research suggesting that 45 percent or more of people who currently had an autism or related diagnosis would not have one under the proposed revision.

Autism groups reacted immediately, fearing that the change in the diagnosis would deny services to children and families who need them.

The committee countered with its own study, suggesting that the new definition would exclude about 10 percent of people currently with a diagnosis. And again, the experts took a half step back.

The new, streamlined definition was approved, but with language that took into account a person’s diagnostic history. “It’s explicit that anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before is now included,” said Catherine Lord, a committee member who worked on the new definition and who is director of the Center for Autism and the Developing Brain in New York. “Essentially everyone gets in.”

Pediatric bipolar disorder posed a different challenge.

In the 1990s and 2000s, psychiatrists began giving aggressive, explosive children a diagnosis of bipolar disorder in increasing numbers. The trend appalled many patient advocates and doctors.

Bipolar disorder, which is characterized by episodes of depression and mania, had previously been an adult problem; now the diagnosis is given to children as young as 2 — along with powerful psychiatric drugs and tranquilizers that also cause rapid weight gain. The committee wanted to stop the trend in its tracks, said experts who were involved.

Most of the children treated for bipolar disorder did not have it, recent research found. The committee settled on an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

“They essentially wanted to have some place for these kids, and D.M.D.D. was all they had in their kit,” said Dr. Gabrielle Carlson, a child psychiatrist at Stony Brook University Medical Center, who provided some outside consultation. “These are mostly kids who have A.D.H.D. or what we would call oppositional defiant disorder, but with this explosive feature. They need help; you can’t wait forever. The question was what to call it, without pretending we know enough to saddle them with a lifelong diagnosis” like bipolar disorder.

D.M.D.D. has its own problems, as many experts were quick to point out. It could be a symptom of an underlying condition, as Dr. Carlson argues. It could “medicalize” frequent temper tantrums. It’s brand new, and no one knows how it will play out in practice.

But it is now in the book — because it was the best solution available, experts inside and outside of the revision process said.

From beginning to end, many experts said, the process of defining psychiatric diagnoses is very much like finding the right one for an individual: it’s a process of negotiation, in many cases.

“That’s one of the take-aways from all this, and I think it’s a good one,” Dr. Carlson said. “A diagnosis is a hypothesis. It’s a start, and you have to start somewhere. But that’s all it is.”

One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.

Read More..

Euro Watch: Italian Political Turmoil Weighs on Markets

ROME — Italian bond yields rose Monday, and stocks in Milan led major European indexes lower, after a weekend of political turmoil in Italy gave rise to fears that the country was headed for renewed instability.

The former prime minister, Silvio Berlusconi, said he would again seek Italy’s highest office after pulling his party’s support from Mario Monti, the unelected official who currently holds the office. Mr. Monti decided over the weekend to step down.

Mr. Berlusconi, a four-time prime minister, left office a year ago as markets pushed Italy to the brink of financial collapse. Mr. Monti has restored Italy’s credibility with investors, who have given the country a break on its borrowing costs. But those gains have come at the cost of painful austerity measures that have worsened the country’s economic situation and given Mr. Berlusconi an opening to attack.

Mr. Monti will leave after Parliament passes a budget this month and may contest national elections against Mr. Berlusconi, with the vote — previously scheduled for April — now possible as early as February or March.

The Milan benchmark MIB index fell as much 2.7 percent in afternoon trading Monday, having fallen as much as 3.6 percent. Italian banks — which as big holders of government bonds remain sensitive to declines in the prices of those bonds — were the big losers. Intesa Sanpaolo, the most active stock, fell 6.2 percent and Unicredit declined 5.9 percent.

The yield gap, or spread, between interest rates on Italian 10-year sovereign bonds and equivalent German securities, the European benchmark for safety, grew to 3.5 percentage points Monday from 3.25 points late Friday, suggesting that investors were growing more wary of holding Italian debt. The Italian 10-year bonds, for which the yield peaked this year at more than 7 percent, were trading to yield 4.8 percent, up 29 basis points. A basis point is one-hundredth of a percent.

A barometer of euro zone blue-chip stocks, the Euro Stoxx 50 index, fell 0.5 percent late in afternoon trading. The euro was little changed from its levels in New York on Friday, at $1.2932.

“It’s as if a tank moved through” the market, said Mario Sechi, editor in chief of the Rome daily newspaper Il Tempo, speaking on Radio 24 on Monday morning. Like many Italian commentators, Mr. Sechi expressed reservations about Mr. Berlusconi’s decision to return to politics.

A dismal economic report Monday served as a reminder that despite Mr. Monti’s success with investors, the real economy continues to suffer. Italian industrial production fell a seasonally adjusted 1.1 percent in October from September, and by 6.2 percent from a year earlier, Istat, the national statistics agency, reported from Rome.

The coming Italian election “remains high on our list of tail risks for 2013,” Holger Schmieding, an economist in London with Berenberg Bank, wrote in a research note. “A Berlusconi campaign against ‘German austerity’ could potentially unsettle markets,” he wrote, and possibly push Spain or Italy into the need for a bailout or require additional bond purchases by the European Central Bank to hold down borrowing costs.

Chancellor Angela Merkel of Germany was to meet Monday with Mr. Monti on the sidelines of the Nobel peace prize ceremony in Oslo, said Georg Streiter, a spokesman for the chancellor.

Ms. Merkel pushed to have Mr. Monti replace Mr. Berlusconi, but found herself on the receiving end of the Italian technocrat’s own campaign for a course of European reform focused more on growth and creating jobs than the restructuring and austerity championed by the German leader.

As a rule, the German government does not comment on its partners’ domestic politics, but Foreign Minister Guido Westerwelle warned that an attempt to scale back Italy’s reform push could result in further destabilization in the euro zone.

“Italy can not remain stagnant on two-thirds of its reform process,” Mr. Westerwelle said through a spokesman. “This would throw not only Italy, but the rest of Europe, into turbulence.”

Spanish bonds also came under renewed pressure following Mr. Monti’s announcement, with the interest rate spread of Spanish 10-year bonds over equivalent German bonds rising to 4.27 percentage points from 4.16 points on Friday. The yield on the benchmark Spanish 10-year rose 10 basis points to 5.5 percent; it reached 7.1 percent in July, amid concerns that Spain would be forced into a full bailout after having to negotiate a €100 billion rescue package for its banks in June.

Luís de Guindos, the Spanish economy minister, warned that Italy’s political turmoil would have an impact on his country. “When doubts emerge over the stability of a neighboring country like Italy, which is also seen as vulnerable, there’s an immediate contagion for us,” he said Monday morning on Spanish national radio.

Asked whether Spain would itself seek further European rescue funding, the economy minister instead said that “the help that Spain needs is that the doubts over the future of the euro be removed.”

Speaking ahead of the Nobel ceremony on Monday, the European Commission president, José Manuel Barroso, said that Italy had to “continue on the road of structural reforms.” The elections, Mr. Barroso said on Sky News, “must not be used to postpone reforms.”

David Jolly reported from Paris. Raphael Minder contributed reporting from Madrid and Melissa Eddy from Berlin.

Read More..

The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carol Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Editor’s Note:

Correction: An earlier version of this post contained an incorrect spelling of the first name of the director of the Families and Health Care Project of the United Hospital Fund. She is Carol Levine, not Carole Levine.

Read More..

The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carol Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Editor’s Note:

Correction: An earlier version of this post contained an incorrect spelling of the first name of the director of the Families and Health Care Project of the United Hospital Fund. She is Carol Levine, not Carole Levine.

Read More..

In Pursuit of John McAfee, Media Are Part of Story

Late last month, the editor in chief of Vice magazine, Rocco Castoro, joined by a photographer, Robert King, managed to secure a plum exclusive: an invitation to travel along with the fugitive tech millionaire John McAfee.

Years earlier, Mr. McAfee had relocated to a Colonel Kurtz-like compound in the jungles of Belize, surrounding himself with armed guards and multiple young lovers. Then, with reports that he was a “person of interest” in the death of a neighbor, Mr. McAfee had gone on the lam. Last Monday, after several days of surreptitious travel, Mr. Castoro and Mr. King posted their first dispatch. It bore the smirking headline, “We Are With John McAfee Right Now, Suckers.”

The gloating was short-lived, however. Within minutes, a reader noticed that the photograph posted with the story still contained GPS location data embedded by the iPhone 4S that took it, and sent out a message via Twitter: “Check the metadata in the photo. Oooops ...” Vice quickly replaced the image, but it was too late. “Oops! Did Vice Just Give Away John McAfee’s Location With Photo Metadata?” a Wired.com headline asked. The article included a Google Earth view of the exact spot the picture had been taken — poolside at the Hotel & Marina Nana Juana in Izabal, Guatemala.

Soon, the Guatemalan police were with John McAfee. This weekend, he is in their custody and is expected to be extradited to Belize, where he faces questioning in connection with the murder of Gregory Faull, a 52-year-old American who was his neighbor. Mr. McAfee’s lawyers are appealing his extradition.

The Vice debacle was just one colorful twist in the relationship between the press, which is always willing to indulge a colorful subject, and Mr. McAfee, who was always eager to bend news coverage to his often inscrutable ends. I first wrote about Mr. McAfee five years before, when he was merely a colorful software pioneer — an apparently clean-living citizen who courted the press mainly to promote his favorite pastime, flying ultralight aircraft. Since then, his life had taken several darker turns. I had only just published a long piece about his purported connections with Belizean drug gangs on the Web site Gizmodo when I received a curt e-mail from a police official in Belize on Nov. 11, “It may interest you to know that there was a murder yesterday in San Pedro Town, Ambergris Caye and McAfee is the prime suspect.”

I passed the information along on Twitter and on Gizmodo and the news took on a life of its own. “It was on all kinds of Tumblr sites, people were talking about it on Twitter, and that fueled a lot of the professional media to say, ‘O.K., everyone’s talking about this, we should have a story on it, too,’ ” said Mat Honan, a senior writer at Wired who has written about the case.

Mr. McAfee went into hiding with a 20-year-old girlfriend, but it was hiding of a uniquely visible kind. Within 36 hours, he began an aggressive campaign to court and spin coverage of his story. He started by calling Joshua Davis, a Wired writer who had spent the summer reporting on a profile for the magazine’s January issue, and fed him fresh details of life on the run every few hours. Mr. Davis passed along his minute-by-minute updates via Twitter and daily blog posts.

News media around the world were rapt: it wasn’t just that Mr. McAfee’s name was stubbornly familiar, a relic of the early days when computer users installed his software to keep viruses away. “A tech millionaire, an exotic Central American locale, murder, the possibility of drugs — the story just has everything,” says Nathalie Malinarich, world editor of the BBC News Web site.

Wired had a problem, though. The murder and Mr. McAfee’s flight had made Mr. Davis’s print article obsolete before it could even hit newsstands. Wired and Mr. Davis updated the material and repackaged it into an e-book that has sold more than 22,000 copies, at one point reaching No. 1 on the Nonfiction Kindle Singles list.

Mr. Davis’s exclusives did not last long. As the week went on, Mr. McAfee granted phone interviews to more reporters (though none to me, with whom he’s declined to communicate since my first Gizmodo piece). Then he set out to spread his message across new electronic platforms. He started a Twitter account and, with the help of a cartoonist he had befriended in Seattle, a blog. To keep the story fresh, Mr. McAfee kept upping his media exposure and the outrageousness of the tales he told. He arranged face-to-face interviews— a Financial Times journalist first, followed by CNN’s Martin Savidge. (Both were told to wait in public places and then were driven to meet Mr. McAfee in locations unknown to them.) Then, in the ultimate act of bravado, he invited Vice’s journalists to tag along.

For reporters, a McAfee exclusive guaranteed a rich share of readers and viewers and social-networking interest. But many found the favor an ambiguous blessing. Mr. McAfee seemed to understand the dynamics of journalism well enough to know which assertions reporters would pass along without double-checking or qualifying — like his claim that he had eluded the police by burying himself in sand and positioning a box over his head — even as his self-created narrative veered ever further into the surreal.

“As soon as reporters start to think, ‘Wait a minute, we’re sort of jeopardizing our objectivity and reputation for this guy,’ he’ll just burn them, and go to the next one,” says the Gizmodo writer Joel Johnson, who found himself cut off after publishing an article Mr. McAfee did not like. “That’s what he did to me, that’s what he’s done to a lot of journalists, and he’s going to do it to the Vice guys, if he hasn’t done it already.”

Vice seemed to remain in Mr. McAfee’s good graces even after the freedom-endangering gaffe. After the secret of his location spread across the Internet, Mr. McAfee quickly went online to claim that the data leak was in fact an intentional piece of misdirection. Mr. King, the Vice photographer, supported the claim on social media. This amounted to following up an “egregiously stupid action with a far worse one,” Mr. Honan wrote in a Wired post later last week, “King apparently lied on his Facebook page and Twitter in order to protect McAfee.”

In a statement, Vice said it would not comment about its reporting in the McAfee case.

“The flight we chronicled was from the start filled with misinformation, rumors, social-media-fed myths, outright lies and overall total weirdness,” the magazine said. “Despite many media outlets’ obvious glee in damning us immediately, Vice has decided to wait and talk to the people on our team who were actually on the ground and who could therefore tell us what actually went down and not just buy into the same rumors, myths and madness that this story has consisted of from the start.”

Indeed, while Mr. McAfee seems determined to drag out his drama as long as he can, some of the journalists who have covered him say they have had enough. “People try to behave ethically,” said Mr. Johnson, who wrote his final post on Mr. McAfee three weeks ago. “And he milks that out of them until they get to the point where they’re like, ‘You know what, you’re just nuts.’ ” He adds, “I know as a journalist I can’t say that, so I’ve got to get out of this story.”

Read More..