IHT Rendezvous: Gallery Stroll: Istanbul

ISTANBUL — Unpredictable weather means winter isn’t the most popular season for visiting Istanbul, but it is a great time for gallery-hopping: Many of the best museums and art spaces in the Beyoglu district have just opened compelling new exhibitions.

At Arter, the curator Emre Baykal has gathered mostly new works by Turkish artists to create the second installment of “Envy, Enmity, Embarrassment.” Here, the artist known as Canan presents the installation, “I beg you please do not speak to me of love,” a room plastered with erotic movie posters from the heyday of the Yesilcam porn industry of the 1970s. In a transparent case in one corner of the room is a seemingly innocent white bathrobe. Embroidered on its back is a suicide note.

Other interesting works include “Twin Goddess: The Sketch of an Encounter,” an embroidered collage by Nilbar Gures using ancient symbols from Anatolian archaeology, and “The Island” by Hera Buyuktasciyan, a look at taboos swept under the rug.

The most powerful piece in this show is Hale Tenger’s “I Know People Like This III.” Visitors who enter the gallery from Istiklal Caddesi walk through this chronological maze of x-ray prints, a sort of light-box labyrinth, that lays out traumatic images from Turkish political history, including public protests, the killing of journalists and scenes of violence that followed the 1980 military coup.

On the parallel street, Mesrutiyet Caddesi, the Pera Museum has just opened a double-barreled program. A retrospective of the works of the Hungarian-American photographer Nickolas Muray covers the dashing man-about-town’s early black-and-white art nudes as well as his color-saturated portraits of beauties like Marilyn Monroe, Elizabeth Taylor and a woman he adored, Frida Kahlo. On another floor, “Between Desert and Sea” presents a selection of 52 works from the Jordan National Gallery of Fine Arts, pieces that speak to topical issues like religion, the rights of women, and the impact of the Arab Spring revolutions.

At the Salt Galata, a 10-minute stroll away on Bankalar Caddesi, “1 + 8″ is an installation of large-screen videos by Cynthia Madansky and Angelika Brudniak, who traveled to the borders between Turkey and its eight neighbors: Greece, Bulgaria, Georgia, Armenia, Nakchivan, Iran, Iraq and Syria to tape local residents talking about their daily lives and hopes. In the case of Iran, just a black screen is shown: The artists were refused permission to film in Iran, but they managed to record audio of Iranians who had crossed into Turkey for personal or business reasons. None felt safe having their faces shown.

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Gadgetwise Blog: Is January the Time to Buy Electronics?

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

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

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

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

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

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

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

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

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


Drew Angerer/The New York Times


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







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




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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


This article has been revised to reflect the following correction:

Correction: January 25, 2013

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



Read More..

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


Drew Angerer/The New York Times


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







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




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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


This article has been revised to reflect the following correction:

Correction: January 25, 2013

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



Read More..

Labor Relations Board Rulings Could Be Undone



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


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


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


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


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


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


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


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


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Syrian Refugees Entering Jordan in Record Numbers, U.N. Says





GENEVA — Syrians are fleeing into Jordan in record numbers to escape escalating violence and destruction that is making it increasingly difficult for civilians to survive, the United Nations refugee agency said on Friday.




More than 4,000 Syrians arrived at a camp in Zaatari in northern Jordan on Thursday and another 2,000 people overnight, Melissa Fleming, the spokeswoman for the United Nations High Commissioner for Refugees, said.


The influx, consisting mainly of families led by women, brought to more than 30,000 the number of Syrians reaching Zaatari this month, close to double the number who arrived in December, Ms. Fleming said.


Many had come from the city and suburbs of Daraa, Ms. Fleming said, and described a “real day-to-day struggle to survive” in the face of combat damage, the closure of medical facilities and shortages of food, water and electricity.


The Zaatari camp, which opened in July, already has some 65,000 people and the agency said it is working with Jordanian authorities to open a second camp by the end of the month to initially accommodate 5,000 refugees and eventually serve some 30,000 people.


Many families arrive with young children or babies, and Zaatari has recorded seven to 10 babies born every day over the past month, according to Ms. Fleming. Many Syrians arrived sick because of the collapse of medical services. Three children died in the camp this week, including a two-day old infant, she said.


The refugee agency reported it is also working double shifts to try to register Syrians who are living elsewhere in Jordan and expects to have 50,000 on its books by the end of February but it noted that Jordanian authorities say 300,000 Syrians have now entered the country.


Jordan’s fears for the impact of this influx on its own stability surfaced last week when Prime Minister Abdullah Ensour said that if the Syrian government collapsed it would not allow refugees to cross its border, but that it would use its military to create safe havens inside Syria for those displaced by conflict.


The number of Syrian refugees in the region is approaching 700,000, the refugee agency said, with 221,000 registered as refugees in Lebanon, 156,000 in Turkey and 76,000 in Iraq.


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Apple Labor Audits Uncover Underage Workers



SAN FRANCISCO — Apple stepped up audits of working conditions at major suppliers last year, discovering multiple cases of employment of underage workers, discrimination and wage problems.


The company, which relies heavily on Asia-based partners like Foxconn Technology Group of Taiwan to assemble its devices, said Thursday that it had conducted 393 audits, up 72 percent from 2011, reviewing sites where more than 1.5 million workers make its gadgets.


In recent years, Apple has faced accusations of building its profits on the backs of poorly treated and severely underpaid workers in China.


That criticism came to the fore around 2010, after reports of suicides at Foxconn drew attention to the long hours that migrant laborers frequently endured, often for a pittance in wages and in severely cramped living conditions.


Foxconn is the trading name of Hon Hai Precision Industry. The company employs 1.2 million workers across China.


Under Tim Cook, who took over as chief executive from Steve Jobs in 2011, Apple has taken steps to improve its record and increase transparency, with measures like the extensive audits of its sprawling supply chain. Last year, it agreed to separate audits by the independent Fair Labor Association.


In an interview Thursday, the senior vice president of operations at Apple, Jeff Williams, said the company had increased its efforts to solve two of the most challenging issues: ensuring there are no underage workers in its supply chain and limiting work time to 60 hours a week.


Apple is now investigating its smaller suppliers — which typically face less oversight on such issues — to bring them into compliance, sometimes even firing them.


“We go deep in the supply chain to find it,” Mr. Williams said. “And when we do find it, we ensure that the underage workers are taken care of, the suppliers are dealt with.”


In one case, Apple terminated its relationship with a component maker after discovering 74 cases in which underage workers were being employed. Apple also found that an employment agency had forged documents to allow children to work illegally at the supplier.


Apple reported both the supplier and the employment agency to the local authorities, the company said in its latest annual report on the conditions in its supply chain.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read More..

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read More..

DealBook: S.E.C. Pick Is Ex-Prosecutor, in Signal to Wall Street

9:13 p.m. | Updated

The White House delivered a strong message to Wall Street on Thursday, taking the unusual step of choosing two former prosecutors as top financial regulators.

But translating that message into action will not be easy, given the complexities of the market and Wall Street’s aggressive nature.

At a short White House ceremony, President Obama named Mary Jo White, the first female United States attorney in Manhattan, to run the Securities and Exchange Commission. Mr. Obama also renominated Richard Cordray as the director of the Consumer Financial Protection Bureau, a position he has held for the last year under a temporary recess appointment without Senate approval.

With the appointments, the president showed a renewed resolve to hold Wall Street accountable for wrongdoing, extolling his candidates’ records as prosecutors.

Ms. White spent more than a decade as a top federal prosecutor in New York City, overseeing the prosecution of the crime boss John Gotti and those responsible for the 1993 World Trade Center bombing. As an Ohio prosecutor, Mr. Cordray filed lawsuits against Bank of America and the American International Group.

“It’s not enough to change the law,” Mr. Obama said. “We also need cops on the beat to enforce the law.”

Still, Ms. White and Mr. Cordray face their own challenges.

While Ms. White, 65, is best known as an aggressive prosecutor, she also built a lucrative legal practice defending Wall Street executives, a potential concern for consumer advocates. And she lacks experience in the financial minutiae central to a regulatory role.

Mr. Cordray, 53, presents another potential problem for the White House. The Senate last year declined to confirm him in the face of Republican and Wall Street opposition to the newly created consumer bureau. Several Republicans on Thursday again voiced their concerns.

“There’s absolutely no excuse for the Senate to wait any longer to confirm him,” Mr. Obama said.

Both Midwestern natives, Ms. White and Mr. Cordray arrived in Washington as outsiders. A five-time “Jeopardy” champion from Ohio, Mr. Cordray became the consumer bureau’s enforcement chief after losing re-election for state attorney general. As Ohio’s top prosecutor, he became known as the Midwestern sheriff of Wall Street.

Ms. White, who was born in Kansas City, Mo., changed career paths after graduating with a master’s degree in psychology. She obtained a law degree from Columbia University in 1974, and a few years later, began her first stint as a federal prosecutor in Manhattan.

She ultimately became the United States attorney in Manhattan, earning a reputation as a tenacious prosecutor with an independent streak. Ms. White embraced the often-repeated joke that her office was the United States attorney for the “sovereign,” rather than Southern, district of New York.

In 1997, aides to Manhattan District Attorney Robert M. Morgenthau accused her of trying to thwart a state insider trading investigation by allowing a defendant charged by the district attorney’s office to plead guilty to federal charges. Doing so effectively ended Mr. Morgenthau’s case, but Ms. White was unapologetic. “To prosecute such crimes under only state law diminishes their seriousness,” she said at the time.

As the chief federal prosecutor in Manhattan, Ms. White pursued white-collar crime and Wall Street fraud. She secured a $340 million fine against Daiwa Bank for illegally covering up trading losses and other crimes.

She distinguished her career with a series of terrorism cases. She supervised the original investigation into Osama bin Laden and Al Qaeda, and oversaw six major trials, including those stemming from the 1993 World Trade Center bombing and a plot to blow up New York landmarks.

Patrick J. Fitzgerald, the former United States attorney in Chicago who previously worked under Ms. White, called her “a force of nature.”

She also trained a generation of federal prosecutors. Two former assistants became high-level S.E.C. officials: Robert S. Khuzami, the departing enforcement chief, and George S. Canellos, his deputy. Preet Bharara, the current United States attorney in Manhattan, whom Ms. White hired in 1999, emphasized her “legendary work ethic,” citing her 1 a.m. e-mail dispatches. Her philosophy, Mr. Bharara said, was that prosecuting wrongdoing was “not just about earning notches on your belt.”

While former employees described her as “no nonsense,” she was often spotted sipping a Bud Light at a weekly social gathering for junior prosecutors. And despite being barely 5 feet tall, she also was an exuberant point guard in a local lawyers’ basketball league, and once arrived at a tennis match on a red motorcycle, while Helen Reddy’s “I Am Woman” blared loudly.

With her prosecutorial victories and independent political status, Ms. White is expected to receive broad support on Capitol Hill. Senator Charles E. Schumer of New York joined a chorus of Democratic enthusiasm on Thursday, declaring that Ms. White was a “tough-as-nails prosecutor.”

But she could face questions about her command of Wall Street arcana.

Regulatory chiefs are often market experts or academics. If confirmed, Ms. White will succeed Elisse B. Walter, a longtime S.E.C. official, who took over as chairwoman after Mary L. Schapiro stepped down as the agency’s leader in December. Ms. Schapiro, a seasoned policy maker and specialist in market structure, overhauled the agency after it was blamed for missing the warning signs of the financial crisis. Ms. White, in contrast, built her career on the law-and-order side of the securities industry, with just a brief stint as a director of the Nasdaq.

The gaps in her résumé could complicate Ms. White’s agenda in the face of fierce Wall Street lobbying. Under the next chairman, the agency must write dozens of rules to carry out the Dodd-Frank act, a regulatory overhaul passed in response to the crisis. The agency also must grapple with the increasingly complex markets and rapid-fire trading that dominate Wall Street.

People close to the S.E.C. note, however, that her husband, John W. White, is a veteran of the agency. From 2006 through 2008, he was head of the S.E.C.’s division of corporation finance.

Ms. Schapiro also argued that Ms. White’s outsider status could inject new life into the agency. “Nobody comes in an expert across the board,” Ms. Schapiro said. “A fresh look on some of these policy issues might be exactly what we need.”

Ms. White could face additional questions about her career, a revolving door in and out of government. In private practice, she defended some of Wall Street’s biggest names, including Kenneth D. Lewis, a former chief of Bank of America. As the head of litigation at Debevoise & Plimpton, she also represented JPMorgan Chase and the board of Morgan Stanley.

Barbara S. Jones, who retired recently from the federal bench in Manhattan and now practices law at the firm Zuckerman Spaeder, said Ms. White, a close friend, would benefit from both prosecuting and defending executives over her career. “She has been on both sides,” Ms. Jones said. “She will be tough when she has to be, but she’ll be fair.”

At the White House on Thursday, Ms. White spoke only briefly, saying she would work “to protect investors and to ensure the strength, efficiency and the transparency of our capital markets.” Mr. Obama noted that Ms. White, whose 43rd wedding anniversary fell on Thursday, was a childhood fan of “The Hardy Boys,” as he was, adding that she “built a career the Hardy boys could only dream of.” “You don’t want to mess with Mary Jo,” he said.

Peter Baker and Kitty Bennett contributed reporting.

A version of this article appeared in print on 01/25/2013, on page A1 of the NewYork edition with the headline: Sign to Wall St. In Obama’s Picks For Regulators.
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