India Ink: Newswallah: Long Reads Edition

As India’s rival national parties, the incumbent Congress and the principal opposition, the Bharatiya Janata Party, begin preparing for the general elections scheduled for 2014, Open Magazine’s Jatin Gandhi analyzes the country’s potential choices for prime minister: Narendra Modi, the controversial chief minister of Gujarat, who was welcomed amid feverish chants of “P.M.! P.M.!” at his party’s New Delhi office last month, and Rahul Gandhi, the 42-year-old heir apparent of the Gandhi dynasty, who took charge last week as vice president of the Congress party.

In the cover story, titled “Devil’s Alternative,” the author writes:

“The din around their PMs-in-waiting pretty much sums up the current situation in the two parties. It is called the TINA factor in politics: There Is No Alternative. It’s Rahul Gandhi for the Congress, Narendra Modi for the BJP. Neither party can afford to pick any other candidate.”

The author scrutinizes the political pitches of the two leaders: Mr. Modi’s promise of economic prosperity through the “Gujarat model” of development, and Mr. Gandhi’s vision for systemic change in a knowledge-based, youth-driven country. “Rahul Gandhi is the Congress’ and Narendra Modi the BJP’s idea of ‘change,’” Jatin Gandhi writes. But, he argues in the piece, in Indian politics, the more things change, the more choice-less it gets.

“At first glance, a new set of party leaders denotes a shift, but take a closer look and you know that the two leading political parties (with 60 per cent of all Lok Sabha seats between them) have more or less the same political stereotypes to offer.”

India Today magazine, too, writes about a leadership crisis in the country. Relying on a “Mood of the Nation” poll, the writer, S. Prasannarajan, opines that the ruling coalition, helmed by the Congress party, has “lost India,” and the opposition, led by the B.J.P., is “caught in an existential crisis,” making way for regional parties “whose idea of India is smaller than their satrapies.”

This cover story, which carries images of Rahul Gandhi in a crisp white kurta and Narendra Modi in a saffron scarf, carries the caption: The UPA’s untested Rahul Gandhi and the NDA’s unanointed Narendra Modi rise above the rest, but India remains unled.

“On the eve of another General Election, Battlefield India, strewn with cracked icons and smashed reputations, tests the patience of one of the world’s most unforgiving democracies,” it says. “India is waiting to be led.”

Shooting by armed forces across the de facto border between India and Pakistan, known as the Line of Control, and the beheading of an Indian soldier this month, tested the fragile peace between the rival neighbors, threatening to cancel out the small but significant gains the countries have made since the Mumbai attacks in November 2008.

An article in Frontline looks at India and Pakistan’s fraught border relations, analyzing the cease-fire agreement that has been in place, largely successfully, since 2003. “The recent incidents have been the most serious in the last decade,” the article says.

The author, John Cherian, notes that as news of the violence emerged, the Indian and Pakistani governments first expressed hope that the incidents would not adversely impact bilateral relations between the nations. He then examines how a jingoistic Indian news media and right-wing opposition parties “forced the United Progressive Alliance (UPA) government to toughen its stance.”

“But better sense seems to have prevailed,” he writes, “after a week of sabre-rattling on both sides.”

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Labor Relations Board Rulings Could Be Undone



By ruling that Mr. Obama’s three recess appointments last January were illegal, the federal appeals court ruling, if upheld, would leave the board with just one member, short of the quorum needed to issue any rulings. The Obama administration could appeal the court ruling, but no announcement was made on Friday.


If the Supreme Court were to uphold Friday’s ruling, issued by the United States Court of Appeals for the District of Columbia Circuit, it would mean that the labor board did not have a quorum since last January and that all its rulings since then should be nullified.


Many Republicans and business groups applauded Friday’s ruling. They often assert that the appointments Mr. Obama made to the board have transformed it into a tool of organized labor. But many Democrats and labor unions say Mr. Obama’s appointments restored ideological balance to the board after it was tipped in favor of business interests under President George W. Bush


Mark G. Pearce, the board’s chairman, issued a statement saying the board disagreed with the ruling and suggested that other appeals courts hearing cases about the constitutionality of Mr. Obama’s appointments could reach a different conclusion.


“In the meantime, the board has important work to do,” said Mr. Pearce, whose agency oversees enforcement of the laws governing strikes and unionization drives. “We will continue to perform our statutory duties and issue decisions.”


Unless the Senate confirms future nominees to the board — Senate Republicans have blocked several of Mr. Obama’s board nominees — Mr. Pearce will be the only member left if Friday’s ruling is upheld. The board has five seats.


Representative Darrell Issa, a California Republican who is the chairman of the Oversight and Government Reform Committee, issued a statement that urged the recess appointees to “do the right thing and step down.” He added, “To avoid further damage to the economy, the N.L.R.B. must take the responsible course and cease issuing any further opinions until a constitutionally sound quorum can be established.”


The three disputed recess appointees included two Democrats, Sharon Block, deputy labor secretary, and Richard Griffin, general counsel to the operating engineers’ union; and one Republican, Terence Flynn, a counsel to a board member. Mr. Flynn resigned last May after being accused of leaking materials about the group’s deliberations. Another Republican member, Brian Hayes, stepped down when his term expired last month.


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40 Years After Roe v. Wade, Thousands March to Oppose Abortion


Drew Angerer/The New York Times


Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.







WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.




On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.


Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.


“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”


Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.


“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”


Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”


The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.


Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.


“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”


Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”


“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.


The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”


Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.


Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.


“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”


This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.



Read More..

40 Years After Roe v. Wade, Thousands March to Oppose Abortion


Drew Angerer/The New York Times


Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.







WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.




On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.


Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.


“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”


Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.


“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”


Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”


The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.


Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.


“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”


Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”


“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.


The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”


Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.


Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.


“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”


This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.



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Gadgetwise Blog: Is January the Time to Buy Electronics?

At the International Consumer Electronics Show in Las Vegas in early January, manufacturers tantalized consumers with new electronics soon to hit the shelves. But what does that do to the prices of current models that are being replaced? Is this a golden buying opportunity?

Yes and no. Yes for TVs, no for laptops. I’ll explain.

Decide.com, which tracks the price of electronics, studied what happened to the cost of TVs and laptops in past years after C.E.S.

What it found is that TV prices dip to near yearly lows after the show, matching holiday prices. With the average price of the top 250 TVs at $1,057, the post-show average is projected to drop an average of $211, to $846, based on data from previous  years. That is a 20 percent savings.

Laptops don’t drop so steeply. After the show, the 100 most popular laptops have historically been discounted 8 percent. This year that would mean the top 100 laptops, which average $780 in price, would be reduced $62, to $718.

Laptop price are lowest in late June through early July, right before the back to school sales, and during the last two weeks of September, after those sales, according to Decide.com’s data. At those times the discounts are typically 10 percent.

Of course, averages can be deceiving. Prices are volatile all year around, so a particular TV or computer you want could be discounted far more at any time.

There are a number of browser add-ons and apps that let you track prices of individual products, or you can use Decide.com – but it will cost you. Membership is $5 a month or $30 a year for full access.

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At Least 8 Die in Egyptian Riots after Soccer Verdict





CAIRO — An Egyptian court sentenced 21 people to death on Saturday on charges related to one of the world’s deadliest incidents of soccer violence, touching off an attempted jailbreak and a riot that killed another eight in the Mediterranean port city that is home to most of the defendants.




The verdict follows deadly clashes between police and demonstrators on Friday, the second anniversary of the uprising that overthrew Egypt’s longtime leader Hosni Mubarak. Such cycles of violence, often lasting for weeks and costing dozens of lives, have occurred regularly in the last two years.


Avid soccer fans from both teams, known as Ultras, hold the police at least partly responsible for the Port Said deaths and have criticized President Mohamed Morsi for doing little to overhaul the force.


Immediately after the verdict, two police officers were shot dead outside Port Said’s main prison when angry relatives tried to storm the facility to free the defendants. Police fired tear gas and rubber bullets, as well as live rounds, at the crowd outside the prison, killing six, security officials said.


Security officials said the military was being deployed to Port Said — the second such deployment in less than 24 hours. The army is often used to keep order by top generals who took over after Mr. Mubarak was ousted, but the military has kept a much lower profile since Mr. Morsi was elected as president in June. The military was also deployed overnight in the city of Suez after eight people died in clashes between security forces and protesters opposed to President Morsi.


Judge Sobhi Abdel-Maguid read out the death sentences related to the Feb. 1 riot in Port Said that killed 74 fans of the Cairo-based Al-Ahly team. Defendants’ lawyers said all those sentenced were fans of the Port Said team, Al-Masry. Executions in Egypt are usually carried out by hanging.


The judge said in his statement, read live on state TV, that he would announce the verdict for the remaining 52 defendants on March 9.


Among those on trial are nine security officials, but none were handed sentences Saturday, lawyers and security officials say.


Fans of al-Ahly, whose stands were attacked by the rival club Al-Masry in the Feb. 1 incident in Port Said, had promised more violence if the accused did not receive death sentences. In the days leading up to the verdict, Al-Ahly fans warned of bloodshed and retribution. Hundreds of Al-Ahly fans gathered outside the Cairo sports club in anticipation of the verdict, chanting against the police and the government.


Before the judge could read out the names of the 21, families erupted in screams of "Allahu akbar!" Arabic for God is great, with their hands in the air and waving pictures of the deceased. One man fainted while others hugged one another. The judge smacked the bench several times to try and contain reaction in the courtroom.


The verdict is not expected to calm tensions between the two rival teams. The judge is expected to make public his reasons for the death sentences March 9, when the remaining 52 defendants receive their sentences.


A Port Said resident and lawyer of one defendant given a death sentence said the verdict was nothing more than "a political decision to calm the public."


"There is nothing to say these people did anything and we don’t understand what this verdict is based on," the lawyer, Mohammed al-Daw, said.


The violence began after the Port Said’s home team won the match, 3-1. Al-Masry fans stormed the pitch after the game ended, attacking Cairo’s Al-Ahly fans.


Authorities shut off the stadium lights, plunging it into darkness. In the exit corridor, the fleeing crowd pressed against a chained gate until it broke open. Many were crushed under the crowd of people trying to flee.


Survivors described a nightmarish scene in the stadium. Police stood by doing nothing, they said, as fans of Al-Masry attacked supporters of the top Cairo club stabbing them and throwing them off bleachers.


Al-Ahly survivors said supporters of Al-Masry carved the words "Port Said" into their bodies and undressed them while beating them with iron bars.


While there has long been bad blood between the two rival teams, many blamed police for failing to perform the usual searches for weapons at the stadium.


Both Al-Ahly Ultras and Al-Masry Ultras widely believe that former members of the ousted government of Mr. Mubarak helped instigate the attack, and that the police at the very least were responsible for gross negligence. It is not clear what kind of evidence, if any, was presented to the court to back up claims that the attack had been orchestrated by governmentofficials.


As is customary in Egypt, the death sentences will be sent to the nation’s top religious authority, the Grand Mufti, for approval, though the court has final say on the matter.


All of the defendants — who were not present in the courtroom Saturday for security reasons — have the right to appeal the verdict.


The incident was the world’s deadliest soccer violence in 15 years.


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Davos 2013: On Russia's To-Do List at Davos: Buff Image







DAVOS, SWITZERLAND — This year at Davos, the Russians are working hard to make a splash.




There is a House of Russia near a main hotel and a media center for Russia at the opposite end of this ski village. And then there is the bevy of Russian politicians, business folk and cultural figures on hand trying to encourage more foreign investment and correct what many of them privately concede is a poor image abroad.


Even Dmitri A. Medvedev, the former president and now prime minister, whose political standing in Russia was tarnished by a swap of offices with Vladimir V. Putin announced in September 2011, subjected himself to a highly unusual spectacle here.


Scores of Russian experts had worked with the World Economic Forum, as the conference here is known, on a presentation they called Scenarios for Russia.


The session on Wednesday, with Mr. Medvedev gamely sitting through the judgment before speaking himself, sketched out three ways that Russia, whose economy is heavily dependent on oil and gas extraction, could develop in the near future.


Based on assumptions like falling energy prices, regional inequalities and even an open split among Russian elites, none of the three possibilities was particularly optimistic. In addition, when the audience was asked to vote on the most needed development for Russia’s near future, it overwhelmingly chose the need to improve governance and overhaul government.


Given recent developments in Moscow, that may come as no surprise. Many political analysts see moves like the recent clampdown on demonstrations and the banning of American adoptions of Russian children as signals that the government is digging in, rather than opening up to change.


Mr. Medvedev’s response, though, was more tepid than many in the audience presumably hoped to hear. He simply repeated past promises, so far unrealized, that Russia will respond positively to demographic, political and economic shifts that could change the status quo.


Sergey Guriyev, a Russian economist, presented perhaps the gloomiest situation: A schism in the Russian elite that could force eventual, possibly sudden, change, in a country still haunted by memories of the 1917 Bolshevik Revolution and all that followed.


The status quo “is not sustainable simply because the Russian middle class will grow and demand reforms,” Mr. Guriyev said.


Over the past 10 years, oil and gas riches trickled down to a new middle class, he argued. “Now, more income doesn’t make people happy,” he said, adding that this Russian class “is unprecedentedly educated and rich for a country with such outdated political institutions.”


Unlike Prime Minister David Cameron of Britain, whose experience on the hustings of British politics lend him an ability to think on his feet and deliver punchy lines, Mr. Medvedev barely opened up to questioning from an audience that was about half the size of the one that packed the hall to hear Mr. Cameron on Thursday, a day after his gamble on European Union membership.


In private conversation, Russian businessmen deplored what they saw as a missed opportunity for Mr. Medvedev to give a forceful speech to the Davos crowd. But foreign investors invited to private sessions with the prime minister later Wednesday and earlier Thursday were much less inclined to criticize him.


Like the Russian business community, these investors are reluctant to speak on the record, citing the uncertainty of doing business in the country. What they also do not speak much about is the healthy return on their money.


While Russian business and the state accounted for most of the estimated $400 billion said by officials to have been invested in 2012, foreign investors get a good return on their money — some in high double digits, one banker said.


Russians often particularly cite China as a rival for foreign attention and money. Reuben Vardanian, a financier now at Russia’s giant Sberbank, said that while many businesspeople, domestic and foreign, saw that their activities “are much more profitable in Russia than in China,” the Chinese gave a greater sense of certainty.


While the circle of foreigners now interested in Russia is widening, Mr. Vardanian told a meeting of mostly Russian reporters, foreigners still often lament that “we can’t understand the rules of the game.”


“They don’t want to deal with, say, Mr. Vardanian, who is then replaced by Mr. Ivanov, and then by Mr. X,” he said. “They want to deal with rules.”


This article has been revised to reflect the following correction:

Correction: January 25, 2013

An earlier version of this article misspelled the first name of Reuben Vardanian, a financier at Sberbank, as Ruben.



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The New Old Age Blog: Time to Recognize Mild Cognitive Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by.

It can make it easier or harder to get an insurance company or Medicare to cover treatments, for example. It factors into a variety of legal and governmental decisions.

And on a personal basis, a psychiatric diagnosis may be welcome (having a name and a treatment plan for what’s bothering us can be comforting) or not (are we really suffering from a mental disorder if we seem depressed after a family member dies?).

That last question refers to a change in the new DSM5, to be published in May, that has generated considerable controversy and that I discussed in an earlier post: the removal of the “bereavement exclusion,” once part of the diagnosis of Major Depressive Disorder.

Another element of the revised DSM could also affect readers: It will include something called Mild Neurocognitive Disorder. The task force revising the manual wanted to align psychiatry with the rest of medicine, which has already begun to distinguish between levels of impairment, said its chairman, David Kupfer, a University of Pittsburgh psychiatrist.

True enough, as we have reported before. Neurologists call it Mild Cognitive Impairment, a stage where cognitive decline becomes noticeable enough to affect daily functioning, yet people can still live independently and have not progressed to dementia.

In fact, a large proportion of people with mild cognitive problems never will develop dementia — but doctors and researchers cannot yet determine who will and who won’t. Biomarkers that could identify the biological brain changes that presage dementia are still years away.

Will it be helpful, then, for health professionals using the DSM5 — most of them not psychiatrists, but primary care doctors — to begin diagnosing Mild Neurocognitive Disorder? Particularly as there is no treatment that can reverse it or reliably slow its progression, if it would progress?

Dr. Ronald Petersen, director of the Mayo Clinic’s Alzheimer’s Disease Research Center and a member of the working group that developed the new DSM5 criteria, said he thought the newly recognized disorder would be useful. “The predementia phase is becoming increasingly important,” he told me in an interview.

Counseling could help people compensate for the memory loss and other deficits they are experiencing, for example. With a DSM-recognized diagnosis, those approaches are more likely to be covered by insurers.

Besides, “one argument against Alzheimer’s therapies is that we wait too late, when there’s too much damage to the central nervous system to repair,” Dr. Petersen said, referring to several recent disappointing drug trials. In the future, with earlier diagnoses, “you may be able to intervene, stop the process and forestall the dementia.”

But as we have seen with screening tests for other diseases, early detection does not always lead to better health or longer lives. It can, however, lead to unnecessary treatments and procedures involving risks of their own. Could that happen with Mild Neurocognitive Disorder?

“It will lead to wild overdiagnosis,” predicted Allen Frances, an emeritus professor of psychiatry at Duke and the chairman of the task force that developed the previous DSM edition. Indeed, about a quarter of people initially diagnosed with mild cognitive impairment are later determined to be normal, a prominent researcher told my colleague Judy Graham last year.

“People will get unnecessary tests and start getting weird treatments that have no proven efficacy,” said Dr. Frances, who has criticized a number of DSM5 changes. “They’re going to worry like crazy about being demented.”

Dr. Petersen agreed that it was a legitimate concern, but “by and large, we’re becoming better at distinguishing between the normal cognitive effects of aging and disease.” (The American Psychiatric Association will publish a specialized DSM for primary care physicians, Dr. Kupfer pointed out, to help guide them through diagnoses.)

It is hard for patients and families to know how to react when experts disagree. But keep in mind that contemporary health care aims for what is called shared decision-making. That means patients and professionals discuss options and weigh the risks and benefits of treatments and procedures, their likely outcomes, patients’ preferences, and come to agreement on how to proceed. This essay in the New England Journal of Medicine calls shared decision-making “the pinnacle of patient-centered care.”

So when Dr. Frances refers to the DSM5 as “a guide, not a bible,” and urges skepticism about some of its diagnoses, he is advocating an approach that patients and families should probably bring to any medical decision.

Seeking further information, asking questions, assessing options — those are reasonable responses if, a few weeks after a loved one’s death, a doctor says you may have major depression. Or if she thinks your memory loss could mean Mild Neurocognitive Disorder.

“The shorter the evaluation, the less the person knows you, the less he or she can explain and justify the diagnosis, the more tests and treatments that will result, the more a person should be cautious and get a second opinion,” Dr. Frances said.

Whatever the DSM5 says, it’s hard to argue with that.

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: Time to Recognize Mild Cognitive Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by.

It can make it easier or harder to get an insurance company or Medicare to cover treatments, for example. It factors into a variety of legal and governmental decisions.

And on a personal basis, a psychiatric diagnosis may be welcome (having a name and a treatment plan for what’s bothering us can be comforting) or not (are we really suffering from a mental disorder if we seem depressed after a family member dies?).

That last question refers to a change in the new DSM5, to be published in May, that has generated considerable controversy and that I discussed in an earlier post: the removal of the “bereavement exclusion,” once part of the diagnosis of Major Depressive Disorder.

Another element of the revised DSM could also affect readers: It will include something called Mild Neurocognitive Disorder. The task force revising the manual wanted to align psychiatry with the rest of medicine, which has already begun to distinguish between levels of impairment, said its chairman, David Kupfer, a University of Pittsburgh psychiatrist.

True enough, as we have reported before. Neurologists call it Mild Cognitive Impairment, a stage where cognitive decline becomes noticeable enough to affect daily functioning, yet people can still live independently and have not progressed to dementia.

In fact, a large proportion of people with mild cognitive problems never will develop dementia — but doctors and researchers cannot yet determine who will and who won’t. Biomarkers that could identify the biological brain changes that presage dementia are still years away.

Will it be helpful, then, for health professionals using the DSM5 — most of them not psychiatrists, but primary care doctors — to begin diagnosing Mild Neurocognitive Disorder? Particularly as there is no treatment that can reverse it or reliably slow its progression, if it would progress?

Dr. Ronald Petersen, director of the Mayo Clinic’s Alzheimer’s Disease Research Center and a member of the working group that developed the new DSM5 criteria, said he thought the newly recognized disorder would be useful. “The predementia phase is becoming increasingly important,” he told me in an interview.

Counseling could help people compensate for the memory loss and other deficits they are experiencing, for example. With a DSM-recognized diagnosis, those approaches are more likely to be covered by insurers.

Besides, “one argument against Alzheimer’s therapies is that we wait too late, when there’s too much damage to the central nervous system to repair,” Dr. Petersen said, referring to several recent disappointing drug trials. In the future, with earlier diagnoses, “you may be able to intervene, stop the process and forestall the dementia.”

But as we have seen with screening tests for other diseases, early detection does not always lead to better health or longer lives. It can, however, lead to unnecessary treatments and procedures involving risks of their own. Could that happen with Mild Neurocognitive Disorder?

“It will lead to wild overdiagnosis,” predicted Allen Frances, an emeritus professor of psychiatry at Duke and the chairman of the task force that developed the previous DSM edition. Indeed, about a quarter of people initially diagnosed with mild cognitive impairment are later determined to be normal, a prominent researcher told my colleague Judy Graham last year.

“People will get unnecessary tests and start getting weird treatments that have no proven efficacy,” said Dr. Frances, who has criticized a number of DSM5 changes. “They’re going to worry like crazy about being demented.”

Dr. Petersen agreed that it was a legitimate concern, but “by and large, we’re becoming better at distinguishing between the normal cognitive effects of aging and disease.” (The American Psychiatric Association will publish a specialized DSM for primary care physicians, Dr. Kupfer pointed out, to help guide them through diagnoses.)

It is hard for patients and families to know how to react when experts disagree. But keep in mind that contemporary health care aims for what is called shared decision-making. That means patients and professionals discuss options and weigh the risks and benefits of treatments and procedures, their likely outcomes, patients’ preferences, and come to agreement on how to proceed. This essay in the New England Journal of Medicine calls shared decision-making “the pinnacle of patient-centered care.”

So when Dr. Frances refers to the DSM5 as “a guide, not a bible,” and urges skepticism about some of its diagnoses, he is advocating an approach that patients and families should probably bring to any medical decision.

Seeking further information, asking questions, assessing options — those are reasonable responses if, a few weeks after a loved one’s death, a doctor says you may have major depression. Or if she thinks your memory loss could mean Mild Neurocognitive Disorder.

“The shorter the evaluation, the less the person knows you, the less he or she can explain and justify the diagnosis, the more tests and treatments that will result, the more a person should be cautious and get a second opinion,” Dr. Frances said.

Whatever the DSM5 says, it’s hard to argue with that.

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

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IHT Rendezvous: France Is Sweet on 'Sugar Man'

A love story is developing between the French and Rodriguez, the Detroit-born musician who flopped in the 1970s, was a star without knowing it in apartheid South Africa and was rediscovered last summer in the United States when the documentary “Searching for Sugar Man” was released.

The film tells the extraordinary story of a talented and philosophical musician who spent his life working in construction while struggling to bring up his three daughters, and the mind-boggling mutual discoveries in 1997: for him, that he was more famous than the Rolling Stones in South Africa, and for South African fans (who believed him to be dead), that he was alive.

The Swedish-U.K. film by Malik Bendjelloul which has made more than $3 million at the box office in the United States, has been nominated for an Academy Award in the documentary category. In France the now-70-year-old Rodriguez has created something of a frenzy: the soundtrack album is among Sony France’s top sales on iTunes. Sony had planned on putting fewer than 3,000 CDs in stores, but after calls from vendors who sensed something was up, made 15,000 copies available.

“It is an honor and a pleasure,” said Rodriguez in an email message last week from Detroit about his popularity in France. “I’ve been to France a couple of times now. It feels like I’m on top of the world.”

The French public has had a tradition of adopting American artists that it considers underappreciated in the United States, from Josephine Baker to Woody Allen, from Paul Auster to Ben Harper. Le Figaro newspaper recently dubbed Rodriguez the “unloved” singer.

David Nivesse, from ARP Selection, the film’s French distributor, and Christophe Servel Molvaer, project manager for Sony Music Legacy, France, say that it all started last November when Rodriguez came to Paris for a private concert following a preview of the documentary.

“He played for half an hour and you could hear a pin drop. There were 600 people in the room and he got a standing ovation,” Mr. Servel Molvaer recalled. “I had never heard of him before. But from the beginning I was captivated by this soul-folk. It’s something magical, and people love his music from the moment they hear it.”

“Music is a language all it’s own,” wrote Rodriguez. “I’ve been playing ‘La Vie En Rose’ a lot lately when I’m looking for sounds. It’s the notes and the rhythms— that is what speaks to me. I’m a music lover. I do vocal against guitar. Sometimes it’s like any words will work. A lot of songs out there have fewer words than guttural sounds like oohs and ahhs and grunts. That works for some people too. I’m glad the French like my stuff. It’s had a long life and I feel lucky for that.”

“Searching for Sugar Man” was released Dec. 26 in just two Paris cinemas. It has beaten all records at the Left Bank Saint Germain movie theater where it is playing. It’s now playing in other cities in France including Bordeaux, Rennes and Nancy.

“We thought the film would do well but this is exceptional,” Mr. Nivesse said.

Rodriguez is playing concerts around the world now. One gig was scheduled for this June at La Cigale, a major Paris venue. It sold out within 72 hours. Another concert was added at the Zenith (capacity 6,500). He is also expected to play at the major French summer music festivals.

“I’ve been working 25 years in the business and never met anyone like this, with so much charisma, even though he doesn’t say much,” said Mr. Servel Molvaer.

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