Israeli Says Syria Twisted Comments by Rebel Supporter

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BEIRUT, Lebanon — A public relations controversy erupted Saturday after a leading Israeli newspaper published comments from a brief interview with the leader of Syria’s main exile opposition group.




The news media outlets of the Syrian government, and its ally Hezbollah, the Lebanese militant group, reported that the opposition leader had declared that Israel had “nothing to fear” from a rebel-led Syrian government. Moreover, the reports said, the opposition was working with other countries to keep Syria’s chemical weapons away from Hezbollah, which he called a “son of the devil.”


But the opposition leader, Sheik Ahmad Moaz al-Khatib, never said any of that, according to the article in the Israeli newspaper, Yediot Aharonot, and its author, a prominent Israeli defense expert, Ronen Bergman.


Sheik Khatib was quoted in the article reiterating the opposition’s promise to keep Syria’s chemical arsenal out of “the hands of unauthorized elements,” and it was the international community, he said, not Israel, that had “nothing to fear.”


When Sheik Khatib realized that Mr. Bergman was an Israeli — after glancing at his business card — he abruptly ended the conversation, Mr. Bergman said in a Skype interview, repeating what he had written.


The original article was published only in Hebrew — and only in print — so it was the Arabic and English versions put out by the Syrian government and Hezbollah that raced around the Internet on Saturday, provoking outrage from government supporters and opponents at Sheik Khatib, who posted a message on his Facebook page denying that he had given the interview.


Yet the episode appeared to have been more than a simple misunderstanding. Syria’s conflict is not only a shooting war but also a propaganda war. Pro-government media apparently could not resist the chance to bolster their contention that the rebellion had been promoted by Israel and the West to punish Syria and its president, President Bashar al-Assad, for taking uncompromising positions against Israel.


“Unfortunately, the original text was less exciting,” Mr. Bergman said. “I would be happy if he would say something like, ‘Yes, we will make peace with Israel’ — then I would get the front page.” As it was, the article elicited little reaction in Israel.


But misrepresentation of the article suggested that it hit a nerve on one issue. An unnamed opposition member, not Sheik Khatib, called Hezbollah “sons of the devil,” according to Mr. Bergman, and said the rebel coalition was working with other countries to ensure that “not one piece of military equipment, not chemical weapons and not any other item, will pass into their hands.”


Syria is Hezbollah’s main conduit for arms, and Hezbollah has backed Mr. Assad’s bloody crackdown at great cost to its popularity in the wider Arab world.


Although Mr. Bergman said the opposition member was offering his own opinion and not presenting official policy, his comments bolstered the widely held view that a rebel-led government might halt the shipment of Iranian arms through Syria to Hezbollah. Hezbollah, a Shiite group and political party, is also concerned about the rise within the rebel movement of extremist Sunni jihadists who view Shiites as apostates.


The misleading reports appeared to be an attempt to further divide the opposition. Sheik Khatib found himself fending off critics from within the anti-Assad movement who objected to his even speaking with an Israeli reporter, though by all accounts he did not initially realize that Mr. Bergman was an Israeli.


It was the second time in a month that Sheik Khatib found himself on the defensive. He recently proposed talks with members of Mr. Assad’s government, but had not built political support for the proposal.


On Friday, Syria’s information minister, Omran al-Zoubi, gave the first official response to the proposal, saying that the government would negotiate with any opposition members who agreed to lay down their arms.


On Saturday, Mr. Assad named new cabinet ministers for oil, finance, social affairs, labor, housing, public works and agriculture, as Syria faces growing economic problems and shortages of electricity, fuel and bread.


Anne Barnard reported from Beirut, and Isabel Kershner from Jerusalem. Hania Mourtada contributed reporting from Beirut.



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Reviewing Three Brands of Tax Preparation Software

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TAX preparation is moving to the cloud.




The makers of the better-known tax prep programs — TurboTax, H&R Block at Home and TaxAct — say that many customers, particularly younger ones, prefer Web-based programs to old-fashioned, desktop versions. Web-based programs — techies call this cloud computing — reside on remote servers that customers access via their browsers. They offer the convenience of working on a return from any Internet-connected computer and having that return stored on the software makers’ secure servers.


After spending several days running my family’s tax information through Web and desktop offerings, I learned that I’m old-school. For a decade, I’ve completed our return on my Mac desktop, and I prefer that. Desktop programs may be costlier and, in some ways, clunkier — you must buy them on CD or download them — but they also offer more flexibility.


A single purchase, for example, lets you prepare and file multiple returns, as you might want to do if you’re part of a same-sex couple or if you help family members or friends with their taxes. And you can more easily jump back and forth between the tax return and the interviews the programs use to gather information. That lets you check entries as you make them, as my wife, a C.P.A., insists upon. What you lose in convenience, you gain in control.


Each of the tax preparation programs, whether desktop or online, has strengths and shortcomings. TurboTax is the easiest to use, importing lots of financial information with just a few clicks. H&R Block promises the most reassuring help — its staff will represent you at no extra charge if you’re audited. TaxAct offers the best price. A look at each provider’s offerings shows where it excelled and stumbled in preparing my family’s 2012 return.


TurboTax


TurboTax’s maker, Intuit, has its roots in technology, not taxes, and its facility with bits and bytes shows in its wares. Its desktop and online programs make doing taxes as simple as such a time-eating task can be. If you end up cursing come tax time, the target will be the I.R.S., not your software.


I downloaded the desktop version of TurboTax Premier for $89.99 — though I learned later that I could have paid $10 less if I’d bought it on CD at my local Staples. The download took only a few seconds, as did the import of information from our 2011 return. All of the unchanged data from 2011 — names, addresses, federal ID numbers, even descriptions of business expenses — popped into the right places on the 2012 forms. Even the names of the charities we support carried over. The software also imported my wife’s W-2 and all of the information on our investments from Vanguard, T. Rowe Price and Fidelity. All I had to do was key in details for a few local banks and update the amounts we’d given to charity.


The online version of TurboTax, by contrast, didn’t import as much. My attempt to transfer our 2011 return failed, and an import from one of the fund companies went awry. I inherited an I.R.A., and the money is invested in about a half-dozen funds. Instead of creating an entry for a single 1099-R, the program created a half-dozen, which I had to combine.


Otherwise, the online program looked and worked much the same way as the desktop software. I didn’t have to pay to try it because TurboTax, like H&R Block and TaxAct, doesn’t require online users to pay until they file their returns. Had I filed with the online version of TurboTax Premier, I would have paid $49.99 for a single federal return — the price as it was discounted at the time. But TurboTax says it could rise to as much as $74.99, its list price, before April 15.


 


TurboTax upgraded its assistance features for this year’s tax filing season — a welcome improvement. In the past, I’d found some help links hard to locate and navigate. When I wanted to pose a question to a tax expert, I had to dig around. But not anymore. When I had a question about recording tax-exempt interest, I clicked on the help link, and TurboTax offered a choice between a call and an online chat. Within seconds, I was e-chatting with Marilyn G., and she pointed me to the right spot on the return. We were done in less than five minutes, and I paid nothing extra. I’ve had a tougher time buying jeans online. (All three companies also provide extensive tax-law explanations embedded in their programs.)


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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

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At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.




The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.


Most of the victims were women and were shot in the back of the head, local reports said.


A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.


Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.


No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.


Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.


Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.


While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.


Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.


Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”


In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.


Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.


“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.


About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.


Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.


Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”


Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”


Aminu Abubakar contributed reported from Kano, Nigeria.



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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

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At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.




The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.


Most of the victims were women and were shot in the back of the head, local reports said.


A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.


Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.


No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.


Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.


Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.


While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.


Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.


Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”


In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.


Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.


“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.


About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.


Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.


Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”


Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”


Aminu Abubakar contributed reported from Kano, Nigeria.



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Israeli Says Syria Twisted Comments by Rebel Supporter

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BEIRUT, Lebanon — A public relations controversy erupted Saturday after a leading Israeli newspaper published comments from a brief interview with the leader of Syria’s main exile opposition group.




The news media outlets of the Syrian government, and its ally Hezbollah, the Lebanese militant group, reported that the opposition leader had declared that Israel had “nothing to fear” from a rebel-led Syrian government. Moreover, the reports said, the opposition was working with other countries to keep Syria’s chemical weapons away from Hezbollah, which he called a “son of the devil.”


But the opposition leader, Sheik Ahmad Moaz al-Khatib, never said any of that, according to the article in the Israeli newspaper, Yediot Aharonot, and its author, a prominent Israeli defense expert, Ronen Bergman.


Sheik Khatib was quoted in the article reiterating the opposition’s promise to keep Syria’s chemical arsenal out of “the hands of unauthorized elements,” and it was the international community, he said, not Israel, that had “nothing to fear.”


When Sheik Khatib realized that Mr. Bergman was an Israeli — after glancing at his business card — he abruptly ended the conversation, Mr. Bergman said in a Skype interview, repeating what he had written.


The original article was published only in Hebrew — and only in print — so it was the Arabic and English versions put out by the Syrian government and Hezbollah that raced around the Internet on Saturday, provoking outrage from government supporters and opponents at Sheik Khatib, who posted a message on his Facebook page denying that he had given the interview.


Yet the episode appeared to have been more than a simple misunderstanding. Syria’s conflict is not only a shooting war but also a propaganda war. Pro-government media apparently could not resist the chance to bolster their contention that the rebellion had been promoted by Israel and the West to punish Syria and its president, President Bashar al-Assad, for taking uncompromising positions against Israel.


“Unfortunately, the original text was less exciting,” Mr. Bergman said. “I would be happy if he would say something like, ‘Yes, we will make peace with Israel’ — then I would get the front page.” As it was, the article elicited little reaction in Israel.


But misrepresentation of the article suggested that it hit a nerve on one issue. An unnamed opposition member, not Sheik Khatib, called Hezbollah “sons of the devil,” according to Mr. Bergman, and said the rebel coalition was working with other countries to ensure that “not one piece of military equipment, not chemical weapons and not any other item, will pass into their hands.”


Syria is Hezbollah’s main conduit for arms, and Hezbollah has backed Mr. Assad’s bloody crackdown at great cost to its popularity in the wider Arab world.


Although Mr. Bergman said the opposition member was offering his own opinion and not presenting official policy, his comments bolstered the widely held view that a rebel-led government might halt the shipment of Iranian arms through Syria to Hezbollah. Hezbollah, a Shiite group and political party, is also concerned about the rise within the rebel movement of extremist Sunni jihadists who view Shiites as apostates.


The misleading reports appeared to be an attempt to further divide the opposition. Sheik Khatib found himself fending off critics from within the anti-Assad movement who objected to his even speaking with an Israeli reporter, though by all accounts he did not initially realize that Mr. Bergman was an Israeli.


It was the second time in a month that Sheik Khatib found himself on the defensive. He recently proposed talks with members of Mr. Assad’s government, but had not built political support for the proposal.


On Friday, Syria’s information minister, Omran al-Zoubi, gave the first official response to the proposal, saying that the government would negotiate with any opposition members who agreed to lay down their arms.


On Saturday, Mr. Assad named new cabinet ministers for oil, finance, social affairs, labor, housing, public works and agriculture, as Syria faces growing economic problems and shortages of electricity, fuel and bread.


Anne Barnard reported from Beirut, and Isabel Kershner from Jerusalem. Hania Mourtada contributed reporting from Beirut.



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An Exhibition on Turkey’s Past Resonates

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ISTANBUL — Two galleries in this city’s old European quarter recently opened exhibitions that showcase the political violence that convulsed the country in the 1970s. The echoes for contemporary Turkey were unmistakable.




On one wall are rows of old newspapers that chronicled through blaring headlines and grainy photographs the bloody street fighting and chaotic demonstrations that culminated in a military coup in 1980.


“Socialist revolution can only be achieved in Turkey through armed victory,” is how one newspaper of the time described the aims of a radical left-wing group that promised to use “revolutionary terror” and “urban chaos” to realize Marxist rule.


That bloody past burst violently into the present with last week’s suicide bombing of the American Embassy in the Turkish capital of Ankara. Initially assumed by many to be the work of Islamic extremists, the attack was quickly traced by the authorities to a man who sneaked into the country by boat from a Greek island in the Aegean Sea and was linked to a homegrown left-wing extremist group whose roots lie in the tumult of the ’70s.


As such, the bombing — even though it struck an American target and was motivated in part by American policy in the Middle East — revealed more about modern Turkey, its violent past and potential for instability than it did about the United States’ war on terror.


“This was no Benghazi,” wrote Ross Wilson, a former American ambassador to Turkey, in an online column for the Atlantic Council, referring to last year’s attack by Islamic extremists on a diplomatic outpost in Libya that resulted in the death of the American ambassador and three others.


For Turkey, the attack was an unpleasant reminder that despite a decade of reforms under the current ruling party, which is rooted in political Islam and headed by Prime Minister Recep Tayyip Erdogan, Turkey has yet to fully emerge from its dark past. Coming at a time when Turkey, with its prosperous economy and political stability, is trying to present itself as a model for countries convulsed by the Arab Spring revolutions, the attack served for many Turks as a reminder of the work left to put their own house in order.


“I think what people have forgotten, because of what happened here in the last 10 years, was how violent Turkish politics used to be,” said Gerald Knaus, of the European Stability Initiative, a policy research organization based in Istanbul. “In the last 10 years Turkey tried to emerge from this period of political violence and confront the skeletons in its closet. But we’ve forgotten how many skeletons there were.”


The attack also underscored how Turkey’s rulers sometimes use those skeletons to justify a growing crackdown on dissent, particularly with a campaign against the news media that has Turkey as the world’s leading jailer of journalists — more even than China or Iran.


“If the activist who blew himself up today had possessed a press card, they would have called him a journalist,” Mr. Erdogan said in comments broadcast on Turkish television shortly after the bombing last week that were immediately condemned by the advocacy group Reporters Without Borders.


Before the attack, Turkish security forces rounded up nearly 100 people accused of ties to the outlawed Revolutionary People’s Liberation Front, the organization the perpetrator belonged to, among them journalists, lawyers, even members of a rock band. The arrests were condemned by human rights groups as another example of Turkey’s broad use of antiterrorism laws to crack down on domestic opponents, particularly journalists and human rights lawyers, with no links to violent activities.


“Turkey’s overbroad antiterrorism laws have been used against an ever-widening circle of people charged for nonviolent political activities and the legitimate exercise of freedom of expression, association and assembly,” Human Rights Watch wrote in a report condemning many of the arrests.


Efkan Bolac, a member of the Contemporary Lawyers Association, was detained in that roundup but was released for lack of evidence.


“A lawyer doesn’t become a rapist if he represents one, or a drug dealer if he represents one,” Mr. Bolac said. “They claim we are members of a terror group, but how is that possible when we spend our entire time at courthouses?”


This week the American ambassador to Turkey, Francis J. Ricciardone Jr., said the F.B.I. was investigating the attack and suggested that the Justice Department might prosecute the group that carried out the bombing.


Yet the attack seemed out of another time and carried a whiff of cold-war-era intrigue, when links between the C.I.A. and Turkey were central to efforts by the United States to counter Soviet influence in the region. It also upended the conventional narrative about modern terrorism. “You’d think 10 years after the war on terror things would be clearer rather than more obfuscated,” said Bruce Hoffman, a terrorism expert at Georgetown University.


In his column in The Hurriyet Daily News, Nihat Ali Ozcan, a security specialist at the Economic Policy Research Foundation in Ankara, likened the attack to a “cold-war-style proxy war” that he speculated was the work of Syria, given the historical links between the group and Syrian intelligence. His observation was reminiscent of the paranoia of a bygone era. At one of the art galleries here, newspapers chronicled the 1977 May Day celebration in Istanbul, when leftist groups gathered for a demonstration that turned bloody.


“This attack is a provocation that links all the way to the C.I.A.,” one headline shrieked.


Sebnem Arsu contributed reporting.



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Snapchat, a Growing App, Lets You See It, Then You Don’t

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J. Emilio Flores for The New York Times


Bobby Murphy, left, and Evan Spiegel are co-founders of Snapchat. Its app can preset expiration dates on pictures.







LOS ANGELES — The ephemeral now has value, at least for users of cellphones.




More than 60 million photos or messages are sent each day through an app called Snapchat and then, after they are viewed for a few seconds, the missives vanish. That disappearing act — and a volume that is over a tenth of the well-established Facebook’s — has made the tiny start-up a technology hit, amassing millions of users and the backing of some of the most respected names in Silicon Valley, even though it doesn’t make any money.


Because images sent through the application self-destruct seconds after they are opened, Snapchat is being embraced as an antidote to a world where nearly every feeling, celebration and life moment is captured to be shared, logged, liked, commented on, stored, searched and sold. For people who don’t want to worry about unflattering pictures or embarrassing status updates coming back to haunt them, the app’s appeal seems obvious. 


Many young people are growing tired of the polished profiles and the advertising come-ons of Facebook, recent surveys have shown. Moreover, young Facebook users are becoming acutely aware of the permanence of the content shared through the Web — and its repercussions later in life. As perceptions of social media change, other start-ups, including Wickr and Vidburn and Facebook’s own Poke, have recently released messaging and video products that self-destruct after a set period of time.


“It became clear how awful social media is,” said one of Snapchat’s founders, Evan Spiegel, 22. “There is real value in sharing moments that don’t live forever.”


The Snapchat service, which started two years ago but has steadily gained users, has been painted as a popular way for people, especially teenagers, to send naughty pictures. But Mr. Spiegel and his co-founder, Bobby Murphy, 24, say Snapchat is gaining traction for more than R-rated exchanges. Mr. Murphy describes the service “a digital version of passing notes in class.”


“You can’t build a business off sexting,” said Mr. Spiegel, using the term for sending racy pictures via text message chats. “It’s such a specific-use case. This is about much more than that.”


Sean Haufler, 21, a computer science major at Yale who uses Snapchat, said he thought it was “dumb” when his younger sister, a high school student, first told him about it. But he began to realize that it was a much more intimate way to communicate with friends. The emotional weight of the content is heavier, he said, because messages are direct and personal. Plus, he said, “the time limits make people more comfortable.”


“People are very self-aware when it comes to their Facebook profiles,” he said. “All the content is very manicured and curated, the best possible portrait of yourself.”


Facebook has certainly taken notice of the desire for impermanence, especially as Snapchat, according to Nielsen statistics, attracted 3.4 million users in December, more than twice as many as the month before. Mark Zuckerberg, the Facebook chief executive, met with the company in December, according to Snapchat’s founders. Shortly after, Facebook started a similar product called Poke.


It was, if nothing else, an endorsement of the idea that the short-lived might have lasting value. In an interview in East Palo Alto, Calif., Peter Deng, Facebook’s director of product management, said Poke was in line with the company’s strategy of experimenting. “The demand comes from real life,” he said. “People want something that is more lightweight than a message and less permanent.”


Snapchat operates far from the world of Silicon Valley in a beach house in Venice Beach. Nonetheless, the start-up has caught the eye of Silicon Valley financiers.


Scott D. Cook, the founder of Intuit and a prominent entrepreneur and investor, has taken the Snapchat founders under his wing, and the start-up recently raised $13.5 million in venture financing, led by Benchmark Capital, which values the company at $60 million to $70 million even without an established revenue stream.


Mitch Lasky, who led Benchmark’s cash infusion, said he first heard about the app from his 16-year-old daughter. “I started hearing Snapchat in the same context as Twitter, Instagram and Facebook,” he said. “That got me curious.”


His firm was aware of the company’s seedier reputation with sexting, but the partners “saw the bigger picture” for the company’s potential foothold in the world of social media.


“People are looking to communicate in a real way,” Mr. Lasky said. “The real self, as opposed to the projected self. That was the piece that resonated the most with me.” Some backers see the possibility of Snapchat making money by allowing advertisers to send coupons or fashion ideas.


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Well: Think Like a Doctor: A Confused and Terrified Patient

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The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

Read More..

Well: Think Like a Doctor: A Confused and Terrified Patient

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The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

Read More..

Venezuela Devalues Currency Amid Shortages and Inflation

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CARACAS — Venezuela announced Friday that it was devaluing its currency, a step that had long been deemed necessary but could push the spiking inflation even higher.




The devaluation, which lowered the currency’s value against the dollar by nearly 50 percent, was aimed at solidifying government finances and easing a tight market for dollars that has choked back imports and led to shortages of basic goods.


The move had been widely anticipated, but it had been unclear whether officials would make what could be a politically risky decision with President Hugo Chávez still out of the country after undergoing cancer surgery in Cuba on Dec. 11.


If Mr. Chávez were to die or were too ill to continue as president, a special election would have to be called, and many analysts thought that the government might try to postpone a devaluation until after that occurred.


“It is a sign of pragmatism that they carry out a devaluation even though we’re all aware there is some likelihood of a presidential election being held soon,” said Francisco Rodríguez, an economist with Bank of America Merrill Lynch. “This shows that they’re willing to correct basic economic distortions.”


The currency, the bolívar, will be set at 6.3 to the dollar. It had been set at 4.3.


Venezuela’s finance minister, Jorge Giordani, said that Mr. Chávez, who has not been seen or heard in public for more than eight weeks, had approved the measures.


“Here is the president’s signature if you want to recognize it or if you still have doubts,” Mr. Giordani said, holding up a document during a televised news conference.


The devaluation will help the government balance its books by giving it nearly 50 percent more bolívars for the dollars it earns selling oil on the world market. Venezuela’s economy is highly dependent on oil, with petroleum sales making up about 95 percent of total exports. The country is the fourth-largest foreign oil supplier to the United States.


Government spending soared last year during the campaign to re-elect Mr. Chávez, leading to a large deficit, even though, at more than $100 a barrel, the price of oil is very high.


Pressure to devalue had been building for months, as the black market exchange rate rose to more than four times the official rate. The imbalance was evident in the prices of many goods. A Big Mac at McDonald’s costs 70 bolívars, or $16.27, at the official pre-devaluation rate.


But the devaluation will also make imported goods more expensive, which will probably make inflation worse. Inflation for the 12 months ended on Jan. 31 was 22.2 percent, one of the highest rates in Latin America.


Surging inflation could cause political problems for the government. But the exchange rate had reduced the dollars available to importers, leading to shortages of goods like sugar, chicken and toilet paper. Many analysts believe that voters blame the government more for shortages than for inflation.


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World Briefing | Europe: Lasagna Products Test Positive for Horsemeat in Britain

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British authorities say beef lasagna products recalled from British supermarkets by the frozen-food company Findus have tested positive for more than 60 percent horsemeat. The revelation comes after millions of burgers were taken off shop shelves this month as it emerged that beef products from three companies in Ireland and Britain contained horse DNA. The Food Standards Agency said Thursday that its tests on Findus’s beef lasagna were part of an investigation into mislabeled meat and that there was no evidence the results posed a food safety risk.


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Television Review: ‘Silicon Valley,’ on ‘American Experience’ on PBS

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“Silicon Valley” is a deceptively grand title for the new “American Experience” documentary Tuesday night on PBS. “Fairchild Semiconductor” would be more accurate. It could even be called “Robert Noyce” or, with a musical score and some dance numbers, “Noyce!”




But the film’s modest goals work in its favor. “Silicon Valley” takes one piece of the sprawling story of the electronics industry in Northern California and tells it with admirable clarity and detail. Stopping well short of the valley’s modern era — the action ends in the early 1970s, with the invention of the microprocessor — it’s rewarding as both history and nostalgia.



The documentary actually touches on several cycles of wistfulness. Nostalgia for the preindustrial Santa Clara Valley of orchards and farm stands, which has been heavy for more than three decades now, is indulged with grainy shots of apricots being picked and young men in letter sweaters and khaki pants walking past the History Corner of the Stanford quad. (Like many films about Silicon Valley, this one also cheats by including San Francisco vistas and cable cars.)



After that stage setting, the film gets to its central story: how in 1957 eight young men, led by a visionary physicist and engineer, Mr. Noyce, took the revolutionary step of leaving their company to form a start-up called Fairchild Semiconductor and in the process created Silicon Valley. Interviews with an array of industry veterans, including two of the three surviving defectors, outline how Fairchild and the companies it spawned both developed the technologies and established the business and financial cultures that would eventually produce behemoths like Apple and Google.



This is dramatic social and scientific history, revealing, among other things, how the semiconductor industry grew to serve the military and the space program long before the rise of the personal computer. But, again, the film’s visceral appeal has much to do with period detail: neatly groomed engineers wearing suits and ties, even on the production floor or at the bar of Walker’s Wagon Wheel in Mountain View; rows of women in smocks and hairnets assembling transistors. (The gender lines are inviolate in these early-’60s photos, and the men are almost invariably white.)



One startling image shows a handwritten list of the many corporations that declined to bankroll the eight pioneers before Fairchild Camera and Instrument said yes. If any of them had possessed more foresight, the silicon chip might have belonged to National Cash Register, Motorola, Philco, BorgWarner, Chrysler, General Mills or United Shoe.



Even with its relatively narrow focus, “Silicon Valley” is highly compressed, and people familiar with the industry may have complaints: that the infighting that made Fairchild Semiconductor’s reign short-lived isn’t fully explored, or that Intel, the chip giant later founded by Mr. Noyce and Gordon Moore, should receive more attention.



Any quibbling aside, though, the film is a captivating look at recent history that already feels ancient, when high technology involved inventing and building things rather than writing code and selling clicks.



American Experience



Silicon Valley



On PBS stations on Tuesday night (check local listings).



Produced by Film Posse for “American Experience.” Directed and edited by Randall MacLowry; written by Mr. MacLowry and Michelle Ferrari, based on a story by Mr. MacLowry; Mr. MacLowry and Tracy Heather Strain, producers; Mark Samels, executive producer for “American Experience”; Michael Murphy, narrator.


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Well: The 'Monday Morning' Medical Screaming Match

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I did not think I would ever see another “morbidity and mortality” conference in which senior doctors publicly attacked their younger colleagues for making medical errors. These types of heated meetings were commonplace when I was a medical student but have largely been abandoned.

Yet here they were again on “Monday Mornings,” a new medical drama on the TNT network, based on a novel by Dr. Sanjay Gupta, CNN’s chief medical correspondent and one of the executive producers of the show. Such screaming matches may make for good television, but it is useful to review why new strategies have emerged for dealing with medical mistakes.

So-called M&M conferences emerged in the early 20th century as a way for physicians to review cases that had either surprising outcomes or had somehow gone wrong. Although the format varied among institutions and departments, surgery M&Ms were especially known for their confrontations, as more experienced surgeons often browbeat younger doctors into admitting their errors and promising to never make them again.

Such conferences were generally closed door — that is, attended only by physicians. Errors were a private matter not to be shared with other hospital staff, let alone patients and families.

But in the late 1970s, a sociology graduate student named Charles L. Bosk gained access to the surgery department at the University of Chicago. His resultant 1979 book, “Forgive and Remember,” was one of the earliest public discussions of how the medical profession addressed its mistakes.

Dr. Bosk developed a helpful terminology. Technical and judgment errors by surgeons could be forgiven, but only if they were remembered and subsequently prevented by those who committed them. Normative errors, which called into question the moral character of the culprit, were unacceptable and potentially jeopardized careers.

Although Dr. Bosk’s book was more observational than proscriptive, his depiction of M&M conferences was disturbing. I remember attending a urology M&M as a medical student in which several senior physicians berated a very well-meaning and competent intern for a perceived mistake. The intern seemed to take it very well, but my fellow students and I were shaken by the event, asking how such hostility could be conducive to learning.

There were lots of angry accusations in the surgical M&Ms in the pilot episode of “Monday Mornings.” In one case, a senior doctor excoriated a colleague who had given Tylenol to a woman with hip pain who turned out to have cancer. “You allowed metastatic cancer to run amok for four months!” he screamed.

If this was what Dr. Bosk would have called a judgment error, the next case raised moral issues. A neurosurgeon had operated on a boy’s brain tumor without doing a complete family history, which would have revealed a disorder of blood clotting. The boy bled to death on the operating table. “The boy died,” announced the head surgeon, “because of a doctor’s arrogance.”

In one respect, it is good to see that the doctors in charge were so concerned. But as the study of medical errors expanded in the 1990s, researchers found that the likelihood of being blamed led physicians to conceal their errors. Meanwhile, although doctors who attended such conferences might indeed not make the exact same mistakes that had been discussed, it was far from clear that M&Ms were the best way to address the larger problem of medical errors, which, according to a 1999 study, killed close to 100,000 Americans annually.

Eventually, experts recommended a “systems approach” to medical errors, similar to what had been developed by the airline industry. The idea was to look at the root causes of errors and to devise systems to prevent them. Was there a way, for example, to ensure that the woman with the hip problem would return to medical care when the Tylenol did not help? Or could operations not be allowed to occur until a complete family history was in the chart? Increasingly, hospitals have put in systems, such as preoperative checklists and computer warnings, that successfully prevent medical errors.

Another key component of the systems approach is to reduce the emphasis on blame. Even the best doctors make mistakes. Impugning them publicly — or even privately — can make them clam up. But if errors are seen as resulting from inadequate systems, physicians and other health professionals should be more willing to speak up.

Of course, the systems approach is not perfect. Studies continue to show that physicians conceal their mistakes. And elaborate systems for preventing errors can at times interfere with getting things done in the hospital.

Finally, it is important not to entirely remove the issue of responsibility. Sad to say, there still are physicians who are careless and others who are arrogant. Even if today’s M&M conferences rarely involve screaming, supervising physicians need to let such colleagues know that these types of behaviors are unacceptable.

Barron H. Lerner, M.D., professor of medicine at New York University Langone Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”
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Well: The 'Monday Morning' Medical Screaming Match

Labels:

I did not think I would ever see another “morbidity and mortality” conference in which senior doctors publicly attacked their younger colleagues for making medical errors. These types of heated meetings were commonplace when I was a medical student but have largely been abandoned.

Yet here they were again on “Monday Mornings,” a new medical drama on the TNT network, based on a novel by Dr. Sanjay Gupta, CNN’s chief medical correspondent and one of the executive producers of the show. Such screaming matches may make for good television, but it is useful to review why new strategies have emerged for dealing with medical mistakes.

So-called M&M conferences emerged in the early 20th century as a way for physicians to review cases that had either surprising outcomes or had somehow gone wrong. Although the format varied among institutions and departments, surgery M&Ms were especially known for their confrontations, as more experienced surgeons often browbeat younger doctors into admitting their errors and promising to never make them again.

Such conferences were generally closed door — that is, attended only by physicians. Errors were a private matter not to be shared with other hospital staff, let alone patients and families.

But in the late 1970s, a sociology graduate student named Charles L. Bosk gained access to the surgery department at the University of Chicago. His resultant 1979 book, “Forgive and Remember,” was one of the earliest public discussions of how the medical profession addressed its mistakes.

Dr. Bosk developed a helpful terminology. Technical and judgment errors by surgeons could be forgiven, but only if they were remembered and subsequently prevented by those who committed them. Normative errors, which called into question the moral character of the culprit, were unacceptable and potentially jeopardized careers.

Although Dr. Bosk’s book was more observational than proscriptive, his depiction of M&M conferences was disturbing. I remember attending a urology M&M as a medical student in which several senior physicians berated a very well-meaning and competent intern for a perceived mistake. The intern seemed to take it very well, but my fellow students and I were shaken by the event, asking how such hostility could be conducive to learning.

There were lots of angry accusations in the surgical M&Ms in the pilot episode of “Monday Mornings.” In one case, a senior doctor excoriated a colleague who had given Tylenol to a woman with hip pain who turned out to have cancer. “You allowed metastatic cancer to run amok for four months!” he screamed.

If this was what Dr. Bosk would have called a judgment error, the next case raised moral issues. A neurosurgeon had operated on a boy’s brain tumor without doing a complete family history, which would have revealed a disorder of blood clotting. The boy bled to death on the operating table. “The boy died,” announced the head surgeon, “because of a doctor’s arrogance.”

In one respect, it is good to see that the doctors in charge were so concerned. But as the study of medical errors expanded in the 1990s, researchers found that the likelihood of being blamed led physicians to conceal their errors. Meanwhile, although doctors who attended such conferences might indeed not make the exact same mistakes that had been discussed, it was far from clear that M&Ms were the best way to address the larger problem of medical errors, which, according to a 1999 study, killed close to 100,000 Americans annually.

Eventually, experts recommended a “systems approach” to medical errors, similar to what had been developed by the airline industry. The idea was to look at the root causes of errors and to devise systems to prevent them. Was there a way, for example, to ensure that the woman with the hip problem would return to medical care when the Tylenol did not help? Or could operations not be allowed to occur until a complete family history was in the chart? Increasingly, hospitals have put in systems, such as preoperative checklists and computer warnings, that successfully prevent medical errors.

Another key component of the systems approach is to reduce the emphasis on blame. Even the best doctors make mistakes. Impugning them publicly — or even privately — can make them clam up. But if errors are seen as resulting from inadequate systems, physicians and other health professionals should be more willing to speak up.

Of course, the systems approach is not perfect. Studies continue to show that physicians conceal their mistakes. And elaborate systems for preventing errors can at times interfere with getting things done in the hospital.

Finally, it is important not to entirely remove the issue of responsibility. Sad to say, there still are physicians who are careless and others who are arrogant. Even if today’s M&M conferences rarely involve screaming, supervising physicians need to let such colleagues know that these types of behaviors are unacceptable.

Barron H. Lerner, M.D., professor of medicine at New York University Langone Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”
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DealBook: 4 Years After Crisis, Ireland Strikes Deal to Ease a Huge Debt Load

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LONDON — The Irish government, trying to lighten the staggering debt burden of bailing out some of its biggest banks four years ago, reached a deal on Thursday with the European Central Bank to give the country more time to repay some of those loans.

The agreement, which came after 18 months of negotiations with the central bank, will enable Ireland to swap 28 billion euros ($38 billion) of high-interest promissory notes — a form of i.o.u.’s — that were used to bail out Anglo Irish Bank in 2009 for long-term government debt.

Although crucial details of the agreement were not disclosed, it appeared to be another important milestone in Ireland’s slow emergence from a banking and real estate crisis that had cut living standards, caused unemployment to soar and left cities scarred by half-finished building projects.

The deal could also be an important step for the euro zone, showing that it is possible for a member to survive the painful financial adjustments needed to recover from the crisis without leaving the currency union. Besides Ireland, Greece and Portugal have borrowed huge sums from the central bank and other international organizations to bail out their governments, while Spain has done likewise to rescue its banks.

By exchanging the promissory notes for government debt, Enda Kenny, the Irish prime minister, and his governing party, Fine Gael, have secured more time for Ireland to put itself on a firmer financial footing.

They have also won a significant concession from the central bank, which had repeatedly rejected Ireland’s plans to restructure some of its debt. The central bank, based in Frankfurt, has been concerned that a refinancing deal for Ireland would set a precedent that could be followed by other countries that have also bailed out big lenders.

Mario Draghi, the central bank’s president, declined to comment on the Irish deal during a news conference Thursday, suggesting that reporters direct their questions to Irish officials.

Mr. Kenny was more than happy to trumpet the deal. “The promissory notes represent a highly onerous and unfair legacy of the banking crisis,” Mr. Kenny told the Irish Parliament on Thursday. “The legacy banking debt hoisted on the Irish taxpayer is a heavy burden.”

Analysts said the debt restructuring was an important step in Ireland’s recovery because the government could either repay existing debt faster than previously expected or pump the extra cash directly into the local economy.

“Ireland has been pushing hard for this deal,” said Jonathan Loynes, the chief European economist at Capital Economics in London. “It’s a victory for Ireland over the European Central Bank.”

After stepping in to save many lenders that made too many bad loans during the 2000s, Dublin eventually had to turn to the European Union and the International Monetary Fund in 2010, which provided a 67.5 billion euro rescue package.

One big part of that bailout, the nationalization of the giant bank Anglo Irish, had left Dublin with onerous annual interest payments of 3.1 billion euros. The figure is about the same amount that Irish politicians have said they need to make in additional cuts in yearly government spending to reduce the country’s debt levels. The hefty interest payments caused widespread anger across Ireland, whose population has already endured several years of tax increases and government spending reductions.

The interest rate on the new government debt is expected to average about 3 percent, instead of rates above 8 percent on the promissory notes. The restructuring also will cut the country’s budget deficit by one billion euros a year, according to a statement from the Irish Finance Ministry, though Ireland’s deficit as a percentage of its overall economy will still be one of the highest in the euro zone.

As part of the deal, the Irish government passed emergency legislation on Thursday to liquidate Anglo Irish Bank, which fell into trouble in the buildup to the financial crisis by lending billions of euros to real estate developers. Many of those loans went bad after Ireland’s real estate bubble burst. The bank had been renamed the Irish Bank Resolution Corporation after its failure and bailout.

Under the terms of the liquidation, Anglo Irish’s loans will be transferred to the National Asset Management Agency, the so-called bad bank set up by the local government. Other assets could be sold to outside investors.

Anglo Irish had been at the center of controversy since the beginning of the financial crisis. Three of its former executives, including its former chief executive, Sean FitzPatrick, are facing fraud charges in connection with loans that authorities have said were granted improperly.

The new legislation, which was signed into law after an all-night parliamentary session, had been rushed through because details of the debt-restructuring plan were leaked on Wednesday. Even as lawmakers were debating the Anglo Irish liquidation, the hashtag #promnight — in reference to the promissory notes — started to trend on Twitter as the Irish public eagerly awaited the outcome.

Politicians had hoped to wait to announce the liquidation after agreeing on new terms with the European Central Bank.

“I would have preferred to be introducing this bill in tandem with a finalized agreement with the European Central Bank,” the Irish finance minister, Michael Noonan, said in a statement.

Despite persistent questioning at a Frankfurt news conference on Thursday, Mr. Draghi resolutely declined to offer any information about the central bank’s role, if any, in helping Ireland reduce its interest payments.

He said the bank’s governing council, which concluded its monthly meeting Thursday, merely “took note” of the Irish action. Mr. Draghi may have wanted to avoid any impression that the central bank was giving a financial break to the Irish government because its charter prohibits it from financing euro zone governments.

Ireland’s multibillion-euro lifeline in 2010 came with strings attached. International creditors demanded that Ireland adopt austerity measures that would cut public spending by $20 billion by 2015.

Salaries for many public sector workers, including nurses and teachers, have been reduced about 20 percent. Welfare programs like social protection and child benefits have been cut. And a series of new taxes has been introduced to refill the government’s coffers.

At first, the cuts plunged Ireland’s economy into recession, but the country’s gross domestic product is expected to grow 1.1 percent this year, much better than the mere 0.1 percent growth projected for the entire euro zone.

Despite the gradual recovery and now a reduction in the country’s debt burden, the Irish prime minister cautioned that more work had to be done to revive the country’s economy.

“Let there be no doubt, this is no silver bullet to end all our economic problems,” Mr. Kenny said on Thursday. “There is still a long way to travel in our country’s journey back to prosperity and full employment.”

Jack Ewing contributed reporting from Frankfurt

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Obama Orders Release of Drone Memos to Lawmakers

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WASHINGTON — The White House on Wednesday directed the Justice Department to release classified documents discussing the legal justification for the use of drones in targeting American citizens abroad who are considered terrorist to the two Congressional intelligence committees, according to an administration official.




The White House announcement appears to refer to a long, detailed 2010 memo from the Justice Department’s Office of Legal Counsel justifying the killing of Anwar al-Awlaki, an American-born cleric who had joined Al Qaeda in Yemen. He was killed in a C.I.A. drone strike in September 2011. Members of Congress have long demanded access to the legal memorandum.


The decision to release the legal memos to the intelligence committees came under pressure, two days after a bipartisan group of 11 senators joined a growing chorus asking for more information about the legal justification for targeted killings, especially of Americans. The announcement also came on the eve of the confirmation hearing scheduled for Thursday for John O. Brennan, President Obama’s choice to be director of the C.I.A. As Mr. Obama’s counterterrorism adviser, Mr. Brennan has been the chief architect of the drone program, and he is expected to be closely questioned about it at the hearing of the Senate Intelligence Committee.


Critics noted that in 2009, Mr. Obama had ordered the public release of the classified memos governing C.I.A. interrogations under President George W. Bush and accused Mr. Obama of hypocrisy. Administration officials replied that the so-called enhanced interrogations had been stopped, while drone strikes continue.


Until Wednesday night, the administration had refused to even officially acknowledge the existence of the documents, which have been reported about in the press. This week, NBC News obtained an unclassified, shorter legal memo, described as a “white paper,” that officials said described the legal framework that officials follow in using the drones.


Administration officials said Mr. Obama had decided to take the action — which they described as extraordinary — out of a desire to involve Congress in the development of the legal framework for the use of drones. Aides noted that Mr. Obama had made a pledge to do that during an appearance on “The Daily Show” last year.


“Today, as part of the president’s ongoing commitment to consult with Congress on national security matters, the president directed the Department of Justice to provide the congressional Intelligence committees access to classified Office of Legal Counsel advice related to the subject of the Department of Justice White Paper,” the administration official said.


The official said that members of the intelligence committees would now get “access” to the documents. It remained unclear what kind of access that would be.


Christopher Anders, senior legislative counsel for the American Civil Liberties Union, called the president’s move “a small step in the right direction.” But he noted that the legal memo or memos were not being shared with either of the armed services committees, which have jurisdiction over Pentagon strikes, or the judiciary committees, which oversee the Justice Department.


The public should be permitted to see at least a redacted version of the relevant memos, Mr. Anders said. “Everyone has a right to know when the government believes it can kill Americans and others,” he said.


The Congressional intelligence committees were created in the late 1970s to exercise oversight after a series of scandals at the spy agencies. The law requires that the committees be kept informed of intelligence activities. But most administrations withhold at least some legal opinions, treating them as confidential legal advice to the president and agency officials.


Senator Dianne Feinstein, the California Democrat who leads the Senate Intelligence Committee, had proposed a clause for the annual intelligence authorization bill requiring that legal opinions on relevant matters be routinely shared with the committees. But the White House objected, and the measure was dropped from the bill.


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App Smart: A Review of Video-Editing Apps for the Smartphone

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App Smart: Video Editing:
Kit Eaton reviews apps that turn smartphone video into fun short films.







I’ll bet that your smartphone is full of lots of little video clips. You know, ones that you make when you see something cute, surprising or beautiful. They may be nice mementos, but I’ll also bet they are not great examples of cinematography. Instead of just leaving these clips in their raw state on your phone, you can use apps to trim off unneeded parts, string clips together or add special effects.









Cute Cut for iOS feels as if it might be for professional users.






Magisto — Magical Video Editor for iOS and Android does most of the tricky technical stuff for you.






Video Edit is a simple and straightforward app for iOS.






One great video editor for Apple’s iOS devices is called Cute Cut. This app feels as if it might be for professional users, with clean graphics and smartly designed menus. Advice windows pop up over its display to help get you started. Click on the plus button to create a new movie, and then select whether your final edited movie will be high-definition or standard, and in landscape display or portrait.


The app’s main editing window then pops up. Here is where you add and edit movie clips. Each clip is organized on the app’s timeline display, and you can stack several clips to be added together to make your final movie.


A double tap on each clip lets you crop its size, trim its length or tweak other features like the original audio volume. You can also add transitions which are movie effects, like a fade between clips. There are also options to add music or commentary, text boxes or still photos.


Cute Cut is very powerful, but occasionally its menu system is confusing. I found it tricky to add transitions between clips because the tools to do so weren’t obvious from the various icons and buttons in the app.


The basic app is free on iTunes, but it prints a “made with Cute Cut” watermark on your movies and limits their length. A $4 upgrade through an in-app purchase removes both these restrictions.


A similarly powerful app for Android, with a friendly icon-based interface, is called Andromedia Video Editor (free on Google Play). It can add transitions, insert still photos and edit the audio accompaniment. The app’s interface is simpler than Cute Cut’s. For example, each clip you are adding is represented by an icon on the main display. Special-effects transitions are shown as a different icon between your clip icons. To edit a clip or adjust a transition, you tap on its icon. When you are finished, you can save your movie or immediately share it on YouTube.


For free software, this app is both powerful and fun to use, but don’t expect precision editing powers or a wide array of video effects. I also managed to crash it a couple of times.


For a simpler and more straightforward video editing on iOS, I like Video Edit (free on iTunes) for its minimal design and easy-to-use interface, but it has limits. All you can do is stack movie clips from your video archive together into one bigger production. It does let you trim each clip (through a double-tap on the little thumbnail image representing the clips), but there are no clever cinemalike transitions available to link the clips.


When you are finished, a click on the tick mark saves your final movie or lets you share it by e-mail, Facebook or YouTube.


An alternative movie editing app that does most of the tricky technical stuff for you is Magisto — Magical Video Editor (free on iOS and Android). Use it to create cute movies and overlay them with special effects. Simply select clips and a special video effect (from options like “Sentimental” or “Let’s Party”). These add colors, blurs, sparkles and so on.


You can also add a song from its short list of music offerings. It takes a few minutes to produce the final video, and while it is often something that would be fun to share with family or friends on Facebook, it is not going to win you an Oscar.


On the downside, this app can be confusing to use, and it requires you sign up for an account before you can save your final movies.


Quick Calls


Epic Games has brought its 3-D graphics demonstrator Epic Citadel to Android. It’s free, and you will be amazed at the console-like imagery as you wander through a medieval castle. It’s also fun, even if there is no game to play, yet. ... The journal-keeping style of Moleskine paper notebooks is now available digitally through an app on Windows Phone, which is great for keeping track of ideas in the form of notes or sketches.


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