The New Old Age Blog: The Ex-Wives Club

Weather permitting, Kappy Lundy and Barbara Thompson are heading out to Vancouver, Wash., on Saturday night to have a holiday dinner with the parents of their daughter’s husband.

Yes, these women both mothered the same children — now grown and with children of their own. Ms. Lundy is their biological parent; Ms. Thompson is the stepmother who married their father after he and Ms. Lundy divorced.

But that doesn’t really begin to describe their relationship. Over more than 40 years, these two have been friends and what they call “wife-in-laws,” in addition to moms-in-tandem. Now, they’re so close they feel like sisters, they say.

There’s yet another dimension to this relationship that makes it so unusual: Ms. Lundy, who is 71, has become a caregiver for Ms. Thompson, who’s 67 and was given a diagnosis of mild cognitive impairment in 2009.

One wife caring for another, through thick and through thin – think about that. It’s another example of how the new old age is spawning unusual — and creative — alliances.

Ms. Lundy went with Ms. Thompson to eight months of classes on memory loss offered by the Alzheimer’s Association chapter in Portland, Ore., where the two women live. And now they go together to monthly meetings of the Wild Bunch, a group of people with dementia and their caregivers who’ve come together to provide each other emotional support. (More on that group to come in a future post.)

Ms. Lundy talks to Ms. Thompson every day and tries to get together with her once a week.

“We’re just really good friends, and we want to know what’s going on, what are you doing, like everybody else,” said Ms. Thompson, who moved into an independent living facility in Portland nearly a year ago, after Ms. Lundy helped pack up her previous apartment.

Ms. Lundy, who lives across town, about 20 minutes away, said: “We’ll go to happy hour together and have a little toddy and maybe a nice meal. And crack up – she makes me laugh.”

Both women grew up in Eugene, Ore., but became friends later, after they moved to Portland in their 20s. Their favorite haunt was the Goose Hollow Inn, a tavern where artists, architects and writers would congregate. Ms. Lundy and her husband began to socialize regularly with Ms. Thompson and her first husband.

“She’s full of life and fun – a gypsy at heart,” is how Ms. Thompson describes Ms. Lundy.

“She’s funny and smart and a really good listener,” is how Ms. Lundy describes Ms. Thompson.

When Ms. Lundy’s marriage to Phil Thompson — a handsome bear of a man, with a charismatic personality and an artistic sensibility — began falling apart, both members of the couple turned to their friend Barbara for support. “She listened to me and my anger, and she listened to him about how he was hurting,” says Ms. Lundy, who was separated from her husband for a year before the divorce was official.

There were no hard feelings when Phil’s feelings toward Barbara turned romantic, Ms. Lundy says. But she didn’t see the couple much during subsequent years of work and travel abroad. During those years, her children, Jessica and David, stayed with their father in Portland.

Eventually, Ms. Lundy came home and was invited to holidays at the Thompson house. She grew close to Barbara again and let go of negative feelings toward her former husband, she said. Over time, they became bound together as family.

“It’s incredible,” their daughter said. “They’re just really caring for each other and not threatened by each other.

“My dad got a big kick out of it and would always introduce them as ‘my wives.’”

When Phil Thompson died in August 2008, both women were at his bedside. And when Ms. Thompson started having memory problems months later, Ms. Lundy was one of the first to notice. “We could see she wasn’t remembering things, but she said, ‘This is my grief,’” Ms. Lundy recalled. It became clear something else might be going on as problems persisted and a doctor’s evaluation yielded the mild cognitive impairment diagnosis.

Ms. Thompson described her reaction to that information: “It was scary. Very scary. I didn’t know if it meant the end of my freedom, of my ability to just live my own life.”

For her part, Ms. Lundy said: “The hardest thing for me from the very beginning was to see my party pal and my dear, dear friend changing. It was very frustrating to me. And very hurtful. I wanted to support her. But sometimes I didn’t have the patience. Because, you know, she wasn’t acting like Barbara. It’s taken a while, but slowly, slowly, slowly and surely, I’ve accepted that this is who Barbara is.”

Ms. Lundy isn’t the only caregiver for Ms. Thompson: Jessica and David, her stepchildren, and two close friends also help out, as needed.

For Ms. Lundy, the uncertainty associated with her friend’s mild cognitive impairment diagnosis is hard to live with. Will it progress to dementia? Will it stay stable, or even get better? The doctor can’t say, and “all that not-knowing business is unsettling,” she said.

Becoming a caregiver has “made our friendship even stronger, I think,” Ms. Lundy says. “We’re closer now. Even though we’ve been friends for years and years, I never felt responsible for her before.”

For Ms. Thompson, what’s hardest is living alone after nearly 30 years of being married to Phil and worrying about losing her independence — notably, her ability to continue driving.

“I feel isolated with the disease,” she said. “And being alone in a new apartment with lots of strangers here has been a little difficult.”

“I’m very grateful to Kappy,” Ms. Thompson said. “I didn’t used to feel that she would be this way. She was always doing her own thing. But she has definitely reached out, beyond what most people would do.”

On Christmas the two women will be at Jessica’s house, arriving at around noon, after the grandchildren have opened their presents, and staying through the late afternoon. After the holidays, Ms. Lundy says she plans to take Ms. Thompson out more often and “have a couple of beers and a laugh and be happy and just be Barbie and Kappy,” two old friends, enjoying each other’s company.

This is the one of the most unusual caregiving relationships I know of. It reaffirms what I’ve been told several times: You never know who will end up being there for you when you need help. Sometimes the people we expect will care for us don’t, and others step forward. Has that been your experience?

Read More..

The New Old Age Blog: The Ex-Wives Club

Weather permitting, Kappy Lundy and Barbara Thompson are heading out to Vancouver, Wash., on Saturday night to have a holiday dinner with the parents of their daughter’s husband.

Yes, these women both mothered the same children — now grown and with children of their own. Ms. Lundy is their biological parent; Ms. Thompson is the stepmother who married their father after he and Ms. Lundy divorced.

But that doesn’t really begin to describe their relationship. Over more than 40 years, these two have been friends and what they call “wife-in-laws,” in addition to moms-in-tandem. Now, they’re so close they feel like sisters, they say.

There’s yet another dimension to this relationship that makes it so unusual: Ms. Lundy, who is 71, has become a caregiver for Ms. Thompson, who’s 67 and was given a diagnosis of mild cognitive impairment in 2009.

One wife caring for another, through thick and through thin – think about that. It’s another example of how the new old age is spawning unusual — and creative — alliances.

Ms. Lundy went with Ms. Thompson to eight months of classes on memory loss offered by the Alzheimer’s Association chapter in Portland, Ore., where the two women live. And now they go together to monthly meetings of the Wild Bunch, a group of people with dementia and their caregivers who’ve come together to provide each other emotional support. (More on that group to come in a future post.)

Ms. Lundy talks to Ms. Thompson every day and tries to get together with her once a week.

“We’re just really good friends, and we want to know what’s going on, what are you doing, like everybody else,” said Ms. Thompson, who moved into an independent living facility in Portland nearly a year ago, after Ms. Lundy helped pack up her previous apartment.

Ms. Lundy, who lives across town, about 20 minutes away, said: “We’ll go to happy hour together and have a little toddy and maybe a nice meal. And crack up – she makes me laugh.”

Both women grew up in Eugene, Ore., but became friends later, after they moved to Portland in their 20s. Their favorite haunt was the Goose Hollow Inn, a tavern where artists, architects and writers would congregate. Ms. Lundy and her husband began to socialize regularly with Ms. Thompson and her first husband.

“She’s full of life and fun – a gypsy at heart,” is how Ms. Thompson describes Ms. Lundy.

“She’s funny and smart and a really good listener,” is how Ms. Lundy describes Ms. Thompson.

When Ms. Lundy’s marriage to Phil Thompson — a handsome bear of a man, with a charismatic personality and an artistic sensibility — began falling apart, both members of the couple turned to their friend Barbara for support. “She listened to me and my anger, and she listened to him about how he was hurting,” says Ms. Lundy, who was separated from her husband for a year before the divorce was official.

There were no hard feelings when Phil’s feelings toward Barbara turned romantic, Ms. Lundy says. But she didn’t see the couple much during subsequent years of work and travel abroad. During those years, her children, Jessica and David, stayed with their father in Portland.

Eventually, Ms. Lundy came home and was invited to holidays at the Thompson house. She grew close to Barbara again and let go of negative feelings toward her former husband, she said. Over time, they became bound together as family.

“It’s incredible,” their daughter said. “They’re just really caring for each other and not threatened by each other.

“My dad got a big kick out of it and would always introduce them as ‘my wives.’”

When Phil Thompson died in August 2008, both women were at his bedside. And when Ms. Thompson started having memory problems months later, Ms. Lundy was one of the first to notice. “We could see she wasn’t remembering things, but she said, ‘This is my grief,’” Ms. Lundy recalled. It became clear something else might be going on as problems persisted and a doctor’s evaluation yielded the mild cognitive impairment diagnosis.

Ms. Thompson described her reaction to that information: “It was scary. Very scary. I didn’t know if it meant the end of my freedom, of my ability to just live my own life.”

For her part, Ms. Lundy said: “The hardest thing for me from the very beginning was to see my party pal and my dear, dear friend changing. It was very frustrating to me. And very hurtful. I wanted to support her. But sometimes I didn’t have the patience. Because, you know, she wasn’t acting like Barbara. It’s taken a while, but slowly, slowly, slowly and surely, I’ve accepted that this is who Barbara is.”

Ms. Lundy isn’t the only caregiver for Ms. Thompson: Jessica and David, her stepchildren, and two close friends also help out, as needed.

For Ms. Lundy, the uncertainty associated with her friend’s mild cognitive impairment diagnosis is hard to live with. Will it progress to dementia? Will it stay stable, or even get better? The doctor can’t say, and “all that not-knowing business is unsettling,” she said.

Becoming a caregiver has “made our friendship even stronger, I think,” Ms. Lundy says. “We’re closer now. Even though we’ve been friends for years and years, I never felt responsible for her before.”

For Ms. Thompson, what’s hardest is living alone after nearly 30 years of being married to Phil and worrying about losing her independence — notably, her ability to continue driving.

“I feel isolated with the disease,” she said. “And being alone in a new apartment with lots of strangers here has been a little difficult.”

“I’m very grateful to Kappy,” Ms. Thompson said. “I didn’t used to feel that she would be this way. She was always doing her own thing. But she has definitely reached out, beyond what most people would do.”

On Christmas the two women will be at Jessica’s house, arriving at around noon, after the grandchildren have opened their presents, and staying through the late afternoon. After the holidays, Ms. Lundy says she plans to take Ms. Thompson out more often and “have a couple of beers and a laugh and be happy and just be Barbie and Kappy,” two old friends, enjoying each other’s company.

This is the one of the most unusual caregiving relationships I know of. It reaffirms what I’ve been told several times: You never know who will end up being there for you when you need help. Sometimes the people we expect will care for us don’t, and others step forward. Has that been your experience?

Read More..

DealBook: Former SAC Trader Is Indicted

A former SAC Capital Advisors portfolio manager was indicted on Friday on securities fraud and conspiracy charges in a case that federal prosecutors have called the most lucrative insider trading scheme ever uncovered.

A federal grand jury in Manhattan indicted the former portfolio manager, Mathew Martoma, a month after the government arrested on him charges that he used inside tips about a clinical drug trial to help SAC earn profits and avoided losses totaling $276 million.

While Stamford, Conn.-based SAC has been touched by several insider trading cases in recent years, there is heightened attention surrounding the Martoma prosecution. For the first time, the government has tied questionable trades to Steven A. Cohen, the billionaire owner of SAC.

“Though disappointing, today’s events come as no surprise,” Mr. Martoma’s lawyer, Charles A. Stillman, said in a statement. “The simple fact is that Mathew Martoma did not trade on inside information, is innocent of all these charges, and we look forward to his ultimate vindication.”

Before Friday’s indictment, there had been speculation that the government, before formally presenting evidence to a grand jury, was trying to gain Mr. Martoma’s cooperation in building a case against Mr. Cohen. Mr. Martoma has rebuffed several earlier efforts by the authorities to enter into plea talks and implicate his boss.

Mr. Cohen has not been charged with any wrongdoing, and a spokesman for SAC has said that he believes that he and SAC have at all times acted appropriately. The Securities and Exchange Commission, which brought a parallel civil action against Mr. Martoma, has warned SAC that it is likely to filed a fraud lawsuit against the firm related to the Martoma case.

Hedge Fund Inquiry

Mr. Martoma, 38, is set to appear in Federal District Court in Manhattan on Jan. 3 for his arraignment, at which time he will enter a plea. The case was assigned to Judge Paul Gardephe, a former federal prosecutor who assumed his seat on the bench in 2008 after an appointment by President George W. Bush.

The government says that Mr. Martoma obtained secret, negative information from a doctor about clinical trials of an Alzheimer’s drug being developed by the pharmaceutical companies Elan and Wyeth. He then, prosecutors say, had a 20-minute telephone conversation with Mr. Cohen.

A day after the phone call, SAC sold $700 million in Elan and Wyeth stock and made a large negative bet on the companies. The companies’ shares plummeted after they announced the disappointing trial results, and SAC booked big profits.

The doctor, Sidney Gilman, is cooperating with prosecutors and has agreed to testify against Mr. Martoma. The government gave Dr. Gilman a non-prosecution agreement, meaning they will not bring criminal charges against him. Such an agreement is highly unusual, legal experts say, and is being used as a pressure point on Mr. Martoma in an effort to get him to “flip” against Mr. Cohen.

Before coming to New York for his arraignment, Mr. Martoma will be spending the holidays with his wife and three young children at home, in Boca Raton, Fla.

Read More..

The Lede Blog: Awaiting the End in a Small Turkish Town

Telegraph TV video reports people have gathered in France and Turkey to await the end of days.

SIRINCE, TURKEY — Despite assurances from leading Islamic and Christian clerics and the global skepticism based on scientific facts, as many as 10,000 people are expected to descend on this small Turkish town in the Aegean region in hopes of being among the few to survive the Dec. 21, 2012, doomsday supposedly predicted by the Mayan calendar.

Said to be identified in ancient Mayan hieroglyphs, at least by those who cannot read them, as one of only three places on earth that would escape the predicted Apocalypse, Sirince has been flooded by visitors hoping to ride out the disaster.

At first, Sirince residents were pleasantly surprised, but also a bit uncomfortable in case there could be some possible truth to the myths, to learn that their village — along with Mount Rtanj in Serbia and Bugarach, in the Corbières Mountains of southern France — was pinpointed as the safe locations for humanity to survive.

Discussions of the end of times in Mexico and Serbia, on the eve of the expected apocolypse.

In France, as my colleague Ellen Barry reported, “the authorities plan to bar access to Bugarach mountain in the south to keep out a flood of visitors who believe it is a sacred place that will protect a lucky few from the end of the world.”

A way to escape the Mayan apocalypse: run for the Serbian mystic mountains! http://t.co/GChOmr2U

— Srećko Šekeljić (@sekeljic) 20 Dec 12

But, like hoteliers in Serbia, the merchants of Sirince have been finding ways to make the best out of the influx. The limited number of hotels in the township, which is normally home to fewer than 1,000 people, have been totally booked at record rates as high as $1,000 for a room, and extra security measures have been taken to maintain order as the predicted end neared.

The ancient Greek town, which is only 12 kilometers from Ephesus, a leading ancient historical site in Turkey and a biblical location where the Virgin Mary is said to have once stayed, offers an authentic Aegean experience with good local wine, fine olive oil and traditional handcrafts.

This month, however, doomsday predictions added a humorous and profitable twist to the tourist trade. Ozon Winery came up with the Doomsday wine that sells for around $11, local shops carry T-shirts reading “Doomsday 2012,” snack shops offer Doomsday Pancakes and clairvoyants offer coffee cup readings advertised as Doomsday Fortunetelling.

The Artemis restaurant prepared a Doomsday Menu for visitors, including Doomsday Soup as a starter, Hell Kebab With Fire Rice as the main dish and Forbidden Apple as the dessert, to be followed with the Final Brew Turkish Tea.

On Facebook, Turkish followers have developed a humorous doomsday itinerary to share online that starts with a breakfast at 10 a.m. on Dec. 21, followed by several events, including viewing the meteor at 8 p.m., a seminar at 11 p.m. to discuss why not everyone has come to Sirince and the actual doomsday at midnight — followed by “Meeting in the Afterlife” and a debate asking, “How Come Sirince Was Not Saved?”

Groups are then scheduled to prepare for divine questioning at 4 a.m. on Dec. 22, take a tour around the pearly gates at 5 a.m. and depart for Heaven and Hell as listed at 6 a.m.

“I haven’t met anyone here taking this seriously, and it’s all about having a fine weekend,” said Engin Vatan, owner of Mistik Konak, a small guesthouse, which was fully booked from weeks before. Having moved to Sirince three years ago after visiting the village for more than 20 years, Mr. Vatan said that he had never witnessed such frantic preparations for such a large crowd in all these years.

“Only 24 hours left, there are no signs of Apocalypse yet,” said Sevan Nisanyan, one of the best-known residents of Sirince, who introduced the village to international tourism 20 years ago with a 60-room hotel. “Our own doomsday house party took off with friends visiting from Toronto, Istanbul and all other world cities.”

Life sparkled in the village on Thursday, the coldest day of the month in years, when shops remained opened until late hours, young people filled the streets and residents enjoyed the company of people from all over the world, wishing such rumors would find them every year.

“Many religious experts bash people coming here, saying that only God would know the date of the doomsday,” Mr. Vatan said. “So how can they be so sure that it’s not Dec. 21 if it’s only the God that knows about it?”

Read More..

U.S. Makes Arrest in Olympus Accounting Scandal

Federal agents arrested a former bank executive in Los Angeles on Thursday in connection with the accounting scandal that erupted last year at Olympus, the Japanese camera and medical equipment maker.

Prosecutors in New York alleged that the executive, Chan Ming Fon, received more than $10 million from Olympus for assisting in its accounting fraud.

The Federal Bureau of Investigation said Mr. Chan, 50, was a citizen of Taiwan residing in Singapore. He was charged with conspiracy to commit wire fraud, with a maximum potential penalty of 20 years in prison. His lawyer was not immediately identifiable.

“As alleged, Chan Ming Fon was handsomely paid to play an international shell game with hundreds of millions of dollars of assets in order to allow Olympus to keep a massive accounting fraud going for years,” said Preet Bharara, the United States attorney in Manhattan, in a news release.

The authorities did not identify the financial institutions with which Mr. Chan was affiliated.

In February, the Japanese authorities arrested seven people in relation to the accounting missteps at Olympus, including Tsuyoshi Kikukawa, the company’s former chairman. Mr. Chan was not among those seven. 

The company has admitted that executives set up a scheme to cover up $1.7 billion of losses. The illicit maneuvers came to light after Olympus fired Michael C. Woodford, its British chief executive, in October 2011. Soon after, Mr. Woodford alleged accounting misdeeds at Olympus.

The Olympus scandal rocked the Japanese corporate sector. The case is being watched closely to gauge how serious Japanese authorities will be in their pursuit of white-collar crime. Under Japanese laws, the men arrested in February could each serve up to 10 years if found guilty. 

Read More..

The Consumer: Grapefruit and Drugs Often Don't Mix

The patient didn’t overdose on medication. She overdosed on grapefruit juice.

The 42-year-old was barely responding when her husband brought her to the emergency room. Her heart rate was slowing, and her blood pressure was falling. Doctors had to insert a breathing tube, and then a pacemaker, to revive her.

They were mystified: The patient’s husband said she suffered from migraines and was taking a blood pressure drug called verapamil to help prevent the headaches. But blood tests showed she had an alarming amount of the drug in her system, five times the safe level.

Did she overdose? Was she trying to commit suicide? It was only after she recovered that doctors were able to piece the story together.

“The culprit was grapefruit juice,” said Dr. Unni Pillai, a nephrologist in St. Louis, Mo., who treated the woman several years ago and later published a case report. “She loved grapefruit juice, and she had such a bad migraine, with nausea and vomiting, that she could not tolerate anything else.”

The previous week, she had been subsisting mainly on grapefruit juice. Then she took verapamil, one of dozens of drugs whose potency is dramatically increased if taken with grapefruit. In her case, the interaction was life-threatening.

Last month, Dr. David Bailey, a Canadian researcher who first described this interaction more than two decades ago, released an updated list of medications affected by grapefruit. There are now 85 such drugs on the market, he noted, including common cholesterol-lowering drugs, new anticancer agents, and some synthetic opiates and psychiatric drugs, as well as certain immunosuppressant medications taken by organ transplant patients, some AIDS medications, and some birth control pills and estrogen treatments. (The full list is online; your browser must be configured to handle PDF files.)

“What drove us to write this paper was the number of new drugs that have come out in the last four years,” said Dr. Bailey, a clinical pharmacologist at the Lawson Health Research Institute, who first discovered the interaction by accident in the 1990s.

How often such reactions occur, however, and how often they are triggered in people consuming regular amounts of juice is debated by scientists. Dr. Bailey believes many cases are missed because doctors don’t think to ask if patients are consuming grapefruit or grapefruit juice.

Even if such incidents are rare, Dr. Bailey argued, they are predictable and entirely avoidable. Many hospitals no longer serve juice, and some prescriptions carry stickers warning patients to avoid grapefruit.

“The bottom line is that even if the frequency is low, the consequences can be dire,” he said. “Why do we have to have a body count before we make changes?”

For 43 of the 85 drugs now on the list, consumption with grapefruit can be life-threatening, Dr. Bailey said. Many are linked to an increase in heart rhythm, known as torsade de pointes, that can lead to death. It can occur even without underlying heart disease and has been seen in patients taking certain anticancer agents, erythromycin and other anti-infective drugs, some cardiovascular drugs like quinidine, the antipsychotics lurasidone and ziprasidone, gastrointestinal agents cisapride and domperidone, and solifenacin, used to treat overactive bladders.

Taken with grapefruit, other drugs like fentanyl, oxycodone and methadone can cause fatal respiratory depression. The interaction also can be caused by other citrus fruits, including Seville oranges, limes and pomelos; one published case report has suggested that pomegranate may increase the potency of certain drugs.

Older people may be more vulnerable, because they are more likely to be both taking medications and drinking more grapefruit juice. The body’s ability to cope with drugs also weakens with age, experts say.

Under normal circumstances, the drugs are metabolized in the gastrointestinal tract, and relatively little is absorbed, because an enzyme in the gut called CYP3A4 deactivates them. But grapefruit contains natural chemicals called furanocoumarins, that inhibit the enzyme, and without it the gut absorbs much more of a drug and blood levels rise dramatically.

For example, someone taking simvastatin (brand name Zocor) who also drinks a small 200-milliliter, or 6.7 ounces, glass of grapefruit juice once a day for three days could see blood levels of the drug triple, increasing the risk for rhabdomyolysis, a breakdown of muscle that can cause kidney damage.

Estradiol and ethinyl estradiol, forms of estrogen used in oral contraceptives and hormone replacement, also interact with grapefruit juice. In one case in the journal Lancet, a 42-year-old woman taking the birth control pill Yaz developed a very serious clot that threatened her leg several days after she started eating just one grapefruit a day, said Dr. Lucinda Grande, a physician in Lacey, Wash., and an author of the case report.

But Dr. Grande also noted that the patient had other risk factors and the circumstances were unusual. “The reason we published it as a case report was because it was so uncommon,” she said. “We need to be careful not to exaggerate this.”

Some drugs that have a narrow “therapeutic range” — where having a bit too much or too little can have serious consequences — require vigilance with regard to grapefruit, said Patrick McDonnell, clinical professor of pharmacy practice at Temple University. These include immunosuppressant agents like cyclosporine that are taken by transplant patients to prevent rejection of a donor organ, he said.

Still, Dr. McDonnell added, most patients suffering adverse reactions are consuming large amounts of grapefruit. “There’s a difference between an occasional section of grapefruit and someone drinking 16 ounces of grapefruit juice a day,” he said.

And, he cautioned, “Not all drugs in the same class respond the same way.” While some statins are affected by grapefruit, for instance, others are not.

Here is some advice from experts for grapefruit lovers:

¶ If you take oral medication of any kind, check the list to see if it interacts with grapefruit. Make sure you understand the potential side effects of an interaction; if they are life-threatening or could cause permanent injury, avoid grapefruit altogether. Some drugs, such as clopidogrel, may be less effective when taken with grapefruit.

¶ If you take one of the listed drugs a regular basis, keep in mind that you may want to avoid grapefruit, as well as pomelo, lime and marmalade. Be on the lookout for symptoms that could be side effects of the drug. If you are on statins, this could be unusual muscle soreness.

¶It is not enough to avoid taking your medicine at the same time as grapefruit. You must avoid consuming grapefruit the whole period that you are on the medication.

¶In general, it is a good idea to avoid sudden dramatic changes in diet and extreme diets that rely on a narrow group of foods. If you can’t live without grapefruit, ask your doctor if there’s an alternative drug for you.

---

Readers may submit comments or questions for The Consumer by e-mail to consumer@nytimes.com.

Read More..

The Consumer: Grapefruit and Drugs Often Don't Mix

The patient didn’t overdose on medication. She overdosed on grapefruit juice.

The 42-year-old was barely responding when her husband brought her to the emergency room. Her heart rate was slowing, and her blood pressure was falling. Doctors had to insert a breathing tube, and then a pacemaker, to revive her.

They were mystified: The patient’s husband said she suffered from migraines and was taking a blood pressure drug called verapamil to help prevent the headaches. But blood tests showed she had an alarming amount of the drug in her system, five times the safe level.

Did she overdose? Was she trying to commit suicide? It was only after she recovered that doctors were able to piece the story together.

“The culprit was grapefruit juice,” said Dr. Unni Pillai, a nephrologist in St. Louis, Mo., who treated the woman several years ago and later published a case report. “She loved grapefruit juice, and she had such a bad migraine, with nausea and vomiting, that she could not tolerate anything else.”

The previous week, she had been subsisting mainly on grapefruit juice. Then she took verapamil, one of dozens of drugs whose potency is dramatically increased if taken with grapefruit. In her case, the interaction was life-threatening.

Last month, Dr. David Bailey, a Canadian researcher who first described this interaction more than two decades ago, released an updated list of medications affected by grapefruit. There are now 85 such drugs on the market, he noted, including common cholesterol-lowering drugs, new anticancer agents, and some synthetic opiates and psychiatric drugs, as well as certain immunosuppressant medications taken by organ transplant patients, some AIDS medications, and some birth control pills and estrogen treatments. (The full list is online; your browser must be configured to handle PDF files.)

“What drove us to write this paper was the number of new drugs that have come out in the last four years,” said Dr. Bailey, a clinical pharmacologist at the Lawson Health Research Institute, who first discovered the interaction by accident in the 1990s.

How often such reactions occur, however, and how often they are triggered in people consuming regular amounts of juice is debated by scientists. Dr. Bailey believes many cases are missed because doctors don’t think to ask if patients are consuming grapefruit or grapefruit juice.

Even if such incidents are rare, Dr. Bailey argued, they are predictable and entirely avoidable. Many hospitals no longer serve juice, and some prescriptions carry stickers warning patients to avoid grapefruit.

“The bottom line is that even if the frequency is low, the consequences can be dire,” he said. “Why do we have to have a body count before we make changes?”

For 43 of the 85 drugs now on the list, consumption with grapefruit can be life-threatening, Dr. Bailey said. Many are linked to an increase in heart rhythm, known as torsade de pointes, that can lead to death. It can occur even without underlying heart disease and has been seen in patients taking certain anticancer agents, erythromycin and other anti-infective drugs, some cardiovascular drugs like quinidine, the antipsychotics lurasidone and ziprasidone, gastrointestinal agents cisapride and domperidone, and solifenacin, used to treat overactive bladders.

Taken with grapefruit, other drugs like fentanyl, oxycodone and methadone can cause fatal respiratory depression. The interaction also can be caused by other citrus fruits, including Seville oranges, limes and pomelos; one published case report has suggested that pomegranate may increase the potency of certain drugs.

Older people may be more vulnerable, because they are more likely to be both taking medications and drinking more grapefruit juice. The body’s ability to cope with drugs also weakens with age, experts say.

Under normal circumstances, the drugs are metabolized in the gastrointestinal tract, and relatively little is absorbed, because an enzyme in the gut called CYP3A4 deactivates them. But grapefruit contains natural chemicals called furanocoumarins, that inhibit the enzyme, and without it the gut absorbs much more of a drug and blood levels rise dramatically.

For example, someone taking simvastatin (brand name Zocor) who also drinks a small 200-milliliter, or 6.7 ounces, glass of grapefruit juice once a day for three days could see blood levels of the drug triple, increasing the risk for rhabdomyolysis, a breakdown of muscle that can cause kidney damage.

Estradiol and ethinyl estradiol, forms of estrogen used in oral contraceptives and hormone replacement, also interact with grapefruit juice. In one case in the journal Lancet, a 42-year-old woman taking the birth control pill Yaz developed a very serious clot that threatened her leg several days after she started eating just one grapefruit a day, said Dr. Lucinda Grande, a physician in Lacey, Wash., and an author of the case report.

But Dr. Grande also noted that the patient had other risk factors and the circumstances were unusual. “The reason we published it as a case report was because it was so uncommon,” she said. “We need to be careful not to exaggerate this.”

Some drugs that have a narrow “therapeutic range” — where having a bit too much or too little can have serious consequences — require vigilance with regard to grapefruit, said Patrick McDonnell, clinical professor of pharmacy practice at Temple University. These include immunosuppressant agents like cyclosporine that are taken by transplant patients to prevent rejection of a donor organ, he said.

Still, Dr. McDonnell added, most patients suffering adverse reactions are consuming large amounts of grapefruit. “There’s a difference between an occasional section of grapefruit and someone drinking 16 ounces of grapefruit juice a day,” he said.

And, he cautioned, “Not all drugs in the same class respond the same way.” While some statins are affected by grapefruit, for instance, others are not.

Here is some advice from experts for grapefruit lovers:

¶ If you take oral medication of any kind, check the list to see if it interacts with grapefruit. Make sure you understand the potential side effects of an interaction; if they are life-threatening or could cause permanent injury, avoid grapefruit altogether. Some drugs, such as clopidogrel, may be less effective when taken with grapefruit.

¶ If you take one of the listed drugs a regular basis, keep in mind that you may want to avoid grapefruit, as well as pomelo, lime and marmalade. Be on the lookout for symptoms that could be side effects of the drug. If you are on statins, this could be unusual muscle soreness.

¶It is not enough to avoid taking your medicine at the same time as grapefruit. You must avoid consuming grapefruit the whole period that you are on the medication.

¶In general, it is a good idea to avoid sudden dramatic changes in diet and extreme diets that rely on a narrow group of foods. If you can’t live without grapefruit, ask your doctor if there’s an alternative drug for you.

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Readers may submit comments or questions for The Consumer by e-mail to consumer@nytimes.com.

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Madoff's Younger Brother Sentenced to 10 Years

NEW YORK (Reuters) - Peter Madoff will serve 10 years in prison for his role in his older brother's multibillion-dollar Ponzi scheme, a U.S. judge said on Thursday.

Peter Madoff, 67, pleaded guilty in June to criminal charges including conspiracy to commit securities fraud for falsifying the books and records of the investment advisory company founded by his brother, Bernard Madoff.

He agreed at the time not to oppose a request by prosecutors for a maximum 10-year prison sentence and agreed to an order requiring him to forfeit a symbolic $143.1 billion. U.S. District Court Judge Laura Taylor Swain approved the sentence on Thursday.

"I am deeply ashamed of my conduct," Peter Madoff said at the sentencing. "I accept full responsibility for my actions."

Of 13 individuals charged criminally in connection with the fraud, Peter Madoff is the only one, other than his brother, who was a member of the Madoff family. Bernard Madoff, 74, was sentenced in 2009 to a 150-year prison term and was ordered to forfeit $170.8 billion.

Customers lost about $20 billion, according to the trustee charged with recovering money for the victims.

Peter Madoff, a lawyer, had been chief compliance officer and a senior managing director at the firm, Bernard L. Madoff Investment Securities.

Prosecutors say Peter Madoff helped create false and misleading documents designed to make it appear that the firm had an effective compliance program. If the firm had such a program, prosecutors said it would have shown that no real trades were taking place.

Peter Madoff also transferred millions of dollars within the Madoff family to avoid tax payments to the Internal Revenue Service and also put his wife on the firm's payroll in a no-show job.

In court papers filed on Monday, John Wing, a lawyer for Peter Madoff, said his client only learned Bernard Madoff had participated in a Ponzi scheme days before it became public.

He argued his client had accepted responsibility and, as a result of the forfeiture, will be "penniless for the rest of his life."

"Peter's life has been shattered by his brother's Ponzi scheme as well as his own conduct and guilty plea, and he will almost certainly live out his remaining days as a jobless pariah, in or out of prison," Wing wrote.

Letters from dozens of friends, family members and business acquaintances in support of Peter Madoff were included in a 190-page filing to the judge. The letters and filing by his lawyers depict him as a younger sibling who looked up to his older brother.

Peter Madoff "idolized his brother more like a father figure" and "never really seemed to be able to stand up to his brother," Karen Binder-Brynes, Peter Madoff's psychologist of nine years, wrote.

Binder-Brynes said her client was "traumatized" by the revelation of the Ponzi scheme after the news became public.

The case is U.S. v. O'Hara et al, U.S. District Court, Southern District of New York, No. 10-cr-00228.

(Reporting by Nate Raymond; Additional reporting by Nick Brown; Editing by Eddie Evans and Tim Dobbyn)

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France Details Plan to Shrink Banking Risk

PARIS — François Hollande began his campaign for the French presidency in January with the declaration that he and his Socialist party were prepared to break from policies that they said had contributed to the financial crisis, notably promising a separation of investment banking from consumer banks.

“My real adversary has no name, no face, no party; it will never be a candidate, even though it governs,” he told supporters at Le Bourget, near Paris. “It is the world of finance.”

Of course, 11 months is a long time in politics. The banking overhaul bill rolled out Wednesday by Mr. Hollande’s finance minister, Pierre Moscovici, was a far cry from the tough talk of January. Les Échos, a French financial daily, summed up the general reaction in a Page One headline: “Hollande’s signature bank law project is on the rails.”

Gone is the strict separation of investment banking from the consumer, or retail, business and its insured deposit base, with banks required simply to “ring-fence” trading for their own books in separately capitalized subsidiaries that remain within the organization. And loopholes in proposed bans on high-frequency trading and agricultural commodity speculation have left those measures essentially toothless.

The banking bill fell well short of a proposal put forth by Erkki Liikanen, the governor of the Bank of Finland, that all banks on the European Union quarantine their risky trading activities. It also fell short of the strictest version of the so-called Volcker plan in the United States, which would prohibit lenders from engaging in proprietary trading altogether.

But French bankers and officials including the Bank of France governor, Christian Noyer, had argued forcefully that Mr. Hollande’s original plans would have put the country’s financial firms at a competitive disadvantage to foreign rivals. Expectations for the bill had been ratcheted down in recent months.

“This isn’t reform for the sake of the banking lobby,” Mr. Moscovici said after he presented the proposal to the cabinet. “It preserves the French universal banking model that has stood the test of time.” The bill represents, he said, a campaign promise Mr. Hollande has kept.

The French Banking Federation said in a statement that the bill would “create new constraints and additional charges at an inopportune moment, when the banks must make considerable efforts to adapt to the Basel III capital rules.”

But analysts played down the significance of the measures, and shares of the biggest French banks — BNP Paribas, Crédit Agricole and Société Générale — rose in Paris on Wednesday.

“It’s all mirrors and smoke,” Christophe Nijdam, a banking analyst at AlphaValue in Paris, said. “In blunt terms, this is not banking reform.”

As evidence, Mr. Nijdam estimated the proposal would require BNP, the largest French lender, to segregate activities that represented just 0.5 percent of its net banking income. In contrast, he said, the Liikanen proposal would require BNP to segregate activities that represented an estimated 13 percent of that income. The difference is important, because if the riskier activities were separated, their financing costs would rise, reducing profitability.

The bill also calls for the creation of a guarantee fund, paid for by a levy on financial institutions, that could be called on to help pay for any banking disaster.

It also gives the government greater reach. The existing Prudential Supervisory Authority would be given the power to wind up any faltering banks. A new agency, the Financial Stability Council, would be charged with anticipating systemic risks to the banking sector, and have the power to order banks to raise capital or take other measures when they encountered difficulties.

Nicolas Véron, a senior fellow at Bruegel, a research institute in Brussels, said the new resolution authority might turn out to be the most important element in the bill. “France has long had a tradition that banks don’t fail,” he said, “and this represents a significant step away from that.”

The banking bill was adopted by the cabinet but must still obtain parliamentary approval. It must also be brought into conformity with emerging European Union rules.

“I was always skeptical that France could do it alone,” Mr. Véron said, adding that it was “not suitable” for the government to be pushing for integration at the E.U. level through a banking union while pushing for a different policy at the domestic level.

On a day when Mr. Hollande was making headlines on a state visit to Algeria, it also fell to Mr. Moscovici to warn that further pension overhauls might be necessary — a revelation that carries political risk for the government.

Mr. Moscovici told RTL radio that changes to the retirement system would have to be considered, despite fixes made in 2010 by Nicolas Sarkozy, Mr. Hollande’s conservative predecessor. Mr. Sarkozy’s changes, including an increase in the retirement age by two years, to 62, were to have kept the system solvent until 2018. But a new study by a government body, the Conseil d’Orientation des Retraites, estimates the retirement plans would have a combined deficit of €18.8 billion, or $23.8 billion, in 2017, up from €15 billion last year.

The study, first reported this week in Le Monde, proposed several means of addressing the gap, including an increase in payroll deductions, a reduction in the average pension, or adding six months to the retirement age.

Mr. Moscovici also sought to play down suggestions of policy differences among members of Mr. Hollande’s government, saying it was natural that ministers would express themselves differently even though they agreed on overall direction.

Referring to the recent dispute with ArcelorMittal, in which Mr. Hollande’s governmentthreatened to take over one of the company’s steel plants, Mr. Moscovici said that temporary nationalization could be “useful” when strategic interests were in play, but could not be an end in itself. He spoke after the industry minister, Arnaud Montebourg, told Le Monde that “temporary nationalization is the solution of the future.”

“Temporary nationalization is a part of the future, not the entire future,” Mr. Moscovici said.

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Kodak to Sell Patents for $525 Million

Eastman Kodak once described the sale of 1,100 digital imaging patents as a windfall that could prop up and even save the beleaguered company.

On Wednesday, the sale was finally announced, but instead of bringing as much as $2.6 billion as Kodak once predicted, the selling price was far short of that amount, at about $525 million. The buyer was a consortium that includes many of the world’s biggest technology firms, among them Apple, Google, Facebook and Samsung Electronics.

Kodak officials said the sale was another crucial step toward emerging from bankruptcy, and turning around a decades-long slide for the Rochester-based corporation.

“This monetization of patents is another major milestone toward successful emergence,” Antonio M. Perez, Kodak’s chief executive, said in a press release. “Our progress has accelerated over the past several weeks as we prepare to emerge as a strong, sustainable company.”

Among the benefits of the sale, Mr. Perez noted, was that it would allow Kodak to largely repay a debtor-in-possession loan it obtained nearly a year ago. It also satisfied a major provision for an $830 million financing facility, approved in November, that required Kodak to sell its patent portfolio for no less than $500 million.

Kodak will retain a license to use the digital imaging portfolio patents in its future businesses, and for those businesses that it is selling.

Part of the sale will be paid by a consortium of technology companies that was organized by Intellectual Ventures and RPX Corporation. The licensees will receive rights to the digital imaging patent portfolio and certain other Kodak patents.

“No single company could have completed this deal and by creating a consortium we were able to ensure that members get access to these important invention rights,” according to a release by Intellectual Ventures, a Washington-based firm that invests in patents. “The patent marketplace is very active, and I.V. expects to be involved in more complex transactions like this in the future.”

Mr. Perez said Kodak was now focused on building its commercial imaging business, which includes printing and packaging for businesses. The company believes it has “significant competitive advantages and strong growth prospects,” according to its press release.

The sale is subject to the approval of the bankruptcy court. In the 11 months or so since Kodak filed for Chapter 11 in January, it has pulled out of the market for consumer inkjet printers, which were once part of Mr. Perez’s turnaround strategy, and sold its film business, which had made Kodak a household name.

“There has been strong interest in that business, as well as our document imaging business that is also for sale, and we are on track to sell them in the first half of 2013,” Christopher K. Veronda, a Kodak spokesman, said in an e-mail.

As for the sale price of its patent portfolio, Mr. Veronda noted that the $2.6 billion estimate was made by a third party that Kodak cited in court papers.

“Certainly other recent speculation was around a fraction of the $525 million we received,” he said. “The price paid is always a reflection of what buyers are willing to pay for an asset or a license.”

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