Clearing the Fog Around Personality Disorders

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

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

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

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

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

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

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

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

Habits of Thought

It wasn’t supposed to be this difficult.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Resisting Simplification 

It was easier said than done.

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

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

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

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

This article has been revised to reflect the following correction:

Correction: November 29, 2012

An earlier version of this article misstated the number of traits included in the proposed criteria for narcissistic personality disorder.   The final proposal relies on two personality traits, not four.

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DealBook: Vinod Khosla Keeps Long-Term Bet on Clean Technology

Vinod Khosla crowed about the clean energy industry last year. Three of the biofuel start-ups in his venture capital portfolio had just gone public, and the stocks had risen considerably after their debuts. “I challenge anybody to claim that clean tech done right is a disaster,” Mr. Khosla said at a conference, rebuffing recent criticism. “We’ve generated more profits there than anybody has.”

Since then, Mr. Khosla, the founder of Khosla Ventures, has watched much of those paper gains evaporate. As the clean energy industry broadly has taken a hit, shares of the biofuel companies — Amyris, Gevo and KiOR — have slumped 70 percent to 90 percent from their peaks. His stakes, once worth as much as $1.3 billion, are now valued at roughly $378 million.

The billionaire investor has been caught in the cyclical downdraft.

The public stocks of solar, wind and biofuel companies are suffering amid industrywide pressures. The price of natural gas remains low. Europe has pulled back on incentives. American subsidies are in question after the bankruptcy of the solar panel maker Solyndra. And China is providing formidable low-cost competition.

“The whole clean tech sector has been out of favor,” said Pavel Molchanov, an analyst at Raymond James & Associates, a brokerage firm. “I’d be hard pressed to name one trading above its I.P.O. price.”

Despite the crosscurrents, Mr. Khosla seems unwavering in his commitment. He is pouring money into start-ups. Khosla Ventures recently invested more in LightSail Energy, a three-year-old start-up working to develop low-cost energy storage. He is also sticking with his public companies. His firm, for example, still owns 54 percent of KiOR.

“He’s a visionary who likes to make big bets on ideas that can really change the world,” said Andy Bechtolsheim, who co-founded Sun Microsystems with Mr. Khosla 30 years ago and shares a house with him at Big Sur on the California coast. “I would think he’s made a larger personal bet on green tech than anybody else.”

While the public markets are raising short-term doubts, the long-term investment thinking remains unchanged. Governments around the globe are pushing to find alternative sources of energy in an effort to reduce their dependence on fossil fuels that may hurt the environment. In a television interview in 2007, Mr. Khosla said “mainstream solutions” could replace up to 80 percent of oil-based power. Without them, he said, “this planet is history the way we know it today.” After Hurricane Sandy, the subject of global warming — and changing climate conditions — has again come to the forefront.

In a recent blog post on the Forbes Web site, Mr. Khosla acknowledged the shift in market sentiment. “Clean tech went through a time when it was in vogue and now it is not,” he wrote. “The financing environment for clean tech companies is tough today,” he added. But he said he still expected “to do better than industry averages by keeping our losing companies to a minority.”

Since founding his venture capital firm in 2004, Mr. Khosla has become one of the most vocal advocates for clean tech innovation, buying stakes in about 60 industry start-ups. Ausra, a solar thermal start-up that had drawn $130 million in venture backing, was sold in 2010 to the French nuclear plant builder Areva for about $250 million, according to one industry estimate. And SeaMicro, a low-power server maker, was bought this year by Advanced Micro Devices for $334 million, more than five times the amount invested by its venture backers, according to a SeaMicro co-founder, Andrew Feldman.

It’s unclear how the broader clean tech portfolio has performed at Khosla Ventures. Mr. Khosla declined to disclose the firm’s returns or to comment for the article.

But one of his funds, which raised $1 billion to invest in clean tech and other start-ups, shows gain of 30 percent since its inception in 2009, according to filings by the California Public Employees’ Retirement System, the largest state pension fund. In his Forbes blog post, Mr. Khosla said a recent fund, which raised $1.05 billion in October 2011, was oversubscribed, and his firm’s broader performance since 2006 had “well exceeded typical venture funds.” In that period, venture funds over all have returned 7.25 percent annually after fees, according to industry data.

Mr. Khosla’s commitment is an outgrowth of his three decades at the cutting edge of technology.

A native of India, Mr. Khosla, 57, earned a master’s degree in biomedical engineering from Carnegie Mellon and an M.B.A. from Stanford in 1980. After starting the design automation company Daisy Systems in 1982, he co-founded Sun Microsystems, then a growing technology company.

At Sun, he supplied drive and vision. But Mr. Khosla, who is known for his blunt talk and intense manner, was replaced as chief executive two years later and left the company shortly thereafter.

In 1986, he joined the venture capital firm Kleiner Perkins Caufield & Byers. Over the next two decades, Mr. Khosla scored sizable returns betting on the growth of fiber optic networks. Two companies, Cerent and Siara Systems, were sold for a combined $15 billion-plus at the height of the late-1990s dot-com bubble.

Mr. Khosla was looking into alternative fuel technologies at Kleiner Perkins when a business plan for an ethanol start-up crossed his desk in 2003. The plan “sat on a corner of my desk for nearly 18 months while I read everything I could about petroleum and its alternatives,” he wrote in an article for Wired magazine in 2006.

When he branched out on his own in 2004, Mr. Khosla invested millions in the ethanol start-up, Celunol. He soon established himself as a top venture capitalist in clean tech, attracting prominent outside investors like Microsoft’s founder, Bill Gates. Former Prime Minister Tony Blair of Britain joined the firm as a senior adviser.

Over the years, Mr. Khosla has experienced his share of blowups.

In September 2011, Khosla-backed Range Fuels, a wood-chips-to-ethanol company, went bankrupt after receiving a $44 million grant from the Department of Energy and $33 million under a Department of Agriculture loan guarantee. When The Wall Street Journal editorial page criticized Range Fuels as an “exercise in corporate welfare,” Mr. Khosla lashed back, saying the authors inhabited an “ivory tower” that was “full of people who don’t understand technology.”

Sometimes, Mr. Khosla’s companies had to pivot from their original plans and focus on new markets. For example, Calera was founded in 2007 with plans to use power plant exhaust to make cement. Mr. Khosla called its technology “game changing” in 2008.

But the company encountered some setbacks. It postponed plans for commercial-scale production in 2010 pending further research and later cut its 145-employee work force by two-thirds. Since then, Calera has broadened its focus, developing other products like fillers for paper and plastics.

Like many venture capital investors, Mr. Khosla will risk a few strikeouts for the chance to hit home runs. “My willingness to fail is what gives me the ability to succeed,” the investor has said frequently.

The odds can be especially brutal in clean technology. The projects are often capital-intensive — like $200 million or more for a biofuels plant — and they can take years to pay out, said Sam Shelton, a research engineer at Georgia Institute of Technology. By comparison, social media start-ups often require little upfront money and few employees. “The economics are totally different,” Mr. Shelton said.

In part, Mr. Khosla aims to take stakes when the companies are still getting off the ground, rather than waiting until they’re more mature and more expensive. He first bought a stake in KiOR, which aims to convert wood chips to gas and diesel fuel, in 2007. The company is now completing the first of five planned plants in Mississippi with the help of a $75 million interest-free loan from the state.

Mr. Khosla is “always thinking at a very high level about the potential of an idea,” KiOR’s chief executive, Fred Cannon, said. “He has a very good feel for when to step on the gas.”

After jumping in early, Mr. Khosla appears willing to ride out the swings, in both directions. Over the years, public filings indicate he has plowed roughly $80 million into KiOR, amassing a 54 percent stake in the company. Although the stock is off its peak levels and I.P.O. investors are still underwater, his holdings are worth $356 million — a threefold gain.

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This post has been revised to reflect the following correction:

Correction: November 30, 2012

An earlier version of this article mischaracterized Mr. Khosla's return on his investment in KiOR. He invested roughly $80 million and his holdings are worth $356 million — a threefold gain, not a fourfold gain.

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As Opposition Coalition Meets in Cairo, More Violence Kills Dozens in Syria

Francisco Leong/Agence France-Presse — Getty Images

Rebels celebrated on top of a downed Syrian jet in Daret Azzeh, 20 miles west of Aleppo, on Wednesday.

In its first major effort to show that it can be a viable political force, the newly formed Syrian opposition coalition started talks in Egypt on Wednesday aimed at forming an alternative to the government of President Bashar al-Assad and paving the way for more international acceptance and aid.

The coalition, whose official name is the National Coalition of Syrian Revolutionary and Opposition Forces, was formed at a meeting in Qatar this month and has been recognized by Britain, France, Turkey and the Gulf Cooperation Council. To win further support from foreign capitals, it must tackle the broader problems of uniting the many opposition groups in exile and the rebels on the ground in Syria.

Delegates were expected to hold their second day of talks in a Cairo hotel on Thursday against the backdrop of a 20-month civil war in which about 40,000 people have been killed in clashes between armed rebels and jihadist fighters on one side and Mr. Assad’s forces on the other. The rebels appear to be gaining in their strategy to challenge the air supremacy of Mr. Assad’s military.

There were reports on Wednesday that for the second successive day, insurgents had shot down a government aircraft. Video posted on the Internet by rebels showed an airplane tail assembly jutting out of debris. Such videos are difficult to verify, but the episode on Wednesday seemed to be confirmed by other witnesses.

“We watched a Syrian plane being shot down as it was flying low to drop bombs” on the town of Daret Azzeh, 20 miles west of Aleppo and close to the Turkish border, said Ugur Cuneydioglu, who said he saw the aircraft being downed from a Turkish border village in southern Hatay Province. “It slowly went down in flames before it hit the ground. It was quite a scene,” Mr. Cuneydioglu said.

The video said the plane had been brought down by “the free men of Daret Azzeh soldiers of God brigade.”

On Tuesday, Syrian rebels said they shot down a military helicopter with a surface-to-air missile outside Aleppo.

The violence on Wednesday also included car bombs in a Damascus suburb that killed dozens of people.

In their first meeting since their umbrella organization was created in Doha, Qatar, on Nov. 11, coalition delegates confronted the realities of the political terrain. Disagreements emerged over the coalition’s composition when one member, the Syrian National Council, tried to increase the number of its representatives.

“Nothing will proceed until we work this out,” said one council member who spoke on condition of anonymity, according to Reuters.

The focus also seemed to be more on deciding how leadership candidates should be chosen rather than on who they might be. “I don’t think we’ll be discussing the election of a transitional government during the meeting today,” said Khaled Khoja, a coalition member. “We’re still discussing whether to have a government or to have committees instead.”

While the group, and the talks, are in their infancy, members appeared to recognize that world supporters were watching for results. Mr. Khoja said that while the group was discussing the coalition’s structure, it wanted to “see the outcome of the meeting in Morocco before deciding on the government.”

He was referring to a meeting planned for next month in Morocco of the so-called Friends of Syria group of nations, which includes the United States. At a meeting in New York City in September that included foreign ministers and Syrian opposition leaders, the group offered modest pledges of support for opponents of the Assad government. The opposition had unified under international pressure to give provinces better representation, and ideally, to oversee the disparate rebel factions while also providing a counterweight to the well-armed jihadist groups in the country.

The conflict has also flared along Syria’s borders with Lebanon, Israel, Turkey and Jordan.

In Turkey, which was once an ally of the Assad government, a team of NATO inspectors visited sites on Wednesday where the alliance might install batteries of Patriot antiaircraft missiles.

Another video on Wednesday showed a rebel fighter holding what appeared to be a complete SA-16 heat-seeking, shoulder-fired missile.

The man claimed to have shot down both the airplane and the helicopter, and said the missiles had been captured by rebels when they overran Base 46 outside Aleppo earlier this month.

High-profile tactical successes in the war have often been followed by videotaped claims of responsibility, and in part are seen as fund-raising opportunities for the fighters. Many claims, including those by the rebel fighters, are impossible to verify immediately.

But it was significant. The SA-16 is more modern and capable than the more commonly seen SA-7. It flies at a faster speed, can be used against aircraft at much wider range of attack angles, has a longer range and is promoted by its Russian exporters as being more resistant to an aircraft’s efforts to thwart it.

Its presence suggested that the rebels have been acquiring more weapons and could be mounting a more meaningful challenge to the Syrian Air Force.

State news media said on Wednesday that two car bombings struck Jaramana, a suburb of Damascus that is populated by members of the Christian and Druse minorities.

The SANA news agency said the death toll was at least 34. An activist group based in Britain, the Syrian Observatory for Human Rights, said 47 people were killed.

Christine Hauser reported from New York, and Hala Droubi from Dubai, United Arab Emirates. Reporting was contributed by Alan Cowell from London; Sebnem Arsu from Istanbul; Hania Mourtada from Beirut, Lebanon; and C. J. Chivers from the United States.

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Obama takes “fiscal cliff” battle to Twitter

WASHINGTON (Reuters) – President Barack Obama opened a new front on Wednesday in the battle between Democrats and Republicans over the best way to avoid the year-end “fiscal cliff” – Twitter.

The web-savvy Obama administration launched a social media campaign that asks Twitter users to add the “#my2k” hashtag to messages with examples of what $ 2,000 means to them.

The amount is roughly what a middle-class family of four would have to pay extra in taxes next year if Congress cannot strike a deal to remove the threat of roughly $ 600 billion in tax hikes and federal spending cuts.

The fast-paced social networking site known for its zippy 140-character comments is a tried-and-true method of reaching Americans. The latest call for such searchable references is an effort to pressure Congress into finding compromise on long-held partisan views.

Obama announced the new Twitter hashtag campaign at a news conference on Wednesday. He and fellow Democrats, who oppose significant cuts to U.S. “entitlement” programs such as Medicare as a way of balancing the budget, have been trying to break Republican opposition to hiking taxes on anyone, including the wealthy.

Promotions of “#my2k” quickly went out to millions of followers of the White House Twitter account and scores of Democratic backers, including former House of Representatives Speaker Nancy Pelosi. Soon, “my2k” was a top-trending subject.

“#My2K means food for a year, the remainder of my student loan paid off or a full month of child care. $ 2200 can make or break a family,” wrote Twitter user Katrina Burchett.

In the anarchic spirit of social media, Republicans, who also polished their Twitter hashtag skills during the bitter 2012 presidential campaign, pounced quickly.

The conservative Heritage Foundation bought the promotional tweet that pops up at the top of the list if one searches for “#my2k” mentions, where the think tank offered its own take on solutions to the fiscal cliff.

House Speaker John Boehner and scores of fellow Republican lawmakers started sharing examples they hoped would put the blame for the lack of a resolution on the Democrats.

“We in the House took steps this summer to avert #fiscalcliff and stop #my2K tax hikes,” wrote Representative Mike Turner. “It’s time for @whitehouse and @SenateDems to act.”

‘BEING AWARE OF WHAT’S GOING ON’

Users on Twitter can sign up to follow one another’s messages, making searchable hashtags a helpful way to sort by subject or theme.

Marcus Messner, who studies social media at Virginia Commonwealth University, said Twitter was a perfect environment to reignite Obama’s base swiftly and gauge public engagement on the issue.

The Obama administration has used Twitter hashtags as part of lobbying campaigns to keep student loan rates low with #dontdoublemyrate and to extend payroll tax cuts with #40dollars, which was their estimate of how much the cuts saved an average family each year.

White House Social Media Director Macon Phillips later called the $ 40dollars hashtag “one of the most significant campaigns we ran on Twitter.”

“It’s about being aware of what’s going on and understanding that in the age of social media, you’re just a participant,” he told an Entrepreneur.com blogger in February. “It’s not something that you can control.”

(Editing by Peter Cooney)

Internet News Headlines – Yahoo! News

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Bonds, Clemens, Sosa on Hall ballot for first time

NEW YORK (AP) — The most polarizing Hall of Fame debate since Pete Rose will now be decided by the baseball shrine's voters: Do Barry Bonds, Roger Clemens and Sammy Sosa belong in Cooperstown despite drug allegations that tainted their huge numbers?

In a monthlong election sure to become a referendum on the Steroids Era, the Hall ballot was released Wednesday, and Bonds, Clemens and Sosa are on it for the first time.

Bonds is the all-time home run champion with 762 and won a record seven MVP awards. Clemens took home a record seven Cy Young trophies and is ninth with 354 victories. Sosa ranks eighth on the homer chart with 609.

Yet for all their HRs, RBIs and Ws, the shadow of PEDs looms large.

"You could see for years that this particular ballot was going to be controversial and divisive to an unprecedented extent," Larry Stone of The Seattle Times wrote in an email. "My hope is that some clarity begins to emerge over the Hall of Fame status of those linked to performance-enhancing drugs. But I doubt it."

More than 600 longtime members of the Baseball Writers' Association of America will vote on the 37-player ballot. Candidates require 75 percent for induction, and the results will be announced Jan. 9.

Craig Biggio, Mike Piazza and Curt Schilling also are among the 24 first-time eligibles. Jack Morris, Jeff Bagwell and Tim Raines are the top holdover candidates.

If recent history is any indication, the odds are solidly stacked against Bonds, Clemens and Sosa. Mark McGwire and Rafael Palmeiro both posted Cooperstown-caliber stats, too, but drug clouds doomed them in Hall voting.

Some who favor Bonds and Clemens claim the bulk of their accomplishments came before baseball got wrapped up in drug scandals. They add that PED use was so prevalent in the 1980s, 1990s and early 2000s that it's unfair to exclude anyone because so many who-did-and-who-didn't questions remain.

Many fans on the other side say drug cheats — suspected or otherwise — should never be afforded the game's highest individual honor.

Either way, this election is baseball's newest hot button, generating the most fervent Hall arguments since Rose. The discussion about Rose was moot, however — the game's career hits leader agreed to a lifetime ban in 1989 after an investigation concluded he bet on games while managing the Cincinnati Reds, and that barred him from the BBWAA ballot.

The BBWAA election rules allow voters to pick up to 10 candidates. As for criteria, this is the only instruction: "Voting shall be based upon the player's record, playing ability, integrity, sportsmanship, character, and contributions to the team(s) on which the player played."

That leaves a lot of room for interpretation.

Bonds, Clemens and Sosa won't get a vote from Mike Klis of The Denver Post.

"Nay on all three. I think in all three cases, their performances were artificially enhanced. Especially in the cases of Bonds and Clemens, their production went up abnormally late in their careers," he wrote in an email.

They'll do better with Bob Dutton of The Kansas City Star.

"I plan to vote for all three. I understand the steroid/PED questions surrounding each one, and I've wrestled with the implications," he wrote in an email.

"My view is these guys played and posted Hall of Fame-type numbers against the competition of their time. That will be my sole yardstick. If Major League Baseball took no action against a player during his career for alleged or suspected steroid/PED use, I'm not going to do so in assessing their career for the Hall of Fame," he said.

San Jose Mercury News columnist Mark Purdy will reserve judgment.

"At the beginning of all this, I made up my mind I had to adopt a consistent policy on the steroid social club. So, my policy has been, with the brilliance in the way they set up the Hall of Fame vote where these guys have a 15-year window, I'm not going to vote for any of those guys until I get the best picture possible of what was happening then," he wrote in an email.

"We learn a little bit more each year. We learned a lot during the Bonds trial. We learned a lot during the Clemens trial. I don't want to say I'm never going to vote for any of them. I want to wait until the end of their eligibility window and have my best idea of what was really going on," he said.

Clemens was acquitted this summer in federal court on six counts that he lied and obstructed Congress when he denied using performance-enhancing drugs.

Bonds was found guilty in 2011 by a federal court jury on one count of obstruction of justice, ruling he gave an evasive answer in 2003 to a grand jury looking into the distribution of illegal steroids. Bonds is appealing the verdict.

McGwire is 10th on the career home run list with 583, but has never received even 24 percent in his six Hall tries. Big Mac has admitted to using steroids and human growth hormone.

Palmeiro is among only four players with 500 homers and 3,000 hits, yet has gotten a high of just 12.6 percent in his two years on the ballot. He drew a 10-day suspension in 2005 after a positive test for PEDs, and said the result was due to a vitamin vial given to him by teammate Miguel Tejada.

Biggio topped the 3,000-hit mark — which always has been considered an automatic credential for Cooperstown — and spent his entire career with the Houston Astros.

"Hopefully, the writers feel strongly that they liked what they saw, and we'll see what happens," Biggio said last week.

Schilling was 216-146 and won three World Series championships, including his "bloody sock" performance for the Boston Red Sox in 2004.

___

AP Baseball Writer Janie McCauley and AP Sports Writers Arnie Stapleton and Dave Skretta contributed to this report.

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Well: Weight Loss Surgery May Not Combat Diabetes Long-Term

Weight loss surgery, which in recent years has been seen as an increasingly attractive option for treating Type 2 diabetes, may not be as effective against the disease as it was initially thought to be, according to a new report. The study found that many obese Type 2 diabetics who undergo gastric bypass surgery do not experience a remission of their disease, and of those that do, about a third redevelop diabetes within five years of their operation.

The findings contrast with the growing perception that surgery is essentially a cure for Type II diabetes. Earlier this year, two widely publicized studies reported that surgery worked better than drugs, diet and exercise in causing a remission of Type 2 diabetes in overweight people whose blood sugar was out of control, leading some experts to call for greater use of surgery in treating the disease. But the studies were small and relatively short, lasting under two years.

The latest study, published in the journal Obesity Surgery, tracked thousands of diabetics who had gastric bypass surgery for more than a decade. It found that many people whose diabetes at first went away were likely to have it return. While weight regain is a common problem among those who undergo bariatric surgery, regaining lost weight did not appear to be the cause of diabetes relapse. Instead, the study found that people whose diabetes was most severe or in its later stages when they had surgery were more likely to have a relapse, regardless of whether they regained weight.

“Some people are under the impression that you have surgery and you’re cured,” said Dr. Vivian Fonseca, the president for medicine and science for the American Diabetes Association, who was not involved in the study. “There have been a lot of claims about how wonderful surgery is for diabetes, and I think this offers a more realistic picture.”

The findings suggest that weight loss surgery may be most effective for treating diabetes in those whose disease is not very advanced. “What we’re learning is that not all diabetic patients do as well as others,” said Dr. David E. Arterburn, the lead author of the study and an associate investigator at the Group Health Research Institute in Seattle. “Those who are early in diabetes seem to do the best, which makes a case for potentially earlier intervention.”

One of the strengths of the new study was that it involved thousands of patients enrolled in three large health plans in California and Minnesota, allowing detailed tracking over many years. All told, 4,434 adult diabetics were followed between 1995 and 2008. All were obese, and all underwent Roux-en-Y operations, the most popular type of gastric bypass procedure.

After surgery, about 68 percent of patients experienced a complete remission of their diabetes. But within five years, 35 percent of those patients had it return. Taken together, that means that most of the subjects in the study, about 56 percent — a figure that includes those whose disease never remitted — had no long-lasting remission of diabetes after surgery.

The researchers found that three factors were particularly good predictors of who was likely to have a relapse of diabetes. If patients, before surgery, had a relatively long duration of diabetes, had poor control of their blood sugar, or were taking insulin, then they were least likely to benefit from gastric bypass. A patient’s weight, either before or after surgery, was not correlated with their likelihood of remission or relapse.

In Type 2 diabetes, the beta cells that produce insulin in the pancreas tend to wear out as the disease progresses, which may explain why some people benefit less from surgery. “If someone is too far advanced in their diabetes, where their pancreas is frankly toward the latter stages of being able to produce insulin, then even after losing a bunch of weight their body may not be able to produce enough insulin to control their blood sugar,” Dr. Arterburn said.

Nonetheless, he said it might be the case that obese diabetics, even those whose disease is advanced, can still benefit from gastric surgery, at least as far as their quality of life and their risk factors for heart disease and other complications are concerned.

“It’s not a surefire cure for everyone,” he said. “But almost universally, patients lose weight after weight loss surgery, and that in and of itself may have so many health benefits.”

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United Is Struggling Two Years After Its Merger With Continental

Nam Y. Huh/Associated Press

A United 787 Dreamliner at O’Hare International Airport in Chicago. United lost $103 million through the third quarter of 2012.

CHICAGO — It was supposed to be a moment for celebration: United Airlines observing the delivery of its second Boeing 787 Dreamliner with a flight from Seattle to Chicago earlier this month for a select group of employees, while senior officers, including Jeffery A. Smisek, United’s hard-charging chief executive, served Champagne and took lunch orders.

Jad Mouawad/The New York Times

Jeff Smisek, the chief of United Airlines, served champagne on a flight to celebrate delivery of a Boeing 787 on Nov. 15.

But before the flight took off that morning, a computer glitch in one of the airline’s computer systems delayed 250 flights around the world for two hours.

So it goes at United these days. The world’s biggest airline, created after United merged with Continental Airlines in 2010, promised an unparalleled global network, with eight major hubs and 5,500 daily flights serving nearly 400 destinations. As an added benefit, the new airline would be led by Mr. Smisek of Continental, which was known for its attention to customer service.

But two years on, United still grapples with a myriad problems in integrating the two airlines. The result has been hobbled operations, angry passengers and soured relations with employees.

The list of United’s troubles this year has been long. Its reservation system failed twice, shutting its Web site, disabling airport kiosks and stranding passengers as flights were delayed or canceled. The day of the 787 flight, another system, which records the aircraft’s weight once passengers and bags are loaded, shut down because of a programming error.

United has the worst operational record among the nation’s top 15 airlines. Its on-time arrival rate in the 12 months through September was just 77.5 percent — six percentage points below the industry average and 10 percentage points lower than Delta Air Lines. It had the highest rate of regularly delayed flights this summer, and generated more customer complaints than all other airlines combined in July, according to the Transportation Department.

The airline even angered the mayor of Houston, Continental’s longtime home and still the carrier’s biggest hub, when it unsuccessfully sought to block Southwest Airlines’ bid to bring international flights to the city’s smaller airport, Hobby. 

The United-Continental merger is weighing on the company’s finances. It took a $60 million charge in the third quarter for merger-related expenses, including repainting planes. It also took a $454 million charge to cover a future cash payment to pilots under a tentative deal reached in August.

While most large airlines reported profits this year, United has lost $103 million in the first three quarters of 2012, with revenue up just 1 percent to $28.5 billion. Its shares are up 7 percent this year compared with a 12 percent gain for the Standard & Poor’s 500-stock index and a 24 percent gain for Delta.

“United remains at a challenging point,” analysts from Barclays wrote last month, and they forecast that the carrier would not begin to see the benefits of its merger until late in 2013 and into 2014. Still, while airlines initially struggle, mergers increase revenue eventually, as the example of Delta’s acquisition of Northwest Airlines demonstrated two years ago.

Mr. Smisek, taking a break from serving coffee halfway through the maiden 787 flight, acknowledged that things were not going as fast as expected, particularly given the aggressive targets he set two years ago. Back then, Mr. Smisek said the merger would be wrapped up in 12 to 18 months. He has since learned to be patient, he said.

“It is still a work in progress,” he said. “The integration of two airlines takes years. It’s very complex. If you look at where we were two years ago, we’ve come a long way.”

Admittedly, the process is complicated. Airline mergers mean combining different technologies, often old computer systems, as well as thousands of procedures used by pilots and flight dispatchers, gate agents, flight attendants and ground crew.

Setbacks are common. Like United, US Airways experienced a breakdown in its booking technology after its combination with America West in 2005. Delta’s on-time performance fell sharply in the year after its purchase of Northwest.

But today, Delta is a leader among big airlines in on-time performance. US Airways had a record third-quarter profit even though it still lacks common work rules for its pilots seven years after its merger.

United has completed many of its merger tasks, particularly as far as passengers are concerned. It has received its single operating certificate from the Federal Aviation Administration, allowing it to run a combined fleet. Despite all the problems this summer, it claims to have finally merged the reservation and technology systems.

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Protesters Gather Again in Cairo Streets to Denounce Morsi

CAIRO — Tens of thousands of people filled the central Tahrir Square on Tuesday afternoon in an outpouring of rage at President Mohamed Morsi’s attempt to claim expansive new powers and at the role in politics played by his party, the Muslim Brotherhood.

An attempt by Mr. Morsi on Monday to soften his edict, by reaffirming his deference to Egyptian courts, did little to constrain the crowd, which some estimates put at hundreds of thousands of people. In scenes that were reminiscent of the popular uprising against President Hosni Mubarak, and that signaled the country’s current widening divides, the protesters dusted off old taunts for Mr. Morsi, the country’s first freely elected leader.

“Leave,” they chanted. “The people want the fall of the regime.”

The president’s opponents turned out large numbers in several other cities, and clashed at times with his supporters, including in Mahalla el-Kubra in the Nile Delta, where more than a hundred people were reportedly injured. The Brotherhood also reported attacks on several of its political offices.

Most significant, though, was the turnout in Tahrir Square, where Egypt’s secular-minded opposition appeared to have momentarily overcome its divisions, bolstering its numbers with new allies among people implacably opposed to the Brotherhood, in an effort to muster a serious, visible challenge to Egypt’s Islamist groups.

It remained unclear whether Tuesday’s numbers signaled a new movement, or a moment. Islamists have repeatedly won at the polls since the fall of Mr. Mubarak, and the Brotherhood has shown its ability to turn out large crowds with little difficulty.

On Tuesday, the Brotherhood mocked the gathering in Tahrir Square, dismissing the protesters as “remnants” of the Mubarak government on a television channel associated with the group and playing down their numbers on Twitter.

The taunts were ignored in Tahrir Square, where the crowd chanted, “The square is full without the Brotherhood.”

The gathering was prompted by an edict released by Mr. Morsi last week that his decisions would be above judicial review, a move that essentially removed the last check on his power, since Egypt’s Parliament had earlier been dissolved by the courts.

Though Mr. Morsi framed the decree as an attempt to insulate Egypt’s constitutional assembly from being dissolved by Mubarak-era judges, it was quickly attacked as a power grab and a worrying return to autocracy. On Monday, through his spokesman, Mr. Morsi again tried to explain his intentions, saying he would work within judicial precedents to hold back efforts to dissolve the constituent assembly, rather than putting his power above judicial scrutiny.

Even as Mr. Morsi tried to placate the country’s judges, Egyptian television on Monday showed the growing polarization of the country in split-screen coverage of two funerals, each for a teenage boy killed in clashes set off by Mr. Morsi’s edict.

“Now blood has been spilled by political factions, so this is not going to go away,” said Rabab el-Mahdi, an activist and professor at the American University in Cairo, adding that these were the first deaths that rival factions had blamed on one another and not on the Mubarak government’s security forces since uprising began last year.

Despite Mr. Morsi’s attempts at clarification, opposition leaders went ahead with Tuesday’s protest. Some said that respect for the judiciary was now only a small part of their cause, and that their goal was to abort the current Islamist-dominated constituent assembly.

Many protesters treated the occasion as a referendum on Mr. Morsi’s rule, saying he and his prime minister had failed to make important changes, like reforming the Interior Ministry.

“I voted for Mr. Morsi,” said Emad Abdel Kawy, 35, a computer engineer. “It seems like he doesn’t know what he’s doing. You expect a revolution to bring revolutionary actions. It didn’t happen.” And like many here, Mr. Abdel Kawy blamed the Brotherhood, which Mr. Morsi helped lead before becoming president.

“It’s clear he doesn’t make the decisions,” he said of Mr. Morsi. “The decisions come to him.”

The gathering brought together the revolution’s hardened activists with their former foes, including supporters of the Mubarak government. Some said that the strange new alliances were just a necessary result of Egypt’s confusing, emerging politics. Yosra Mostafa, a 28-year-old activist, said she realized that some of Mr. Mubarak’s supporters had turned out simply because they sought a return to power.

“I don’t mind being on their side to oust a dictator,” she said, speaking of Mr. Morsi.

The show of unity masked deep divisions between the opposition and other groups and even in them, Ms. Mahdi said.

“This is not a united front, and I am inside it,” she said. “Every single political group in the country is now divided over this. Is the decree revolutionary justice or building a new dictatorship? Should we align ourselves with felool” — the term for the remnants of the old government — “or should we be revolutionary purists?”

Yasser el-Shimy, an Egypt analyst at the International Crisis Group, argued that the persistence of protests against Mr. Morsi reflected in part the failure of the opposition to accept its own recent election defeats, including of the parliamentary and presidential elections.

“It has never come to terms with these defeats, so it tries to delegitimize the Muslim Brotherhood,” he said.

Mayy El Sheikh and Mai Ayyad contributed reporting.

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Phils' Ruiz suspended 25 games after positive test

PHILADELPHIA (AP) — Add catcher to the Philadelphia Phillies' needs this offseason.

All-Star Carlos Ruiz was suspended Tuesday for the first 25 games of next season following a positive test for an amphetamine. The 33-year-old catcher had a career year in 2012, hitting .325 with 16 homers and 68 RBIs in 114 games.

"I am sincerely regretful for my mistake in taking a prohibited stimulant," Ruiz said in a statement issued by the Major League Baseball Players Association. "I apologize to my teammates, the Phillies organization and the Philadelphia fans. I will serve the imposed 25-game suspension to begin the season and I look forward to returning to the field and working toward bringing a championship back to Philadelphia in 2013."

Ruiz will be eligible to participate in spring training, including exhibition games.

"The Phillies fully support Major League Baseball's drug program," the team said. "We are disappointed by the news of this violation of the program. We will support Carlos in an appropriate manner and move forward to achieve our goal to play championship-caliber baseball in 2013."

Erik Kratz will likely begin the 2013 season as Philadelphia's starting catcher while Ruiz serves his suspension. Kratz, a career minor-leaguer, filled in nicely when he finally got a chance after Ruiz went down with a foot injury. Kratz hit .248, but had nine doubles, nine homers and 26 RBIs in only 141 at-bats. Kratz also threw out 45 percent of base-stealers (15 of 33).

Still, losing Ruiz hurts a lineup that struggled mightily last year. Ruiz moved up from his usual No. 8 spot and took over for an injured Ryan Howard as the team's cleanup hitter for a chunk of the season. He batted fifth after Howard returned in July.

The Phillies, who finished 81-81 after winning five straight NL East titles, have several holes to fill. Only Howard, Chase Utley and Jimmy Rollins are certain regulars. Utley, though, didn't play until late May in 2011 and late June in 2012 because of chronic knee injuries.

General manager Ruben Amaro Jr. hopes to add a starting center fielder, another starting outfielder and a third baseman either through free agency or trades. Now he'll also need a backup catcher for Kratz for the first month. Brian Schneider served as the team's primary backup the last three seasons, but only batted .212 in 122 games.

The Phillies have two top prospects catching in the minors. Sebastian Valle hit .253 with 17 homers and 58 RBIs in 80 games at Double-A Reading and Triple-A Lehigh Valley. Tommy Joseph, acquired in the trade that sent Hunter Pence to San Francisco, hit .257 with 11 homers and 48 RBIs for the Giants' and Phillies' Double-A affiliates.

Ruiz became the eighth player suspended this year under the major league testing program, the second for amphetamines following Baltimore shortstop Ryan Adams. The eight suspensions are the most since 2007.

This had to be Ruiz's second positive test for a stimulant. An initial positive for a stimulant does not trigger a suspension, only that the player must undergo follow-up testing.

There have been 102 suspensions this year under the minor league testing program.

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Follow Rob Maaddi on Twitter: https://twitter.com/RobMaaddi

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Global Update: Investing in Eyeglasses for Poor Would Boost International Economy

BSIP/UIG Via Getty Images

Eliminating the worldwide shortage of eyeglasses could cost up to $28 billion, but would add more than $200 billion to the global economy, according to a study published last month in the Bulletin of the World Health Organization.

The $28 billion would cover the cost of training 65,000 optometrists and equipping clinics where they could prescribe eyeglasses, which can now be mass-produced for as little as $2 a pair. The study was done by scientists from Australia and the Johns Hopkins Bloomberg School of Public Health.

The authors assumed that 703 million people worldwide have uncorrected nearsightedness or farsightedness severe enough to impair their work, and that 80 percent of them could be helped with off-the-rack glasses, which would need to be replaced every five years.

The biggest productivity savings from better vision would not be in very poor regions like Africa but in moderately poor countries where more people have factory jobs or trades like driving or running a sewing machine.

Without the equivalent of reading glasses, “lots of skilled crafts become very difficult after age 40 or 45,” said Kevin Frick, a Johns Hopkins health policy economist and study co-author. “You don’t want to be swinging a hammer if you can’t see the nail.”

If millions of schoolchildren who need glasses got them, the return on investment could be even greater, he said, but that would be in the future and was not calculated in this study.

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