Ecstasy Treatment for Post-Traumatic Stress Shows Promise

Gretchen Ertl for The New York Times

ALTERNATIVE TREATMENT Rick Doblin of the Multidisciplinary Association for Psychedelic Studies, which is financing research into the drug Ecstasy.

Hundreds of Iraq and Afghanistan veterans with post-traumatic stress have recently contacted a husband-and-wife team who work in suburban South Carolina to seek help. Many are desperate, pleading for treatment and willing to travel to get it.

The soldiers have no interest in traditional talking cures or prescription drugs that have given them little relief. They are lining up to try an alternative: MDMA, better known as Ecstasy, a party drug that surfaced in the 1980s and ’90s that can induce pulses of euphoria and a radiating affection. Government regulators criminalized the drug in 1985, placing it on a list of prohibited substances that includes heroin and LSD. But in recent years, regulators have licensed a small number of labs to produce MDMA for research purposes.

“I feel survivor’s guilt, both for coming back from Iraq alive and now for having had a chance to do this therapy,” said Anthony, a 25-year-old living near Charleston, S.C., who asked that his last name not be used because of the stigma of taking the drug. “I’m a different person because of it.”

In a paper posted online Tuesday by the Journal of Psychopharmacology, Michael and Ann Mithoefer, the husband-and-wife team offering the treatment — which combines psychotherapy with a dose of MDMA — write that they found 15 of 21 people who recovered from severe post-traumatic stress in the therapy in the early 2000s reported minor to virtually no symptoms today. Many said they have received other kinds of therapy since then, but not with MDMA.

The Mithoefers — he is a psychiatrist and she is a nurse — collaborated on the study with researchers at the Medical University of South Carolina and the nonprofit Multidisciplinary Association for Psychedelic Studies.

The patients in this group included mostly rape victims, and experts familiar with the work cautioned that it was preliminary, based on small numbers, and its applicability to war trauma entirely unknown. A spokeswoman for the Department of Defense said the military was not involved in any research of MDMA.

But given the scarcity of good treatments for post-traumatic stress, “there is a tremendous need to study novel medications,” including MDMA, said Dr. John H. Krystal, chairman of psychiatry at the Yale School of Medicine.

The study is the first long-term test to suggest that psychiatrists’ tentative interest in hallucinogens and other recreational drugs — which have been taboo since the 1960s — could pay off. And news that the Mithoefers are beginning to test the drug in veterans is out, in the military press and on veterans’ blogs. “We’ve had more than 250 vets call us,” Dr. Mithoefer said. “There’s a long waiting list, we wish we could enroll them all.”

The couple, working with other researchers, will treat no more than 24 veterans with the therapy, following Food and Drug Administration protocols for testing an experimental drug; MDMA is not approved for any medical uses.

A handful of similar experiments using MDMA, LSD or marijuana are now in the works in Switzerland, Israel and Britain, as well as in this country. Both military and civilian researchers are watching closely. So far, the research has been largely supported by nonprofit groups.

“When it comes to the health and well-being of those who serve, we should leave our politics at the door and not be afraid to follow the data,” said Brig. Gen. Loree Sutton, a psychiatrist who recently retired from the Army. “There’s now an evidence base for this MDMA therapy and a plausible story about what may be going on in the brain to account for the effects.”

In interviews, two people who have had the therapy — one, Anthony, currently in the veterans study, and another who received the therapy independently — said that MDMA produced a mental sweet spot that allowed them to feel and talk about their trauma without being overwhelmed by it.

“It changed my perspective on the entire experience of working at ground zero,” said Patrick, a 46-year-old living in San Francisco, who worked long hours in the rubble after the Sept. 11, 2001, attacks searching in vain for survivors, as desperate family members of the victims looked on, pleading for information. “At times I had this beautiful, peaceful feeling down in the pit, that I had a purpose, that I was doing what I needed to be doing. And I began in therapy to identify with that,” rather than the guilt and sadness.

This article has been revised to reflect the following correction:

Correction: November 20, 2012

An earlier version of this article described incorrectly the office arrangement the Mithoefers use to conduct therapy sessions using MDMA. They hold the sessions in an office in a converted house, but they do not conduct the sessions in their home office.

Read More..

Ecstasy Treatment for Post-Traumatic Stress Shows Promise

Gretchen Ertl for The New York Times

ALTERNATIVE TREATMENT Rick Doblin of the Multidisciplinary Association for Psychedelic Studies, which is financing research into the drug Ecstasy.

Hundreds of Iraq and Afghanistan veterans with post-traumatic stress have recently contacted a husband-and-wife team who work in suburban South Carolina to seek help. Many are desperate, pleading for treatment and willing to travel to get it.

The soldiers have no interest in traditional talking cures or prescription drugs that have given them little relief. They are lining up to try an alternative: MDMA, better known as Ecstasy, a party drug that surfaced in the 1980s and ’90s that can induce pulses of euphoria and a radiating affection. Government regulators criminalized the drug in 1985, placing it on a list of prohibited substances that includes heroin and LSD. But in recent years, regulators have licensed a small number of labs to produce MDMA for research purposes.

“I feel survivor’s guilt, both for coming back from Iraq alive and now for having had a chance to do this therapy,” said Anthony, a 25-year-old living near Charleston, S.C., who asked that his last name not be used because of the stigma of taking the drug. “I’m a different person because of it.”

In a paper posted online Tuesday by the Journal of Psychopharmacology, Michael and Ann Mithoefer, the husband-and-wife team offering the treatment — which combines psychotherapy with a dose of MDMA — write that they found 15 of 21 people who recovered from severe post-traumatic stress in the therapy in the early 2000s reported minor to virtually no symptoms today. Many said they have received other kinds of therapy since then, but not with MDMA.

The Mithoefers — he is a psychiatrist and she is a nurse — collaborated on the study with researchers at the Medical University of South Carolina and the nonprofit Multidisciplinary Association for Psychedelic Studies.

The patients in this group included mostly rape victims, and experts familiar with the work cautioned that it was preliminary, based on small numbers, and its applicability to war trauma entirely unknown. A spokeswoman for the Department of Defense said the military was not involved in any research of MDMA.

But given the scarcity of good treatments for post-traumatic stress, “there is a tremendous need to study novel medications,” including MDMA, said Dr. John H. Krystal, chairman of psychiatry at the Yale School of Medicine.

The study is the first long-term test to suggest that psychiatrists’ tentative interest in hallucinogens and other recreational drugs — which have been taboo since the 1960s — could pay off. And news that the Mithoefers are beginning to test the drug in veterans is out, in the military press and on veterans’ blogs. “We’ve had more than 250 vets call us,” Dr. Mithoefer said. “There’s a long waiting list, we wish we could enroll them all.”

The couple, working with other researchers, will treat no more than 24 veterans with the therapy, following Food and Drug Administration protocols for testing an experimental drug; MDMA is not approved for any medical uses.

A handful of similar experiments using MDMA, LSD or marijuana are now in the works in Switzerland, Israel and Britain, as well as in this country. Both military and civilian researchers are watching closely. So far, the research has been largely supported by nonprofit groups.

“When it comes to the health and well-being of those who serve, we should leave our politics at the door and not be afraid to follow the data,” said Brig. Gen. Loree Sutton, a psychiatrist who recently retired from the Army. “There’s now an evidence base for this MDMA therapy and a plausible story about what may be going on in the brain to account for the effects.”

In interviews, two people who have had the therapy — one, Anthony, currently in the veterans study, and another who received the therapy independently — said that MDMA produced a mental sweet spot that allowed them to feel and talk about their trauma without being overwhelmed by it.

“It changed my perspective on the entire experience of working at ground zero,” said Patrick, a 46-year-old living in San Francisco, who worked long hours in the rubble after the Sept. 11, 2001, attacks searching in vain for survivors, as desperate family members of the victims looked on, pleading for information. “At times I had this beautiful, peaceful feeling down in the pit, that I had a purpose, that I was doing what I needed to be doing. And I began in therapy to identify with that,” rather than the guilt and sadness.

This article has been revised to reflect the following correction:

Correction: November 20, 2012

An earlier version of this article described incorrectly the office arrangement the Mithoefers use to conduct therapy sessions using MDMA. They hold the sessions in an office in a converted house, but they do not conduct the sessions in their home office.

Read More..

Virtual U.: Colleges Turn to Crowd-Sourcing Courses

Ozier Muhammad/The New York Times

Prof. Mitchell Duneier of Princeton is adapting his classroom teaching style for an online audience of tens of thousands.

Teaching Introduction to Sociology is almost second nature to Mitchell Duneier, a professor at Princeton: he has taught it 30 times, and a textbook he co-wrote is in its eighth edition. But last summer, as he transformed the class into a free online course, he had to grapple with some brand-new questions: Where should he focus his gaze while a camera recorded the lectures? How could the 40,000 students who enrolled online share their ideas? And how would he know what they were learning?

In many ways, the arc of Professor Duneier’s evolution, from professor in a lecture hall to online instructor of tens of thousands, reflects a larger movement, one with the potential to transform higher education. Already, a handful of companies are offering elite college-level instruction — once available to only a select few, on campus, at great cost — free, to anyone with an Internet connection.

Moreover, these massive open online courses, or MOOCs, harness the power of their huge enrollments to teach in new ways, applying crowd-sourcing technology to discussion forums and grading and enabling professors to use online lectures and reserve on-campus class time for interaction with students.

The spread of MOOCs is likely to have wide fallout. Lower-tier colleges, already facing resistance over high tuition, may have trouble convincing students that their courses are worth the price. And some experts voice reservations about how online learning can be assessed and warn of the potential for cheating.

MOOCs first landed in the spotlight last year, when Sebastian Thrun, a Stanford professor, offered a free artificial-intelligence course, attracting 160,000 students in 190 nations. The resulting storm of publicity galvanized elite research universities across the country to begin to open higher education to everyone — with the hope of perhaps, eventually, making money doing so.

The expansion has been dizzying. Millions of students are now enrolled in hundreds of online courses, including those offered by Udacity, Mr. Thrun’s spinoff company; edX, a joint venture of Harvard and the Massachusetts Institute of Technology; and Coursera, a Stanford spinoff that is offering Professor Duneier’s course and 200 others.

No one knows just how these massive courses will evolve, but their appeal to a broad audience is unquestioned: retirees in Indiana see them as a route to lifelong learning, students in India as their only lifeline to college-level work.

The professors involved face new challenges. “It was really intimidating at the beginning to do these lectures with no live audience, no sense of who was listening and how they were reacting,” Professor Duneier said. “I talk about things like racial differences in I.Q., Abu Ghraib and public bathrooms, and I worried that my lectures might come across as examples of American ethnocentrism.”

Feedback came quickly. When his first lecture went online, students wrote hundreds, then thousands, of comments and questions in online discussion forums — far too many for Professor Duneier to keep up with. But crowd-sourcing technology helped: every student reading the forum could vote questions and comments up or down, allowing him to spot important topics and tailor his lectures to respond.

Bigger Audiences

Top universities with courses like Professor Duneier’s stand to gain, both in prestige and in their ability to refine their pedagogy; few seem worried about diluting their brand-name appeal. The risks are greater for lesser colleges, which may be tempted to drop some of their own introductory courses — and some professors who teach them — and substitute cheaper online instruction from big-name professors.

“We’ve reached the tipping point where every major university is thinking about what they will do online,” said Peter McPherson, the president of the Association of Public and Land-Grant Universities. “In a way, the most important thing about these MOOCs from the top universities is that they provide cover, so other universities don’t need to apologize about putting courses online.”

In the rush to keep up, elite universities are lining up to join forces with a MOOC provider. Coursera, which began with Princeton, the University of Pennsylvania, Stanford and the University of Michigan in April, currently leads the field with 33 university partners. But edX, too, is expanding rapidly — the University of California, Berkeley, has joined, and the University of Texas announced that it would use edX courses for credit. Already, students in one Udacity class can get credit through the Global Campus of Colorado State University. Most MOOC providers are making plans to offer credit — and charge fees for certificates and proctored exams.

Read More..

Truce in Gaza Is Close, Egyptian Officials Say

JERUSALEM — Diplomatic efforts accelerated on Tuesday to end the deadly confrontation between Israel and Palestinian militants in Gaza, as the United States sent Secretary of State Hillary Rodham Clinton to the Middle East and Egypt’s president and his senior aides expressed confidence that a cease-fire was close.

The diplomatic moves to end the nearly week-old crisis came on a day of some of the most intense violence yet, in what appeared to be efforts by the antagonists to get their last attacks done before a cease-fire went into effect.

Israeli aerial forces assaulted several Gaza targets in multiple strikes, including a suspected rocket-launching site near Al Shifa hospital, which killed more than a dozen people, and Israeli naval vessels launched an intensive shelling aimed at the Gaza coastline. A delegation visiting from the Arab League canceled a news conference at the hospital because of the Israeli aerial assaults as wailing ambulances brought victims in, some of them decapitated.

Militants in Gaza fired a barrage of rockets into southern Israel, killing an Israeli soldier — the first military casualty on the Israeli side since the hostilities broke out last week. The Israel Defense Forces said the soldier, identified as Yosef Fartuk, 18, died from a rocket strike that hit an area near Gaza.

Other Palestinian rockets hit the southern Israeli cities of Beersheba and Ashdod, and longer-range rockets were fired at Tel Aviv and Jerusalem, but neither main city was struck and no casualties were reported. One Gaza rocket hit a building in the Israeli city of Rishon Lezion, just south of Tel Aviv, injuring one person and wrecking the top three floors.

Senior Egyptian officials in Cairo said Israel and Hamas, the militant Islamist group that governs Gaza, were “very close” to a cease-fire agreement that could be announced within hours. “We have not received final approval but I hope to receive it any moment,” said Essam el-Haddad, President Mohamed Morsi’s top foreign affairs adviser.

Foreign diplomats who were briefed on the outlines of a tentative agreement said it had been structured in stages — first, an announcement at approximately 10 p.m. local time (3 p.m. E.S.T.) of a cease-fire, followed by its implementation at midnight, for 48 hours. That would allow time for Mrs. Clinton to arrive, and to create a window for negotiators to agree on conditions for a longer-term cessation of hostilities.

Whether Hamas can enforce control over all of the militant Palestinian factions in Gaza to hold their fire during that period remained unclear.

The announcement of Mrs. Clinton’s active role in efforts to defuse the crisis added a strong new dimension to the multinational push to avert a new Middle East war. Israel has amassed thousands of soldiers on the border with Gaza and has threatened to invade the crowded Palestinian enclave for the second time in four years to stop the persistent rockets that have been lobbed at Israel.

Mrs. Clinton, who accompanied President Obama on his three-country Asia trip, left Cambodia on her own plane immediately for the Middle East. She was en route to Jerusalem to meet with Prime Minister Benjamin Netanyahu of Israel, then head to the West Bank to meet with Palestinian leaders and finally to Cairo to consult with Egyptian officials.

Mr. Obama made a number of late-night phone calls from his Asian tour to the Middle East on Monday night that contributed to his conclusion that he had to become more engaged and that Mrs. Clinton might be able to accomplish something.

With Ban Ki-moon, the United Nations secretary general, also in Israel on Tuesday, a senior official in Prime Minister Benjamin Netanyahu’s office said Israel had decided to give more time to diplomacy before starting a ground invasion into Gaza. But Israel has not withdrawn other options.

“I prefer a diplomatic solution,” Mr. Netanyahu said in a statement at the start of a meeting in Jerusalem with the German foreign minister, Guido Westerwelle. “I hope that we can get one, but if not, we have every right to defend ourselves with other means and we shall use them.

“As you know, we seek a diplomatic unwinding to this, through the discussions of cease-fire,” Mr. Netanyahu added. “But if the firing continues, we will have to take broader action and we won’t hesitate to do so.”

Intensifying the pressure on Hamas after a day of heavy rocket fire out of Gaza against southern Israel, the Israeli military said on Tuesday afternoon that it had distributed leaflets over Gaza instructing the Palestinian residents in several areas to evacuate their homes immediately, “for your safety,” and to move toward defined zones in central Gaza City. That seemed intended to signal that plans for a ground operation were imminent should the cease-fire talks fail. About three hours before Mr. Ban was scheduled to meet Mr. Netanyahu in Jerusalem, sirens sounded across the city in the early afternoon announcing an incoming rocket from Gaza. The military wing of Hamas said it had fired at the city. The rocket fell short, landing harmlessly in the West Bank just south of Jerusalem, and the military said it landed on open ground near a Palestinian village.

The rocket attack on the city, which is holy to Jews, Muslims and Christians, was the second in less than a week. On Friday, a rocket landed in a similar location, the police said.

Isabel Kershner reported from Jerusalem; Peter Baker from Phnom Penh, Cambodia; and Rick Gladstone from New York. Reporting was contributed by Jodi Rudoren from Gaza City, David D. Kirkpatrick from Cairo, Ethan Bronner from Jerusalem and David E. Sanger from Washington.

Read More..

News Corporation Looks at Potential Acquisitions

Kevork Djansezian/Getty Images

Rupert Murdoch, second from left, with his sons, Lachlan, left, and James, second from right, and Chase Carey, News Corporation’s president and chief operating officer, in July in Sun Valley, Idaho.

The media conglomerate, which had been on its heels for more than a year because of the phone hacking scandal in Britain, is looking to make acquisitions again. First on the list could be a 49 percent stake in the Yes Network in New York, a purchase that could become the foundation for a new nationwide sports network to compete with ESPN.

News Corporation’s stock has reached highs as the company prepares to transfer its underperforming publishing assets, including newspapers like The Wall Street Journal and The New York Post, into a separate publicly traded entity.

One of the crucial factors in the decision was that the split would allow Rupert Murdoch, the company’s chairman and chief executive, to buy into the businesses he loves without upsetting investors who are more interested in cable and broadcast. Potential targets include The Los Angeles Times, The Chicago Tribune and more education companies.

“Rupert has his mojo back,” said Todd Juenger, a media analyst at Sanford C. Bernstein. “The stock is up, investors are happy with the company’s recent decisions.”

“He is definitely rubbing his hands together,” a person with knowledge of News Corporation’s deal-making discussions said of Mr. Murdoch.

In the last several weeks, Mr. Murdoch has exuded a satisfaction and sure-footedness that people close to the company said they had not seen since before Mr. Murdoch’s British newspaper unit became embroiled in a phone hacking scandal. That is in part because hacking has been overtaken in the press by an unfolding scandal at the British Broadcasting Corporation.

The BBC, which Mr. Murdoch and his son James have frequently criticized, is accused of canceling a news program’s segment about serial child molesting committed by longtime host Jimmy Savile, and broadcasting false reports of pedophilia about a member of Margaret Thatcher’s administration.

People close to Mr. Murdoch said he considered the BBC scandal karmic justice for months of negative coverage of News Corporation, and he has provided almost daily commentary via Twitter. “BBC getting into deeper mess,” he wrote on Nov. 10. “After Savile scandal, now prominent news program falsely names senior pol as pedophile.”

And the BBC scandal touches another Murdoch rival — The New York Times, whose parent company’s new chief executive, Mark Thompson, served as director general at the BBC. Mr. Thompson’s replacement at the BBC, George Entwistle, resigned on Nov. 11 after just 54 days on the job. “Look to new CEO to shape up NYT unless recalled to BBC to explain latest scandal,” Mr. Murdoch wrote on Twitter last month.

As News Corporation sank into its hacking scandal last year, it delayed new acquisitions. In September, Britain’s Office of Communications, known as Ofcom, said that British Sky Broadcasting, 39.1 percent owned by News Corporation, was “fit and proper” to hold a broadcast license. The decision removed a cloud of uncertainty at News Corporation’s Manhattan headquarters and cleared the company to revisit deals, analysts said.

“The internal narrative at the company is that the boss is in shopping mode,” said one person close to News Corporation who could not discuss Mr. Murdoch’s thinking publicly.

Dropping its $12 billion bid for the portion of BSkyB that it did not already own gave News Corporation ample cash to complete share buybacks and consider other acquisitions. The company had $9.6 billion in cash at the end of its 2012 fiscal year and in September borrowed another $1 billion.

On a recent earnings call, Chase Carey, News Corporation’s president and chief operating officer, said: “We always seem to be the topic of the day when it comes to a rumor of some transaction.” Still, he added: “There are places where we think we should kick the tires on things.”

Last week News Corporation neared a deal with Yankees Global Enterprises to buy a 49 percent stake in the Yes Network, a regional New York sports network, with a valuation of about $3 billion. A stake in Yes would add to News Corporation’s lineup of regional sports channels and contribute to its reported plans to introduce a national cable sports channel that could take on the Walt Disney Company’s ESPN.

“It’s one of the only businesses where there’s no No. 2,” said Michael Nathanson, a media analyst at Nomura Securities. “In our view, sports is the safest asset in media.”

This month the company paid an estimated $250 million for the portion of ESPN Star Sports that it did not already own. ESPN Star Sports, based in Singapore, operates 17 sports networks in five languages around Asia.

Read More..

Teenage Boys, Worried About Body Image, Take Health Risks

Béatrice de Géa for The New York Times

David Abusheikh at a gym in Brooklyn. He goes six days a week and says he uses protein supplements to help build muscle.

It is not just girls these days who are consumed by an unattainable body image.

Take David Abusheikh. At age 15, he started lifting weights for two hours a day, six days a week. Now that he is a senior at Fort Hamilton High School in Brooklyn, he has been adding protein bars and shakes to his diet to put on muscle without gaining fat.

“I didn’t used to be into supplements,” said Mr. Abusheikh, 18, who plans on a career in engineering, “but I wanted something that would help me get bigger a little faster.”

Pediatricians are starting to sound alarm bells about boys who take unhealthy measures to try to achieve Charles Atlas bodies that only genetics can truly confer. Whether it is long hours in the gym, allowances blown on expensive supplements or even risky experiments with illegal steroids, the price American boys are willing to pay for the perfect body appears to be on the rise.

In a study to be published on Monday in the journal Pediatrics, more than 40 percent of boys in middle school and high school said they regularly exercised with the goal of increasing muscle mass. Thirty-eight percent said they used protein supplements, and nearly 6 percent said they had experimented with steroids.

Over all, 90 percent of the 1,307 boys in the survey — who lived in the Minneapolis-St. Paul area, but typify what doctors say is a national phenomenon — said they exercised at least occasionally to add muscle.

“There has been a striking change in attitudes toward male body image in the last 30 years,” said Dr. Harrison Pope, a psychiatry professor at Harvard who studies bodybuilding culture and was not involved in the study. The portrayal of men as fat-free and chiseled “is dramatically more prevalent in society than it was a generation ago,” he said.

While college-age men have long been interested in bodybuilding, pediatricians say they have been surprised to find that now even middle school boys are so absorbed with building muscles. And their youth adds an element of risk.

Just as girls who count every calorie in an effort to be thin may do themselves more harm than good, boys who chase an illusory image of manhood may end up stunting their development, doctors say, particularly when they turn to supplements — or, worse, steroids — to supercharge their results.

“The problem with supplements is they’re not regulated like drugs, so it’s very hard to know what’s in them,” said Dr. Shalender Bhasin, a professor of medicine at Boston University School of Medicine. Some contain anabolic steroids, and even high-quality protein supplements might be dangerous in large amounts, or if taken to replace meals, he said. “These things just haven’t been studied very well,” he said.

Anabolic steroids pose a special danger to developing bodies, Dr. Bhasin said. Steroids “stop testosterone production in men,” he said, leading to terrible withdrawal problems when still-growing boys try to stop taking them. Still, the constant association of steroids with elite athletes like Lance Armstrong and Barry Bonds perpetuates the notion that they can be managed successfully.

Online, in bodybuilding forums for teenagers, boys barely out of puberty share weight-lifting regimens and body fat percentages, and judge one another’s progress. On Tumblr and Facebook, teenagers post images of ripped athletes under the heading “fitspo” or “fitspiraton,” which are short for “fitness inspiration.” The tags are spinoffs of “thinspo” and “thinspiration” pictures and videos, which have been banned from many sites for promoting anorexia.

“Lifted b4 school today felt good but was weak as hell,” wrote one boy who said he was 15 and from Tallahassee, Fla., on a message board on Bodybuilding.com in September, saying he bench-pressed 245 pounds. “Barely got it.”

Many of these boys probably see themselves in Mike Sorrentino, “The Situation” from the “Jersey Shore” series on MTV, or the Adam Sackler character, on the HBO series “Girls,” who rarely wears a shirt or takes a break from his crunches.

Mr. Abusheikh, for instance, has a Facebook page full of photos of himself shirtless or showing off his six-pack abs. At his high school, participation in the annual bodybuilding competition hit an all-time high of 30 students this year.

“They ask us about everything,” said Peter Rivera, a physical education teacher at Fort Hamilton High School who helps oversee the competition. “How do I lose weight? How do I gain muscle? How many times a week should I work out?” Some boys want to be stronger for sports, Mr. Rivera said, but others “want to change their body type.”

Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard. And instructors like Mr. Rivera say most boys are eager for advice on the healthiest, drug-free ways to get in shape.

With so little known about supplements, it can be difficult, particularly for teenagers, to make wise decisions.

This article has been revised to reflect the following correction:

Correction: November 19, 2012

An earlier version of this article gave an incorrect nationality for the soccer player Cristiano Ronaldo. He is Portuguese, not Brazilian. Because of an editing error, it misstated the number of boys included in the survey. The researchers interviewed 2,793 boys and girls, not 2,800 boys. It also described incorrectly the title of Dr. Shalender Bhasin. He is a professor of medicine at Boston University School of Medicine, not at the Boston Medical Center. An earlier version of an online picture caption misspelled the surname of the person pictured in one instance. He is David Abusheikh, not Abusheikm.

Read More..

Teenage Boys, Worried About Body Image, Take Health Risks

Béatrice de Géa for The New York Times

David Abusheikh at a gym in Brooklyn. He goes six days a week and says he uses protein supplements to help build muscle.

It is not just girls these days who are consumed by an unattainable body image.

Take David Abusheikh. At age 15, he started lifting weights for two hours a day, six days a week. Now that he is a senior at Fort Hamilton High School in Brooklyn, he has been adding protein bars and shakes to his diet to put on muscle without gaining fat.

“I didn’t used to be into supplements,” said Mr. Abusheikh, 18, who plans on a career in engineering, “but I wanted something that would help me get bigger a little faster.”

Pediatricians are starting to sound alarm bells about boys who take unhealthy measures to try to achieve Charles Atlas bodies that only genetics can truly confer. Whether it is long hours in the gym, allowances blown on expensive supplements or even risky experiments with illegal steroids, the price American boys are willing to pay for the perfect body appears to be on the rise.

In a study to be published on Monday in the journal Pediatrics, more than 40 percent of boys in middle school and high school said they regularly exercised with the goal of increasing muscle mass. Thirty-eight percent said they used protein supplements, and nearly 6 percent said they had experimented with steroids.

Over all, 90 percent of the 1,307 boys in the survey — who lived in the Minneapolis-St. Paul area, but typify what doctors say is a national phenomenon — said they exercised at least occasionally to add muscle.

“There has been a striking change in attitudes toward male body image in the last 30 years,” said Dr. Harrison Pope, a psychiatry professor at Harvard who studies bodybuilding culture and was not involved in the study. The portrayal of men as fat-free and chiseled “is dramatically more prevalent in society than it was a generation ago,” he said.

While college-age men have long been interested in bodybuilding, pediatricians say they have been surprised to find that now even middle school boys are so absorbed with building muscles. And their youth adds an element of risk.

Just as girls who count every calorie in an effort to be thin may do themselves more harm than good, boys who chase an illusory image of manhood may end up stunting their development, doctors say, particularly when they turn to supplements — or, worse, steroids — to supercharge their results.

“The problem with supplements is they’re not regulated like drugs, so it’s very hard to know what’s in them,” said Dr. Shalender Bhasin, a professor of medicine at Boston University School of Medicine. Some contain anabolic steroids, and even high-quality protein supplements might be dangerous in large amounts, or if taken to replace meals, he said. “These things just haven’t been studied very well,” he said.

Anabolic steroids pose a special danger to developing bodies, Dr. Bhasin said. Steroids “stop testosterone production in men,” he said, leading to terrible withdrawal problems when still-growing boys try to stop taking them. Still, the constant association of steroids with elite athletes like Lance Armstrong and Barry Bonds perpetuates the notion that they can be managed successfully.

Online, in bodybuilding forums for teenagers, boys barely out of puberty share weight-lifting regimens and body fat percentages, and judge one another’s progress. On Tumblr and Facebook, teenagers post images of ripped athletes under the heading “fitspo” or “fitspiraton,” which are short for “fitness inspiration.” The tags are spinoffs of “thinspo” and “thinspiration” pictures and videos, which have been banned from many sites for promoting anorexia.

“Lifted b4 school today felt good but was weak as hell,” wrote one boy who said he was 15 and from Tallahassee, Fla., on a message board on Bodybuilding.com in September, saying he bench-pressed 245 pounds. “Barely got it.”

Many of these boys probably see themselves in Mike Sorrentino, “The Situation” from the “Jersey Shore” series on MTV, or the Adam Sackler character, on the HBO series “Girls,” who rarely wears a shirt or takes a break from his crunches.

Mr. Abusheikh, for instance, has a Facebook page full of photos of himself shirtless or showing off his six-pack abs. At his high school, participation in the annual bodybuilding competition hit an all-time high of 30 students this year.

“They ask us about everything,” said Peter Rivera, a physical education teacher at Fort Hamilton High School who helps oversee the competition. “How do I lose weight? How do I gain muscle? How many times a week should I work out?” Some boys want to be stronger for sports, Mr. Rivera said, but others “want to change their body type.”

Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard. And instructors like Mr. Rivera say most boys are eager for advice on the healthiest, drug-free ways to get in shape.

With so little known about supplements, it can be difficult, particularly for teenagers, to make wise decisions.

This article has been revised to reflect the following correction:

Correction: November 19, 2012

An earlier version of this article gave an incorrect nationality for the soccer player Cristiano Ronaldo. He is Portuguese, not Brazilian. Because of an editing error, it misstated the number of boys included in the survey. The researchers interviewed 2,793 boys and girls, not 2,800 boys. It also described incorrectly the title of Dr. Shalender Bhasin. He is a professor of medicine at Boston University School of Medicine, not at the Boston Medical Center.

Read More..

The iEconomy: As Boom Lures App Creators, Tough Part Is Making a Living

Daniel Rosenbaum for The New York Times

Shawn and Stephanie Grimes’s efforts have cost $200,000 in lost income and savings, but their apps have earned less than $5,000 this year.

ROSEDALE, Md. — Shawn and Stephanie Grimes spent much of the last two years pursuing their dream of doing research and development for Apple, the world’s most successful corporation.

But they did not actually have jobs at Apple. It was freelance work that came with nothing in the way of a regular income, health insurance or retirement plan. Instead, the Grimeses tried to prepare by willingly, even eagerly, throwing overboard just about everything they could.

They sold one of their cars, gave some possessions to relatives and sold others in a yard sale, rented out their six-bedroom house and stayed with family for a while. They even cashed in Mr. Grimes’s 401(k).

“We didn’t lose any sleep over it,” said Mr. Grimes, 32. “I’ll retire when I die.”

The couple’s chosen field is so new it did not even exist a few years ago: writing software applications for mobile devices like the iPhone or iPad. Even as unemployment remained stubbornly high and the economy struggled to emerge from the recession’s shadow, the ranks of computer software engineers, including app writers, increased nearly 8 percent in 2010 to more than a million, according to the latest available government data for that category. These software engineers now outnumber farmers and have almost caught up with lawyers.

Much as the Web set off the dot-com boom 15 years ago, apps have inspired a new class of entrepreneurs. These innovators have turned cellphones and tablets into tools for discovering, organizing and controlling the world, spawning a multibillion-dollar industry virtually overnight. The iPhone and iPad have about 700,000 apps, from Instagram to Angry Birds.

Yet with the American economy yielding few good opportunities in recent years, there is debate about how real, and lasting, the rise in app employment might be.

Despite the rumors of hordes of hip programmers starting million-dollar businesses from their kitchen tables, only a small minority of developers actually make a living by creating their own apps, according to surveys and experts. The Grimeses began their venture with high hopes, but their apps, most of them for toddlers, did not come quickly enough or sell fast enough.

And programming is not a skill that just anyone can learn. While people already employed in tech jobs have added app writing to their résumés, the profession offers few options to most unemployed, underemployed and discouraged workers.

One success story is Ethan Nicholas, who earned more than $1 million in 2009 after writing a game for the iPhone. But he says the app writing world has experienced tectonic shifts since then.

“Can someone drop everything and start writing apps? Sure,” said Mr. Nicholas, 34, who quit his job to write apps after iShoot, an artillery game, became a sensation. “Can they start writing good apps? Not often, no. I got lucky with iShoot, because back then a decent app could still be successful. But competition is fierce nowadays, and decent isn’t good enough.”

The boom in apps comes as economists are debating the changing nature of work, which technology is reshaping at an accelerating speed. The upheaval, in some ways echoing the mechanization of agriculture a century ago, began its latest turbulent phase with the migration of tech manufacturing to places like China. Now service and even white-collar jobs, like file clerks and data entry specialists or office support staff and mechanical drafters, are disappearing.

“Technology is always destroying jobs and always creating jobs, but in recent years the destruction has been happening faster than the creation,” said Erik Brynjolfsson, an economist and director of the M.I.T. Center for Digital Business.

Still, the digital transition is creating enormous wealth and opportunity. Four of the most valuable American companies — Apple, Google, Microsoft and I.B.M. — are rooted in technology. And it was Apple, more than any other company, that set off the app revolution with the iPhone and iPad. Since Apple unleashed the world’s freelance coders to build applications four years ago, it has paid them more than $6.5 billion in royalties.

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The iEconomy: As Boom Lures App Creators, Tough Part Is Making a Living

Daniel Rosenbaum for The New York Times

Shawn and Stephanie Grimes’s efforts have cost $200,000 in lost income and savings, but their apps have earned less than $5,000 this year.

ROSEDALE, Md. — Shawn and Stephanie Grimes spent much of the last two years pursuing their dream of doing research and development for Apple, the world’s most successful corporation.

But they did not actually have jobs at Apple. It was freelance work that came with nothing in the way of a regular income, health insurance or retirement plan. Instead, the Grimeses tried to prepare by willingly, even eagerly, throwing overboard just about everything they could.

They sold one of their cars, gave some possessions to relatives and sold others in a yard sale, rented out their six-bedroom house and stayed with family for a while. They even cashed in Mr. Grimes’s 401(k).

“We didn’t lose any sleep over it,” said Mr. Grimes, 32. “I’ll retire when I die.”

The couple’s chosen field is so new it did not even exist a few years ago: writing software applications for mobile devices like the iPhone or iPad. Even as unemployment remained stubbornly high and the economy struggled to emerge from the recession’s shadow, the ranks of computer software engineers, including app writers, increased nearly 8 percent in 2010 to more than a million, according to the latest available government data for that category. These software engineers now outnumber farmers and have almost caught up with lawyers.

Much as the Web set off the dot-com boom 15 years ago, apps have inspired a new class of entrepreneurs. These innovators have turned cellphones and tablets into tools for discovering, organizing and controlling the world, spawning a multibillion-dollar industry virtually overnight. The iPhone and iPad have about 700,000 apps, from Instagram to Angry Birds.

Yet with the American economy yielding few good opportunities in recent years, there is debate about how real, and lasting, the rise in app employment might be.

Despite the rumors of hordes of hip programmers starting million-dollar businesses from their kitchen tables, only a small minority of developers actually make a living by creating their own apps, according to surveys and experts. The Grimeses began their venture with high hopes, but their apps, most of them for toddlers, did not come quickly enough or sell fast enough.

And programming is not a skill that just anyone can learn. While people already employed in tech jobs have added app writing to their résumés, the profession offers few options to most unemployed, underemployed and discouraged workers.

One success story is Ethan Nicholas, who earned more than $1 million in 2009 after writing a game for the iPhone. But he says the app writing world has experienced tectonic shifts since then.

“Can someone drop everything and start writing apps? Sure,” said Mr. Nicholas, 34, who quit his job to write apps after iShoot, an artillery game, became a sensation. “Can they start writing good apps? Not often, no. I got lucky with iShoot, because back then a decent app could still be successful. But competition is fierce nowadays, and decent isn’t good enough.”

The boom in apps comes as economists are debating the changing nature of work, which technology is reshaping at an accelerating speed. The upheaval, in some ways echoing the mechanization of agriculture a century ago, began its latest turbulent phase with the migration of tech manufacturing to places like China. Now service and even white-collar jobs, like file clerks and data entry specialists or office support staff and mechanical drafters, are disappearing.

“Technology is always destroying jobs and always creating jobs, but in recent years the destruction has been happening faster than the creation,” said Erik Brynjolfsson, an economist and director of the M.I.T. Center for Digital Business.

Still, the digital transition is creating enormous wealth and opportunity. Four of the most valuable American companies — Apple, Google, Microsoft and I.B.M. — are rooted in technology. And it was Apple, more than any other company, that set off the app revolution with the iPhone and iPad. Since Apple unleashed the world’s freelance coders to build applications four years ago, it has paid them more than $6.5 billion in royalties.

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Ashlyn Blocker, the Girl Who Feels No Pain

Jeff Riedel for The New York Times

Ashlyn Blocker, who feels no pain, at home in Patterson, GA.

The girl who feels no pain was in the kitchen, stirring ramen noodles, when the spoon slipped from her hand and dropped into the pot of boiling water. It was a school night; the TV was on in the living room, and her mother was folding clothes on the couch. Without thinking, Ashlyn Blocker reached her right hand in to retrieve the spoon, then took her hand out of the water and stood looking at it under the oven light. She walked a few steps to the sink and ran cold water over all her faded white scars, then called to her mother, “I just put my fingers in!” Her mother, Tara Blocker, dropped the clothes and rushed to her daughter’s side. “Oh, my lord!” she said — after 13 years, that same old fear — and then she got some ice and gently pressed it against her daughter’s hand, relieved that the burn wasn’t worse.

Tara Blocker

When Ashlyn was 2, her mother had to wrap her hands to keep her from biting them.

“I showed her how to get another utensil and fish the spoon out,” Tara said with a weary laugh when she recounted the story to me two months later. “Another thing,” she said, “she’s starting to use flat irons for her hair, and those things get superhot.”

Tara was sitting on the couch in a T-shirt printed with the words “Camp Painless But Hopeful.” Ashlyn was curled on the living-room carpet crocheting a purse from one of the skeins of yarn she keeps piled in her room. Her 10-year-old sister, Tristen, was in the leather recliner, asleep on top of their father, John Blocker, who stretched out there after work and was slowly falling asleep, too. The house smelled of the homemade macaroni and cheese they were going to have for dinner. A South Georgia rainstorm drummed the gutters, and lightning illuminated the batting cage and the pool in the backyard.

Without lifting her eyes from the crochet hooks in her hands, Ashlyn spoke up to add one detail to her mother’s story. “I was just thinking, What did I just do?” she said.

Over six days with the Blockers, I watched Ashlyn behave like any 13-year-old girl, brushing her hair, dancing around and jumping on her bed. I also saw her run without regard for her body through the house as her parents pleaded with her to stop. And she played an intense game of air hockey with her sister, slamming the puck on the table as hard and fast as she could. When she made an egg sandwich on the skillet, she pressed her hands onto the bread as Tara had taught her, to make sure it was cool before she put it into her mouth. She can feel warmth and coolness, but not the more extreme temperatures that would cause anyone else to recoil in pain.

Tara and John weren’t completely comfortable leaving Ashlyn alone in the kitchen, but it was something they felt they had to do, a concession to her growing independence. They made a point of telling stories about how responsible she is, but every one came with a companion anecdote that was painful to hear. There was the time she burned the flesh off the palms of her hands when she was 2. John was using a pressure-washer in the driveway and left its motor running; in the moments that they took their eyes off her, Ashlyn walked over and put her hands on the muffler. When she lifted them up the skin was seared away. There was the one about the fire ants that swarmed her in the backyard, biting her over a hundred times while she looked at them and yelled: “Bugs! Bugs!” There was the time she broke her ankle and ran around on it for two days before her parents realized something was wrong. They told these stories as casually as they talked about Tristen’s softball games or their son Dereck’s golf skills, but it was clear they were still struggling after all these years with how to keep Ashlyn safe.

A couple of nights after telling me the story about putting her hand in the boiling water, Ashlyn sat in the kitchen, playing with the headband that held back her long brown hair. We had all been drawing on napkins and playing checkers and listening to Ashlyn and Tristen sing “Call Me Maybe,” when all of a sudden Tara gasped and lifted the hair away from her daughter’s ears. She was bleeding beneath it. The headband had been cutting into her skin entire time we were sitting there.

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