Clearing the Fog Around Personality Disorders

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.

But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.

The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”

The entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?

Habits of Thought

It wasn’t supposed to be this difficult.

Personality problems aren’t exactly new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its rogues’ gallery of vainglorious, murderous dictators.

Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.

Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of “confounded identities” that are now considered personality disorders.

Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling — in who they were.

“These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired,” said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. “They had problems that were neither psychotic nor neurotic. They represented something else altogether.”

Several prototypes soon began to emerge. “A pedantic sense of order is typical of the compulsive character,” wrote the Freudian analyst Wilhelm Reich in his 1933 book, “Character Analysis,” a groundbreaking text. “In both big and small things, he lives his life according to a preconceived, irrevocable pattern.”

Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention.

In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.

These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.

Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.

This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a catchall label meaning little more than “this person has problems” became the most common of the diagnoses.

It’s a murky area, and in recent years many therapists didn’t have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.

Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.

“The diagnoses simply weren’t being used very much, and there was a real need to make the whole system much more accessible,” Dr. Lenzenweger said.

Resisting Simplification 

It was easier said than done.

The most central, memorable, and knowable element of any person — personality — still defies any consensus.

A team of experts appointed by the psychiatric association has worked for more than five years to find some unifying system of diagnosis for personality problems.

The panel proposed a system based in part on a failure to “develop a coherent sense of self or identity.” Not good enough, some psychiatric theorists said.

Later, the experts tied elements of the disorders to distortions in basic traits.

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News Analysis: St. Jude Medical Suffers for Redacting a Product Name

Peter Muhly for The New York Times

Dr. Ernest Lau holds a Durata lead from a St. Jude Medical Fortify ICD, an implanted heart defibrillator.

IS covering a product’s name in a public document a sign that a company has something to hide? And how should doctors, patients and investors react if the product at issue is one on which peoples’ lives and a company’s fortunes depend?

Such questions now loom over St. Jude Medical after the disclosure last week that its executives had blacked out the name of a heart device component when they released a critical federal report involving the product. The value of St. Jude has since plummeted more than $1 billion, or 12 percent. But the company’s actions may have a more lasting impact on its reputation and the health of patients, some experts say.

Last week’s incident was the latest development in a controversy involving the component, an electrical wire that connects an implanted defibrillator to a patient’s heart. St. Jude officials say the wire, which is known as the Durata, is safe. But uncertainty about the company’s statements is growing, underscored by its handling of the report, which involved a Food and Drug Administration inspection of a plant that makes the Durata.

St. Jude released that report in October as part of a filing with the Securities and Exchange Commission. The F.D.A. provides device makers with the reports in an unaltered form, and they may contain criticisms of a company’s procedures.

But the version of the report that St. Jude filed with the S.E.C. left some doctors and analysts uncertain about which company product or products were at issue for a simple reason — St. Jude had redacted, or blocked out, all 20 references to the Durata in it.

Company executives said they had done so based on their “good faith” interpretation of how the F.D.A. would act if it publicly released the report under the Freedom of Information Act. But both an F.D.A spokeswoman and a lawyer who specializes in medical devices took exception with that view, saying that names of approved products typically do not qualify as the type of confidential business information that the F.D.A. would redact.

Among other things, F.D.A. inspectors found significant flaws in the company’s testing and oversight of the Durata. It was those revelations and the implications that the problems could lead to further F.D.A. action against St. Jude that led to the sharp fall last week in its stock price.

In 2005, Guidant, a device maker that no longer exists, also found itself under scrutiny. Back then, its executives decided not to tell doctors that one of its defibrillators could short-circuit when a patient needed an electrical jolt to save a life. The expert who brought the Guidant problem to light, Dr. Robert Hauser, a heart specialist in Minnesota, has also raised concerns about the St. Jude wires, adding that he believes that its executives have been less than forthright.

“Patients and physicians would appreciate more information,” Dr. Hauser said.

In an earlier interview, St. Jude’s chief executive, Daniel J. Starks, said the company had hidden nothing about the Durata or another heart wire named the Riata, which it stopped selling in 2010.

“We’ve been more transparent than others,” said Mr. Starks, referring to company competitors like Medtronic.

Still, some Wall Street analysts share Dr. Hauser’s view. And if one St. Jude executive can claim credit for shaping their opinion, it would be Mr. Starks.

Earlier this year, he sought, among other things, to have a medical journal retract an article written by Dr. Hauser that was critical of the Riata. The publication refused.

Now, after St. Jude’s latest misfire, Wall Street analysts, who usually agree more than disagree, are placing wildly differing bets on St. Jude, with some valuing it at $48 a share and others at $30. On Monday, St. Jude closed at $31.86 on the New York Stock Exchange.

One of those bearish analysts, Matthew Dodds of Citigroup, said he thought the Food and Drug Administration might act soon on Durata. “I believe that a lot of their actions have made the situation worse, ” he said of the company’s executives.

A St. Jude spokeswoman, Amy Jo Meyer, reiterated the company’s stance that it had interpreted agency rules in “good faith” when releasing the redacted report about the Durata. An F.D.A. spokeswoman, Mary Long, said the agency did not consider the names of approved products to be confidential. And a lawyer, William Vodra, said that while device makers try to make a confidentiality argument for product data they consider embarrassing, like injury reports, they rarely succeed.

“In my experience, the F.D.A. consistently rejects” such arguments, Mr. Vodra wrote in an e-mail.

For patients, the dilemma may become more excruciating. The company’s earlier heart wire, the Riata, has begun failing prematurely in some of the 128,000 patients worldwide who received it. And those patients and their doctors face a difficult decision: whether to leave it in place or have it surgically removed, a procedure that carries significant risks.

St. Jude executives say that the Durata, which uses a different type of insulation than the Riata, is not prone to such problems.

And with the Durata already implanted in 278,000 people, many heart specialists certainly hope they are right.

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Time Slipping, U.S. Ponders Afghan Role After 2014

WASHINGTON — American and allied military planners are drawing up the broad outlines of a force that would remain in Afghanistan following the handover to Afghan security after 2014, including a small counterterrorism force with an eye toward Al Qaeda, senior officials say.

Under the emerging plan, the American counterterrorism force might number less than 1,000, one military official said. In a parallel effort, NATO forces would advise Afghan forces at major regional military and police headquarters but most likely have a minimal battlefield role, with the exception of some special operations advisers.

Final decisions on the size of the American and NATO presence after 2014 and its precise configuration have not been made by the United States or its allies. But one option calls for about 10,000 American and several thousand non-American NATO troops.

The planning for a post-2014 mission has emerged as an early test for President Obama in his new term as he tries to flesh out the strategy for transferring the responsibility for security to the Afghans. But it is not the only challenge: After the White House decides what sort of military presence to propose to the Afghan government for after 2014, it must turn to the question of how quickly to reduce its troop force before then.

As one of his last acts as senior American commander in Afghanistan, Gen. John R. Allen is expected to submit a formal recommendation for how quickly to begin withdrawing the United States’ 66,000 troops. Two American officials who are involved in Afghan issues said that General Allen wants to keep a significant military capability through the fighting season ending in fall 2013, which could translate to a force of more than 60,000 troops until the end of that period.

Afghan forces are to assume the lead role for the war next year, and a military officer said that such a troop level would enable the United States to better support them, maintain the initiative and control critical terrain.

But such an approach may entail a heavier military involvement than the White House, which appears weary of the war, might like.

The White House is expected to ask General Allen to submit a range of options for drawing down forces next year, including some involving substantial reductions in troop levels.

“The White House has not yet asked General Allen for his assessment, nor have we begun considering any specific recommendations for troop numbers in 2013 and 2014,” said George Little, the Pentagon spokesman. “What is true is that in June 2011 the president made clear that our forces would continue to come home at a steady pace as we transition to an Afghan lead for security. That it still the case.”

The issue is already a politically contentious one. Some leading Democratic lawmakers have signaled that they would like to see steady troop reductions next year while Republicans have argued that speedy withdrawals would jeopardize hard-won gains.

There are also questions about General Allen’s future: his e-mails to a woman linked to the F.B.I. inquiry that disclosed David H. Petraeus’s affair are being investigated by the Pentagon inspector general.

But General Allen has resumed his duties in Kabul, and Mr. Obama has said that he thinks highly of his military performance. The Marine general who has been nominated to replace him, Joseph F. Dunford Jr., is not scheduled to take up the post until early February and recently told Congress that he had not been part of the planning process.

The planning for a post-2014 force is the Obama administration’s first order of business on Afghanistan for several reasons. The United States has opened talks with the Afghans on a security agreement that would authorize an American troop presence in Afghanistan after 2014. So American officials need to define what role American and NATO forces might play then.

In addition, NATO’s political arm has authorized the alliance’s military planners to develop a concept for how to carry out the post-2014 mission, which is to be approved by the alliance’s defense ministers early next year.

The planning for after 2014 turns on troubling questions on how to guard against the expansion of terrorist groups and advise an Afghan military that has little airpower, poor logistics and difficulties evacuating and treating its own wounded. But it will also depend heavily on the willingness of allied nations to contribute troops and funds.

Reporting was contributed by Matthew Rosenberg and Alissa J. Rubin from Kabul, Afghanistan, and Eric Schmitt and Wesley S. Morgan from Washington.

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Yes, the Government Can Still Spy on Your Digital Life (for Now)

Ahead of a controversial Senate debate on digital privacy this week, the battle over warrantless cell-phone and Internet searches is beginning to take shape — even as law-enforcement agencies continue to carry out the searches anyway. Judges across the country have thrown out cases that used tracked digital American lives without warrants, but others haven’t, reports The New York Times‘s Somini Sengupta. A DC court, for example, compared text messages to voicemail messages, which because they can be overheard are not protected by state privacy laws, argued one judge. A Louisiana court is deciding if cell-phone records are like business records. Another court ruled that GPS cell phone tracking without a warrant was fine, too. Others, however, argue that cell phones are more than just a paper trail. One judge called cell phones “raw, unvarnished and immediate, revealing the most intimate of thoughts and emotions,” as in something that is subject to higher privacy standards. Meanwhile, we see the same inconsistencies with Internet protections, reports The Wall Street Journal‘s Joe Pallazolo. A federal court recently ruled that people who use their neighbors’ WiFi without permission forfeit privacy, opening up government officials to warrantless searches. The same ruling other courts have made for IP addresses. However, the law isn’t that clear-cut, either, argues George Washington University professor Oren Kerr. 

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Without clear rules, government agencies have continued investigations with warrantless searches. As people have started using cell phones more often and for more than just calling, law enforcement agency requests for cell-phone information have increased, reported The New York Times‘s Eric Lichtblau earlier this year. AT&T gets more than 700 requests a day from various agencies, triple what it got in 2007, he notes. Last year, the total number of requests came in at at least 1.3 million. At the same time, the application for wiretapping warrants declined 14 percent last year to 2,732, according to the Administrative Office of the United States Courts. A curious pattern considering the requests for information have gone up. Though these wireless carriers say they require a search warrant, a court order or a formal subpoena to release information, “in cases that law enforcement officials deem an emergency, a less formal request is often enough,” writes Lichtblau. Or, it’s possible that law enforcement has opted for other forms of tracking that don’t require warrants, at least not according to some judges. 

RELATED: Saints GM Denies Using Nixonian Dirty Tricks; Directing the NFL Draft

A Senate debate beginning Thursday to make changes on the Electronic Communications Privacy Act might bring some clarity to these issues. However, it’s unclear if the revised bill will give the government more or less power, and it doesn’t sound like the vote will apply to all cell phone or Internet data. An early draft of the bill reportedly allowed warrantless e-mail searches, reported CNET’s Declan McCullagh. Since, Senator Patrick Leahy, who is spearheading the bill, has denied that the updates to the regulation will do that, however. Instead, the revised bill will require search warrants to get into email no matter how old, says Sengupta. That should presumably apply to some of our smartphone and Internet data, too. But it doesn’t address text messages or location information, other concerns of consumers.

Wireless News Headlines – Yahoo! News

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Rolling Stones storm London; New York next

LONDON (AP) — The verdict is in: The Rolling Stones are back. They may look old, but they still sound young.

That was the consensus Monday as Britain's rock critics responded to the Stones 50th anniversary bash Sunday night, the first of five shows to commemorate their half century of rhythm and blues-tinged rock. It was the band's first London performance in five years, and their own advancing years had led some to be skeptical that they could still perform at the highest level.

They were led by the seemingly ageless Mick Jagger, whose strutting style has not been dimmed, and backed by brilliant guitarists Keith Richards and Ronnie Wood and the energetic drumming of Charlie Watts, who is now past 70 but shows no sign of slowing down. There was a stunning guest appearance by former Stone Mick Taylor, who stole the show during a searing performance of "Midnight Rambler" and a brief visit from former bassist Bill Wyman.

The Daily Mail's Jan Moir said the Stones had somehow beaten the aging process: "You might imagine that they had been worn down by life, by wives, by arthritis, by scandals old and new, by drugs, but no — they seemed indestructible." She said their swampy, gritty sound remains unique after half a century.

Daily Telegraph reviewer Neil McCormick said the band exceeded all expectations. He described the weaving of the guitarists, mixed with Jagger's blues harmonica, as a wonder.

"When looking for the secret of the Stones, it is perhaps that they actually listen to each other while they play, and almost lose themselves in it, while their brilliant frontman keeps it all together," he wrote.

Ebullient fans agreed with this assessment, as did the Guardian newspaper, which gave the performance four out of five stars.

Jagger, in skin-tight black pants, a sparkly tie and a matching checked jacket and hat, took time out from singing to thank the crowd for its loyalty.

"It's amazing that we're still doing this, and it's amazing that you're still buying our records and coming to our shows," he said. "Thank you, thank you, thank you."

Lead guitarist Keith Richards, whose survival has surprised many who thought he would succumb to drugs and drink, was blunter: "We made it," he said. "I'm happy to see you. I'm happy to see anybody."

But the band's fiery music was no joke, fuelled by strong guest appearances by Taylor, and Mary J. Blige, who shook the house in a duet with Jagger on "Gimme Shelter," and Jeff Beck.

The 50th anniversary show, which will be followed by one more in London, then three in the greater New York area, lacked some of the band's customary bravado — the "world's greatest rock 'n' roll band" intro was shelved — and there were some rare nostalgic touches.

The concert began with some early Stones' numbers rarely heard in concert, including the band's cover of the Lennon-McCartney rocker "I Wanna Be Your Man" and a cover of "It's All Over Now," written by Bobby Womack and Shirley Womack.

They didn't shy away from their darker numbers, including "Paint It Black" and "Sympathy for the Devil" — Jagger started that one wearing a slightly silly black, purple-lined faux fur cape that conjured up his late '60s satanic image.

He even cracked a joke about one of the band's low points, telling the audience it was in for a treat: "We're going to play the entire "Their Satanic Majesty's Request" album now," he said, referring to one of the band's least-loved efforts, a psychedelic travesty that has been largely, mercifully, forgotten.

He didn't make good on his threat.

Jagger seemed more mellow than usual, chatting a bit about the good old days and asking if there was anyone in the crowd who had seen them in 1962, when they first took to the stage.

He said 2012 had been a terrific year for Britain and that the Stones nearly missed the boat, playing no role in the celebration of the Queen's Diamond Jubilee, the London Olympics, or the new James Bond film.

"We just got in under the wire," he said. "We feel pretty good."

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

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DealBook: New Breed of SAC Capital Hire Is at Center of Insider Trading Case

When Mathew Martoma walked onto the trading floor at SAC Capital Advisors six years ago, he represented a new breed of employee at the giant hedge fund.

Steven A. Cohen, SAC’s billionaire founder, had burnished his reputation as a market wizard by surrounding himself with hard-charging traders — many of them former college jocks and frat boys who thrived in the fund’s competitive, testosterone-fueled environment.

But the brainy and unassuming Mr. Martoma, armed with a Stanford business degree and an expertise in biomedicine, was part of a wave of SAC hires in a crack new research unit. They were just as driven but had more distinguished pedigrees, hailing from top investment banks and elite schools. They were drawn to the firm, in part, by the lavish annual bonuses Mr. Cohen bestowed upon his top performers, sometimes reaching into the tens of millions of dollars.

When Mr. Martoma walks into Federal District Court in Manhattan on Monday morning, he will represent something else: the latest in a growing list of former SAC employees who find themselves accused of breaking the law.

The case against Mr. Martoma, made in a criminal complaint filed by the government last week, represents a watershed moment in its multiyear investigation of insider trading at SAC. For the first time, prosecutors have linked Mr. Cohen to trading activity that the government contends was illegal.

Mr. Martoma has rebuffed efforts by federal authorities to persuade him to plead guilty and cooperate, said a person briefed on the investigation who was not authorized to discuss the case. But if he were to “flip,” Mr. Martoma could help the government with its investigation of Mr. Cohen.

The government has placed Mr. Martoma, 38, at the center of what it calls the most lucrative insider-trading scheme it has ever uncovered. Mr. Martoma is charged with corrupting a doctor who had access to secret drug data, then using that information to gain profits and avert losses totaling $276 million. Mr. Martoma closely collaborated with Mr. Cohen on the questionable trades, prosecutors contend. Mr. Cohen, 56, of Greenwich, Conn., has not been charged, and there is no allegation that he knew the information was confidential. Through a spokesman, Mr. Cohen said that he had at all times acted appropriately.

Charles A. Stillman, a lawyer for Mr. Martoma, who will appear before a federal magistrate judge Monday, said he expected his client to be exonerated.

But with Mr. Martoma’s arrest last week, the clouds over SAC, which is based in Stamford, Conn., and Mr. Cohen have darkened. The government has now implicated five former SAC employees in its sweeping investigation into insider trading; three have admitted their crimes. Three other SAC alumni have also been charged with illegal trading after they left the firm; two have pleaded guilty.

Former employees of Mr. Cohen, all of whom spoke on the condition of anonymity, said that the case against Mr. Martoma highlighted SAC’s high-stress, pressure-packed culture. They described a ruthless place where those who helped Mr. Cohen make money would earn fortunes, while laggards could be fired abruptly, even for a single wrong-way trade.

Though SAC, with about 1,000 employees, manages about $14 billion in assets and has pushed into more esoteric investment strategies, at its core the firm buys and sells stocks. Mr. Cohen and his staff are known for relentlessly digging for information about publicly traded companies to form a “mosaic,” building a complete picture of the company’s prospects that gives the firm an edge over other investors.

SAC hired Mr. Martoma to help Mr. Cohen gain that edge. The son of Indian immigrants, Mr. Martoma was born Ajai Mathew Mariamdani Thomas, but changed his name in 2003, according to legal records. Raised in Merritt Island, Fla., outside Cape Canaveral, Mr. Martoma graduated summa cum laude from Duke University in 1995, where he studied biomedicine, ethics and public policy. After college, Mr. Martoma worked in Washington at the National Human Genome Research Institute.

He spent a year and a half at Harvard Law School, then dropped out to earn a business degree at Stanford University. He blended his passion for medicine and a desire to work on Wall Street by pursuing a career as a stock analyst covering health care companies. After a stint at a smaller hedge fund, Sirios Capital Management in Boston, Mr. Martoma joined SAC.

He became part of a new unit, CR Intrinsic, which was set up as a research engine of SAC. CR Intrinsic (the CR stands for Cumulative Return) was led by Matthew Grossman, an ambitious young analyst who became Mr. Cohen’s right-hand man. Mr. Grossman had worked at Tiger Management, the hedge fund known for its rigorous research and longer-term investment horizon.

With a deep network of contacts in the pharmaceutical and biotech fields, Mr. Martoma made a mark at CR Intrinsic. The volatile health care stocks in which Mr. Martoma specialized had long been favorites of Mr. Cohen’s, offering the potential for big returns through betting on the outcome of events like clinical trials for promising drugs.

To bolster his knowledge, Mr. Martoma tapped into expert-network firms, which employ consultants who match money managers with industry specialists, including public company employees.

For an information-driven hedge fund like SAC, the temptation to exploit the expert-network relationship was immense, two former employees said.

Two of the former SAC employees who have admitted to insider trading said they used expert-network firms to obtain secret information about public companies. And of the roughly 70 insider trading cases that federal prosecutors in Manhattan have brought in the last three years, more than a dozen have involved expert networks.

Mr. Martoma’s case began in 2006, when the expert-network firm Gerson Lehrman Group connected him to Sidney Gilman, a neurology professor at the University of Michigan and a specialist in Alzheimer’s disease. Dr. Gilman, who moonlighted as a consultant for Gerson Lehrman, helped oversee clinical trials for bapineuzumab, or bapi, a new Alzheimer’s drug being jointly developed by Elan and Wyeth.

He also brazenly leaked to Mr. Martoma secret data about the trials throughout 2008, according to the government, violating his duty to the drug companies and breaching his agreement with Gerson Lehrman not to divulge confidential information to money managers. Dr. Gilman earned $108,000 from his work for SAC, the government said.

At first, Dr. Gilman’s positive updates on the Alzheimer’s drug trials emboldened SAC to make big bets on Elan and Wyeth, prosecutors said. Mr. Martoma worked closely with Mr. Cohen on the investments, highlighting the drug companies in his weekly “best ideas” list submitted to Mr. Cohen. SAC accumulated $700 million worth of Elan and Wyeth shares, making it one of the fund’s largest bets.

Prosecutors say that in July 2008 Dr. Gilman received more complete results about bapi showing problems with the drug’s efficacy. He then shared those results with Mr. Martoma, the government contends.

With the public announcement of the data just a week away, Mr. Martoma e-mailed Mr. Cohen on a Sunday, according to the complaint. Within the hour, the two were on the phone and spoke for 20 minutes, prosecutors say.

Over several days, SAC not only sold its entire positions in Elan and Wyeth, but shorted, or bet against, the drug companies’ shares, the government said. On July 29, the companies announced results of the drug trial and their shares sank. SAC avoided about $194 million in losses by selling the stocks and then made $83 million by shorting them, according to court filings. Still, SAC paid Mr. Martoma a $9.4 million bonus in 2008 that was largely attributable to his contributions on the Elan and Wyeth trades, prosecutors said. But the firm fired him in early 2010 after his stock picks flagged. The case against Mr. Martoma stemmed in part from a referral made to federal securities regulators. In 2008, the Financial Industry Regulatory Authority observed unusual short-sales in the drug stocks and noted the abnormal activity, regulators said.

Prosecutors recently reached a nonprosecution agreement with Dr. Gilman, meaning they will not charge him. The Justice Department rarely strikes nonprosecution agreements with individuals. The government’s deal with Dr. Gilman, legal experts say, could put pressure on Mr. Martoma to strike a plea deal and cooperate.

Alain Delaquérière contributed reporting.

A version of this article appeared in print on 11/26/2012, on page B1 of the NewYork edition with the headline: New Breed of SAC Capital Hire Is at Center of Insider Trading Case.

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New Senate’s First Task Will Likely Be Trying to Fix Itself

Jacquelyn Martin/Associated Press

At a news conference after meeting with President Obama about the budget, from left, Nancy Pelosi, the House Democratic leader; Harry Reid, the Senate Democratic leader; Speaker John A. Boehner; and Mitch McConnell, the Senate Republican leader.

WASHINGTON — Senator Bob Dole had just assumed the mantle of Senate majority leader, after the Republican landslide of 1994, when he confronted a problem.

Piles of Republican legislation from Newt Gingrich’s self-styled “revolutionary” House were stacking up in a narrowly divided, more deliberate Senate, and Democrats were threatening to gum up the works with amendments that would stall the bills.

Mr. Dole turned to the Senate’s Democratic master of floor procedure, Robert C. Byrd of West Virginia, who taught him a parliamentary trick known to Senate insiders as “filling the tree,” Mr. Dole recalled.

The convoluted procedure allows the majority leader to claim all opportunity for offering changes to a bill, effectively preventing any other senator from proposing an amendment intended to slow down legislation or force a politically embarrassing vote.

“I never knew what ‘filling the tree’ was until I tried it, but it turned out to be pretty good,” Mr. Dole said, ruefully accepting a share of the blame for the parliamentary arms race that has consumed the Senate in recent years. “I don’t think there’s any credit.”

The increased use of the tactic, which had previously been rare, is part of the procedural warfare that has reached a zenith over the past two years in the Senate. Republicans threaten to filibuster and propose politically charged amendments, Democrats fill the amendment tree, and Republicans filibuster in retaliation.

The tactic initially meant to speed bills has instead helped slow them down. The Senate — the legislative body that was designed as the saucer to cool the House’s tempestuous teacup — has become a deep freeze, where even once-routine matters have become hopelessly stuck and a supermajority is needed to pass almost anything.

As a result, the first fight of the next Senate, which convenes in January, is not likely to be over a fiscal crisis, immigration, taxes or any issue that animated the elections of 2012. It will instead probably be over how and whether to change a troubled Senate, members and aides say.

With his majority enhanced and a crop of frustrated young Democrats pushing him hard, Senator Harry Reid of Nevada, the Democratic leader, says he will move on the first day of the 113th Congress to diminish the power of Republicans to obstruct legislation. “We need to change the way we do business in the Senate,” said Senator Tom Udall, Democrat of New Mexico. “Right now, we have gridlock. We have delay. We have obstruction, and we don’t have any accountability.”

The pressure leaves Mr. Reid with a weighty decision: whether to ram through a change in the rules with a simple majority that would significantly diminish Republicans’ power to slow or stop legislation.

The changes under consideration may sound arcane, but they would have such a profound impact that they are referred to as the “nuclear option.” In effect, they would remake a Senate that was long run on compromise and gentlemen’s agreements into something more like the House, where the majority rules almost absolutely.

Critics of the idea, who exist in both parties, say such a change would do great damage, causing Washington to career from one set of policies to another, depending on which party held power.

Senator Mitch McConnell of Kentucky, the Republican leader, said he would aggressively fight any rule change and blamed the Democratic majority for the Senate’s dysfunction. “This notion that the Senate is dysfunctional is not because of the rules,” he said. “It’s because of behavior.”

Supporters of the idea, who also do not fit a neat ideological profile, argue that the collegial Senate of the past no longer exists and that American democracy is often paralyzed as a result. Today’s Senate, they say, has left crucial positions unfilled, like a confirmed head for the new Consumer Financial Protection Bureau, and is preventing action on major issues like job creation proposals.

“There is a tendency to look to the past through rose-colored glasses, to some mythical golden era when everyone got along and cooperated. That’s not true. It’s always been tough, and it’s always been rough,” said George Mitchell, a former Democratic majority leader who would now back some changes. “But I do believe and accept the premise that it’s worse now.”

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Hobbits, superheroes put magic in NZ film industry

WELLINGTON, New Zealand (AP) — A crate full of sushi arrives. Workers wearing wetsuit shirts or in bare feet bustle past with slim laptops. With days to go, a buzzing intensity fills the once-dilapidated warehouses where Peter Jackson's visual-effects studio is rushing to finish the opening film in "The Hobbit" trilogy.

The fevered pace at the Weta Digital studio near Wellington will last nearly until the actors walk the red carpet Nov. 28 for the world premiere. But after "The Hobbit: An Unexpected Journey" hits theaters, there's more work to be done.

Weta Digital is the centerpiece of a filmmaking empire that Jackson and close collaborators have built in his New Zealand hometown, realizing his dream of bringing a slice of Hollywood to Wellington. It's a one-stop shop for making major movies — not only his own, but other blockbusters like "Avatar" and "The Avengers" and hoped-for blockbusters like next year's "Man of Steel."

Along the way, Jackson has become revered here, even receiving a knighthood. His humble demeanor and crumpled appearance appeal to distinctly New Zealand values, yet his modesty belies his influence. He's also attracted criticism along the way.

The special-effects workforce of 150 on "The Lord of the Rings" trilogy a decade ago now numbers 1,100. Only five of Weta Digital's workers are actual employees, however, while the rest are contractors. Many accept the situation because movie work often comes irregularly but pays well. Union leaders, though, say the workers lack labor protections existing in almost any other industry.

Like many colleagues, Weta Digital's director, Joe Letteri, came to New Zealand in 2001 to work on the "Rings" trilogy for two years. The work kept coming, so he bought a house in Wellington and stayed.

"People come here because they know it's their chance to do something really great and to get it up on the screen," he said in a recent interview.

Jackson, who declined to be interviewed for this story, launched Weta in 1993 with fellow filmmakers Jamie Selkirk and Richard Taylor. Named after an oversized New Zealand insect, the company later was split into its digital arm and Weta Workshop, which makes props and costumes.

Loving homages to the craft are present in Weta Digital's seven buildings around the green-hilled suburb of Miramar. There are old-time movie posters, prop skulls of dinosaurs and apes, and a wall of latex face impressions of actors from Chris O'Donnell to Tom Cruise.

Its huge data center, with the computing power of 30,000 laptops, resembles a milk-processing plant because only the dairy industry in New Zealand knew how to build cooling systems on such a grand scale.

Little of Weta's current work was visible. Visitors must sign confidentiality agreements, and the working areas of the facilities are off-limits. The company is secretive about any unannounced projects, beyond saying Weta will be working solidly for the next two years, when the two later "Hobbit" films are scheduled to be released.

The workforce has changed from majority American to about 60 percent New Zealanders. The only skill that's needed, Letteri says, is the ability to use a computer as a tool.

Beyond having creativity as a filmmaker, Jackson has proved a savvy businessman, Letteri says.

"The film business in general is volatile, and visual effects has to be sitting right on the crest of that wave," Letteri says. "We don't get asked to do something that somebody has seen before."

The government calculates that feature films contribute $560 million each year to New Zealand's economy. Like many countries, New Zealand offers incentives and rebates to film companies and will contribute about $100 million toward the $500 million production costs of "The Hobbit" trilogy. Almost every big budget film goes through Jackson's companies.

"New Zealand has a good reputation for delivering films on time and under budget, and Jackson has been superb at that," says John Yeabsley, a senior fellow at New Zealand's Institute of Economic Research. "Nobody has the same record or the magic ability to bring home the bacon as Sir Peter."

"You cannot overestimate the fact that Peter is a brand," says Graeme Mason, chief executive of the New Zealand Film Commission. "He's built this incredible reputational position, which has a snowball effect."

Back in 2010, however, a labor dispute erupted before filming began on "The Hobbit." Unions said they would boycott the movie if the actors didn't get to collectively negotiate. Jackson and others warned that New Zealand could lose the films to Europe. Warner Bros. executives flew to New Zealand and held a high-stakes meeting with Prime Minister John Key, whose government changed labor laws overnight to clarify that movie workers were exempt from being treated as regular employees.

Helen Kelly, president of the New Zealand Council of Trade Unions, says a compromise could easily have been reached. She says the law changes amounted to unnecessary union-busting and a "gross breach" of employment laws.

"I was very disappointed at Peter Jackson for lobbying for that," she says, "and I was furious at the government for doing it."

Weta Digital's general manager Tom Greally compared it to the construction industry, where multiple contractors and mobile workers do specific projects and then move on.

Animal rights activists said last week they plan to picket the premiere of "The Hobbit" after wranglers alleged that three horses and up to two dozen other animals died in unsafe conditions at a farm where animals were boarded for the movies. Jackson's spokesman Matt Dravitzki acknowledged two horses died preventable deaths at the farm but said the production company worked quickly to improve animal housing and safety. He rejected claims any animals were mistreated or abused.

Jackson's team pointed out that 55 percent of animal images in "The Hobbit" were computer generated at Weta. The People for the Ethical Treatment of Animals (PETA) have asked Jackson in the future to create all his animals in the studio.

Controversies aside, the rise of Weta and the expat American community in and around Miramar is visible in everything from a Mexican restaurant to yoga classes. On Halloween, which in the past was not much celebrated in New Zealand, hundreds of costumed children roamed about collecting candy. Americans gave the tradition a boost here, but the locals have embraced it.

The National Business Review newspaper estimates Jackson's personal fortune to be about $400 million, which could rise considerably if "The Hobbit" franchise succeeds. Public records show Jackson has partial ownership stakes in 21 private companies, most connected with his film empire. He's spent some of his money on philanthropy, helping save a historic church and a performance theater.

For all his influence, Jackson maintains a hobbit-like existence himself, preferring a quiet home life outside of work. In the end, many say, he seems to be driven by what has interested him from the start: telling great stories on the big screen.

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Follow Nick Perry on Twitter at http://twitter.com/nickgbperry

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Indian Prostitutes’ New Autonomy Imperils AIDS Fight

Kuni Takahashi for The New York Times

Sex workers in Mumbai’s long-established red-light district, where brothels are dwindling.

MUMBAI, India — Millions once bought sex in the narrow alleys of Kamathipura, a vast red-light district here. But prostitutes with inexpensive mobile phones are luring customers elsewhere, and that is endangering the astonishing progress India has made against AIDS.

Indeed, the recent closings of hundreds of ancient brothels, while something of an economic victory for prostitutes, may one day cost them, and many others, their lives.

“The place where sex happens turns out to be an important H.I.V. prevention point,” said Saggurti Niranjan, program associate of the Population Council. “And when we don’t know where that is, we can’t help stop the transmission.”

Cellphones, those tiny gateways to modernity, have recently allowed prostitutes to shed the shackles of brothel madams and strike out on their own. But that independence has made prostitutes far harder for government and safe-sex counselors to trace. And without the advice and free condoms those counselors provide, prostitutes and their customers are returning to dangerous ways.

Studies show that prostitutes who rely on cellphones are more susceptible to H.I.V. because they are far less likely than their brothel-based peers to require their clients to wear condoms.

In interviews, prostitutes said they had surrendered some control in the bedroom in exchange for far more control over their incomes.

“Now, I get the full cash in my hand before we start,” said Neelan, a prostitute with four children whose side business in sex work is unknown to her husband and neighbors. (Neelan is a professional name, not her real one.)

“Earlier, if the customer got scared and didn’t go all the way, the madam might not charge the full amount,” she explained. “But if they back out now, I say that I have removed all my clothes and am going to keep the money.”

India has been the world’s most surprising AIDS success story. Though infections did not appear in India until 1986, many predicted the nation would soon become the epidemic’s focal point. In 2002, the C.I.A.’s National Intelligence Council predicted that India would have as many as 25 million AIDS cases by 2010. Instead, India now has about 1.5 million.

An important reason the disease never took extensive hold in India is that most women here have fewer sexual partners than in many other developing countries. Just as important was an intensive effort underwritten by the World Bank and the Bill and Melinda Gates Foundation to target high-risk groups like prostitutes, gay men and intravenous drug users.

But the Gates Foundation is now largely ending its oversight and support for AIDS prevention in India, just as efforts directed at prostitutes are becoming much more difficult. Experts say it is too early to identify how much H.I.V. infections might rise.

“Nowadays, the mobility of sex workers is huge, and contacting them is very difficult,” said Ashok Alexander, the former director in India of the Gates Foundation. “It’s a totally different challenge, and the strategies will also have to change.”

An example of the strategies that had been working can be found in Delhi’s red-light district on Garstin Bastion Road near the old Delhi railway station, where brothels have thrived since the 16th century. A walk through dark alleys, past blind beggars and up narrow, steep and deeply worn stone staircases brings customers into brightly lighted rooms teeming with scores of women brushing each other’s hair, trying on new dresses, eating snacks, performing the latest Bollywood dances, tending small children and disappearing into tiny bedrooms with nervous men who come out moments later buttoning their trousers.

A 2009 government survey found 2,000 prostitutes at Garstin Bastion (also known as G. B.) Road who served about 8,000 men a day. The government estimated that if it could deliver as many as 320,000 free condoms each month and train dozens of prostitutes to counsel safe-sex practices to their peers, AIDS infections could be significantly reduced. Instead of broadcasting safe-sex messages across the country — an expensive and inefficient strategy commonly employed in much of the world — it encircled Garstin Bastion with a firebreak of posters with messages like “Don’t take a risk, use a condom” and “When a condom is in, risk is out.”

Surprising many international AIDS experts, these and related tactics worked. Studies showed that condom use among clients of prostitutes soared.

“To the credit of the Indian strategists, their focus on these high-risk groups paid off,” said Dr. Peter Piot, the former executive director of U.N.AIDS and now director of the London School of Hygiene and Tropical Medicine. A number of other countries, following India’s example, have achieved impressive results over the past decade as well, according to the latest United Nations report, which was released last week.

Sruthi Gottipati contributed reporting in Mumbai and New Delhi.

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