The New Old Age Blog: In the Middle: Helping Unhappy Couples

A post on Monday discussed the forces that can make an older couple’s good marriage suddenly go bad — an array of subtle, and often-misunderstood, mental, physical and emotional factors that can upset the equilibrium of even the happiest marriages.

Now we have consulted marriage counselors and geriatricians to find out what caregivers — either the grown children of the couple, or one of the spouses involved– can do to help restore peace and balance to these relationships. The experts consulted uniformly agreed that even older people can at least take steps to reduce tensions and improve their relationship, even if they cannot actually change. (Really, who can, at any age?)

“Even though the situation may seem overwhelming, take heart,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc., who specializes in neuropsychology and rehabilitation psychology. “Couples who have been together for 60 years tend to have worked out ways to manage conflict – or they wouldn’t still be together.”

Retreat to a neutral corner

When grown children see their parents fight, many want to run and hide. But those who are assuming an increased caregiving role often feel impelled to jump in and “fix” the problem, as they do with the other caregiving issues.

If you are so inclined, experts speak with one loud voice to advise: Don’t!

Trying to act as emotional broker between your parents can backfire. (Now they tell me! Suffice it to say that after one such effort my sister said to me in not exactly the friendliest tone, “Well, that went well, didn’t it?”)

“It’s better if your parents can find somebody else to talk to than you,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and the author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Don’t give up on marital therapy

“Marital therapy for individuals over 65 years of age is difficult, since habits of a lifetime are deeply ingrained,” stated a study in The Canadian Journal of Medicine, one of the few in the medical literature about marital therapy among older people.

“Yet, in a sense, marital therapy is more crucial for the elderly than for younger patients,” the study continued. “At a time when they are least adaptable and most vulnerable to stress and are entering perhaps the most difficult period of their lives, the elderly must learn new methods of relating and coping” because of the physical and mental changes described in our earlier post.

There’s another reason learning to cope with life changes as a couple is even more critical for older couples: Unlike younger couples, the elderly are rarely in a position to leave the marriage and start over.

Help at least one spouse get counseling

What if only half the couple is ready to seek counseling? Not a problem, therapists said. “You want to help the part of the couple that is suffering,” said Dr. Elaine Rodino, a therapist in private practice in State College, Penn. “The other person may still be the curmudgeon, but I think of it as the law of physics: When you change one aspect of the formula, things change in the total.”

When dementia affects one of the spouses, therapy can help the caregiving spouse learn coping techniques, “which can reduce the marital discord and stress that can make conditions, especially cognitive difficulties, worse,” said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine.

Consider the general practitioner or internist

If the couple won’t see a marriage counselor or therapist, can a family doctor be of any use? The experts had mixed responses.

Many pointed out that general practitioners have neither the time nor the training to offer much relationship help, unless the origin of the problem is exclusively physical. Others thought they could be of use, if given a little direction from the family.

“I encourage the kids to talk to the doctor in advance and let him know something is going on – signs of depression or other problems the parents won’t talk about,” advised Dr. Dale, adding that a consultation with a geriatrician who is more familiar with problems of the aging might be even more productive. “Then the doctor can say, ‘Gee, you sound really frustrated or down — are there any reasons we can explore?’”

Don’t overlook the importance of intimacy

“Mutually stimulating sexual relationships need care and feeding by both partners at any age, but especially in the geriatric years,” according to a study on marital therapy for the elderly. “The need for physical contact, warmth and touching perhaps reaches a peak in this age of loneliness, decreased self-esteem and poor health.”

Forget the idea that elderly couples are too shy to talk about intimacy, insisted Dr. Rodino. “I saw a couple in their 80s, the husband was getting penile injections at the doctor’s office, and then they hurried home to have sex.”

But Dr. Rodino does concede that for older patients it is especially important to focus not only on sexual function and performance, but on “touching, and non-intercourse sexual relations; I help them rekindle the affection and emotional closeness,” Dr. Rodino said.

Address any neuropsychological issues.

To find out whether the sudden marital conflict may stem from early mental cognitive impairment (M.C.I.) —or to rule M.C.I. out and find the real source of trouble — make sure the spouse obtains a full neuropsychological evaluation. If it is M.C.I., “it convinces everybody that there is more than just abstinence, it’s not a personality problem — and they need to address it,” said Dr. Dale.

Don’t overlook simple solutions

“Sometimes a memory problem is something simple, like low Vitamin B12, that is easily fixed,” said Dr. Dale. “Or hypothyroidism, which is quite common, can affect memory.”

In that case, doctors administer synthroid, a thyroid hormone replacement that Dr. Dale said is “very safe, with almost no side effects.” Other changes in behavior can also be the result of a simple problem or be remedied by a change in medication. Don’t assume the worst.

Put an end to the blame game

Help reframe the problem. “Even if dementia is involved, let them know it’s not that their partner hates them, it’s that he is having cognitive changes,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago.

“When you re-frame it like that, it’s easier for the spouse not to take it personally and not blame themselves and feel it’s something they did,” said Dr. Waite. “It can make a difference.”

A 2009 study in the journal Gerontologist supports this notion: “Care partners likely would benefit from strategies aimed at reducing self-blame, enhancing coping skills … and communicating effectively with the person with M.C.I and significant others.”

Separate the anxiety

Divide and conquer — time away improves time together.

“Older couples, especially those with disabilities, spend way too much time together,” said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program. “It would be a problem for any couple.”

Caregivers can best help by arranging for an activity or outing that each spouse can do separately so they can return to each other refreshed and more cheerful. “That can help a lot,” said Dr. Gwyther.

Dial down the tone

For spouse caregivers, it is important to watch not just what is said, but how it is said. In any relationship, tone influences our interpretation of what our partner says. Those with M.C.I. will especially react to tone, rather than the substance of the exchange, Dr. Dale said.

“Ratchet down the emotions, repeat things calmly,” Dr. Dale said. The person with cognitive problems doesn’t know he asked the same question five times — he only knows that you sound angry at him for no reason he can fathom. One spouse’s anger fuels the other’s, and pretty soon there is a fight or withdrawal.

Zero tolerance for violence

If a spouse becomes violent, “that’s an entirely different issue,” said Dr. Schlossberg. “Call in an expert on family violence” or the police.

Help them help others

Nobody likes feeling dependent and having to ask for help. Finding a way to have your loved one volunteer, help others and continue to feel useful can improve moods and marital interactions – even if M.C.I. is involved.

With one couple Dr. Gwyther saw, the wife was not only “driving her husband nuts because she was asking him the same questions over and over,” but she could no longer drive and deliver food in a mobile meals program as she used to. “So her husband agreed to be the driver — and she took the meals to the doors,” Dr. Gwyther recalled.”It made her feel good to continue to do that — and it made them feel good to do it together.”

Caregiver, heal thyself

You have heard it a million times here and elsewhere but, unlike us, this advice never gets old.

If you are exhausted from caregiving, you are bound to be cranky, and that will make everybody around you edgy and irritable, too — especially the spouse who requires your care. Taking the time to look after your own health and engage in activities that bring you pleasure can go a long way toward reducing stress and reestablishing a peaceful balance in a marriage.

How have you coped with tensions in your marriage — or in your elderly parents’ marriage, as you care for them in their old age? Share in the comments below.

Read More..

DealBook: Massachusetts Fines Morgan Stanley Over Facebook I.P.O.

Morgan Stanley is paying for its role in the troubled stock market debut of Facebook.

On Monday, Massachusetts’s top financial authority fined the bank $5 million for violating securities laws, the first major regulatory action tied to Facebook’s initial public stock offering.

William F. Galvin, the secretary of the commonwealth of Massachusetts, accused the bank of improperly influencing the stock offering process. The regulator’s consent order asserts that a senior Morgan Stanley banker coached Facebook on how to share information with stock analysts who cover the social media company, a potential violation of a landmark legal settlement with Wall Street. While the banker never contacted the analysts directly, his actions, Mr. Galvin said, put ordinary investors at a disadvantage because they lacked access to the same research.

“The broader message here is we are going to use any means possible to enforce the strict code in place about giving out information,” Mr. Galvin said in an interview. “We want to get the message across that if Wall Street wants to get confidence back, they can’t disadvantage Main Street.”

The consent order did not name the Morgan Stanley banker, referring to him as a “senior investment banker.” But information in the regulator’s order indicated that it was Michael Grimes, one of the nation’s most influential technology bankers.

“Morgan Stanley is committed to robust compliance with both the letter and the spirit of all applicable regulations and laws,” a Morgan Stanley spokeswoman, Mary Claire Delaney, said. Morgan Stanley, in settling the case, neither admitted nor denied guilt.

Mr. Grimes, through Ms. Delaney, declined to comment. Although the banker was referred to in the order, Mr. Grimes has not been personally accused of any wrongdoing.

The Facebook public offering was one of the most highly anticipated debuts of the last decade. In the run-up to the offering, investor interest was robust, prompting the company to increase the size of the offering and raise the share price to $38.

But the I.P.O. quickly turned into a debacle. The first day of trading was plagued with problems. The shares quickly fell below their offering price. The stock closed on Monday at $26.75.

Since the offering, Mr. Galvin and other regulators have opened wide-ranging investigations into Facebook and the banks that handled its debut. The continuing inquiries by the Securities and Exchange Commission and the Financial Industry Regulatory Authority are examining how the banks disseminated nonpublic information to big investors — and whether it conflicted with Facebook’s public disclosures.

Regulators are also looking into Nasdaq, the exchange where Facebook trades. They are questioning whether the exchange failed to properly test its trading systems, which faltered during the stock offering.

The Massachusetts regulator is focused on Morgan Stanley’s communications with analysts.

Shortly before the Facebook offering, analysts at several banks lowered their growth estimates for the social network. The move came after Facebook issued an amended prospectus, detailing a potential slowdown in revenue.

A Facebook executive, whose name was not given in the order but who was referred to as the treasurer, also reached out to analysts. Mr. Galvin’s order asserted that the executive, in private conversations with analysts, had provided additional information on the revenue. The order indicated that Mr. Grimes was personally involved in the decision to file the new prospectus and to have Facebook communicate with analysts.

“Morgan Stanley’s senior investment banker did everything but make the phone calls himself,” the Massachusetts regulator said in a statement, referring to Mr. Grimes. “He not only rehearsed with Facebook’s treasurer who placed the calls to the research analysts, but he also drafted the majority of the script Facebook’s treasurer utilized.”

Just 12 minutes after filing the amended prospectus with regulators on May 9, the Facebook treasurer phoned Wall Street research analysts from her hotel, according to the order. She had a 15-minute conversation with Morgan Stanley analysts, and then spoke with JPMorgan Chase and other banks.

The calls provided the analysts with additional information that did not appear in the amended prospectus, the order said. The conversations, for example, included “quantitative information regarding Facebook’s” second-quarter 2012 projections.

This behavior, Mr. Galvin said, crossed the line, violating the regulatory settlement on stock research that Morgan Stanley and other companies signed in 2003. The agreement limits the communication between bankers and research analysts and bans companies from influencing stock reports to try to bolster banking operations.

The Morgan Stanley case falls into a curious gray area.

Bankers spend months preparing companies to go public, a role that includes providing guidance on research analysts. In this instance, Mr. Grimes did not personally place the calls, which would have been a clear violation of securities laws.

In his testimony before the Massachusetts regulator’s staff, Mr. Grimes indicated that the bank had pushed for Facebook to file publicly an amended prospectus to avoid “the appearance” that the company was sharing information with a select group of clients rather than broadly with investors. Mr. Grimes, the order noted, consulted with Morgan Stanley and Facebook lawyers. Ultimately, Facebook’s chief financial officer, David A. Ebersman, e-mailed the company’s board to say that the new filing would “help us to continue to deliver accurate” information without “someone claiming we are providing any selective disclosure.”

Mr. Grimes, in testimony with the regulator, further defended his role. While the Facebook treasurer was making the calls, he noted that “I was far down the hall so I wouldn’t hear anything.”

Even so, Mr. Grimes, according to the consent order, e-mailed Mr. Ebersman to say that the Facebook treasurer “was a champ in the hotel tonight,” after the treasurer wrapped up the calls.

A version of this article appeared in print on 12/18/2012, on page B1 of the NewYork edition with the headline: Morgan Stanley Is Fined Over Facebook I.P.O. Role.

Read More..

Attackers in Pakistan Kill Anti-Polio Workers

ISLAMABAD, Pakistan — Five Pakistani women and a man were killed on Tuesday in separate attacks on health workers participating in a national drive to eradicate polio from Pakistan.

Athar Hussain/Reuters

Family members mourned the death of Nasima Bibi, a female worker with an anti-polio drive campaign in Pakistan, who was shot by gunmen on Tuesday.

Akhtar Soomro/Reuters

The bodies of two female workers with an anti-polio drive lay in the morgue at Jinnah Hospital in Karachi on Tuesday.

The attacks forced health officials to temporarily suspend a large polio vaccination drive in Karachi, the country’s most populous city, where the disease has been making a worrisome comeback in recent years.

Saghir Ahmed, the health minister for southern Sindh Province, said he had ordered the 24,000 aid workers taking part in the campaign in Karachi to immediately stop work. It was not clear when they would resume.

The shooting represented a brutal setback to polio immunization efforts in Pakistan, one of just three countries in the world where the disease remains endemic. Pakistan accounted for 198 new cases last year — the highest rate in the world, followed by Afghanistan and Nigeria.

There was no immediate claim of responsibility, but Taliban insurgents have repeatedly vowed to target anti-polio workers, accusing them of being spies.

In the tribal areas along the Afghan border, Taliban leaders have issued religious edicts declaring that the United States runs a spy network under the guise of vaccination programs.

That perception was strengthened after the American commando raid that killed Osama bin Laden in June 2011, when it emerged that the Central Intelligence Agency had paid a Pakistani doctor to run a vaccination program in Abbottabad, where Bin Laden was hiding, in a bid to obtain DNA evidence from his family.

Pakistani authorities arrested the doctor, Shakil Afridi, shortly after the American raid, and he has been sentenced to 33 years in prison.

Despite the negative perceptions, the government has pressed ahead with a large polio vaccination campaign, usually conducted in three-day spurts involving tens of thousands of health workers who administer medicine to children under 5.

The shootings on Tuesday came on the second day of the latest drive, which has now been called off in Karachi. After an attack on a United Nations doctor from Ghana in Karachi last July, officials were braced for some sort of militant resistance. But the extent and scale of the attacks Tuesday caught the government by surprise.

In the attacks in Karachi, three teams of health volunteers were targeted in poor neighborhoods: Landhi, Orangi and Baldia Town.

Two female aid workers were killed in an attack in Landhi, according to local news reports. In Orangi, unknown gunmen opened fire on a health team, killing one woman and a male volunteer. Another female worker was killed in nearby Baldia Town.

The Karachi neighborhoods where aid workers were targeted Tuesday are being used as safe havens by militants, who have escaped American drone strikes in North and South Waziristan tribal regions, according to police officials. Security forces regularly conduct search operations in these neighborhoods.

In the northwestern city of Peshawar, gunmen riding a motorcycle opened fire on two sisters who had volunteered to help administer polio drops, killing one.

The attacks on polio workers followed a bold Taliban assault on a major Pakistan Air Force base in Peshawar over the weekend that killed at least 15 people and a militant bomb attack in a nearby tribal village on Monday that killed another 19.

For Pakistan’s beleaguered progressives, the attack on female health workers was another sign of how the country’s extremist fringe would stoop to attack the vulnerable and minorities.

“Ahmadis, Shias, Hazaras, Christians, child activists, doctors, anti-polio workers — who’s next on the target list, Pakistan?” asked Mira Hashmi in a post on Twitter.

Zia ur-Rehman contributed reporting from Karachi

Read More..

Fiscal Cliff Casts Big Shadow on Sunnier 2013 Economic Forecasts

The American economy could finally have a pretty good year next year — assuming Washington does its part.

Economists see a number of sources of underlying strength in the economy, but for the growth to gain traction, they say, political leaders need to avoid the broad tax increases and spending cuts now being debated.

The nascent housing rebound, the natural gas boom, record profit margins, a friendlier credit market for small businesses, along with pent-up demand for autos and other big purchases, could in combination unleash growth and hiring that the economy needs.

“Underneath all the shenanigans in Washington, there’s a lot of strengthening,” said Ian Shepherdson, chief economist at Pantheon Macroeconomics.

More robust growth next year — perhaps higher than 3 percent later in the year, according to some of the more optimistic forecasts — would certainly be a stark reversal from the current sluggish path.

There is a range of opinion among economists, though, and some warn of continued sluggishness, especially in the beginning of the year.

Estimates for the last quarter of 2012 are hovering around an unusually weak 1 percent annualized rate.

That dismal pace is driven partly by drags from Europe’s recession and China’s slowdown; partly by companies readjusting after potentially overstocking their back-room shelves in the third quarter; and largely by worries about the so-called fiscal cliff of spending cuts and tax increases set for early 2013.

Surveys of consumer and business confidence in recent weeks have plummeted to recession-era lows. With such uncertainty, businesses have also recently curtailed spending on capital investments like computers, delivery trucks and other equipment, apparently in anticipation of higher tax rates and the destructive side effects of government cutbacks. Given that capital expenditures have been weak recently, some economists believe businesses will start spending more if Congress ends or at least delays the risk of severe fiscal tightening.

“You would think there must be for most businesses a list of projects they’d like to do which they’ve just been pushing a little bit into the future because they haven’t been able to justify taking the risk because they don’t know what’s around the corner,” said Nigel Gault, chief United States economist for IHS Global Insight. “When they know more about the future, and what tax rates they’ll be paying, they will be able to dust off those plans and finally execute them.”

Improving access to credit helps these capital expenditures become not only more attractive, but also more accessible. Commercial and industrial loans have been rising in recent months, according to the Federal Reserve. The National Federation of Independent Business has also reported that the share of small business owners who say their credit needs are not being met has been falling.

Additionally, corporate profits reached a high, even adjusting for inflation, in the third quarter. Companies have amassed a lot of cash that they can use to buy equipment or hire people if they feel secure enough about the recovery.

Consumers, on the other hand, are still not exactly cash-rich, particularly since their disposable income has been flat to falling in recent months. But in the last few years they have deleveraged greatly — either by paying down debt or having it written off through default — and, more important, they are feeling a little wealthier because the housing market appears to have bottomed out. The country has finally worked its way through the excess housing inventory from the bubble years, and now housing prices and housing construction are rising.

Household formation is picking up: young people are finally moving into their own homes, as are other Americans who had lived with family or friends.

“We’re slowly but steadily improving, with more job opportunities in particular for younger households,” said Mark Zandi, chief economist at Moody’s Analytics. “They can only live with their parents for so long. There are powerful centrifugal forces in those households, on both sides. As soon as they have a chance to get out, many will take it.”

Demographic data suggests that there should be about a million more households headed by younger Americans today than there actually are. That bodes well for continued formation of households next year, and new household formation is typically accompanied by other spending like furniture and kitchenware. Under normal circumstances, each new household adds about $145,000 to output that year as the spending ripples through the economy, Mr. Zandi says.

As is the case with businesses, economists see consumers unleashing some of their pent-up demand for cars. The average age of all vehicles in operation in America is at a record high of 11.2 years, according to the research firm R. L. Polk, which tracks vehicle sales and registrations. Vehicle sales have already been posting large gains this year.

The major caveat to all these relatively upbeat indicators, of course, is that Congress might override all this strength with deep austerity measures.

Even without all of the federal tax increases and spending cuts scheduled for 2013, the government sector will slow growth because state and local governments are still shrinking, said Michael Feroli, chief United States economist for JPMorgan Chase. The sharp fiscal tightening at the federal level under current law would not only drag on growth but throw the entire economy back into recession, according to numerous private and government forecasters.

The nonpartisan Congressional Budget Office has estimated that the entirety of the so-called fiscal cliff would shave about three percentage points off gross domestic product growth next year.

A more modest tightening along the lines of what President Obama wants — which would include extending most existing tax rates and spending programs — would still substantially reduce growth, analysts say. Charles Dumas, the chairman of Lombard Street Research, forecasts about a two percentage point subtraction from output growth next year under a situation where most of the Bush tax cuts are kept, the payroll tax holiday is phased out and most of the scheduled spending cuts are eliminated.

“The full drag posed by the cliff is sufficient to erase roughly two and a half years’ worth of economic gains,” said Joseph A. LaVorgna, chief United States economist at Deutsche Bank.

Read More..

Experts Say Thimerosal Ban Would Imperil Global Health Efforts

A group of prominent doctors and public health experts warns in articles to be published Monday in the journal Pediatrics that banning thimerosal, a mercury compound used as a preservative in vaccines, would devastate public health efforts in developing countries.

Representatives from governments around the world will meet in Geneva next month in a session convened by the United Nations Environmental Program to prepare a global treaty to reduce health hazards by banning certain products and processes that release mercury into the environment.

But a proposal that the ban include thimerosal, which has been used since the 1930s to prevent bacterial and fungal contamination in multidose vials of vaccines, has drawn strong criticism from pediatricians.

They say that the ethyl-mercury compound is critical for vaccine use in the developing world, where multidose vials are a mainstay.

Banning it would require switching to single-dose vials for vaccines, which would cost far more and require new networks of cold storage facilities and additional capacity for waste disposal, the authors of the articles said.

“The result would be millions of people, predominantly in low- and middle-income countries, with significantly restricted access to lifesaving vaccines for many years,” they wrote.

In the United States, thimerosal has not been used in children’s vaccines since the early 2000s after the Food and Drug Administration and public health groups came under pressure from advocacy groups that believed there was an association between the compound and autism in children.

At the time, few, if any, studies had evaluated the compound’s safety, so the American Academy of Pediatrics called for its elimination in children’s vaccines, a recommendation that the authors argued was made under the principle of “do no harm.”

Since then, however, there has been a lot of research, and the evidence is overwhelming that thimerosal is not harmful, the authors said. Louis Z. Cooper, a former president of the academy and one of the authors, said that if the members had known then what they know now, they never would have recommended against using it. “Science clearly documented that we can’t find hazards from thimerosal in vaccines,” he said. “The preservative plays a critical role in distribution of vaccine to the global community. It was a no-brainer what our position needed to be.”

Advocacy groups have lobbied to include the substance in the ban, and some global health experts worry that because the government representatives due to vote next month are for the most part ministers of environment, not health, they may not appreciate the consequences of banning thimerosal in vaccines. The Pediatrics articles are timed to raise a warning before the meeting.

“If you don’t know about this, and you’re a minister of environment who doesn’t usually deal with health, it’s confusing,” said Heidi Larson, senior lecturer at the London School of Hygiene and Tropical Medicine, who runs the Vaccine Confidence Project.

In an open letter to the United Nations Environmental Program and the World Health Organization this year, the Coalition for Mercury-Free Drugs, a nonprofit group that supports the ban, disputed the assertion that scientific studies had offered proof that thimerosal is safe, and urged member states to include it in the ban.

That it is being used in developing countries, but not developed countries, is an “injustice,” the letter said.

The World Health Organization has also weighed in. In April, a group of experts on immunization wrote in a report that they were “gravely concerned that current global discussions may threaten access to thimerosal-containing vaccines without scientific justification.”

Dr. Larson said she believed that the efforts of pediatricians and global health experts, including the W.H.O., would influence the negotiations in Geneva and that the compound would most likely be left out of the final ban.

“You can’t just pull the plug on something without having a plan for an alternative,” she said.

Read More..

Experts Say Thimerosal Ban Would Imperil Global Health Efforts

A group of prominent doctors and public health experts warns in articles to be published Monday in the journal Pediatrics that banning thimerosal, a mercury compound used as a preservative in vaccines, would devastate public health efforts in developing countries.

Representatives from governments around the world will meet in Geneva next month in a session convened by the United Nations Environmental Program to prepare a global treaty to reduce health hazards by banning certain products and processes that release mercury into the environment.

But a proposal that the ban include thimerosal, which has been used since the 1930s to prevent bacterial and fungal contamination in multidose vials of vaccines, has drawn strong criticism from pediatricians.

They say that the ethyl-mercury compound is critical for vaccine use in the developing world, where multidose vials are a mainstay.

Banning it would require switching to single-dose vials for vaccines, which would cost far more and require new networks of cold storage facilities and additional capacity for waste disposal, the authors of the articles said.

“The result would be millions of people, predominantly in low- and middle-income countries, with significantly restricted access to lifesaving vaccines for many years,” they wrote.

In the United States, thimerosal has not been used in children’s vaccines since the early 2000s after the Food and Drug Administration and public health groups came under pressure from advocacy groups that believed there was an association between the compound and autism in children.

At the time, few, if any, studies had evaluated the compound’s safety, so the American Academy of Pediatrics called for its elimination in children’s vaccines, a recommendation that the authors argued was made under the principle of “do no harm.”

Since then, however, there has been a lot of research, and the evidence is overwhelming that thimerosal is not harmful, the authors said. Louis Z. Cooper, a former president of the academy and one of the authors, said that if the members had known then what they know now, they never would have recommended against using it. “Science clearly documented that we can’t find hazards from thimerosal in vaccines,” he said. “The preservative plays a critical role in distribution of vaccine to the global community. It was a no-brainer what our position needed to be.”

Advocacy groups have lobbied to include the substance in the ban, and some global health experts worry that because the government representatives due to vote next month are for the most part ministers of environment, not health, they may not appreciate the consequences of banning thimerosal in vaccines. The Pediatrics articles are timed to raise a warning before the meeting.

“If you don’t know about this, and you’re a minister of environment who doesn’t usually deal with health, it’s confusing,” said Heidi Larson, senior lecturer at the London School of Hygiene and Tropical Medicine, who runs the Vaccine Confidence Project.

In an open letter to the United Nations Environmental Program and the World Health Organization this year, the Coalition for Mercury-Free Drugs, a nonprofit group that supports the ban, disputed the assertion that scientific studies had offered proof that thimerosal is safe, and urged member states to include it in the ban.

That it is being used in developing countries, but not developed countries, is an “injustice,” the letter said.

The World Health Organization has also weighed in. In April, a group of experts on immunization wrote in a report that they were “gravely concerned that current global discussions may threaten access to thimerosal-containing vaccines without scientific justification.”

Dr. Larson said she believed that the efforts of pediatricians and global health experts, including the W.H.O., would influence the negotiations in Geneva and that the compound would most likely be left out of the final ban.

“You can’t just pull the plug on something without having a plan for an alternative,” she said.

Read More..

In Europe, a Push for Higher Phone Fees

BERLIN — When the authorities have tinkered with European telecommunications rules, it has usually been to lower prices for consumers, whether through retail price controls on mobile roaming fees or mandatory cuts in regulated interconnection charges.

But this year, to encourage more investment in high-speed broadband networks, regulators are considering helping the biggest operators increase a main source of income: the rent they receive from rivals that lease their landline grids.

The architect of the plan, Neelie Kroes, the European Union’s digital agenda commissioner, has pitched the increases as part of a broader package to stimulate spending while preserving competition and consumer choice.

The plan, however, has alarmed operators that would have to pay the higher charges, like the British mobile operator Vodafone. Vittorio Colao, chief executive of Vodafone, said that the plan to increase the fees collected by former monopolies, including BT, Deutsche Telekom, France Télécom, KPN, Telecom Italia and Telefónica, could lead to a “re-monopolization” of the business.

Mr. Colao said he was worried that landline operators would use the additional revenue to lower their own prices and try to squeeze competitors like Vodafone.

“Increasing the incentive to invest is a good thing,” Mr. Colao said. But now Ms. Kroes must “demonstrate that these new criteria won’t contaminate the competitive arena in Europe,” he said.

Under the plan, the European Commission, the executive arm of the European Union, would begin regulating the fees that mobile operators routinely pay to lease the grids of landline operators.

In much of the world, running telecommunications lines to homes and businesses has traditionally been the domain of a local monopoly, or sometimes a duopoly in the case of telephones and cable television in the United States. Until 1998, countries in the European Union were allowed to maintain national monopolies for this “local loop” to the consumer.

With deregulation, however, the former monopolies were required to unbundle the cost of the local loop and offer it to competitors, thus allowing companies like Vodafone to enter the market.

Despite 14 years of deregulation, and the addition of more than 100 mobile operators in Europe, the former monopolies still supply the majority of fixed-line services in their home countries. In Spain, Telefónica has more than 70 percent of this business.

Until now, these unbundling rates have been set by national regulators, and the average monthly cost per customer in the European Union stands at €8.62, or $11.35. The fee typically makes up a third or more of monthly landline phone bills in Europe and also influences wireless prices because it affects mobile operator costs. The fee ranges from €4.20 in Slovakia to €12.41 in Ireland.

Mrs. Kroes proposed to lower, not raise, unbundling fees in September 2011, to make the old landline networks less profitable for big operators and to encourage them to invest in new networks. But the former monopolies protested, and after personal appeals from executives at big operators, in some cases accompanied by their investors, she reversed course.

Ms. Kroes is proposing that each country within the European Union be required to set its fee within the range of €8 to €10 per month, according to a copy of her proposal obtained by the International Herald Tribune. The new range would most likely require 10 E.U. countries where the fee is currently below this range to raise it, in some cases only slightly, and in others, sharply.

The increases would in all likelihood be passed on to consumers. The rise in fees could be greatest in Eastern Europe, where regulators have been most aggressive in setting low leasing rates to encourage competition. The level of leasing charges could double in Estonia, Latvia, Poland and Slovakia.

Mr. Colao, the Vodafone chief executive, said Ms. Kroes needed to tighten the legal safeguards in her plan to prevent big operators from exploiting access to landline networks.

Read More..

10 Afghan Girls Killed in Old Mine Blast; Car Bomb Kills One in Kabul

Parwiz/Reuters

Afghan villagers gathered around the bodies of girls who were killed by an explosion on Monday.

KABUL, Afghanistan — A suicide bomber driving a car packed with explosives targeted the compound of a private military contractor on the eastern outskirts of Kabul on Monday, killing at least one person and injuring at least 15 others, including foreigners, the police said.

In a separate episode, 10 girls were killed in a rural district of eastern Afghanistan on Monday when a roadside bomb exploded while they were collecting firewood, the Afghan police said. The office of the governor of Nangarhar Province said the girls were all between 9 and 11 years old. The Ministry of Education said some were as young as 6.

The Kabul explosion sent a large plume of smoke above the capital on the Jalalabad road, a main thoroughfare leading east out of the city lined with shops, yards and industrial units.

The target was a company called Contrack International, said Gen. Mohammed Dawood Amin, Kabul’s deputy chief of police. Officials said Contrack was a construction maintenance company that provided logistics services for the Afghan Army and police and NATO coalition bases.

“There was a blast, a boom and a wall fell down,” said Roheen Fedai, 19, who said he worked in the company’s call center. Shortly after the blast, he was wandering close to the compound with his hand in a bandage and blood on his face from an eye injury.

The car exploded in a small lane between the company and another compound housing a carton-making factory, blasting down walls and destroying a two-story office.

Barialyia, a security official for Contrack, said the company’s country director was wounded in the explosion. He said five American and South African citizens were among the injured.

Mr. Fedai said Contrack was an American-owned supplier to the Afghan military. Officials here also said the company was American-owned, but the company could not be reached to confirm this or other details about the attack. Its Web site says its headquarters are in McLean, Va., and shows that it has provided services for the United States military in the past.

The compound is close to a NATO base, Camp Phoenix, and other NATO installations. The Taliban claimed responsibility, but a coalition spokesman in Kabul, Lt. Col. Hagen Messer, said the attack did not affect the NATO bases, and there were no coalition casualties.

In the blast in eastern Afghanistan, Hazarat Hussain Masharaqiwal, a spokesman for the police chief of Nangarhar Province, said that the children discovered the unexploded bomb near their village, and that it went off when they hit it with an ax. The explosion also injured a boy who was with them.

The local police said the bomb probably dated from the civil war or even the Soviet occupation of the country.

The United States-led International Security Assistance Force in Afghanistan said the explosion was caused by the accidental triggering of an old land mine, quoting the governor of Chaparhar District in Nangarhar.

In a statement, Gen. John R. Allen, the commander of American and international forces in Afghanistan, said he was saddened by the girls’ deaths. “Over three decades of conflict, Afghanistan became one of the most heavily mined countries on earth,” he said.

Sharifullah Sahak contributed reporting from Kabul, Afghanistan, and Khalid Alokozai from Nangarhar.

Read More..

As Gold Is Spirited Out of Afghanistan, Officials Wonder Why

Zalmai for The New York Times

A Kabul jewelry shop. Officials are concerned about gold being flown out of Afghanistan.

KABUL, Afghanistan — Packed into hand luggage and tucked into jacket pockets, roughly hewed bars of gold are being flown out of Kabul with increasing regularity, confounding Afghan and American officials who fear money launderers have found a new way to spirit funds from the country.

Most of the gold is being carried on commercial flights destined for Dubai, according to airport security reports and officials. The amounts carried by single couriers are often heavy enough that passengers flying from Kabul to the Persian Gulf emirate would be well advised to heed warnings about the danger of bags falling from overhead compartments. One courier, for instance, carried nearly 60 pounds of gold bars, each about the size of an iPhone, aboard an early morning flight in mid-October, according to an airport security report. The load was worth more than $1.5 million.

The gold is fully declared and legal to fly. Some, if not most, is legitimately being sent by gold dealers seeking to have old and damaged jewelry refashioned into new pieces by skilled craftsmen in the Persian Gulf, said Afghan officials and gold dealers.

But gold dealers in Kabul and current and former Kabul airport officials say there has been a surge in shipments since early summer. The talk of a growing exodus of gold from Afghanistan has been spreading among the business community here, and in recent weeks has caught the attention of Afghan and American officials. The officials are now puzzling over the origin of the gold — very little is mined in Afghanistan, although larger mines are planned — and why so much appears to be heading for Dubai.

“We are investigating it, and if we find this is a way of laundering money, we will intervene,” said Noorullah Delawari, the governor of Afghanistan’s central bank. Yet he acknowledged that there were more questions than answers at this point. “I don’t know where so much gold would come from, unless you can tell me something about it,” he said in an interview. Or, as a European official who tracks the Afghan economy put it, “new mysteries abound” as the war appears to be drawing to a close.

Figuring out what precisely is happening in the Afghan economy remains as confounding as ever. Nearly 90 percent of the financial activity takes place outside formal banks. Written contracts are the exception, receipts are rare and statistics are often unreliable. Money laundering is commonplace, say Western and Afghan officials.

As a result, with the gold, “right now you’re stuck in that situation we usually are: is there something bad going on here or is this just the Afghan way of commerce?” said a senior American official who tracks illicit financial networks.

There is reason to be suspicious: the gold shipments track with the far larger problem of cash smuggling. For years, flights have left Kabul almost every day carrying thick wads of bank notes — dollars, euros, Norwegian kroner, Saudi Arabian riyals and other currencies — stuffed into suitcases, packed into boxes and shrink-wrapped onto pallets. At one point, cash was even being hidden in food trays aboard now-defunct Pamir Airways flights to Dubai.

Last year alone, Afghanistan’s central bank says, roughly $4.5 billion in cash was spirited out through the airport. Efforts to stanch the flow have had limited impact, and concerns about money laundering persist, according to a report released last week by the United States Special Inspector General for Afghanistan Reconstruction.

The unimpeded “bulk cash flows raise the risk of money laundering and bulk cash smuggling — tools often used to finance terrorist, narcotics and other illicit operations,” the report said. The cash, and now the gold, is most often taken to Dubai, where officials are known for asking few questions. Many wealthy Afghans park their money and families in the emirate, and gold dealers say more middle-class Afghans are sending money and gold — seen as a safeguard against economic ruin — to Dubai as talk of a postwar economic collapse grows louder.

But given Dubai’s reputation as a haven for laundered money, an Afghan official said that the “obvious suspicion” is that at least some of the apparent growth in gold shipments to Dubai is tied to the myriad illicit activities — opium smuggling, corruption, Taliban taxation schemes — that have come to define Afghanistan’s economy.

There are also indications that Iran could be dipping into the Afghan gold trade. It is already buying up dollars and euros here to circumvent American and European sanctions, and it may be using gold for the same purpose.

Yahya, a dealer in Kabul, said other gold traders were helping Iran buy the precious metal here. Payment was being made in oil or with Iranian rials, which readily circulate in western Afghanistan. The Afghan dealers are then taking it to Dubai, where the gold is sold for dollars. The money is then moved to China, where it was used to buy needed goods or simply funneled back to Iran, said Yahya, who like many Afghans uses a single name.

Read More..

Dr. William F. House, Inventor of Cochlear Implant, Dies

Dr. William F. House, a medical researcher who braved skepticism to invent the cochlear implant, an electronic device considered to be the first to restore a human sense, died on Dec. 7 at his home in Aurora, Ore. He was 89.

The cause was metastatic melanoma, his daughter, Karen House, said.

Dr. House pushed against conventional thinking throughout his career. Over the objections of some, he introduced the surgical microscope to ear surgery. Tackling a form of vertigo that doctors had believed was psychosomatic, he developed a surgical procedure that enabled the first American in space to travel to the moon. Peering at the bones of the inner ear, he found enrapturing beauty.

Even after his ear-implant device had largely been supplanted by more sophisticated, and more expensive, devices, Dr. House remained convinced of his own version’s utility and advocated that it be used to help the world’s poor.

Today, more than 200,000 people in the world have inner-ear implants, a third of them in the United States. A majority of young deaf children receive them, and most people with the implants learn to understand speech with no visual help.

Hearing aids amplify sound to help the hearing-impaired. But many deaf people cannot hear at all because sound cannot be transmitted to their brains, however much it is amplified. This is because the delicate hair cells that line the cochlea, the liquid-filled spiral cavity of the inner ear, are damaged. When healthy, these hairs — more than 15,000 altogether — translate mechanical vibrations produced by sound into electrical signals and deliver them to the auditory nerve.

Dr. House’s cochlear implant electronically translated sound into mechanical vibrations. His initial device, implanted in 1961, was eventually rejected by the body. But after refining its materials, he created a long-lasting version and implanted it in 1969.

More than a decade would pass before the Food and Drug Administration approved the cochlear implant, but when it did, in 1984, Mark Novitch, the agency’s deputy commissioner, said, “For the first time a device can, to a degree, replace an organ of the human senses.”

One of Dr. House’s early implant patients, from an experimental trial, wrote to him in 1981 saying, “I no longer live in a world of soundless movement and voiceless faces.”

But for 27 years, Dr. House had faced stern opposition while he was developing the device. Doctors and scientists said it would not work, or not work very well, calling it a cruel hoax on people desperate to hear. Some said he was motivated by the prospect of financial gain. Some criticized him for experimenting on human subjects. Some advocates for the deaf said the device deprived its users of the dignity of their deafness without fully integrating them into the hearing world.

Even when the American Academy of Ophthalmology and Otolaryngology endorsed implants in 1977, it specifically denounced Dr. House’s version. It recommended more complicated versions, which were then under development and later became the standard.

But his work is broadly viewed as having sped the development of implants and enlarged understanding of the inner ear. Jack Urban, an aerospace engineer, helped develop the surgical microscope as well as mechanical and electronic aspects of the House implant.

Karl White, founding director of the National Center for Hearing Assessment and Management, said in an interview that it would have taken a decade longer to invent the cochlear implant without Dr. House’s contributions. He called him “a giant in the field.”

After embracing the use of the microscope in ear surgery, Dr. House developed procedures — radical for their time — for removing tumors from the back portion of the brain without causing facial paralysis; they cut the death rate from the surgery to less than 1 percent from 40 percent.

He also developed the first surgical treatment for Meniere’s disease, which involves debilitating vertigo and had been viewed as a psychosomatic condition. His procedure cured the astronaut Alan B. Shepard Jr. of the disease, clearing him to command the Apollo 14 mission to the moon in 1971. In 1961, Shepard had become the first American launched into space.

In presenting Dr. House with an award in 1995, the American Academy of Otolaryngology-Head and Neck Surgery Foundation said, “He has developed more new concepts in otology than almost any other single person in history.”

William Fouts House was born in Kansas City, Mo., on Dec. 1, 1923. When he was 3 his family moved to Whittier, Calif., where he grew up on a ranch. He did pre-dental studies at Whittier College and the University of Southern California, and earned a doctorate in dentistry at the University of California, Berkeley. After serving his required two years in the Navy — and filling the requisite 300 cavities a month — he went back to U.S.C. to pursue an interest in oral surgery. He earned his medical degree in 1953. After a residency at Los Angeles County Hospital, he joined the Los Angeles Foundation of Otology, a nonprofit research institution founded by his brother, Howard. Today it is called the House Research Institute.

Many at the time thought ear surgery was a declining field because of the effectiveness of antibiotics in dealing with ear maladies. But Dr. House saw antibiotics as enabling more sophisticated surgery by diminishing the threat of infection.

When his brother returned from West Germany with a surgical microscope, Dr. House saw its potential and adopted it for ear surgery; he is credited with introducing the device to the field. But again there was resistance. As Dr. House wrote in his memoir, “The Struggles of a Medical Innovator: Cochlear Implants and Other Ear Surgeries” (2011), some eye doctors initially criticized his use of a microscope in surgery as reckless and unnecessary for a surgeon with good eyesight.

Dr. House also used the microscope as a research tool. One night a week he would take one to a morgue for use in dissecting ears to gain insights that might lead to new surgical procedures. His initial reaction, he said, was how beautiful the bones seemed; he compared the experience to one’s first view of the Grand Canyon. His wife, the former June Stendhal, a nurse, often helped.

She died in 2008 after 64 years of marriage. In addition to his daughter, Dr. House is survived by a son, David; three grandchildren; and two great-grandchildren.

The implant Dr. House invented used a single channel to deliver information to the hearing system, as opposed to the multiple channels of competing models. The 3M Company, the original licensee of the House implant, sold its rights to another company, the Cochlear Corporation, in 1989. Cochlear later abandoned his design in favor of the multichannel version.

But Dr. House continued to fight for his single-electrode approach, saying it was far cheaper, and offered voluminous material as evidence of its efficacy. He had hoped to resume production of it and make it available to the poor around the world.

Neither the institute nor Dr. House made any money on the implant. He never sought a patent on any of his inventions, he said, because he did not want to restrict other researchers. A nephew, Dr. John House, the current president of the House institute, said his uncle had made the deal to license it to the 3M Company not for profit but simply to get it built by a reputable manufacturer.

Reflecting on his business decisions in his memoir, Dr. House acknowledged, “I might be a little richer today.”

Read More..