Well: Expressing the Inexpressible

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another is “Barn Wish” by Kim Knedler Hewett.

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

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


Have you written a poem about cancer? Please share them with us in the comments section below.
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Gadgetwise Blog: This Robot Does Do Windows

The robots at this year’s Consumer Electronics Show fell largely into two categories: floor cleaners and toys. But there was an exception.

That was a robot taken cleaning to new heights – literally. It is the Winbot 7 Series from Ecovacs, and this robot does do windows.

The Winbot works much like any of the floor cleaning robots, only it works on vertical surfaces. Stick it outside on your window glass and it figures out the size of your window, then travels in a zigzag pattern to clean the surface.

The Winbot has to be plugged into an electrical outlet that feeds a powerful vacuum motor that keeps it stuck to the glass as it creeps around. There is a safety tether to keep the Winbot from bombing pedestrians below if it were to lose power. If the Winbot encounters a problem it sounds an alarm.

The Winbot has a damp cleaning pad on its leading edge that is followed by a squeegee and a drying pad in back. The reusable pads could require machine washing after a single large dirty window, but more typically the company said they needed a wash every few months.

The price of replacement parts and cleaning solution have not been yet determined. The Winbot becomes available in April at a list price of $300 for the 710 model that cleans framed windows, and $400 for the 730 model that cleans framed and frameless windows.

They will be available through the Ecovacs Web site.


This post has been revised to reflect the following correction:

Correction: February 7, 2013

Because of incorrect information from a company representative, an earlier version of this post misstated the prices of Winbot robots. The Winbot 710 costs $300, not $200, and the Winbot 730 costs $400, not $300.

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The Lede: Egyptian Prime Minister Criticized for Soliloquy on 'Ignorant' Mothers

Video of remarks by Egypt’s prime minister, Hisham Qandil, who blamed infant illness on “ignorant” rural mothers who fail to clean their breasts before nursing.

Last Updated, Thursday, 1:21 p.m. With angry protesters challenging the Egyptian government’s grip on strategic cities of the Suez Canal, the army chief warning of the potential “collapse of the state,” violent sexual assault plaguing demonstrations in Tahrir Square and more than 50 deaths in the latest round of street clashes, the nation’s prime minister spoke this week on state television about a social problem that few people saw coming: unclean breasts.

In rambling remarks broadcast on the state broadcaster Nile TV, Prime Minister Hisham Qandil turned his attention to the problem of diarrhea among infants in the Egyptian countryside. Specifically, he said: “I am certain, I don’t know, but am certain, that there are villages in Egypt in the 21st century where children get diarrhea” because “the mother nurses them and out of ignorance does not undertake personal hygiene of her breasts.”

He said that in rural areas, “there is no water and there is no sanitary sewer drainage.” Mr. Qandil also made a confusing reference to sexual assault, saying that in many villages “the men go to the mosque” while “the women go to the fields and they get raped.”

Mr. Qandil, an agricultural engineer and former water minister, spoke about villages that he said he had visited in the rural province of Beni Suef, 70 miles south of Cairo, the capital. Video of the remarks posted on YouTube shows that several male and female listeners appeared uncomfortable as the prime minister spoke.

On Thursday, Bloomberg News reported that a group of Beni Suef residents responded to Mr. Qandil’s comments by filing a legal complaint for libel and slander against the Prime Minister:

The claim against Prime Minister Hisham Qandil alleges he slandered and insulted the city’s female residents by saying they did not pay enough attention to personal hygiene, resulting in infants coming down with diarrhoea.

The remarks have also sparked controversy online and in Egypt’s raucous Arabic-language media. On Monday night, a talk show host on the independent Tahrir television network, Dina Abdel Fattah, asked her viewers, “Can you imagine, an Egyptian prime minister addressing a topic like that, while we have martyrs in the street, we have people being killed every day, we have entire provinces in a state of unrest?”

An Egyptian television host, Dina Abdel Fattah, attacked the prime minister for his comments blaming rural women’s personal hygiene for infant diarrhea.

On Twitter, several people agreed that it was odd for the prime minister to broach this subject in the midst of Egypt’s political crises. Others were shocked that Mr. Qandil, who holds a Ph.D. from North Carolina State University, would argue that women’s personal hygiene could cause diarrhea.

In the United States, medical consensus says that breast-feeding is beneficial for babies, and few studies appear to have been done on the effect of a mother’s personal hygiene on infant digestion. According to a pamphlet produced by the Office of Women’s Health at the United States Department of Health and Human Services, breast milk is “liquid gold,” rich in nutrients and antibodies, with “just the right amount of fat, sugar, water and protein” to help babies grow.

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Tool Kit: Protecting Your Privacy on the New Facebook





Facebook is a personal vault that can contain photos of your firstborn, plans to bring down your government and, occasionally, a record of your indiscretions.




It can be scoured by police officers, partners and would-be employers. It can be mined by marketers to show tailored advertisements.


And now, with Facebook’s newfangled search tool, it can allow strangers, along with “friends” on Facebook, to discover who you are, what you like and where you go.


Facebook insists it is up to you to decide how much you want others to see. And that is true, to some extent. But you cannot entirely opt out of Facebook searches. Facebook, however, does let you fine-tune who can see your “likes” and pictures, and, to a lesser extent, how much of yourself to expose to marketers.


The latest of its frequent changes to the site’s privacy settings was made in December. Facebook is nudging each of its billion subscribers to review them. The nudge could not have been more timely, said Sarah Downey, a lawyer with the Boston company Abine, which markets tools to help users control their visibility online. “It is more important than ever to lock down your Facebook privacy settings now that everything you post will be even easier to find,” she said.


That is to say, your settings will determine, to a large extent, who can find you when they search for women who buy dresses for toddlers or, more unsettling, women who jog a particular secluded trail.


What can you do? Ask yourself four simple questions.


QUESTION 1 How would you like to be found?


Go to “who can see my stuff” on the upper right side of your Facebook page. Click on “see more settings.” By default, search engines can link to your timeline. You can turn that off if you wish.


Go to “activity log.” Here you can review all your posts, pictures, “likes” and status updates. If you are concerned about who can see what, look at the original privacy setting of the original post.


In my case, I had been tagged eating a bowl of ricotta with my fingers at midnight near Arezzo. My friend who posted the picture enabled it to be seen by anyone, which means that it would show up in a stranger’s search for, I don’t know, people who eat ricotta with their fingers at midnight. I am tagged in other photos that are visible only to friends of the person who posted them. The point is, you want to look carefully at what the original settings are for those photos and “likes,” and decide whether you would like to be associated with them “I don’t get this Facebook thing either,” said one woman whose friend request I had accepted in January 2008. “But everyone in our generation seems to be on it.”


If you are concerned about things that might embarrass or endanger you on Facebook — Syrians who endorse the opposition may not want to be discovered by government apparatchiks — comb through your timeline and get rid of them. The only way to ensure that a post or photo is not discovered is to “unlike” or “delete” it.


Make yourself a pot of tea. This may take a while. The nostalgia may just be amusing.


QUESTION 2 What do you want the world to know about you?


Go to your profile page and click “About me.” Decide if you would like your gender, or the name of your spouse, to be visible on your timeline. Think about whether you want your birthday to be seen on your timeline. Your date of birth is an important piece of personal information for hackers to exploit.


A tool created a couple of weeks ago by a team of college students offers to look for certain words and phrases that could embarrass other college students as they apply for internships and jobs. It is called Simplewash, formerly Facewash, and it looks for profanity, references to drugs and other faux pas that you do not necessarily want, say, a law school admissions officer to see. Socioclean is another application that scours your Facebook posts. It is selling its service to college campuses to offer to students.


QUESTION 3 Do you mind being tracked by advertisers?


Facebook has eyes across the Web; one study found that its so-called widget — the innocuous blue letter “f” — is integrated into 20 percent of the 10,000 most popular Web sites.


This is how it works. I browsed an e-commerce site for girls’ dresses. When I logged back on to Facebook several days later, I was urged to buy dresses for “my darling daughter.” Facebook says that this kind of “retargeting” is a lucrative source of revenue. If that is annoying, several tools can help you block trackers. Abine, DisconnectMe and Ghostery offer browser extensions. Once installed on your Web browser, these extensions will tell you how many trackers they have blocked.


If you see an ad on the right rail of your Facebook page based on your Web browsing history, you can also opt out directly on Facebook. Hover over the “X” next to the ad and choose from the drop-down menu: “Hide this ad,” you could say. Or hide all ads from this brand. Facebook does not serve the ads itself, so to opt out of certain kinds of targeted ads, you must go to the third party that Facebook works with to show ads based on the Web sites you have browsed.


QUESTION 4 Whom do you want to befriend?


Now is the time to review whom you count among your Facebook friends. Your boss? Do you really want her to see pictures of you in Las Vegas? And the woman you met in Lamaze class: do you want the apps she has installed to know who you are? Privacyfix.com, a browser extension, shows you how to keep your friends’ Facebook applications from sucking you into their orbit. It is preparing to introduce a tool to control what it calls your “exposure” to the Facebook search engine.


Secure.me offers a similar feature. Depending on your privacy settings, that photo-sharing app that your Lamaze compatriot just installed could, in one click, know who you are and have access to all the photos that you thought you were sharing with “friends.”


One of Facebook’s cleverest heists is the word “friend.” It makes you think all your Facebook contacts are really your “friends.” They may not be.


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

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

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

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

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

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

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

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

The reasons are well known:

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Gadgetwise Blog: Your Lost Bags Sent a Text, Come Get Them

While services for tracking luggage with RFID tags, bar codes or GPS have been around for a while, a company called Trakdot is taking a slightly different approach. It is putting a radio transceiver on your bags that tells you where your luggage is when it isn’t where it should be.

It costs less than GPS trackers and the company says it is more secure than the RFID tags and bar codes.

The Trakdot doesn’t use GPS, which uses a lot of battery power. You don’t want the batteries to die before you get your bags back. Instead, it sends out a mobile phone signal that lets you find its general vicinity – within 30 feet, the company says – by seeing which cell towers it is near. This uses a lot less power than GPS. Trakdot estimates it can work for up to a month of continuous use on standard AA batteries.

Another battery saver, the Trakdot shuts down when on a plane. It senses when it is moving at more than 100 knots, then shuts down. Both the Federal Communications Commission and the Federal Aviation Administration have approved the device, according to the company.

Every 20 minutes the device pops on briefly to check speed, then shuts down again until the plane lands. Then it sends a text to show where the bag has arrived.

The Trakdot is $50, with an activation fee of $9 and a $13 annual fee. The device will be available in April.

The company concedes that a big warehouse might effectively block the signal, and that the Trakdot is as prone to dead areas as your mobile phone. If your bag disappears you should check Buffalo. That’s where my lost luggage goes. Always Buffalo.

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Clashes Erupt in Damascus, Shattering Lull, as Prospects for Talks Dim


Goran Tomasevic/Reuters


A building in the Damascus suburb of Zamalka was hit by a mortar shell fired by the Syrian Army on Wednesday.







BEIRUT, Lebanon — Syrian insurgents attacked military checkpoints and other targets in parts of central Damascus on Wednesday, antigovernment activist groups reported. The fighting shattered a lull there as prospects for any talks between the antagonists appeared to dim, a week after the opposition coalition leader first proposed the surprise idea of a dialogue aimed at ending the war.




Some antigovernment activists described the resumption of fighting, which had lapsed for the past few weeks, as part of a renewed effort by rebels to seize control of central Damascus, the Syrian capital, although that depiction seemed highly exaggerated. Witness accounts said many people were going about their business, while others noted that previous rebel claims of territorial gains in Damascus had almost always turned out to be embellished or unfounded.


Representatives of the Military Council of Damascus, an insurgent group, said that at least 33 members of President Bashar al-Assad’s security forces in Damascus had surrendered, while others had fled central Al Abasiyeen Square, and that other forces had erected roadblocks on all access streets to the area to thwart the movement of rebel fighters.


Salam Mohammed, an activist in Damascus, described Al Abasiyeen Square as “on fire,” and a video clip uploaded on YouTube showed a thick column of black smoke spiraling over the area while the sound of shelling could be heard. A voice is heard saying the shelling had started a fire. The Local Coordination Committees, an anti-Assad activist network in Syria, also reported gunfire in nearby streets.


Firas al-Horani, a military council spokesman, said fighters of the Free Syrian Army, the main armed opposition group, were in control of Al Abasiyeen Square. He also said, “The capital, Damascus, is in a state of paralysis at the moment, and clashes are in full force in the streets.”


It was impossible to confirm Mr. Horani’s assertions or the extent of the fighting because of Syrian government restrictions on foreign news organizations. But Syria’s state-run media said insurgent claims of combat success in Damascus were false. “Those are miserable attempts to raise the morale of terrorists who are fleeing our valiant armed forces,” said SANA, the official news agency.


Deadly violence also was reported in the Homs Province town of Palmyra, the site of a notorious prison where Mr. Assad’s father, Hafez, ordered the summary execution of about 1,000 prisoners during an uprising against his family’s grip on power in the 1980s.


The Syrian Observatory for Human Rights, a Britain-based group with a network of contacts inside Syria, said two booby-trapped cars exploded near the military intelligence and state security branches, killing at least 12 members of the security forces and wounding more than 20. The observatory said government forces deployed throughout Palmyra afterward, engaging in gun battles with insurgents that left at least eight civilians wounded in the cross-fire.


SANA also reported an attack but said it was caused by two suicide bombers who had targeted a residential part of the town, killing an unspecified number of civilians.


The new mayhem came as discord appeared to grow within the National Coalition of Syrian Revolutionary and Opposition Forces, the umbrella anti-Assad group, over a proposal made on Jan. 30 by Sheik Ahmad Moaz al-Khatib, its leader, to engage in talks with Mr. Assad’s government aimed at ending the nearly two-year-old conflict, which has left more than 60,000 people dead. Although Sheik Khatib’s proposal contained a number of conditions, it broke a longstanding principle that Mr. Assad must relinquish power before any talks can begin.


Many of Sheik Khatib’s colleagues grudgingly agreed to go along with the proposal after it had been made, but critical voices have been rising, especially among the coalition’s more militant elements.


In a new video uploaded on YouTube, a cleric from the Nusra Front, an anti-Assad Islamist militant group that the Obama administration has classified as a terrorist organization, said in a prayer speech that brute force against Mr. Assad and his disciples was the only solution.


“We will cut their heads, we swear to kill them all, and they will see our worst war,” said the cleric, who spoke in Libyan-accented Arabic at a mosque in the contested northern city of Aleppo, holding a sword in his right hand. “No for the negotiations, no for the talks, no retreat in a jihad for God’s sake.”


Hania Mourtada reported from Beirut, and Rick Gladstone from New York. Karam Shoumali contributed reporting from Antakya, Turkey.



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DealBook: Case Details Internal Tension at S.&P. Amid Subprime Problems

The subprime loans packaged up as complex securities for Standard & Poor’s to rate were already failing at such a fast clip in the fall of 2006 that some analysts at the firm thought they must be seeing typographical errors.

At the time, the nation’s biggest rating agency was making record profits, attaching sterling ratings to mortgage-related securities that were increasingly going bad. Inside the firm’s headquarters in lower Manhattan, tensions were escalating. Some executives pushed to revise the firm’s rating models in hopes of preserving market share and profits, while others expressed deep concerns about the poor performance of the securities, according to court records.

“This market is a wildly spinning top which is going to end badly,” one executive wrote in a confidential memo.

The account, culled from reams of internal e-mails, is part of civil fraud charges that the Justice Department filed late Monday against S.&P. in federal court in Los Angeles, accusing the firm of inflating ratings of mortgage investments and setting them up for a crash when the financial crisis struck.

The government is seeking $5 billion in penalties against the company to cover losses to investors like state pension funds and federally insured banks and credit unions. The amount would be more than five times what S.&P. made in 2011. S.&P. said it would vigorously defend itself against “these unwarranted claims.”

Sixteen states, including Iowa, Mississippi and Illinois, joined the joined the federal suit, and the New York attorney general said he was taking separate actions. California’s attorney general, Kamala D. Harris, said the state pension funds lost nearly $1 billion on the soured investments. The Securities and Exchange Commission has also been investigating possible wrongdoing at S.& P.

“The action we announce today marks an important step forward in the administration’s ongoing effort to investigate — and punish — the conduct that is believed to have continued to the worst economic crisis in recent history,” said Attorney General Eric Holder. The Justice Department called its investigation “Alchemy,” after medieval alchemists’ attempts to turn lead into gold.

Standard & Poor’s defended its corporate practices on Tuesday, saying the civil lawsuit filed by the Justice Department was “meritless.”

“Claims that we deliberately kept ratings high when we knew they should be lower are simply not true. S.&P. has always been committed to serving the interests of investors and all market participants by providing independent opinions on creditworthiness based on available information,” the rating agency said in a statement on Tuesday.

The company said that at all times its actions reflected its best judgments about the investments at the heart of the suit — about 40 collateralized debt obligations, or C.D.O.’s, an exotic type of security made up of bundles of residential mortgage-backed securities, which in turn were composed of individual home loans.

“Unfortunately,” the company’s statement said, “S.&P., like everyone else, did not predict the speed and severity of the coming crisis and how credit quality would ultimately be affected.”

McGraw-Hill shares were down 5 percent to $47.51 in early afternoon trading on the New York Stock Exchange, and have lost 19 percent of their value over the past two days.

The case is the first significant federal action against the ratings industry, which during the boom years bestowed high ratings that made many mortgage-related investments appear safer than they actually were.

It was unclear whether the Justice Department was looking at the other two major ratings agencies, Moody’s Investors Service and Fitch. Mr. West said he would not discuss actions against other rating agencies. In addition to joining the suit against S.&P., James Hood, the attorney general in Mississippi, said his state has also filed lawsuit against Moody’s.

The joint federal-state suit against S.&P. claims that from September 2004 through October 2007, S.&P. “knowingly and with the intent to defraud, devised, participated in, and executed a scheme to defraud investors” in certain mortgage-related securities. S.&P. also falsely represented that its ratings “were objective, independent, uninfluenced by any conflicts of interest,” the suit said.

Settlement talks between S.&P. and the Justice Department broke down in the last two weeks after prosecutors sought a penalty in excess of $1 billion and insisted that the company admit wrongdoing, several people with knowledge of the talks said. That amount would wipe out the profits of McGraw-Hill for an entire year. S.&P. had proposed a settlement of around $100 million, the people said. The government pressed for an admission of guilt to at least one count of fraud, said the people. S.&P. told prosecutors it could not admit guilt without exposing itself to liability in a multitude of civil cases.

On Monday, a spokesman for Moody’s declined to comment. A spokesman for Fitch, Daniel J. Noonan, said the agency could not comment on an action against Standard & Poor’s, but added, “We have no reason to believe Fitch is a target of any such action.”

The securities were created at the height of the housing boom, mainly for investment banks. S.&P. was paid fees of about $13 million for rating them. The firm gave the government more than 20 million pages of e-mails as part of its investigation, the people with knowledge of the process said.

Since the financial crisis in 2008, the ratings agencies’ business practices have been widely criticized and questions have been raised as to whether independent analysis was corrupted by Wall Street’s push for profits.

A Senate investigation made public in 2010 found that S.& P. and Moody’s used inaccurate rating models from 2004 to 2007 that failed to predict how high-risk mortgages would perform; allowed competitive pressures to affect their ratings; and failed to reassess past ratings after improving their models in 2006.

The companies failed to assign adequate staff to examine exotic investments, and failed to take mortgage fraud, lax underwriting and “unsustainable home price appreciation” into account in their models, the inquiry found.

“Rating agencies continue to create an even bigger monster — the C.D.O. market,” one S.&P. employee wrote in an internal e-mail in December 2006. “Let’s hope we are all wealthy and retired by the time this house of cards falters.”

Another S.&P. employee wrote in an instant message the next April, reproduced in the complaint: “We rate every deal. It could be structured by cows and we would rate it.”

In its statement Tuesday, S.&P. said that “the e-mail that says deals ‘could be structured by cows’ and be rated by S.&P. had nothing to do with R.M.B.S. or C.D.O. ratings or any S.&P. model. The company added that “the analyst had her concerns addressed with the issuer before S.&P. issued any rating.” S.&P. said that there was robust internal debate about how a rapidly deteriorating housing market might affect the C.D.O.’s, “and we applied the collective judgment of our committee-based system in good faith.”

“The e-mail excerpts cherry picked by D.O.J. have been taken out of context, are contradicted by other evidence, and do not reflect our culture, integrity or how we do business,” the credit rating agency said.

The three major ratings agencies are typically paid by the issuers of the securities they rate — in this case, the banks that had packaged the mortgage-backed securities and wanted to market them. The investors were not involved in the process but depended on the rating agencies’ assessments.

In a separate statement on Monday, S.&P. said it had begun stress-testing the mortgage-backed securities as early as 2005, trying to see how they would perform in a severe market downturn. S.&P. said it had also sent out early warning signals, downgrading hundreds of mortgage-backed securities, starting in 2006. Nor was it the only one to have underestimated the coming crisis, it said — even the Federal Reserve’s Open Market Committee believed that any problems within the housing sector could be contained.

The Justice Department, the company said, “would be wrong in contending that S.&P. ratings were motivated by commercial considerations and not issued in good faith.”

For many years, the ratings agencies have defended themselves successfully in civil litigation by saying their ratings were independent opinions, protected by the First Amendment, which guarantees the right to free speech. But developments in the wake of the financial crisis have raised questions about the agencies’ independence.

One federal judge, Shira A. Scheindlin, ruled in 2009 that the First Amendment did not apply in a lawsuit over ratings issued by S.&P. and Moody’s, because the mortgage-backed securities had not been offered to the public at large. Judge Scheindlin also agreed with the plaintiffs, who argued the ratings were not opinions, but misrepresentations, possibly the result of fraud or negligence.

The federal-state action is the first time a credit-rating agency has been charged under a 1989 law intended to protect taxpayers from frauds involving federally insured financial institutions, which since the financial crisis has been used against a number of federally insured banks, including Wells Fargo, Bank of America and Citigroup.

The government is taking a novel approach by accusing S.&P. of defrauding a federally insured institution and therefore injuring the taxpayer.

The lawsuit was filed in Central District of California, home to the defunct Western Federal Corporate Credit Union, which was the largest corporate credit union in the country. The credit union collapsed during the 2008 financial crisis after suffering huge losses on mortgage-backed securities rated by S.&P.

The Justice Department said it interviewed about 150 people in the investigation, including former S.&P. executives and analysts.

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Personal Health: Effective Addiction Treatment

Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.

But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you’re not alone. And chances are, it’s not your fault.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.

According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.

A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” The report added, “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.”

The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered “a form of medical malpractice.”

The failings of many treatment programs — and the comprehensive therapies that have been scientifically validated but remain vastly underused — are described in an eye-opening new book, “Inside Rehab,” by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed “Sober for Good.”

“There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches,” A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.

Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.

Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher’s exhaustive exploration in the first place.

In an interview, Ms. Fletcher said she wanted to inform consumers “about science-based practices that should form the basis of addiction treatment” and explode some of the myths surrounding it.

One such myth is the belief that most addicts need to go to a rehab center.

“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.

Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”

Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, “You don’t treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr “to serve as a model to demonstrate what comprehensive 21st century treatment should look like.”

“While some people are helped by one intensive round of treatment, the majority of addicts continue to need services,” Dr. Willenbring said. He cited the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed.

Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.

“We have some pretty good drugs to help people with addiction problems, but doctors don’t know how to use them,” he said. “The 12-step community doesn’t want to use relapse-prevention medication because they view it as a crutch.”

Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.

Check on the credentials of the program’s personnel, who should have “at least a master’s degree,” Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.

Does the facility’s approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don’t choose it just because it’s the best known approach.

Meet with the therapist who will treat you and ask what your treatment plan will be. “It should be more than movies, lectures or three-hour classes three times a week,” Ms. Fletcher said. “You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.”

Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.”

Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.

Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, “Get Your Loved One Sober,” with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.

This is the first of two articles on addiction treatment.

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DealBook: $24 Billion Buyout for Dell, Biggest Since 2007

9:32 a.m. | Updated

Dell announced on Tuesday that it had agreed to go private in a $24.4 billion deal led by its founder and the investment firm Silver Lake, in the biggest leveraged buyout since the financial crisis.

Under the terms of the deal, the buyers’ consortium, which also includes Microsoft, will pay $13.65 a share in cash. That is roughly 25 percent above where Dell’s stock traded before word emerged of the negotiations of its sale.

Michael S. Dell will contribute his stake of roughly 14 percent toward the transaction, and will contribute additional cash through his private investment firm, MSD Capital. Silver Lake is expected to contribute about $1 billion in cash, while Microsoft will loan an additional $2 billion.

Dell’s board is said to have met on Monday night to vote on the deal. In its statement, the company said Mr. Dell recused himself from any discussions about a transaction and did not vote.

As a newly private company – now more firmly under the control of Mr. Dell – the computer maker will seek to revive itself after years of decline. The takeover represents Mr. Dell’s most drastic effort yet to turn around the company he founded in a college dormitory room in 1984 and expanded into one of the world’s biggest sellers of personal computers.

But the advent of new competition, first from other PC manufacturers and then smartphones and the iPad, severely eroded Dell’s business. Such is the concern about the company’s future that Microsoft agreed to lend some of its considerable financial muscle to shore up one of its most important business partners.

“I believe this transaction will open an exciting new chapter for Dell, our customers and team members,” Mr. Dell said in a statement. “Dell has made solid progress executing this strategy over the past four years, but we recognize that it will still take more time, investment and patience, and I believe our efforts will be better supported by partnering with Silver Lake in our shared vision.”

Still, analysts have expressed concern that even a move away from the unyielding scrutiny of the public markets will not let Mr. Dell accomplish what years of previous turnaround efforts have failed to achieve.

Nevertheless, the transaction represents a watershed moment for the private equity industry, reaching heights unseen over the past five years. It is the biggest leveraged buyout since the Blackstone Group‘s $26 billion takeover of Hilton Hotels in the summer of 2007, and it is supported by more than $15 billion of debt financing raised by no fewer than four banks.

“Michael Dell is a true visionary and one of the pre-eminent leaders of the global technology industry,” Egon Durban, a managing partner at Silver Lake, said in a statement. “Silver Lake is looking forward to partnering with him, the talented management team at Dell and the investor group to innovate, invest in long-term growth initiatives and accelerate the company’s transformation strategy to become an integrated and diversified global I.T. solutions provider.”

Mr. Dell first approached the board about taking the company private in August. That prompted the board to form a special committee, with JPMorgan Chase and the law firm Debevoise & Plimpton as advisers. It was charged with considering alternatives to a management buyout, including other deals or borrowing money to pay out a special dividend.

To help ward off accusations of self-dealing by Mr. Dell, the special committee has hired an independent investment bank, Evercore Partners, specifically to oversee a 45-day “go shop” period in which the company will solicit other potential buyers.

“The special committee and its advisers conducted a disciplined and independent process intended to ensure the best outcome for shareholders,” Alex J. Mandl, the head of the Dell independent committee, said in a statement. “Importantly, the go-shop process provides a real opportunity to determine if there are alternatives superior to the present offer from Mr. Dell and Silver Lake.”

Dell itself was advised by Goldman Sachs and the law firm Hogan Lovells, while Mr. Dell retained Wachtell, Lipton, Rosen & Katz as legal counsel. Silver Lake was advised by Bank of America Merrill Lynch, Barclays, Credit Suisse, RBC Capital Markets and the law firm Simpson Thacher & Bartlett.

On Tuesday, Mr. Dell sent a memo to company employees about the deal. Here is a copy of the memo:

Today, we announced a definitive agreement for me and global technology investment firm Silver Lake to acquire Dell and take it private.

This transaction is an exciting new chapter for Dell, our team and our customers. We can immediately deliver value to stockholders, while continuing to execute our long-term growth strategy and focus on helping customers achieve their goals.

Together, we have built an incredible business that generates nearly $60 billion in annual revenue. We deliver enormous customer value through end-to-end solutions that are scalable, secure and easy to manage, and Enterprise Solutions and Services now account for 50 percent of our gross margins.

Dell’s transformation is well underway, but we recognize it will still take more time, investment and patience. I believe that we are better served with partners who will provide long-term support to help Dell innovate and accelerate the company’s transformation strategy. We’ll have the flexibility to continue organic and inorganic investment, and grow our business for the long term.

I am particularly pleased to be in partnership with Silver Lake, a world-class investment firm with an outstanding reputation and significant experience in the technology sector. They know all the technology business models, understand the value chain and have an extremely strong global network of contacts. I am also glad that Microsoft is part of the transaction, further building on a nearly 30-year relationship.

I am honored to continue serving as chairman and CEO, and I look forward to working with all of you, including our current senior leadership team, to accelerate our efforts. There is much more we can accomplish together. I am committed to this journey and I am grateful for your dedication and support. Please, stay focused on delivering results for our customers and our company.

There is still considerable work to be done, and undoubtedly both challenges and triumphs lie ahead, but as always, we are making the right decisions to position Dell, our team and our customers for long-term success.

Michael

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