I Was Misinformed: The Time She Tried Viagra





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




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


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


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


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


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


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


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


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


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


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


“Want to drop some Viagra?” I say.


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


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


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


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


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


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



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DealBook: In a Switch, Investors Are Buying European Bank Bonds

LONDON — European bank debt, once an investment pariah, is suddenly popular.

In recent weeks, money managers have been readily buying the new bonds of the region’s financial institutions, deals that just months ago would have seemed unpalatable. Bank of Ireland, which received a bailout in 2010, sold $1.3 billion of bonds on Tuesday and found strong demand. It was the largest offering by an Irish bank without a government guarantee in almost three years.

The gradual thawing of the capital markets is a good sign for the region’s banks. In the midst of the crisis, institutions, especially in troubled economies like Ireland and Portugal, have been struggling to raise money from private investors. The latest deals will help bolster banks’ capital levels and strengthen their balance sheets.

But the bonds could leave investors exposed, especially given the precarious situation in Europe. The sovereign debt crisis continues to weigh on the economy. The financial markets remain volatile. And profit at the region’s banks is flagging.

“It’s a great time to be issuing high-yield debt but not to be investing in it,” said Robin Doumar, managing partner at the private equity firm Park Square Capital.

For now, bondholders are taking comfort in the policy makers’ response to the sovereign debt crisis.

In late August, the European Central Bank began an unlimited bond-buying program aimed at lowering countries’ borrowing costs and breathing life into local economies. By essentially offering a blank check to help Europe’s troubled governments, policy makers calmed short-term fears that some of the region’s banks might need to be bailed out, reviving interest in the companies’ bonds.

“The biggest driver of demand has been the policy responses from the European Central Bank,” said Melissa Smith, head of European high-grade debt capital markets at JPMorgan Chase in London. “It’s provided stability as policy makers have stated their commitment to preserving the euro zone.”

With interest rates at record lows, European bank debt looks especially appealing to investors.

On Thursday, the British bank Barclays sold $3 billion of 10-year bonds at 7.6 percent. The Portuguese lender Banco Espírito Santo recently issued $958 million worth of debt at 5.9 percent.

By comparison, a 10-year Treasury is paying 1.8 percent. Germany has offered a negative yield on some of its sovereign debt maturities this year.

Even the yields on junk bonds, the risky corporate debt that pays high interest rates, are coming down as investors pile into such securities. The average yield is now just 5.8 percent, according to a Bank of America Merrill Lynch index. Historically, they have paid 10 percent or even more.

“There’s been a huge contraction,” said Robert Ellison, head of European debt capital markets for financial institutions at UBS in London.

The industry has been quick to capitalize on investors’ desperate hunt for returns. Banks in Europe have issued a combined $318 billion of unsecured debt so far this year, almost triple the amount raised by their American counterparts, according to the data provider Dealogic.

The capital markets are being discerning. This year, well-financed companies in Northern Europe, like Nordea Bank of Sweden, have been able to sell the largest lots of bonds at relatively reasonable rates. Smaller banks, particularly in Southern Europe, have had to offer investors better rates to win support for their bond deals.

Even so, it is a stark contrast from almost a year ago. With the capital markets paralyzed, the European Central Bank then had to step in to stabilize the banks, offering $1.3 trillion in short-term, low-cost loans to financial companies.

As they find renewed interest from private investors, European banks can more easily raise money, fortifying their balance sheets in case of unexpected losses. At regulators’ behest, financial institutions in the region have been increasing their capital levels.

But bond investors, in their thirst for yield, may be overlooking signs of potential trouble.

Barclays, for instance, sold a controversial type of debt, known as contingent convertible bonds. With these so-called CoCo bonds, investors can be wiped out if the bank’s capital falls below a certain threshold. While Barclays’ balance sheet is in good shape, bondholders’ willingness to accept such conditions highlights the risks in the market. Traditional bondholders can usually recoup at least some of their principal even if a company goes bankrupt.

At the same time, many European financial institutions are still in fragile shape. The Bank of Ireland, in which the Irish government still has a small stake, is struggling to divest itself of many risky loans that it made before the financial crisis. Portugal’s economy is also expected to contract 3 percent this year, which will probably depress the earnings of Banco Espírito Santo.

The question for investors is whether the reward is worth the risk.

Read More..

Israelis Launch Major Assault on Gaza, Killing Hamas Commander





GAZA — Israel on Wednesday launched one of the most ferocious assaults on Gaza since its invasion four years ago, hitting at least 20 targets in aerial attacks that killed the top military commander of Hamas, drew strong condemnation from Egypt and escalated the risks of a new war in the Middle East.




The Israelis coupled the intensity of the airstrikes with the threat of another ground invasion and warnings to all Hamas leaders in Gaza to stay out of sight or risk the same fate as the Hamas military commander, Ahmed al-Jabari, who was killed in a pinpoint airstrike as he was traveling by car down a Gaza street. “We recommend that no Hamas operatives, whether low level or senior leaders, show their faces above ground in the days ahead,” the Israel Defense Forces said in a Twitter message.


The ferocity of the airstrikes, which Israel called Operation “Pillar of Defense” in response to repeated rocket attacks by Gaza-based Palestinian militants, provoked rage in Gaza, where Hamas said the airstrikes amounted to war and promised a harsh response. It quickly launched dozens of rockets into southern Israel, including several that struck the city of Beersheba, shattering windows and damaging cars but causing no injuries.


Civil-defense authorities in Israel, anticipating retaliation, raised alert levels early in the day and told residents in southern Israel to take precautions. Many remained indoors or congregated in bomb shelters.


The Hamas-run Health Ministry in Gaza said the Israeli attacks had killed at least five others besides Mr. Jabari, including a baby and a 7-year-old girl, and had wounded at least 40.


The abrupt escalation in hostilities between Israel and Hamas, the militant organization regarded by Israel as a terrorist group sworn to Israel’s destruction, came amid rising tensions between Israel and all of its Arab neighbors. Israel has faced growing lawlessness on its border with the Sinai, including cross-border attacks. It recently fired twice into Syria, which is caught in a civil war, after munitions fell in the Israeli-occupied Golan Heights, and it has absorbed rocket fire from Gaza, which has damaged homes and frightened the population.


Israeli officials had promised a robust response to the rocket fire, but for the moment, at least, opted against a ground invasion and instead chose airstrikes and targeted killings.


The Israeli attacks especially threatened to further complicate Israel’s fragile relations with Egypt, where the Islamist-led government of President Mohamed Morsi, reversing a policy of ousted predecessor Hosni Mubarak, had established closer ties with Hamas and had been acting as a mediator to restore calm between Israel and Gaza-based militant groups.


In the first crisis in Israeli-Egyptian relations since Mr. Morsi came to power, he called the Israeli actions “wanton aggression on the Gaza Strip.” He ordered Egypt’s ambassador to Israel to return home, summoned the Israeli ambassador to protest, and called for emergency meetings of both the United Nations Security Council and the Arab League over the Gaza attacks. Egyptian state media said Foreign Minister Mohamed Amr had “warned Israel against the consequences of escalation and the negative reflections it may have on the security and stability of the region.”


Mr. Morsi’s Freedom and Justice Party, which was founded by the Muslim Brotherhood, posted a video on its Web site of what was described as the burned body of a Palestinian child said to have been killed in the Israeli attacks, in what appeared to be a deliberate attempt to inflame passions. His party also issued a statement saying: “The wanton aggression against Gaza proves that Israel has yet to realize that Egypt has changed and that the Egyptian people who revolted against oppression will not accept assaulting Gaza.”


A spokesman for Hamas, Fawzi Barhoum, said the Israelis had “committed a dangerous crime and broke all redlines,” and that “the Israeli occupation will regret and pay a high price.”


Military officials in Israel, which announced responsibility for the death of Mr. Jabari, later said in a statement that their forces had carried out additional airstrikes in Gaza targeting what they described as “a significant number of long-range rocket sites” owned by Hamas that had stored rockets capable of reaching 25 miles into Israel. The statement said the airstrikes had dealt a “significant blow to the terror organization’s underground rocket-launching capabilities.”


Yisrael Katz, a minister from Israel’s governing Likud Party, issued a statement saying that the operation had sent a message to the Hamas political leaders in Gaza “that the head of the snake must be smashed. Israel will continue to kill and target anyone who is involved in the rocket attacks.”Hamas and medical officials in Gaza said both Mr. Jabari and a companion were killed by the airstrike on his car in Gaza City. Israeli news media said the companion was Mr. Jabari’s son, but there was no immediate confirmation.


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



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App Smart: News360, Edge Extended, Need for Speed and Other Great Android Apps





Tablets are changing computing, there’s no doubt. I realized this when I saw my 2-year-old son pick up an iPad and master its basic controls, including discovering a child’s app, in about half an hour. The iPad led the way into this brave new world more or less alone at first. It has taken until now for the sheer pressure of innovation inside Apple’s rivals to lead to some great Android-based tablets finally making a mark.




If you’re a new owner of one of these, you’ll be happy to know that there’s many an app that will simultaneously thrill you, inform you and welcome you into the world of tablet computing.


For a great news experience, the free app News360 has to be one of the better news-aggregating ones I’ve seen on any platform. When you first open the app, you are presented with a long list of topics that it can aggregate for your convenience into different categories, from arts through science to zombies.


The app uses this profile to grab news from the Web and present it to you within its elegant interface. This is dominated by picture-based “tiles” for each news article the app collects. Each tile tells you the appropriate category, where the news item came from and when. Tapping on one of these tiles takes you to a new page that contains a screen grab of the original online source, alongside the text the app has collected from the article.


The pleasure of News360 is that you can either satisfy your curiosity by tapping on a link to read the original article or decide you have learned enough and navigate on. You can also mark the article as interesting, save it for reading offline — perhaps on a commute — or share it on a social network. These controls are also accessible from the initial “tiles” screen, where you flip over an article’s tile to see the controls. The flip is accompanied by a very pleasing animation. It’s just a little graphical touch, but small details like this make an app great fun.


Part of the fun of having a new tablet is showing off its graphical prowess. Games are a great way to do this. I’ve had immense fun with Edge Extended (about $3 on Google Play). In this game, you play a multicolored cube that you roll around a blocky terrain to collect targets. You swipe your finger on the screen to make the cube flop onto its faces to move. There are all the classic elements of collecting points, avoiding pitfalls, activating switches and so on. But despite its graphical simplicity, the app is swift-paced and very satisfying; it even gave me that sensation of falling from a height in some of its trickier parts.


If you really want to impress people with your tablet’s screen, then you’ll probably get a kick out of a game like Need for Speed Most Wanted ($7 on Google play). It’s a racing game that uses motion to control steering and simple tap controls to brake, slide the car in a drift or turn on a nitrous turbo boost. True to the “Most Wanted” title, you race on regular roads, not racetracks, and can get in trouble with the police. This app has all the typical racing fun, along with the ability to earn points that unlock better cars and so on. But the standout feature is the attractiveness of the graphics, and the image rendering even includes reflections of passing buildings in puddles. It’s really eye-popping, and it even works on a diminutive tablet like the Nexus 7.


If racing’s not your thing, you may like SoulCraft THD instead. In this hack-and-slash role-playing game, you control your character from above as it fights its way through a fantasy landscape of dungeons and cities. As on a standard computer action game, you can earn spells and improve your character’s powers.


The game is “freemium” so it’s free to download and play, but you have to make in-game purchases with real money to advance quickly. The graphics are slick, but don’t expect the kind of detailed rendering you would see on a gaming PC.


If you want to make your pals who own iPads jealous, turn on an animated background. This shows off the computing power of your tablet and Android’s skills, too.


Right now my tablet is rocking the seasonal Autumn Tree Live Wallpaper, which is $1. You can control all sorts of aspects of the app, including what type of trees wave their autumnal leaves in the wind, and it’s delightful. It’s also something that a stock iPad absolutely can’t do.


Have fun, but here’s a big reminder for you: Not all Android tablets will play nicely with all tablet apps, and some features depend on installing the latest edition of the operating system.


Quick Calls


Fresh and free on Android and iOS is a highly unusual “experimental” game, Curiosity. It’s a cube with faces made of millions of smaller cubes. Players all around the world hack away at these by tapping on their devices. A single prize is hidden inside an unknown number of layers. It’s weirdly fun to play ... One of the earliest and slickest apps for Windows 8/RT devices is the official Wikipedia app (free), which shows the online encyclopedia in its most elegant, graphical format yet.


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Personal Health: Quitting Smoking for Good

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

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

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

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

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

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

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

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

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

Addiction and Withdrawal

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

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

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

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

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

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

Aids for Quitting

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

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

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

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

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

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

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

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


This post has been revised to reflect the following correction:

Correction: November 14, 2012

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

Read More..

Personal Health: Quitting Smoking for Good

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

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

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

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

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

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

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

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

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

Addiction and Withdrawal

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

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

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

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

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

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

Aids for Quitting

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

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

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

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

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

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

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

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


This post has been revised to reflect the following correction:

Correction: November 14, 2012

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

Read More..

5-Hour Energy Is Cited in 13 Death Reports





Federal officials have received reports of 13 deaths over the last four years that cited the possible involvement of 5-Hour Energy, a highly caffeinated energy shot, according to Food and Drug Administration records and an interview with an agency official.




The disclosure of the reports is the second time in recent weeks that F.D.A. filings citing energy drinks and deaths have emerged. Last month, the agency acknowledged it had received five fatality filings mentioning another popular energy drink, Monster Energy.


Since 2009, 5-Hour Energy has been mentioned in some 90 filings with the F.D.A., including more than 30 that involved serious or life-threatening injuries like heart attacks, convulsions and, in one case, a spontaneous abortion, a summary of F.D.A. records reviewed by The New York Times showed.


The filing of an incident report with the F.D.A. does not mean that a product was responsible for a death or an injury or contributed in any way to it. Such reports can be fragmentary in nature and difficult to investigate.


The distributor of 5-Hour Energy, Living Essentials of Farmington Hills, Mich., did not respond to written questions about the filings, and its top executive declined to be interviewed. Living Essentials is a unit of the product’s producer, Innovation Ventures.


However, in a statement, Living Essentials said the product was safe when used as directed and that it was “unaware of any deaths proven to be caused by the consumption of 5-Hour Energy.”


Since the public disclosure of reports about Monster Energy, its producer, Monster Beverage of Corona, Calif., has repeatedly said that its products are safe, adding that they were not the cause of any of the health problems reported to the F.D.A.


Shares of Monster Beverage, which traded above $80 earlier this year, closed Wednesday at $44.74.


The fast-growing energy drink industry is facing increasing scrutiny over issues like labeling disclosures and possible health risks. Some lawmakers are calling on the F.D.A. to increase its regulation of the products and the New York State attorney general is investigating the practices of several producers.


Unlike Red Bull, Monster Energy and some other energy drinks that look like beverages, 5-Hour Energy is sold in a two-ounce bottle referred to as a shot. The company does not disclose the amount of caffeine in each bottle, but a recent article published by Consumer Reports placed that level at about 215 milligrams.


An eight-ounce cup of coffee, depending on how it is made, can contain from 100 to 150 milligrams of caffeine.


The F.D.A. has stated that it does not have sufficient scientific evidence to justify changing how it regulates caffeine or other ingredients in energy products. The issue of how to do so is complicated by the fact that some high-caffeine drinks, like Red Bull, are sold under agency rules governing beverages, while others, like 5-Hour Energy and Monster Energy, are marketed as dietary supplements. The categories have differing ingredient rules and reporting requirements.


In an interview Wednesday, Daniel Fabricant, the director of the agency’s division of dietary supplement programs, said the agency was looking into the death reports that cited 5-Hour Energy. He said that while medical information in such reports could rule out a link with the product, other reports could contain insufficient information to determine what role, if any, a supplement might have played.


Mr. Fabricant said that the 13 fatality reports that mentioned 5-Hour Energy had all been submitted to the F.D.A. by Living Essentials. Since late 2008, producers of dietary supplements are required to notify the F.D.A. when they become aware of a death or serious injury that may be related to their product.


Currently, the agency does not publicly disclose adverse event filings about dietary supplements like 5-Hour Energy. Companies that market energy drinks as beverages are not required to make such reports to the agency, although they can do so voluntarily, Mr. Fabricant said.


Along with caffeine, 5-Hour Energy contains other ingredients, like very high levels of certain B vitamins and an amino acid called taurine.


Reached by telephone, the chief executive of the Living Essentials, Manoj Bhargava, declined to discuss the filings and said he believed an article about the reports would cast the company in a negative light.


“I am not interested in making any comment,” Mr. Bhargava said.


Subsequently, the company issued a statement, that said, among other things, that it took “reports of any potential adverse event tied to our products very seriously,” adding that the company complied “with all of our reporting requirements” to the F.D.A.


The company also stated that it marketed 5-Hour Energy to “hardworking adults who need an extra boost of energy.” The product’s label recommends that it not be used by woman who are pregnant or by children under 12 years of age.


The number of reports filed with the F.D.A. that mention 5-Hour Energy appears particularly striking. In 2010, for example, the F.D.A. received a total of 17 fatality reports that mentioned a dietary supplement or a weight loss product, two broad categories that cover more than 50,000 products, according to Mr. Fabricant, the F.D.A. official.


He added that it was difficult to put the volume of 5-Hour Energy filings into context because he believed that some supplement manufacturers were probably not following the mandated reporting rules and that consumers and doctors might also be unaware that they can file incident reports with the agency. Last year, the F.D.A. received only 2,000 reports about fatalities or serious injuries that cited dietary supplements and weight loss products, he said.


Another federal agency, the Substance Abuse and Mental Health Services Administration, reported late last year that more than 13,000 emergency room visits in 2009 were associated with energy drinks alone.


Along with Living Essentials, The Times sent queries last week to several producers asking whether they had received reports linking fatalities or serious injuries to their products.


Representatives for two of those companies — Red Bull and Coca-Cola, which sells NOS and Full Throttle — said they were unaware of any such reports. A representative for PepsiCo, which makes Amp, declined to comment, stating that such reports constituted “nonpublic information.”


In addition to Red Bull, NOS, Full Throttle and Amp are also marketed as beverages, rather than as dietary supplements.


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White House Supports Top U.S. Commander in Afghanistan





President Obama has faith in Gen. John R. Allen, the top American and NATO commander in Afghanistan, the White House spokesman said on Tuesday, after it was disclosed that the general was under investigation for what the Pentagon called “inappropriate communication” with the woman whose complaint to the F.B.I. set off the scandal involving David H. Petraeus’s extramarital affair.




“The president thinks very highly of General Allen,” the spokesman, Jay Carney, said at a White House news briefing. “He has faith in General Allen,” and believes that he has done “an excellent job” as commander in Afghanistan, Mr. Carney added. General Allen’s recent nomination to become the supreme allied commander in Europe, Mr. Carney said, is delayed at the request of Defense Secretary Leon E. Panetta pending the investigation’s outcome.


Mr. Panetta and other officials disclosed overnight the investigation into General Allen’s e-mails with Jill Kelley, the woman in Tampa, Fla., who was seen by Paula Broadwell, Mr. Petraeus’s lover, as a rival for his attentions.


Mr. Petraeus’s affair led to his resignation as head of the C.I.A. on Friday, and the F.B.I.’s investigations into e-mails in the matter apparently led in turn to General Allen’s correspondence.


In a statement released to reporters on his plane en route to Australia early Tuesday, Mr. Panetta said the F.B.I. on Sunday had referred “a matter involving” General Allen to the Pentagon.


Mr. Panetta turned the matter over to the Pentagon’s inspector general to conduct an investigation into what a defense official said were thousands of pages of documents, many of them e-mails between General Allen and Ms. Kelley.


A senior law enforcement official in Washington said on Tuesday that F.B.I. investigators, looking into Ms. Kelley’s complaint about anonymous e-mails she had received, examined all of her e-mails as a routine step.


“When you get involved in a cybercase like this, you have to look at everything,” the official said, suggesting that Ms. Kelley may not have considered that possibility when she filed the complaint. “The real question is why someone decided to open this can of worms.”


The official would not describe the content of the e-mails between General Allen and Ms. Kelley or say specifically why F.B.I. officials had decided to pass them on to the Defense Department. “Generally, the nature of the e-mails warranted providing them to D.O.D.,” he said.


Under military law, adultery can be a crime.


The defense official on Mr. Panetta’s plane said that General Allen, who is also married, told Pentagon officials that he had done nothing wrong. Neither he nor Ms. Kelley, who is also married with children, could be reached for comment early Tuesday. Mr. Panetta’s statement praised General Allen for his leadership in Afghanistan and said, “He is entitled to due process in this matter.”


A senior Defense Department official said General Allen had denied having an extramarital affair with Ms. Kelley. But the official said the content of some of the e-mails “was of a flirtatious nature.”


“Some were of an affectionate nature,” the official said, adding that it was unclear whether the flirtatiousness expressed was from General Allen to Ms. Kelley, from Ms. Kelley to General Allen, or mutual.


“That is what makes the e-mails potentially inappropriate,” he said.


The official said that he had not read the e-mails, but had been briefed on the content, and that they did not contain anything inappropriate regarding operations or security.


But there were conflicting assessments of the content of the e-mails. Associates of General Allen said that the e-mails were of an innocuous nature. Some of the e-mails, these associates said, used terms of endearment, but not in a flirtatious way.


Pentagon officials cautioned against making too much of the number of documents, since some might be from e-mail chains, or brief messages printed out on a whole page.


The Pentagon inspector general’s investigation opens up what could be a widening scandal into two of the most prominent generals of their generation: Mr. Petraeus, who was the top commander in Iraq and Afghanistan before he retired from the military and became director of the C.I.A., only to resign on Friday because of the affair, and General Allen, who also served in Iraq and now commands 68,000 American troops in Afghanistan.


Although General Allen will remain the commander in Afghanistan, Mr. Panetta said that he had asked President Obama to delay the general’s nomination to be the commander of American forces in Europe and the supreme allied commander of NATO, two positions he was to move into after what was expected to be easy confirmation by the Senate. Mr. Panetta said in his statement that Mr. Obama agreed with his request.


Scott Shane and Thom Shanker contributed reporting from Washington.



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Zynga Executive Defects to Facebook



NEW YORK (AP) — Zynga's finance chief is leaving the troubled online game company to join Facebook.


San Francisco-based Zynga Inc. said Tuesday that David Wehner will take a "senior finance position" at the social networking company. His exact title will be vice president of corporate finance and business planning, Facebook said.


Chief accounting officer, Mark Vranesh, is replacing Wehner as chief financial officer, returning to the post he held from 2008 to 2010, while Zynga was still a private company.


Zynga also reshuffled its executive ranks, a move CEO Mark Pincus said puts the company in a position for "long-term growth." Zynga, whose games include "FarmVille" and "Texas HoldEm Poker," has seen its stock price fall sharply in recent months amid concerns about its ability to make money from mobile games, off of Facebook.


David Ko, who was previously chief mobile officer, is now chief operations officer. Barry Cottle, who came to Zynga from Electronic Arts Inc., is now chief revenue officer. He was previously executive vice president of business and corporate development.


The appointments seek to fill some of the holes left by executives who've left Zynga in recent months. John Schappert, Zynga's chief operating officer, left in August after less than a year and a half on the job. Schappert's exit was followed by that of Mike Verdu, the company's chief creative officer. And in September Jeff Karp, the chief marketing and chief revenue officer, left the company.


Zynga is also reaffirming its guidance. The company still expects adjusted earnings of 2 or 3 cents per share. Analysts polled by FactSet expect 3 cents.


Zynga shares closed up 1 cent at $2.11 and added 2 cents in after-hours trading.


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‘Dream Team’ of Behavioral Scientists Advised Obama Campaign


Chris Keane/Reuters


DOOR TO DOOR Ricky Hall, an Obama volunteer, in Charlotte, N.C., last week.







Late last year Matthew Barzun, an official with the Obama campaign, called Craig Fox, a psychologist in Los Angeles, and invited him to a political planning meeting in Chicago, according to two people who attended the session.




“He said, ‘Bring the whole group; let’s hear what you have to say,’ ” recalled Dr. Fox, a behavioral economist at the University of California, Los Angeles.


So began an effort by a team of social scientists to help their favored candidate in the 2012 presidential election. Some members of the team had consulted with the Obama campaign in the 2008 cycle, but the meeting in January signaled a different direction.


“The culture of the campaign had changed,” Dr. Fox said. “Before then I felt like we had to sell ourselves; this time there was a real hunger for our ideas.”


This election season the Obama campaign won a reputation for drawing on the tools of social science. The book “The Victory Lab,” by Sasha Issenberg, and news reports have portrayed an operation that ran its own experiment and, among other efforts, consulted with the Analyst Institute, a Washington voter research group established in 2007 by union officials and their allies to help Democratic candidates.


Less well known is that the Obama campaign also had a panel of unpaid academic advisers. The group — which calls itself the “consortium of behavioral scientists,” or COBS — provided ideas on how to counter false rumors, like one that President Obama is a Muslim. It suggested how to characterize the Republican opponent, Mitt Romney, in advertisements. It also delivered research-based advice on how to mobilize voters.


“In the way it used research, this was a campaign like no other,” said Todd Rogers, a psychologist at Harvard’s Kennedy School of Government and a former director of the Analyst Institute. “It’s a big change for a culture that historically has relied on consultants, experts and gurulike intuition.”


When asked about the outside psychologists, the Obama campaign would neither confirm nor deny a relationship with them. “This campaign was built on the energy, enthusiasm and ingenuity of thousands of grass-roots supporters and our staff in the states and in Chicago,” said Adam Fetcher, a campaign spokesman. “Throughout the campaign we saw an outpouring of individuals across the country who lent a wide variety of ideas and input to our efforts to get the president re-elected.”


For their part, consortium members said they did nothing more than pass on research-based ideas, in e-mails and conference calls. They said they could talk only in general terms about the research, because they had signed nondisclosure agreements with the campaign.


In addition to Dr. Fox, the consortium included Susan T. Fiske of Princeton University; Samuel L. Popkin of the University of California, San Diego; Robert Cialdini, a professor emeritus at Arizona State University; Richard H. Thaler, a professor of behavioral science and economics at the University of Chicago’s business school; and Michael Morris, a psychologist at Columbia.


“A kind of dream team, in my opinion,” Dr. Fox said.


He said that the ideas the team proposed were “little things that can make a difference” in people’s behavior.


For example, Dr. Fiske’s research has shown that when deciding on a candidate, people generally focus on two elements: competence and warmth. “A candidate wants to make sure to score high on both dimensions,” Dr. Fiske said in an interview. “You can’t just run on the idea that everyone wants to have a beer with you; some people care a whole lot about competence.”


Mr. Romney was recognized as a competent businessman, polling found. But he was often portrayed in opposition ads as distant, unable to relate to the problems of ordinary people.


When it comes to countering rumors, psychologists have found that the best strategy is not to deny the charge (“I am not a flip-flopper”) but to affirm a competing notion. “The denial works in the short term; but in the long term people remember only the association, like ‘Obama and Muslim,’ ” said Dr. Fox, of the persistent false rumor.


The president’s team affirmed that he is a Christian.


At least some of the consortium’s proposals seemed to have found their way into daily operations. Campaign volunteers who knocked on doors last week in swing states like Pennsylvania, Ohio and Nevada did not merely remind people to vote and arrange for rides to the polls. Rather, they worked from a script, using subtle motivational techniques that research has shown can prompt people to take action.


“We used the scripts more as a guide,” said Sarah Weinstein, 18, a Columbia freshman who traveled with a group to Cleveland the weekend before the election. “The actual language we used was invested in the individual person.”


This article has been revised to reflect the following correction:

Correction: November 13, 2012

An earlier version of this article omitted a word from the title of the book by Sasha Issenberg that examines data-driven strategies in political campaigns. It is “The Victory Lab,”  not “Victory Lab.”



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