At Least 8 Die in Egyptian Riots after Soccer Verdict

CAIRO — An Egyptian court sentenced 21 people to death on Saturday on charges related to one of the world’s deadliest incidents of soccer violence, touching off an attempted jailbreak and a riot that killed at least 16 in the Mediterranean port city that is home to most of the defendants.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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DealBook: Despite Calm, Draghi Raises Economic Concerns

DAVOS, Switzerland — Dubbing 2012 as the year the euro was relaunched, the president of the European Central Bank expressed concern that renewed calm on financial markets had not yet led to economic growth and better lives for European citizens.

Mario Draghi, the E.C.B. president and the person who can probably take more credit than anyone for the relative tranquility that greets visitors to the World Economic Forum this year, used an appearance here to take stock of the state of the euro zone.

Mr. Draghi said that central bank measures last year had prevented a banking crisis. And he also praised government leaders for steps they took to strengthen the currency union, for example agreeing to put the E.C.B. in charge of supervising banks — a change that will be phased in over the next year.

And the net effect of those moves? ‘‘To say the least the jury is still out,’’ Mr. Draghi said. ‘‘We haven’t seen an equal momentum on the real side of the economy. That’s where we have to do some more.’’

The euro zone economy has stabilized at a very low level, Mr. Draghi said, and should begin to recover in the second half of 2013.

Data released Friday supported the thesis of a gradual recovery. The Ifo business climate index, a closely watched indicator of business confidence in Germany, rose more than expected. The survey suggested that the euro zone’s largest economy is growing again after a contraction at the end of 2012.

What’s more, the E.C.B. said Friday that more euro-zone banks than expected had chosen to make early repayment of three-year central bank loans they took out a year ago. The volume of early repayment is seen as a sign that at least some banks are healthier than they were, and able to raise money on their own. The E.C.B. said 278 banks would pay back 137 billion euros, of a total of 489 billion euros they borrowed a year ago at exceedingly low interest rates.

Banks could borrow the money at the E.C.B.’s benchmark interest rate, currently 0.75 percent. But some may have felt that there was a stigma attached. Even though the E.C.B. does not disclose borrowers, banks may have been concerned about appearing weak in the eyes of the central bank. In addition, banks needed to post bonds or other assets as collateral, and some may now prefer to deploy the assets elsewhere.

Looking ahead, Mr. Draghi described 2013 as a year of implementation, when the E.C.B. and governments would begin carrying out decisions they made last year.

The E.C.B. would begin assuming authority over banks, he said, and governments would carry out changes designed to improve their ability to respond to crises and police each other’s spending. As central supervisor, the E.C.B. central bank is expected to be more willing than national regulators to force sick banks to confront their problems.

Mr. Draghi defended the E.C.B.’s position that euro zone governments must continue to work to get spending under control. Austerity — a word Mr. Draghi said he does not like — has been a de facto condition for measures the central bank has taken to contain the crisis and give governments space for economic reforms.

‘‘Fiscal consolidation is unavoidable,’’ Mr. Draghi said during on-stage questioning by John Lipsky, a former first deputy managing director of the International Monetary Fund. ‘‘There can’t be any sustainable growth, any sustainable equity achieved through an endless creation of debt.’’

But Mr. Draghi conceded that budget cutting can push countries into recession, and he said governments should cut spending on operations rather than curtailing outlays for infrastructure projects like bridges and roads.

Asked by Mr. Lipsky whether the E.C.B. would follow the U.S. Federal Reserve in setting benchmarks for unemployment that would prompt the central bank to lower rates or take other action, Mr. Draghi said no.

But, in what could signal a subtle shift in E.C.B. thinking, Mr. Draghi suggested that the central bank can pursue economic growth as part of its prime mandate to defend price stability.

‘‘We have given plenty of evidence we can do so within the existing framework,’’ Mr. Draghi said.

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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..

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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India Ink: Five Questions For: Aminatta Forna

Aminatta Forna’s most recent novel, “The Memory of Love,” won the Commonwealth Writers’ Prize Best Book Award for 2011. 

Her previous novels include the “The Devil that Danced on the Water” and “Ancestor Stones,” which won the 2007 German Liberaturpreis, the Hurston Wright Legacy Award for Debut Fiction in 2007 and the Aidoo-Snyder Book Prize in the United States in 2010. India Ink interviewed her at the Jaipur Literature Festival.  

What are the occupational hazards of being a writer?

I don’t have a pension plan! I love it so much I can’t say that there are any but I think that a lot of people can write – some people write one book and never write another – and the reason that writers continue to write is that we are people who are capable of living in a room on our own with imaginary friends for the rest of our life. If you can do that, then you can be a writer but many people find they can’t do that.

What is your everyday writing ritual?

Most writers I know go for word counts, and I used to be a journalist so I guess that’s ingrained. But if you do something you have to have a goal. Some writers deny it but I think most people feel they have to have some sort of goal. We bought a house about 10 years ago and did up this whole room exactly the way I thought I wanted it as a writer and I discovered I couldn’t write a word in it. I had to go and write the whole book in the British library. Now I do work in that room.

I don’t have very many little fetishes but the one I do have is that I like a particular mug to drink out of. It’s just a small china cup and I get very upset if my husband moves it. He just can’t understand why it matters so much. And of course I’ve got a hoard of displacement activities – all the things you do when you should be writing. I put on the wash, I do the dishes, and I organize things. But they’re part of the ritual so at the beginning of a book the house is always very, very clean. But then once I’ve got past the end of the beginning as it were, once the book has got a certain momentum, then the house gets increasingly untidy because the writing takes over. But I firmly believe that all of those activities are part of the process of thinking. But nobody can talk to you while you do them. Which my husband does understand and the lady who cleans my house also understands.

Why does the Jaipur Literature Fest matter to you?

These festivals are just burgeoning all over the world and that’s really good because books are apparently under threat and we always hear that the publishing industry is dying yet there’s quite obviously a very strong interest in books and the ideas that books contain. But Jaipur in particular matters because it is away from what was once the center – it is the shifting of the center from outside the West and into these emerging cultural and economic powerhouses like India. Kenya’s now got a wonderful book festival, people are talking about maybe locating one in West Africa. The reason I come is because I can talk to audiences who are not the kind of people I find walking down the street in London.

How do you deal with your critics?

Well I understood quite early on that if I was going to accept the good ones I would have to accept the bad ones too so I try and take it on the chin. But when I did your job I went to interview Vikram Seth, and his response to me was, “It’s one person’s opinion.”

Why should we read your latest book, ‘The Memory of Love’?

Increasingly there are those of us who write from outside the center and those are the writers that I’m most interested in because they bring me into worlds that I did not previously know. And that as a writer is what I try to create. To both look at the particular of a world that other people might not know and look at the extremes that people face but also find the universality of that.

It’s also a good story.

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DealBook: Commerzbank to Cut Up to 6,000 Jobs

LONDON – Commerzbank, the second-largest lender in Germany, is planning to cut up to 6,000 jobs in a bid to increase earnings, joining other European banks that have announced restructuring plans in recent months.

The bank said on Thursday that it expected to eliminate 4,000 to 6,000 jobs by 2016, or 7 to 10 percent of its work force.

The layoffs will affect Commerzbank’s global operations, particularly a retail division that had expanded rapidly in recent years, according to a person with direct knowledge of the matter who spoke on condition of anonymity because he was not authorized to speak publicly.

In the wake of tougher capital requirements, sluggish economic growth and growing concerns about risky trading activity, several European banks have announced efforts to reduce their work forces, shed unwanted assets and increase capital reserves.

In October, the Swiss financial giant UBS said it would eliminate 10,000 jobs in its investment bank in a move to reduce exposure to risky trading activity and to focus on its wealth management division.

Barclays, which is to formally announce its own restructuring plan on Feb. 12, also started consulting with staff members in its investment banking unit this week over potential layoffs.

The expected job cuts at Barclays could result in up to a 10 percent reduction, or around 2,000 jobs, in the division, according to two people with direct knowledge of the matter who spoke on condition of anonymity because they were not authorized to speak publicly. On Thursday, Barclays started to reduce the size of its investment banking staff in Asia by 15 percent, or 70 jobs, according to one of the people.

On Jan. 17, the firm’s new chief executive, Antony P. Jenkins, told staff members they should leave the bank if they did not want to help rebuild its reputation. Barclays agreed last year to a $450 million settlement with American and British authorities over the manipulation of the London interbank offered rate, or Libor, a crucial benchmark rate.

The layoffs at Commerzbank come after efforts by the bank’s chief executive, Martin Blessing, to sell some of the firm’s 160 billion euros ($213 billion) of noncore assets, including shipping and real estate investments. The bank is also trying to reduce its exposure to European sovereign debt because of continuing volatility in countries like Spain and Greece.

Commerzbank said it would start negotiations with employee unions in early February to decide on the final number of layoffs. The announcement comes a day after Mr. Blessing was spotted at a party on Wednesday night at the luxury Belvedere hotel in Davos, whose attendees also included Deutsche Bank’s co-chief executive Anshu Jain. The Commerzbank chief is attending the World Economic Forum in the Swiss town.

Commerzbank received an 18.2 billion euro bailout from the German government in 2008 after its mistimed acquisition of a rival German bank, Dresdner, for 5.5 billion euros at the height of the financial crisis. As part of the deal, the German government still owns a 24 percent stake in Commerzbank.

Shares in Commerzbank bank rose less than 1 percent in morning trading in Frankfurt on Thursday.

European banks have been struggling through a series of recent financial scandals, mounting demands to increase capital reserves and growing political pressure to increase lending to stimulate local economies.

The Continent’s major financial institutions will begin reporting earnings next week, and analysts will be waiting to see if they will follow UBS’s lead in announcing major changes in response to these pressures.

“We believe that UBS has kicked off the much-awaited industry restructuring, even if each bank takes a different path,” Citigroup banking analysts told investors in a research note.

Neil Gough reported from Hong Kong. Jack Ewing contributed reporting from Davos.

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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Francis, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

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: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Francis, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

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

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Bits Blog: Keeping the Internet Safe From Governments

Even before the World Conference on International Telecommunications took place last month in Dubai, Internet activists anticipated trouble. So did Congress, which issued a resolution calling it “essential” that the Internet remain “stable, secure and free from governmental control.”

The worries proved prescient. The conference, which supposedly was going to modernize some ancient regulations, instead offered a treaty that in the eyes of some critics would have given repressive states permission to crack down on dissent. The United States delegate refused to sign it. Fifty-four other countries, including Canada, Peru, Japan and most of Western Europe, voted no as well.

The OpenNet Initiative estimates that about a third of Internet users live in countries that engage in “substantive” or “pervasive” blocking of Internet content. They tended to be among the 89 countries that signed the treaty, including Russia, Cambodia, Iran, China, Cuba, Egypt and Angola.

Those in favor of a free and open Internet have long had a problem with the International Telecommunication Union, the affiliate of the United Nations that ran the conference. They see the I.T.U., which dates back to 1865, as longing for the pre-Internet era, when its influence and fortunes were greater. As a result, activists think, the I.T.U. has become aligned with, and a tool of, countries that desire more governmental control over public speech.

In the wake of the Dubai meeting, there are renewed calls to scale back United States financing of the I.T.U. drastically. The logic is, why are taxpayers supporting an organization whose motives they oppose?

“Paying for both sides of a conflict is unsustainable and illogical, and should simply be corrected,” says the De-Fund the I.T.U. Web site, which has posted a petition on the White House Web site.

The De-Fund site notes that the petition is not asking the United States government to take an unprecedented first step. “Many of our free-market democratic allies, led by Germany, France, Spain and Finland, have already de-funded the I.T.U. Likewise, right-thinking American companies like I.B.M., Cingular, Microsoft, Fox, Agilent, Sprint, Harris, Loral and Xerox, and others, have already withdrawn their private-sector contributions from the I.T.U.”

The petition was the brainchild of Bill Woodcock, the Berkeley-based research director of Packet Clearing House, a nonprofit institute. “This is really about whether people should be allowed to say what they think,” Mr. Woodcock said. “The Internet enables free speech, and that makes it very dangerous to countries that try to control public discourse.”

The United States government contributes about 8 percent of the I.T.U.’s budget. The 55 countries that voted against the treaty contribute about three-quarters of it. If the White House receives 25,000 signatures by Feb. 10, it will review and quite possibly act on the petition. As of Tuesday, it had about 600 signatures with minimal publicity.

A spokesman for the I.T.U., which is based in Switzerland, did not respond to an e-mail seeking comment.

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