Gays in Pakistan Move Cautiously to Gain Acceptance

Max Becherer for the International Herald Tribune

HIDING IN PLAIN SIGHT Ali, a gay man who lives in Lahore, is in a support group for lesbian, gay, bisexual and transgender Pakistanis. “The gay scene here is very hush-hush,” he says.

LAHORE, Pakistan — The group meets irregularly in a simple building among a row of shops here that close in the evening. Drapes cover the windows. Sometimes members watch movies or read poetry. Occasionally, they give a party, dance and drink and let off steam.

The group is invitation only, by word of mouth. Members communicate through an e-mail list and are careful not to jeopardize the location of their meetings. One room is reserved for “crisis situations,” when someone may need a place to hide, most often from her own family. This is their safe space — a support group for lesbian, gay, bisexual and transgender Pakistanis.

“The gay scene here is very hush-hush,” said Ali, a member who did not want his full name used. “I wish it was a bit more open, but you make do with what you have.”

That is slowly changing as a relative handful of younger gays and lesbians, many educated in the West, seek to foster more acceptance of their sexuality and to carve out an identity, even in a climate of religious conservatism.

Homosexual acts remain illegal in Pakistan, based on laws constructed by the British during colonial rule. No civil rights legislation exists to protect gays and lesbians from discrimination.

But the reality is far more complex, more akin to “don’t ask, don’t tell” than a state-sponsored witch hunt. For a long time, the state’s willful blindness has provided space enough for gays and lesbians. They socialize, organize, date and even live together as couples, though discreetly.

One journalist, in his early 40s, has been living as a gay man in Pakistan for almost two decades. “It’s very easy being gay here, to be honest,” he said, though he and several others interviewed did not want their names used for fear of the social and legal repercussions. “You can live without being hassled about it,” he said, “as long as you are not wearing a pink tutu and running down the street carrying a rainbow flag.”

The reason is that while the notion of homosexuality may be taboo, homosocial, and even homosexual, behavior is common enough. Pakistani society is sharply segregated on gender lines, with taboos about extramarital sex that make it almost harder to conduct a secret heterosexual romance than a homosexual one. Displays of affection between men in public, like hugging and holding hands, are common. “A guy can be with a guy anytime, anywhere, and no one will raise an eyebrow,” the journalist said.

For many in his and previous generations, he said, same-sex attraction was not necessarily an issue because it did not involve questions of identity. Many Pakistani men who have sex with men do not think of themselves as gay. Some do it regularly, when they need a break from their wives, they say, and some for money.

But all the examples of homosexual relations — in Sufi poetry, Urdu literature or discreet sexual conduct — occur within the private sphere, said Hina Jilani, a human rights lawyer and activist for women’s and minority rights. Homoeroticism can be expressed but not named.

“The biggest hurdle,” Ms. Jilani said, “is finding the proper context in which to bring this issue out into the open.”

That is what the gay and lesbian support group in Lahore is slowly seeking to do, even if it still meets in what amounts to near secrecy.

The driving force behind the group comes from two women, ages 30 and 33. They are keenly aware of the oddity that two women, partners no less, have become architects of the modern gay scene in Lahore; if gay and bisexual men barely register in the collective societal consciousness of Pakistan, their female counterparts are even less visible.

“The organizing came from my personal experience of extreme isolation, the sense of being alone and different,” the 30-year-old said.

She decided that she needed to find others like her in Pakistan. Eight people, mostly the couple’s friends, attended the first meeting in January 2009.

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

Q. Tell me about your leadership approach.

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

Q. Why is that so important to you?

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

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

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

Q. Parse that for me.

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

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

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

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

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

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

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

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

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

Q. How do you hire?

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

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

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

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

Q. Really? They asked that?

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

This interview has been edited and condensed.

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Second Illness Infects Meningitis Sufferers

Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.

The new problem, called an epidural abscess, is an infection near the spine at the site where the drug — contaminated by a fungus — was injected to treat back or neck pain. The abscesses are a localized infection, different from meningitis, which affects the membranes covering the brain and spinal cord. But in some cases, an untreated abscess can cause meningitis. The abscesses have formed even while patients were taking powerful antifungal medicines, putting them back in the hospital for more treatment, often with surgery.

The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.

“We’re hearing about it in Michigan and other locations as well,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the Centers for Disease Control and Prevention. “We don’t have a good handle on how many people are coming back.”

He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”

In the last few days, about a third of the 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, Mich., have returned with abscesses, said Dr. Lakshmi K. Halasyamani, the chief medical officer.

“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”

She and other experts said they were especially puzzled that the infections could occur even though patients were taking drugs that, at least in tests, appeared to work against the fungus causing the infection, a type of black mold called Exserohilum.

The main symptom is severe pain near the injection site. But the abscesses are internal, with no visible signs on the skin, so it takes an M.R.I. scan to make the diagnosis. Some patients have more than one abscess. In some cases, the infection can be drained or cleaned out by a neurosurgeon.

But sometimes fungal strands and abnormal tissue are wrapped around nerves and cannot be surgically removed, said Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan. In such cases, all doctors can do is give a combination of antifungal drugs and hope for the best. They have very little experience with this type of infection.

Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.

A spokesman for the health department in Tennessee, which has had 78 meningitis cases, said that a few cases of epidural abscess had also occurred there, and that the state was trying to assess the extent of the problem.

Dr. Chiller said doctors were also reporting that some patients exposed to the tainted drug had arachnoiditis, a nerve inflammation near the spine that can cause intense pain, bladder problems and numbness.

“Unfortunately, we know from the rare cases of fungal meningitis that occur, that you can have complicated courses for this disease, and it requires prolonged therapy and can have some devastating consequences,” he said.

The meningitis outbreak, first recognized in late September, is one of the worst public health disasters ever caused by a contaminated drug. So far, 29 people have died, often from strokes caused by the infection. The case count is continuing to rise. The drug was a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. Three contaminated lots of the drug, more than 17,000 vials, were shipped around the country, and about 14,000 people were injected with the drug, mostly for neck and back pain. But some received injections for arthritic joints and have developed joint infections.

Inspections of the compounding center have revealed extensive contamination. It has been shut down, as has another Massachusetts company, Ameridose, with some of the same owners. Both companies have had their products recalled.

Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.

Read More..

Second Illness Infects Meningitis Sufferers

Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.

The new problem, called an epidural abscess, is an infection near the spine at the site where the drug — contaminated by a fungus — was injected to treat back or neck pain. The abscesses are a localized infection, different from meningitis, which affects the membranes covering the brain and spinal cord. But in some cases, an untreated abscess can cause meningitis. The abscesses have formed even while patients were taking powerful antifungal medicines, putting them back in the hospital for more treatment, often with surgery.

The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.

“We’re hearing about it in Michigan and other locations as well,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the Centers for Disease Control and Prevention. “We don’t have a good handle on how many people are coming back.”

He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”

In the last few days, about a third of the 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, Mich., have returned with abscesses, said Dr. Lakshmi K. Halasyamani, the chief medical officer.

“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”

She and other experts said they were especially puzzled that the infections could occur even though patients were taking drugs that, at least in tests, appeared to work against the fungus causing the infection, a type of black mold called Exserohilum.

The main symptom is severe pain near the injection site. But the abscesses are internal, with no visible signs on the skin, so it takes an M.R.I. scan to make the diagnosis. Some patients have more than one abscess. In some cases, the infection can be drained or cleaned out by a neurosurgeon.

But sometimes fungal strands and abnormal tissue are wrapped around nerves and cannot be surgically removed, said Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan. In such cases, all doctors can do is give a combination of antifungal drugs and hope for the best. They have very little experience with this type of infection.

Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.

A spokesman for the health department in Tennessee, which has had 78 meningitis cases, said that a few cases of epidural abscess had also occurred there, and that the state was trying to assess the extent of the problem.

Dr. Chiller said doctors were also reporting that some patients exposed to the tainted drug had arachnoiditis, a nerve inflammation near the spine that can cause intense pain, bladder problems and numbness.

“Unfortunately, we know from the rare cases of fungal meningitis that occur, that you can have complicated courses for this disease, and it requires prolonged therapy and can have some devastating consequences,” he said.

The meningitis outbreak, first recognized in late September, is one of the worst public health disasters ever caused by a contaminated drug. So far, 29 people have died, often from strokes caused by the infection. The case count is continuing to rise. The drug was a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. Three contaminated lots of the drug, more than 17,000 vials, were shipped around the country, and about 14,000 people were injected with the drug, mostly for neck and back pain. But some received injections for arthritic joints and have developed joint infections.

Inspections of the compounding center have revealed extensive contamination. It has been shut down, as has another Massachusetts company, Ameridose, with some of the same owners. Both companies have had their products recalled.

Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.

Read More..

Google Casts a Big Shadow on Smaller Web Sites

Annie Tritt for The New York Times

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

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

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

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

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

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

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

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

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

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

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

For policy makers, Google is a tough call.

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

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

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

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

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

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

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

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

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

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

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

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Petraeus’s Lower C.I.A. Profile Leaves Benghazi Void

WASHINGTON — In 14 months as C.I.A. director, David H. Petraeus has shunned the spotlight he once courted as America’s most famous general. His low-profile style has won the loyalty of the White House, easing old tensions with President Obama, and he has overcome some of the skepticism he faced from the agency’s work force, which is always wary of the military brass.

Brendan Smialowski/Getty Images

The low-profile style of David H. Petraeus, right, has won the loyalty of the White House, easing old tensions with President Obama.

Win Mcnamee/Getty Images

C.I.A. director, David H. Petraeus, right, appeared before the Senate Select Committee on Intelligence in Washington in January.

But since an attack killed four Americans seven weeks ago in Benghazi, Libya, his deliberately low profile, and the C.I.A.’s penchant for secrecy, have left a void that has been filled by a news media and Congressional furor over whether it could have been prevented. Rather than acknowledge the C.I.A.’s presence in Benghazi, Mr. Petraeus and other agency officials fought a losing battle to keep it secret, even as the events there became a point of contention in the presidential campaign.

Finally, on Thursday, with Mr. Petraeus away on a visit to the Middle East, pressure from critics prompted intelligence officials to give their own account of the chaotic night when two security officers died along with the American ambassador, J. Christopher Stevens, and another diplomat. The officials acknowledged for the first time that the security officers, both former members of the Navy SEALs, worked on contract for the C.I.A., which occupied one of the buildings that were attacked.

The Benghazi crisis is the biggest challenge so far in the first civilian job held by Mr. Petraeus, who retired from the Army and dropped the “General” when he went to the C.I.A. He gets mostly high marks from government colleagues and outside experts for his overall performance. But the transition has meant learning a markedly different culture, at an agency famously resistant to outsiders.

“I think he’s a brilliant man, but he’s also a four-star general,” said Senator Dianne Feinstein, the chairwoman of the Senate Intelligence Committee. “Four-stars are saluted, not questioned. He’s now running an agency where everything is questioned, whether you’re a four-star or a senator. It’s a culture change.”

Mr. Petraeus, who turns 60 next week, has had to learn that C.I.A. officers will not automatically defer to his judgments, as military subordinates often did. “The attitude at the agency is, ‘You may be the director, but I’m the Thailand analyst,’ ” said one C.I.A. veteran.

Long a media star as the most prominent military leader of his generation, Mr. Petraeus abruptly abandoned that style at the C.I.A. Operating amid widespread complaints about leaks of classified information, he has stopped giving interviews, speaks to Congress in closed sessions and travels the globe to consult with foreign spy services with little news media notice.

“He thinks he has to be very discreet and let others in the government do the talking,” said Michael E. O’Hanlon, a Brookings Institution scholar who is a friend of Mr. Petraeus’s and a member of the C.I.A.’s advisory board.

Mr. Petraeus’s no-news, no-nonsense style stands out especially starkly against that of his effusive predecessor, Leon E. Panetta, who is now the defense secretary.

Mr. Panetta, a gregarious politician by profession, was unusually open with Congress and sometimes with the public — to a fault, some might say, when he spoke candidly after leaving the C.I.A. about a Pakistani doctor’s role in helping hunt for Osama bin Laden, or about the agency’s drone operations.

Mr. Petraeus’s discretion and relentless work ethic have had a positive side for him: old tensions with Mr. Obama, which grew out of differing views on the wars in Iraq and Afghanistan, appear to be gone. Mr. Petraeus is at the White House several times a week, attending National Security Council sessions and meeting weekly with James R. Clapper Jr., the director of national intelligence, and Thomas E. Donilon, Mr. Obama’s national security adviser. Mr. Donilon said recently that the C.I.A. director “has done an exceptional job,” bringing “deep experience, intellectual rigor and enthusiasm” to his work.

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Urban Athlete: Discover Outdoors Offers Mountain Fitness Class

Willie Davis for The New York Times

Rey Soriano, foreground, holding himself on suspension trainers in a workout run by Discover Outdoors.

I HAVE spent a small fortune over the years on gym memberships. But all you really need to get in shape, I now know, are a few granite paving stones, some sandbags and a backpack full of water jugs.

Willie Davis for The New York Times

David Tacheny, center, leading an exercise known as “pack mule,” as Courtney McBride pulls May Yu Whu.

Willie Davis for The New York Times

Mr. Tacheny explaining how to use paving stones as weights.

Willie Davis for The New York Times

Wendy Tsang, left, lifting a Bulgarian sandbag.

Early one Sunday morning I arrived at the entrance to Riverside Park for an exercise class called Mountain Fitness. A Manhattan adventure outfitter, Discover Outdoors, describes the class as a way to “train like a guide,” and uses rocks, logs, sandbags and water jugs in a quest to improve “functional fitness.” The company started offering the class a year ago after customers asked how they should train for the more challenging hiking and trekking adventures it offers.

Our instructor, David Tacheny, a guide and personal trainer, told us that a typical gym workout doesn’t engage all the muscles you’ll use on, say, a rock-climbing excursion. A leg press machine, for instance, works the pushing muscles of the legs. Squatting while raising a heavy rock above your head, on the other hand, also uses the back, abdominal muscles and shoulders, and it better approximates what it’s like to lift an overstuffed backpack.

“This is how guides train,” he said. “We don’t go run miles on flat terrain. We don’t just pump iron.”

All the exercises can be adapted to different levels of fitness. Our group of eight (including one man) looked plenty fit and included several people who belonged to social sports clubs in the city and competed in triathlons. Melanie Pessin, a triathlon competitor, did an eight-mile run before showing up for class. “I’m training for a half-marathon,” she said.

After a 10-minute warm-up, Mr. Tacheny took us to a pile of rectangular paving stones, each weighing 25 to 40 pounds. Standing with legs apart, we swung our stones out from between our legs into the air, using our hips instead of our arms for power.

The “halo” routine entailed holding the stone at chin level and circling it in a tight arc around the head. Next were squat presses, with the stones raised over our heads. At this point my back muscles went on strike, forcing me to switch to an imaginary stone.

Why just lift stones, though, when you can run with them — or throw them? Mr. Tacheny had us hold our stones at chest level, heave them as far as we could toward a tree in the distance, then run to pick them up; we were to repeat the move until we reached the tree.

Next, he divided us into two groups for a rousing game of what I came to call ducking stones. Each team started with an equal number of stones at the base of a tree. We were supposed to fetch a stone and run with it, depositing it at the base of the opposing team’s tree. After two minutes, whichever team had the fewest stones remaining would win. Mayhem ensued, with stones flying everywhere, to the point where I would yell out, “Don’t hit me!” whenever I stooped to pick one up.

Next, Mr. Tacheny introduced the “pack mule” exercise. Each team of two received a harness made of straps. One person held the straps and pulled while the teammate, attached to the harness at the other end, resisted. To inspire us, he recounted the story of two guides who pulled 100-pound sleds up a glacier while carrying 85-pound backpacks.

Freed from their harnesses, the class members followed Mr. Tacheny on a five-minute jog to a remote section of the park. There, he had stored a jump rope, a backpack full of water jugs, two crescent-shaped Bulgarian sandbags and some straps that he tied around tree branches. Instant exercise stations: pull-ups and push-ups using the straps; squats and leg lifts with the backpack or with a sandbag draped over the shoulders; a cardio workout using the jump rope.

After completing our circuits, we gathered in a circle and applauded ourselves for our hard work. “You got a sense of how to vary your workouts a little,” Mr. Tacheny told us, adding that gym routines didn’t appeal to him anymore, and that riding his bike 60 to 70 miles a day had gotten old. “But this stuff,” he said as we all dragged ourselves out of the park, “you won’t get bored with it.”

Discover Outdoors holds 90-minute Mountain Fitness classes for $20 at Riverside Park in Manhattan; (212) 579-4568, discoveroutdoors.com.

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Urban Athlete: Discover Outdoors Offers Mountain Fitness Class

Willie Davis for The New York Times

Rey Soriano, foreground, holding himself on suspension trainers in a workout run by Discover Outdoors.

I HAVE spent a small fortune over the years on gym memberships. But all you really need to get in shape, I now know, are a few granite paving stones, some sandbags and a backpack full of water jugs.

Willie Davis for The New York Times

David Tacheny, center, leading an exercise known as “pack mule,” as Courtney McBride pulls May Yu Whu.

Willie Davis for The New York Times

Mr. Tacheny explaining how to use paving stones as weights.

Willie Davis for The New York Times

Wendy Tsang, left, lifting a Bulgarian sandbag.

Early one Sunday morning I arrived at the entrance to Riverside Park for an exercise class called Mountain Fitness. A Manhattan adventure outfitter, Discover Outdoors, describes the class as a way to “train like a guide,” and uses rocks, logs, sandbags and water jugs in a quest to improve “functional fitness.” The company started offering the class a year ago after customers asked how they should train for the more challenging hiking and trekking adventures it offers.

Our instructor, David Tacheny, a guide and personal trainer, told us that a typical gym workout doesn’t engage all the muscles you’ll use on, say, a rock-climbing excursion. A leg press machine, for instance, works the pushing muscles of the legs. Squatting while raising a heavy rock above your head, on the other hand, also uses the back, abdominal muscles and shoulders, and it better approximates what it’s like to lift an overstuffed backpack.

“This is how guides train,” he said. “We don’t go run miles on flat terrain. We don’t just pump iron.”

All the exercises can be adapted to different levels of fitness. Our group of eight (including one man) looked plenty fit and included several people who belonged to social sports clubs in the city and competed in triathlons. Melanie Pessin, a triathlon competitor, did an eight-mile run before showing up for class. “I’m training for a half-marathon,” she said.

After a 10-minute warm-up, Mr. Tacheny took us to a pile of rectangular paving stones, each weighing 25 to 40 pounds. Standing with legs apart, we swung our stones out from between our legs into the air, using our hips instead of our arms for power.

The “halo” routine entailed holding the stone at chin level and circling it in a tight arc around the head. Next were squat presses, with the stones raised over our heads. At this point my back muscles went on strike, forcing me to switch to an imaginary stone.

Why just lift stones, though, when you can run with them — or throw them? Mr. Tacheny had us hold our stones at chest level, heave them as far as we could toward a tree in the distance, then run to pick them up; we were to repeat the move until we reached the tree.

Next, he divided us into two groups for a rousing game of what I came to call ducking stones. Each team started with an equal number of stones at the base of a tree. We were supposed to fetch a stone and run with it, depositing it at the base of the opposing team’s tree. After two minutes, whichever team had the fewest stones remaining would win. Mayhem ensued, with stones flying everywhere, to the point where I would yell out, “Don’t hit me!” whenever I stooped to pick one up.

Next, Mr. Tacheny introduced the “pack mule” exercise. Each team of two received a harness made of straps. One person held the straps and pulled while the teammate, attached to the harness at the other end, resisted. To inspire us, he recounted the story of two guides who pulled 100-pound sleds up a glacier while carrying 85-pound backpacks.

Freed from their harnesses, the class members followed Mr. Tacheny on a five-minute jog to a remote section of the park. There, he had stored a jump rope, a backpack full of water jugs, two crescent-shaped Bulgarian sandbags and some straps that he tied around tree branches. Instant exercise stations: pull-ups and push-ups using the straps; squats and leg lifts with the backpack or with a sandbag draped over the shoulders; a cardio workout using the jump rope.

After completing our circuits, we gathered in a circle and applauded ourselves for our hard work. “You got a sense of how to vary your workouts a little,” Mr. Tacheny told us, adding that gym routines didn’t appeal to him anymore, and that riding his bike 60 to 70 miles a day had gotten old. “But this stuff,” he said as we all dragged ourselves out of the park, “you won’t get bored with it.”

Discover Outdoors holds 90-minute Mountain Fitness classes for $20 at Riverside Park in Manhattan; (212) 579-4568, discoveroutdoors.com.

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A Promising Drug With a Flaw

Dr. Bryan A. Cotton, a trauma surgeon in Houston, had not heard much about the new anticlotting drug Pradaxa other than the commercials he had seen during Sunday football games.

Then people using Pradaxa started showing up in his emergency room. One man in his 70s fell at home and arrived at the hospital alert and talking. But he rapidly declined. “We pretty much threw the whole kitchen sink at him,” recalled Dr. Cotton, who works at Memorial Hermann-Texas Medical Center. “But he still bled to death on the table.”

Unlike warfarin, an older drug, there is no antidote to reverse the blood-thinning effects of Pradaxa.

“You feel helpless,” Dr. Cotton said. The drug has contributed to the bleeding deaths of at least eight patients at the hospital. “And that’s a very bad feeling for us.”

Pradaxa has become a blockbuster drug in its two years on the market, bringing in more than $1 billion in sales for its maker, the privately held German drug maker Boehringer Ingelheim.

But Pradaxa has been linked to more than 500 deaths in the United States, and a chorus of complaints has risen from doctors, victims’ families and others in the medical community, who worry that the approval process was not sufficiently rigorous because it allowed a potentially dangerous drug to be sold without an option for reversing its effects.

Pradaxa is an example, some critics say, of what can happen when a drug that performs well in tightly controlled trials is released into the messy world of real-life medicine. Boehringer Ingelheim said it was working on developing an antidote but that even without one, patients in a large clinical trial died at roughly the same rate as those who were taking warfarin.

The Food and Drug Administration released a report on Friday that found that the drug did not show a higher risk of bleeding than for patients taking warfarin. The report did not address the lack of an antidote for Pradaxa.

“The evolving spontaneous reporting patterns do not indicate a change in the favorable benefit-risk profile of Pradaxa, when used correctly according to the approved label,” Boehringer Ingelheim said in a statement. In other words, the drug is still safe. But some reports have indicated that doctors are not sufficiently cautious when prescribing Pradaxa, giving the drug to older people or those with kidney problems even though there is evidence that the bleeding risks are higher in those groups. The company recommends testing patients’ kidney function before prescribing Pradaxa and notes that the risk of bleeding increases with age.

“The problem is that the people that prescribe this, as a general rule, are cardiologists and family practitioners,” said Dr. Mark L. Mosley, director of the emergency room at Wesley Medical Center in Wichita, Kan. “The people that see the harm are your E.R. docs and your trauma docs.”

Critics say that at least until an antidote is found, better disclosure or more limited use of Pradaxa may be preferable. Patients’ lawyers have begun turning their attention to the drug. More than 100 lawsuits have been filed in federal courts and lawyers say thousands more are expected.

When the F.D.A. approved Pradaxa in October 2010, the drug was hailed as the first in a new category of replacements for warfarin, the nearly 60-year-old drug used to prevent strokes in people with a heart-rhythm disorder known as atrial fibrillation.

Warfarin requires careful monitoring of a patient’s diet and drug regimen, and frequent blood tests to ensure that it is working. Pradaxa required no such monitoring and, compared with warfarin, appeared to be better at preventing strokes.

Sales of the drug took off. By the end of 2011, after just over a year on the market, 17 percent of patients with atrial fibrillation were being prescribed Pradaxa, compared with 44 percent for warfarin, according to a study released in September. About 725,000 patients in the United States have used the drug, according to the F.D.A.

But almost as soon as doctors started prescribing Pradaxa, concerns surfaced about its safety. Pradaxa was identified as the primary suspect in 542 patient deaths reported to the F.D.A. in 2011, and was linked to more reports of injury or death than any of the more than 800 drugs regularly monitored by the Institute for Safe Medication Practices, a nonprofit based in Pennsylvania that monitors medicine safety.

Dr. Mosley said he found it “shocking, just shocking” that the F.D.A. approved Pradaxa, which is also called dabigatran, even though no antidote was available.

In a statement, the F.D.A. said, “the lack of an antidote notwithstanding, dabigatran was superior to warfarin in preventing strokes in a large clinical trial. The rates of bleeding were similar.” In the study it released on Friday, the F.D.A. examined health insurance claims and hospital data and reached a similar conclusion.

Warfarin, which is also known by the brand name Coumadin, can often be reversed by giving a patient vitamin K or other substances. Warfarin, too, can be deadly but, doctors said, they at least have options.

“The practical experience is that once hemorrhagic complications occur in this drug, it is much more likely to be a catastrophe than with Coumadin,” said Dr. Richard H. Schmidt, an associate professor of neurosurgery at the University of Utah, who treated an 83-year-old man who died from bleeding and was using Pradaxa.

Boehringer Ingelheim recommends treating bleeding patients with dialysis to help flush the drug from the body, although it notes that “the amount of data supporting this approach is limited.”

Several doctors said that option was not realistic. “People that are bleeding to death aren’t going to tolerate being put on dialysis,” Dr. Cotton said.

Two other new drugs intended as warfarin replacements also lack antidotes. Doctors said they had not seen as many bleeding deaths associated with Xarelto, which was approved in 2011 and is sold by Bayer and Johnson & Johnson. On Friday, the F.D.A. approved Xarelto to also treat deep vein thrombosis and pulmonary embolism, two kinds of blood clots. Pradaxa is approved in the United States only to prevent stroke in patients with atrial fibrillation. A third drug, Eliquis, by Bristol-Myers Squibb and Pfizer, has not yet been approved by the F.D.A. Representatives for both drugs said trials showed their products were safe, adding that the companies were investigating different antidotes. Boehringer Ingelheim is expected to present several new studies of Pradaxa’s safety and efficacy — including one that examines potential antidotes — at the American Heart Association scientific conference next week in Los Angeles.

Some cardiologists have said that Pradaxa and the other new drugs represent real advances over warfarin. Around 40 percent of people with atrial fibrillation do not take any drugs for it, a recent study showed, putting them at risk for strokes.

“I think the benefit of the drug clearly exceeds the risk because to me, a disabling stroke has a greater weight than a bleeding complication,” said Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles and a member of the F.D.A. committee that voted to approve Pradaxa.

But those calculations make little sense to Walter Daumler, who said he watched his 78-year-old sister, Doris, bleed to death in May. Mr. Daumler, who lives in Wisconsin, has hired a lawyer and is considering suing. He said the doctors told him that because she was on Pradaxa, there was nothing they could do.

“My No. 1 goal is to stop this insidious drug,” Mr. Daumler said. “To get this off the market, so others will not undergo or witness what I saw.”

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Withdrawal of a Congressional Research Report on Tax Rates Raises Questions

WASHINGTON — The Congressional Research Service has withdrawn an economic report that found no correlation between top tax rates and economic growth, a central tenet of conservative economic theory, after Senate Republicans raised concerns about the paper’s findings and wording.

The decision, made in late September against the advice of the agency’s economic team leadership, drew almost no notice at the time. Senator Charles E. Schumer, Democrat of New York, cited the study a week and a half after it was withdrawn in a speech on tax policy at the National Press Club.

But it could actually draw new attention to the report, which questions the premise that lowering the top marginal tax rate stimulates economic growth and job creation.

“This has hues of a banana republic,” Mr. Schumer said. “They didn’t like a report, and instead of rebutting it, they had them take it down.”

Republicans did not say whether they had asked the research service, a nonpartisan arm of the Library of Congress, to take the report out of circulation, but they were clear that they protested its tone and findings.

Don Stewart, a spokesman for the Senate Republican leader, Mitch McConnell of Kentucky, said Mr. McConnell and other senators “raised concerns about the methodology and other flaws.” Mr. Stewart added that people outside of Congress had also criticized the study and that officials at the research service “decided, on their own, to pull the study pending further review.”

Senate Republican aides said they had protested both the tone of the report and its findings. Aides to Mr. McConnell presented a bill of particulars to the research service that included objections to the use of the term “Bush tax cuts” and the report’s reference to “tax cuts for the rich,” which Republicans contended was politically freighted.

They also protested on economic grounds, saying that the author, Thomas L. Hungerford, was looking for a macroeconomic response to tax cuts within the first year of the policy change without sufficiently taking into account the time lag of economic policies. Further, they complained that his analysis had not taken into account other policies affecting growth, such as the Federal Reserve’s decisions on interest rates.

“There were a lot of problems with the report from a real, legitimate economic analysis perspective,” said Antonia Ferrier, a spokeswoman for the Senate Finance Committee’s Republicans. “We relayed them to C.R.S. It was a good discussion. We have a good, constructive relationship with them. Then it was pulled.”

The pressure applied to the research service comes amid a broader Republican effort to raise questions about research and statistics that were once trusted as nonpartisan and apolitical.

The Bureau of Labor Statistics on Friday will release unemployment figures for October, a month after some conservatives denounced its last report as politically tinged to abet President Obama’s re-election. When the bureau suggested its October report might be delayed by Hurricane Sandy, some conservatives immediately suggested politics were at play.

Republicans have also tried to discredit the private Tax Policy Center ever since the research organization declared that Mitt Romney’s proposal to cut tax rates by 20 percent while protecting the middle class and not increasing the deficit was mathematically impossible. For years, conservatives have pressed the nonpartisan Congressional Budget Office to factor in robust economic growth when it is asked to calculate the cost of tax cuts to the federal budget.

Congressional aides and outside economists said they were not aware of previous efforts to discredit a study from the research service.

“When their math doesn’t add up, Republicans claim that their vague version of economic growth will somehow magically make up the difference. And when that is refuted, they’re left with nothing more to lean on than charges of bias against nonpartisan experts,” said Representative Sander Levin of Michigan, ranking Democrat on the House Ways and Means Committee.

Jared Bernstein, a former economist for Vice President Joseph R. Biden Jr., conceded that “tax cuts for the rich” was “not exactly academic prose,” but he said the analysis did examine policy time lags and controlled for several outside factors, including monetary policy.

“This sounds to me like a complete political hit job and another example of people who don’t like the results and try to use backdoor ways to suppress them,” he said. “I’ve never seen anything like this, and frankly, it makes me worried.”

Janine D’Addario, a spokeswoman for the Congressional Research Service, would not comment on internal deliberations over the decision. She confirmed that the report was no longer in official circulation.

A person with knowledge of the deliberations, who requested anonymity, said the Sept. 28 decision to withdraw the report was made against the advice of the research service’s economics division, and that Mr. Hungerford stood by its findings.

The report received wide notice from media outlets and liberal and conservative policy analysts when it was released on Sept. 14. It examined the historical fluctuations of the top income tax rates and the rates on capital gains since World War II, and concluded that those fluctuations did not appear to affect the nation’s economic growth.

“The reduction in the top tax rates appears to be uncorrelated with saving, investment and productivity growth. The top tax rates appear to have little or no relation to the size of the economic pie,” the report said. “However, the top tax rate reductions appear to be associated with the increasing concentration of income at the top of the income distribution.”

The Congressional Research Service does such reports at the request of lawmakers, and the research is considered private. Although the reports are posted on the service’s Web site, they are available only to members and staff. Their public release is subject to lawmakers’ discretion.

But the Hungerford study was bound to be widely circulated. It emerged in the final months of a presidential campaign in which tax policy has been a central focus. Mr. Romney, the Republican nominee, maintains that any increase in the top tax rates on income and capital gains would slow economic growth and crush the job market’s recovery.

President Obama has promised to allow cuts on the top two income tax rates to expire in January, lifting the rates from 33 and 35 percent, their level during most of George W. Bush’s presidency, to 36 percent and 39.6 percent, where they were during most of the Clinton administration. Mr. Obama maintains the increases would not hurt the economy and are the fairest way to reduce the deficit.

Mr. Hungerford, a specialist in public finance who earned his economics doctorate from the University of Michigan, has contributed at least $5,000 this election cycle to a combination of Mr. Obama’s campaign, the Democratic National Committee, the Democratic Senatorial Campaign Committee and the Democratic Congressional Campaign Committee.

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Technology Is Changing How Students Learn, Teachers Say

Nancy Palmieri for The New York Times

Lisa Baldwin, a chemistry teacher, works with her students to fight through academic challenges.

There is a widespread belief among teachers that students’ constant use of digital technology is hampering their attention spans and ability to persevere in the face of challenging tasks, according to two surveys of teachers being released on Thursday.

Monica Almeida/The New York Times

Hope Molina-Porter, an English teacher in Fullerton, Calif., worries that technology is deeply altering how students learn.

The researchers note that their findings represent the subjective views of teachers and should not be seen as definitive proof that widespread use of computers, phones and video games affects students’ capability to focus.

Even so, the researchers who performed the studies, as well as scholars who study technology’s impact on behavior and the brain, say the studies are significant because of the vantage points of teachers, who spend hours a day observing students.

The timing of the studies, from two well-regarded research organizations, appears to be coincidental.

One was conducted by the Pew Internet Project, a division of the Pew Research Center that focuses on technology-related research. The other comes from Common Sense Media, a nonprofit organization in San Francisco that advises parents on media use by children. It was conducted by Vicky Rideout, a researcher who has previously shown that media use among children and teenagers ages 8 to 18 has grown so fast that they on average spend twice as much time with screens each year as they spend in school.

Teachers who were not involved in the surveys echoed their findings in interviews, saying they felt they had to work harder to capture and hold students’ attention.

“I’m an entertainer. I have to do a song and dance to capture their attention,” said Hope Molina-Porter, 37, an English teacher at Troy High School in Fullerton, Calif., who has taught for 14 years. She teaches accelerated students, but has noted a marked decline in the depth and analysis of their written work.

She said she did not want to shrink from the challenge of engaging them, nor did other teachers interviewed, but she also worried that technology was causing a deeper shift in how students learned. She also wondered if teachers were adding to the problem by adjusting their lessons to accommodate shorter attention spans.

“Are we contributing to this?” Ms. Molina-Porter said. “What’s going to happen when they don’t have constant entertainment?”

Scholars who study the role of media in society say no long-term studies have been done that adequately show how and if student attention span has changed because of the use of digital technology. But there is mounting indirect evidence that constant use of technology can affect behavior, particularly in developing brains, because of heavy stimulation and rapid shifts in attention.

Kristen Purcell, the associate director for research at Pew, acknowledged that the findings could be viewed from another perspective: that the education system must adjust to better accommodate the way students learn, a point that some teachers brought up in focus groups themselves.

“What we’re labeling as ‘distraction,’ some see as a failure of adults to see how these kids process information,” Ms. Purcell said. “They’re not saying distraction is good but that the label of ‘distraction’ is a judgment of this generation.”

The surveys also found that many teachers said technology could be a useful educational tool. In the Pew survey, which was done in conjunction with the College Board and the National Writing Project, roughly 75 percent of 2,462 teachers surveyed said that the Internet and search engines had a “mostly positive” impact on student research skills. And they said such tools had made students more self-sufficient researchers.

But nearly 90 percent said that digital technologies were creating “an easily distracted generation with short attention spans.”

Similarly, of the 685 teachers surveyed in the Common Sense project, 71 percent said they thought technology was hurting attention span “somewhat” or “a lot.” About 60 percent said it hindered students’ ability to write and communicate face to face, and almost half said it hurt critical thinking and their ability to do homework.

There was little difference in how younger and older teachers perceived the impact of technology.

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