Health Testing on Mice Is Found Misleading in Some Cases

Evan McGlinn for The New York Times

Dr. H. Shaw Warren is one of the authors of a new study that questions the use of laboratory mice as models for all human diseases.

For decades, mice have been the species of choice in the study of human diseases. But now, researchers report evidence that the mouse model has been totally misleading for at least three major killers — sepsis, burns and trauma. As a result, years and billions of dollars have been wasted following false leads, they say.

The study’s findings do not mean that mice are useless models for all human diseases. But, its authors said, they do raise troubling questions about diseases like the ones in the study that involve the immune system, including cancer and heart disease.

“Our article raises at least the possibility that a parallel situation may be present,” said Dr. H. Shaw Warren, a sepsis researcher at Massachusetts General Hospital and a lead author of the new study.

The paper, published Monday in Proceedings of the National Academy of Sciences, helps explain why every one of nearly 150 drugs tested at a huge expense in patients with sepsis has failed. The drug tests all were based on studies in mice. And mice, it turns out, can have something that looks like sepsis in humans, but is very different from the condition in humans.

Medical experts not associated with the study said that the findings should change the course of research worldwide for a deadly and frustrating condition. Sepsis, a potentially deadly reaction that occurs as the body tries to fight an infection, afflicts 750,000 patients a year in the United States, kills one-fourth to one-half of them, and costs the nation $17 billion a year. It is the leading cause of death in intensive-care units.

“This is a game changer,” said Dr. Mitchell Fink, a sepsis expert at the University of California, Los Angeles, of the new study.

“It’s amazing,” said Dr. Richard Wenzel, a former chairman at the department of internal medicine at Virginia Commonwealth University and a former editor of The New England Journal of Medicine. “They are absolutely right on.”

Potentially deadly immune responses occur when a person’s immune system overreacts to what it perceives as danger signals, including toxic molecules from bacteria, viruses, fungi, or proteins released from cells damaged by trauma or burns, said Dr. Clifford S. Deutschman, who directs sepsis research at the University of Pennsylvania and was not part of the study.

The ramped-up immune system releases its own proteins in such overwhelming amounts that capillaries begin to leak. The leak becomes excessive, and serum seeps out of the tiny blood vessels. Blood pressure falls, and vital organs do not get enough blood. Despite efforts, doctors and nurses in an intensive-care unit or an emergency room may be unable to keep up with the leaks, stop the infection or halt the tissue damage. Vital organs eventually fail.

The new study, which took 10 years and involved 39 researchers from across the country, began by studying white blood cells from hundreds of patients with severe burns, trauma or sepsis to see what genes were being used by white blood cells when responding to these danger signals.

The researchers found some interesting patterns and accumulated a large, rigorously collected data set that should help move the field forward, said Ronald W. Davis, a genomics expert at Stanford University and a lead author of the new paper. Some patterns seemed to predict who would survive and who would end up in intensive care, clinging to life and, often, dying.

The group had tried to publish its findings in several papers. One objection, Dr. Davis said, was that the researchers had not shown the same gene response had happened in mice.

“They were so used to doing mouse studies that they thought that was how you validate things,” he said. “They are so ingrained in trying to cure mice that they forget we are trying to cure humans.”

“That started us thinking,” he continued. “Is it the same in the mouse or not?”

The group decided to look, expecting to find some similarities. But when the data were analyzed, there were none at all.

“We were kind of blown away,” Dr. Davis said.

The drug failures became clear. For example, often in mice, a gene would be used, while in humans, the comparable gene would be suppressed. A drug that worked in mice by disabling that gene could make the response even more deadly in humans.

Even more surprising, Dr. Warren said, was that different conditions in mice — burns, trauma, sepsis — did not fit the same pattern. Each condition used different groups of genes. In humans, though, similar genes were used in all three conditions. That means, Dr. Warren said, that if researchers can find a drug that works for one of those conditions in people, it might work for all three.

This article has been revised to reflect the following correction:

Correction: February 11, 2013

An earlier version of this article misstated the position of Dr. Richard Wenzel. He is a former chairman of the department of internal medicine at Virginia Commonwealth University. He is not currently the chairman.

Read More..

Health Testing on Mice Is Found Misleading in Some Cases

Evan McGlinn for The New York Times

Dr. H. Shaw Warren is one of the authors of a new study that questions the use of laboratory mice as models for all human diseases.

For decades, mice have been the species of choice in the study of human diseases. But now, researchers report evidence that the mouse model has been totally misleading for at least three major killers — sepsis, burns and trauma. As a result, years and billions of dollars have been wasted following false leads, they say.

The study’s findings do not mean that mice are useless models for all human diseases. But, its authors said, they do raise troubling questions about diseases like the ones in the study that involve the immune system, including cancer and heart disease.

“Our article raises at least the possibility that a parallel situation may be present,” said Dr. H. Shaw Warren, a sepsis researcher at Massachusetts General Hospital and a lead author of the new study.

The paper, published Monday in Proceedings of the National Academy of Sciences, helps explain why every one of nearly 150 drugs tested at a huge expense in patients with sepsis has failed. The drug tests all were based on studies in mice. And mice, it turns out, can have something that looks like sepsis in humans, but is very different from the condition in humans.

Medical experts not associated with the study said that the findings should change the course of research worldwide for a deadly and frustrating condition. Sepsis, a potentially deadly reaction that occurs as the body tries to fight an infection, afflicts 750,000 patients a year in the United States, kills one-fourth to one-half of them, and costs the nation $17 billion a year. It is the leading cause of death in intensive-care units.

“This is a game changer,” said Dr. Mitchell Fink, a sepsis expert at the University of California, Los Angeles, of the new study.

“It’s amazing,” said Dr. Richard Wenzel, a former chairman at the department of internal medicine at Virginia Commonwealth University and a former editor of The New England Journal of Medicine. “They are absolutely right on.”

Potentially deadly immune responses occur when a person’s immune system overreacts to what it perceives as danger signals, including toxic molecules from bacteria, viruses, fungi, or proteins released from cells damaged by trauma or burns, said Dr. Clifford S. Deutschman, who directs sepsis research at the University of Pennsylvania and was not part of the study.

The ramped-up immune system releases its own proteins in such overwhelming amounts that capillaries begin to leak. The leak becomes excessive, and serum seeps out of the tiny blood vessels. Blood pressure falls, and vital organs do not get enough blood. Despite efforts, doctors and nurses in an intensive-care unit or an emergency room may be unable to keep up with the leaks, stop the infection or halt the tissue damage. Vital organs eventually fail.

The new study, which took 10 years and involved 39 researchers from across the country, began by studying white blood cells from hundreds of patients with severe burns, trauma or sepsis to see what genes were being used by white blood cells when responding to these danger signals.

The researchers found some interesting patterns and accumulated a large, rigorously collected data set that should help move the field forward, said Ronald W. Davis, a genomics expert at Stanford University and a lead author of the new paper. Some patterns seemed to predict who would survive and who would end up in intensive care, clinging to life and, often, dying.

The group had tried to publish its findings in several papers. One objection, Dr. Davis said, was that the researchers had not shown the same gene response had happened in mice.

“They were so used to doing mouse studies that they thought that was how you validate things,” he said. “They are so ingrained in trying to cure mice that they forget we are trying to cure humans.”

“That started us thinking,” he continued. “Is it the same in the mouse or not?”

The group decided to look, expecting to find some similarities. But when the data were analyzed, there were none at all.

“We were kind of blown away,” Dr. Davis said.

The drug failures became clear. For example, often in mice, a gene would be used, while in humans, the comparable gene would be suppressed. A drug that worked in mice by disabling that gene could make the response even more deadly in humans.

Even more surprising, Dr. Warren said, was that different conditions in mice — burns, trauma, sepsis — did not fit the same pattern. Each condition used different groups of genes. In humans, though, similar genes were used in all three conditions. That means, Dr. Warren said, that if researchers can find a drug that works for one of those conditions in people, it might work for all three.

This article has been revised to reflect the following correction:

Correction: February 11, 2013

An earlier version of this article misstated the position of Dr. Richard Wenzel. He is a former chairman of the department of internal medicine at Virginia Commonwealth University. He is not currently the chairman.

Read More..

Media Decoder: A CBS Deal Bolsters Amazon's Challenge to Netflix

Slowly but confidently, Amazon is building a library of television shows and movies to rival that of Netflix, much to the satisfaction of media companies like Time Warner and CBS, whose executives love to see the competition.

Although Amazon will not unveil its own original television shows until the fall at the earliest, it is spending hundreds of millions of dollars to have the exclusive Web rights to shows it can brag about on its Amazon Prime streaming service, like “Downton Abbey,” from PBS, and “Falling Skies,” from TNT.

The latest example came on Monday, when Amazon announced an unusual arrangement with CBS, the country’s most-watched television network, to carry episodes of “Under the Dome” just days after the series makes its debut on TV in June.

“This deal is yet another sign that the streaming marketplace is becoming more and more robust,” said Scott Koondel, the chief content licensing officer for CBS, a position that was created two months ago. “Advances in user-friendly technology from companies like Amazon and Netflix are a boon for premium content owners.”

Amazon has a long way to go to rival Netflix in terms of TV and movie selection. But in some corners of the media business, it is already perceived to be Pepsi to Netflix’s Coke. And many other companies — among them Google, Sony, Intel and a new joint venture between Redbox and Verizon — are trying to come up with a Red Bull or a Snapple they can call their own.

While Netflix has won attention for unveiling a high quality show, “House of Cards,” on its streaming service, “it is increasingly hard to ignore the progress Amazon has made in a relatively short amount of time,” Richard Greenfield, an analyst at BTIG Research, wrote two weeks ago. He predicted that Amazon would quietly spend more than $500 million on video this year.

Amazon declined to comment on that figure. Its nearly two-year-old streaming service, called Prime Instant Video, is bundled as part of its $79 annual Amazon Prime membership, which also provides two-day free shipping and a monthly Kindle e-book rental. The company says it has millions of Amazon Prime subscribers, but it will not disclose the precise number. Netflix has about 27 million streaming subscribers in the United States.

Instant Video started simply enough about two years ago, with relatively cheap acquisitions of older television shows from networks like CBS and nonexclusive rights to older films from studios like Universal. But Amazon’s recent deals have revealed the company’s ambitions.

When Netflix dropped the rights to some cable series like “Pawn Stars” last fall, Amazon swooped in and started streaming them. When Time Warner wanted to sell streams of some of its cable dramas, Amazon bought the exclusive rights to “The Closer” and “Falling Skies,” while Netflix bought “Dallas.”

“This emerging back end for cable originals is a very promising sign,” Jeffrey L. Bewkes, chief executive of Time Warner, told investors last week, “since it should result in production values for cable originals getting even better over time.”

Perhaps its biggest deal yet came last week, when it clinched the rights to past and future seasons of the PBS hit “Downton Abbey.” By July, “Downton” will be gone from Netflix.

Both streaming services mine the data of their users to determine what kinds of shows to license, and what not to. The first two seasons of “Downton” were the “most-streamed TV show on Prime Instant Video,” said Brad Beale, who oversees video acquisitions for Amazon, so it was a “pretty easy decision” to bid for seasons three and four (and five, if it is produced).

“Data is a great proxy for what our customers love,” Mr. Beale added in a telephone interview. “We’re blessed to have a platform that gives us a lot of insight into what our customers love.”

“Under the Dome” — based on the Stephen King novel and produced by Steven Spielberg’s Amblin Television — will be unique because each episode will go onto Amazon four days after its premiere on TV. CBS stands to make more money this way than it now does by streaming shows on CBS.com and attaching ads.

Analysts expect to see more such deals as broadcasters move away from the free online model made popular by Hulu. Hulu has a subscription component as well, but it has not announced any notable licensing deals the way Netflix and Amazon have done. Its owners are at odds over the future of the service, and its founding chief executive, Jason Kilar, will leave later this winter.

Netflix says it expects to compete with Amazon the way HBO and Showtime compete — with TV dramas and comedies of their own. “When it comes to competition, we not only have a superior content offering due to our larger budget, but we are further along the experience curve,” Netflix told investors last month. In other words, Amazon is cheap, off-brand Cola.

While Netflix has four more original series on tap this year, Amazon is trying out test episodes of six comedies and five children’s series. This year, Amazon will stream them and, after hearing from viewers, decide which ones will become series.

Roy Price, the head of Amazon Studios, said the pilot process will ensure quality, just as it does for traditional television networks, and make viewers and producers pay attention to Amazon’s video projects.

“All that matters is being great,” he said. “There’s no great benefit in being good; people don’t change their habits for good.”

Read More..

Syrian War Closes In on the Heart of Damascus

Goran Tomasevic/Reuters

Fighters from the Free Syrian Army's Tahrir al Sham brigade look at a Syrian Army base in the Arabeen neighborhood of Damascus.

DAMASCUS, Syria — Unkempt government soldiers, some appearing drunk, have been deployed near a rebel-held railway station in the southern reaches of this tense capital. Office workers on 29th of May Street, in the heart of the city, tell of huddling at their desks, trapped inside for hours by gun battles that sound alarmingly close.

Soldiers have swept through city neighborhoods, making arrests ahead of a threatened rebel advance downtown, even as opposition fighters edge past the city limits, carrying mortars and shelling security buildings. Fighter jets that pounded the suburbs for months have begun to strike Jobar, an outlying neighborhood of Damascus proper, creating the disturbing spectacle of a government’s bombing its own capital.

On Sunday, the government sent tanks there to battle rebels for control of a key ring road.

In this war of murky battlefield reports, it is hard to know whether the rebels’ recent forays past some of the capital’s circle of defenses — in an operation that they have, perhaps immodestly, named the “Battle of Armageddon” — will lead to more lasting gains than earlier offensives did. But travels along the city’s battlefronts in recent days made clear that new lines, psychological as much as geographical, had been crossed.

“I didn’t see my family for more than a year,” a government soldier from a distant province said in a rare outpouring of candor. He was checking drivers’ identifications near the railway station at a checkpoint where hundreds of soldiers arrived last week with tanks and other armored vehicles.

“I am tired and haven’t slept well for a week,” he said, confiding in a traveler who happened to be from his hometown. “I have one wish — to see my family and have a long, long sleep. Then I don’t care if I die.”

For months, this ancient city has been hunched in a defensive crouch as fighting raged in suburbs that curve around the city’s south and east. On the western edge of the city, the palace of the embattled president, Bashar al-Assad, sits on a steep, well-defended ridge.

In between, Damascus, with its walled Old City, grand diagonal avenues and crowded working-class districts, has remained the eye of the storm. People keep going to work, even as electric service grows sporadic and groceries dwindle, even as the road to the airport is often cut off by fighting outside the city, and even as smoke from artillery and airstrikes in suburbs becomes a regular feature on the horizon.

But after rebels took the railway station 10 days ago in a city district called Qadam and attacked Abassiyeen Square on an approach to the city center on Wednesday, a new level of alarm and disorder has suffused the city. Rebels have pushed farther into the capital than at any point since July, when they briefly held part of a southern neighborhood.

Near the Qadam railway station last week, many of the government soldiers, their hair and beards untrimmed, wore disheveled or dirty uniforms and smelled as if they had not had showers in a long time. Some soldiers and security officers even appeared drunk, walking unsteadily with their weapons askew — a shocking sight in Syria, where regimented security forces and smartly uniformed officers have long been presented as a symbol of national pride.

The deployment appeared aimed at stopping the rebels from advancing past Qadam, either across the city’s ring road and toward the downtown or to suburbs to the east to close a gap in the opposition’s front line.

But even stationed here in Damascus, the heart of the government’s power, the soldier at the checkpoint — who was steady on his feet — said he felt vulnerable.

“It is very scary to spend a night and you expect to be shot or slaughtered at any moment,” he said. “We spend our nights counting the minutes until daytime.”

The government has hit back hard, striking Qadam with artillery and airstrikes. It has also made pre-emptive arrests in Midan, the neighboring district, closer to downtown, where rebels gained a temporary foothold in July and which they said was their next target.

Anne Barnard reported from Beirut, Lebanon.

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Reviewing Three Brands of Tax Preparation Software

TAX preparation is moving to the cloud.

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

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

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

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

TurboTax

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

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

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

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

 

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

Read More..

For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

Read More..

For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

Read More..

Advertising: Self Magazine Widens Its Focus for a Younger Audience

WHAT’S the point of having Michelle Obama’s triceps if you can’t show them off in a smart sleeveless sheath?

That seems to be the thinking behind a remake of Self magazine, the Condé Nast publication best known for teaching women how to crunch their abs, tone their thighs and eat the right foods.

Self is broadening its tight focus on exercise and wellness to become a more general lifestyle magazine infused with more beauty and fashion, an effort that will include editorial changes, a new look for the cover and logo and licensing agreements.

“We think there’s a shift in how women think of their bodies and beauty,” said Laura McEwen, the vice president and publisher of Self. “Being fit and fashionable are really one.”

According to Ms. McEwen, the magazine’s typical reader is in her mid-30s with a median household income of $75,000 a year; the rebranded magazine is meant to appeal to the generation of women 18 to 30 who are obsessed with social media. “The magazine is being edited for the women who think in 140 characters,” she said, referring to the character limit of a Twitter post.

That editorial shift can be most felt in the chatty headlines created for subsections in the magazine and its bolder, fashion-focused images. One section, “It’s a Thing,” highlights new trends (in March, the color will be lemon yellow). Others include “You Look Awesome in That,” featuring fashion coverage, and “Just Shoot Me Now,” which doles out advice to readers in embarrassing situations.

Self finds itself between two of its biggest competitors in women’s fitness magazines.

The magazine, which has a total print circulation of 1.5 million readers, had a slight increase in advertising dollars, but not ad pages, last year. Advertisers spent $163.2 million on ads in the magazine in 2012, a 1.8 percent increase from 2011, when they spent $160.2 million.

Total ad pages declined 2.3 percent to 905.4 in 2012 from 926 in 2011, according to data from the Publishers Information Bureau. Online, the magazine has 6.9 million unique visitors a month, executives said, with a fifth of that traffic coming from the social media content sharing site Pinterest.

Shape magazine, which is owned by American Media, claims a similarly strong print circulation of 1.63 million readers, but has had a tough time sustaining advertising dollars. The fitness and lifestyle magazine suffered an 18.4 percent decrease in advertising revenue from 2011, when advertisers spent $206.8 million, to 2012, when they spent $168.8 million on the magazine. The total number of ad pages in the magazine decreased 22.7 percent from 2011 to 2012.

Women’s Health, which is owned by Meredith, showed a 12.3 percent increase in paid advertising from 2011 to 2012, and a 6.8 percent increase in ad pages for the same period. In 2011 the magazine reported a circulation of 1.6 million.

Self magazine, its Web site and its mobile site will be divided into three main sections that focus on body, looks and lifestyle. The new look, which will make its debut this week, includes a larger font for the title and a clean white background. The changes will be consistent across all platforms.

Readers will also be able to download a new mobile application, called Self Plus. When users hover their phones over pages tagged with icons promoting the app, they can watch videos and skim through photo galleries and other content.

Millennial women, said Lucy Schulte Danziger, the editor in chief of Self, have “this sense that you want to be really healthy, but you also want to go drink martinis with your friends.” (To that end, the March issue will include a calorie-counting game on matching cocktails with bar food without blowing your diet.) “It’s trying to have fun. It should be fun; this is not rocket science,” she said.

Self’s last makeover was in 2010, when it overhauled its design, updated its logo and tweaked section headlines.

Beyond the latest editorial changes is a range of marketing efforts to get the word out. Print and digital ads will run in Condé Nast magazines like Allure, Glamour and Lucky and on taxi tops in New York City. Digital ads will also run on DailyCandy.com and Refinery29.com.

The March issue of Self, featuring the dancer Julianne Hough on the cover, will be available in print on Feb 19. Ms. Hough is the lead actress in the new film “Safe Haven.” Self will also be the co-host at a premiere party for the film on Monday in New York City.

The brand has also licensed its name to a new line of fitness gear including yoga mats and kettlebells and is considering extending that to healthy food products. Self is also capitalizing on its annual event, “Self Workout in the Park,” by announcing a college-themed contest, “Self Workout on the Quad,” where college students who participate most heavily with the Facebook “Workout in the Park” social game can win an event at their school.

Sponsors for the event include Garnier, Reebok, Calvin Klein, LaRoche-Posay, LeSportsac, Luna Bar and Club Med. Ads promoting the contest will be shown on HerCampus.com.

“This is clearly a strategy not only to reach young women readers where they’re at right now, but also to be more attractive to advertisers,” said Laura Portwood-Stacer, a visiting assistant professor of media, culture and communication at the Steinhardt School of Culture, Education and Human Development at New York University. “It seems to tap into this trend of fitness lifestyle consumption that you see a lot now.”

One new advertiser is LeSportsac, which in addition to sponsoring the workout events, will advertise in the April issue of Self.

“Seeing where the consumer is going today is very much lifestyle,” said Paula Spadaccini, the marketing director for LeSportsac. “They don’t just aspire to wear Christian Louboutin and be very fashionable. They also aspire to be fit and cook healthy recipes.”

Walter Coyle, the president of Pedone, an independent advertising agency, said that some of his clients like Burt’s Bees, the beauty product line, and Essie, the nail polish brand, will continue to advertise in Self, and that other clients including Clarins and Lacoste were considering it. “Whenever a formidable magazine like Self reimagines its position in the marketplace, it’s something everyone is going to look at,” he said.

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Israeli Says Syria Twisted Comments by Rebel Supporter

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Reviewing Three Brands of Tax Preparation Software

TAX preparation is moving to the cloud.

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

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

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

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

TurboTax

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

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

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

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

 

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

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