Ground Zero Volunteers Face Obstacles to Compensation





On the day the terrorists flew into the World Trade Center, the Wu-Tang Clan canceled its meeting with a record mixer named Richard Oliver, so Mr. Oliver rushed downtown from his Hell’s Kitchen apartment to help out.




He said he spent three sleepless days at ground zero, tossing body bags. “Then I went home, ate, crashed, woke up,” he said. He had left his Dr. Martens boots on the landing outside his apartment, where he said they “had rotted away.”


“That was kind of frightening,” he continued. “I was breathing that stuff.”


After the Sept. 11 attacks, nothing symbolized the city’s rallying around like many New Yorkers who helped at ground zero for days, weeks, months, without being asked. Now Mr. Oliver, suffering from back pain and a chronic sinus infection, is among scores of volunteers who have begun filing claims for compensation from a $2.8 billion fund that Congress created in 2010.


But proving they were there and eligible for the money is turning out to be its own forbidding task.


The other large classes of people who qualify — firefighters, police officers, contractors, city workers, residents and students — have it relatively simple, since they are more likely to have official work orders, attendance records and leases to back them up. But more than a decade later, many volunteers have only the sketchiest proof that they are eligible for the fund, which is expected to make its first awards early this year. (A separate $1.5 billion treatment fund also was created.)


They are volunteers like Terry Graves, now ill with lung cancer, who kept a few business cards of people she worked with until 2007, then threw them away. Or Jaime Hazan, a former Web designer with gastric reflux, chronically inflamed sinuses and asthma, who managed to dig up a photograph of himself at ground zero — taken from behind.


Or Mr. Oliver, who has a terse two-sentence thank-you note on American Red Cross letterhead, dated 2004, which does not meet the requirement that it be witnessed or sworn.


“For some people, there’s great records,” said Noah H. Kushlefsky, whose law firm, Kreindler & Kreindler, is representing volunteers and others who expect to make claims. “But in some respects, it was a little bit of a free-for-all. Other people went down there and joined the bucket brigade, talked their way in. It’s going to be harder for those people, and we do have clients like that.”


As documentation, the fund requires volunteers to have orders, instructions or confirmation of tasks they performed, or medical records created during the time they were in what is being called the exposure zone, including the area south of Canal Street, and areas where debris was being taken.


Failing that, it will be enough to submit two sworn statements — meaning the writer swears to its truth, under penalty of perjury — from witnesses describing when the volunteers were there and what they were doing.


Proving presence at the site might actually be harder than proving the illness is related to Sept. 11, since the rules now allow a host of ailments to be covered, including 50 kinds of cancer, despite an absence of evidence linking cancer to ground zero.


A study by the New York City health department, just published in the Journal of the American Medical Association, found no clear association between cancer and Sept. 11, though the researchers noted that some cancers take many years to develop.


Unlike the original compensation fund, administered by Kenneth Feinberg, which dealt mainly with people who were killed or maimed in the attack, “This one is dealing with injuries that are very common,” said Sheila L. Birnbaum, a former mediator and personal injury defense lawyer, who is in charge of the new fund. “So it’s sort of a very hard process from the fund’s point of view to make the right call, and it requires some evidence that people were actually there.”


Asked how closely the fund would scrutinize documents like sworn statements, Ms. Birnbaum said she understood how hard it was to recreate records after a decade, and was going on the basic assumption that people would be honest.


In his career as a record mixer, Mr. Oliver, 56, has been associated with 7 platinum and 11 gold records, and 2 Grammy credits, which now line the walls of his condominium in College Point, Queens. He said he first got wind of the Sept. 11 attacks from a client, the Wu-Tang Clan. “One of the main guys called me: ‘Did you see what’s on TV? Because our meeting ain’t going to happen,’ ” he recalled.


Having taken a hazmat course after high school, he called the Red Cross and was told they needed people like him. “I left my soon-to-be-ex-wife and 1-year-old son and went down,” he said. “I came back three days later,” after surviving on his own adrenaline, Little Debbie cakes handed out to volunteers and bottled water. After working for three days setting up a morgue, he was willing to go back, he said, but “they said we have trained people now, thank you very much for your service.”


Read More..

Ground Zero Volunteers Face Obstacles to Compensation





On the day the terrorists flew into the World Trade Center, the Wu-Tang Clan canceled its meeting with a record mixer named Richard Oliver, so Mr. Oliver rushed downtown from his Hell’s Kitchen apartment to help out.




He said he spent three sleepless days at ground zero, tossing body bags. “Then I went home, ate, crashed, woke up,” he said. He had left his Dr. Martens boots on the landing outside his apartment, where he said they “had rotted away.”


“That was kind of frightening,” he continued. “I was breathing that stuff.”


After the Sept. 11 attacks, nothing symbolized the city’s rallying around like many New Yorkers who helped at ground zero for days, weeks, months, without being asked. Now Mr. Oliver, suffering from back pain and a chronic sinus infection, is among scores of volunteers who have begun filing claims for compensation from a $2.8 billion fund that Congress created in 2010.


But proving they were there and eligible for the money is turning out to be its own forbidding task.


The other large classes of people who qualify — firefighters, police officers, contractors, city workers, residents and students — have it relatively simple, since they are more likely to have official work orders, attendance records and leases to back them up. But more than a decade later, many volunteers have only the sketchiest proof that they are eligible for the fund, which is expected to make its first awards early this year. (A separate $1.5 billion treatment fund also was created.)


They are volunteers like Terry Graves, now ill with lung cancer, who kept a few business cards of people she worked with until 2007, then threw them away. Or Jaime Hazan, a former Web designer with gastric reflux, chronically inflamed sinuses and asthma, who managed to dig up a photograph of himself at ground zero — taken from behind.


Or Mr. Oliver, who has a terse two-sentence thank-you note on American Red Cross letterhead, dated 2004, which does not meet the requirement that it be witnessed or sworn.


“For some people, there’s great records,” said Noah H. Kushlefsky, whose law firm, Kreindler & Kreindler, is representing volunteers and others who expect to make claims. “But in some respects, it was a little bit of a free-for-all. Other people went down there and joined the bucket brigade, talked their way in. It’s going to be harder for those people, and we do have clients like that.”


As documentation, the fund requires volunteers to have orders, instructions or confirmation of tasks they performed, or medical records created during the time they were in what is being called the exposure zone, including the area south of Canal Street, and areas where debris was being taken.


Failing that, it will be enough to submit two sworn statements — meaning the writer swears to its truth, under penalty of perjury — from witnesses describing when the volunteers were there and what they were doing.


Proving presence at the site might actually be harder than proving the illness is related to Sept. 11, since the rules now allow a host of ailments to be covered, including 50 kinds of cancer, despite an absence of evidence linking cancer to ground zero.


A study by the New York City health department, just published in the Journal of the American Medical Association, found no clear association between cancer and Sept. 11, though the researchers noted that some cancers take many years to develop.


Unlike the original compensation fund, administered by Kenneth Feinberg, which dealt mainly with people who were killed or maimed in the attack, “This one is dealing with injuries that are very common,” said Sheila L. Birnbaum, a former mediator and personal injury defense lawyer, who is in charge of the new fund. “So it’s sort of a very hard process from the fund’s point of view to make the right call, and it requires some evidence that people were actually there.”


Asked how closely the fund would scrutinize documents like sworn statements, Ms. Birnbaum said she understood how hard it was to recreate records after a decade, and was going on the basic assumption that people would be honest.


In his career as a record mixer, Mr. Oliver, 56, has been associated with 7 platinum and 11 gold records, and 2 Grammy credits, which now line the walls of his condominium in College Point, Queens. He said he first got wind of the Sept. 11 attacks from a client, the Wu-Tang Clan. “One of the main guys called me: ‘Did you see what’s on TV? Because our meeting ain’t going to happen,’ ” he recalled.


Having taken a hazmat course after high school, he called the Red Cross and was told they needed people like him. “I left my soon-to-be-ex-wife and 1-year-old son and went down,” he said. “I came back three days later,” after surviving on his own adrenaline, Little Debbie cakes handed out to volunteers and bottled water. After working for three days setting up a morgue, he was willing to go back, he said, but “they said we have trained people now, thank you very much for your service.”


Read More..

Frequent Flier: An Environmentalist Weighs the Fallout of Flying


Ami Vitale


M. Sanjayan, the lead scientist for The Nature Conservancy, at Firehole River in Yellowstone National Park.







I FLY a lot. And honestly, flying now is a means to an end, although I used to enjoy it. It’s not that I hate it or am paranoid. It’s just that it’s a chore.






Q. How often do you fly for business?


A. Once or twice a week, mostly domestic, but also international about once a month.


Q. What’s your least favorite airport?


A. I hate to say it and know I will get criticized, but it’s Denver International. It should be a great airport, but it isn’t. There are no amenities, no decent meals, no nothing.


Q. Of all the places you’ve been, what’s the best?


A. East Africa. It’s where humans evolved, and it always feels like a homecoming to me. The temperature, the way it looks, the gestalt rekindles a cellular memory that when I’m there I’m in my ancestral home. I think it’s where humans really belong.


Q. What’s your secret airport vice?


A. I catch up on TV shows that I can’t watch at any other time. I’ve watched entire seasons of “Breaking Bad,” “Homeland” and “Downton Abbey” all in one trip.





As the lead scientist for the Nature Conservancy, I am fully aware of the ramifications of flying and its effect on the environment, but sometimes I have to do it. I do always ask myself the question: When I get to my destination, what can I deliver? In other words, is it really important for me to be someplace?


If not, I’m not going to go. I don’t go to meetings, conferences or events unless if I have a very specific role. And then, of course, there’s a personal toll. Flying can be tough on the body and spirit, even if you take good care of yourself.


I love seeing kids take their first flight. It can be so cool to fly as a kid, even today with all the hassle and limited service.


The first time I got to fly was as a 5-year-old on a KLM DC-8 from Colombo in Sri Lanka to Amsterdam. It was a huge thrill. My dad gave me the window seat and I stayed awake for as long as I could, following our path over darkened Asia and then Europe.


As I remember it, the food was fantastic. It was served in a tray that was partitioned into little quadrants. We ate with forks and knives, not with our hands as we did at home in Sri Lanka. Cheese was wrapped in foil, chocolate came in a Delft blue wrapper with a windmill stamped on it, and the juice wasn’t straight from an orange but a box. It was such a big deal to eat like a Westerner.


Since I often travel to remote locations, I rarely carry luggage. I want everything I need close at hand and I hate having to wait and guess whether my luggage will make it. If I really need something I don’t have, I can usually buy it locally. Occasionally, I don’t have a choice because a trip may be too long or too complicated for me to avoid taking my own gear. One time, I was particularly thankful that I put a red jersey in my carry-on.


A few years ago in Alaska, I was stranded with a Discovery Channel crew. We were on a sandy island on the Tana River in the gigantic Wrangell-St. Elias wilderness. The river was running ragged with heavy glacial melt and our rafts were no match for the white water.


We were drenched and miserable. To perhaps catch a passing plane’s attention, I actually wrote a message out on the sand beach with a big stick, just like you see in the movies. When I did see a plane coming, I whirled my red jersey over my head to catch the eye of the bush pilot.


The plane came in very low, the pilot read the message in the sand about our need for help, and then he tossed out a radio and a note, wrapped in his rain jacket. It was amazing. We used the radio to talk to him, and then we arranged a pickup.


The funny thing was that when I was writing out the message in the sand, which gave our GPS coordinates and pickup date, everyone who was with me had advice about what I should say, how big the letters should be, how to make it visible and so on. I mean, really?


Flagging down flying aircraft while you’re on an island is not as common as hailing a cab in rush hour. But everyone had an opinion.


As a scientist, I have to replicate experiments. This is one I don’t really want to repeat ever again.


By M. Sanjayan, as told to Joan Raymond. E-mail: joan.raymond@nytimes.com



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Some Companies Seek to Wean Employees From Their Smartphones





Resolutions to change behavior are common at this time of year, but they usually involve exercising more or smoking less. Now, some companies are adopting policies aimed at weaning employees from their electronic devices.







Matthew Ryan Williams for The New York Times

Michelle Barry and Mark Jacobsen of Centric Brand Anthropology strive for the elusive work-life balance.







Atos, an international information technology company, plans to phase out all e-mails among employees by the end of 2013 and rely instead on other forms of communication. And starting in the new year, employees at Daimler, the German automaker, can have incoming e-mail automatically deleted during vacations so they do not return to a flooded in-box. An automatic message tells the sender which person is temporarily dealing with the employee’s e-mail.


No one is expected to be on call at all hours of the day and night, and “switching off” after work is important, “even if you are on a business trip,” said Sabrina Schrimpf, a Daimler spokeswoman, referring to the company’s recently released report, “Balanced! — Reconciling Employees’ Work and Private Lives.”


Disconnecting can be more challenging for business travelers who frequently work across time zones.


And there is a ripple effect, said Leslie A. Perlow, a professor of leadership at Harvard Business School and the author of “Sleeping With Your Smartphone.” “These guys fly in the middle of the night and send e-mails back to colleagues” who wait up, ready to respond.


A study conducted last spring by the Pew Research Center’s Internet and American Life Project found that while mobile phones were valued as a way to stay productive, there were downsides to being available at all times. The nationwide survey of 2,254 adults found that 44 percent of cellphone owners had slept with their phone next to their bed and that 67 percent had experienced “phantom rings,” checking their phone even when it was not ringing or vibrating. Still, the proportion of cellphone owners who said they “could live without it” has gone up, to 37 percent from 29 percent in 2006.


Sam Chapman, chief executive of Empower Public Relations in Chicago, said he used to feel phantom vibrations and frequently read and sent e-mail on his BlackBerry in the middle of the night. He slept poorly, did not feel refreshed in the morning and considered himself addicted. “I wanted to make sure that what happened to me didn’t happen to my employees,” he said.


So Mr. Chapman adopted what he called a BlackBerry blackout policy. He and his staff of about 20 turn off their BlackBerrys from 6 p.m. to 6 a.m. on weekdays and completely on weekends for all work-related use, with rare exceptions. “When I’m well rested, I show up to work ready to go,” he said.


He maintains that regimen while traveling, and said the policy had increased company productivity.


Professor Perlow agreed that companies could improve their bottom line by encouraging employees to disconnect at times. “Being constantly on actually undermines productivity,” she said.


But it is not always easy. In early 2012, when Michelle Barry, Mark Jacobsen and a third partner created Centric Brand Anthropology, a Seattle-based company that advises clients on brand strategy, design and culture management, they gave serious thought to the issue.


“A huge priority for us was to have a good balance between work-life,” said Mr. Jacobsen, Centric’s vice president and creative director. “Yet we have found that very difficult to do while working with large multinational clients,” which often require international travel and constant availability.


Being a start-up compounded those challenges. “Just because you can e-mail at 2 a.m., doesn’t mean it’s a good thing,” he said.


Centric encourages employees to prepare a week before a trip, designating a colleague as backup, informing clients about their travel plans, and trying to avoid deadlines immediately after they return. Employees are also encouraged to take spouses or partners on longer assignments and to build in downtime, said Ms. Barry, the company’s president and chief executive. When traveling, she said, “I make a commitment to myself not to stay up all night answering e-mails.”


Experts say there is no firm data for how many companies have policies restricting the use of electronic devices outside the office. “The companies I know actively encourage workers to stay connected after hours and on weekends,” said Dennis J. Garritan, a managing partner of the private equity firm Palmer Hill Capital and an adjunct professor at Harvard Business School.


Read More..

U.S. Birthrate Dips, Especially for Hispanics





ORLANDO, Fla. — Hispanic women in the United States, who have generally had the highest fertility rates in the country, are choosing to have fewer children. Both immigrant and native-born Latinas had steeper birthrate declines from 2007 to 2010 than other groups, including non-Hispanic whites, blacks and Asians, a drop some demographers and sociologists attribute to changes in the views of many Hispanic women about motherhood.




As a result, in 2011, the American birthrate hit a record low, with 63 births per 1,000 women ages 15 to 44, led by the decline in births to immigrant women. The national birthrate is now about half what it was during the baby boom years, when it peaked in 1957 at 122.7 births per 1,000 women of childbearing age.


The decline in birthrates was steepest among Mexican-American women and women who immigrated from Mexico, at 25.7 percent. This has reversed a trend in which immigrant mothers accounted for a rising share of births in the United States, according to a recent report by the Pew Research Center. In 2010, birthrates among all Hispanics reached their lowest level in 20 years, the center found.


The sudden drop-off, which coincided with the onset of the recession, suggests that attitudes have changed since the days when older generations of Latinos prized large families and more closely followed Roman Catholic teachings, which forbid artificial contraception.


Interviews with young Latinas, as well as reproductive health experts, show that the reasons for deciding to have fewer children are many, involving greater access to information about contraceptives and women’s health, as well as higher education.


When Marucci Guzman decided to marry Tom Beard here seven years ago, the idea of having a large family — a Guzman tradition back in Puerto Rico — was out of the question.


“We thought one, maybe two,” said Ms. Guzman Beard, who gave birth to a daughter, Attalai, four years ago.


Asked whether Attalai might ever get her wish for a little brother or sister, Ms. Guzman Beard, 29, a vice president at a public service organization, said: “I want to go to law school. I’m married. I work. When do I have time?”


The decisions were not made in a vacuum but amid a sputtering economy, which, interviewees said, weighed heavily on their minds.


Latinos suffered larger percentage declines in household wealth than white, black or Asian households from 2005 to 2009, and, according to the Pew report, their rates of poverty and unemployment also grew more sharply after the recession began.


Prolonged recessions do produce dips in the birthrate, but a drop as large as Latinos have experienced is atypical, said William H. Frey, a sociologist and demographer at the Brookings Institution. “It is surprising,” Mr. Frey said. “When you hear about a decrease in the birthrate, you don’t expect Latinos to be at the forefront of the trend.”


D’Vera Cohn, a senior writer at the Pew Research Center and an author of the report, said that in past recessions, when overall fertility dipped, “it bounced back over time when the economy got better.”


“If history repeats itself, that will happen again,” she said.


But to Mr. Frey, the decrease has signaled much about the aspirations of young Latinos to become full and permanent members of the upwardly mobile middle class, despite the challenges posed by the struggling economy.


Jersey Garcia, a 37-year-old public health worker in Miami, is in the first generation of her family to live permanently outside of the Dominican Republic, where her maternal and paternal grandmothers had a total of 27 children.


“I have two right now,” Ms. Garcia said. “It’s just a good number that I can handle.”


“Before, I probably would have been pressured to have more,” she added. “I think living in the United States, I don’t have family members close by to help me, and it takes a village to raise a child. So the feeling is, keep what you have right now.”


But that has not been easy. Even with health insurance, Ms. Garcia’s preferred method of long-term birth control, an IUD, has been unaffordable. Birth control pills, too, with a $50 co-payment a month, were too costly for her budget. “I couldn’t afford it,” she said. “So what I’ve been doing is condoms.”


According to research by the National Latina Institute for Reproductive Health, the overwhelming majority of Latinas have used contraception at some point in their lives, but they face economic barriers to consistent use. As a consequence, Latinas still experience unintended pregnancy at a rate higher than non-Hispanic whites, according to the institute.


And while the share of births to teenage mothers has dropped over the past two decades for all women, the highest share of births to teenage mothers is among native-born Hispanics.


“There are still a lot of barriers to information and access to contraception that exist,” said Jessica Gonzáles-Rojas, 36, the executive director of the institute, who has one son. “We still need to do a lot of work.”


Read More..

U.S. Birthrate Dips, Especially for Hispanics





ORLANDO, Fla. — Hispanic women in the United States, who have generally had the highest fertility rates in the country, are choosing to have fewer children. Both immigrant and native-born Latinas had steeper birthrate declines from 2007 to 2010 than other groups, including non-Hispanic whites, blacks and Asians, a drop some demographers and sociologists attribute to changes in the views of many Hispanic women about motherhood.




As a result, in 2011, the American birthrate hit a record low, with 63 births per 1,000 women ages 15 to 44, led by the decline in births to immigrant women. The national birthrate is now about half what it was during the baby boom years, when it peaked in 1957 at 122.7 births per 1,000 women of childbearing age.


The decline in birthrates was steepest among Mexican-American women and women who immigrated from Mexico, at 25.7 percent. This has reversed a trend in which immigrant mothers accounted for a rising share of births in the United States, according to a recent report by the Pew Research Center. In 2010, birthrates among all Hispanics reached their lowest level in 20 years, the center found.


The sudden drop-off, which coincided with the onset of the recession, suggests that attitudes have changed since the days when older generations of Latinos prized large families and more closely followed Roman Catholic teachings, which forbid artificial contraception.


Interviews with young Latinas, as well as reproductive health experts, show that the reasons for deciding to have fewer children are many, involving greater access to information about contraceptives and women’s health, as well as higher education.


When Marucci Guzman decided to marry Tom Beard here seven years ago, the idea of having a large family — a Guzman tradition back in Puerto Rico — was out of the question.


“We thought one, maybe two,” said Ms. Guzman Beard, who gave birth to a daughter, Attalai, four years ago.


Asked whether Attalai might ever get her wish for a little brother or sister, Ms. Guzman Beard, 29, a vice president at a public service organization, said: “I want to go to law school. I’m married. I work. When do I have time?”


The decisions were not made in a vacuum but amid a sputtering economy, which, interviewees said, weighed heavily on their minds.


Latinos suffered larger percentage declines in household wealth than white, black or Asian households from 2005 to 2009, and, according to the Pew report, their rates of poverty and unemployment also grew more sharply after the recession began.


Prolonged recessions do produce dips in the birthrate, but a drop as large as Latinos have experienced is atypical, said William H. Frey, a sociologist and demographer at the Brookings Institution. “It is surprising,” Mr. Frey said. “When you hear about a decrease in the birthrate, you don’t expect Latinos to be at the forefront of the trend.”


D’Vera Cohn, a senior writer at the Pew Research Center and an author of the report, said that in past recessions, when overall fertility dipped, “it bounced back over time when the economy got better.”


“If history repeats itself, that will happen again,” she said.


But to Mr. Frey, the decrease has signaled much about the aspirations of young Latinos to become full and permanent members of the upwardly mobile middle class, despite the challenges posed by the struggling economy.


Jersey Garcia, a 37-year-old public health worker in Miami, is in the first generation of her family to live permanently outside of the Dominican Republic, where her maternal and paternal grandmothers had a total of 27 children.


“I have two right now,” Ms. Garcia said. “It’s just a good number that I can handle.”


“Before, I probably would have been pressured to have more,” she added. “I think living in the United States, I don’t have family members close by to help me, and it takes a village to raise a child. So the feeling is, keep what you have right now.”


But that has not been easy. Even with health insurance, Ms. Garcia’s preferred method of long-term birth control, an IUD, has been unaffordable. Birth control pills, too, with a $50 co-payment a month, were too costly for her budget. “I couldn’t afford it,” she said. “So what I’ve been doing is condoms.”


According to research by the National Latina Institute for Reproductive Health, the overwhelming majority of Latinas have used contraception at some point in their lives, but they face economic barriers to consistent use. As a consequence, Latinas still experience unintended pregnancy at a rate higher than non-Hispanic whites, according to the institute.


And while the share of births to teenage mothers has dropped over the past two decades for all women, the highest share of births to teenage mothers is among native-born Hispanics.


“There are still a lot of barriers to information and access to contraception that exist,” said Jessica Gonzáles-Rojas, 36, the executive director of the institute, who has one son. “We still need to do a lot of work.”


Read More..

Afghan Army Deaths on the Rise





KABUL, Afghanistan — The Afghan government has hit a grim record in its quest to take over the country’s security from coalition forces: more than 1,000 soldiers died in 2012, a roughly 20 percent increase from 2011.




Though the Afghan Army’s death rates have outstripped those for international forces in recent years, the new figures show the widest margin yet, as more and more Afghan units have taken the field. International forces were reported to have lost about 400 soldiers in 2012, the lowest number since 2008.


The progress of the Afghan National Army in being able to fight the insurgency is crucial to the international coalition’s exit strategy as the formal end of NATO combat operations looms in 2014. Afghan officials say that Afghan forces now plan and lead 80 percent of combat operations across the country. And as the army has filled out its ranks, the number of those killed has risen as well. Since 2008, the number of enlisted soldiers has nearly tripled, to 195,000.


Depending on how one reads the numbers, the latest figures can be both hopeful and troubling. Inasmuch as the uptick in deaths indicates a more active role for the army, the data is encouraging: Afghan-led operations would be expected to result in more Afghan casualties, after all. But for some, the statistics also raise questions about whether the army is ready to take over control of the country’s security.


“These high figures send a message to Afghans as well as the international community that the Afghan security forces are not ready to take over and that we will witness even more severe casualties in the next couple of years,” said Jawid Kohistani, a military analyst based in Kabul. “The only thing preventing the Taliban from taking over a district or a province or carrying out more audacious attacks is the presence of foreign forces who are equipped with modern and advanced technology.”


Progress has been uneven on numerous fronts. Accidents make up a significant number of the Afghan Army deaths. Almost no units can operate without assistance from coalition forces. And defections and low re-enlistment rates are also troubling — the government has to replace about a third of its troops every year.


Even the Defense Ministry acknowledged weaknesses when announcing the updated figures Sunday. Gen. Zahir Azimi, the ministry’s spokesman, said that poor equipment and training left soldiers exposed. Homemade bombs and mines caused about 85 percent of the deaths this year, a figure he said would come down with proper equipment. Intelligence gathering is also a weak spot for the national army.


“We are still heavily relying on foreigners for our intelligence,” he said. “We are hopeful that by the end of 2014 our army is equipped with intelligence capabilities and equipment.”


Among other concerns the government must consider while building the army is how to keep soldiers from being killed by the Taliban. In recent weeks, the Taliban have mounted a campaign to kidnap and kill soldiers who are on leave from their jobs. On Saturday, the Taliban killed a soldier returning from vacation to his base in Laghman Province.


“They take soldiers out of their homes and brutally execute them,” General Azimi said. “Can anyone see even a small bit of respect for human rights?”


But if the general sounded somewhat chastened by the task ahead, commanders on the ground struck a more upbeat note about the future.


“The army is getting better every day and our soldiers will not face any problem next year,” said Gen. Zamarai, commander of the second brigade of the Afghan National Army in Paktika Province, who uses only one name. “As the foreign forces leave, the army is filling the districts and bases, and so far we have managed to provide tight security for the residents of the province.”


Farooq Jan Mangal contributed reporting from Khost Province, Afghanistan.



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Questcor Finds Profit for Acthar Drug, at $28,000 a Vial


Kevin Moloney for The New York Times


Christina Culver with her son Tyler, 6, at home in Colorado Springs this month. In 2007, Tyler was hospitalized when the price of Acthar soared.





THE doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.


The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.


“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.


How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers.


At least until recently, that is. Now some doctors, insurance companies and investors are beginning to have doubts about whether the drug is really any better than much cheaper alternatives. Short-sellers have written scathing criticisms of the company, questioning its marketing tactics and predicting that its shareholders are highly vulnerable.


 That Acthar is even a potential blockbuster is a remarkable turn of events, considering that the drug was developed in the 1950s by a division of Armour & Company, the meatpacking company that once ruled the Union Stock Yards of Chicago. As in the 1950s, Acthar is still extracted from the pituitary glands of slaughtered pigs — essentially a byproduct of the meatpacking industry.


The most important use of Acthar has been to treat infantile spasms, also known as West syndrome, a rare, sometimes fatal epileptic disorder that generally strikes before the age of 1.


For several years, Questcor, which is based in Anaheim, lost money on Acthar because the drug’s market was so small. In 2007, it raised the price overnight, to more than $23,000 a vial, from $1,650, bringing the cost of a typical course of treatment for infantile spasms to above $100,000. It said it needed the high price to keep the drug on the market.


“We have this drug at a very high price right now because, really, our principal market is infantile spasms,” Don M. Bailey, Questcor’s chief executive, told analysts in 2009. “And we only have about 800 patients a year. It’s a very, very small — tiny — market.”


Companies often charge stratospheric prices for drugs for rare diseases — known as orphan drugs — and Acthar’s price is not as high as some. Society generally tolerates those costs to encourage drug companies to develop crucial, possibly lifesaving drugs for these often neglected diseases.


But Questcor did almost no research or development to bring Acthar to market, merely buying the rights to the drug from its previous owner for $100,000 in 2001. And while the manufacturing of Acthar is complex, it accounts for only about 1 cent of every dollar that Questcor charges for the drug.


Moreover, the tiny “orphan” market soon became much bigger. Before long, Questcor began marketing the drug for multiple sclerosis, nephrotic syndrome and rheumatologic conditions, even though there is little evidence that Acthar is more effective for those other conditions than alternatives that are far cheaper. And the company did so without being required to prove that the drug actually works. That is because Acthar was approved for use in 1952, before the Food and Drug Administration required clinical trials to show a drug is effective for a particular disease. Acthar is essentially grandfathered in.


Today, only about 10 percent of the drug’s sales are for infantile spasms. The new uses, Mr. Bailey has told analysts, represent multibillion-dollar opportunities for Acthar and Questcor, its sole maker.


The results have been beyond even the company’s wildest dreams. Sales of Acthar, which accounts for essentially all of Questcor’s sales, totaled nearly $350 million in the first nine months this year, up 145 percent from the period a year earlier. In the same period, Questcor’s earnings per share nearly tripled, to $2.12. In the five years after the big Acthar price increase in August 2007, Questcor shares rose from around 60 cents to about $50, in one of the best performances of any stock in any industry.


But in September, the shares plummeted after Aetna, the big insurer, said it would no longer pay for Acthar, except to treat infantile spasms, because of lack of evidence the drug worked for other diseases. The stock now trades at $26.93.


Peter Wickersham, senior vice president for cost of care at Prime Therapeutics, a pharmacy benefits manager that has found the drug is possibly being overused, says the huge increase in Acthar’s price for patients “just invites the type of scrutiny that it’s received.”


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Dr. Rita Levi-Montalcini, a Revolutionary in the Study of the Brain, Dies at 103


Fabio Campana/European Pressphoto Agency


Dr. Rita Levi-Montalcini in 2007. She discovered chemical tools the body uses to direct cell growth and build nerve networks.







Dr. Rita Levi-Montalcini, a Nobel Prize-winning neurologist who discovered critical chemical tools that the body uses to direct cell growth and build nerve networks, opening the way for the study of how those processes can go wrong in diseases like dementia and cancer, died on Sunday at her home in Rome. She was 103.




Her death was announced by Mayor Gianni Alemanno of Rome.


“I don’t use these words easily, but her work revolutionized the study of neural development, from how we think about it to how we intervene,” said Dr. Gerald D. Fishbach, a neuroscientist and professor emeritus at Columbia.


Scientists had virtually no idea how embryo cells built a latticework of intricate connections to other cells when Dr. Levi-Montalcini began studying chicken embryos in the bedroom of her house in Turin, Italy, during World War II. After years of obsessive study, much of it at Washington University in St. Louis with Dr. Viktor Hamburger, she found a protein that, when released by cells, attracted nerve growth from nearby developing cells.


In the early 1950s, she and Dr. Stanley Cohen, a biochemist also at Washington University, isolated and described the chemical, known as nerve growth factor — and in the process altered the study of cell growth and development. Scientists soon realized that the protein gave them a new way to study and understand disorders of neural growth, like cancer, or of degeneration, like Alzheimer’s disease, and to potentially develop therapies.


In the years after the discovery, Dr. Levi-Montalcini, Dr. Cohen and others described a large family of such growth-promoting agents, each of which worked to regulate the growth of specific cells. One, called epidermal growth factor and discovered by Dr. Cohen, plays a central role in breast cancer; in part by studying its behavior, scientists developed drugs to combat the abnormal growth.


In 1986, Dr. Levi-Montalcini and Dr. Cohen shared the Nobel Prize in Physiology or Medicine for their work.


Dr. Cohen, now an emeritus professor at Vanderbilt University, said Dr. Levi-Montalcini possessed a rare combination of intuition and passion, as well as biological knowledge. “She had this feeling for what was happening biologically,” he said. “She was an intuitive observer, and she saw that something was making these nerve connections grow and was determined to find out what it was.”


One of four children, Rita Levi-Montalcini was born in Turin on April 22, 1909, to Adamo Levi, an engineer, and Adele Montalcini, a painter, both Italian Jews who traced their roots to the Roman Empire. In keeping with the Victorian customs of the time, Mr. Levi discouraged his three daughters from entering college, fearing that it would interfere with their lives as wives and mothers.


It was not a future that Rita wanted. She had decided to become a doctor and told her father so. “He listened, looking at me with that serious and penetrating gaze of his that caused me such trepidation,” she wrote in her autobiography, “In Praise of Imperfection” (1988). He also agreed to support her.


She graduated summa cum laude from the University of Turin medical school in 1936. Two years later, Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. She began her research anyway, setting up a small laboratory in her home to study chick embryos, inspired by the work of Dr. Hamburger, a prominent researcher in St. Louis who also worked with the embryos.


During World War II, the family fled Turin for the countryside, and in 1943 the invasion by Germany forced them to Florence. The family returned at the close of the war, in 1945, and Dr. Hamburger soon invited Dr. Levi-Montalcini to work for a year in his lab at Washington University.


She stayed on, becoming an associate professor in 1956 and a full professor in 1958. In 1962, she helped establish the Institute of Cell Biology in Rome and became its first director. She retired from Washington University in 1977, becoming a guest professor and splitting her time between Rome and St. Louis.


Italy honored her in 2001 by making her a senator for life.


An elegant presence, confident and passionate, she was a sought-after speaker until late in life. “At 100, I have a mind that is superior — thanks to experience — than when I was 20,” she said in 2009.


She never married and had no children. In addition to her autobiography, she was the author or co-author of dozens of research studies and received numerous professional awards, including the National Medal of Science.


“It is imperfection — not perfection — that is the end result of the program written into that formidably complex engine that is the human brain,” Dr. Levi-Montalcini wrote in her autobiography, “and of the influences exerted upon us by the environment and whoever takes care of us during the long years of our physical, psychological and intellectual development.”


This article has been revised to reflect the following correction:

Correction: December 30, 2012

An earlier version of this obituary misstated the year Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. It was 1938, not 1936.



Read More..

Dr. Rita Levi-Montalcini, a Revolutionary in the Study of the Brain, Dies at 103


Fabio Campana/European Pressphoto Agency


Dr. Rita Levi-Montalcini in 2007. She discovered chemical tools the body uses to direct cell growth and build nerve networks.







Dr. Rita Levi-Montalcini, a Nobel Prize-winning neurologist who discovered critical chemical tools that the body uses to direct cell growth and build nerve networks, opening the way for the study of how those processes can go wrong in diseases like dementia and cancer, died on Sunday at her home in Rome. She was 103.




Her death was announced by Mayor Gianni Alemanno of Rome.


“I don’t use these words easily, but her work revolutionized the study of neural development, from how we think about it to how we intervene,” said Dr. Gerald D. Fishbach, a neuroscientist and professor emeritus at Columbia.


Scientists had virtually no idea how embryo cells built a latticework of intricate connections to other cells when Dr. Levi-Montalcini began studying chicken embryos in the bedroom of her house in Turin, Italy, during World War II. After years of obsessive study, much of it at Washington University in St. Louis with Dr. Viktor Hamburger, she found a protein that, when released by cells, attracted nerve growth from nearby developing cells.


In the early 1950s, she and Dr. Stanley Cohen, a biochemist also at Washington University, isolated and described the chemical, known as nerve growth factor — and in the process altered the study of cell growth and development. Scientists soon realized that the protein gave them a new way to study and understand disorders of neural growth, like cancer, or of degeneration, like Alzheimer’s disease, and to potentially develop therapies.


In the years after the discovery, Dr. Levi-Montalcini, Dr. Cohen and others described a large family of such growth-promoting agents, each of which worked to regulate the growth of specific cells. One, called epidermal growth factor and discovered by Dr. Cohen, plays a central role in breast cancer; in part by studying its behavior, scientists developed drugs to combat the abnormal growth.


In 1986, Dr. Levi-Montalcini and Dr. Cohen shared the Nobel Prize in Physiology or Medicine for their work.


Dr. Cohen, now an emeritus professor at Vanderbilt University, said Dr. Levi-Montalcini possessed a rare combination of intuition and passion, as well as biological knowledge. “She had this feeling for what was happening biologically,” he said. “She was an intuitive observer, and she saw that something was making these nerve connections grow and was determined to find out what it was.”


One of four children, Rita Levi-Montalcini was born in Turin on April 22, 1909, to Adamo Levi, an engineer, and Adele Montalcini, a painter, both Italian Jews who traced their roots to the Roman Empire. In keeping with the Victorian customs of the time, Mr. Levi discouraged his three daughters from entering college, fearing that it would interfere with their lives as wives and mothers.


It was not a future that Rita wanted. She had decided to become a doctor and told her father so. “He listened, looking at me with that serious and penetrating gaze of his that caused me such trepidation,” she wrote in her autobiography, “In Praise of Imperfection” (1988). He also agreed to support her.


She graduated summa cum laude from the University of Turin medical school in 1936. Two years later, Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. She began her research anyway, setting up a small laboratory in her home to study chick embryos, inspired by the work of Dr. Hamburger, a prominent researcher in St. Louis who also worked with the embryos.


During World War II, the family fled Turin for the countryside, and in 1943 the invasion by Germany forced them to Florence. The family returned at the close of the war, in 1945, and Dr. Hamburger soon invited Dr. Levi-Montalcini to work for a year in his lab at Washington University.


She stayed on, becoming an associate professor in 1956 and a full professor in 1958. In 1962, she helped establish the Institute of Cell Biology in Rome and became its first director. She retired from Washington University in 1977, becoming a guest professor and splitting her time between Rome and St. Louis.


Italy honored her in 2001 by making her a senator for life.


An elegant presence, confident and passionate, she was a sought-after speaker until late in life. “At 100, I have a mind that is superior — thanks to experience — than when I was 20,” she said in 2009.


She never married and had no children. In addition to her autobiography, she was the author or co-author of dozens of research studies and received numerous professional awards, including the National Medal of Science.


“It is imperfection — not perfection — that is the end result of the program written into that formidably complex engine that is the human brain,” Dr. Levi-Montalcini wrote in her autobiography, “and of the influences exerted upon us by the environment and whoever takes care of us during the long years of our physical, psychological and intellectual development.”


This article has been revised to reflect the following correction:

Correction: December 30, 2012

An earlier version of this obituary misstated the year Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. It was 1938, not 1936.



Read More..