The iEconomy: As Boom Lures App Creators, Tough Part Is Making a Living

Béatrice de Géa for The New York Times

Ethan Nicholas has made more than $1 million on an artillery game.

ROSEDALE, Md. — Shawn and Stephanie Grimes spent much of the last two years pursuing their dream of doing research and development for Apple, the world’s most successful corporation.

But they did not actually have jobs at Apple. It was freelance work that came with nothing in the way of a regular income, health insurance or retirement plan. Instead, the Grimeses tried to prepare by willingly, even eagerly, throwing overboard just about everything they could.

They sold one of their cars, gave some possessions to relatives and sold others in a yard sale, rented out their six-bedroom house and stayed with family for a while. They even cashed in Mr. Grimes’s 401(k).

“We didn’t lose any sleep over it,” said Mr. Grimes, 32. “I’ll retire when I die.”

The couple’s chosen field is so new it did not even exist a few years ago: writing software applications for mobile devices like the iPhone or iPad. Even as unemployment remained stubbornly high and the economy struggled to emerge from the recession’s shadow, the ranks of computer software engineers, including app writers, increased nearly 8 percent in 2010 to more than a million, according to the latest available government data for that category. These software engineers now outnumber farmers and have almost caught up with lawyers.

Much as the Web set off the dot-com boom 15 years ago, apps have inspired a new class of entrepreneurs. These innovators have turned cellphones and tablets into tools for discovering, organizing and controlling the world, spawning a multibillion-dollar industry virtually overnight. The iPhone and iPad have about 700,000 apps, from Instagram to Angry Birds.

Yet with the American economy yielding few good opportunities in recent years, there is debate about how real, and lasting, the rise in app employment might be.

Despite the rumors of hordes of hip programmers starting million-dollar businesses from their kitchen tables, only a small minority of developers actually make a living by creating their own apps, according to surveys and experts. The Grimeses began their venture with high hopes, but their apps, most of them for toddlers, did not come quickly enough or sell fast enough.

And programming is not a skill that just anyone can learn. While people already employed in tech jobs have added app writing to their résumés, the profession offers few options to most unemployed, underemployed and discouraged workers.

One success story is Ethan Nicholas, who earned more than $1 million in 2009 after writing a game for the iPhone. But he says the app writing world has experienced tectonic shifts since then.

“Can someone drop everything and start writing apps? Sure,” said Mr. Nicholas, 34, who quit his job to write apps after iShoot, an artillery game, became a sensation. “Can they start writing good apps? Not often, no. I got lucky with iShoot, because back then a decent app could still be successful. But competition is fierce nowadays, and decent isn’t good enough.”

The boom in apps comes as economists are debating the changing nature of work, which technology is reshaping at an accelerating speed. The upheaval, in some ways echoing the mechanization of agriculture a century ago, began its latest turbulent phase with the migration of tech manufacturing to places like China. Now service and even white-collar jobs, like file clerks and data entry specialists or office support staff and mechanical drafters, are disappearing.

“Technology is always destroying jobs and always creating jobs, but in recent years the destruction has been happening faster than the creation,” said Erik Brynjolfsson, an economist and director of the M.I.T. Center for Digital Business.

Still, the digital transition is creating enormous wealth and opportunity. Four of the most valuable American companies — Apple, Google, Microsoft and I.B.M. — are rooted in technology. And it was Apple, more than any other company, that set off the app revolution with the iPhone and iPad. Since Apple unleashed the world’s freelance coders to build applications four years ago, it has paid them more than $6.5 billion in royalties.

Read More..

The Neediest Cases: Emerging From a Bleak Life to Become Fabulous Phil

For years, Phillip Johnson was caught in what seemed like an endless trench of bad luck. He was fired from a job, experienced intensifying psychological problems, lost his apartment and spent time in homeless shelters. At one point, he was hospitalized after overdosing on an antipsychotic drug.

“I had a rough road,” he said.

Since his hospital stay two years ago, and despite setbacks, Mr. Johnson, 27, has been getting his life on track. At Brooklyn Community Services, where he goes for daily counseling and therapy, everybody knows him as Fabulous Phil.

“Phillip is a light, the way he evokes happiness in other people,” his former caseworker, Teresa O’Brien, said. “Phillip’s character led directly to his nickname.”

About six months ago, with Ms. O’Brien’s help, Mr. Johnson started an event: Fabulous Phil Friday Dance Party Fridays.

One recent afternoon at the agency, 30 clients and a few counselors were eating cake, drinking soft drinks and juice, and grooving for 45 minutes to Jay-Z and Drake pulsating from a boom box.

Mr. Johnson’s voice rose with excitement when he talked about the party. Clients and counselors, he said, “enjoy themselves.”

“They connect more; they communicate more,” he continued. “Everybody is celebrating and laughing.”

The leadership Mr. Johnson now displays seems to be a far cry from the excruciatingly introverted person he was.

As an only child living with his single mother in public housing in Bedford-Stuyvesant, Brooklyn, he said, he tended to isolate himself. “A lot of kids my age would say, ‘Come outside,’ but I would always stay in my room,” he said. He occupied himself by writing comic books or reading them, his favorites being Batman and Spiderman because, he said, “they were heroes who saved the day.”

After graduating from high school in 2003, he worked odd jobs until 2006, when he took a full-time position at a food court at La Guardia Airport, where he helped to clean up. The steady paycheck allowed him to leave his mother’s apartment and rent a room in Queens.

But the depression and bleak moods that had shadowed him throughout middle and high school asserted themselves.

“My thinking got confused,” he said. “Racing thoughts through my mind. Disorganized thoughts. I had a hard time focusing on one thing.”

In 2008, after two years on the job, Mr. Johnson was fired for loud and inappropriate behavior, and for being “unpredictable,” he said. The boss said he needed counseling. He moved back in with his mother, and in 2009 entered a program at an outpatient addiction treatment service, Bridge Back to Life. It was there, he said, that he received a diagnosis of schizophrenia and help with his depression and marijuana use.

But one evening in May 2010, he had a bout with insomnia.

He realized the antipsychotic medication he had been prescribed, Risperdal, made him feel tired, he said, so he took 12 of the pills, rather than his usual dosage of two pills twice a day. When 12 did not work, he took 6 more.

“The next morning when I woke up, it was hard for me to breathe,” he said.

He called an ambulance, which took to Woodhull Hospital. He was released after about a month.

Not long after, he returned to his mother’s apartment, but by February 2011, they both decided he should leave, and he relocated to a homeless shelter in East New York, where, he said, eight other people were crammed into his cubicle and there were “bedbugs, people lying in your bed, breaking into your locker to steal your stuff.”

In late spring 2011, he found a room for rent in Manhattan, but by Thanksgiving he was hospitalized again. Another stint in a shelter followed in April, when his building was sold.

Finally, in July, Mr. Johnson moved to supported housing on Staten Island, where he lives with a roommate. His monthly $900 Social Security disability check is sent to the residence, which deducts $600 for rent and gives him $175 in spending money; he has breakfast and lunch at the Brooklyn agency. To assist Mr. Johnson with unexpected expenses, a grant of $550 through The New York Times Neediest Cases Fund went to buy him a bed and pay a Medicare prescription plan fee for three months.

“I was so happy I have a bed to sleep on,” he said about the replacement for an air mattress. “When I have a long day, I have a bed to lay in, and I feel good about that.”

Mr. Johnson’s goals include getting his driver’s license — “I already have a learner’s permit,” he said, proudly — finishing his program at the agency, and then entering an apprenticeship program to become a plumber, carpenter or mechanic.

But seeing how his peers have benefited from Fabulous Phil Fridays has made him vow to remain involved with people dealing with mental illnesses or substance abuse.

He was asked at the party: Might he be like the comic-book heroes he loves? A smile spread across his face. He seemed to think so.

Read More..

The Neediest Cases: Emerging From a Bleak Life to Become Fabulous Phil

For years, Phillip Johnson was caught in what seemed like an endless trench of bad luck. He was fired from a job, experienced intensifying psychological problems, lost his apartment and spent time in homeless shelters. At one point, he was hospitalized after overdosing on an antipsychotic drug.

“I had a rough road,” he said.

Since his hospital stay two years ago, and despite setbacks, Mr. Johnson, 27, has been getting his life on track. At Brooklyn Community Services, where he goes for daily counseling and therapy, everybody knows him as Fabulous Phil.

“Phillip is a light, the way he evokes happiness in other people,” his former caseworker, Teresa O’Brien, said. “Phillip’s character led directly to his nickname.”

About six months ago, with Ms. O’Brien’s help, Mr. Johnson started an event: Fabulous Phil Friday Dance Party Fridays.

One recent afternoon at the agency, 30 clients and a few counselors were eating cake, drinking soft drinks and juice, and grooving for 45 minutes to Jay-Z and Drake pulsating from a boom box.

Mr. Johnson’s voice rose with excitement when he talked about the party. Clients and counselors, he said, “enjoy themselves.”

“They connect more; they communicate more,” he continued. “Everybody is celebrating and laughing.”

The leadership Mr. Johnson now displays seems to be a far cry from the excruciatingly introverted person he was.

As an only child living with his single mother in public housing in Bedford-Stuyvesant, Brooklyn, he said, he tended to isolate himself. “A lot of kids my age would say, ‘Come outside,’ but I would always stay in my room,” he said. He occupied himself by writing comic books or reading them, his favorites being Batman and Spiderman because, he said, “they were heroes who saved the day.”

After graduating from high school in 2003, he worked odd jobs until 2006, when he took a full-time position at a food court at La Guardia Airport, where he helped to clean up. The steady paycheck allowed him to leave his mother’s apartment and rent a room in Queens.

But the depression and bleak moods that had shadowed him throughout middle and high school asserted themselves.

“My thinking got confused,” he said. “Racing thoughts through my mind. Disorganized thoughts. I had a hard time focusing on one thing.”

In 2008, after two years on the job, Mr. Johnson was fired for loud and inappropriate behavior, and for being “unpredictable,” he said. The boss said he needed counseling. He moved back in with his mother, and in 2009 entered a program at an outpatient addiction treatment service, Bridge Back to Life. It was there, he said, that he received a diagnosis of schizophrenia and help with his depression and marijuana use.

But one evening in May 2010, he had a bout with insomnia.

He realized the antipsychotic medication he had been prescribed, Risperdal, made him feel tired, he said, so he took 12 of the pills, rather than his usual dosage of two pills twice a day. When 12 did not work, he took 6 more.

“The next morning when I woke up, it was hard for me to breathe,” he said.

He called an ambulance, which took to Woodhull Hospital. He was released after about a month.

Not long after, he returned to his mother’s apartment, but by February 2011, they both decided he should leave, and he relocated to a homeless shelter in East New York, where, he said, eight other people were crammed into his cubicle and there were “bedbugs, people lying in your bed, breaking into your locker to steal your stuff.”

In late spring 2011, he found a room for rent in Manhattan, but by Thanksgiving he was hospitalized again. Another stint in a shelter followed in April, when his building was sold.

Finally, in July, Mr. Johnson moved to supported housing on Staten Island, where he lives with a roommate. His monthly $900 Social Security disability check is sent to the residence, which deducts $600 for rent and gives him $175 in spending money; he has breakfast and lunch at the Brooklyn agency. To assist Mr. Johnson with unexpected expenses, a grant of $550 through The New York Times Neediest Cases Fund went to buy him a bed and pay a Medicare prescription plan fee for three months.

“I was so happy I have a bed to sleep on,” he said about the replacement for an air mattress. “When I have a long day, I have a bed to lay in, and I feel good about that.”

Mr. Johnson’s goals include getting his driver’s license — “I already have a learner’s permit,” he said, proudly — finishing his program at the agency, and then entering an apprenticeship program to become a plumber, carpenter or mechanic.

But seeing how his peers have benefited from Fabulous Phil Fridays has made him vow to remain involved with people dealing with mental illnesses or substance abuse.

He was asked at the party: Might he be like the comic-book heroes he loves? A smile spread across his face. He seemed to think so.

Read More..

The iEconomy: As Boom Lures App Creators, Tough Part Is Making a Living

Béatrice de Géa for The New York Times

Ethan Nicholas has made more than $1 million on an artillery game.

ROSEDALE, Md. — Shawn and Stephanie Grimes spent much of the last two years pursuing their dream of doing research and development for Apple, the world’s most successful corporation.

But they did not actually have jobs at Apple. It was freelance work that came with nothing in the way of a regular income, health insurance or retirement plan. Instead, the Grimeses tried to prepare by willingly, even eagerly, throwing overboard just about everything they could.

They sold one of their cars, gave some possessions to relatives and sold others in a yard sale, rented out their six-bedroom house and stayed with family for a while. They even cashed in Mr. Grimes’s 401(k).

“We didn’t lose any sleep over it,” said Mr. Grimes, 32. “I’ll retire when I die.”

The couple’s chosen field is so new it did not even exist a few years ago: writing software applications for mobile devices like the iPhone or iPad. Even as unemployment remained stubbornly high and the economy struggled to emerge from the recession’s shadow, the ranks of computer software engineers, including app writers, increased nearly 8 percent in 2010 to more than a million, according to the latest available government data for that category. These software engineers now outnumber farmers and have almost caught up with lawyers.

Much as the Web set off the dot-com boom 15 years ago, apps have inspired a new class of entrepreneurs. These innovators have turned cellphones and tablets into tools for discovering, organizing and controlling the world, spawning a multibillion-dollar industry virtually overnight. The iPhone and iPad have about 700,000 apps, from Instagram to Angry Birds.

Yet with the American economy yielding few good opportunities in recent years, there is debate about how real, and lasting, the rise in app employment might be.

Despite the rumors of hordes of hip programmers starting million-dollar businesses from their kitchen tables, only a small minority of developers actually make a living by creating their own apps, according to surveys and experts. The Grimeses began their venture with high hopes, but their apps, most of them for toddlers, did not come quickly enough or sell fast enough.

And programming is not a skill that just anyone can learn. While people already employed in tech jobs have added app writing to their résumés, the profession offers few options to most unemployed, underemployed and discouraged workers.

One success story is Ethan Nicholas, who earned more than $1 million in 2009 after writing a game for the iPhone. But he says the app writing world has experienced tectonic shifts since then.

“Can someone drop everything and start writing apps? Sure,” said Mr. Nicholas, 34, who quit his job to write apps after iShoot, an artillery game, became a sensation. “Can they start writing good apps? Not often, no. I got lucky with iShoot, because back then a decent app could still be successful. But competition is fierce nowadays, and decent isn’t good enough.”

The boom in apps comes as economists are debating the changing nature of work, which technology is reshaping at an accelerating speed. The upheaval, in some ways echoing the mechanization of agriculture a century ago, began its latest turbulent phase with the migration of tech manufacturing to places like China. Now service and even white-collar jobs, like file clerks and data entry specialists or office support staff and mechanical drafters, are disappearing.

“Technology is always destroying jobs and always creating jobs, but in recent years the destruction has been happening faster than the creation,” said Erik Brynjolfsson, an economist and director of the M.I.T. Center for Digital Business.

Still, the digital transition is creating enormous wealth and opportunity. Four of the most valuable American companies — Apple, Google, Microsoft and I.B.M. — are rooted in technology. And it was Apple, more than any other company, that set off the app revolution with the iPhone and iPad. Since Apple unleashed the world’s freelance coders to build applications four years ago, it has paid them more than $6.5 billion in royalties.

Read More..

Israel Destroys Hamas Prime Minister’s Office

Bernat Armangue/Associated Press

A Palestinian man walked among debris after an Israeli airstrike on Saturday at the Gaza City office of Ismail Haniya, the prime minister of Hamas.

JERUSALEM — Israel retaliated for Palestinian rocket attacks on Tel Aviv and Jerusalem with five airstrikes before dawn Saturday on the Gaza City offices of Ismail Haniya, the prime minister of Hamas — the militant Islamist group that governs Gaza.

The military said it had struck more than 200 targets overnight, including scores of underground rocket launchers and smuggling tunnels in Rafah, on the Gaza-Egypt border. Along with Mr. Haniya’s headquarters, which was destroyed, the military said in a statement that it had struck the Hamas police and homeland security headquarters, and the house of a Hamas commander, Ahmed Randor.

Seven Hamas militants were killed Saturday morning in two separate attacks — four in Rafah, and three in the Al Maghazi refugee camp, in the middle of the Gaza Strip, Hamas said.

Explaining the Israeli rationale for moving from attacking purely militant targets to government buildings in Gaza, Mark Regev, a spokesman for Prime Minister Benjamin Netanyahu, said on Saturday, “It is clear that Hamas itself makes no distinction between its terrorist military machine and the government structure and that they are intertwined.

“We have seen Hamas consistently using so-called civilian facilities for the purposes of hiding their terrorist military machine, including weapons,” he added.

About 30 rockets were fired from Gaza into southern Israel on Saturday morning, one landing in the yard of a house. Three soldiers were slightly injured by one of the rockets, the Israeli military said.

Despite the fighting, Foreign Minister Rafik Abdessalem of Tunisia visited Gaza on Saturday, condemning the Israeli attacks during an appearance at the Al Shifa hospital.

“Israel has to understand that there is an international law and it has to respect the international law to stop the aggression against the Palestinian people,” The Associated Press reported Mr. Abdessalem as saying.

On Friday, emboldened by displays of Egyptian solidarity and undeterred by Israel’s advanced aerial firepower, Palestinian militants under siege in Gaza had broadened their rocket targets, aiming at Jerusalem for the first time, sending a second volley screeching toward Tel Aviv and pushing the Israelis closer to a ground invasion.

Israel’s government more than doubled the number of army reservists it could call to combat if needed in the increasingly lethal showdown with Gaza’s Hamas fighters and their affiliates, after they fired more than 700 rockets into southern Israel over the last year. The escalation has raised fears of a new chapter of war in the intractable Arab-Israeli conflict.

The Israeli military closed some roads adjacent to Gaza in anticipation of a possible infantry move into the territory, which would be the first Israeli military presence on the ground in Gaza since the three-week invasion of 2008-9.

Ghazi Hamad, the deputy foreign minister of Hamas, said Saturday that the Tunisian foreign minister’s visit, following the visit Friday by the Egyptian prime minister, showed that “we as Palestinians are not alone.”

“All Arab nations are with us and against the occupation,” he said. “This will give a strong message to the international community.”

Asked about the possibility of a ceasefire agreement, Mr. Hamad said Israel would have to agree to cancel the buffer zone, a strip of land 300 meters, or almost 1,000 feet, wide along the northern and eastern Gaza borders where Israel does not allow people to go; those who enter can be shot.

Mr. Hamad said the attacks on Hamas government buildings are “a policy of Israel to put pressure on people” but would not significantly change the dynamic of the current fighting.

“Israel has the capacity to destroy all buildings in Gaza, all homes,” he said. “But this is against humanity.

“They destroyed our government buildings before many times, but we rebuild again,” he added. “It’s a long struggle, a long story. It will not stop today or tomorrow.”

The Israel Defense Forces said it would “continue targeting sites that are used to carry out terror attacks against Israeli citizens.”

Many residents of Jerusalem, which Israel claims as its capital despite objections from the city’s large Palestinian population and others throughout the Middle East, were startled Friday when wartime sirens warning of impending danger wailed at dusk, followed by at least two dull thuds. Hamas’s military wing claimed in a statement that they were rockets fired from Gaza, 48 miles away, and had been meant to hit the Israeli Parliament.

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Shortcuts: The Meaning in a Drawer Full of Old Family Snapshots

Eric Thayer/Reuters

A resident found photos as she sifted the debris of a house destroyed by Hurricane Sandy in Union Beach, N.J.

I WASN’T going to write about Hurricane Sandy. I was going to write about the changing nature of photographs and our relationship to them in this digital age.

Doug Mills/The New York Times

Picture-taking is now mainly digital, making prints of photos uncommon.

But as I began my research, I came across a Facebook page where lost photos from the storm were posted. Called “Union Beach — Photos and Misplaced Items,” the page shows photos of newborns and birthday parties, weddings and family gatherings.

Starting the morning after the storm devastated her community of Union Beach, N.J., Jeanette Van Houten and her niece have collected over a thousand photos and some photo albums. She is making it her mission to scan and post to Facebook as many as possible, including those turned into the fire department, police station and borough hall.

In addition, she was handed a drawerful of over a thousand family photos that must have been wrenched from a dresser.

About 60 photos have been claimed so far, and some professionals have offered to restore damaged photos free.

“These photos were passed down through families and they survived Sandy, even if the structures they were in didn’t,” Ms. Van Houten said. “They tell our story.”

With the Facebook page, Ms. Van Houten uses newer technology to help people reconnect with their old-fashioned snapshots. And seeing the photographs of mundane scenes and milestones on Facebook, along with the grateful comments from people who got back a bit of their lives, reminded me of both the fragility and strength of photos and their continuing importance in our lives. Judith Dupré, author of “Monuments: America’s History in Art and Memory” (Random House, 2007), and other books, teaches a class at her local library in Mamaroneck, N.Y., called “Stories from My Life,” for older residents. They use photos and stories to write about their lives.

“They bring in a basketful of photos,” Ms. Dupré said. “Each one of these photos contains a story — they’re like a key that opens the door to a life.”

And a printed photo “is a different species than a digital photo,” she said. “I don’t think anyone’s figured out the place of digital photos in terms of memory keeping.”

When an elderly aunt of hers died and left behind lots of photographs, Ms. Dupré said the family took them to the memorial service.

“We had a table and people could select and take what they wanted,” she said. “It was a very moving part of the memorial.”

Of course, even prints can lose their meaning and poignancy through the generations.

And in some cases, as with Hurricane Sandy, photos may be safer in cyberspace than in an album on a bookshelf — as long as you remember to upload them to a site like Flickr, Shutterfly, Snapfish or countless other photo sites available. (And make sure you know how long a site will keep your photos. Some, for example, require you to show some activity at least once a year.) That way, if you lose your hard drive, you don’t lose your photos.

But Ms. Dupré said she worried that photos that existed only online somewhere might die with the photographer.

“I don’t even know what my parents have in terms of digital photography,” she said. She said she put the password to her photos safely away with her will and other documents, so her children can access them.

Now I’m not trying to say that the old-fashioned way is the only way. Photography has constantly evolved. The Brownie camera, first sold by Kodak for $1 in 1900, radicalized photography by making it available to just about everyone.

But, and I know this largely a generational thing, I can’t help but wonder about the ubiquity of the cellphone photo. As Ms. Dupré said, “The infinite number of digital photos that can be taken has devalued the single image and made one-of-a-kind prints that much more precious.”

E-mail: shortcuts@nytimes.com

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Drug Shortages Are Becoming Persistent in U.S.

Paul Davis, the chief of a rural ambulance squad in southern Ohio, was down to his last vial of morphine earlier this fall when a woman with a broken leg needed a ride to the hospital.

The trip was 30 minutes, and the patient was in pain. But because of a nationwide shortage, his morphine supply had dwindled from four doses to just one, presenting Mr. Davis with a stark quandary. Should he treat the woman, who was clearly suffering? Or should he save it for a patient who might need it more?

In the end, he opted not to give her the morphine, a decision that haunts him still. “I just feel like I’m not doing my job,” said Mr. Davis, who is chief of the rescue squad in Vernon, Ohio. He has since refilled his supply. “I shouldn’t have to make those kinds of decisions.”

From rural ambulance squads to prestigious hospitals, health care workers are struggling to keep vital medicines in stock because of a drug shortage crisis that is proving to be stubbornly difficult to fix. Rationing is just one example of the extraordinary lengths being taken to address the shortage, which health care workers say has ceased to be a temporary emergency and is now a fact of life. In desperation, they are resorting to treating patients with less effective alternative medicines and using expired drugs. The Cleveland Clinic has hired a pharmacist whose only job is to track down hard-to-find drugs.

Caused largely by an array of manufacturing problems, the shortage has prompted Congressional hearings, a presidential order and pledges by generic drug makers to communicate better with federal regulators.

The problem peaked in 2011, when a record 251 drugs were declared in short supply. This year, slightly more than 100 were placed on the list, and workers say the battle to keep pharmacy shelves stocked continues unabated. The list of hard-to-find medicines ranges from basic drugs like the heart medicine nitroglycerin to a lidocaine injection, which is used to numb tissue before surgery.

A deadly meningitis outbreak caused by contamination at a large drug producer could worsen the situation, federal officials have warned. The Food and Drug Administration said that shortages of six drugs — medicines used during surgery and to treat conditions like congestive heart failure — could get worse after a big compounding pharmacy closed over concerns about drug safety. The pharmacy, Ameridose, shares some management with the New England Compounding Center, which is at the center of a meningitis outbreak that has claimed 33 lives.

“When you can’t treat basic things — cardiac arrest, pain management, seizures — you’re in trouble,” said Dr. Carol Cunningham, the state medical director for the Ohio Department of Public Safety’s emergency services division. “When you only have five tools in your toolbox and three of them are gone, what do you do?”

Dr. Margaret A. Hamburg, the F.D.A. commissioner, said in an interview this week that she was “guardedly optimistic” that the shortage crisis was abating. “I think there’s been an enormous amount of progress,” she said. “We’re seeing real change in the number of shortages that we’re able to recognize early.” More than 150 new shortages have been prevented this year, according to the agency.

But Erin Fox, who tracks supply levels for a broader range of drugs at the University of Utah, said once a drug became scarce, it tended to stay scarce. The university’s Drug Information Service was actively tracking 282 hard-to-find products by the end of the third quarter of this year, a record.

“The shortages we have aren’t going away — they’re not resolving,” she said. “But the good news is we’re not piling more shortages on top.”

In 2011, prompted by emotional pleas by cancer patients and others who said the drug shortage was threatening lives, President Obama issued an executive order requiring drug makers to notify the F.D.A. when a shortage appeared imminent. The agency also loosened some restrictions on importing drugs, and sped up approvals by other manufacturers to make certain medicines.

A law passed this summer contains several provisions aimed at improving the situation, including expediting approval of new generic medicines and requiring the agency’s enforcement unit to better coordinate with its drug-shortage officials before it takes action against a manufacturer.

Ralph G. Neas, the chief executive of the Generic Pharmaceutical Association, said fixing the drug shortage was complex and would take time, but was a top priority. “One shortage is one shortage too many,” he said. “One patient not getting a critical drug is one patient too many.”

Federal drug officials trace much of the drug shortage crisis to delays at plants that make sterile injectable drugs, which account for about 80 percent of the scarce medicines. Nearly a third of the industry’s manufacturing capacity is not running because of plant closings or shutdowns to fix serious quality issues. Other shortages have been caused by supply disruptions of the raw ingredients used to make the drugs, or by manufacturers exiting the market.

Read More..

Drug Shortages Are Becoming Persistent in U.S.

Paul Davis, the chief of a rural ambulance squad in southern Ohio, was down to his last vial of morphine earlier this fall when a woman with a broken leg needed a ride to the hospital.

The trip was 30 minutes, and the patient was in pain. But because of a nationwide shortage, his morphine supply had dwindled from four doses to just one, presenting Mr. Davis with a stark quandary. Should he treat the woman, who was clearly suffering? Or should he save it for a patient who might need it more?

In the end, he opted not to give her the morphine, a decision that haunts him still. “I just feel like I’m not doing my job,” said Mr. Davis, who is chief of the rescue squad in Vernon, Ohio. He has since refilled his supply. “I shouldn’t have to make those kinds of decisions.”

From rural ambulance squads to prestigious hospitals, health care workers are struggling to keep vital medicines in stock because of a drug shortage crisis that is proving to be stubbornly difficult to fix. Rationing is just one example of the extraordinary lengths being taken to address the shortage, which health care workers say has ceased to be a temporary emergency and is now a fact of life. In desperation, they are resorting to treating patients with less effective alternative medicines and using expired drugs. The Cleveland Clinic has hired a pharmacist whose only job is to track down hard-to-find drugs.

Caused largely by an array of manufacturing problems, the shortage has prompted Congressional hearings, a presidential order and pledges by generic drug makers to communicate better with federal regulators.

The problem peaked in 2011, when a record 251 drugs were declared in short supply. This year, slightly more than 100 were placed on the list, and workers say the battle to keep pharmacy shelves stocked continues unabated. The list of hard-to-find medicines ranges from basic drugs like the heart medicine nitroglycerin to a lidocaine injection, which is used to numb tissue before surgery.

A deadly meningitis outbreak caused by contamination at a large drug producer could worsen the situation, federal officials have warned. The Food and Drug Administration said that shortages of six drugs — medicines used during surgery and to treat conditions like congestive heart failure — could get worse after a big compounding pharmacy closed over concerns about drug safety. The pharmacy, Ameridose, shares some management with the New England Compounding Center, which is at the center of a meningitis outbreak that has claimed 33 lives.

“When you can’t treat basic things — cardiac arrest, pain management, seizures — you’re in trouble,” said Dr. Carol Cunningham, the state medical director for the Ohio Department of Public Safety’s emergency services division. “When you only have five tools in your toolbox and three of them are gone, what do you do?”

Dr. Margaret A. Hamburg, the F.D.A. commissioner, said in an interview this week that she was “guardedly optimistic” that the shortage crisis was abating. “I think there’s been an enormous amount of progress,” she said. “We’re seeing real change in the number of shortages that we’re able to recognize early.” More than 150 new shortages have been prevented this year, according to the agency.

But Erin Fox, who tracks supply levels for a broader range of drugs at the University of Utah, said once a drug became scarce, it tended to stay scarce. The university’s Drug Information Service was actively tracking 282 hard-to-find products by the end of the third quarter of this year, a record.

“The shortages we have aren’t going away — they’re not resolving,” she said. “But the good news is we’re not piling more shortages on top.”

In 2011, prompted by emotional pleas by cancer patients and others who said the drug shortage was threatening lives, President Obama issued an executive order requiring drug makers to notify the F.D.A. when a shortage appeared imminent. The agency also loosened some restrictions on importing drugs, and sped up approvals by other manufacturers to make certain medicines.

A law passed this summer contains several provisions aimed at improving the situation, including expediting approval of new generic medicines and requiring the agency’s enforcement unit to better coordinate with its drug-shortage officials before it takes action against a manufacturer.

Ralph G. Neas, the chief executive of the Generic Pharmaceutical Association, said fixing the drug shortage was complex and would take time, but was a top priority. “One shortage is one shortage too many,” he said. “One patient not getting a critical drug is one patient too many.”

Federal drug officials trace much of the drug shortage crisis to delays at plants that make sterile injectable drugs, which account for about 80 percent of the scarce medicines. Nearly a third of the industry’s manufacturing capacity is not running because of plant closings or shutdowns to fix serious quality issues. Other shortages have been caused by supply disruptions of the raw ingredients used to make the drugs, or by manufacturers exiting the market.

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DealBook: As Labor Talks Collapse, Hostess Turns Out Lights

What might be the last Twinkie in America — at least for a while — rolled off a factory line Friday morning. It was just like the millions that had come before it, golden, cream-filled empty calories, a monument to classic American junk food.

But it is likely to be the last under the current management. After not one but two bankruptcies, Hostess Brands, the beleaguered purveyor of Twinkies, Ho Hos, Sno Balls and Wonder bread, announced plans to wind down operations and sell off its brands.

Since filing for Chapter 11 bankruptcy protection in January, Hostess has been trying to renegotiate its labor contracts in a bid to cut costs. But the talks fell apart, and last week one union went on strike.

The so-called liquidation will probably spell the end of Hostess, an 82-year-old company that has endured wars, countless diet fads and even an earlier Chapter 11 filing. Although the company could theoretically negotiate a last-minute deal with the union, Hostess is moving to shut factories and lay off a large majority of its 18,500 employees.

But Twinkies and the other well-known brands could eventually find new life under a different owner. As part of the process, Hostess is looking to auction off its assets, and suitors could find value in the portfolio.

“The potential loss of iconic brands is difficult,” said the company’s chief executive, Gregory F. Rayburn. “But it’s overshadowed by the 18,500 families that are out of work.”

The company’s current problems stem, in part, from the legacy of its past.

An amalgam of brands and businesses, the company has evolved over the years through acquisitions. In the 1960s and 1970s, the company, then called Interstate, bought more than a dozen regional bakeries scattered across the country. A couple of decades later, it paid $330 million for the Continental Baking Company, picking up a portfolio of brands like Wonder and Hostess.

As the national appetite for junk food waned, the company fell on hard times, struggling against rising labor and commodity costs. In 2004, it filed for bankruptcy for the first time.

Five years later, the company emerged from Chapter 11 as Hostess Brands, so named after its most prominent division. With America’s new health-conscious attitude, it sought to reshape the business to changing times, introducing new products like 100-calorie Twinkie Bites.

But the new private equity backers loaded the company with debt, making it difficult to invest in new equipment. Earlier this year, Hostess had more than $860 million of debt.

The labor costs, too, proved insurmountable, a situation that has been complicated by years of deal-making. The bulk of the work force belongs to 12 unions, including the International Brotherhood of Teamsters and the Bakery, Confectionery, Tobacco Workers and Grain Millers International Union.

The combination of debt and labor costs has hurt profits. The company posted revenue of $2.5 billion in the fiscal year 2011, the last available data. But it reported a net loss of $341 million.

With profits eroding, the company filed for Chapter 11 in January. It originally hoped to reorganize its finances, seeking lower labor costs, including an immediate 8 percent pay cut.

The negotiations have been contentious.

The Teamsters, which has 6,700 members at Hostess, said it played an instrumental role in ousting Hostess’s previous chief executive, Brian J. Driscoll, this year after the board tripled his compensation to $2.55 million. The union also hired a financial consultant, Harry J. Wilson, who had worked on the General Motors restructuring.

While highly critical of management missteps, the Teamsters agreed in September to major concessions, including cuts in wages and company contributions to health care. As part of the deal, the union was to receive a 25 percent share of the company’s stock and a $100 million claim in bankruptcy.

“The objective was to preserve jobs,” said Ken Hall, the Teamsters’ general secretary-treasurer. “When you have a company that’s in the financial situation that Hostess is, it’s just not possible to maintain everything you have.”

But Hostess reached an impasse with the bakery union. Frank Hurt, the union’s president, seemed to lose patience with Hostess’s management, upset that it was in bankruptcy for the second time despite $100 million in labor concessions. He saw little promise that management would turn things around.

“Our members decided they were not going to take any more abuse from a company they have given so much to for so many years,” said Mr. Hurt. “They decided that they were not going to agree to another round of outrageous wage and benefit cuts and give up their pension only to see yet another management team fail and Wall Street vulture capitalists and ‘restructuring specialists’ walk away with untold millions of dollars.”

About a month ago, Mr. Rayburn said, the bakers union stopped returning the company’s phone calls altogether. For its part, the bakery union said the company had taken an overly aggressive approach. David Durkee, the union’s secretary-treasurer, said Hostess had given an ultimatum. “They said, ‘If you do not ratify this, we are going to liquidate based on your vote.’ ”

With the company standing firm, the bakery union struck last week, affecting nearly two-thirds of the company’s factories across the country. The Teamsters drivers honored the picket line, further shutting down the operations. The company gave union members until 5 p.m. on Thursday to return to work.

Mr. Rayburn said the financial strain of the strike was too much for the company, which had already reached the limits of its bankruptcy financing. Over the last week, Hostess lost tens of millions of dollars as many customers’ orders went unfilled. And its lenders would not open their wallets one more time.

By Thursday morning, Hostess’s executives were ensconced in the company’s headquarters in Irving, Tex., still hoping that enough employees would return to work to resume production. A small number of workers had already crossed the picket lines that had sprung up at most of the baker’s factories, but more than 10 plants remained well below their necessary capacity.

Mr. Rayburn’s deadline of 5 p.m. passed without either side backing down. Soon after, executives asked the company’s legal advisers to finish the court motions that would begin the liquidation. Papers had been drawn up well before that afternoon.

Around 7 p.m., Mr. Rayburn had his final discussions with the company’s board and his senior managers and made the call to begin winding down.

“We were trying to focus on where people were having success, but I had to make a call,” Mr. Rayburn said.

A version of this article appeared in print on 11/17/2012, on page B1 of the NewYork edition with the headline: A Push to Save the Twinkies: As Labor Talks Collapse, Hostess Turns Out Lights.

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Israel Girds for Ground Assault in Gaza; Egypt’s Premier Visits

GAZA CITY — After a morning of heavy rocket fire from Gaza into Israel, the Israeli military seemed to be edging closer toward a ground invasion of Gaza on Friday, saying forces were “on standby” and “ready to enter should it be decided that a ground operation is necessary.”

In a statement, the Israeli military said paratrooper and infantry brigades had completed final preparations for a potential ground operation that would be the first since the winter of 2008-09, when Israel drew broad international reproach for an invasion that claimed 1,400 Palestinian lives for the loss of 13 Israelis.

The statement came after scores of rockets were fired into Israel, striking major cities of the south, causing widespread panic and damage and shattering plans for a temporary cease-fire during a remarkable visit to Gaza by the Egyptian prime minister that showed the shifting dynamics of Middle East politics since the turmoil of the so-called Arab Spring.

Word of the potential invasion emerged shortly before a rocket from Gaza struck somewhere near Tel Aviv after sirens wailed. It was the second such attempt to strike at the city in two days. Hamas said it fired a single “homemade” projectile toward Tel Aviv.

The rapidly escalating confrontation between Gaza and Israel followed an Israel airstrike on Wednesday that killed the top commander of Hamas, and the tit-for-tat violence is widely seen as a potential catalyst for broader hostilities at a time of spreading turmoil in Syria and elsewhere in the region.

The Israeli military said that Col. Amir Baram, commander of the Israeli Defense Forces’ paratroopers brigade, had addressed his forces during a preparatory briefing in the field, saying: “We are already 48 hours into an operation that we knew would have to happen. We have spoken about it during training, exercises and conferences. There is now doubt that we have to operate. This is why we enlisted, and why we have trained.”

Witnesses on the Gaza-Israel border said tanks had massed in several places.

Early on Friday, the Israeli military said it had called up 16,000 army reservists after Defense Minister Ehud Barak authorized the call-up of 30,000 reservists, if needed, to move against what it considers an unacceptable security threat from smuggled rockets amassed by Hamas, which does not recognize Israel’s right to exist.

It was not initially clear whether the show of Israeli force on the ground in fact portended an invasion or was meant as more of an intimidation tactic to further pressure Hamas leaders, who had all been forced into hiding on Wednesday after the Israelis killed the group’s military chief, Ahmed al-Jabari, in a pinpoint aerial bombing. But Israel’s preparations seemed to pick up on Friday after the persistent attempts to land rockets in Tel Aviv added new urgency while Hamas itself seemed emboldened by Egypt’s support.

“The time in which the Israeli occupation does whatever it wants in Gaza is gone,” said Ismail Haniya, the Hams prime minister.

Initially, the Egyptian initiative was portrayed as a potential harbinger of reduced hostilities, and, as Prime Minister Hesham Kandil of Egypt prepared to travel to Gaza, Israel agreed to a temporary conditional cease-fire for the visit. But the truce never took root.

Israel Radio said Palestinian militants fired 25 rockets into southern Israel, one of them striking a house. There were no immediate reports of casualties.

What sounded like airstrikes by Israeli F-16s were also audible in Gaza City. The Israeli military said no such strikes had taken place, but the Hamas Health Ministry reported that two people, including a child, were killed in the north of Gaza City while the Egyptian delegation was on the ground, pushing the Palestinian death toll in three days of aerial bombardment to 21.

Three Israelis were killed in a rocket attack on Thursday in Kiryat Malachi, a small town in southern Israel, when a rocket fired from Gaza struck their apartment building.

Mr. Kandil’s visit produced dramatic imagery to underpin the Egyptian government’s support for Hamas, which Israel, the United States and much of the West consider to be a terrorist organization.

Mr. Kandil and Mr. Haniya visited the Al Shifa hospital amid a huge scrum of bodyguards and journalists, saying they had carried the body of Mohammed Yasser, one of eight children who Palestinian health officials say have been killed in the surge of violence since a top Hamas commander was killed in an Israeli airstrike on Wednesday.

“This is the blood of our children on our clothes,” Mr. Haniya said as he showed spatters on his clothing, “These are the Egyptian and the Palestinian blood united together.”

Like President Mohamed Morsi of Egypt on Thursday, Mr. Kandil walked a delicate line between support for Hamas, condemnation of Israel and a quest for calm in a region increasingly threatened by the spillovers from Syria’s civil war, as well as by the long-festering impasse between the Israelis and Palestinians.

Jodi Rudoren reported from Gaza City, Isabel Kershner from Jerusalem, and Alan Cowell from Paris. Reporting was contributed by Fares Akram from Gaza, Rick Gladstone from New York, Rina Castelnuovo from Gaza-Israel border, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem, and Elisabeth Bumiller from Bangkok.

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