Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”


Have you written a poem about cancer? Please share them with us in the comments section below.
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Media Decoder Blog: Led by Celebrity Titles, Magazine Newsstand Sales Slide

2:11 p.m. | Updated As the magazine industry continues to suffer from declining circulation, celebrity gossip magazines and young women’s titles have taken some of the biggest hits.

According to data released by the Alliance for Audited Media on Thursday morning, overall paid and verified circulation of magazines declined slightly by 0.3 percent in the second half of 2012. But newsstand sales – which are often viewed as the best barometer of how well a magazine is doing – dropped by 8.2 percent.

These figures were far worse for celebrity magazines, which largely suffered double-digit declines. People’s newsstand sales dropped by 12.2 percent while US Weekly experienced a 14.6 percent decline. In Touch Weekly declined by 14.8 percent and Life & Style Weekly suffered a 19.1 percent drop on newsstands.

Some young women’s magazines like Cosmopolitan and Glamour, which often attract an overlapping audience as celebrity magazines, also suffered major hits. Cosmopolitan had an 18.5 percent decline in newsstand sales while Glamour’s newsstand sales declined by 14.5 percent.

John Harrington, an industry consultant, said that both categories are suffering because young women can access a lot of similar content online.

“They’re fighting all the social media and information that’s just available in so many places,” said Mr. Harrington about the kinds of pressures these magazines are under. “Some of the same factors are that their audience are people who are digitally adept and tend to go to social media.”
While all magazines reported a rise in digital subscribers and the number of average digital magazine copies more than doubled from the year before, these numbers still make up less than 2.4 percent of the entire magazine industry’s average circulation.

Industry experts said that magazines also suffered from what was and was not happening in the world. Steven Cohn, editor of the Media Industry Newsletter, said that celebrity weeklies didn’t benefit from the boom that comes from celebrity weddings, births or deaths in recent months. He expects that business prospects may improve for these titles in the second half of the year after Prince William and Kate Middleton have their first child.

“In the second half of 2012, there was no royal wedding. There was no tragedy like the death of Michael Jackson,” said Mr. Cohen. “They should get a bump by the royal birth.”

Mr. Cohen added that Hurricane Sandy also may have hurt newsstand sales. He noted that even during an election year, Time Inc. experienced a decline in newsstand sales. Newsstand sales for the magazine declined to 58,776 in the second half of 2012 from 76,555 from the same time in 2011.

“I think Sandy is a factor,” said Mr. Cohen. “It certainly hurt newsstand in New York and New Jersey, which is the biggest market in the country.”

While Family Circle and Woman’s Day both noted rises in their newsstand sales, Mr. Harrington said that both magazines had cut back their frequency of publication to 12 times a year from 15 times a year. Both magazines also are relatively inexpensive.

“That helped their average newsstand sales and they’re still relatively lower priced items,” said Mr. Harrington.

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The Lede: Video of Protests Across Tunisia After an Opposition Leader Is Gunned Down

Video of a protest outside the interior ministry in Tunis on Wednesday from the blog Nawaat.

As my colleagues Kareem Fahim and Gerry Mullany report, there were protests across Tunisia on Wednesday following the assassination of Chokri Belaid, a leader of the secular opposition.

Video shot by activist bloggers for the independent Tunisian site Nawaat showed protesters rallying outside the interior ministry on the tree-lined Avenue Habib Bourguiba in Tunis early in the day, and then being chased from the street by police officers who fired tear gas into the crowd and beat demonstrators.

The Tunisian blog Nawaat’s video of police officers attacking protesters in Tunis on Wednesday.

After the avenue was cleared, witnesses reported that a small crowd accompanied the ambulance carrying Mr. Belaid’s body down the same street.

As news of the assassination spread, there were protests in other cities and reports of attacks on the offices of Ennahda, the ruling Islamist party. Mr. Belaid had criticized Ennahda’s leaders for failing to condemn violent attacks on his party’s activists by young Islamists, in a television appearance shortly before his death, the French radio station Europe 1 reported.

Agence France-Presse video showed protesters marching in Sidi Bouzid, the town where the Tunisian revolt began.

More video of the demonstration in Tunis, and a clip of protesters occupying the headquarters of Ennahda in the city of Sfax, was posted online by Jadal, a Tunisian news site set up by the Institute for Peace and War Reporting.

Video from the Tunisian news site Jadal, said to show protesters occupying the offices of the ruling party in Sfax on Wednesday.

A demonstration outside the office of Ennahda in the coastal city of Mahdia was caught on video by a Nawaat blogger.

Before the demonstration at the interior ministry was attacked by the police, activists in the crowd posted updates on the protest on Twitter.

Among the chants, witnesses reported, were calls for the resignation of the interior minister, Ali Larayedh, a leader of Ennahda who is a former dissident.

Mr. Larayedh called the assassination of Mr. Belaid a “terrorist act” and “a blow to the democratic transition experience in Tunisia,” the state news agency reported.

One member of the crowd was Amira Yahyaoui, the president of the rights organization Al Bawsala, who suggested that Tunisians had waited long enough for reform of the hated police force. After Mr. Balaid’s death, she wrote, it was “necessary to go inside the interior ministry and clear out the incompetents and, worse, the facilitators” who had allowed such acts of political violence to take place.

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Braun says he used Fla clinic owner as consultant


NEW YORK (AP) — Milwaukee Brewers slugger Ryan Braun said the person who ran the Florida clinic being investigated by Major League Baseball was used only as a consultant on his drug suspension appeal last year.


"I have nothing to hide," Braun said in a statement released by his representatives on Tuesday night.


Earlier in the day, Yahoo Sports reported the 2011 NL MVP's name showed up three times in records of the Biogenesis of America LLC clinic. Yahoo said no specific performance-enhancing drugs were listed next to his name.


The Miami New Times recently released clinic documents that purportedly linked Alex Rodriguez, Gio Gonzalez, Melky Cabrera and other players to purchases of banned drugs from the now-closed anti-aging center.


Rodriguez and Cabrera were on the list with Braun that also included New York Yankees catcher Francisco Cervelli and Baltimore Orioles infielder Danny Valencia.


Braun said his name was in the Biogenesis records because of an issue over payment to Anthony Bosch, who ran the clinic near Miami.


"There was a dispute over compensation for Bosch's work, which is why my lawyer and I are listed under 'moneys owed' and not on any other list," Braun said.


"I have nothing to hide and have never had any other relationship with Bosch," he said. "I will fully cooperate with any inquiry into this matter."


On Tuesday, MLB officials asked the Miami New Times for the records the alternative newspaper obtained for its story.


Asked specifically about Braun's name in the documents before the five-time All-Star released his statement, MLB spokesman Pat Courtney said: "Aware of report and are in the midst of an active investigation in South Florida."


Braun tested positive during the 2011 postseason for elevated testosterone levels. He maintained his innocence and his 50-game suspension was overturned during spring training last year when arbitrator Shyam Das ruled in favor of Braun due to chain of custody issues involving the sample.


With that, Braun became the first major leaguer to have a drug suspension overturned.


"During the course of preparing for my successful appeal last year, my attorneys, who were previously familiar with Tony Bosch, used him as a consultant. More specifically, he answered questions about T/E ratio and possibilities of tampering with samples," Braun said.


The T/E ratio is a comparison of the levels of testosterone to epitestosterone.


Braun led the NL in homers (41), runs (108) and slugging percentage (.595) last season while batting .319 with 112 RBIs and 30 stolen bases. He finished second to San Francisco catcher Buster Posey in MVP balloting."


Cervelli, who spent nearly all of last season in Triple-A, posted a statement on Twitter later Tuesday night.


"Following my foot injury in March 2011, I consulted with a number of experts, including BioGenesis Clinic, for (cont)," Cervelli posted, "(cont)legal ways to aid my rehab and recovery. I purchased supplements that I am certain were not prohibited by Major League Baseball."


An email sent to Valencia's agent was not returned.


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The New Old Age Blog: For Women, Reduced Access to Long-Term Care Insurance

“This was a very, very good business for a short time, with people buying long-term care insurance like it was candy in a candy store,’’ said Michael Perry, a vice president at the Opus Advisory Group, a strategic financial planning firm in Purchase, N.Y.

No more. Mr. Perry has sold only one long-term care policy in the last six months and is “backing off from marketing’’ them as he watches this corner of the insurance business contract, raise premiums, tighten eligibility requirements and reduce key benefits. Long-term care insurance is a comparatively new product, launched in the late ’80s, and only now, as claims begin to pour in, have the actual costs to insurers become apparent.

Companies like MetLife, Prudential Financial, Allianz and Berkshire Financial (a subsidiary of Guardian) have stopped selling new policies and are hiking premiums for the ones already in place — up 37 percent, by one estimate, in 2011. Insurers are increasing elimination periods — the period during which a beneficiary must cover his or her own costs — and reducing inflation protection to 3 percent from 5 percent, once customary. They are requiring home visits instead of phone interviews from new applicants, as well as blood tests and a thorough examination of their medical records.

But the change that has generated the most public attention is so-called gender-distinct pricing, a new strategy that will raise rates for single women by as much as 40 percent beginning in April. Genworth Financial, the nation’s largest long-term care insurance provider with more than a million policy holders, is the first to win approval by state insurance commissions to raise rates for single women purchasing new policies. Women, most of them single by the time they reach advanced age, cost the company $2 of every $3 in benefits paid so far, according to Steve Zabel, Genworth’s senior vice president for long-term care insurance.

The company also will introduce what Mr. Zabel called “enhanced underwriting,” or more stringent qualifying standards, including blood testing to check for nicotine, drugs and markers of cardiovascular disease for all new applicants, regardless of gender or marital status.

Now permitted in all states except Montana and Colorado, gender-distinct pricing will not affect Genworth’s current policyholders, only new applicants. But all other carriers are likely to follow, according to Jesse Slome, executive director of the American Association for Long-Term Insurance, a trade group in Westlake Village, Calif. With the entire industry headed toward higher rates, Mr. Slome recently warned women that “the window is closing” and that now is the time to grab a policy while the price is still manageable.

Women have always paid less than men for life insurance. But because they live longer, women are the disproportionate beneficiaries of long-term care insurance, which paid out $6.6 billion in benefits in 2011. Mr. Slome expects that number to top $7 billion in 2012.

The reasons are well known:

* On average, women outlive men by five years. Among those born in 1960, the average man will live to age 67 and the average woman to age 73. And women who reach age 65 can expect to live an average of 20 more years.

* By age 75, 7 in 10 women are widowed, divorced or have never been married. Some 40 percent of them live alone, compared to 22 percent of men. Two-thirds of those past the age of 85 are women, as are 80 percent of centenarians.

* Women who live to age 65 experience on average two years of disability requiring assistance before death. Those who reach age 80 will require three years of assistance.

* In nursing homes, the most expensive form of long-term care, 7 in 10 residents are women. They represent 76 percent of the residents in assisted living facilities and two-thirds of the recipients of home care. Virtually none of this is paid for by Medicare, the government’s health plan for those 65-and-over. In nursing homes, Medicaid, a poverty program, kicks in for residents who run out of money.

“Woman live longer than men,” said Suzanna de Baca, a vice president of wealth strategies at Ameriprise Financial. “This may mean we experience a longer period of decline. Unfortunately, we are often less likely to have a partner around to help take care of us than our male counterparts.’’

Long-term care, Mr. Slome said, “is truly a women’s issue.”

While acknowledging the extra expense of caring for women, Mr. Slome said that in his view insurance carriers are being disingenuous in blaming the new policies on long-apparent gender differences. Rather he said, the culprit in the changing requirements is interest rates. “Blame the Federal Reserve,’’ he said.

Insurance carriers invest premiums and need to earn enough on that investment to pay benefits. When interest rates were higher, it was not all that difficult. Now the numbers don’t pencil out, and stockholders are fuming. But it is illegal to file for premium increases with the state insurance commissions based on changes in the financial market, Mr. Slome said.

This position does not endear Mr. Slome to his membership, at least one of whom disputes the claim. Asked if the new rate policies were related to interest rates, Mr. Zabel of Genworth, in an e-mail, replied with a succinct “no.”

Insurers say they were not able to judge the costs of care until the payouts began in earnest.

So what is a woman trying to prepare for old age supposed to do, especially after the elimination of the Class Act, a modest attempt to include long-term care in the Affordable Care Act?

Ms. da Baca suggests “careful and thorough budgeting,” “focusing on wellness,” and “proactive steps” to research suitable places to live when home is no longer an option. Ms. da Baca also advises women to make home modifications — incrementally, as one’s budget permits — to increase the chances that you’ll be able to stay there longer.

Mr. Perry, of the Opus Advisory Group, suggests an intriguing option: life insurance with a chronic care rider, which permits the policy-holder to spend money for such needs while alive, although doing so will reduce the tax-free death benefit. Still, not all buyers — or their survivors — are willing to sacrifice those benefits.

“The need is still there, no question about it,’’ Mr. Perry said. But long-term care insurance is likely to become much harder for everyone to find and afford, especially women.


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State of the Art: Microsoft’s Surface Pro Works Like a Tablet and a PC





For decades, Microsoft has subsisted on the milk of its two cash cows: Windows and Office. The company’s occasional ventures into hardware generally haven’t ended well: (*cough*) Zune, Kin Phone, Spot Watch (*cough*).




But the new Surface Pro tablet, which goes on sale Saturday, seemed to have more going for it than any Microsoft hardware since the Xbox.


Everybody knows what a tablet is, right? It’s a black touch-screen slab, like an iPad or an Android tablet. It doesn’t run real Windows or Mac software — it runs much simpler apps. It’s not a real computer.


But with the Surface Pro ($900 for the 64-gigabyte model, $1,000 for a 128-gig machine), Microsoft asks: Why not?


The Surface Pro looks like a tablet. It can work like a tablet. You can hold it in one hand and draw on it with the other. It even comes with a plastic stylus that works beautifully.


But inside, the Pro is a full-blown Windows PC, with the same Intel chip that powers many high-end laptops, and even two fans to keep it cool (they’re silent). As a result, the Pro can run any of the four million Windows programs, like iTunes, Photoshop, Quicken and, of course, Word, Excel and PowerPoint.


The Surface Pro is beautiful. It’s clad in matte-black metal, beveled at the edges like a Stealth helicopter. Its connectors immediately suggest its post-iPad capabilities, like a memory-card slot for expanded storage. The screen is bright and beautiful, with 1080p high-definition resolution (1,080 by 1,820) — but when you connect the tablet to a TV or desktop monitor, it can send out an even bigger, sharper picture (2,550 by 1,440). There’s one USB 3.0 jack in the tablet, and a second ingeniously built into the power cord, so you can charge your phone as you work. Or you can connect anything you’d connect to a PC: external drives, flash drives, keyboard, mouse, speakers, cameras and so on.


Are you getting it? This is a PC, not an iPad.


As though to hammer home that point, Microsoft has endowed the Surface Pro with two unusual extras that complete the transformation from tablet to PC in about two seconds.


First, this tablet has a kickstand. It’s a thin metal flap that disappears completely when closed, but holds the tablet at a nice angle when you’re working or watching a movie.


Second, you can buy Microsoft’s now-famous keyboard cover. There are two models, actually. One is about as thick as a shirt cardboard. You can type on it — slowly — but you’re tapping drawings of keys, not actual keys. It’s called the Touch Cover ($100 with Surface purchase).


The other keyboard, the Type Cover ($130) is thicker — a quarter-inch — but its keys really travel, and it has a trackpad. You can really type on this thing.


Either keyboard attaches to the tablet with a powerful magnetic click. For tablet use, you can flip either keyboard around to the back; it disables itself so you don’t type gibberish by accident.


And if you really want to go whole hog with the insta-PC idea, you should also spring for the matching Touch Wedge mouse. It’s a tiny $40 cordless wedge, not much bigger than the AA battery that powers it, with supercrisp buttons and a touch surface on top for scrolling.


Now, when I wrote a first-look post on my blog last month , I was surprised by the reader reactions. Over and over, they posted the same argument:


“For that money, I could buy a very nice lightweight laptop with a dedicated keyboard and much more storage. Why should I buy Surface Pro when I can have more for less?”


Why? Because the Surface Pro does things most laptops can’t do. Like it weighs two pounds, with touch screen. Or work in portrait orientation, like a clipboard. Or remain comfortable in one hand as you make medical rounds, take inventory or sketch a portrait. Or stay in a bag as it goes through airport security (the TSA says tablets are O.K. to stay in).


You also hear: “But haven’t there been full-blown PC tablets before?”


Yes, there are a couple. But without the kickstand and keyboard cover, they can’t change instantly into a desktop computer.


So it’s true: for this much money, you could buy a very nice laptop. You could also buy a five-day cruise, a Gucci handbag or 250 gallons of milk. They just happen to be different beasts.


All right then: the Surface Pro is fast, flexible and astonishingly compact for what it does; that much is unassailable. But in practice, there are some disappointments and confusions.


E-mail: pogue@nytimes.com



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Same-Sex Marriage Law Gains in Britain


Luke Macgregor/Reuters


Demonstrators Martin Brown, left, and Archie Young were outside Parliament Tuesday in support of gay marriage in England.







LONDON — The House of Commons overwhelmingly approved a law on Tuesday permitting same-sex marriage, a major gain for a bill that Prime Minister David Cameron has made a centerpiece of his drive to modernize his Conservative Party.




The House of Commons voted 400 to 175 for the measure after its second reading, a stage in the parliamentary process that gives approval in principle to legislation before it goes forward for detailed scrutiny. If enacted as expected later this year, the bill will add Britain to a growing list of nations that have passed laws approving same-sex marriage: 13, including seven in Europe, according to a tally in The Guardian newspaper on Tuesday that included the United States, where deep political divisions over the issue have limited same-sex marriage laws to a small group of states.


Many of the opponents were Conservatives. The resurgent Labour Party, which is riding high in the polls, is strongly in favor of same-sex marriages, as is the third major party in British politics, the Liberal Democrats.


Although Mr. Cameron played the role of protagonist for the bill before British lawmakers, and risked adding momentum to a restiveness about his leadership among right-wing Conservative backbenchers, he was not among the 70 or so members of the House of Commons who spoke in the debate on Tuesday.


But he addressed reporters at 10 Downing Street, where he had been holding talks with Vice President Joseph R. Biden Jr.


“Today is an important day,” he said, before heading for the Commons to cast his vote. “I am a strong believer in marriage. It helps people commit to each other, and I think it is right that gay people should be able to get married too.”


“Yes, this is about equality,” he added. “But it is also about making our society stronger. I know there are strong views on both side of the argument; I accept that. But I think this is an important step forward for our country.”


A day after the newly confirmed archbishop of Canterbury, Justin Welby, took office saying that he shared the Church of England’s opposition to marriage between people of the same gender, three cabinet officials said in a letter published in The Daily Telegraph that the new legislation was “the right thing to do at the right time.”


“Marriage has evolved over time,” the letter said. “We believe that opening it up to same-sex couples will strengthen, not weaken, the institution.”


It continued: “Attitudes toward gay people have changed. A substantial majority of the public now favor allowing same-sex couples to marry, and support has increased rapidly.”


The three ministers — George Osborne, the chancellor of the Exchequer, Foreign Secretary William Hague and Home Secretary Theresa May — also asked whether it was “any longer acceptable to exclude people from marriage simply because they love someone of the same sex.”


The debate divided Britain’s Conservatives, who lead in uneasy coalition with the Liberal Democrats.


Opponents of the legislation argued that it would alienate traditional Conservative voters, jeopardizing Mr. Cameron’s prospects in the 2015 national election. But supporters said it would bring in new backing from outside the party, and Mr. Cameron’s support of it is part of his effort to position the party for the general election.


Archbishop Welby, 57, was confirmed Monday to replace the Most Rev. Rowan Williams, who has retired after 10 years in office.


The new archbishop, the spiritual head of the world’s 77 million Anglicans, endorsed the traditional view that while the Church of England has no objection to civil partnerships between people of the same gender, it is, as a recent church statement put it, “committed to the traditional understanding of the institution of marriage as being between one man and one woman.”


Ed Miliband, the leader of the opposition Labour Party, said Monday that he would be “voting for equal marriage in the House of Commons, and I’ll be doing so proudly.” He also said he would urge his 255 legislators in the 649-member body to vote with him, although a small group will probably not.


“I’ll be voting for equal marriage for a very simple reason: I don’t think that the person you love should determine the rights you have,” Mr. Miliband said Monday.


The legislation, which applies to England and Wales, would permit civil marriage between same-sex couples, but specifically exempt the Church of England and other faiths from an obligation to perform such ceremonies. Some faith groups, including the Quakers, have said they want the legal right to perform same-sex marriages.


In their letter, Mr. Osborne, Mr. Hague and Ms. May said: “Our party also has a strong belief in religious freedom, a vital element of a free society. The bill ensures that no faith group will be forced to conduct same-sex marriages. The legal advice is clear that these protections for religious groups cannot be overturned by the courts.”


It said: “Religious freedom works both ways. Why should faith groups, such as the Quakers, that wish to conduct gay marriages be forbidden from doing so? This bill will enhance religious freedom, not restrict it.”


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Lindsey Vonn tears knee ligaments, out for season


SCHLADMING, Austria (AP) — Lindsey Vonn will miss the rest of the ski season after tearing knee ligaments and breaking a bone in her leg in a high-speed crash Tuesday at the world championships. The U.S. team expects her to return for the next World Cup season and the 2014 Sochi Olympics.


Vonn lost balance on her right leg while landing a jump in the super-G. She flipped in the air, landed on her back and smashed through a gate before coming to a halt.


The four-time overall World Cup winner and 2010 Olympic downhill champion received medical treatment on the slope for 12 minutes before being taken by helicopter to a hospital in Schladming.


The 28-year-old star tore her anterior cruciate ligament and medial collateral ligament in her right knee. U.S. team medical director Kyle Wilkens said in a statement. The broken bone in her lower leg was described as a "lateral tibial plateau fracture."


Christian Kaulfersch, the assistant medical director at the worlds, said Vonn left the Schladming hospital Tuesday afternoon and will have surgery at another hospital.


"She first wanted to go back to the team hotel to mentally deal with all what has happened," Kaulfersch said.


Team physician William Sterett was with Vonn but declined to offer any more information when contacted by The Associated Press.


This is the sixth straight major championship in which Vonn has been hit with injuries. The crash in the opening event of the championships came almost exactly a year before the Olympics.


"She will be out for the remainder of this season but is expected to return to racing for the 2013-14 ... World Cup season and the 2014 Olympic Winter Games in Sochi," the team said.


Vonn returned to the circuit last month after an almost monthlong break from racing to fully recover from an intestinal illness that put her in a hospital for two days in November.


The start of Tuesday's race was delayed by 3½ hours because of fog hanging over the course and the skiers began in waning light at 2:30 p.m. Even before Vonn's crash, a course worker fell and also had to be airlifted. He was reported to have broken his nose.


All the delays made for flat light when Vonn raced.


"Lindsey did a great job on top and Lindsey has won a lot of races in flat light so the flat light was definitely not a problem," U.S. Alpine director Patrick Riml told the AP.


"We are upset obviously with what happened, but if you don't know the facts and why they decided to start and what the weather forecast was it's hard to say without any reasoning," Riml said. "And they probably had a reason, otherwise they wouldn't have started."


It was difficult to pinpoint when Vonn lost control as she came off a left turn into the jump.


"She jumped a little bit in the wrong direction and started to correct that a little bit in the air and put a lot of pressure on the outside ski exactly in the landing and she couldn't hold the pressure and then (she crashed)," International Ski Federation women's race director Atle Skaardal said.


Skaardal defended the decision to race.


"I can confirm that the visibility was great, there were no problems, and the course was also in good shape," he said. "I don't see that any outside factors played a role in this accident. ... The other factors were like they were supposed to be for ski racing."


Two years ago, Vonn pulled out midway through the last worlds in Garmisch-Partenkirchen, Germany, because of a mild concussion. At the 2010 Vancouver Olympics, Vonn skied despite a severely bruised shin to win the downhill and take bronze in the super-G.


At the 2009 worlds in Val d'Isere, France, she sliced her thumb open on a champagne bottle after sweeping gold in the downhill and super-G, forcing her out of the giant slalom. At the 2007 worlds in Are, Sweden, Vonn injured her knee in training and missed her final two events.


And at the 2006 Turin Olympics, she had a horrific crash in downhill training and went directly from her hospital room to the mountain to compete in four of her five events.


Having regained her form in recent weeks, Vonn trailed eventual race winner Tina Maze of Slovenia by just 0.12 seconds at an intermediate interval shortly before Tuesday's crash.


The conditions varied from racer to racer.


Former overall winner Maria Hoefl-Riesch of Germany started immediately after Vonn and skied off course.


"It's not a very difficult course but in some parts you couldn't see anything," said Fabienne Suter of Switzerland, who finished fifth.


However, Vonn teammate Julia Mancuso thrived in the difficult conditions and won the bronze medal.


"It's the same for everybody," U.S. speed coach Chip White said. "Everyone had to wait for a long time and that's always difficult. And the holds were every 15 minutes so it really doesn't give you a chance to go and do something else. You're always kind of on edge at the ready. It's a difficult situation but everybody had the same difficult situation."


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Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.


Catherine Saint Louis speaks about using SimplyThick in premature infants.



Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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Bucks Blog: Many Relying on Home Equity for Retirement

Even though the housing market has not recovered, nearly half of older working Americans expect to use equity in their homes to help finance their retirement, a new survey finds.

Roughly 47 percent of employed Americans ages 50 to 70 said they were relying on equity in their homes, the Retirement Check-In survey from Ameriprise Financial found. The finding is surprising, an accompanying report notes, because housing values in many parts of the country remain below the level they were before the recession. Also, 37 percent of homeowners say they’re not on track to pay off their mortgage before they retire.

More people said they were relying on home equity now compared with before the recession, the report finds. When participants were asked whether, before the downturn, they had expected to rely on home equity to help pay for their retirement, just 39 percent said yes.

While the reason for that shift isn’t entirely clear, the report says its plausible that the loss in value of other investments during the recession may have been so steep that many older workers feel they have no other alternative, even if their homes are worth less than they used to be.

“My hypothesis is that people didn’t think they were going to need to tap into equity because they thought they would have sufficient assets,” said Suzanna de Baca, vice president of wealth strategies at Ameriprise Financial. “Now, despite the fact they have reduced home equity, the shortfall between what they’ve saved and what they need is greater.”

The finding is typical of a “perplexing disparity” between Americans’ emotional outlook for retirement and the reality they face, the report said.

For instance, nearly three-quarters indicated that their dream retirement included taking “really nice vacations.” Yet, when asked if they would be able to afford the essentials in retirement, fewer than half said they felt “extremely” or “very” confident. And just 38 percent said they were confident they could afford the extras they had been anticipating in retirement, like traveling and hobbies.

The telephone survey included 1,000 employed Americans age 50 to 70, with investable assets of at least $100,000 (including employer-based retirement plans, but not real estate) and who are planning to retire at some point. Koski Research conducted the survey on behalf of Ameriprise Financial from Oct. 31 and Nov. 14, 2012. The margin of sampling error is plus or minus 3 percentage points.

What role does home equity play in your retirement plans?

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