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.

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News Analysis: St. Jude Medical Suffers for Redacting a Product Name

Peter Muhly for The New York Times

Dr. Ernest Lau holds a Durata lead from a St. Jude Medical Fortify ICD, an implanted heart defibrillator.

IS covering a product’s name in a public document a sign that a company has something to hide? And how should doctors, patients and investors react if the product at issue is one on which peoples’ lives and a company’s fortunes depend?

Such questions now loom over St. Jude Medical after the disclosure last week that its executives had blacked out the name of a heart device component when they released a critical federal report involving the product. The value of St. Jude has since plummeted more than $1 billion, or 12 percent. But the company’s actions may have a more lasting impact on its reputation and the health of patients, some experts say.

Last week’s incident was the latest development in a controversy involving the component, an electrical wire that connects an implanted defibrillator to a patient’s heart. St. Jude officials say the wire, which is known as the Durata, is safe. But uncertainty about the company’s statements is growing, underscored by its handling of the report, which involved a Food and Drug Administration inspection of a plant that makes the Durata.

St. Jude released that report in October as part of a filing with the Securities and Exchange Commission. The F.D.A. provides device makers with the reports in an unaltered form, and they may contain criticisms of a company’s procedures.

But the version of the report that St. Jude filed with the S.E.C. left some doctors and analysts uncertain about which company product or products were at issue for a simple reason — St. Jude had redacted, or blocked out, all 20 references to the Durata in it.

Company executives said they had done so based on their “good faith” interpretation of how the F.D.A. would act if it publicly released the report under the Freedom of Information Act. But both an F.D.A spokeswoman and a lawyer who specializes in medical devices took exception with that view, saying that names of approved products typically do not qualify as the type of confidential business information that the F.D.A. would redact.

Among other things, F.D.A. inspectors found significant flaws in the company’s testing and oversight of the Durata. It was those revelations and the implications that the problems could lead to further F.D.A. action against St. Jude that led to the sharp fall last week in its stock price.

In 2005, Guidant, a device maker that no longer exists, also found itself under scrutiny. Back then, its executives decided not to tell doctors that one of its defibrillators could short-circuit when a patient needed an electrical jolt to save a life. The expert who brought the Guidant problem to light, Dr. Robert Hauser, a heart specialist in Minnesota, has also raised concerns about the St. Jude wires, adding that he believes that its executives have been less than forthright.

“Patients and physicians would appreciate more information,” Dr. Hauser said.

In an earlier interview, St. Jude’s chief executive, Daniel J. Starks, said the company had hidden nothing about the Durata or another heart wire named the Riata, which it stopped selling in 2010.

“We’ve been more transparent than others,” said Mr. Starks, referring to company competitors like Medtronic.

Still, some Wall Street analysts share Dr. Hauser’s view. And if one St. Jude executive can claim credit for shaping their opinion, it would be Mr. Starks.

Earlier this year, he sought, among other things, to have a medical journal retract an article written by Dr. Hauser that was critical of the Riata. The publication refused.

Now, after St. Jude’s latest misfire, Wall Street analysts, who usually agree more than disagree, are placing wildly differing bets on St. Jude, with some valuing it at $48 a share and others at $30. On Monday, St. Jude closed at $31.86 on the New York Stock Exchange.

One of those bearish analysts, Matthew Dodds of Citigroup, said he thought the Food and Drug Administration might act soon on Durata. “I believe that a lot of their actions have made the situation worse, ” he said of the company’s executives.

A St. Jude spokeswoman, Amy Jo Meyer, reiterated the company’s stance that it had interpreted agency rules in “good faith” when releasing the redacted report about the Durata. An F.D.A. spokeswoman, Mary Long, said the agency did not consider the names of approved products to be confidential. And a lawyer, William Vodra, said that while device makers try to make a confidentiality argument for product data they consider embarrassing, like injury reports, they rarely succeed.

“In my experience, the F.D.A. consistently rejects” such arguments, Mr. Vodra wrote in an e-mail.

For patients, the dilemma may become more excruciating. The company’s earlier heart wire, the Riata, has begun failing prematurely in some of the 128,000 patients worldwide who received it. And those patients and their doctors face a difficult decision: whether to leave it in place or have it surgically removed, a procedure that carries significant risks.

St. Jude executives say that the Durata, which uses a different type of insulation than the Riata, is not prone to such problems.

And with the Durata already implanted in 278,000 people, many heart specialists certainly hope they are right.

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Sex, love, surrogacy and 'Sessions'

BERKELEY, Calif. — Cheryl Cohen Greene likes to spend weekends close to home with her husband, Bob, a former postal worker. Often, they go hiking in the Berkeley Hills that surround their neighborhood, or watch movies in the living room of their modest duplex.

At 68, Greene is trim for her age and says she'd lose 10 pounds if she didn't love food so much. She's a devoted grandmother who frequently visits with her two children and grandchildren.

No one would guess that more than 900 people have paid to have sex with her.

Greene has worked as a surrogate partner therapist for 40 years. During one-on-one sessions at her home, which doubles as an office, she uses sensual touch to guide those who struggle with sex and intimacy issues. She almost always removes her clothes. And — yes — she sleeps with her patients. In the bed, by the way, that she shares with her spouse.

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"For a long time, I didn't bring it up at cocktail parties," says Greene, who keeps hand-carved wooden statues of genitalia in the nooks and crannies of her home. A close look at her bookshelves reveals "The Guide to Getting It On" and hundreds of other sex-related titles, along with "Calorie Counting" and "The Big Book of Jewish Humor." A big Tupperware container labeled "Cheryl's Vitamins" rests on a coffee table.

"If people have an attitude about my job," she says, "I just feel sorry for them for not understanding that there's a difference between me and a prostitute."

Greene's career choice is getting newfound attention from "The Sessions," a movie based on the true story of Mark O'Brien, a journalist and poet paralyzed from the neck down. Greene, played in the film by Helen Hunt, was hired by the late O'Brien when he wanted to lose his virginity at age 38.

Not all of the attention is positive. Although some in the country's small community of sex surrogates are hopeful that "The Sessions" might inspire more people to join the profession, others say the movie does not accurately depict the career path and its therapeutic worth.

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"I would never get naked in my first session with someone like Cheryl's character does in the movie," says Shai Rotem, a 43-year-old male surrogate, who began his career in his native Israel and now practices in Los Angeles. "We have to get to know one another first and develop a safe rapport."

Greene is one of fewer than 40 practicing partner therapists in the U.S. certified by the International Professional Surrogates Assn., a governing body for the industry.

Two decades ago, there were hundreds of surrogates working in the U.S. after sex researchers William Masters and Virginia Johnson popularized the idea in their 1970 book "Human Sexual Inadequacy." With the rise of AIDS in the mid-1980s, many spouses of surrogates insisted their partners quit the profession.

"There's no law against it because the intent is not to exchange sex for money," says IPSA president Vena Blanchard. "These clients are paying tons of money to sit and talk and do breathing exercises and learn about their body. So much of the work has nothing to do with intercourse or arousal."

Greene, who speaks with a thick Boston accent, was born in Salem, Mass., grew up Catholic and converted to Judaism after marrying her first husband, Michael Cohen. She and Cohen had an open marriage, which in the 1970s wasn't unusual among their Bay Area peers. She also worked as a nude art model and walked around her home naked, even with her children in the room.

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She first considered becoming a surrogate after a friend handed her a copy of the pseudonymous "Surrogate Wife: The Story of a Masters & Johnson Sexual Therapist and the Nine Cases She Treated." The friend told her, "I think you would be good at this work."

She learned to practice conjoint therapy — where two or more people work through issues together — from two therapists who trained with Masters and Johnson. Soon, she began answering calls for the San Francisco Sex Information hotline, and discovered how much she liked helping people with their sex-related questions.

"I wasn't even thinking about the fact that I'd be sleeping with strangers," she says of her decision to become a surrogate. "I just liked the idea of guiding people to be more relaxed about their sexuality."

Greene sits in her bedroom as she talks, and through the window's plantation shutters, her son's home is visible. He and his family live behind Greene's residence.

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Alt Text: How to Tell Real SEALs From Basement-Dwelling Posers

The White House recently congratulated the makers of Troop ID, a service designed to help online merchants securely identify members of the armed forces. This was a significant recommendation, the first software application to be publicly praised by the president since he canceled a 2009 press conference in order to play Doodle Jump.

While I’m happy that troops will be able to claim their 10 percent discount on water bottles and mock turtlenecks, I’m a bit disappointed that the service is apparently only being used in a retail context. After the whole Stolen Valor saga, you’d think there’d be a huge demand for a secure way to vet self-described vets.

Here’s a statistic: While there are only 2,500 active-duty Navy SEALs at any given time, there are approximately 4 million people claiming to be current or former Navy SEALs in various chat rooms and message boards on the internet. This is because any argument is 200 percent more convincing when presented by a Navy SEAL.

A couple of examples:

Unconvincing: “As a mall food court assistant supervisor, I believe that our mission in Afghanistan is necessary to the stability of the Middle East.”
Convincing: “As a Navy SEAL, I believe that our mission in Afghanistan is necessary to the stability of the Middle East.”

Unconvincing: “As a teaching assistant in comparative literature, I believe that The Silmarillion is vastly overrated by Tolkien fans.”
Convincing: “As a Navy SEAL, I believe that The Silmarillion is vastly overrated by Tolkien fans.”

With results like that, it’s no wonder that people are attempting to fraudulently win arguments by pretending to be members of elite military squads like the SEALs, the Green Berets, the Army Rangers and occasionally G.I. Joe. It seems to me that Troop ID could be used to distinguish the Special Forces from the basement-dwelling posers.

Once we have that technology in place, we could easily expand it to ferret out other internet pretenders. For instance, before you claim that you’re going to show up at someone’s house and beat them up, or argue that you’d have a mugger in a headlock before he could say “hand over the cash,” you’d be expected to use the ToughGuy ID service to certify that you have actually, at some point, won a fight that wasn’t against a sibling at least four years younger than you.

Our founding fathers created the First Amendment protections on free speech for a good reason: because it’s freaking hilarious.

Or before you can declare that the solution to the “fiscal cliff” crisis is obvious to anyone who knows anything about economics, you’d be expected to provide proof to Expert ID that your main credentials in economics aren’t limited to having seen both Atlas Shrugged movies.

I say “expected to” because I’m not saying that you would have to sign up for these services. Goodness no, my ludicrous and improbable fantasies aren’t that tyrannical. I believe that our founding fathers created the First Amendment protections on free speech for a good reason: because it’s freaking hilarious. There’s nothing more fun than watching someone weave ever-more-desperate lies to cover up their unwillingness to either put, or shut, up.

However, I do think there’s one vital concern that overrides the right to free speech: Before commenting on a humor column on the web, everyone should be required to take a simple test that would confirm that they have the basic human ability to recognize sarcasm and hyperbole.

- - -

Born helpless, naked and unable to provide for himself, Lore Sjöberg overcame these handicaps to become a commando, a commandant and a cormorant.

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

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DealBook: New Breed of SAC Capital Hire Is at Center of Insider Trading Case

When Mathew Martoma walked onto the trading floor at SAC Capital Advisors six years ago, he represented a new breed of employee at the giant hedge fund.

Steven A. Cohen, SAC’s billionaire founder, had burnished his reputation as a market wizard by surrounding himself with hard-charging traders — many of them former college jocks and frat boys who thrived in the fund’s competitive, testosterone-fueled environment.

But the brainy and unassuming Mr. Martoma, armed with a Stanford business degree and an expertise in biomedicine, was part of a wave of SAC hires in a crack new research unit. They were just as driven but had more distinguished pedigrees, hailing from top investment banks and elite schools. They were drawn to the firm, in part, by the lavish annual bonuses Mr. Cohen bestowed upon his top performers, sometimes reaching into the tens of millions of dollars.

When Mr. Martoma walks into Federal District Court in Manhattan on Monday morning, he will represent something else: the latest in a growing list of former SAC employees who find themselves accused of breaking the law.

The case against Mr. Martoma, made in a criminal complaint filed by the government last week, represents a watershed moment in its multiyear investigation of insider trading at SAC. For the first time, prosecutors have linked Mr. Cohen to trading activity that the government contends was illegal.

Mr. Martoma has rebuffed efforts by federal authorities to persuade him to plead guilty and cooperate, said a person briefed on the investigation who was not authorized to discuss the case. But if he were to “flip,” Mr. Martoma could help the government with its investigation of Mr. Cohen.

The government has placed Mr. Martoma, 38, at the center of what it calls the most lucrative insider-trading scheme it has ever uncovered. Mr. Martoma is charged with corrupting a doctor who had access to secret drug data, then using that information to gain profits and avert losses totaling $276 million. Mr. Martoma closely collaborated with Mr. Cohen on the questionable trades, prosecutors contend. Mr. Cohen, 56, of Greenwich, Conn., has not been charged, and there is no allegation that he knew the information was confidential. Through a spokesman, Mr. Cohen said that he had at all times acted appropriately.

Charles A. Stillman, a lawyer for Mr. Martoma, who will appear before a federal magistrate judge Monday, said he expected his client to be exonerated.

But with Mr. Martoma’s arrest last week, the clouds over SAC, which is based in Stamford, Conn., and Mr. Cohen have darkened. The government has now implicated five former SAC employees in its sweeping investigation into insider trading; three have admitted their crimes. Three other SAC alumni have also been charged with illegal trading after they left the firm; two have pleaded guilty.

Former employees of Mr. Cohen, all of whom spoke on the condition of anonymity, said that the case against Mr. Martoma highlighted SAC’s high-stress, pressure-packed culture. They described a ruthless place where those who helped Mr. Cohen make money would earn fortunes, while laggards could be fired abruptly, even for a single wrong-way trade.

Though SAC, with about 1,000 employees, manages about $14 billion in assets and has pushed into more esoteric investment strategies, at its core the firm buys and sells stocks. Mr. Cohen and his staff are known for relentlessly digging for information about publicly traded companies to form a “mosaic,” building a complete picture of the company’s prospects that gives the firm an edge over other investors.

SAC hired Mr. Martoma to help Mr. Cohen gain that edge. The son of Indian immigrants, Mr. Martoma was born Ajai Mathew Mariamdani Thomas, but changed his name in 2003, according to legal records. Raised in Merritt Island, Fla., outside Cape Canaveral, Mr. Martoma graduated summa cum laude from Duke University in 1995, where he studied biomedicine, ethics and public policy. After college, Mr. Martoma worked in Washington at the National Human Genome Research Institute.

He spent a year and a half at Harvard Law School, then dropped out to earn a business degree at Stanford University. He blended his passion for medicine and a desire to work on Wall Street by pursuing a career as a stock analyst covering health care companies. After a stint at a smaller hedge fund, Sirios Capital Management in Boston, Mr. Martoma joined SAC.

He became part of a new unit, CR Intrinsic, which was set up as a research engine of SAC. CR Intrinsic (the CR stands for Cumulative Return) was led by Matthew Grossman, an ambitious young analyst who became Mr. Cohen’s right-hand man. Mr. Grossman had worked at Tiger Management, the hedge fund known for its rigorous research and longer-term investment horizon.

With a deep network of contacts in the pharmaceutical and biotech fields, Mr. Martoma made a mark at CR Intrinsic. The volatile health care stocks in which Mr. Martoma specialized had long been favorites of Mr. Cohen’s, offering the potential for big returns through betting on the outcome of events like clinical trials for promising drugs.

To bolster his knowledge, Mr. Martoma tapped into expert-network firms, which employ consultants who match money managers with industry specialists, including public company employees.

For an information-driven hedge fund like SAC, the temptation to exploit the expert-network relationship was immense, two former employees said.

Two of the former SAC employees who have admitted to insider trading said they used expert-network firms to obtain secret information about public companies. And of the roughly 70 insider trading cases that federal prosecutors in Manhattan have brought in the last three years, more than a dozen have involved expert networks.

Mr. Martoma’s case began in 2006, when the expert-network firm Gerson Lehrman Group connected him to Sidney Gilman, a neurology professor at the University of Michigan and a specialist in Alzheimer’s disease. Dr. Gilman, who moonlighted as a consultant for Gerson Lehrman, helped oversee clinical trials for bapineuzumab, or bapi, a new Alzheimer’s drug being jointly developed by Elan and Wyeth.

He also brazenly leaked to Mr. Martoma secret data about the trials throughout 2008, according to the government, violating his duty to the drug companies and breaching his agreement with Gerson Lehrman not to divulge confidential information to money managers. Dr. Gilman earned $108,000 from his work for SAC, the government said.

At first, Dr. Gilman’s positive updates on the Alzheimer’s drug trials emboldened SAC to make big bets on Elan and Wyeth, prosecutors said. Mr. Martoma worked closely with Mr. Cohen on the investments, highlighting the drug companies in his weekly “best ideas” list submitted to Mr. Cohen. SAC accumulated $700 million worth of Elan and Wyeth shares, making it one of the fund’s largest bets.

Prosecutors say that in July 2008 Dr. Gilman received more complete results about bapi showing problems with the drug’s efficacy. He then shared those results with Mr. Martoma, the government contends.

With the public announcement of the data just a week away, Mr. Martoma e-mailed Mr. Cohen on a Sunday, according to the complaint. Within the hour, the two were on the phone and spoke for 20 minutes, prosecutors say.

Over several days, SAC not only sold its entire positions in Elan and Wyeth, but shorted, or bet against, the drug companies’ shares, the government said. On July 29, the companies announced results of the drug trial and their shares sank. SAC avoided about $194 million in losses by selling the stocks and then made $83 million by shorting them, according to court filings. Still, SAC paid Mr. Martoma a $9.4 million bonus in 2008 that was largely attributable to his contributions on the Elan and Wyeth trades, prosecutors said. But the firm fired him in early 2010 after his stock picks flagged. The case against Mr. Martoma stemmed in part from a referral made to federal securities regulators. In 2008, the Financial Industry Regulatory Authority observed unusual short-sales in the drug stocks and noted the abnormal activity, regulators said.

Prosecutors recently reached a nonprosecution agreement with Dr. Gilman, meaning they will not charge him. The Justice Department rarely strikes nonprosecution agreements with individuals. The government’s deal with Dr. Gilman, legal experts say, could put pressure on Mr. Martoma to strike a plea deal and cooperate.

Alain Delaquérière contributed reporting.

A version of this article appeared in print on 11/26/2012, on page B1 of the NewYork edition with the headline: New Breed of SAC Capital Hire Is at Center of Insider Trading Case.

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Solar power plants burden the counties that host them

When it comes to attracting business to California's eastern deserts, Inyo County is none too choosy.

Since the 19th century the sparsely populated county has worked to attract industries shunned by others, including gold, tungsten and salt mining. The message: Your business may be messy, but if you plan to hire our residents, the welcome mat is out.

So the county grew giddy last year as it began to consider hosting a huge, clean industry. BrightSource Energy, developer of the proposed $2.7-billion Hidden Hills solar power plant 230 miles northeast of Los Angeles, promised a bounty of jobs and a windfall in tax receipts. In a county that issued just six building permits in 2011, Inyo officials first estimated that property taxes from the facility would boost the general fund 17%.

But upon closer inspection, the picture didn't seem so rosy.

An economic consultant hired by the county found that property tax revenue would be a fraction of the customary amount because portions of the plant qualifiy for a solar tax exclusion. Fewer than 10 local workers would land permanent positions — and just 5% of the construction jobs would be filled by county residents. And construction workers are likely to spend their money across the nearby state line, in Nevada.

Worse, the project would cost the county $11 million to $12 million during the 30-month construction phase, with much of the money going to upgrade a historic two-lane road to the plant. Once the plant begins operation, the county estimates taxpayers will foot the bill for nearly $2 million a year in additional public safety and other services.

Two of California's other Mojave Desert counties, Riverside and San Bernardino, have made similar discoveries. Like Inyo, they are now pushing back against solar developers, asking them to cover the costs of servicing the new industry.

"Southern California is going to become the home to the state's ability to meet its solar goals," said Gerry Newcombe, public works director for San Bernardino County. "That's great, but where are the benefits to the county?"

Desert counties also are anticipating costly shifts in land use, including the conversion of taxable private property into habitat for endangered species. Solar developers are required to buy land to offset the loss of habitat caused by their projects. Once the property is acquired, it cannot be developed, which reduces its potential for tax revenue.

Two of the largest solar plants in the world are under construction in San Bernardino County. But county officials are not sure if revenue from the projects will offset the cost of additional fire and safety services, which analysts say will amount to millions of dollars a year.

For example, the $2.2-billion Ivanpah solar project at the county's eastern border has agreed to pay $377,000 annually, but that may not be enough to cover the county's new costs related to the plant. The county doesn't know how much solar plants will drain from its budget because the projects are being planned and approved too quickly for adequate analysis, officials say.

"We really support private development and generating jobs," Newcombe said. "On the other hand, I am concerned that it's going too fast. I don't know that we've had a chance to appreciate the long-term impacts."

The county is also worried because most of the land inside its borders is owned by the federal government, and up to 1 million acres of that — nearly 8% of the county — could be set aside for solar development, removing it from public access and recreational opportunities, Newcombe said.

Counties that object to the pace of development, however, have been scolded for standing in the way of progress. Not only is renewable energy a priority of the Obama administration, it is also the darling of California's chief executive.

Gov. Jerry Brown has vowed to "crush" opponents of solar projects. At the launch of a solar farm near Sacramento, the governor pledged: "It's not easy. There are gonna be screw-ups. There are gonna be bankruptcies. There'll be indictments and there'll be deaths. But we're gonna keep going — and nothing's gonna stop me."

Counties have little say because the state controls planning and licensing of large-scale projects. The California Energy Commission issues the permits for utility-scale solar farms, and counties depend on the commission's staff to look out for their interests.

To the extent that California counties are pushing back against industrial solar, the rebellion began in Riverside County more than a year ago.

Some 20 utility-scale solar farms are proposed in the eastern stretch of the county on 118,000 acres of federal land along the Interstate 10 corridor between Desert Center and Blythe.

The Riverside County Board of Supervisors considered charging companies a franchise fee to offset the effects on roads and public services and to compensate for the loss of recreation and tourism access to the 185 square miles of federal land. Local officials saw it as a matter of fairness. Public utilities pay 2% of gross receipts to the county, for example.

"The solar companies are the beneficiaries of huge government loans, tax credits and, most critically for me, property tax exemptions, at the expense of taxpayers," said county Supervisor John Benoit, referring to a variety of taxpayer-supported loans and grants available to large solar projects as part of the Obama administration's renewable energy initiative. "I came to the conclusion that my taxpayers need to get something back."

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Tracking Mars: Curiosity Makes Its Mark on the Red Planet

Since Curiosity landed on mars on Aug. 6, the rover has traveled hundreds of feet over the Martian surface. In the process, it has tracked up the sandy, dusty terrain, leaving tire marks, scoop divots, Morse code and one tiny piece of itself behind.

Unlike the Apollo astronauts' footprints on the moon, Curiosity's trails will probably be wiped away by the planet's frequent wind and sand storms. But there is still something so incredible about these little ephemeral marks we are making on another world.

Though the physical traces won't last, their impact lives on in the images the rover is sending back to Earth. Here are some of our favorite shots of Curiosity's tracks on Mars.

Image: NASA/JPL-Caltech

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Dave Roberts brings diversity to the San Diego County supervisors

DEL MAR — In January, when he joins the San Diego County Board of Supervisors, Dave Roberts will be the only Democrat among four Republicans, the first Democrat on the board in more than two decades.

He will also be the first new supervisor in 18 years. And he will be the only one who is not a graduate of San Diego State. He has three degrees from American University in Washington, D.C.

He's also gay and married to a retired Air Force master sergeant. The two are adoptive parents to five former foster children, ages 4 to 17, who call them Daddy Dave and Daddy Wally.

With Roberts' election to a district representing a portion of San Diego and several seaside communities north of the city, diversity has arrived for the Board of Supervisors, long one of the region's most homogenous governing bodies.

"I'm going to bring some unique characteristics," Roberts, 51, said with a laugh during a family outing on the beach here.

Roberts hopes to concentrate on the same issues he focused on while serving on the Solana Beach City Council, where he is currently deputy mayor: regional fire protection, expansion of the San Dieguito River Park and "sensible" growth.

Roberts is a Democrat in the style of Republican-leaning northern San Diego County: fiscally conservative. He worked as a budget analyst for the Department of Defense and as a corporate vice president for the La Jolla-based defense contractor SAIC. He was a Republican until some in the GOP took exception to a gay man working in the Pentagon.

"The Republicans wanted me to be fired," Roberts said. "That's when I changed political parties."

Some of his first experience in government came from working as a staffer to Sen. Lowell Weicker, a Republican from Connecticut. "I learned from working for Sen. Weicker that you can make change if you're in the right place," Roberts said.

In 2009, Democratic party officials encouraged Roberts to seek the party's nomination to face incumbent Brian Bilbray (R-Carlsbad) in the 50th Congressional District.

On the verge of declaring his candidacy, Roberts was alerted by social workers about two children who needed a "forever" home. He decided that the adoption process took precedence over his political career.

Now there are five children in the two-story home in Solana Beach once owned by singer Patti Page: Robert, 17; Alex, 12; Julian, 8; Joe, 5; and Natalee, 4. Three of the children have taken the last name Roberts, and two took his spouse's last name, Oliver.

"We don't like double names," Roberts said.

Roberts and Wally Oliver, 55, have been together for 14 years. They had a commitment ceremony in 1998 and married in July 2008 in the brief period when county clerks in California were allowed to issue same-sex marriage licenses.

The family may soon expand.

"Wally would like a baby," Roberts said. "We're not Jewish, but we believe in the Jewish proverb: 'If you can save one soul, you can save the world.'"

During his race against a Republican opponent, Roberts was endorsed by the retiring incumbent, Pam Slater-Price. He has also begun discussions with Supervisor Dianne Jacob, possibly the most fiscally conservative member of the board.

He also looks forward to working with Supervisor Bill Horn, an ex-Marine who supported Proposition 8, the measure to ban same-sex marriage, and has said he opposes gays in the military. "He says things from time to time that remind me of my father," Roberts said.

For all of their fiscal conservatism, the supervisors have not dabbled much in social issues in a way that might satisfy some elements in the GOP. The board took no position on Proposition 8. Health clinics in gay neighborhoods and AIDS prevention programs are funded without controversy.

Roberts may be different in another respect from his colleagues: He will not be assigning a staff member to send out his Twitter messages. He sends out his own tweets — lots of them, on topics political and personal.

Last week, among many tweets, was one announcing that he has hired his predecessor's chief-of-staff, praising him for his "broad experience, management style and network of contacts."

And the next tweet: "Took the kids out for frozen yogurt at Seaside Yogurt in Del Mar for a treat."

tony.perry@latimes.com

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How One <em>Myst</em> Fan Made Himself a Real-Life Linking Book

The classic PC game Myst was known for drawing people in to its massive, surreal world. But maker Mike Ando took a little piece of that world and drew it into ours. He made a lovingly authentic replica of the Linking Book that helps the main character — you — navigate the world.

Myst was a ground-breaking point-and-click adventure game created by Cyan Worlds, made of hundreds of beautifully rendered scenes whose combined size made the game so big that it needed a CD-ROM to play, back when many computers didn’t have them. It was the first breakout hit in PC gaming and from its release in 1993 it held the title of best-selling PC game until 2002 when The Sims surpassed it.

The game spawned four sequels, along with novels, music, and an MMO that is still online and being powered by donations from the fan base. The games have been widely ported and the game — once so huge that you needed special hardware to run it — is now available for download on iOS (among other places). In other words, it’s a pretty big deal.

At the core of Myst’s story was a mystical technology called Linking Books that pulled players into other realms, called Ages. They were these beautiful old tomes that, when opened, showed an animated preview of the Age to which you’d be linked.

“Ever since I first played the game, I always wanted my own linking book,” says Ando, “Of course, there was no way my old bulky 486 would fit within a book, but as time marched on technology advanced and computers became smaller. Eventually technology caught up and it was possible to shrink everything down to fit inside the book.”

Ando says his drive to make this project began six years ago when he learned where Cyan got the texture reference for the books — Harper’s New Monthly Magazine, Volume LIV, Issue 312, December 1876 to May 1877. “My mind hatched all sorts of plans about what I’d do once I had the book,” he says, “and finally I decided to set the bar as high as I could — all the Myst games, all playable, and playable well, even the 3-D ones at 30fps.”

To do this, Ando needed to perform two main feats. First, he needed to find the parts to make a computer that would fit in an extremely limited space. Then, he needed to restore the antique book, customize it to look like the ones from Myst, and gut it to make room for the compact computer that would power the game.

“Research was the main skill involved,” says Ando, “I spent hundreds of hours, literally, trying to find suitable components to meet all my requirements.”

To build the tiny computer that powers the Linking Book, Ando needed to find a X86 board that could fit inside. Most mobile devices run on ARM, but Ando wanted to run the original releases of each game, so porting wouldn’t do. It had to be X86.

“To give you an idea of how uncommon it is to shrink an X86 computer down this small,” he says, “the smallest X86 computer made by Apple, the Mac Mini, is 17 cm — this book is only 12 cm, plus I had to squeeze in my own power source and screen.”

The parts that made up the computer came from specialist vendors that ordinarily sell to aerospace and other niche enterprise customers. Ando ended up ordering a mixture of store-bought parts, and custom PCB layouts, soldering the whole thing together and switching out components between a bunch of boards to get the most efficient versions. He says he designed the touchscreen controller himself.

And as for the touchscreen itself? At one point in his search, he found himself talking to a vendor in China to arrange for a custom design. “His English skills were so poor I suggested we talk in Chinese and I used Google Translate, so I guess you could add that to my skills,” he says. “I suspect he just found one already to size and charged me as if they made it. If so, good for him — I couldn’t find one anywhere.”

For restoration and preparation of the book, Ando turned to Ian Bates, the president of the Australian Bookbinding Association. Bates handled the restoration of the cover, along with cutting the pages and embossing the book with the Myst logotype (but only after Ando had picked which of the several versions of the Myst font they should use).

If you find yourself gasping in horror at the idea that a book restorer would destroy a beautiful old book for a strange electronics project, Ando wants to assure you that nothing of value was lost. “The book I used is basically a cross between a Reader’s Digest & a gossip magazine and many of the articles are incomplete,” he says, “Today, books like this are sold to interior designers literally by the meter without any care given to their contents, author or title. Their main value rests on the aesthetics of their spine.”

Photos courtesy of Mike Ando.

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