Personal Health: Quitting Smoking for Good

Few smokers would claim that it’s easy to quit. The addiction to nicotine is strong and repeatedly reinforced by circumstances that prompt smokers to light up.

Yet the millions who have successfully quit are proof that a smoke-free life is achievable, even by those who have been regular, even heavy, smokers for decades.

Today, 19 percent of American adults smoke, down from more than 42 percent half a century ago, when Luther Terry, the United States surgeon general, formed a committee to produce the first official report on the health effects of smoking. Ever-increasing restrictions on where people can smoke have helped to swell the ranks of former smokers.

Now, however, as we approach the American Cancer Society’s 37th Great American Smokeout on Thursday, the decline in adult smoking has stalled despite the economic downturn and the soaring price of cigarettes.

Currently, 45 million Americans are regular smokers who, if they remain smokers, can on average expect to live 10 fewer years. Half will die of a tobacco-related disease, and many others will suffer for years with smoking-caused illness. Smoking adds $96 billion to the annual cost of medical care in this country, Dr. Nancy A. Rigotti wrote in The Journal of the American Medical Association last month. Even as some adult smokers quit, their ranks are being swelled by the 800,000 teenagers who become regular smokers each year and by young adults who, through advertising and giveaways, are now the prime targets of the tobacco industry.

People ages 18 to 25 now have the nation’s highest smoking rate: about 34 percent counted in the National Survey on Drug Use and Health in 2010 reported smoking cigarettes in the previous month. I had to hold my breath the other day as dozens of 20-somethings streamed out of art gallery openings and lighted up. Do they not know how easy it is to get hooked on nicotine and how challenging it can be to escape this addiction?

Challenging, yes, but by no means impossible. On the Web you can download a “Guide to Quitting Smoking,” with detailed descriptions of all the tools and tips to help you become an ex-smoker once and for all.

Or consult the new book by Dr. Richard Brunswick, a retired family physician in Northampton, Mass., who says he’s helped hundreds of people escape the clutches of nicotine and smoking. (The printable parts of the book’s provocative title are “Can’t Quit? You Can Stop Smoking.”)

“There is no magic pill or formula for beating back nicotine addiction,” Dr. Brunswick said. “However, with a better understanding of why you smoke and the different tools you can use to control the urge to light up, you can stop being a slave to your cigarettes.”

Addiction and Withdrawal

Nicotine beats a direct path to the brain, where it provides both relaxation and a small energy boost. But few smokers realize that the stress and lethargy they are trying to relieve are a result of nicotine withdrawal, not some underlying distress. Break the addiction, and the ill feelings are likely to dissipate.

Physical withdrawal from nicotine is short-lived. Four days without it and the worst is over, with remaining symptoms gone within a month, Dr. Brunswick said. But emotional and circumstantial tugs to smoke can last much longer.

Depending on when and why you smoke, cues can include needing a break from work, having to focus on a challenging task, drinking coffee or alcohol, being with other people who smoke or in places you associate with smoking, finishing a meal or sexual activity, and feeling depressed or upset.

To break such links, you must first identify them and then replace them with other activities, like taking a walk, chewing sugar-free gum or taking deep breaths. These can help you control cravings until the urge passes.

If you’ve failed at quitting before, try to identify what went wrong and do things differently this time, Dr. Brunswick suggests. Most smokers need several attempts before they can become permanent ex-smokers.

Perhaps most important is to be sure you are serious about quitting; if not, wait until you are. Motivation is half the battle. Also, should you slip and have a cigarette after days or weeks of not smoking, don’t assume you’ve failed and give up. Just go right back to not smoking.

Aids for Quitting

Many if not most smokers need two kinds of assistance to become lasting ex-smokers: psychological support and medicinal aids. Only about 4 percent to 7 percent of people are able to quit smoking on any given attempt without help, the cancer society says.

All 50 states and the District of Columbia have free telephone-based support programs that connect would-be quitters to trained counselors. Together, you can plan a stop-smoking method that suits your smoking pattern and helps you avoid common pitfalls.

Online support groups and Nicotine Anonymous can help as well. To find a group, ask a local hospital or call the cancer society at (800) 227-2345. Consider telling relatives and friends about your intention to quit, and plan to spend time in smoke-free settings.

More than a dozen treatments can help you break the physical addiction to tobacco. Most popular is nicotine replacement therapy, sold both with and without a prescription. The Food and Drug Administration has approved five types: nicotine patches of varying strengths, gums, sprays, inhalers and lozenges that can curb withdrawal symptoms and help you gradually reduce your dependence on nicotine.

Two prescription drugs are also effective: an extended-release form of the antidepressant bupropion (Zyban or Wellbutrin), which reduces nicotine cravings, and varenicline (Chantix), which blocks nicotine receptors in the brain, reducing both the pleasurable effects of smoking and the symptoms of nicotine withdrawal. Combining a nicotine replacement with one of these drugs is often more effective than either approach alone.

Other suggested techniques, like hypnosis and acupuncture, have helped some people quit but lack strong proof of their effectiveness. Tobacco lozenges and pouches and nicotine lollipops and lip balms lack evidence as quitting aids, and no clinical trials have been published showing that electronic cigarettes can help people quit.

The cancer society suggests picking a “quit day”; ridding your home, car and workplace of smoking paraphernalia; choosing a stop-smoking plan, and stocking up on whatever aids you may need.

On the chosen day, keep active; drink lots of water and juices; use a nicotine replacement; change your routine if possible; and avoid alcohol, situations you associate with smoking and people who are smoking.

---

This post has been revised to reflect the following correction:

Correction: November 16, 2012

An earlier version of this column stated imprecisely the rate of smoking among young adults. According to the National Survey on Drug Use and Health, in 2010 about 34 percent of people ages 18 to 25 smoked cigarettes in the month before the survey -- not daily. (About 16 percent of them reported smoking daily, according to the survey.)

This post has been revised to reflect the following correction:

Correction: November 14, 2012

An earlier version of this column misstated the rate of smoking among young adults. According to the National Survey on Drug Use and Health, in 2010 about 34 percent of people ages 18 to 25 smoked cigarettes, not 40 percent. (That is the share of young adults who use tobacco products of any kind, according to the survey.)

Read More..

Personal Health: Quitting Smoking for Good

Few smokers would claim that it’s easy to quit. The addiction to nicotine is strong and repeatedly reinforced by circumstances that prompt smokers to light up.

Yet the millions who have successfully quit are proof that a smoke-free life is achievable, even by those who have been regular, even heavy, smokers for decades.

Today, 19 percent of American adults smoke, down from more than 42 percent half a century ago, when Luther Terry, the United States surgeon general, formed a committee to produce the first official report on the health effects of smoking. Ever-increasing restrictions on where people can smoke have helped to swell the ranks of former smokers.

Now, however, as we approach the American Cancer Society’s 37th Great American Smokeout on Thursday, the decline in adult smoking has stalled despite the economic downturn and the soaring price of cigarettes.

Currently, 45 million Americans are regular smokers who, if they remain smokers, can on average expect to live 10 fewer years. Half will die of a tobacco-related disease, and many others will suffer for years with smoking-caused illness. Smoking adds $96 billion to the annual cost of medical care in this country, Dr. Nancy A. Rigotti wrote in The Journal of the American Medical Association last month. Even as some adult smokers quit, their ranks are being swelled by the 800,000 teenagers who become regular smokers each year and by young adults who, through advertising and giveaways, are now the prime targets of the tobacco industry.

People ages 18 to 25 now have the nation’s highest smoking rate: about 34 percent counted in the National Survey on Drug Use and Health in 2010 reported smoking cigarettes in the previous month. I had to hold my breath the other day as dozens of 20-somethings streamed out of art gallery openings and lighted up. Do they not know how easy it is to get hooked on nicotine and how challenging it can be to escape this addiction?

Challenging, yes, but by no means impossible. On the Web you can download a “Guide to Quitting Smoking,” with detailed descriptions of all the tools and tips to help you become an ex-smoker once and for all.

Or consult the new book by Dr. Richard Brunswick, a retired family physician in Northampton, Mass., who says he’s helped hundreds of people escape the clutches of nicotine and smoking. (The printable parts of the book’s provocative title are “Can’t Quit? You Can Stop Smoking.”)

“There is no magic pill or formula for beating back nicotine addiction,” Dr. Brunswick said. “However, with a better understanding of why you smoke and the different tools you can use to control the urge to light up, you can stop being a slave to your cigarettes.”

Addiction and Withdrawal

Nicotine beats a direct path to the brain, where it provides both relaxation and a small energy boost. But few smokers realize that the stress and lethargy they are trying to relieve are a result of nicotine withdrawal, not some underlying distress. Break the addiction, and the ill feelings are likely to dissipate.

Physical withdrawal from nicotine is short-lived. Four days without it and the worst is over, with remaining symptoms gone within a month, Dr. Brunswick said. But emotional and circumstantial tugs to smoke can last much longer.

Depending on when and why you smoke, cues can include needing a break from work, having to focus on a challenging task, drinking coffee or alcohol, being with other people who smoke or in places you associate with smoking, finishing a meal or sexual activity, and feeling depressed or upset.

To break such links, you must first identify them and then replace them with other activities, like taking a walk, chewing sugar-free gum or taking deep breaths. These can help you control cravings until the urge passes.

If you’ve failed at quitting before, try to identify what went wrong and do things differently this time, Dr. Brunswick suggests. Most smokers need several attempts before they can become permanent ex-smokers.

Perhaps most important is to be sure you are serious about quitting; if not, wait until you are. Motivation is half the battle. Also, should you slip and have a cigarette after days or weeks of not smoking, don’t assume you’ve failed and give up. Just go right back to not smoking.

Aids for Quitting

Many if not most smokers need two kinds of assistance to become lasting ex-smokers: psychological support and medicinal aids. Only about 4 percent to 7 percent of people are able to quit smoking on any given attempt without help, the cancer society says.

All 50 states and the District of Columbia have free telephone-based support programs that connect would-be quitters to trained counselors. Together, you can plan a stop-smoking method that suits your smoking pattern and helps you avoid common pitfalls.

Online support groups and Nicotine Anonymous can help as well. To find a group, ask a local hospital or call the cancer society at (800) 227-2345. Consider telling relatives and friends about your intention to quit, and plan to spend time in smoke-free settings.

More than a dozen treatments can help you break the physical addiction to tobacco. Most popular is nicotine replacement therapy, sold both with and without a prescription. The Food and Drug Administration has approved five types: nicotine patches of varying strengths, gums, sprays, inhalers and lozenges that can curb withdrawal symptoms and help you gradually reduce your dependence on nicotine.

Two prescription drugs are also effective: an extended-release form of the antidepressant bupropion (Zyban or Wellbutrin), which reduces nicotine cravings, and varenicline (Chantix), which blocks nicotine receptors in the brain, reducing both the pleasurable effects of smoking and the symptoms of nicotine withdrawal. Combining a nicotine replacement with one of these drugs is often more effective than either approach alone.

Other suggested techniques, like hypnosis and acupuncture, have helped some people quit but lack strong proof of their effectiveness. Tobacco lozenges and pouches and nicotine lollipops and lip balms lack evidence as quitting aids, and no clinical trials have been published showing that electronic cigarettes can help people quit.

The cancer society suggests picking a “quit day”; ridding your home, car and workplace of smoking paraphernalia; choosing a stop-smoking plan, and stocking up on whatever aids you may need.

On the chosen day, keep active; drink lots of water and juices; use a nicotine replacement; change your routine if possible; and avoid alcohol, situations you associate with smoking and people who are smoking.

---

This post has been revised to reflect the following correction:

Correction: November 16, 2012

An earlier version of this column stated imprecisely the rate of smoking among young adults. According to the National Survey on Drug Use and Health, in 2010 about 34 percent of people ages 18 to 25 smoked cigarettes in the month before the survey -- not daily. (About 16 percent of them reported smoking daily, according to the survey.)

This post has been revised to reflect the following correction:

Correction: November 14, 2012

An earlier version of this column misstated the rate of smoking among young adults. According to the National Survey on Drug Use and Health, in 2010 about 34 percent of people ages 18 to 25 smoked cigarettes, not 40 percent. (That is the share of young adults who use tobacco products of any kind, according to the survey.)

Read More..

Trying to Keep Your E-Mails Secret When the C.I.A. Chief Couldn’t

If David H. Petraeus couldn’t keep his affair from prying eyes as director of the Central Intelligence Agency, then how is the average American to keep a secret?

In the past, a spymaster might have placed a flower pot with a red flag on his balcony or drawn a mark on page 20 of his mistress’s newspaper. Instead, Mr. Petraeus used Gmail. And he got caught.

Granted, most people don’t have the Federal Bureau of Investigation sifting through their personal e-mails, but privacy experts say people grossly underestimate how transparent their digital communications have become.

“What people don’t realize is that hacking and spying went mainstream a decade ago,” said Dan Kaminsky, an Internet security researcher. “They think hacking is some difficult thing. Meanwhile, everyone is reading everyone else’s e-mails — girlfriends are reading boyfriends’, bosses are reading employees’ — because it’s just so easy to do.”

Face it: no matter what you are trying to hide in your e-mail in-box or text message folder — be it an extramarital affair or company trade secrets — it is possible that someone will find out. If it involves criminal activity or litigation, the odds increase because the government has search and subpoena powers that can be used to get any and all information, whether it is stored on your computer or, as is more likely these days, stored in the cloud. And lawyers for the other side in a lawsuit can get reams of documents in court-sanctioned discovery.

Still determined? Thought so. You certainly are not alone, as there are legitimate reasons that people want to keep private all types of information and communications that are not suspicious (like the contents of your will, for example, or a chronic illness). In that case, here are your best shots at hiding the skeletons in your digital closet.

KNOW YOUR ADVERSARY. Technically speaking, the undoing of Mr. Petraeus was not the extramarital affair, per se, it was that he misunderstood the threat. He and his mistress/biographer, Paula Broadwell, may have thought the threat was their spouses snooping through their e-mails, not the F.B.I. looking through Google’s e-mail servers.

“Understanding the threat is always the most difficult part of security technology,” said Matthew Blaze, an associate professor of computer and information science at the University of Pennsylvania and a security and cryptography specialist. “If they believed the threat to be a government with the ability to get their login records from a service provider, not just their spouse, they might have acted differently.”

To hide their affair from their spouses, the two reportedly limited their digital communications to a shared Gmail account. They did not send e-mails, but saved messages to the draft folder instead, ostensibly to avoid a digital trail. It is unlikely either of their spouses would have seen it.

But neither took necessary steps to hide their computers’ I.P. addresses. According to published accounts of the affair, Ms. Broadwell exposed the subterfuge when she used the same computer to send harassing e-mails to a woman in Florida, Jill Kelley, who sent them to a friend at the F.B.I.

Authorities matched the digital trail from Ms. Kelley’s e-mails — some had been sent via hotel Wi-Fi networks — to hotel guest lists. In crosschecking lists of hotel guests, they arrived at Ms. Broadwell and her computer, which led them to more e-mail accounts, including the one she shared with Mr. Petraeus.

HIDE YOUR LOCATION The two could have masked their I.P. addresses using Tor, a popular privacy tool that allows anonymous Web browsing. They could have also used a virtual private network, which adds a layer of security to public Wi-Fi networks like the one in your hotel room.

By not doing so, Mr. Blaze said, “they made a fairly elementary mistake.” E-mail providers like Google and Yahoo keep login records, which reveal I.P. addresses, for 18 months, during which they can easily be subpoenaed. The Fourth Amendment requires the authorities to get a warrant from a judge to search physical property. Rules governing e-mail searches are far more lax: Under the 1986 Electronic Communications Privacy Act, a warrant is not required for e-mails six months old or older. Even if e-mails are more recent, the federal government needs a search warrant only for “unopened” e-mail, according to the Department of Justice’s manual for electronic searches. The rest requires only a subpoena.

Google reported that United States law enforcement agencies requested data for 16,281 accounts from January to June of this year, and it complied in 90 percent of cases.

GO OFF THE RECORD At bare minimum, choose the “off the record” feature on Google Talk, Google’s instant messaging client, which ensures that nothing typed is saved or searchable in either person’s Gmail account.

Read More..

Palestinian Rockets Kill Three Israelis and Trigger Air Sirens in Tel Aviv

KIRYAT MALACHI, Israel — Israel and Hamas brushed aside international calls for restraint on Thursday and escalated their lethal conflict over Gaza, where Palestinian militants launched hundreds of rockets into Israeli territory, targeting Tel Aviv for the first time, and Israel intensified its aerial assaults and sent tanks rumbling toward the Gaza border for a possible invasion.

Defense Minister Ehud Barak of Israel, expressing outrage over a pair of long-range Palestinian rockets that whizzed toward Tel Aviv and triggered the first air raid warning in the Israeli metropolis since it was threatened by Iraqi Scuds in the Persian Gulf war of 1991, said, “There will be a price for that escalation that the other side will have to pay.”

He authorized the call-up of 30,000 army reservists if needed, another sign that Israel was preparing to invade Gaza for the second time in four years to crush what it considers an unacceptable security threat from smuggled rockets amassed by Hamas, the militant Islamist group that governs the isolated coastal enclave and does not recognize Israel’s right to exist.

It was not clear whether the show of Israeli force on the ground in fact portended an invasion or was meant as more of an intimidation tactic to further pressure Hamas leaders, who had all been forced into hiding on Wednesday after the Israelis killed the group’s military chief in a pinpoint aerial bombing. But Prime Minister Benjamin Netanyahu of Israel said he was prepared to “take whatever action is necessary.”

Although Tel Aviv was not hit on Thursday and the rockets heading toward the city of 400,000 apparently fell harmlessly elsewhere, the ability of militants 40 miles away to fire those weapons underscored, in the Israeli government’s view, the justification for the intensive aerial assaults on hundreds of suspected rocket storage sites and other targets in Gaza.

Health officials in Gaza said at least 19 people, including five children and a pregnant teenager, had been killed over two days of nearly nonstop aerial attacks by Israel, and dozens had been wounded. Three Israelis were killed on Thursday in Kiryat Malachi, this small southern Israeli town, when a rocket fired from Gaza struck their apartment house.

In a sign of solidarity with Hamas as well as a diplomatic move to ease the crisis, President Mohamed Morsi of Egypt ordered his prime minister to lead a delegation to Gaza on Friday. In another diplomatic signal, Ban Ki-moon, the United Nations secretary general, also planned to visit Jerusalem, Cairo and Ramallah, the West Bank headquarters of the Palestinian Authority, in coming days.

In Washington, Obama administration officials said they had asked friendly Arab countries with ties to Hamas, which the United States and Israel regard as a terrorist group, to use their influence to seek a way to defuse the hostilities. At the same time, however, a State Department spokesman, Mark Toner, reiterated to reporters the American position that Israel had a right to defend itself from the rocket fire and that the “onus was on Hamas” to stop it.

There was no sign that either side was prepared, at least not yet, to restore the uneasy truce that has mostly prevailed since the last time the Israelis invaded Gaza in the winter of 2008-2009, a three-week war that left 1,400 Palestinians dead and drew widespread international condemnation.

Denunciations of Israel for what critics called a renewal of its aggressive and disproportionate attacks spread quickly on the second day of the aerial assaults. The biggest criticism came from the 120-nation Nonaligned Movement, the largest bloc at the United Nations. In a statement released by Iran, which holds the group’s rotating presidency and is one of Israel’s most ardent foes, the group said: “Israel, the occupying power, is, once more, escalating its military campaign against the Palestinian people, particularly in the Gaza Strip.” The group made no mention of the Palestinian rocket fire aimed at Israel but condemned “this act of aggression by the Israelis and their resort to force against the defenseless people” and demanded “decisive action by the U.N. Security Council.”

Isabel Kershner reported from Kiryat Malachi, Israel, and Rick Gladstone from New York. Reporting was contributed by Fares Akram from Gaza, Rina Castelnuovo from Kiryat Malachi, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem and Alan Cowell from Paris.

Isabel Kershner reported from Kiryat Malachi, Israel, and Rick Gladstone from New York. Reporting was contributed by Fares Akram from Gaza, Rina Castelnuovo from Kiryat Malachi, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem and Alan Cowell from Paris.

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Hurt by Rivals From Asia, Dell Profit Falls 47%

SAN FRANCISCO (Reuters) — Dell’s third-quarter profit fell 47 percent, the company said on Thursday, hurt by lower PC sales and weaker demand from large corporations. But Dell said it expected revenue to grow as much as 5 percent in the current quarter compared with sales in the previous one.

The company, once the world’s top PC maker and a pioneer in computer supply chain management, is struggling to defend its market share against Asian rivals like Lenovo. It is trying to bolster growth by focusing on products and services to corporations.

The company, founded by its chief executive, Michael Dell, said that it saw “the challenging global macroeconomic environment continuing in the fourth quarter.”

Net income was $475 million, or 27 cents a share, compared with $893 million, or 49 cents a share, in the period a year earlier. Excluding certain items, it earned 39 cents a share, compared with an average forecast of 40 cents.

Revenue fell 11 percent, to $13.7 billion, slightly less than the average analyst estimate of $13.89 billion, according to Thomson Reuters.

Dell’s chief financial officer, Brian T. Gladden, said in an interview that corporate customers continued to postpone technology spending.

“It’s not clear what’s going to cause them to increase their spending in the short term, given the uncertainty in the economy,” he said.

Dell’s enterprise solutions revenue rose 3 percent to $4.8 billion, while server and networking revenue climbed 11 percent. In contrast, consumer revenue plummeted 23 percent to $2.5 billion, underscoring the plight of the broader PC market. And sales to large corporations declined 8 percent to $4.2 billion.

The consumer market is improving with the introduction of the Windows 8 operating system from Microsoft, which has been designed with touch-screen devices and Internet-based computing in mind, Mr. Gladden said.

Part of the spending weakness among corporate customers comes from worry over early next year, when trillions of dollars in tax increases and automatic spending cuts will begin to go into force unless lawmakers agree on legislation to reduce the budget deficit, Mr. Gladden said.

The cuts could take a toll on consumer and government spending and cause the economy to stall.

“I would tell you that the behavior we are seeing from our customers today is actually driven by that uncertainty,” Mr. Gladden said. “It’s not like it’s all going to happen overnight. It’s affecting our business today.”

Dell is ensuring that it has access to cash in case there is no Congressional action.

“I would say there are several things we are doing from a planning standpoint,” Mr. Gladden said, “to ensure that we are in a position to have appropriate access to liquidity.” He said Dell was making sure it would have access to lines of credit and commercial paper.

Dell shares fell around 2 percent in late trading from their close of $9.56. The shares initially rose after the release of the results.

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I Was Misinformed: The Time She Tried Viagra

I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing.

But then, I am proud to say, I was among the early, and from what I gather, rare female users.

It happened when the drug was introduced around 1998. I was 50, but after chemotherapy for breast cancer — and later, advanced ovarian cancer — I was, hormonally speaking, pretty much running on fumes. Whether this had diminished my sex drive I did not yet know. One may have Zorba-esque impulses when a cancer diagnosis first comes in; but a treatment that leaves you bald, moon-faced and exhausted knocks that out of your system pretty fast.

But by 1998, the cancer was gone, my hair was back and I was ready to get back in the game. I was talking to an endocrinologist when I brought up Viagra. This was not to deal with the age-related physical changes I knew it would not address, it was more along the feminist lines of equal pay for equal work: if men have this new sex drug, I want this new sex drug.

“I know it’s supposed to work by increasing blood flow,” I told the doctor, “But if that’s true for men, shouldn’t it be true for women, too?”

“You’re the third woman who asked me that this week,” he said.

He wrote me a prescription. I was not seeing anyone, so I understood that I would have to do both parts myself, but that was fine. I have a low drug threshold and figured it might be best the first time to fly solo. My memory of the directions are hazy: I think there was a warning that one might have a facial flush or headaches or drop dead of a heart attack; that you were to take a pill at least an hour before you planned to get lucky, and, as zero hour approached, you were supposed to help things along by thinking beautiful thoughts, kind of like Peter Pan teaching Wendy and the boys how to fly.

But you know how it is: It’s hard to think beautiful thoughts when you’re wondering, “Is it happening? Do I feel anything? Woof, woof? Hello, sailor? Naaah.”

After about an hour, however, I was aware of a dramatic change. I had developed a red flush on my face; I was a hot tomato, though not the kind I had planned. I had also developed a horrible headache. The sex pill had turned into a bad joke: Not now, honey, I have a headache.

I put a cold cloth on my head and went to sleep. But here’s where it got good: When I slept, I dreamed; one of those extraordinary, sensual, swimming in silk sort of things. I woke up dazed and glowing with just one thought: I gotta get this baby out on the highway and see what it can do.

A few months later I am fixed up with a guy, and after a time he is, under the Seinfeldian definition of human relations (Saturday night date assumed) my official boyfriend. He is middle aged, in good health. How to describe our romantic life with the delicacy a family publication requires? Perhaps a line from “Veronika, der Lenz ist da” (“Veronica, Spring Is Here”), a song popularized by the German group the Comedian Harmonists: “Veronika, der Spargel Wächst” (“Veronica, the asparagus are blooming”). On the other hand, sometimes not. And so, one day, I put it out there in the manner of sport:

“Want to drop some Viagra?” I say.

Here we go again, falling into what I am beginning to think is an inevitable pattern: lying there like a lox, or two loxes, waiting for the train to pull into the station. (Yes, I know it’s a mixed metaphor, but at least I didn’t bring in the asparagus.) So there we are, waiting. And then, suddenly, spring comes to Suffolk County. It’s such a presence. I’m wondering if I should ask it if it hit traffic on the L.I.E. We sit there staring.

My reaction is less impressive. I don’t get a headache this time. And romantically, things are more so, but not so much that I feel compelled to try the little blue pills again.

Onward roll the years. I have a new man in my life, who is 63. He does have health problems, for which his doctor prescribes an E.D. drug. I no longer have any interest in them. My curiosity has been satisfied. Plus I am deeply in love, an aphrodisiac yet to be encapsulated in pharmaceuticals.

We take a vacation in mountain Mexico. We pop into a drugstore to pick up sunscreen and spot the whole gang, Cialis, Viagra, Levitra, on a shelf at the checkout counter. No prescription needed in Mexico, the clerk says. We buy all three drugs and return to the hotel. I try some, he tries some. In retrospect, given the altitude and his health, we are lucky we did not kill him. I came across an old photo the other day. He is on the bed, the drugs in their boxes lined up a in a semi-circle around him. He looks a bit dazed and his nose is red.

Looking at the picture, I wonder if he had a cold.

Then I remember: the flush, the damn flush. If I had kids, I suppose I would have to lie about it.

Read More..

I Was Misinformed: The Time She Tried Viagra

I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing.

But then, I am proud to say, I was among the early, and from what I gather, rare female users.

It happened when the drug was introduced around 1998. I was 50, but after chemotherapy for breast cancer — and later, advanced ovarian cancer — I was, hormonally speaking, pretty much running on fumes. Whether this had diminished my sex drive I did not yet know. One may have Zorba-esque impulses when a cancer diagnosis first comes in; but a treatment that leaves you bald, moon-faced and exhausted knocks that out of your system pretty fast.

But by 1998, the cancer was gone, my hair was back and I was ready to get back in the game. I was talking to an endocrinologist when I brought up Viagra. This was not to deal with the age-related physical changes I knew it would not address, it was more along the feminist lines of equal pay for equal work: if men have this new sex drug, I want this new sex drug.

“I know it’s supposed to work by increasing blood flow,” I told the doctor, “But if that’s true for men, shouldn’t it be true for women, too?”

“You’re the third woman who asked me that this week,” he said.

He wrote me a prescription. I was not seeing anyone, so I understood that I would have to do both parts myself, but that was fine. I have a low drug threshold and figured it might be best the first time to fly solo. My memory of the directions are hazy: I think there was a warning that one might have a facial flush or headaches or drop dead of a heart attack; that you were to take a pill at least an hour before you planned to get lucky, and, as zero hour approached, you were supposed to help things along by thinking beautiful thoughts, kind of like Peter Pan teaching Wendy and the boys how to fly.

But you know how it is: It’s hard to think beautiful thoughts when you’re wondering, “Is it happening? Do I feel anything? Woof, woof? Hello, sailor? Naaah.”

After about an hour, however, I was aware of a dramatic change. I had developed a red flush on my face; I was a hot tomato, though not the kind I had planned. I had also developed a horrible headache. The sex pill had turned into a bad joke: Not now, honey, I have a headache.

I put a cold cloth on my head and went to sleep. But here’s where it got good: When I slept, I dreamed; one of those extraordinary, sensual, swimming in silk sort of things. I woke up dazed and glowing with just one thought: I gotta get this baby out on the highway and see what it can do.

A few months later I am fixed up with a guy, and after a time he is, under the Seinfeldian definition of human relations (Saturday night date assumed) my official boyfriend. He is middle aged, in good health. How to describe our romantic life with the delicacy a family publication requires? Perhaps a line from “Veronika, der Lenz ist da” (“Veronica, Spring Is Here”), a song popularized by the German group the Comedian Harmonists: “Veronika, der Spargel Wächst” (“Veronica, the asparagus are blooming”). On the other hand, sometimes not. And so, one day, I put it out there in the manner of sport:

“Want to drop some Viagra?” I say.

Here we go again, falling into what I am beginning to think is an inevitable pattern: lying there like a lox, or two loxes, waiting for the train to pull into the station. (Yes, I know it’s a mixed metaphor, but at least I didn’t bring in the asparagus.) So there we are, waiting. And then, suddenly, spring comes to Suffolk County. It’s such a presence. I’m wondering if I should ask it if it hit traffic on the L.I.E. We sit there staring.

My reaction is less impressive. I don’t get a headache this time. And romantically, things are more so, but not so much that I feel compelled to try the little blue pills again.

Onward roll the years. I have a new man in my life, who is 63. He does have health problems, for which his doctor prescribes an E.D. drug. I no longer have any interest in them. My curiosity has been satisfied. Plus I am deeply in love, an aphrodisiac yet to be encapsulated in pharmaceuticals.

We take a vacation in mountain Mexico. We pop into a drugstore to pick up sunscreen and spot the whole gang, Cialis, Viagra, Levitra, on a shelf at the checkout counter. No prescription needed in Mexico, the clerk says. We buy all three drugs and return to the hotel. I try some, he tries some. In retrospect, given the altitude and his health, we are lucky we did not kill him. I came across an old photo the other day. He is on the bed, the drugs in their boxes lined up a in a semi-circle around him. He looks a bit dazed and his nose is red.

Looking at the picture, I wonder if he had a cold.

Then I remember: the flush, the damn flush. If I had kids, I suppose I would have to lie about it.

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Wal-Mart Inquiry Reflects Alarm on Corruption

Wal-Mart on Thursday reported that its investigation into violations of a federal antibribery law had extended beyond Mexico to China, India and Brazil, some of the retailer’s most important international markets.

The disclosure, made in a regulatory filing, suggests Wal-Mart has uncovered evidence into potential violations of the Foreign Corrupt Practices Act, as the fallout continues from a bribery scheme involving the opening of stores in Mexico that was the subject of a New York Times investigation in April.

The announcement underscores the degree to which Wal-Mart recognizes that corruption may have infected its international operations, and reflects a growing alarm among the company’s internal investigators. People with knowledge of the matter described how a relatively routine compliance audit rapidly transformed into a full-blown investigation late last year — involving hundreds of lawyers and three former federal prosecutors — when the company learned that The Times was examining problems with its operations in Mexico.

A person with direct knowledge of the company’s internal investigation cautioned that Thursday’s disclosure did not mean Wal-Mart had concluded it had paid bribes in China, India and Brazil. But it did indicate that the company had found enough evidence to justify concern about its business practices in the three countries — concerns that go beyond initial inquiries and that are serious enough that shareholders needed to be told.

A Wal-Mart spokesman declined to elaborate on the filing.

The Justice Department and the Securities and Exchange Commission, with Wal-Mart’s cooperation, are also looking into the company’s compliance with the antibribery law.

The Times reported in April that seven years ago, Wal-Mart had found credible evidence that its Mexican subsidiary had paid bribes in its effort to build more stores, a violation of the corrupt practices act, and that an internal investigation had been suppressed by executives at the company’s Arkansas headquarters.

Wal-Mart has so far spent $35 million on a compliance program that began in the spring, and has more than 300 outside lawyers and accountants working on it, the company said. It has spent $99 million in nine months on the current investigation.

Consequences of the expanding investigation could include slower expansion overseas and the identification of even more problems. The company said in the filing on Thursday that new inquiries had begun in countries “including but not limited to” China, India and Brazil.

While the disclosure did not specify the nature of the possible bribery problems in the three countries, it “clearly will cause more scrutiny on every real estate project being considered, and one would think at the minimum it will slow down the process as more controls need to be passed through,” said Colin McGranahan, an analyst with Sanford C. Bernstein.

International growth is critical to Wal-Mart, the world’s largest retailer, and Brazil, India, China and Mexico together make up the largest portion of the company’s foreign locations.

Wal-Mart’s international division had been on a growth binge, though that has been slowing lately. In third-quarter results reported Thursday, the company said international sales rose 2.4 percent to $33.2 billion, making up about 29 percent of the company’s overall sales.

More than half of Wal-Mart’s 10,150 stores are international. Mexico has 2,230 stores. Brazil has 534, China, 384.

C. Douglas McMillon, chief executive of Walmart International, said in June that he did not expect the investigation to hinder international growth. “Only time will tell,” he said.

Wal-Mart’s expanding investigation began in spring 2011 as a relatively routine audit of how well its foreign subsidiaries were complying with its anticorruption policies. It is keeping the Justice Department and the S.E.C. apprised of the investigation.

The review was initiated by Jeffrey J. Gearhart, Wal-Mart’s general counsel, who had seen news reports about how Tyson Foods had been charged with relatively minor violations of the Foreign Corrupt Practices Act. He decided it made sense to test Wal-Mart’s internal defenses against corruption.

The audit began in Mexico, China and Brazil, the countries Wal-Mart executives considered the most likely source of problems. Wal-Mart hired the accounting firm KPMG and the law firm Greenberg Traurig to conduct the audit. The firms conducted interviews and spot checks of record systems to check whether Wal-Mart’s subsidiaries were carrying out required compliance procedures.

Charlie Savage, Vikas Bajaj and Andrew Downie contributed reporting.

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Changing of the Guard: Corruption in China Military Poses Test

Sim Chi Yin for The New York Times

Hostesses posed outside the Great Hall of the People in Beijing on Wednesday as the Communist Party Congress closed.

BEIJING — An insider critique of corruption in China’s military, circulating just as new leadership is about to take over the armed forces, warns that graft and wide-scale abuses pose as much of a threat to the nation’s security as the United States.

Col. Liu Mingfu, the author of the book, “Why the Liberation Army Can Win,” is not a lone voice.

Earlier this year, a powerful army official gave an emotional speech describing corruption as a “do-or-die struggle,” and days later, according to widely published accounts, a prominent general, Gu Junshan, a deputy director of the logistics department, was arrested on suspicion of corruption. He now awaits trial. The general is reported to have made huge profits on illicit land deals and given more than 400 houses intended for retired officers to friends.

Those excesses may be mere trifles compared with the depth of the overall corruption, the speech by Gen. Liu Yuan, an associate of the presumptive new party leader, Xi Jinping, suggested.

For Mr. Xi, who boasts a military pedigree from his father — a guerrilla leader who helped bring Mao Zedong to power in 1949 — China’s fast modernizing army will be a bulwark of his standing at home and influence abroad.

But the depth of graft and brazen profiteering in the People’s Liberation Army poses a delicate problem for the new leader, one that Colonel Liu and others have warned could undermine the status of the Communist Party.

As part of the nation’s once-a-decade handover of power, Mr. Xi is also expected to assume the chairmanship of the 12-member Central Military Commission immediately. Hu Jintao, the departing party leader, is expected to break precedent and not retain his position atop the body, which oversees the armed forces, for an extended period after his retirement, unlike previous leaders.

Recent territorial disputes with Japan and Southeast Asian neighbors have raised nationalist sentiment in China, and the popular desire for a strong military could make it politically dangerous for Mr. Xi to embark on a campaign that unmasks squandering of public funds.

In his opening speech to the 18th Party Congress, Mr. Hu said China would aim to become “a maritime power.” It was one of the few references in the address about foreign affairs, and one that suggested the government would continue the double-digit increases in expenditures for the military.

But along with the modernization and bigger budgets has come more corruption, a problem that pervades China’s ruling party and its government.

For the first time in the history of the People’s Liberation Army, Chinese analysts say, the land-based army has had to give up its dominance of the military commission.

The former commander of the air force, Xu Qiliang, will be a vice chairman, giving the air force new weight in big decisions, they said. An army general, Fan Changlong, the former commander of the Jinan Military Region, will also be a vice chairman.

These two men will run the day-to-day operations of the military, Chinese analysts said.

In his book, Colonel Liu, a former professor at China’s National Defense University, wrote that the army had not been tested in decades and had grown complacent. “As a military that has not fought a war for 30 years, the People’s Liberation Army has reached a stage in which its biggest danger and No. 1 foe is corruption,” he wrote.

Colonel Liu first became prominent in 2010 with the publication of his book “The China Dream,” an ultranationalist tract arguing that China should build the world’s strongest military and move swiftly to supplant the United States as the global “champion.”

In his new work, the colonel drew a parallel with 1894, when China’s forces were swiftly defeated by a rapidly modernizing Japan, even though the Chinese were equipped with expensive ships from Europe. Historians often attribute the defeat to corruption.

Another retired army officer, and a member of the aristocratic class known as the princelings, said that corruption existed throughout the military but that the new commission would probably refrain from a sustained campaign against it.

Bree Feng contributed research.

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State of the Art: A Review of New Activity-Tracking Bands From Nike and Jawbone

Maybe you’ve heard: Americans are becoming less fit and more fat. There are all kinds of theories about why — bigger meal portions, omnipresent corn syrup and sugar, fewer pickup stickball games after school. But people are starting to think that in many cases, body weight might somehow be linked to diet and exercise.

Now, studies have shown that if there’s some visible, omnipresent monitor of your negative behavior — spending too much money, eating too much food, using too much power in your home — you’re far more likely to correct it.

That’s the idea behind personal activity-tracking bracelets like the Nike FuelBand ($150) and the improved Jawbone Up band ($130). They make you constantly aware of how active you are (or aren’t). They let you compare your data with friends online, establishing a friendly rivalry or at least guilt. And they therefore motivate you to make changes that add up: park farther away, take the stairs, get off one bus stop early.

There are plenty of other fitness trackers, including clip-onto-clothing trackers (like the FitBit and Striiv) and wristwatchlike gadgets (like Motorola’s MotoActiv). But the beauty of the bracelets is that you can leave them on — asleep, in the shower, shirtless or even all three — and so you’re more likely to stick with the program.

Now, those who follow the wearable, accelerometer-based fitness-tracking gadget industry are no doubt scratching their heads right about now. The Up band? Wasn’t that a bracelet that came out about a year ago, and crashed and burned in a humiliatingly public epidemic of hardware failures? Didn’t Jawbone, a company known for Bluetooth speakers and earpieces, pull Up off the market, offering a generous mea culpa (“You can receive a full refund for UP. This is true even if you decide to keep your UP band”)?

Yes.

The company says that after months of testing and millions of dollars in research, it realized that the original band, billed as waterproof, actually wasn’t quite. Water, sweat and shower soap managed to seep inside and short out the components.

The new Up band, the company swears, is bulletproof. Or at least really, truly waterproof. The company says it redesigned 17 parts and made 28 improvements in the manufacturing process. The new band looks identical — it’s still a stiff, rubber, overgrown C in a choice of colors, with ends that overshoot each other — but inside, it’s far better shielded and enclosed. (It’s also $30 more expensive.)

The corresponding iPhone app has had some work done, too. The central conceit is a Facebook-style timeline of your life. Each “post” represents a day’s worth of activity, or a night of sleep, or a meal. (You can enter nonstep-based workouts manually, like biking or weights.) Your friends’ health developments can show up in your stream, too.

That doesn’t mean that the app is ready for its close-up. It’s fairly baffling, housing as it does duplicate hidden menus, and it has its share of bugs and quirks. Why, on a screen that’s much taller than it is wide, are your progress graphs inch-tall bars swimming in empty space? And wow — if you did a situp every time you got the “Sorry, there was an error connecting with the UP server” message, you’d have abs of concrete. (An Android app is in the works.)

What’s great, though, is that the Up’s ambitions extend beyond simple activity tracking. If you do a double press on the button at the end of the band when you go to bed, for example, the bracelet does an impressive job of tracking your night of sleep: how long it takes you to drift off, how many times you wake up, how many hours you spend in light and deep sleep.

A related, extremely useful feature: when you need a power nap (a 25-minute quick sleep, whose refreshing qualities have been well documented in studies), the band doesn’t start counting until it sees that you’re actually asleep. So you actually get 25 minutes, after which the band vibrates to rouse you. That’s something the average pedometer doesn’t do.

You can track your food intake in any of three ways: by taking a photo of what you eat, by scanning the bar code on its package (the app instantly and correctly identifies it) or by choosing from a categorized list of common foodstuffs. It’s still fairly manual — no wristband can tell what you’re shoving into your mouth — so most people probably won’t bother.

E-mail: pogue@nytimes.com

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