The New Old Age Blog: Grief Over New Depression Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

---

This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

Read More..

The New Old Age Blog: Grief Over New Depression Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

---

This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

Read More..

Starbucks Earnings Increased 13% in Latest Quarter

The company’s results were helped by a 6 percent increase in global sales at cafes open at least a year.

The performance reflects the turnaround Starbucks has made since its struggles during the recession. After bringing back its founder, Howard Schultz, as chief executive in 2008, the company embarked on a reorganization that included closing underperforming stores in the United States.

Mr. Schultz has said that the company has the ability to keep growing even through a turbulent economy because most people see Starbucks as an “affordable luxury.”

Starbucks said it earned $432.2 million, or 57 cents a share, in the quarter, up from $382.1 million, or 50 cents a share, a year earlier. Revenue in the period ending Dec. 30, the first quarter of Starbucks’s fiscal year, rose 11 percent, to $3.8 billion. Analysts had expected a profit of 57 cents a share and revenue of $3.85 billion, according to FactSet.

Shares rose 11 cents on Thursday, to $54.57 a share.

Read More..

The Making of Yair Lapid, Israel’s New Power Broker

Oliver Weiken/European Pressphoto Agency

Yair Lapid spoke to reporters in Tel Aviv on Wednesday, a day after his centrist party became the second-largest faction in Parliament.

TEL AVIV — They pitched tents along Rothschild Boulevard and took to the streets in unprecedented numbers, hundreds of thousands demonstrating against the rising costs of gas, apartments, even cottage cheese.

Back on the genteel boulevard on Wednesday, many of those middle-class protesters from 2011 said they had taken their grievances to the ballot box the day before, helping to catapult Yair Lapid, a suave, handsome journalist-turned-populist-politician, into Israel’s newest power broker.

“He spoke out the strongest about how everything in this country is upside down,” said Elad Shoshan, 28, who works with computers and rents an apartment on a cheaper street off the boulevard.

Echoing his candidate’s mantra, Roni Klein, 52, an accountant, said, “My wife and I work, and still it is very hard for us to finish the month.”

Mr. Lapid’s new, centrist Yesh Atid party shocked the political establishment by winning 19 of Parliament’s 120 seats, becoming Israel’s second-largest faction and a crucial partner for Prime Minister Benjamin Netanyahu, whose relatively poor showing left him scrambling to form a stable coalition.

While Mr. Netanyahu remains all but assured of serving a third term — Mr. Lapid said Wednesday that he would not unite with Arab lawmakers to stop him — Yesh Atid’s ascendance promises to shift the government’s focus to pocketbook concerns despite the pressing foreign policy issues Israel faces.

Mr. Lapid’s campaign hardly challenged Mr. Netanyahu’s policies on the Iranian nuclear threat, the tumult in the Arab world or the Israeli-Palestinian conflict. This was the first election in memory in which such existential security issues were not emphasized, as a growing majority of Israelis see them as too tough to tackle. Even Mr. Netanyahu barely spoke about Iran, his raison d’être.

Instead, voters and analysts alike said Mr. Lapid had captured the hearts of Israel’s silent majority with his personal charm and a positive, inclusive message that harnessed the everyday frustrations that fueled the huge social justice protests in 2011.

One pollster found that about 40 percent of Mr. Lapid’s supporters defined themselves as right-leaning, and in Israel’s coalition system, many saw his success as a tactical move by voters not to oust Mr. Netanyahu but to nudge him to broaden the agenda.

On Wednesday, the prime minister embraced Mr. Lapid’s platform, promising a government “as broad as possible” that would bring change on three fronts: affordable housing, government reform and forcing ultra-Orthodox Jews to “share the burden” of military service and taxes.

Some saw the results as a victory for secular Jews at a time of conflict with the ultra-Orthodox over resources and religious pluralism. Mr. Lapid’s stronghold was here in coastal Tel Aviv and its bourgeois suburbs, where he won about 1 in 4 votes cast, and Modiin, a fast-growing bedroom community halfway between here and Jerusalem.

Tamar Hermann, a political scientist and vice president of Israel’s Open University, called Mr. Lapid “the epitome of the Israeli dream” and described his voters as “the mainstream of the mainstream.”

“This is the kind of voting you can take your kids to and teach them a lesson in civic fulfillment without taking any risks,” Professor Hermann said. “They are complaining, but this is a kind of the zeitgeist, not real agony, not real suffering, not real dissatisfaction with the basic cornerstone of the system. It’s just polishing here and there.”

The election results were widely seen as a rebuke to the status quo, but not necessarily a call for change in approach to contentious questions like what to do about the Palestinians. While Mr. Lapid has called for a return to negotiations, he shares Mr. Netanyahu’s skepticism about the lack of a partner, saying this week, “I don’t think the Arabs want peace.” He opposes division of Jerusalem and made his foreign policy speech in Ariel, a sprawling Jewish settlement 12 miles into the West Bank that the Palestinians see as problematic for the viability of their state.

“The majority of Israelis came to the conclusion that there will be no new Middle East,” Mr. Lapid said over cappuccino here last month. “What we want is not a happy marriage, but a decent divorce.”

Instead, the change voters were seeking was more about the nature of politics itself.

Irit Pazner Garshowitz contributed reporting.

Read More..

Apple’s Profits Are Flat, and Stock Drops

Apple on Wednesday reported the kind of quarter most big companies would envy, posting a profit of $13.1 billion and selling 28 percent more iPhones and 48 percent more iPads, its two biggest products.

Its stock quickly sank 11 percent.

What is going on? Because of its great success in recent years, many investors have come to expect nothing short of perfection from Apple. And while it is still widely considered the most innovative company in the technology world, a maker of products that its devoted customers cannot live without, Apple is facing a range of challenges.

It is dealing with increased competition from big rivals like Samsung and Google, and with so many people already using smartphones, the market is not quite as untapped as it once was. Apple is forging into cheaper product categories, meaning lower profit margins. And given that Apple has grown so big, with sales of more than $160 billion in the last 12 months, keeping up its heady growth rate is becoming harder and harder.

Once-euphoric investors, who pushed Apple’s stock to a record high of $702.10 last September, have become nervous, and in after-hours trading on Wednesday, the stock traded at $461.30, down 34 percent from its peak.

Apple has reinvented itself several times over the last decade with groundbreaking new products, and could do so again. Television and electronic payments are among the markets where analysts believe the company could make a serious push, leading it to new heights.

“Apple has really been able to invent whole new markets,” said John Gallaugher, an associate professor at Boston College’s Carroll School of Management. “That’s where it differs from companies like Microsoft. I don’t think the mojo of this team has evaporated.”

In a conference call with analysts, Timothy D. Cook, Apple’s chief executive, said the company’s pipeline of new products was “chock-full.”

“We feel great about what we have in store,” he said, without adding details.

In the meantime, though, the love affair that investors once had with Apple is clearly waning.

“There’s nothing that can help the stock from sliding now,” said Mark Moskowitz, an analyst at J. P. Morgan Securities, who said Apple’s holiday sales met his own forecasts, even though they missed others’ predictions.

For years, Apple has offered an unusual alchemy: it was not only a large, highly profitable tech company, but one with the rapid growth rate of a start-up. It pulled this off under the leadership of Steven P. Jobs, its former chief executive who died in late 2011. He had a startling knack for finding new multibillion-dollar opportunities for Apple with the iPod, iPhone and iPad, but his death has accentuated concerns about the company’s prospects.

A big part of Apple’s challenge is that it is now so large that it seems unrealistic, mathematically, for the company to continue finding new pots of gold big enough to maintain its growth. In a recent research report, A. M. Sacconaghi, an analyst at Bernstein Research, calculated that were Apple to grow for the next five years at the same rate as the last five years, its revenue would be $1.2 trillion, or about the size of Australia’s gross domestic product.

Mr. Sacconaghi said in an interview that technology companies often enter a phase of “growth purgatory” as they shift to a slower lane. Their stocks can tumble by 25 percent or more.

“This transition is often very messy,” he said.

On Wednesday, Apple did not appear to provide a strong enough reason for investors to warm to it again. It said its profits were flat because of higher manufacturing costs, even as revenue rose 18 percent.

Apple’s net income for its fiscal first quarter ending Dec. 29 was $13.1 billion, or $13.81 a share, compared with $13.1 billion, or $13.87 a share, in the same period a year earlier. Revenue was $54.5 billion, up from $46.33 billion a year ago. Those results compared to the average estimates of $13.44 a share earnings and revenue of $54.73 billion from analysts surveyed by Thomson Reuters.

Apple’s growth in the quarter looked positively anemic compared with the huge numbers it used to deliver. For the holiday quarter of 2011, in contrast, its revenue jumped 73 percent and its profit soared 118 percent.

In its financial forecasts for the current quarter, Apple provided numbers that suggest a decline of roughly 20 percent in earnings a share, according to Mr. Sacconaghi’s calculations.

A number of analysts say they still believe the company’s good times are not over. “Sentiment has turned super-pessimistic on Apple, where they’ve gone from being able to do no wrong to suddenly being able to do no right,” said Rob Cihra, an analyst at Evercore Partners. “I tend to think the company’s momentum is a heck of a lot more solid than people are concerned about.”

Mr. Cihra said Apple’s iPhone and iPad sales missed some of the most optimistic forecasts, but “all in, it was a pretty darned good quarter.”

One factor that hurt comparisons between Apple’s most recent holiday quarter and the previous one was that its 2012 quarter was a week shorter.

Headed into the holiday quarter, analysts were especially worried about Apple’s profit margins, which the company had warned would decline as a result of a near total overhaul of the company’s product line.

While new products are routine for a company like Apple, it said the sheer number of devices it released around the holidays, including the iPhone 5, iPad Mini and new Mac computers, was unusual.

But negative sentiment has further hardened amid reports that Apple had cut orders for components with a supplier, potentially suggesting weak demand for the iPhone.

Mr. Cook cautioned that investors shouldn’t place too much significance on such reports because Apple often gets its parts from multiple sources.

“I would suggest that it’s good to question the accuracy of any rumor about our build plans,” he said.

Read More..

Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

Read More..

Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

Read More..

Edging From Europe, Britain Adds to Continent’s Unease

Oli Scarff/Getty Images

Prime Minister David Cameron of Britain speaking in London on Wednesday.

BRUSSELS — The French are engaged in a lonely military adventure in Africa. The Germans are preoccupied with domestic elections rather than regional affairs. Unemployment in some countries is at historic highs and economies across Europe are still mired in recession.

Now Prime Minister David Cameron of Britain has added to Europe’s malaise, vowing to reduce British entanglement with the European Union — or allow his people to vote in a referendum to leave the bloc altogether.

The pledge from the British prompted swift retorts from France and Germany, which said no member has the option of “cherry picking” whatever European rules it wants to enforce. But it reflected a growing sense of unease, not only in Britain but across the Continent, that while the acute phase of the financial crisis has passed, the challenge to Europe’s mission and even its membership has not.

Even the United States has injected itself into the matter, with an unusually public insistence that Britain, a close ally, stay in the union, fearing that its departure would heighten centrifugal forces that would weaken Europe as a diplomatic, military and financial partner.

With the threat of a sudden breakup of the euro zone appearing to recede in recent months, Europe has seen a resurgence of narrow national interests that risks swamping always-elusive common goals. The bickering is undercutting hopes in some circles that the struggle to save the euro had laid the groundwork for “more Europe.”

“As pressure from the financial markets recedes and a sense of urgency lifts, the appetite for serious reform is melting away like butter in the sun,” said Thomas Klau, head of the Paris office of the European Council on Foreign Relations. “Now that markets no longer hold a knife under leaders’ throats, they are slipping back into their normal mode, which is to manage their own immediate reality.”

For Mr. Cameron, with elections coming in 2015, that means heading off a challenge from the hard-right, anti-Europe U.K. Independence Party, known as UKIP, while shoring up support for his government, which recently admitted that its unpopular austerity program would have to be extended to 2018, analysts said. He is also anxious to avoid the sort of ruinous intraparty split over Europe that bedeviled the prime ministerships of two of his Conservative predecessors, Margaret Thatcher and John Major.

That comes against a backdrop of declining public support for British membership in Europe — only 45 percent last year, down from 51 percent in 2011, in polls conducted by the Pew Research Global Attitudes Project.

Mr. Cameron’s speech Wednesday in London calling for a referendum had been in the works for some time but, Mr. Klau noted, it was delivered at a moment when the European Union had begun to declare victory over doomsayers who predicted the common currency and even the whole union could crumble. This mood of calm, Mr. Klau said, has given leaders “the political space” to turn their eyes from Europe toward more pressing and, for politicians seeking re-election, far more important domestic concerns.

The decision by President François Hollande of France to send troops to Mali to halt an advance by rebels with ties to Islamist extremists reprises a long tradition of French interventions in its former African colonies — and has bolstered the Socialist president’s previously flagging popularity.

The French move has been supported by the European Union, whose member states share French fears about the spread of radicalism across the Mediterranean. But it has superseded the bloc’s own ambitions to become a serious player in global affairs and still left the French to fight mostly on their own. The union is sending some military trainers.

Europe’s economic troubles, meanwhile, are far from over, with much of the Continent expected to be in recession this year. Even Germany seems to be losing momentum — its economy contracted by 0.5 percent in the final months of last year. Elsewhere, unemployment is soaring to levels that could threaten grave social unrest, with more than a quarter of working-age people in Greece and Spain without jobs.

Alan Cowell contributed reporting from London.

Read More..

Exit Polls in Israel Suggest Netanyahu’s Showing Is Weaker Than Expected

Pool photo by Uriel Sinai

Prime Minister Benjamin Netanyahu of Israel touched the Western Wall on Tuesday in Jerusalem.

TEL AVIV — A weakened Prime Minister Benjamin Netanyahu emerged Wednesday from Israel’s national election likely to serve a third term, according to preliminary results and political analysts after voters on Tuesday gave a surprising second place to a new centrist party founded by a television celebrity who emphasized kitchen-table issues like class size and apartment prices.

Baz Ratner/Reuters

A polling station on Tuesday in the West Bank Jewish settlement of Elon Moreh, near Nablus.

For Mr. Netanyahu, who entered the race an overwhelming favorite with no obvious challenger, the outcome was a humbling rebuke as his ticket lost seats in the new Parliament. Overall, the prime minister’s conservative team came in first, but it was the center, led by the political novice Yair Lapid, 49, that emerged newly invigorated, suggesting that at the very least Israel’s rightward tilt may be stalled.

Mr. Lapid, a telegenic celebrity whose father made a splash with his own short-lived centrist party a decade ago, based his campaign on issues that resonated with the middle class, including the need to integrate the ultra-Orthodox into the army and the work force.

Perhaps as important, he also avoided antagonizing the right, having not emphasized traditional issues of the left, like the peace process. Like a large majority of the Israeli public, he supports a two-state solution to the Israeli-Palestinian conflict, but is skeptical of the Palestinian leadership’s willingness to negotiate seriously; he has called for a return to peace talks but has not made it a priority.

On Tuesday, Mr. Netanyahu implored his supporters to turn out, reading signs that voters were not embracing his message of security and his party’s conservative agenda. The day ended with Mr. Netanyahu reaching out again —this time to Mr. Lapid, offering to work with Israel’s newest kingmaker as part of the “broadest coalition possible.”

Israel’s political hierarchy is only partly determined during an election. The next stage, when factions try to build a majority coalition, decides who will rule, how they will rule and for how long. While Mr. Lapid has signaled a willingness to work with Mr. Netanyahu, the ultimate coalition may bring together parties with such different ideologies and agendas that the result is neither a shift to the right nor the left, but paralysis.

Still, for the center, it was a time of celebration.

“The citizens of Israel today said no to politics of fear and hatred,” Mr. Lapid told an upscale crowd of supporters that had welcomed him with drums, dancing and popping Champagne corks. “They said no to the possibility that we might splinter off into sectors, and groups and tribes and narrow interest groups. They said no to extremists, and they said no to antidemocratic behavior.”

With three-quarters of the votes counted by 3 a.m. Wednesday, Israel Radio reported that Mr. Netanyahu’s conservative Likud-Beiteinu ticket was poised to take 31 of Parliament’s 120 seats, with Mr. Lapid’s party, There Is a Future, coming in second with 19, far more than polls had predicted. The right wing and religious parties that make up Mr. Netanyahu’s current coalition garnered a thin majority of perhaps 62 seats, pushing him to try to join with Mr. Lapid instead and possibly embrace other center and left-leaning groups. Labor took 15 seats in early returns and Jewish Home, a new religious-nationalist party, 11

The prime minister called Mr. Lapid shortly after the polls closed at 10 p.m. Tuesday and, according to Israeli television reports, told him that they had great things to do together for the country. In his speech to a rowdy crowd of supporters here Wednesday morning, he said, “I see many partners.”

Mr. Lapid said he was open to working with Mr. Netanyahu, saying the only way to face Israel’s challenges was “together.” But he added: “What is good for Israel is not in the possession of the right, and nor is it in the possession of the left. It lies in the possibility of creating here a real and decent center.”

The results were a blow to the prime minister, whose aggressive push to expand Jewish settlements in East Jerusalem and the West Bank has led to international condemnation and strained relations with Washington. The support for Mr. Lapid and the left-leaning Labor Party showed voters responded strongly to an emphasis on domestic, socioeconomic issues that brought 500,000 people to the streets of Tel Aviv in the summer of 2011.

Jodi Rudoren reported from Tel Aviv, and Isabel Kershner from Jerusalem. Myra Noveck contributed reporting from Jerusalem.

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Despite Strong Earnings, Google Is Still Stymied by Mobile

SAN FRANCISCO — Although Google is scrambling to meet consumers as they flock to mobile devices, the question is whether it is moving fast enough.

Investors were comforted on Tuesday when Google announced strong fourth-quarter earnings, and the stock rebounded from a dip over the last week, climbing 5 percent in after-hours trading.

But a closer look at the results shows that while Google continues to be a moneymaking machine, its most lucrative business, search on desktop computers, is slowing, while Google has not yet figured out how to make equivalent profits on mobile devices.

“You would expect Google to be a key player benefiting from mobile, but that hasn’t played out in the last year,” said Jordan Rohan, a Stifel Nicolaus analyst.

The price advertisers pay Google each time someone clicks on an ad, known as cost per click or C.P.C., decreased 6 percent from the fourth quarter a year ago, falling for the fifth consecutive quarter on a yearly basis, though not as much as some analysts had feared.

The cost per click has been declining largely because advertisers pay less for mobile ads, and more people are using Google on their mobile devices and fewer on their desktop computers.

Still, Google has been trying to improve its mobile products — from developing new kinds of mobile ad campaigns to building devices like the Nexus 4 smartphone — and its executives say it is a matter of time before the numbers improve. Already, in the fourth quarter, the cost per click rose 2 percent from the previous quarter.

“We’re in some uncharted territory because of the rapid rate of change in these things, but I’m very optimistic about it,” said Larry Page, Google’s chief executive, on a conference call with analysts after the earnings were announced. “I think the C.P.C.’s will improve as the devices improve, as well.”

Mr. Page, who has had health problems related to his voice, sounded unusually weak and breathy.

Google reported revenue that was lower than analysts had expected. Google warned last week that analysts’ expectations were off target because Google sold Motorola’s set-top box division during the quarter and so did not include it in the quarterly results. Still, even including that division of Motorola, Google’s revenue would have missed expectations.

The company reported fourth-quarter revenue of $14.42 billion, an increase of 36 percent over the year-ago quarter. Net revenue, which excludes payments to the company’s advertising partners, was $11.34 billion, up from $8.13 billion. Net income rose 7 percent to $2.89 billion, or $8.62 a share.

The fourth quarter is generally Google’s brightest because it makes much of its money on retail ads that run during the holiday shopping season. This holiday season was the first that Google charged e-commerce companies to be included in its comparison shopping engine, and these so-called product listing ads contributed to its bottom line.

“Despite talk about retail having a weak season, Google’s product listing ad program has taken off quite successfully,” said Sid Shah, director of business analytics at Adobe, which handles $2 billion in annual advertising spending.

Home Depot increased mobile commerce sales by four times after using Google mobile ads, said Patrick Pichette, Google’s chief financial officer. He also cited YouTube ad revenue, saying the “Gangnam Style” video, the most-watched on record, has earned $8 million in online advertising deals. Election ad spending on Google increased five times over the 2008 election, he said.

Nonetheless, Google’s mobile challenge overhung even its usual holiday shopping sparkle. Consumers are increasingly shopping on phones and tablets, yet Google and other companies have not yet figured out how best to profit from mobile users.

One problem is that advertisers pay about half as much for an ad on a mobile device, in part because they are not yet sure how effective mobile ads can be. Another challenge is that consumers increasingly use apps, like Yelp or Kayak, to search on mobile devices instead of using Google.

And even when consumers use Google for mobile searches, they are often doing so on Apple devices like iPhones, for which Google has to pay Apple a fee. Those types of fees are large — equivalent to 25 percent of Google’s revenue in the quarter.

The shift to mobile is happening as Google’s biggest, most lucrative business — desktop search — is slowing. The share of clicks on Google results that happen on desktop computers has fallen to 73 percent from 77 percent in the last six months, while the share of clicks on tablets and smartphones has increased to 27 percent from 23 percent, according to data from Adobe.

The problem is that clicks on retail ads on tablets, for instance, cost about 16 percent less than they do on the desktop, according to Adobe. The price of clicks on retail ads on tablets rose 16 percent over the last year, but on smartphones they fell 11 percent.

As the desktop search sector slows, Google has a new search competitor to contend with: Facebook, which last week introduced a new form of personalized social search on the site.

Google has also recently become a maker of mobile devices, both by acquiring money-losing Motorola and by producing the line of Nexus devices with manufacturer partners.

In the fourth quarter, Google sold about 1.5 million Nexus phones and tablets, not including those sold by other retailers, according to estimates from JPMorgan, and has had trouble keeping supply up with demand.

Eventually, Google hopes, these various businesses will help it solve the mobile revenue riddle, but analysts say they do not expect it to happen in the near term. “You have your Motorola Android phone, get offered a local deal, go into the merchant, use Google Checkout to pay and get rewards,” said Colin Gillis, an analyst at BGC Partners. “That’s the grand vision and it’s a nice vision, but it’s not happening in March.”

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