France Debates Gay Marriage Law


Jeff Pachoud/Agence France-Presse — Getty Images


Demonstrators in Lyon, France, spoke out in December in favor of same-sex marriage. President François Hollande supports a “marriage for all” bill.







PARIS — Frigide Barjot has made a career of mocking the establishment of France, dressing in fluorescent pink sweaters, playing in a band called the Dead Pompidous and hosting a philosophy soirée at which she handed out T-shirts with the logo, “Kierkegaard is my homeboy.”




But Ms. Barjot, born Virginie Merle 50 years ago, has also rediscovered her religious roots, writing a book called “Confessions of a Trendy Catholic.” And she has become one of the main actors and voices in France’s fierce debate over gay marriage, adoption rights and state financing for procreation assistance. It is a debate as sincere and confused, in a way, as Ms. Barjot’s own involvement.


Despite her love of mockery and her support for the rights of gay couples, she is strongly opposed to gay marriage, and especially to the part of a proposed law that would allow married gay couples to adopt children and be recognized as their parents. On Sunday, she will help lead a large demonstration called “La Manif Pour Tous,” or a demonstration for everyone, a follow-up to an initial protest in November.


Legalizing gay marriage — “marriage for all” — was a campaign promise by President François Hollande, a Socialist, but it has proved tricky and divisive in France, which is a secular republic but remains an essentially Roman Catholic country where few go to church. He promised to enact it within a year of taking office last May, and his draft bill will go before Parliament for debate by the end of this month.


Same-sex marriages are now performed in about a dozen countries and at least 9 of the 50 states in America, while it is constitutionally banned in others. But gay marriage was not a big issue in the 2012 presidential campaign, and there are a number of cases about its legality before the Supreme Court.


In France, religious leaders have become deeply involved, arguing that the government should be cautious before redefining the institution of marriage and legal “parenthood.” The chief rabbi of France, Gilles Bernheim, has cautioned about toying with the idea that gender has become “a social role that we choose for ourselves,” instead of “a given element of nature that man has to accept.”


Pope Benedict XVI cited Rabbi Bernheim in a Christmas address opposing gay marriage, saying that it was wrong for people “to deny their nature and decide it is not something previously given to them, but that they make themselves.” He drew a parallel between those who deplore “the manipulation of nature” where “our environment is concerned,” but sanction it as “man’s fundamental choice where he himself is concerned.”


The intervention of religious leaders in opposition, including Muslims, has caused something of an uproar, especially among supporters of the Socialist government. The minister in charge of education, Vincent Peillon, has even warned parochial schools against having debates in classrooms about the merits of gay marriage and adoption, citing a threat to French secularism, bringing charges of Catholic-bashing.


“To make a child, you need a man and a woman,” Ms. Barjot said. For a gay couple to become the legal parents of a child “is totally contrary to reality,” she said.


She is quite happy for gay couples to have official status and legal protections. “The problem is not homosexuality, but human filiation,” she argues — a child’s need to have legal affiliation and access to its biological parents.


Mr. Hollande and his government say that they were elected on a clear platform and will pass the “marriage for all” law, and that the legislature, not the street, will decide.


A careful political tactician, however, Mr. Hollande has said he wants to keep separate from the marriage law the demand of some Socialist legislators that the government also legalize access to state-financed help for married lesbian couples seeking to bear children. On this issue, Mr. Hollande describes himself as not having strong views, which means that he does not favor the idea.


Scott Sayare contributed reporting.



Read More..

DealBook: Ping An Shares Fall for 2nd Straight Day

SHANGHAI – Shares in the Ping An Group, the Chinese insurance and banking giant, fell in Shanghai trading for the second consecutive day on Wednesday over concerns that the British bank HSBC was having trouble selling its 15.6 percent stake in the company.

HSBC had announced plans in December to sell a $9.4 billion stake in Ping An to the Charoen Pokphand Group of Thailand. Part of that sale has already been completed. But media outlets have reported this week that the China Development Bank, a big state lender, has decided not to finance the rest of the deal and that the China Insurance Regulatory Commission is likely to reject the deal.

The report, first published by The South China Morning Post, could not be independently confirmed. The parties involved all declined to comment on Wednesday. A spokesman for Ping An, which is based in Shenzhen, China, would say only that approval of the deal was proceeding normally.

But several analysts have expressed doubts that the full deal will go through on time. In Hong Kong, Ping An shares rebounded on Wednesday from a sharp drop on Tuesday, while Ping An’s share price continued to decline for a second day in trading on the Shanghai Stock Exchange.

The deal is facing difficulty at a time of growing scrutiny of Ping An. The company, which is one of the largest insurers in China and a financial conglomerate worth about $60 billion, has longstanding financial ties to the relatives of China’s prime minister, Wen Jiabao, according to documents obtained by The New York Times.

The Times reported in October and November that the relatives of China’s prime minister had amassed a multibillion-dollar stake in Ping An before the company’s initial public stock offering in 2004.

The stake was bought from a Chinese state-owned company for about $65 million in late 2002, and was at one time worth as much as $3.7 billion. The relatives of Mr. Wen owned a portion of those shares through a series of holding companies. It is unclear whether they have sold their entire stake.

The relatives of China’s former Central Bank chief, Dai Xianglong, also held a Ping An stake through holding companies during the same period. At one time, the companies controlled about $3.1 billion in Ping An shares, according to corporate documents obtained by The Times.

The relatives obtained the shares at a time when the two senior government officials were effectively acting as financial regulators with oversight of Ping An during a crucial period before its I.P.O. in 2004.

The relatives of the two senior officials have denied holding the stakes.

HSBC acquired its initial stake in Ping An in September 2002, and bought additional stakes in Ping An from Morgan Stanley and Goldman Sachs. On Dec. 5, HSBC said it planned to sell its entire 15.6 percent stake to the Charoen Pokphand Group of Thailand to increase capital.

Soon after, one of China’s top business publications, Caixin, reported that a large part of the payment for the first part of the purchase would come from a group of Chinese investors and Ping An’s management team, as well as the former president of Thailand, Thaksin Shinawatra. Ping An and Charoen Pokphand disputed the Caixin magazine report.

Ping An is widely regarded as one of the most successful financial services firms in China. The company was founded in 1988, and has operated as a shareholding company since shortly after that time. It is not considered a state- owned company, but the government of Shenzhen has always held a big stake in Ping An, which operates the country’s second-largest insurer.

Read More..

Recipes for Health: Cauliflower and Tuna Salad — Recipes for Health


Andrew Scrivani for The New York Times







I have added tuna to a classic Italian antipasto of cauliflower and capers dressed with vinegar and olive oil. For the best results give the cauliflower lots of time to marinate.




1 large or 2 small or medium cauliflowers, broken into small florets


1 5-ounce can water-packed light (not albacore) tuna, drained


1 plump garlic clove, minced or pureéd


1/3 cup chopped flat-leaf parsley


3 tablespoons capers, drained and rinsed


1 tablespoon fresh lemon juice


3 tablespoons sherry vinegar or champagne vinegar


6 tablespoons extra virgin olive oil


Salt and freshly ground pepper


1. Place the cauliflower in a steaming basket over 1 inch of boiling water, cover and steam 1 minute. Lift the lid for 15 seconds, then cover again and steam for 5 to 8 minutes, until tender. Refresh with cold water, then drain on paper towels.


2. In a large bowl, break up the tuna fish and add the cauliflower.


3. In a small bowl or measuring cup, mix together the garlic, parsley, capers, lemon juice, vinegar, and olive oil. Season generously with salt and pepper. Add the cauliflower and toss together. Marinate, stirring from time to time, for 30 minutes if possible before serving. Serve warm, cold, or at room temperature.


Yield: Serves 6 as a starter or side dish


Advance preparation: You can make this up to a day ahead, but omit the parsley until shortly before serving so that it doesn’t fade. It keeps well in the refrigerator for up to 5 days.


Nutritional information per serving: 188 calories; 15 grams fat; 2 grams saturated fat; 2 grams polyunsaturated fat; 10 grams monounsaturated fat; 10 milligrams cholesterol; 8 grams carbohydrates; 3 grams dietary fiber; 261 milligrams sodium (does not include salt to taste); 9 grams protein


Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”


Read More..

Recipes for Health: Cauliflower and Tuna Salad — Recipes for Health


Andrew Scrivani for The New York Times







I have added tuna to a classic Italian antipasto of cauliflower and capers dressed with vinegar and olive oil. For the best results give the cauliflower lots of time to marinate.




1 large or 2 small or medium cauliflowers, broken into small florets


1 5-ounce can water-packed light (not albacore) tuna, drained


1 plump garlic clove, minced or pureéd


1/3 cup chopped flat-leaf parsley


3 tablespoons capers, drained and rinsed


1 tablespoon fresh lemon juice


3 tablespoons sherry vinegar or champagne vinegar


6 tablespoons extra virgin olive oil


Salt and freshly ground pepper


1. Place the cauliflower in a steaming basket over 1 inch of boiling water, cover and steam 1 minute. Lift the lid for 15 seconds, then cover again and steam for 5 to 8 minutes, until tender. Refresh with cold water, then drain on paper towels.


2. In a large bowl, break up the tuna fish and add the cauliflower.


3. In a small bowl or measuring cup, mix together the garlic, parsley, capers, lemon juice, vinegar, and olive oil. Season generously with salt and pepper. Add the cauliflower and toss together. Marinate, stirring from time to time, for 30 minutes if possible before serving. Serve warm, cold, or at room temperature.


Yield: Serves 6 as a starter or side dish


Advance preparation: You can make this up to a day ahead, but omit the parsley until shortly before serving so that it doesn’t fade. It keeps well in the refrigerator for up to 5 days.


Nutritional information per serving: 188 calories; 15 grams fat; 2 grams saturated fat; 2 grams polyunsaturated fat; 10 grams monounsaturated fat; 10 milligrams cholesterol; 8 grams carbohydrates; 3 grams dietary fiber; 261 milligrams sodium (does not include salt to taste); 9 grams protein


Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”


Read More..

Online Banking Attacks Were Work of Iran, U.S. Officials Say





SAN FRANCISCO — The attackers hit one American bank after the next. As in so many previous attacks, dozens of online banking sites slowed, hiccupped or ground to a halt before recovering several minutes later.







Daniel Rosenbaum for The New York Times

James A. Lewis of the Center for Strategic and International Studies in Washington believes that recent online attacks on American banks have been the work of Iran.







But there was something disturbingly different about the wave of online attacks on American banks in recent weeks. Security researchers say that instead of exploiting individual computers, the attackers engineered networks of computers in data centers, transforming the online equivalent of a few yapping Chihuahuas into a pack of fire-breathing Godzillas.


The skill required to carry out attacks on this scale has convinced United States government officials and security researchers that they are the work of Iran, most likely in retaliation for economic sanctions and online attacks by the United States.


“There is no doubt within the U.S. government that Iran is behind these attacks,” said James A. Lewis, a former official in the State and Commerce Departments and a computer security expert at the Center for Strategic and International Studies in Washington.


Mr. Lewis said the amount of traffic flooding American banking sites was “multiple times” the amount that Russia directed at Estonia in a monthlong online assault in 2007 that nearly crippled the Baltic nation.


American officials have not offered any technical evidence to back up their claims, but computer security experts say the recent attacks showed a level of sophistication far beyond that of amateur hackers. Also, the hackers chose to pursue disruption, not money: another earmark of state-sponsored attacks, the experts said.


“The scale, the scope and the effectiveness of these attacks have been unprecedented,” said Carl Herberger, vice president of security solutions at Radware, a security firm that has been investigating the attacks on behalf of banks and cloud service providers. “There have never been this many financial institutions under this much duress.”


Since September, intruders have caused major disruptions to the online banking sites of Bank of America, Citigroup, Wells Fargo, U.S. Bancorp, PNC, Capital One, Fifth Third Bank, BB&T and HSBC.


They employed DDoS attacks, or distributed denial of service attacks, named because hackers deny customers service by directing large volumes of traffic to a site until it collapses. No bank accounts were breached and no customers’ money was taken.


By using data centers, the attackers are simply keeping up with the times. Companies and consumers are increasingly conducting their business over large-scale “clouds” of hundreds, even thousands, of networked computer servers.


These clouds are run by Amazon and Google, but also by many smaller players who commonly rent them to other companies. It appears the hackers remotely hijacked some of these clouds and used the computing power to take down American banking sites.


“There’s a sense now that attackers are crafting their own private clouds,” either by creating networks of individual machines or by stealing resources wholesale from poorly maintained corporate clouds, said John Kindervag, an analyst at Forrester Research.


How, exactly, attackers are hijacking data centers is still a mystery. Making matters more complex, they have simultaneously introduced another weapon: encrypted DDoS attacks.


Banks encrypt customers’ online transactions for security, but the encryption process consumes system resources. By flooding banking sites with encryption requests, attackers can further slow or cripple sites with fewer requests.


A hacker group calling itself Izz ad-Din al-Qassam Cyber Fighters has claimed in online posts that it was responsible for the attacks.


The group said it attacked the banks in retaliation for an anti-Islam video that mocked the Prophet Muhammad, and pledged to continue its campaign until the video was scrubbed from the Internet. It called the campaign Operation Ababil, a reference to a story in the Koran in which Allah sends swallows to defeat an army of elephants dispatched by the king of Yemen to attack Mecca in A.D. 571.


But American intelligence officials say the group is actually a cover for Iran. They claim Iran is waging the attacks in retaliation for Western economic sanctions and for a series of cyberattacks on its own systems. In the last three years, three sophisticated computer viruses — called Flame, Duqu and Stuxnet — have hit computers in Iran. The New York Times reported last year that the United States, together with Israel, was responsible for Stuxnet, the virus used to destroy centrifuges in an Iranian nuclear facility in 2010.


“It’s a bit of a grudge match,” said Mr. Lewis of the Center for Strategic and International Studies.


Read More..

India Ink: India Lodges Protest with Pakistan Over Soldiers' Deaths

India said it summoned Pakistan’s envoy in New Delhi on Wednesday to strongly protest the killing and mutilation of two Indian soldiers in the disputed territory of Kashmir after the second firefight in three days between the nuclear-armed neighbors.

The Indian government said that Pakistan troops crossed the de facto border, known as the Line of Control, on Tuesday and attacked Indian soldiers who were patrolling the area, subjecting two soldiers’ bodies to “barbaric and inhuman mutilation.”

“The government of Pakistan was asked to immediately investigate these actions that are in contravention of all norms of international conduct and ensure that these do not recur,” the Indian Foreign Ministry said in a statement.

Pakistan denied the allegations. A military official, speaking on the customary condition of anonymity, called it “Indian propaganda” to divert attention from a clash on Sunday in which a Pakistani soldier died.

Kashmir, a rocky Himalayan region that once witnessed a bloody insurgency and is still claimed by both India and Pakistan, has been a major focus of tension in South Asia. The two countries have fought two wars over Kashmir, but a cease-fire has been in place there for a decade.

It is unclear whether this latest clash between India and Pakistan will derail the steps the neighbors have taken to warm their relationship since the 2008 terror attacks on Mumbai by militants based in Pakistan. Recent high-level negotiations have included a new visa agreement that eased restrictions for travelers and plans to bolster trade ties between the two rival nations.

Read More..

DealBook: Easing of Rules for Banks Acknowledges Reality

When a global committee of regulators and central bankers agreed to a new set of rules for the banking system a year and a half ago, Jamie Dimon, the chief executive of JPMorgan Chase, told The Financial Times, “I’m very close to thinking the United States shouldn’t be in Basel anymore. I would not have agreed to rules that are blatantly anti-American.”

Over the last weekend, Mr. Dimon finally got what he had wanted: a form of deregulation of sorts. The new international capital requirements for banks, known as Basel III — apologies if your eyes are glazing over — were significantly relaxed by regulators.

Instead of requiring banks to maintain, by 2015, a certain amount of assets that can quickly be turned into cash, the most stringent deadline was pushed to 2019. Perhaps more important, the type of assets that could be counted in a bank’s liquidity requirement was changed to be more flexible, including securities backed by mortgages, for example, instead of simply sovereign debt.

This sounds boring, but it is important stuff. Increasing bank capital and liquidity requirements — think of it as the size of a bank’s rainy day fund — is arguably more significant than all of the new laws in the Dodd-Frank Wall Street Reform and Consumer Protection Act. The more capital a bank is required to hold, the lower the chance it could suffer a run on the bank like Lehman Brothers did in 2008.

Given memories of the financial crisis, the idea that regulators would loosen rules even a smidgen is considered a huge giveaway. The conventional wisdom is that the banks are the big winners and the regulators are, once again, patsies, capitulating under pressure to the all-powerful financial industry. The headlines tell the story: “Banks Win 4-Year Delay as Basel Liquidity Rule Loosened,” Bloomberg declared. The Financial Times splashed, “ ‘Massive Softening’ of Basel Rules.” “Bank Regulators Retreat,” the Huffington Post said. Reuters described the new regulations as a “light touch.”

Mayra Rodríguez Valladares, a managing principal at MRV Associates, a regulatory consulting firm, put it this way, “With every part of Basel III that is gutted, we are increasingly back where we were at the eve of the crisis.” She went on to say, “In today’s financial world, regulators pretend to supervise while banks pretend to be liquid.”

But this is a knee-jerk response.

While there is no question that the original rules would do a better job preventing the next 100-year flood in the banking system, their quick adoption most likely would have created their own drag on the economy because bank lending would most likely have been curtailed.

“If Basel had been implemented this year as written, it almost certainly would have thrown the U.S. and other economies into a recession more than going over the fiscal cliff ever would have,” John Berlau of the Competitive Enterprise Institute, a research organization promoting free markets, wrote. Mr. Berlau, who may have a penchant for hyperbole, had been calling the deadline the Basel cliff. He added, “Basel III has been delayed, and for Main Street growth and financial stability, that is all to the good.”

Mr. Berlau is right. In truth, the reason that regulators ultimately chose to relax the rules was simple practicality: many banks in Europe and some in the United States would have never been able to meet the requirements without significantly reducing the amount of credit they were to extend to Main Street over the next two years, according to people involved in the Basel decision process.

That’s the other side of the regulatory coin that Main Street often forgets about. At the time that the original rules were written in 2010, the consensus among economists was that the global economy would be in much better shape today than it is.

“Nobody set out to make it stronger or weaker, but to make it more realistic,” Mervyn A. King, governor of the Bank of England, explained.

Let’s be clear: high capital requirements are a good thing to do to reduce risk in the system. And there is no question that the banks, especially in the United States, are in a much stronger position than they were. Let’s also stipulate that the Basel committee did a horrible job before the financial crisis in setting and enforcing proper standards. Basel’s loosening of rules before the crisis that worsened the pain of the global banking system.

But the push for stricter rules just as the global economy is trying to nurse itself back to health, simply to satisfy the public, rather to find a solution that balances the risks to the economy and the banking system, would have been a mistake. The chances of a leverage-induced crisis from Wall Street banks right now is quite low.

The challenge for regulators is making sure their memories aren’t so short that they seek to scale back the rules again.


This post has been revised to reflect the following correction:

Correction: January 8, 2013

An earlier version of this article misstated the affiliation of John Berlau. He is a senior fellow at the Competitive Enterprise Institute, not the Bastiat Institute.

A version of this article appeared in print on 01/08/2013, on page B1 of the NewYork edition with the headline: Easing of Rules For Banks Acknowledges Reality.
Read More..

The New Old Age Blog: Who Should Receive Organ Transplants?

Joe Gammalo had been contending with pulmonary fibrosis, a scarring of the lungs, for more than a decade when he came to the Cleveland Clinic in 2008 seeking a lung transplant.

“It had gotten to the point where I was on oxygen all the time and in a wheelchair,” he told me in an interview. “I didn’t expect to live.”

Lung transplants are a dicey proposition, involving a huge surgical procedure, arduous follow-up, the lifelong use of potent immunosuppressive drugs and high rates of serious side effects. “It’s not like taking out an appendix,” said Dr. Marie Budev, the medical director of the clinic’s lung transplant program.

Only 50 to 57 percent of all recipients live for five years, she noted, and they will still die of their disease. But there’s no other treatment for pulmonary fibrosis.

Some medical centers would have turned Mr. Gammalo away. Because survival rates are even lower for older patients, guidelines from the International Society for Heart and Lung Transplantation caution against lung transplants for those over 65, though they set no age limit.

But “we are known as an aggressive, high-risk center,” said Dr. Budev. So Mr. Gammalo was 66 when he received a lung; his newly found buddy, Clyde Conn, who received the other lung from the same donor, was 69.

You can’t mistake the trend: A graying population and revised policies determining who gets priority for donated organs, have led to a rising proportion of older adults receiving transplants.

My colleague Judith Graham has reported on the increase in heart transplants, but the pattern extends to other organs, too.

The number of kidney transplants performed annually on adults over 65 tripled between 1998 and last year, according to data from the Scientific Registry of Transplant Recipients. In 2001, 7.4 percent of liver transplant recipients were over 65; last year, that rose to 13 percent.

The rise in elderly lung transplant candidates is particularly dramatic because, since 2005, a “lung allocation score” puts those at the highest mortality risk, rather than those who’ve waited longest, at the top of the list.

In 2001, about 3 percent of those on the wait list and of those transplanted were over 65; last year, older patients represented almost 18 percent of wait-listed candidates and more than a quarter of transplant recipients. (Medicare pays for the surgery, though patients face co-pays and considerable out-of-pocket costs, including for drugs and travel.)

The debate has grown, too: When the number of adults awaiting transplants keeps growing, but organ donations stay flat, is it desirable or even ethical that an increasing proportion of recipients are elderly?

Dr. Budev, who estimated that a third of her program’s patients are over 65, votes yes. As long as a program selects candidates carefully, “how can you deny them a therapy?” she asked. So the Cleveland Clinic has no age limit. “We feel that everyone should have a chance.”

At the University of Michigan, by contrast, the age limit remains 65, though Dr. Kevin Chan, the transplant program’s medical director, acknowledged that some fit older patients get transplanted.

“You can talk about this all day — it’s a tough one,” Dr. Chan said. Younger recipients have greater physiologic reserve to aid in the arduous recovery; older ones face higher risk of subsequent kidney failure, stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with.

Donated lungs, fragile and prone to injury, are a particularly scarce commodity. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants and 1,949 heart transplants. Only1,830 patients received lung transplants.

“What if there’s a 35-year-old on a ventilator who needs the lung just as much?” Dr. Chan said. “Why should a 72-year-old possibly take away a lung from a 35-year-old?” Yet, he acknowledged, “it’s easy to look at the statistics and say, ‘Give the lungs to younger patients.’ At the bedside, when you meet this patient and family, it’s a lot different.”

These questions about who deserves scarce resources — those most likely to die without them? or those most likely to live longer with them? — will persist as the population ages. They’re also likely to arise when the International Society for Heart and Lung Transplantation begins working towards revised guidelines this spring. (I’d also like to hear your take, below.)

Lots of 65- and 75-year-olds are very healthy. Yet transplants themselves can cause harm and there’s no backup, like dialysis. Without the transplant, they die. But when the transplant goes wrong, they also die.

More than four years post-transplant, the Cleveland Clinic’s “lung brothers” are success stories. Mr. Conn, who lives near Dayton, Ohio, can’t walk very far or lift more than 10 pounds, but he works part time as a real-estate appraiser and enjoys cruises with his wife.

Mr. Gammalo, a onetime musician, has developed diabetes, like nearly half of all lung recipients. But he went onstage a few weeks back to sing “Don’t Be Cruel” with his son’s rock band, “a highlight of both our lives,” he said.

Yet when I asked Mr. Conn, now 73, how he felt about having priority over a younger but healthier person, he paused. “It’s a good question,” he said, to which he had no answer.


Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

The New Old Age Blog: Who Should Receive Organ Transplants?

Joe Gammalo had been contending with pulmonary fibrosis, a scarring of the lungs, for more than a decade when he came to the Cleveland Clinic in 2008 seeking a lung transplant.

“It had gotten to the point where I was on oxygen all the time and in a wheelchair,” he told me in an interview. “I didn’t expect to live.”

Lung transplants are a dicey proposition, involving a huge surgical procedure, arduous follow-up, the lifelong use of potent immunosuppressive drugs and high rates of serious side effects. “It’s not like taking out an appendix,” said Dr. Marie Budev, the medical director of the clinic’s lung transplant program.

Only 50 to 57 percent of all recipients live for five years, she noted, and they will still die of their disease. But there’s no other treatment for pulmonary fibrosis.

Some medical centers would have turned Mr. Gammalo away. Because survival rates are even lower for older patients, guidelines from the International Society for Heart and Lung Transplantation caution against lung transplants for those over 65, though they set no age limit.

But “we are known as an aggressive, high-risk center,” said Dr. Budev. So Mr. Gammalo was 66 when he received a lung; his newly found buddy, Clyde Conn, who received the other lung from the same donor, was 69.

You can’t mistake the trend: A graying population and revised policies determining who gets priority for donated organs, have led to a rising proportion of older adults receiving transplants.

My colleague Judith Graham has reported on the increase in heart transplants, but the pattern extends to other organs, too.

The number of kidney transplants performed annually on adults over 65 tripled between 1998 and last year, according to data from the Scientific Registry of Transplant Recipients. In 2001, 7.4 percent of liver transplant recipients were over 65; last year, that rose to 13 percent.

The rise in elderly lung transplant candidates is particularly dramatic because, since 2005, a “lung allocation score” puts those at the highest mortality risk, rather than those who’ve waited longest, at the top of the list.

In 2001, about 3 percent of those on the wait list and of those transplanted were over 65; last year, older patients represented almost 18 percent of wait-listed candidates and more than a quarter of transplant recipients. (Medicare pays for the surgery, though patients face co-pays and considerable out-of-pocket costs, including for drugs and travel.)

The debate has grown, too: When the number of adults awaiting transplants keeps growing, but organ donations stay flat, is it desirable or even ethical that an increasing proportion of recipients are elderly?

Dr. Budev, who estimated that a third of her program’s patients are over 65, votes yes. As long as a program selects candidates carefully, “how can you deny them a therapy?” she asked. So the Cleveland Clinic has no age limit. “We feel that everyone should have a chance.”

At the University of Michigan, by contrast, the age limit remains 65, though Dr. Kevin Chan, the transplant program’s medical director, acknowledged that some fit older patients get transplanted.

“You can talk about this all day — it’s a tough one,” Dr. Chan said. Younger recipients have greater physiologic reserve to aid in the arduous recovery; older ones face higher risk of subsequent kidney failure, stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with.

Donated lungs, fragile and prone to injury, are a particularly scarce commodity. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants and 1,949 heart transplants. Only1,830 patients received lung transplants.

“What if there’s a 35-year-old on a ventilator who needs the lung just as much?” Dr. Chan said. “Why should a 72-year-old possibly take away a lung from a 35-year-old?” Yet, he acknowledged, “it’s easy to look at the statistics and say, ‘Give the lungs to younger patients.’ At the bedside, when you meet this patient and family, it’s a lot different.”

These questions about who deserves scarce resources — those most likely to die without them? or those most likely to live longer with them? — will persist as the population ages. They’re also likely to arise when the International Society for Heart and Lung Transplantation begins working towards revised guidelines this spring. (I’d also like to hear your take, below.)

Lots of 65- and 75-year-olds are very healthy. Yet transplants themselves can cause harm and there’s no backup, like dialysis. Without the transplant, they die. But when the transplant goes wrong, they also die.

More than four years post-transplant, the Cleveland Clinic’s “lung brothers” are success stories. Mr. Conn, who lives near Dayton, Ohio, can’t walk very far or lift more than 10 pounds, but he works part time as a real-estate appraiser and enjoys cruises with his wife.

Mr. Gammalo, a onetime musician, has developed diabetes, like nearly half of all lung recipients. But he went onstage a few weeks back to sing “Don’t Be Cruel” with his son’s rock band, “a highlight of both our lives,” he said.

Yet when I asked Mr. Conn, now 73, how he felt about having priority over a younger but healthier person, he paused. “It’s a good question,” he said, to which he had no answer.


Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

Mobile Apps Drive Rapid Changes in Search Technology





SAN FRANCISCO — When the Federal Trade Commission decided last week to close its antitrust investigation of Google without charges, one important factor, though hardly mentioned, was just beneath the surface: the mobile revolution.




Google has repeatedly made the argument — and the commission agreed — that the speed of change in the technology industry made it impossible for regulators to impose restrictions without stalling future innovations.


Exhibit A is the mobile device. Nowhere has technology changed as rapidly and consumer behavior as broadly. As people abandon desktop computers for mobile ones, existing tech companies’ business models are being upended and new companies are blooming.


“Mobile is very much a moving target,” said Herbert Hovenkamp, a professor of antitrust law at the University of Iowa who has been a paid adviser to Google. “This is a market in which new competitors come in a week’s time.”


When the commission began its investigation 19 months ago, for instance, the iPhone did not have the Siri voice search, Apple did not have its own mapping service and Yelp’s mobile apps had no ads. By the time the inquiry concluded, all of that had changed. Google had new competitors on all sides trying to chip away at its hold on the mobile search and advertising market.


Still, Google is even more dominant on mobile phones than on desktop computers. It has 96 percent of the world’s mobile search market, according to StatCounter, which tracks Web use. It collects 57 percent of mobile ad revenue in the United States, while Facebook, its nearest competitor, gets just 9 percent, according to eMarketer.


But, analysts say, as people change their search habits on mobile devices — bypassing Google to go straight to apps like Yelp’s, for example — that dominance could wane, or a competitor could swoop in and knock Google off its perch.


“It’s important to recognize that many mobile apps are really vertical search engines,” said Rebecca Lieb, a digital media analyst at the Altimeter Group. “It is impossible to really say anyone dominates a section of mobile in a secure way right now.”


On cellphones or tablets, for instance, people increasingly skip Google altogether in favor of apps like Flixster for movie times or Kayak for flights.


Apple is taking on mobile search with Siri on the iPhone, which can answer questions about the weather or search for nearby restaurants. With its new mapping service, Apple has also entered local search.


On Friday, Blekko, a search start-up, introduced an app called Izik for Apple and Android devices. It tries to make searching more tablet-friendly by showing images instead of just links, and making it easier to swipe through many pages of results with a finger.


On mobile devices, said Rich Skrenta, chief executive of Blekko, “the user experience is so different that we think it opens things up. On your desktop, if it doesn’t look like Google, you think that’s not a search engine. On a tablet, it’s just vastly different.”


Jon Leibowitz, chairman of the F.T.C., said at a news conference Thursday that the speed of change in the tech industry meant that “you want to be careful before you apply sanctions.”


The commission also considered Google’s partnerships with cellphone makers like Samsung and HTC that license Google search on phones, so that a search box shows up on the home screen. In the end it decided not to take action against Google.


Some Google critics said that even though the competitive landscape is different on mobile devices, it should not have influenced the government’s analysis of Google’s behavior on the desktop Web.


“There’s no doubt that mobile applications, including Yelp’s, give consumers the ability to bypass the major search engines and go directly to the best provider of the service they’re looking for,” said Vince Sollitto, vice president for government relations at Yelp. Still, he added, “I don’t see how that impacts how someone is acting anticompetitively on the desktop.”


(One of Google’s concessions to the federal agency, that it would allow other Web companies to ask Google not to show their content in its own vertical search products — a chief complaint of Yelp’s — applies to mobile as well.)


But others said antitrust enforcement in the 21st century needs to be more agile.


Nick Wingfield contributed reporting from Seattle.



Read More..