Broad Powers Seen for Obama in Cyberstrikes

WASHINGTON — A secret legal review on the use of America’s growing arsenal of cyberweapons has concluded that President Obama has the broad power to order a pre-emptive strike if the United States detects credible evidence of a major digital attack looming from abroad, according to officials involved in the review. 

That decision is among several reached in recent months as the administration moves, in the next few weeks, to approve the nation’s first rules for how the military can defend, or retaliate, against a major cyberattack. New policies will also govern how the intelligence agencies can carry out searches of faraway computer networks for signs of potential attacks on the United States and, if the president approves, attack adversaries by injecting them with destructive code — even if there is no declared war.

The rules will be highly classified, just as those governing drone strikes have been closely held. John O. Brennan, Mr. Obama’s chief counterterrorism adviser and his nominee to run the Central Intelligence Agency, played a central role in developing the administration’s policies regarding both drones and cyberwarfare, the two newest and most politically sensitive weapons in the American arsenal.  

Cyberweaponry is the newest and perhaps most complex arms race under way. The Pentagon has created a new Cyber Command, and computer network warfare is one of the few parts of the military budget that is expected to grow. Officials said that the new cyberpolicies had been guided by a decade of evolution in counterterrorism policy, particularly on the division of authority between the military and the intelligence agencies in deploying cyberweapons. Officials spoke on condition of anonymity because they were not authorized to talk on the record.

Under current rules, the military can openly carry out counterterrorism missions in nations where the United States operates under the rules of war, like Afghanistan. But the intelligence agencies have the authority to carry out clandestine drone strikes and commando raids in places like Pakistan and Yemen, which are not declared war zones. The results have provoked wide protests.

Mr. Obama is known to have approved the use of cyberweapons only once, early in his presidency, when he ordered an escalating series of cyberattacks against Iran’s nuclear enrichment facilities. The operation was code-named Olympic Games, and while it began inside the Pentagon under President George W. Bush, it was quickly taken over by the National Security Agency, the largest of the intelligence agencies, under the president’s authority to conduct covert action.

As the process of defining the rules of engagement began more than a year ago, one senior administration official emphasized that the United States had restrained its use of cyberweapons. “There are levels of cyberwarfare that are far more aggressive than anything that has been used or recommended to be done,” the official said. 

The attacks on Iran illustrated that a nation’s infrastructure can be destroyed without bombing it or sending in saboteurs.

While many potential targets are military, a country’s power grids, financial systems and communications networks can also be crippled. Even more complex, nonstate actors, like terrorists or criminal groups, can mount attacks, and it is often difficult to tell who is responsible. Some critics have said the cyberthreat is being exaggerated by contractors and consultants who see billions in potential earnings.

One senior American official said that officials quickly determined that the cyberweapons were so powerful that — like nuclear weapons — they should be unleashed only on the direct orders of the commander in chief. 

A possible exception would be in cases of narrowly targeted tactical strikes by the military, like turning off an air defense system during a conventional strike against an adversary.

“There are very, very few instances in cyberoperations in which the decision will be made at a level below the president,” the official said. That means the administration has ruled out the use of “automatic” retaliation if a cyberattack on America’s infrastructure is detected, even if the virus is traveling at network speeds.

 While the rules have been in development for more than two years, they are coming out at a time of greatly increased cyberattacks on American companies and critical infrastructure. The Department of Homeland Security recently announced that an American power station, which it did not name, was crippled for weeks by cyberattacks. The New York Times reported last week that it had been struck, for more than four months, by a cyberattack emanating from China. The Wall Street Journal and The Washington Post have reported similar attacks on their systems.

 “While this is all described in neutral terms — what are we going to do about cyberattacks — the underlying question is, ‘What are we going to do about China?’ ” said Richard Falkenrath, a senior fellow at the Council on Foreign Relations. “There’s a lot of signaling going on between the two countries on this subject.”

International law allows any nation to defend itself from threats, and the United States has applied that concept to conduct pre-emptive attacks.

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Medicines Co. Licenses Rights to Cholesterol Drug

The drug, known as ALN-PCS, inhibits a protein in the body known as PCSK9. Such drugs might one day be used to treat millions of people who do not achieve sufficient cholesterol-lowering from commonly used statins, such as Lipitor.

The Medicines Company will pay $25 million initially and as much as $180 million later if certain development and sales goals are met, under the deal expected to be formally announced Monday. It will also pay Alnylam, which is based in Cambridge, Mass., double-digit royalties on global sales.

That is small payment for a drug with presumably a huge potential market, probably reflecting that Alnylam is still in the first of three phases of clinical trials, well behind some far bigger competitors.

The team of Sanofi and Regeneron Pharmaceuticals is already entering the third and final stage of trials with their PCSK9 inhibitor, as is Amgen. Pfizer and Roche are in midstage trials.

ALN-PCS is different from the other drugs. It uses a gene-silencing mechanism called RNA interference, aimed at shutting off production of the PCSK9 protein. The other drugs are proteins called monoclonal antibodies that inhibit the action of PCSK9 after it has been formed.

Alnylam and the Medicines Company hope that turning off the faucet, as it were, will be more efficient than mopping the floor, allowing their drug to be given less frequently and in smaller amounts.

But that has yet to be proved. No drug using RNA interference has reached the market.

The Medicines Company, based in Parsippany, N.J., generates almost all of its revenue from one product — Angiomax, an anticlotting drug used when patients receive stents to open clogged arteries.

Dr. Clive A. Meanwell, chief executive of the company, said that PCSK9 inhibitors are likely to be used at first mainly by patients with severe lipid problems under the care of interventional cardiologists, the same doctors who use Angiomax. “It really is quite adjacent to what we do,” he said.

The Medicines Company licensed Angiomax from Biogen Idec, where the drug was invented and initially developed under a team led by Dr. John M. Maraganore, who is now the chief executive of Alnylam.

“It’s a bit like getting the band back together,” Dr. Maraganore said.

Read More..

Medicines Co. Licenses Rights to Cholesterol Drug

The drug, known as ALN-PCS, inhibits a protein in the body known as PCSK9. Such drugs might one day be used to treat millions of people who do not achieve sufficient cholesterol-lowering from commonly used statins, such as Lipitor.

The Medicines Company will pay $25 million initially and as much as $180 million later if certain development and sales goals are met, under the deal expected to be formally announced Monday. It will also pay Alnylam, which is based in Cambridge, Mass., double-digit royalties on global sales.

That is small payment for a drug with presumably a huge potential market, probably reflecting that Alnylam is still in the first of three phases of clinical trials, well behind some far bigger competitors.

The team of Sanofi and Regeneron Pharmaceuticals is already entering the third and final stage of trials with their PCSK9 inhibitor, as is Amgen. Pfizer and Roche are in midstage trials.

ALN-PCS is different from the other drugs. It uses a gene-silencing mechanism called RNA interference, aimed at shutting off production of the PCSK9 protein. The other drugs are proteins called monoclonal antibodies that inhibit the action of PCSK9 after it has been formed.

Alnylam and the Medicines Company hope that turning off the faucet, as it were, will be more efficient than mopping the floor, allowing their drug to be given less frequently and in smaller amounts.

But that has yet to be proved. No drug using RNA interference has reached the market.

The Medicines Company, based in Parsippany, N.J., generates almost all of its revenue from one product — Angiomax, an anticlotting drug used when patients receive stents to open clogged arteries.

Dr. Clive A. Meanwell, chief executive of the company, said that PCSK9 inhibitors are likely to be used at first mainly by patients with severe lipid problems under the care of interventional cardiologists, the same doctors who use Angiomax. “It really is quite adjacent to what we do,” he said.

The Medicines Company licensed Angiomax from Biogen Idec, where the drug was invented and initially developed under a team led by Dr. John M. Maraganore, who is now the chief executive of Alnylam.

“It’s a bit like getting the band back together,” Dr. Maraganore said.

Read More..

Medicines Co. Licenses Rights to Cholesterol Drug

The drug, known as ALN-PCS, inhibits a protein in the body known as PCSK9. Such drugs might one day be used to treat millions of people who do not achieve sufficient cholesterol-lowering from commonly used statins, such as Lipitor.

The Medicines Company will pay $25 million initially and as much as $180 million later if certain development and sales goals are met, under the deal expected to be formally announced Monday. It will also pay Alnylam, which is based in Cambridge, Mass., double-digit royalties on global sales.

That is small payment for a drug with presumably a huge potential market, probably reflecting that Alnylam is still in the first of three phases of clinical trials, well behind some far bigger competitors.

The team of Sanofi and Regeneron Pharmaceuticals is already entering the third and final stage of trials with their PCSK9 inhibitor, as is Amgen. Pfizer and Roche are in midstage trials.

ALN-PCS is different from the other drugs. It uses a gene-silencing mechanism called RNA interference, aimed at shutting off production of the PCSK9 protein. The other drugs are proteins called monoclonal antibodies that inhibit the action of PCSK9 after it has been formed.

Alnylam and the Medicines Company hope that turning off the faucet, as it were, will be more efficient than mopping the floor, allowing their drug to be given less frequently and in smaller amounts.

But that has yet to be proved. No drug using RNA interference has reached the market.

The Medicines Company, based in Parsippany, N.J., generates almost all of its revenue from one product — Angiomax, an anticlotting drug used when patients receive stents to open clogged arteries.

Dr. Clive A. Meanwell, chief executive of the company, said that PCSK9 inhibitors are likely to be used at first mainly by patients with severe lipid problems under the care of interventional cardiologists, the same doctors who use Angiomax. “It really is quite adjacent to what we do,” he said.

The Medicines Company licensed Angiomax from Biogen Idec, where the drug was invented and initially developed under a team led by Dr. John M. Maraganore, who is now the chief executive of Alnylam.

“It’s a bit like getting the band back together,” Dr. Maraganore said.

Read More..

IHT Rendezvous: In Villages, Praying for the Souls of Tibetan Self-Immolators

BEIJING — Since November, when cold winter began in the high Tibetan Plateau, thousands of Tibetan villagers have been gathering daily to pray for the souls of the nearly 100 Tibetans who have burned themselves to death in protest over Chinese rule, in a show of widespread support for the self-immolators among ordinary people, according to witness testimony from a person recently returned from the region.

In traditional winter prayer meetings in villages, they gather to chant “Om mani padme hum,” Tibetan Buddhism’s most important mantra, which speeds a soul toward a good reincarnation, said the person, who witnessed a meeting in the Tibetan region of Qinghai Province in China.

The meetings are a sign of support for the self-immolators and point to widespread dislike among ordinary Tibetans for repressive policies in the region that have turned it into an “open-air prison,” said one ethnic Tibetan police officer in Lhasa, quoted by the witness.

The witness cannot be identified because of the high risk of persecution by the Chinese authorities. But the reliable account of ongoing, severe repression and resentment among Tibetans confirms other reports from the Tibet Autonomous Region or from Tibetan regions in Chinese provinces, where the authorities have been cracking down as they try to stop the spread of the self-immolations.

Chinese courts last week sentenced eight Tibetans for helping self-immolators, The Associated Press reported, including one man to death with a two-year reprieve, and others to between 3 and 12 years in jail, according to Xinhua, the state news agency.

The detail and content of the grass-roots prayer meetings is new.

“The meetings are a traditional thing to do during the winter and are held daily in different villages, and last three days,” the witness said. They are known in Chinese as “fahui,” or dharma meetings (also Buddhist law meetings).

“People drive on motorbikes for long distances, 50 or 60 kilometers, to whichever village is holding a prayer meeting. It’s mostly adults, and they are anywhere between 16 and over 80 years old. As soon as they can drive a motorbike, they’ll go,” the person said.

“Around 1,000 people may attend, often going from one meeting to another without returning home.”

“Their aim is for each meeting to have chanted ‘Om mani padme hum’ 100 million times. There’s no question that they regard the self-immolators as very great, and believe that with the help of their prayers, they will come back as powerful and blessed people,” said the person, who confessed to having reservations about the self-immolations.

Yet, “It’s extremely moving. Because if the self-immolations really were a mistake, how could they get so much support and sympathy form ordinary people?”

As my colleague Jim Yardley reports from India, where many Tibetans live in exile, some there are questioning the self-immolations.

The witness confirmed that, saying: “There is a feeling among some Tibetans,” especially monks or those in the religious hierarchy, “that the Dalai Lama needs to say something to stop it.”

Yet Tibetans who are deeply unhappy with Chinese rule are constrained in how they can protest.

“The problem is that Tibetans are Buddhists. The way things are there now, in other places, people might rise up and set off bombs. But they can’t do that because Buddhists believe you shouldn’t destroy other people’s happiness. So the only way they can protest is by killing themselves,” the person said.

And so the grass-roots support goes on.

The testimony from this person also confirmed reports of a very harsh crackdown under way in Lhasa, seat of the Jokhang, Tibet’s holiest temple, and the Potala Palace, the former home of the Dalai Lama, whom Tibetans revere and who has lived in exile since fleeing the Chinese in 1959.

The crackdown, in response to the self-immolations that began not long after an uprising in Lhasa was crushed in 2008, has turned Tibet into “an open-air prison,” said an ethnic Tibetan police officer. Like some other ethnic Tibetan police officers, he was considering resigning his post, he said.

“Lhasa used to be a sacred place for Buddhism. Now it’s a sacred place for Marxism-Leninism,” he said. “Every day there are meetings where leaders both big and small tell you that maintaining stability,” or “weiwen,” in Chinese, “is the most important thing, what the main tasks in Lhasa are. Lhasa is no longer a Buddhist sacred place,” he said.

“Lhasa is stuffed with police, every 10 paces there are several. I am growing to hate my own work. It’s really not possible to keep doing it. Some have already resigned,” he told the witness.

The crackdown includes forbidding ethnic Tibetans from the outlying regions, like Qinghai or Sichuan Provinces, which lie outside Tibet proper, from traveling to Tibet and is strictly enforced at airports and other transport nodes. Ethnic Han Chinese, however, can pass, effectively making Tibet out of bounds for many Tibetans.

Any Tibetan from outside the region wishing to travel to Lhasa must have a “sponsor” in the city working for the government, the witness said. They must surrender their identity cards and be photographed. Uniformed and plainclothes police officers and military patrol heavily in the city, trying to stop self-immolations.

The ban on ethnic Tibetans from outside Tibet, many of whom have traditionally taken pilgrimages to Lhasa, means that hotels and other businesses in the city have suffered since last May when they were ordered shut to such travelers. A petition is currently circulating from hotel owners asking the government to compensate them financially, “or we will take our request higher.” For reasons of political sensitivity, the petition, which has been seen by this newspaper, cannot be discussed in detail.

It is also extremely difficult for ordinary ethnic Tibetans to get a passport, meaning they cannot travel overseas, the witness said. The person believes the government’s motive is to minimize accounts, like this one, of the harsh repression in the region.

“They don’t want Tibetans leaving the country and telling the world what’s happening there. Hundreds of people leaving and telling the world is very different from one or two,” the person said.

With the Lunar New Year approaching, the prayer meetings will soon be scaled back, as farm work and animal husbandry resume. For now, though, the villagers are praying hard for the souls of the dead, millions of mantras circulating in the thin air of the plateau.

“They say, we want their lives to come back. We want world peace. They pray for Tibet to have peaceful and happy days, and the world, too,” the person said.

Said the police officer: “Living in this tightly controlled atmosphere is unbearable. There’s no feeling of happiness. But maybe it’s good this way, it may speed up the day when the situation has to change. But I don’t have the courage to self-immolate. Maybe after I retire I’ll go to Beijing and petition.”

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Slipstream: Consumer Data Protection Laws, an Ocean Apart

OVER the years, the United States and Europe have taken different approaches toward protecting people’s personal information. Now the two sides are struggling to bridge that divide.

On this side of the Atlantic, Congress has enacted a patchwork quilt of privacy laws that separately limit the use of Americans’ medical records, credit reports, video rental records and so on. On the other side, the European Union has instituted more of a blanket regulatory system; it has a common directive that gives its citizens certain fundamental rights — like the right to obtain copies of records held about them by companies and institutions — that Americans now lack.

Even so, United States officials maintain that the divergent approaches are equal. “The sum of the parts of U.S. privacy protection is equal to or greater than the single whole of Europe,” says Cameron F. Kerry, general counsel of the Commerce Department. He is overseeing an agency effort to help develop voluntary, enforceable codes of conduct for industry groups, like app developers, whose collection and use of consumer data are now unregulated.

Europe begs to differ.

“Yes, we share the basic idea of privacy,” says Peter Hustinx, Europe’s data protection supervisor. “But there is a huge deficit on the U.S. side.”

Alas, the data-control divide appears to be widening.

A year ago, the European Commission proposed comprehensive reforms to strengthen online privacy rights — changes that could have big repercussions for American technology companies and marketers that operate in the European Union. American officials, trade groups and tech executives have responded by taking frequent treks to Brussels and other cities, where they have urged regulators and legislators to reconsider the one-regulation-fits-all-data approach. What’s at stake, American industry representatives say, is nothing less than a free and commerce-friendly Internet.

“The ecosystem of the Internet is very delicate,” says Kevin Richards, senior vice president of federal government affairs at TechAmerica, a trade group that represents companies like Google and Microsoft. “It’s not wise to have an overly broad, prescriptive, one-size-fits-all approach that would hinder or undermine the ability of companies to innovate in a global economy.”

European Union members already have data protection laws in place, based on a directive from 1995 that laid out principles for the collection of personal information. The proposed new rules would strengthen some existing provisions. They would standardize data protections across the 27 member states. They would also provide some new rights, such as “data portability” — the right of consumers to easily transfer their text files, photographs and videos from one social network, or e-mail or cloud storage service, to another. And they would subject companies that violate the rules to penalties of up to 2 percent of their annual global revenue.

Asked for comment, Viviane Reding, the vice president of the European Commission and the architect of the proposed regulation, said in a statement: “The main problem is that our rules predate the digital age and it became increasingly clear in recent years that they needed an update.” She continued: “That is why I have proposed a root-and-branch reform of the E.U.’s data protection rules — currently under discussion in the European Parliament and the Council of the E.U. — that will both protect citizens’ rights and facilitate business in the digital age.”

BUT some provisions seem too rigid to United States officials and trade groups. They argue that the American approach — sector-specific privacy laws, in addition to industry self-regulation and enforcement by the Federal Trade Commission — is more nimble.

“We hope that Europe will move in the direction of those multistakeholder standards, and not standards which are not flexible and don’t move at Internet speed,” says Mr. Kerry, who has taken at least four trips to European cities in the last year to discuss these issues.

From the perspective of some European legislators, however, United States representatives seem more interested in protecting commerce than consumers. The full-court American effort may have backfired, they say, pushing some European officials toward even broader measures. Last month, Jan Philipp Albrecht, a representative of the European Parliament who reviewed the draft regulation, proposed additional rights for citizens — like the right not to be subject to consumer profiling.

“My impression is that the U.S. Chamber of Commerce and the Commerce Department are mostly just following the interests of Silicon Valley,” he says. “This leads to heavy pressure on the European regulator, I can say.”

But Mr. Kerry says the United States must make its views known if the systems are to work in concert.

“I know that some people have raised eyebrows at our involvement; I make no apologies,” Mr. Kerry says. “We in the United States and countries and businesses around the world are stakeholders in this process. This has an important impact on the global economy.”

The solution to this trans-Atlantic clash may simply be American ingenuity.

Last year, President Barack Obama proposed a “Consumer Privacy Bill of Rights” that would give Americans many of the same baseline protections that the draft European rule proposes to reinforce. These include the right of access to records that companies hold about them, the right to correct those records and the right to have limits on the personal data that companies collect and keep. Administration officials said they would work with Congress on legislation based on those rights and to extend oversight to industries not currently covered by federal privacy laws.

A coalition of more than a dozen American advocacy groups said it would send a letter on Monday to senior Obama administration officials, seeking a meeting to ensure that American policy makers’ efforts in Europe “are not averse to the views expressed by the president.” The coalition includes the Electronic Privacy Information Center and the Center for Digital Democracy.

“Does the Obama administration really want to be on the opposite side of the European effort to upgrade and modernize its privacy law which is at its core about the protection of a fundamental freedom?” asks Marc Rotenberg, executive director of the Electronic Privacy Information Center.

European officials hold out hope that Congress will enact baseline consumer privacy protections for Americans.

“This development — which is much welcomed in Europe — shows that we have much in common,” Ms. Reding of the European Commission said in her statement, speaking of the privacy bill of rights. “Convergence is springing up and synergies are possible.”

E-mail: slipstream@nytimes.com.

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Concerns About A.D.H.D. Practices and Amphetamine Addiction

Before his addiction, Richard Fee was a popular college class president and aspiring medical student. "You keep giving Adderall to my son, you're going to kill him," said Rick Fee, Richard's father, to one of his son's doctors.

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

Andrea Mohin/The New York Times

MENTAL HEALTH CLINIC Dominion Psychiatric Associates in Virginia Beach, where Richard Fee was treated by Dr. Waldo M. Ellison. After observing Richard and hearing his complaints about concentration, Dr. Ellison diagnosed attention deficit hyperactivity disorder and prescribed the stimulant Adderall.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.

“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”

“...when he was in elementary school he fidgeted, daydreamed and got A’s. he has been an A-B student until mid college when he became scattered and he wandered while reading He never had to study. Presently without medication, his mind thinks most of the time, he procrastinated, he multitasks not finishing in a timely manner.”

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that he was taking Vyvanse for A.D.H.D.

Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year and that he had seen a doctor and received a diagnosis. His father reacted with surprise. Richard had never shown any A.D.H.D. symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Mr. Fee also expressed concerns about the safety of his son’s taking daily amphetamines for a condition he might not have.

“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”

Read More..

Concerns About A.D.H.D. Practices and Amphetamine Addiction

Before his addiction, Richard Fee was a popular college class president and aspiring medical student. "You keep giving Adderall to my son, you're going to kill him," said Rick Fee, Richard's father, to one of his son's doctors.

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

Andrea Mohin/The New York Times

MENTAL HEALTH CLINIC Dominion Psychiatric Associates in Virginia Beach, where Richard Fee was treated by Dr. Waldo M. Ellison. After observing Richard and hearing his complaints about concentration, Dr. Ellison diagnosed attention deficit hyperactivity disorder and prescribed the stimulant Adderall.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.

“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”

“...when he was in elementary school he fidgeted, daydreamed and got A’s. he has been an A-B student until mid college when he became scattered and he wandered while reading He never had to study. Presently without medication, his mind thinks most of the time, he procrastinated, he multitasks not finishing in a timely manner.”

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that he was taking Vyvanse for A.D.H.D.

Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year and that he had seen a doctor and received a diagnosis. His father reacted with surprise. Richard had never shown any A.D.H.D. symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Mr. Fee also expressed concerns about the safety of his son’s taking daily amphetamines for a condition he might not have.

“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”

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Iceland, Prosecutor of Bankers, Sees Meager Returns

Ilvy Njiokiktjien for The New York Times

"Greed is not a crime. But the question is: where does greed lead?" said Olafur Hauksson, a special prosecutor in Reykjavik.

REYKJAVIK, Iceland — As chief of police in a tiny fishing town for 11 years, Olafur Hauksson developed what he thought was a basic understanding of the criminal mind. The typical lawbreaker, he said, recalling his many encounters with small-time criminals, “clearly knows that he crossed the line” and generally sees “the difference between right and wrong.”

Today, the burly, 48-year-old former policeman is struggling with a very different sort of suspect. Reassigned to Reykjavik, the Icelandic capital, to lead what has become one of the world’s most sweeping investigation into the bankers whose actions contributed to the global financial crisis in 2008, Mr. Hauksson now faces suspects who “are not aware of when they crossed the line” and “defend their actions every step of the way.”

With the global economy still struggling to recover from the financial maelstrom five years ago, governments around the world have been criticized for largely failing to punish the bankers who were responsible for the calamity. But even here in Iceland, a country of just 320,000 that has gone after financiers with far more vigor than the United States and other countries hit by the crisis, obtaining criminal convictions has proved devilishly difficult.

Public hostility toward bankers is so strong in Iceland that “it is easier to say you are dealing drugs than to say you’re a banker,” said Thorvaldur Sigurjonsson, the former head of trading for Kaupthing, a once high-flying bank that crumbled. He has been called in for questioning by Mr. Hauksson’s office but has not been charged with any wrongdoing.

Yet, in the four years since the Icelandic Parliament passed a law ordering the appointment of an unnamed special prosecutor to investigate those blamed for the country’s spectacular meltdown in 2008, only a handful of bankers have been convicted.

Ministers in a left-leaning coalition government elected after the crash agree that the wheels of justice have ground slowly, but they call for patience, explaining that the process must follow the law, not vengeful passions.

“We are not going after people just to satisfy public anger,” said Steingrimur J. Sigfusson, Iceland’s minister of industry, a former finance minister and leader of the Left-Green Movement that is part of the governing coalition.

Hordur Torfa, a popular singer-songwriter who helped organize protests that forced the previous conservative government to resign, acknowledged that “people are getting impatient” but said they needed to accept that “this is not the French Revolution. I don’t believe in taking bankers out and hanging them or shooting them.”

Others are less patient. “The whole process is far too slow,” said Thorarinn Einarsson, a left-wing activist. “It only shows that ‘banksters’ can get away with doing whatever they want.”

Mr. Hauksson, the special prosecutor, said he was frustrated by the slow pace but thought it vital that his office scrupulously follow legal procedure. “Revenge is not something we want as our main driver in this process. Our work must be proper today and be seen as proper in the future,” he said.

Part of the difficulty in prosecuting bankers, he said, is that the law is often unclear on what constitutes a criminal offense in high finance. “Greed is not a crime,” he noted. “But the question is: where does greed lead?”

Mr. Hauksson said it was often easy to show that bankers violated their own internal rules for lending and other activities, but “as in all cases involving theft or fraud, the most difficult thing is proving intent.”

And there are the bankers themselves. Those who have been brought in for questioning often bristle at being asked to account for their actions. “They are not used to being questioned. These people are not used to finding themselves in this situation,” Mr. Hauksson said. They also hire expensive lawyers.

The special prosecutor’s office initially had only five staff members but now has more than 100 investigators, lawyers and financial experts, and it has relocated to a big new office. It has opened about 100 cases, with more than 120 people now under investigation for possible crimes relating to an Icelandic financial sector that grew so big it dwarfed the rest of the economy.

To help ease Mr. Hauksson’s task, legislators amended the law to allow investigators easy access to confidential bank information, something that previously required a court order.

Parliament also voted to put the country’s prime minister at the time of the banking debacle on trial for negligence before a special tribunal. (A proposal to try his cabinet failed.) Mr. Hauksson was not involved in the case against the former leader, Geir H. Haarde, who last year was found guilty of failing to keep ministers properly informed about the 2008 crisis but was acquitted on more serious charges that could have resulted in a prison sentence.

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India Ink: Selling ‘Midnight’s Children’ in India

“Am I allowed to mention the Rushdie word?” quipped the historian and author Tom Holland at the recently concluded Jaipur Literature Festival. Mr. Holland was speaking of Salman Rushdie’s 1981 novel, “Midnight’s Children,” a book he called a contemporary classic.

His comment alluded to the political baggage attached to Mr. Rushdie in India, the country of his birth, because of his novel “The Satanic Verses,” which is banned in India and sparked a death threat against him from Iran in 1989. Last year, Mr. Rushdie canceled a scheduled appearance at the Jaipur Literary Festival because of an assassination threat against him in connection with the book.

Controversy over Mr. Rushdie flared up again this week, as he came to India to promote the film “Midnight’s Children,” directed by the award-winning filmmaker Deepa Mehta and based upon Mr. Rushdie’s acclaimed novel by the same name. Beginning on the eve of India’s independence from British rule, “Midnight’s Children” follows the country through its early years as a new nation through the lives of the children born at the stroke of midnight on Aug. 15, 1947.

On Wednesday, Mr. Rushdie was scheduled to attend a publicity event in Kolkata for the movie, along with Ms. Mehta. However, the visit was called off at the last minute, giving rise to speculation that the state government had canceled the visit because of pressure from Muslim groups.

On Friday, Mr. Rushdie said as much on Twitter. “The simple fact is that the Chief Minister Mamata Banerjee ordered the police to block my arrival,” he said. In a statement issued Friday, he clarified that he had been planning to take part in a session at the Kolkata Literary Meet, where he had been invited by the organizers to appear as “a surprise guest.” He also said that a police source had shared his itinerary with the press, thereby inciting trouble.

“What is happening in India nowadays is an accumulating scandal and a growing disgrace to this great nation,” said Mr. Rushdie in the statement. “I can only hope that the people of India have the will to demand that such assaults on freedom cease once and for all.”

However, Mr. Rushdie was able to attend the premiere of the film at Mumbai’s PVR Cinema in Phoenix Mills on Thursday. The theater was lined with nearly 50 police officers standing guard, and two truckloads of officers sat outside the gates of the mall complex.

The premiere was well attended by the actors in the movie, including Shriya Saran, Shahana Goswami, Kulbhushan Kharbanda and Rahul Bose, and they were in a celebratory mood.

“I think that this is a bit of good news that in the middle of dark times for our creative freedom that this film is releasing here,” Mr. Bose said at the premiere. “I am sentimentally invested in the movie because it’s a movie I was supposed to be part of in a production 15 years ago. That one was stymied at the last moment, but this one wasn’t. And I’m playing a small role, but it’s nice to be part of it.”

As the crowd vied to get a view of Mr. Rushdie as he entered, he gamely posed for photographs with fans and greeted friends and well-wishers. Also in attendance were the actress Nandita Das, the director and screenwriter Dev Benegal, the film director and screenwriter Sudhir Mishra, the cricketer Yuvraj Singh, the columnist Anil Dharker and the actor Arunoday Singh.

While film adaptations of books, particularly those considered classics, are always tricky, “Midnight’s Children” elicited a largely positive response. “I think Midnight’s Children is a pretty impossible book to make a film of, and this one is a fantastic effort,” said the Indian stage and film actor Gerson da Cunha after the screening. “I just hope that it works in India because, well, it is a difficult film.”

The performances by each of the actors drew wide praise from the audience, who clapped enthusiastically at the end of the film. “The search for identity as depicted by the actors was very touching,” said Dolly Thakore, a veteran theater actress.

“Midnight’s Children,” which had its worldwide premiere at the Toronto Film Festival in September, is opening in India in 250 theaters and 15 cities, a wider rollout than in Canada in November (120 screens) and in Britain in late December (180 screens). A release in the United States is slated for April.

Distributed in India by PVR Pictures, the film is opening across a “good number of screens,” said the company’s vice president of marketing, Arun Nair.

“As a nondubbed, nonaction film, it’s a big opening for an English film,” Mr. Nair added, noting in comparison that other similar English-language films, like last year’s “Killing Them Softly,” starring Brad Pitt, opened in only 75 screens. (Big-budget Hollywood movies, typically dubbed in local languages, open to much larger audiences. “The Amazing Spider-Man,” for example, opened in 1,250 screens while “The Avengers” opened in 1,100.)

While there was initially some uncertainty about the film finding a distributor in India, when PVR purchased the movie rights in October, Kamal Gianchandani, the company’s president, told Reuters that he was not expecting any trouble. “We don’t think the film is controversial,” he said.

Apart from the canceled Kolkata event, “Midnight’s Children” seems to have elicited a muted response from the public so far, which is surprising, considering Mr. Rushdie’s involvement and the book’s criticism of Indira Gandhi and her imposition of emergency powers in India between 1975 and 1977. Three years after the book was published, Mrs. Gandhi sued for defamation in Britain, over a single sentence that implied she was responsible for her husband’s death. The case was settled out of court, with Mr. Rushdie deleting the sentence.

The Congress Party, which reveres Mrs. Gandhi as an icon, has said nothing publicly. The film passed the censors without any cuts.

The movie was shot in Sri Lanka, somewhat secretly, said Ms. Mehta, who has been the target of protests by Hindu fundamentalists. “He’s got the Muslims, and I’ve got the Hindus,” she told the The Globe and Mail two years ago. Production was briefly interrupted because the Iranians protested, but was allowed to go ahead after the intervention of the Sri Lankan president. The filmmakers changed the title to “Winds of Change” for the remainder of the shoot.

A somewhat stealthy marketing strategy by PVR Pictures appears to have paid off for “Midnight’s Children,” which opened throughout the country Friday with little incident. “With Salman Rushdie, we did not want a repeat of Jaipur 2012,” said Mr. Nair.

“Controversies only create awareness for a film. What we were aiming for was ‘intent to watch,’ ” he said. “We avoided all controversy by keeping his plans in India under wraps. We targeted specific media, the six news channels and English-language press and specific cities.”

In Mumbai earlier this week, the venue for a promotional event for the movie was shifted from the Landmark bookstore at Infiniti Mall, in suburban Andheri, to south Mumbai’s National Center for the Performing Arts. Ashutosh Pandey, the chief operating officer of Landmark, said in a press release that the move was due to “security concerns.”

The new venue was the Little Theater, a 114-seater tucked inside the center’s compound, with plenty of police personnel and plainclothes officers in attendance. Anil Dharker, who heads Literature Live, a local literary festival, later said that he was asked to organize a new venue four days before the scheduled promotional gig. “I knew the N.C.P.A. would support it. I said, ‘We will keep it for people only I know.’ We sent out no invites.”

Mr. Rushdie may be the sharpest assessor of why “Midnight’s Children” appears to have avoided attracting the screaming hordes. Last March, he told a spellbound audience at a conclave organized by the news magazine India Today: “I have this theory that the Indian electorate is smarter than the politicians and sees through them. Yes, people can sometimes be whipped up, as they were by the religious extremists in Jaipur. But how many people? How big are these mobs? How representative are they? These attacks, whether upon my book or people’s films or plays or paintings or whatever, these are not things that come from the bottom up.”

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