Unlikely Model for H.I.V. Prevention: Adult Film Industry

Stephanie Diani for The New York Times

INDUSTRY DATABASE Shylar Cobi, right, a film producer, confirmed test results of the actors who perform as James Deen and Stoya.

LOS ANGELES — Before they take off all their clothes, the actors who perform as James Deen and Stoya go through a ritual unique to the heterosexual adult film industry.

First, they show each other their cellphones: Each has an e-mail from a laboratory saying he or she just tested negative for H.I.V., syphilis, chlamydia and gonorrhea.

Then they sit beside the film’s producer, Shylar Cobi, as he checks an industry database with their real names to confirm that those negative tests are less than 15 days old.

Then, out on the pool terrace of the day’s set — a music producer’s hilltop home with a view of the Hollywood sign — they yank down their pants and stand around joking as Mr. Cobi quickly inspects their mouths, hands and genitals for sores.

“I’m not a doctor,” Mr. Cobi, who wears a pleasantly sheepish grin, says. “I’m only qualified to do this because I’ve been shooting porn since 1990 and I know what looks bad.”

Bizarre as the ritual is, it seems to work.

The industry’s medical consultants say that about 350,000 sex scenes have been shot without condoms since 2004, and H.I.V. has not been transmitted on a set once.

Outside the world of pornography, the industry’s testing regimen is not well known, and no serious academic study of it has ever been done. But when it was described to several AIDS experts, they all reacted by saying that there were far fewer infections than they would have expected, given how much high-risk sex takes place.

“I don’t think there’s any question that it works,” said Dr. Allan Ronald, a Canadian AIDS specialist who did landmark studies of the virus in prostitutes in a Nairobi slum. “I’m a little uncomfortable, because it’s giving the wrong message — that you can have multiple sex partners without condoms — but I can’t say it doesn’t work.”

Despite the regimen’s apparent success, California health officials and an advocacy group, the AIDS Healthcare Foundation, are trying to make it illegal to shoot without condoms. They argue that other sexually transmitted diseases are rampant in the industry, though the industry trade group disputes that.

In January, the city of Los Angeles passed a law requiring actors to wear condoms. A measure to do the same for the whole county is on the ballot on Tuesday.

Producers say the condom requirement will drive them out of business since consumers will not buy such films. Local newspapers like The Los Angeles Times oppose the ballot measure, calling it well-intentioned but unenforceable, and warning that it could drive up to 10,000 jobs out of state.

Very frequent testing makes it almost impossible for an actor to stay infected without being caught, said Dr. Jacques Pepin, the author of “The Origins of AIDS” and an expert on transmission rates. “And if you are having sex mostly with people who themselves are tested all the time, this must further reduce the risk.”

When the virus first enters a high-risk group like heroin users, urban prostitutes or habitués of gay bathhouses, it usually infects 30 to 60 percent of the cohort within a few years, studies have shown. The same would be expected in pornography, where performers can have more than a dozen partners a month, but the industry says self-policing has prevented it.

“Our talent base has sex exponentially more than other people, but we’re all on the same page about keeping it out,” said Steven Hirsch, the founder of Vivid Entertainment, one of the biggest studios.

Performers have to test negative every 28 days, although some studios recently switched to every 14.

If a test is positive, all the studios across the country that adhere to standards set by the Free Speech Coalition, an industry trade group, are obliged to stop filming until all the on-screen partners of that performer, all their partners, and all their partners’ partners, are found and retested. In 2004, the industry shut down for three months to do that.

It has had briefer shutdowns in each of the last four years.

In 2009 and 2010, no other infected performers were found. Coalition representatives said an infected woman in 2009, from Nevada, may have had an infected boyfriend, and offered evidence that a man infected in 2010 in Florida had worked outside the industry as a prostitute. The 2011 test was a false positive.

A shutdown in August came after several actors got syphilis, not H.I.V. All performers were given a choice: Take antibiotics, or pass two back-to-back syphilis tests 14 days apart.

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Antwerp Journal: Antwerp’s Diamond Industry Facing Challenges

Colin Delfosse for The New York Times

Indian businessmen in the diamond district of Antwerp, Belgium.

ANTWERP, Belgium — Step off the train here and you cannot miss the signs on the stores: Diamond World, Diamond Gallery, Diamond Creations or simply, Diamonds. Of late, there are the banners and posters reading simply, “Antwerp Loves Diamonds.”

Though this Belgian port has had a love affair with diamonds for centuries, of late it seems to be losing some of its passion. For years now, much of the lucrative but labor-intensive business of cutting and polishing stones has been drifting to low-wage centers in the developing world, like Mumbai, Dubai and Shanghai.

More ominously, in recent years, diamond traders have been accused of a range of violations, including tax fraud, money laundering and cheating on customs payments when buying and selling stones.

Local business leaders recognize the threat. This year, they embarked on what local newspapers described as a “charm offensive.” In a 160-page program, titled Project 2020, the World Diamond Center, a trade-promotion group, outlined plans to draw business back to Antwerp by simplifying and accelerating trading via online systems. That, the industry hopes, will win back some of the polishing business lost to Asian countries with new technology, like fully automated diamond polishers, and generally burnish the image of the diamond business in the public’s jaded eye.

“This is our strength,” said Ari Epstein, 36, a lawyer who is chief executive of the World Diamond Center and the son of a diamond trader, whose father emigrated from a village in Romania in the 1960s. “We have the critical mass so that every diamond finds a buyer and seller.”

Antwerp has by no means fallen out of love with the gems. In all, the market employs 8,000 people and creates work indirectly for 26,000 others as insurers, bankers, security guards and drivers. Last year, turnover in the local diamond business amounted to $56 billion, Mr. Epstein said, its best year ever.

While total revenues are expected to drop this year because of the troubled world economy, he acknowledged, a stroll along Hoveniersstraat, or Gardner’s Street, leads through the heart of the market, where almost 85 percent of the world’s uncut diamonds are still traded.

“I come here once a month,” said Sheh Kamliss, a trader in his 30s, who travels from his native India to buy uncut stones and sell polished diamonds. “This is the international market,” he added, chatting with fellow Indian traders outside the Diamond Club of Antwerp, one of many locations where deals are struck.

On any given day but Friday or the Jewish holidays, Hoveniersstraat, with its tiny Sephardic synagogue, is liberally sprinkled with Orthodox Jewish traders, many of them Hasidim.

But their once dominant presence has been squeezed by the arrival of traders from new markets, like Mr. Kamliss. Now people from about 70 nations are present, including Indians, Israelis, Lebanese, Russians, Chinese and others. Along neighboring Lange Herentalsestraat, Rachel’s Kosher Restaurant is now flanked by the Bollywood Indian Restaurant and the Shanti Shop Indian supermarket. In the nearby Jewish quarter, Patel’s Cash & Carry recently installed itself right next to Moszkowitz, the butcher.

Some here say this globalization of the business has opened the door to abuse.

Omega Diamonds, a major market maker, came under investigation and its executives fled Belgium when an employee-turned-whistle-blower revealed in 2006 how Omega had traded diamonds out of Africa for years, avoiding taxes by transacting deals through Dubai, Tel Aviv and Geneva, then moving the profits back to Belgium.

“Because of global changes, the trade routes have changed,” said David Renous, 47, the whistle blower, who is now writing a book on the subject. “New hubs, like Dubai, the Singapore of the Middle East, sometimes close their eyes to criminality.”

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Coptic Church Chooses Pope Who Rejects Politics

Tara Todras-Whitehill for The New York Times

Coptic clergymen at a ceremony on Sunday for choosing a pope.

CAIRO — A blindfolded 6-year-old reached into a glass bowl on Sunday to pick the first new Coptic pope in more than 40 years, a patriarch who promises a new era of integration for Egypt’s Christian minority as it grapples with a wave of sectarian violence, new Islamist domination of politics, and internal pressures for reform.

Tara Todras-Whitehill for The New York Times

The acting Coptic pope, before a banner of Bishop Tawadros, held up the names of other candidates to show that the selection was fair.

Speaking to the television cameras that surrounded him at his monastery in a desert town, the pope-designate, Bishop Tawadros, indicated that he planned to reverse the explicitly political role of his predecessor, Pope Shenouda III, who died in March. For four decades, Shenouda acted as the Copts’ chief representative in public life, won special favors for his flock by publicly endorsing President Hosni Mubarak, and last year urged in vain that Copts stay away from the protests that ultimately toppled the strongman.

“The most important thing is for the church to go back and live consistently within the spiritual boundaries because this is its main work, spiritual work,” the bishop said, and he promised to begin a process of “rearranging the house from the inside” and “pushing new blood” after his installation later this month as Pope Tawadros II. Interviewed on Coptic television recently, he struck a new tone by including as his priorities “living with our brothers, the Muslims” and “the responsibility of preserving our shared life.”

“Integrating in the society is a fundamental scriptural Christian trait,” Bishop Tawadros said then. “This integration is a must — moderate constructive integration,” he added. “All of us, as Egyptians, have to participate.”

Coptic activists and intellectuals said the turn away from politics signaled a sweeping transformation in the Christian minority’s relationship to the Egyptian state but also addressed a firm demand by the Christian laity to claim a voice in a more democratic Egypt.

“It can’t continue the way it used to be,” said Youssef Sidhom, editor of the Coptic newspaper Watani. “It is not in the interests of the Copts, if they are trying to speak for themselves as full and equal citizens, to have an intermediary speaking for them, and especially if he is a religious authority. I think the church has gotten this message loud and clear.”

In Egypt’s first free elections for Parliament and president, Christians voted overwhelmingly along sectarian lines, seeking to pool their votes around the most secular candidates — only to see their favorites fall under the Islamist tide. After the Muslim Brotherhood’s political party won parliamentary leadership and then the presidency, many Egyptians joked that the group put a candidate up for Coptic pope, too.

In recent interviews, intellectuals and activists, and churchgoers leaving Mass after the selection of the pope, all said they had concluded that Christians would have to build alliances with Muslims who shared their goal of nonsectarian citizenship.

“We are not the Muslim Brotherhood,” said Tarek Samir, a sales manager leaving the cathedral after the selection of Bishop Tawadros. “Politics is a dirty word to us, and we do not think it should be mixed with religion. But there are moderate Muslims who live the same life we do, who go to work with us, who live together with us, and if I am in trouble they will help me.”

Copts, often estimated to make up about 10 percent of Egypt’s 80 million people, trace their roots here to centuries before the birth of the Prophet Muhammad. They consider St. Mark their first pope; Tawadros II will be the 118th. In some ways, they are now at the spearhead of a challenge confronting Christian minorities across the region amid the tumult of the Arab Spring. In Iraq, Lebanon, Syria and elsewhere, Christian minorities had made peace with authoritarian rulers in the hope of protection from the Muslim majorities. But now the old bargains have broken, leaving Christians to fend for themselves.

In Egypt, the revolution last year coincided with by far the deadliest 12 months of sectarian violence in decades, including the bombing of an Alexandria church weeks before the revolt, the destruction of at least three churches in sectarian feuds, and the killing of about two dozen Coptic demonstrators by Egyptian soldiers squashing a protest — the single bloodiest episode of sectarian violence in at least half a century.

Known as the Maspero massacre after a nearby television building, the slaughter elicited attempts by top generals to blame the Copts and scant sympathy from the main Islamist groups, crystallizing Coptic anxieties.

Mayy El Sheikh and Mai Ayyad contributed reporting.

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Critic’s Notebook: ‘Start-Ups: Silicon Valley’ and ‘LOLwork’ on Bravo

When word got out about “Start-Ups: Silicon Valley,” the valley started to have conniptions. Among the more clever responses was a tweet by a TechCrunch editor: “Here Comes Silicon Valley Boo Boo.”

Bravo

The siblings Ben and Hermione Way bumble through a presentation after a toga party in “Start-Ups: Silicon Valley.”

Breaking news about the arts, coverage of live events, critical reviews, multimedia and more.

A sortable calendar of noteworthy cultural events in the New York region, selected by Times critics.

Of course the real geeks of Mountain View and Menlo Park are smart enough to know that reality is the last thing to expect from a Bravo reality show. What you expect is manufactured camaraderie and conflict, tears, cleavage and product placement, and when “Start-Ups” begins on Monday night that’s what you’ll get, along with togas and flying cocktails. Any new technology is strictly a rumor, and the only deal making happens between consenting adults at the toga party.

On the basis of a trailer released by Bravo, “Start-Ups” has already been criticized — and rightly so — for focusing on the lovely cityscapes of San Francisco rather than the flat expanses of San Jose, Sunnyvale and the other cities that actually make up Silicon Valley. The pilot has an aerial shot of downtown Mountain View and a few scenes inside the Four Seasons Hotel in East Palo Alto, but the dominant images are panoramic views of the sexier city to the north.

Also more than a little unreal, in Silicon Valley terms, is the homogeneity of the six-member principal cast, which is generally attractive — one woman is a former Milwaukee Bucks dancer — and entirely white; Asians and blacks appear around the edges as friends, bosses and hair and makeup women. Much of the episode is spent establishing the entrepreneurial bona fides of these six as well as the reality-TV personas they wear like wineglass tags: mean, vain, ambitious, alcoholic, gay, British.

That leaves time for just two significant scenes: the party, at which apps, Web sites and online shows (none of the six entrepreneurs plans to make a physical product) take a back seat to fighting, flirting and skimpy costumes; and an actual pitch, by two of the cast, to an actual Silicon Valley venture capitalist, Dave McClure.

The pitch is the episode’s high point, as the brother and sister Ben and Hermione bumble and brazen their way through a disastrous presentation of a health-and-fitness app that doesn’t yet exist. It begins badly when Mr. McClure finds Hermione, post-party, sleeping under a conference table, and doesn’t improve when he learns there is no product to look at, just a few screen shots on a laptop. Ben, whose explanation of the app is cut off by Mr. McClure, provides the pilot’s one laugh-out-loud moment when he huffs, “I found it slightly disrespectful, him just going through the whole thing and making his own judgments.”

Making its debut on Bravo on Wednesday night is “LOLwork,” another reality series set in the digital world. It takes us inside the offices of Cheezburger, a Seattle-based Internet humor publisher built on funny pictures of cats with fractured-English captions, and while its story lines appear to be as staged as those of “Start-Ups,” it has a depressed, workaday vibe that makes it by far the superior show.

“LOLwork” is about real people doing a real job. In the pilot the staff members of Cheezburger (its primary Web site is icanhascheezburger.com) are pitted against one another in a competition that was probably made for TV, but they’re not glamorized. We can see that they’re young, smart, prematurely cynical and fully aware of both the superficiality and profitability of what they do for a living.

In “Start-Ups” the would-be entrepreneurs describe their products in grandiose generalities: “It’s an app to help you live longer and stay fitter,” “It’s an app around personal goals,” “I want other people to have that same satisfaction that I’ve had in changing my life.” In “LOLwork” Ben Huh, the chief executive of Cheezburger, tells the employee whose idea wins the contest, “It was so bad that it was good, and ironically that’s actually the kind of stuff that works on the Internet.” You can practically hear the souls of his workers shriveling.

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Well: Winter Squash Recipes for Health

Some of the more varied vegetables of fall all go by the same name: squash. But as Martha Rose Shulman explains in this week’s Recipes for Health, you can discover new flavors by cooking with a squash of a different color.

This week it’s hard not to think about pumpkins, even though most of you won’t be cooking your jack-o’-lanterns. But along with the pumpkins in bins outside my supermarket, there are as many kabocha squashes, butternuts, acorns and large, squat European pumpkins that the French call potirons.

You can use either butternut or kabocha squash in this week’s recipes, though the two are not identical in texture or flavor. Butternut is a denser, slightly sweeter squash, and kabocha has an earthier flavor. Kabocha squash absorbs flavors beautifully and is especially well suited for salads because of the nice way it absorbs tart dressings.

For more ways to cook with these hardy vegetables, see all of the winter squash Recipes for Health.

Here are five new ways to cook with squash.

Puréed Winter Squash Soup With Ginger: One of the most comforting dishes you can make with winter squash is a puréed soup.

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Lasagna With Roasted Kabocha Squash and Béchamel: No-boil noodles make this rich-tasting lasagna easier to prepare.

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Roasted Beet and Winter Squash Salad With Walnuts: This composed salad sets the colors of the beets and the squash against each other beautifully.

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Winter Squash and Molasses Muffins: Add walnuts and raisins or chopped apricots to personalize these moist muffins.

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Balsamic Roasted Winter Squash and Wild Rice Salad: Tossing the squash with the vinegar before roasting deepens the flavors of both.

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Well: Winter Squash Recipes for Health

Some of the more varied vegetables of fall all go by the same name: squash. But as Martha Rose Shulman explains in this week’s Recipes for Health, you can discover new flavors by cooking with a squash of a different color.

This week it’s hard not to think about pumpkins, even though most of you won’t be cooking your jack-o’-lanterns. But along with the pumpkins in bins outside my supermarket, there are as many kabocha squashes, butternuts, acorns and large, squat European pumpkins that the French call potirons.

You can use either butternut or kabocha squash in this week’s recipes, though the two are not identical in texture or flavor. Butternut is a denser, slightly sweeter squash, and kabocha has an earthier flavor. Kabocha squash absorbs flavors beautifully and is especially well suited for salads because of the nice way it absorbs tart dressings.

For more ways to cook with these hardy vegetables, see all of the winter squash Recipes for Health.

Here are five new ways to cook with squash.

Puréed Winter Squash Soup With Ginger: One of the most comforting dishes you can make with winter squash is a puréed soup.

---

Lasagna With Roasted Kabocha Squash and Béchamel: No-boil noodles make this rich-tasting lasagna easier to prepare.

---

Roasted Beet and Winter Squash Salad With Walnuts: This composed salad sets the colors of the beets and the squash against each other beautifully.

---

Winter Squash and Molasses Muffins: Add walnuts and raisins or chopped apricots to personalize these moist muffins.

---

Balsamic Roasted Winter Squash and Wild Rice Salad: Tossing the squash with the vinegar before roasting deepens the flavors of both.

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Benghazi Attack Raises Doubts About U.S. Abilities in Region

Esam Omran Al-Fetori/Reuters

The attack at the American Mission on Sept. 11, seen here, and an annex in Benghazi, Libya, points to a limitation in the capabilities of the American military command responsible for countries swept up in the Arab Spring.

WASHINGTON — About three hours after the American diplomatic mission in Benghazi, Libya, came under attack, the Pentagon issued an urgent call for an array of quick-reaction forces, including an elite Special Forces team that was on a training mission in Croatia.

The team dropped what it was doing and prepared to move to the Sigonella naval air station in Sicily, a short flight from Benghazi and other hot spots in the region. By the time the unit arrived at the base, however, the surviving Americans at the Benghazi mission had been evacuated to Tripoli, and Ambassador J. Christopher Stevens and three other Americans were dead.

The assault, on the anniversary of the Sept. 11, 2001, attacks on the United States, has already exposed shortcomings in the Obama administration’s ability to secure diplomatic missions and act on intelligence warnings. But this previously undisclosed episode, described by several American officials, points to a limitation in the capabilities of the American military command responsible for a large swath of countries swept up in the Arab Spring.

At the heart of the issue is the Africa Command, established in 2007, well before the Arab Spring uprisings and before an affiliate of Al Qaeda became a major regional threat. It did not have on hand what every other regional combatant command has: its own force able to respond rapidly to emergencies — a Commanders’ In-Extremis Force, or C.I.F.

To respond to the Benghazi attack, the Africa Command had to borrow the C.I.F. that belongs to the European Command, because its own force is still in training. It also had no AC-130 gunships or armed drones readily available.

As officials in the White House and Pentagon scrambled to respond to the torrent of reports pouring out from Libya — with Mr. Stevens missing and officials worried that he might have been taken hostage — they took the extraordinary step of sending elite Delta Force commandos, with their own helicopters and ground vehicles, from their base at Fort Bragg, N.C., to Sicily. Those troops also arrived too late.

“The fact of the matter is these forces were not in place until after the attacks were over,” a Pentagon spokesman, George Little, said on Friday, referring to a range of special operations soldiers and other personnel. “We did respond. The secretary ordered forces to move. They simply were not able to arrive in time.”

An examination of these tumultuous events undercuts the criticism leveled by some Republicans that the Obama administration did not try to respond militarily to the crisis. The attack was not a running eight-hour firefight as some critics have contended, questioning how an adequate response could not be mustered in that time, but rather two relatively short, intense assaults separated by a lull of four hours. But the administration’s response also shows that the forces in the region had not been adequately reconfigured.

The Africa Command was spun off from the European Command. At the time it was set up, the Pentagon thought it would be devoted mostly to training African troops and building military ties with African nations. Because of African sensitivities about an overt American military presence in the region, the command’s headquarters was established in Stuttgart, Germany.

While the other regional commands, including the Pacific Command and the Central Command, responsible for the Middle East and South Asia, have their own specialized quick-reaction forces, the Africa Command has had an arrangement to borrow the European Command’s force when needed. The Africa Command has been building its own team from scratch, and its nascent strike force was in the process of being formed in the United States on Sept. 11, a senior military official said.

“The conversation about getting them closer to Africa has new energy,” the military official said.

Some Pentagon officials said that it was unrealistic to think a quick-reaction force could have been sent in time even if the African Command had one ready to act on the base in Sicily when the attack unfolded, and asserted that such a small force might not have even been effective or the best means to protect an embassy. But critics say there has been a gap in the command’s quick-reaction capability, which the force would have helped fill.

A spokesman for the command declined to comment on how its capabilities might be improved.

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Corner Office | John Duffy: John Duffy of 3C Interactive, on Inspiration and Aspiration

Q. Tell me about your leadership approach.

A. Consistency is important to me. I think my partners and employees appreciate the fact that you get the same John Duffy every day, regardless of the circumstances. You don’t have to think about how to approach me. If one of my employees told me that they had to think about what my mood was on a particular day — “How is he? Can we talk?” — I’d quit. I never want to be that person.

Q. Why is that so important to you?

A. I had a boss who was consistent, pragmatic and disciplined, and he had a big impact on my career. I liked being able to do what I was doing and go back to him for stability and consistency. That helped me be more successful. So I don’t let the things that are bothering me affect how I communicate with people. I try not to, anyway.

Q. What else is important about your approach to leadership?

A. I want to be somebody who not only inspires people, but also helps them learn to aspire. I think there’s a pretty big difference.

Q. Parse that for me.

A. Well, I’m a pretty good salesperson, and I think I’m a fun guy. And if we go out and spend some time and have lunch or a couple of beers, I think you’ll go away being happy that you spent time with me. You’ll feel good, and hopefully inspired by my adventures and stories.

You can also be working with someone regularly and teaching them to aspire for their own development, and helping them understand that there’s a path, a trail of bread crumbs that they can follow that will make a difference in their life. It might be experiences they get, exposure to new things, the questions they ask themselves or the skills associated with planning, problem solving and decision making.

When I work with younger people in our company and talk to them about what they’re doing, why they’re doing it and how it fits into their life plan, hopefully that has a more powerful and longer-term effect than just inspiring them temporarily. I don’t want to be like the guy on the stage who makes you feel great. It’s about taking someone and helping them understand that they can have an impact.

Q. What are some other important leadership lessons you’ve learned?

A. One thing that is critical for me, and critical for the people in our business to be successful, is being coachable. I had a lot of experience with coaches in environments where I was the least successful person in the group. I was on a great wrestling team in college. I was not that great of a wrestler. I didn’t necessarily win a lot of matches, but I had an impact on the team. That has to do with having the attitude that I’m there because I want to get better. I could have gone to a team where I could have been the best player. That has zero appeal for me. I want to be the dumbest, poorest, least successful guy in the room so I can learn what I have to do. I’ve always felt that way.

Q. What are some things that are important to you in terms of culture?

A. We have absolutely clear discussions with everyone about how respect is the thing that cannot be messed with in our culture. We will not allow a cancer. When we have problems with somebody gossiping, or someone being disrespectful to a superior or a subordinate, or a peer, it is swarmed on and dealt with. We don’t always throw that person out, though there are times when you have to do that. But we make everyone understand that the reason the culture works is that we have that respect. And there is a comfort level and a feeling of safety inside our business.

We recently did an employee survey that was really intense. It wasn’t just, “Are you happy?” It was 11 questions about your happiness, answered on a scale of one to seven. The question that kept me up for a week was, “Do you trust John Duffy?” Not the company, not the mission. I was asking them about me. How do you feel about me? I got more than 90 percent extraordinarily positive responses. So that’s where it starts. I have to set the example for treating all of our employees properly, respectfully and appropriately.

When they’re awesome, I tell them they’re awesome. When they mess it up, they hear about it. But do it the right way. Do it consistently. Do it with respect. No yelling and screaming, but here’s our expectation, and here’s where you missed. What do you think you need to do to get better so this doesn’t happen again? That’s what creates the positive culture. That’s what attracts amazingly talented people.

Q. How do you hire?

A. If we’re going to bring someone into the company, especially in a leadership capacity, they have to be additive to the culture, so the process is going to take a while to make sure we’re going to enjoy working with them. And we have to make sure that what they’re going to do in our business helps them meet their long-term objectives. Before we hire people, we also ask them to write a plan. How are you going to be successful here in your first 100 days? Everyone has to do that.

Q. How many words do you typically want or expect?

A. That’s actually the best part. There’s no guidance. I’m asking you, what will you do? And there’s no wrong answer.

By the time a prospect is writing a plan to make a presentation on how they’ll be successful at our company, we’ve decided we want them. The plan is as much about understanding what they will do once they get here. What is their perspective of us? Where do they think they’ll add value? How will they get started? It’s as much about us learning what their expectations are, and where they think we’re at, so we can make that integration happen a little more seamlessly. It’s a very telling process. We lose some candidates when we ask for a plan. Somebody once said, “Are you going to pay me for that?”

Q. Really? They asked that?

A. That was my favorite: “Well, if you hire me as a consultant, I’ll write a plan.”

This interview has been edited and condensed.

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Opinion: Seeing Things? Hearing Things? Many of Us Do

HALLUCINATIONS are very startling and frightening: you suddenly see, or hear or smell something — something that is not there. Your immediate, bewildered feeling is, what is going on? Where is this coming from? The hallucination is convincingly real, produced by the same neural pathways as actual perception, and yet no one else seems to see it. And then you are forced to the conclusion that something — something unprecedented — is happening in your own brain or mind. Are you going insane, getting dementia, having a stroke?

In other cultures, hallucinations have been regarded as gifts from the gods or the Muses, but in modern times they seem to carry an ominous significance in the public (and also the medical) mind, as portents of severe mental or neurological disorders. Having hallucinations is a fearful secret for many people — millions of people — never to be mentioned, hardly to be acknowledged to oneself, and yet far from uncommon. The vast majority are benign — and, indeed, in many circumstances, perfectly normal. Most of us have experienced them from time to time, during a fever or with the sensory monotony of a desert or empty road, or sometimes, seemingly, out of the blue.

Many of us, as we lie in bed with closed eyes, awaiting sleep, have so-called hypnagogic hallucinations — geometric patterns, or faces, sometimes landscapes. Such patterns or scenes may be almost too faint to notice, or they may be very elaborate, brilliantly colored and rapidly changing — people used to compare them to slide shows.

At the other end of sleep are hypnopompic hallucinations, seen with open eyes, upon first waking. These may be ordinary (an intensification of color perhaps, or someone calling your name) or terrifying (especially if combined with sleep paralysis) — a vast spider, a pterodactyl above the bed, poised to strike.

Hallucinations (of sight, sound, smell or other sensations) can be associated with migraine or seizures, with fever or delirium. In chronic disease hospitals, nursing homes, and I.C.U.’s, hallucinations are often a result of too many medications and interactions between them, compounded by illness, anxiety and unfamiliar surroundings.

But hallucinations can have a positive and comforting role, too — this is especially true with bereavement hallucinations, seeing the face or hearing the voice of one’s deceased spouse, siblings, parents or child — and may play an important part in the mourning process. Such bereavement hallucinations frequently occur in the first year or two of bereavement, when they are most “needed.”

Working in old-age homes for many years, I have been struck by how many elderly people with impaired hearing are prone to auditory and, even more commonly, musical hallucinations — involuntary music in their minds that seems so real that at first they may think it is a neighbor’s stereo.

People with impaired sight, similarly, may start to have strange, visual hallucinations, sometimes just of patterns but often more elaborate visions of complex scenes or ranks of people in exotic dress. Perhaps 20 percent of those losing their vision or hearing may have such hallucinations.

I was called in to see one patient, Rosalie, a blind lady in her 90s, when she started to have visual hallucinations; the staff psychiatrist was also summoned. Rosalie was concerned that she might be having a stroke or getting Alzheimer’s or reacting to some medication. But I was able to reassure her that nothing was amiss neurologically. I explained to her that if the visual parts of the brain are deprived of actual input, they are hungry for stimulation and may concoct images of their own. Rosalie was greatly relieved by this, and delighted to know that there was even a name for her condition: Charles Bonnet syndrome. “Tell the nurses,” she said, drawing herself up in her chair, “that I have Charles Bonnet syndrome!”

Rosalie asked me how many people had C.B.S., and I told her hundreds of thousands, perhaps, in the United States alone. I told her that many people were afraid to mention their hallucinations. I described a recent study of elderly blind patients in the Netherlands which found that only a quarter of people with C.B.S. mentioned it to their doctors — the others were too afraid or too ashamed. It is only when physicians gently inquire (often avoiding the word “hallucination”) that people feel free to admit seeing things that are not there — despite their blindness.

Rosalie was indignant at this, and said, “You must write about it — tell my story!” I do tell her story, at length, in my book on hallucinations, along with the stories of many others. Most of these people have been reluctant to admit to their hallucinations. Often, when they do, they are misdiagnosed or undiagnosed — told that it’s nothing, or that their condition has no explanation.

Misdiagnosis is especially common if people admit to “hearing voices.” In a famous 1973 study by the Stanford psychologist David Rosenhan, eight “pseudopatients” presented themselves at various hospitals across the country, saying that they “heard voices.” All behaved normally otherwise, but were nonetheless determined to be (and treated as) schizophrenic (apart from one, who was given the diagnosis of “manic-depressive psychosis”). In this and follow-up studies, Professor Rosenhan demonstrated convincingly that auditory hallucinations and schizophrenia were synonymous in the medical mind.

WHILE many people with schizophrenia do hear voices at certain times in their lives, the inverse is not true: most people who hear voices (as much as 10 percent of the population) are not mentally ill. For them, hearing voices is a normal mode of experience.

My patients tell me about their hallucinations because I am open to hearing about them, because they know me and trust that I can usually run down the cause of their hallucinations. For the most part, these experiences are unthreatening and, once accommodated, even mildly diverting.

David Stewart, a Charles Bonnet syndrome patient with whom I corresponded, writes of his hallucinations as being “altogether friendly,” and imagines his eyes saying: “Sorry to have let you down. We recognize that blindness is no fun, so we’ve organized this small syndrome, a sort of coda to your sighted life. It’s not much, but it’s the best we can manage.”

Mr. Stewart has been able to take his hallucinations in good humor, since he knows they are not a sign of mental decline or madness. For too many patients, though, the shame, the secrecy, the stigma, persists.

Oliver Sacks is a professor of neurology at the N.Y.U. School of Medicine and the author, most recently, of the forthcoming book “Hallucinations.”

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Google Casts a Big Shadow on Smaller Web Sites

Annie Tritt for The New York Times

Jeffrey G. Katz, the chief executive of Wize Commerce, seen with employees. He says that about 60 percent of the traffic for the company’s Nextag comparison-shopping site comes from Google.

In a geeky fire drill, engineers and outside consultants at Nextag scrambled to see if the problem was its own fault. Maybe some inadvertent change had prompted Google’s algorithm to demote Nextag when a person typed in shopping-related search terms like “kitchen table” or “lawn mower.”

But no, the engineers determined. And traffic from Google’s search engine continued to decline, by half.

Nextag’s response? It doubled its spending on Google paid search advertising in the last five months.

The move was costly but necessary to retain shoppers, Mr. Katz says, because an estimated 60 percent of Nextag’s traffic comes from Google, both from free search and paid search ads, which are ads that are related to search results and appear next to them. “We had to do it,” says Mr. Katz, chief executive of Wize Commerce, owner of Nextag. “We’re living in Google’s world.”

Regulators in the United States and Europe are conducting sweeping inquiries of Google, the dominant Internet search and advertising company. Google rose by technological innovation and business acumen; in the United States, it has 67 percent of the search market and collects 75 percent of search ad dollars. Being big is no crime, but if a powerful company uses market muscle to stifle competition, that is an antitrust violation.

So the government is focusing on life in Google’s world for the sprawling economic ecosystem of Web sites that depend on their ranking in search results. What is it like to live this way, in a giant’s shadow? The experience of its inhabitants is nuanced and complex, a blend of admiration and fear.

The relationship between Google and Web sites, publishers and advertisers often seems lopsided, if not unfair. Yet Google has also provided and nurtured a landscape of opportunity. Its ecosystem generates $80 billion a year in revenue for 1.8 million businesses, Web sites and nonprofit organizations in the United States alone, it estimates.

The government’s scrutiny of Google is the most exhaustive investigation of a major corporation since the pursuit of Microsoft in the late 1990s.

The staff of the Federal Trade Commission has recommended preparing an antitrust suit against Google, according to people briefed on the inquiry, who spoke on the condition they not be identified. But the commissioners must vote to proceed. Even if they do, the government and Google could settle.

Google has drawn the attention of antitrust officials as it has moved aggressively beyond its dominant product — search and search advertising — into fields like online commerce and local reviews. The antitrust issue is whether Google uses its search engine to favor its offerings like Google Shopping and Google Plus Local over rivals.

For policy makers, Google is a tough call.

“What to do with an attractive monopolist, like Google, is a really challenging issue for antitrust,” says Tim Wu, a professor at Columbia Law School and a former senior adviser to the F.T.C. “The goal is to encourage them to stay in power by continuing to innovate instead of excluding competitors.”

SPEAKING at a Google Zeitgeist conference in Arizona last month, Larry Page, the company’s co-founder and chief executive, said he understood the government scrutiny of his company, given Google’s size and reach. “There’s very many decisions we make that really impact a lot of people,” he acknowledged.

The main reason is that Google is continually adjusting its search algorithm — the smart software that determines the relevance, ranking and presentation of search results, typically links to other Web sites.

Google says it makes the changes to improve its service, and has long maintained that its algorithm weeds out low-quality sites and shows the most useful results, whether or not they link to Google products.

“Our first and highest goal has to be to get the user the information they want as quickly and easily as possible,” says Matt Cutts, leader of the Web spam team at Google.

But Google’s algorithm is secret, and changes can leave Web sites scrambling.

Consider Vote-USA.org, a nonprofit group started in 2003. It provides online information for voters to avoid the frustration of arriving at a polling booth and barely recognizing half the names on the ballot. The site posts free sample ballots for federal, state and local elections with candidates’ pictures, biographies and views on issues.

In the 2004 and 2006 elections, users created tens of thousands of sample ballots. By 2008, traffic had fallen sharply, says Ron Kahlow, who runs Vote-USA.org, because “we dropped off the face of the map on Google.”

As founder of a search-engine optimization company and a recipient of grants that Google gives nonprofits to advertise free, Mr. Kahlow knows a thing or two about how to operate in Google’s world. He pored over Google’s guidelines for Web sites, made changes and e-mailed Google. Yet he received no response.

“I lost all donations to support the operation,” he said. “It was very, very painful.”

A breakthrough came through a personal connection. A friend of Mr. Kahlow knew Ed Black, chief executive of the Computer & Communications Industry Association, whose members include Google. Mr. Black made an inquiry on Mr. Kahlow’s behalf, and a Google engineer investigated.

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