I Was Misinformed: The Time She Tried Viagra

I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing. But then, I am proud to say, I was among the early, and from what I gather, rare female users. It happened when the drug...

Read More..

Major Retailers Start Selling Financial Products, Challenging Banks

On a recent shopping trip to Costco, Lilly Neubauer picked up paper towels, lentils, carrots — and a home mortgage. While Ms. Neubauer, 27, said she was surprised to find the warehouse club selling financial products, she and her husband saved about $200 a month by refinancing there this year. She also bought home insurance from Costco, she said, again because it was cheaper there. ...

Read More..

Top U.S. Commander in Afghanistan Is Linked to Petraeus Scandal

PERTH, Australia — Gen. John R. Allen, the top American and NATO commander in Afghanistan, has become ensnared in the scandal over an extramarital affair acknowledged by David H. Petraeus, a former general. General Allen is being investigated for what a senior defense official said early Tuesday was “inappropriate communication” with Jill Kelley, a woman in Tampa, Fla., who was seen by Mr. Petraeus’s...

Read More..

Roethlisberger has sprained shoulder

{ttle}

{cptn}","template_name":"ss_thmb_play_ttle","i18n":{"end_of_gallery_header":"End of Gallery","end_of_gallery_next":"View Again"},"metadata":{"pagination":"{firstVisible} - {lastVisible} of {numItems}","ult":{"spaceid":"95733958","sec":""}}},{"id": "hcm-carousel-935648304", "dataManager": C.dmgr, "mediator": C.mdtr, "group_name":"hcm-carousel-935648304", "track_item_selected":1,"tracking":{
"spaceid" : "95733958",
"events" : {
"click" : {
"any" : {
"yui-carousel-prev" : {
"node" : "a",
"data" : {"sec":"HCMOL on article right rail","slk":"prev","itc":"1" },
"bubbles" : true,
"test": function(params){
var carousel = params.obj.getCarousel();
var pages = carousel._pages;

// if same page, don't beacon
if(("_ult_current_page" in carousel) && carousel._ult_current_page==pages.cur) return false;

// keep track of current position within this closure
carousel._ult_current_page = pages.cur;

return true;
}
},
"yui-carousel-next" : {
"node" : "a",
"data" : {"sec":"HCMOL on article right rail","slk":"next","itc":"1" },
"bubbles" : true,
"test": function(params){
var carousel = params.obj.getCarousel();
var pages = carousel._pages;

// no more pages, don't beacon again
// if same page, don't beacon
if(("_ult_current_page" in carousel) && carousel._ult_current_page==pages.cur) return false;

// keep track of current position within this closure
carousel._ult_current_page = pages.cur;
return true;
}
}
}
}
}
}
}));
});
Y.later(10, this, function() {(function() {
try{
if (Math.floor(Math.random()*10) == 1) {
var loc = window.location,
decoded = decodeURI(loc.pathname),
encoded = encodeURI(decoded),
uri = loc.protocol + "//" + loc.host + encoded + ((loc.search.length > 0) ? loc.search + '&' : '?') + "_cacheable=1",
xmlhttp;

if (window.XMLHttpRequest)
xmlhttp = new XMLHttpRequest();
else
xmlhttp = new ActiveXObject("Microsoft.XMLHTTP");

xmlhttp.open("GET",uri,true);
xmlhttp.send();
}
}catch(e){}
})();
});
Y.later(10, this, function() {Y.namespace("Media").ywaSettings = '"projectId": "10001256862979", "documentName": "", "documentGroup": "", "ywaColo" : "vscale3", "spaceId" : "95733958" ,"customFields" : { "12" : "classic", "13" : "story" }';
Y.Media.YWA.init(Y.namespace("Media").ywaSettings);
});
Y.later(10, this, function() {if(document.onclick===YAHOO.Media.PreventDefaultHandler.newClick){document.onclick=YAHOO.Media.PreventDefaultHandler.oldClick;}
});
});
});

Read More..

Q & A: Weighing the Evidence

Q. My husband weighs twice as much as I do, yet we take the same dose of over-the-counter medications, as recommended on the packaging. Shouldn’t weight be a factor?

A. There is little information about using weight as a factor in adjusting doses of either prescription or over-the-counter medications, said Dr. Steven A. Kaplan, director of the Iris Cantor Men’s Health Center at NewYork-Presbyterian/Weill Cornell hospital.

“We are beginning to study different responses by weight,” he said, but he and other researchers have reached no conclusions on recommendations for therapy.

“In my own field, urology,” he added, “my opinion is that it is more likely for the recommended dose to be ineffective in a larger person rather than to be toxic in a thinner adult.”

Some prescription drugs, like chemotherapy agents, already have their dosages adjusted for weight because of their highly toxic nature. As for over-the-counter drugs, recommended doses generally tend to be weighted in favor of safety rather than efficacy, Dr. Kaplan said.

He and other doctors emphasized the importance of following package directions. For example, acetaminophen (like Tylenol) can present a life-threatening risk if the liver cannot process a high dose. If you find that the recommended dose does not work for you, Dr. Kaplan said, speak to your doctor.

C. CLAIBORNE RAY

Readers may submit questions by mail to Question, Science Times, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.

Read More..

Square Feet: A Wounded Wall Street Is Expected to Stay Put

Emmanuel Dunand/Agence France-Presse — Getty Images

A businessman made his way Monday into One New York Plaza in Manhattan's financial district, where the cleanup from Hurricane Sandy was still underway.

More than two weeks after Hurricane Sandy came ashore in Manhattan, sending an 11-foot surge of seawater over much of the southern tip of the island, the financial district is still in tatters.

Dozens of office buildings that were flooded by the storm still lack power and are off-limits to tenants, and many streets are a chaotic mess of generators, work crews and pumps.

Still trying to gauge the extent of the damage, many landlords have been vague about when their buildings will reopen. And some tenants, who have been uprooted to tiny conference rooms in New Jersey or industrial spaces in Brooklyn, are weighing whether to come back to the neighborhood at all.

But despite the uncertainty and destruction, many analysts don’t expect the bulk of tenants to pack up and leave for good, nor do they think that future tenants will rule out the neighborhood over fears they might get flooded.

“I don’t think it will become an overriding factor in the location decision,” said John Wheeler, the head downtown broker for Jones Lang LaSalle, echoing other top brokers. “I guess time will tell if I’m being too sanguine about this.”Brokers add that the neighborhood remains a compelling place to locate a business. Even with some train lines hampered by storm damage, it is still amply served by mass transit, with more than a dozen subway lines and ferry service. The new apartments and condos built in recent years, along with new boutiques and restaurants, also mean that many people can now live a few blocks from their office.

Besides, rents are notably competitive with other business districts in Manhattan, at about $40 a square foot in the financial district, compared with $65 in midtown, according to Cassidy Turley, the brokerage, though the downtown figure is expected to climb when the two new World Trade Center buildings come online.

Complicating the prognosis about the neighborhood’s long-term health is the fact that getting an exact handle on the extent of damage has been tricky. Many major landlords have been reluctant to respond to even basic questions about the status of their buildings. And many brokers have refused to discuss individual properties.

And while the city’s Buildings Department declared early last week that nine downtown buildings were completely off-limits, and another 445 were partially habitable, it did not differentiate between commercial and residential structures.

Jones Lang LaSalle has been one of the few brokerages to tackle the issue. It concluded that a hefty 20 percent of all the major office buildings below Canal Street are closed, or 37 out of 183, according to data compiled as of Monday. And those shuttered buildings, most of which are east of Broadway, represent 29.2 million square feet of space, the data shows.

Anecdotal evidence, too, suggests the damage has been severe. Late last week, the Water Street corridor, which runs along the East River, appeared alarmingly hard-hit.

Men in white hazmat outfits pushed garbage bins on streets, which rumbled with the sounds of generators. Several traffic lights were still dark. Clumps of yellow hoses snaked up escalators and through lobbies. And security guards, protecting against looters, were more numerous than people wearing suits.

Among the buildings confirmed closed were: 99 Wall Street, 199 Water Street, One Wall Street Plaza and 180 Maiden Lane. Others that appear to be closed include 55 Water Street, 85 Broad Street, 7 Hanover Square and 10 Hanover Square, among others. Four New York Plaza, where The Daily News is based, could be closed for a year, though One New York Plaza, whose basement shopping center took on 30 feet of water, should reopen in two weeks, according to a spokeswoman for the building’s landlord, Brookfield Office Properties.

Going forward, some tenants are concerned that floods will become a regular occurrence; after all, just 15 months ago, the city was soaked by Tropical Storm Irene. These tenants say their fears were confirmed by comments that Gov. Andrew M. Cuomo made after Hurricane Sandy about how destructive weather events are likely to recur.

“He was like, ‘If you don’t believe in global warming, wake up and see what’s happening here,’ and he was right,” said Andrea Katz, a development director for WBAI, the public radio station, which has a 10,000-square-foot space at 120 Wall Street. The lower floors of the Art Deco building, which is at South Street and owned by Silverstein Properties, were flooded by Hurricane Sandy.

Read More..

Syrian Jet Strikes Close to Border With Turkey

Murad Sezer/Reuters

Syrians fled from Ras al-Ain after an airstrike by Syrian forces on Monday.

GAZIANTEP, Turkey — A Syrian MIG-25 jet bombed the rebel-held town of Ras al-Ain a few yards from the Turkish border on Monday, Syrian witnesses said.

Veli Gurgah/Anadolu Agency, via European Pressphoto Agency

Smoke rose from Ras al-Ain as it was bombed.

Murad Sezer/Reuters

Syrians crossed into Turkey after the airstrike.

Murad Sezer/Reuters

A boy was wounded in the attack.

The attack demolished at least 15 buildings and killed many civilians, Nezir Alan, a doctor who witnessed the bombing, said. Local officials, quoted by The Associated Press, said at least six people were killed, but Dr. Alan said the toll was higher.

“We pulled bodies of 12 people from the rubble and are now trying to reach bodies of 8 others,” he said in a telephone interview. “There are around 70 injured, 50 of whom were in critical condition, and they are being transferred to Turkish hospitals across the border.”

Turkish fighter jets were seen in Turkish airspace shortly after the explosion, and a Syrian helicopter hovered above Ras al-Ain, which is only few yards from Ceylanpinar, a Turkish border town, Syrian witnesses said. “The plane appeared in seconds, dropped a bomb and killed children. Here is total chaos,” Dr. Alan said.

Ambulances were rushed to Ceylanpinar, Haber Turk, a private news television station, reported.

Windows of shops and houses in Ceylanpinar were shattered, and people on both sides of the border were seen running in panic, while military vehicles raced down streets as a huge cloud of smoke hung over the area, Haber Turk footage showed minutes after the explosion.

There were no immediate reports of any deaths or injuries on the Turkish side of the border.

Clashes in Ras al-Ain have intensified in recent days, prompting thousands of Syrians to seek refuge in Turkey.

Civilians in Ceylanpinar and other nearby towns were advised not to travel in areas close to the border.

Five Turkish civilians were killed in October when a Syrian shell landed in Akcakale, another border town about 75 miles west of Ceylanpinar, an act that prompted the Turkish Parliament to revise engagement rules and allow the military to retaliate in case of a direct threat from the border region.

The Turkish Army has increased its deployment along the 550-mile border with Syria since June, after Syria shot down a Turkish military jet, straining already tense relations between Ankara and Damascus.

The Turkish government is also considering asking NATO to station Patriot missiles in its border region to counter potential attacks from Syria.

Read More..

Lakers hire Mike D'Antoni as new coach

LOS ANGELES (AP) — The Los Angeles Lakers hired Mike D'Antoni late Sunday night, signing the former coach of the Suns and Knicks to replace Mike Brown.

The Lakers and D'Antoni's agent, Warren LeGarie, confirmed the deal two days after the Lakers fired Brown five games into the season.

D'Antoni agreed to a three-year deal worth $12 million, with a team option for a fourth season.

D'Antoni got the high-profile job running the 16-time NBA champions only after the club's top brass extensively discussed the job with former Lakers coach Phil Jackson.

The 11-time NBA champion coach met with Lakers owners Jerry and Jim Buss and general manager Mitch Kupchak on Saturday to weigh a return for a third stint on Los Angeles' bench.

The Lakers instead went with D'Antoni, a respected offensive strategist who coached Lakers point guard Steve Nash in Phoenix during the best years of their respective careers. D'Antoni was less successful during four seasons in New York, but at least restored the once-moribund Knicks to competence before resigning last March.

"Dr. (Jerry) Buss, Jim Buss and Mitch Kupchak unanimously agreed that Mike was the best coach for this roster at this time," Lakers spokesman John Black said.

The 61-year-old D'Antoni underwent knee replacement surgery earlier this month, and could be physically limited early in his tenure. Black said the Lakers aren't certain when D'Antoni will travel to Los Angeles to begin work.

Interim coach Bernie Bickerstaff will continue running the Lakers until D'Antoni arrives. Los Angeles beat Sacramento 103-90 on Sunday night, improving to 2-0 under Bickerstaff after a 1-4 start under Brown.

The Lakers' next game is Tuesday night against San Antonio at Staples Center.

After Brown's dismissal, Nash and Kobe Bryant both expressed enthusiasm about the prospect of playing for D'Antoni, although Bryant also campaigned eagerly for Jackson.

Bryant idolized D'Antoni while growing up in Italy, where D'Antoni was a star player for Olimpia Milano in the Italian pro league. D'Antoni also has been an assistant coach on various U.S. national teams featuring Bryant, including the gold medal-winning squad at the London Olympics.

Nash won two MVP awards while running D'Antoni's signature up-tempo offense for the final four seasons of the coach's five-year tenure with the Suns.

Nash and D'Antoni won at least 54 games each season and reached two Western Conference finals — and they eliminated Bryant's Lakers from the first round of the playoffs in 2006 and 2007, still the only first-round exits of Kobe's 17-year career.

D'Antoni then coached New York to just one playoff appearance and no postseason victories. He also coached the Denver Nuggets during the lockout-shortened 1998-99 season.

But his NBA accomplishments can't measure up to Jackson, who won five titles and reached seven NBA finals during two stints totaling 11 seasons with Los Angeles.

Jackson walked away from the club 18 months ago after a second-round playoff sweep by Dallas, and Brown led Los Angeles to a 41-25 mark followed by another second-round playoff defeat last summer.

The Lakers then traded for Nash and Dwight Howard, setting up a season of enormous expectations for Brown — but the Lakers struggled to learn his new, Princeton-influenced offense while playing mediocre defense.

After the Lakers stumbled out of the gate while Howard and Bryant missed preseason games to preserve their health, Nash incurred a small fracture in his leg during the Lakers' second regular-season game, keeping him out of the lineup for their past five games and for at least another week.

The Lakers have improved to 3-4 under Bickerstaff after following up their winless preseason with four losses in their first five regular-season games, the club's worst start since 1993.

Despite his reputation for offensive acumen, D'Antoni's NBA teams typically have played fairly solid defense, statistically speaking — and they never had the imposing Howard or defensive stopper Metta World Peace in their lineups.

Nash had his best NBA seasons as the versatile quarterback of the Suns' offense under D'Antoni, and point guard Jeremy Lin became a star on the Knicks last season while filling much the same role.

D'Antoni resigned late last season following a six-game losing streak, surprising many observers, and former assistant coach Mike Woodson led the Knicks to the playoffs.

Phoenix visits Staples Center on Friday.

Read More..

The New Old Age Blog: What Chemo Can't Do

Let’s start with a simple medical fact: Chemotherapy doesn’t cure people who have very advanced Stage 4 lung or colon cancer.

Chemo can be quite effective at earlier stages. Even in late-stage disease, it may relieve symptoms for a while; it might help someone with tumors in his lungs breathe more easily, for example. Chemo can extend life for weeks or months.

It can also make the recipient feel nauseated, wiped out and generally lousy, and require him to spend more time in clinics and hospitals than a dying person might choose to. But it can’t banish cancer. Many aspects of medical prognosis and treatment are uncertain. Not this one.

Such patients’ doctors have almost certainly told them their cancer is incurable. Those who opted for chemotherapy anyway had to sign consent forms spelling out the potential side effects. Yet Dr. Jane Weeks, a research oncologist at Dana-Farber Cancer Institute in Boston, knew from previous studies that cancer patients can develop unrealistic ideas about their odds of survival.

So as she and her co-authors began analyzing results from the first representative national study of patients with advanced cancer, all undergoing chemotherapy, to see what they thought about its effects, Dr. Weeks expected many — perhaps a third of them — to get it wrong.

She was staggered to see how mistaken she was.

Nearly 1,200 patients or their surrogates were interviewed within months of a diagnosis of Stage 4 colon or lung cancer. They answered a number of questions during these telephone interviews, but the key one was: “After talking with your doctors, how likely did you think it was that chemotherapy would cure your cancer?” The only correct answer: “Not at all likely.”

But a great majority chose one of the other responses indicating some likelihood of cure or else said they didn’t know. The study, just published in The New England Journal of Medicine, found that 69 percent of lung cancer patients and 81 percent of those with colon cancer misunderstood the purpose of the very treatment they’d been undergoing.

The misperception was significantly higher among African-Americans, Asians and Hispanics than among whites — but not because of education levels, the usual variable in studies of health knowledge. “It suggests that this reflects cultural differences,” Dr. Weeks said.

Strangely, the patients who responded inaccurately also were more likely to highly rate their communications with doctors. Those who grasped that chemo wasn’t curative were, in effect, penalizing the doctors who helped them reach that understanding.

In a way, Dr. Weeks said, this makes sense. It reflects what researchers call optimism bias — or what Dr. Douglas White, a University of Pittsburgh bioethicist, has called “the powerful desire not to be dead.”

These were not very elderly people.  The bulk were ages 55 to 69. Only about a quarter of colon cancer patients and about a third of those with lung cancer were over age 70.

“It’s completely understandable that patients want to believe the chemo will cure them,” Dr. Weeks said. “And it’s understandable that physicians hesitate to take away that false hope.”

But this confusion can have unhappy consequences. For patients to make truly informed decisions, “they need to understand the outcomes,” Dr. Weeks said. “If they’re missing this critical fact, that can’t happen.”

People often hit rough times during weeks of chemotherapy. Common side effects include nausea and vomiting, diarrhea and fatigue; there are many trips to hospitals for IV drugs, X-rays and blood tests. “They’ll soldier on if they think it will cure them,” Dr. Weeks said. “Any of us would.”

But if these patients might respond differently if they understand that chemo is meant to make them feel better but may have the opposite effect, or that it may buy them another 10 to 12 weeks (a reasonable average for lung cancer) or maybe a year (for colon cancer) but won’t prevent their deaths.

Moreover, “if patients think chemo has a chance of curing them, they’ll be less likely to have end-of-life discussions early on,” Dr. Weeks said. “And they pay a price for that later” — if they enter hospice care much too late or die in hospitals instead of at home, as many prefer.

Possibly, at the time of the initial discussions, these patients recognized that chemo didn’t equal cure, she hypothesized. Then, they and their doctors began to focus on doing something, and they stopped seeing their cancer as incurable.

But realism — as palliative care doctors know — doesn’t have to mean despair. “A really good physician can communicate effectively and still maintain patient trust and confidence,” Dr. Weeks said.

“We have the tools to help patients make these difficult decisions,” two Johns Hopkins physicians, Dr. Thomas J. Smith and Dr. Dan Longo, wrote in an editorial published with the study. “We just need the gumption and incentives to use them.”

---

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

Read More..

You're the Boss Blog: Will Higher Taxes Affect Small Businesses? You Tell Us

The Agenda

How small-business issues are shaping politics and policy.

President Obama may have won a decisive reelection victory, but it is John Boehner, the Republican speaker of the House, who is making the rounds and claiming a mandate. And everywhere he goes, he’s talking about what would happen to small businesses if the Bush-era tax cuts on the wealthiest Americans are allowed to expire. To ABC News’s Diane Sawyer, Mr. Boehner said, “Raising taxes on small-business people is the wrong prescription given where our economy is.” He told USA Today, “Raising taxes on small businesses will kill jobs in America. It is as simple as that.”

In a statement to reporters the day after the election, Mr. Boehner made what some observers described as a concession: House Republicans would consider new revenue as part of a deal to avert the “fiscal cliff.” But he then explained that the new revenue could not come from higher tax rates. “In the New Testament, a parable is told of two men. One built his house on sand; the other built his house on rock,” he said. “The foundation of our country’s economy — the rock of our economy — has always been small businesses in the private sector. I ran one of those small businesses, and I can tell you: raising small businesses’ taxes means they don’t grow.”

To support the claim, Mr. Boehner turned to the same controversial Ernst & Young study on which Mitt Romney relied in the first presidential debate in Denver.

Of course, this view is no less controversial now than it was at the time of that debate. Since the debate, we’ve learned about a September report (pdf) from the nonpartisan, and respected, Congressional Research Service, which surveyed the historical record and found that “the reduction in the top tax rates have had little association with saving, investment, or productivity growth” — but “appear to be associated with the increasing concentration of income at the top of the income distribution.” The Congressional Research Service withdrew the report after Republican senators complained.

Then, last week, a report from the Congressional Budget Office seemed to suggest that raising the tax rates on the wealthiest Americans would have little effect on economic output in the fourth quarter of 2013.* Extending the top tax rates would cost the economy 200,000 jobs, according to the C.B.O., an estimate well below the 700,000 jobs that Ernst & Young predicted would be lost. In fact, the C.B.O. figures show that while raising taxes (on everybody) amounts to about two-thirds of the total deficit reduction in 2013, it has a much smaller effect on gross domestic product, the measurement for output. (The C.B.O. report relies in part on economic modeling, much like the Ernst & Young study, meaning that the C.B.O.’s assumptions about the relationship between taxes and economic output informed the results.)

And Agenda readers who own small businesses have weighed in as well. Jed Horovitz in New Jersey wrote, “Each year, I decide how much money to re-invest in my company and how much to take out. Because I pay taxes on my profit, I always look for productive ways to invest in my company first. Spending pretax money makes sense. If my taxes were lower, I would take more money out and just put it in the bank.”

Carol Gillen, who described herself as “the wife and bookkeeper of a small-business owner” in New York, said, “Demand drives hiring, not the personal income tax of the owner.”

But The Agenda would like to hear from more business owners. We want to take a close look at how you and your companies would be affected by increasing the top tax rates, including how it might affect hiring and investment plans. It would be an intensive profile — we would want to talk through specifics on revenue, income, taxes and investments. (We have made the same request to the National Federation of Independent Business and the S Corporation Association of America, both of which strongly oppose any income tax increase.)

It’s a lot to ask, we know, but it’s an important issue. If you own such a company and have employees — making you a job-creator — and you’re game, please drop us a line to let us know you’re interested.

*More precisely, the C.B.O. report said that extending all of the Bush tax cuts and fixing the Alternative Minimum Tax so that it does not reach deeper into the middle class would add about 1.4 percent to the nation’s gross domestic product in the fourth quarter of 2013. Meanwhile, fixing the Alternative Minimum Tax and extending all of the Bush tax cuts except for wealthier Americans would add about 1.3 percent to G.D.P., so the additional G.D.P. attributed to extending the tax cuts for the top two tax brackets amounts to one-tenth of 1 percent.

Read More..