British Ministers Seek Support for Gay Marriage Law

LONDON — As the British Parliament prepared to vote Tuesday on a law permitting same-sex marriage that has divided church and state, senior cabinet ministers launched a last-minute attempt to deflect an embarrassing rebellion by Conservative lawmakers against Prime Minister David Cameron’s support for the new legislation.

A day after the newly-confirmed archbishop of Canterbury, Justin Welby, took office saying he shares the Church of England’s opposition to marriage between people of the same gender, three cabinet officials said in a letter published in The Daily Telegraph that the new legislation was “the right thing to do at the right time.”

“Marriage has evolved over time. We believe that opening it up to same-sex couples will strengthen, not weaken, the institution. Attitudes toward gay people have changed. A substantial majority of the public now favor allowing same sex couples to marry, and support has increased rapidly.”

The three ministers — George Osborne, the chancellor of the Exchequer, Foreign Secretary William Hague and Home Secretary Theresa May — also asked whether it was “any longer acceptable to exclude people from marriage simply because they love someone of the same sex.”

The debate has divided Britain’s Conservatives, who rule in uneasy coalition with the smaller Liberal Democrats. Political analysts forecast that, when the vote is held on Tuesday evening in Parliament, it will be approved despite opposition by scores of Conservative lawmakers because the bulk of Liberal Democrat and opposition Labour legislators are in favor.

However, that outcome could embarrass Mr. Cameron since he will be securing approval for a change that he has championed with the support of his political adversaries and in the teeth of opposition from within his own ranks. The size of the likely revolt among Conservative lawmakers is uncertain, but Mr. Cameron’s allies are trying to reduce it, seeing the vote as a test of his authority.

Opponents of the legislation say it will alienate traditional Conservative voters, jeopardizing Mr. Cameron’s prospects at the 2015 national election. But supporters say it will bring in new backing from outside the party.

Coincidentally, the vote is scheduled a day after Archbishop Welby, 57, was confirmed in his new post to replace the Most Rev. Rowan Williams, who has retired 10 years in office.

The new archbishop, the spiritual head of the world’s 77 million Anglicans, endorsed the traditional view that while the Church of England has no objection to civil partnerships between people of the same gender, it is, as a recent church statement put it, “committed to the traditional understanding of the institution of marriage as being between one man and one woman.”

Ed Miliband, the leader of the opposition Labour Party, said Monday that he would be “voting for equal marriage in the House of Commons, and I’ll be doing so proudly.” He also said he would urge his 255 legislators in the 649-member body to vote with him, although a small group will likely vote against.

“I’ll be voting for equal marriage for a very simple reason: I don’t think that the person you love should determine the rights you have,” Mr. Miliband said on Monday.

The legislation, which applies to England and Wales, would permit civil marriage between same-sex couples, but specifically exempt the Church of England and other faiths from an obligation to perform such ceremonies. Some faith groups, including the Quakers, have said they want the legal right to perform same-sex marriages.

In their letter, Mr. Osborne, Mr. Hague and Ms. May said: “Our party also has a strong belief in religious freedom, a vital element of a free society. The Bill ensures that no faith group will be forced to conduct same-sex marriages. The legal advice is clear that these protections for religious groups cannot be overturned by the courts.”

“Religious freedom works both ways. Why should faith groups, such as the Quakers, that wish to conduct gay marriages be forbidden from doing so? This Bill will enhance religious freedom, not restrict it.”

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DealBook: New Details Suggest a Defense in SAC Case

At the center of the government’s insider trading case against a former portfolio manager at the hedge fund SAC Capital Advisors is a trade that directly involves Steven A. Cohen, the billionaire owner of the fund.

New details about the case have emerged that could cast doubt on the way that trade has been portrayed by the authorities, suggesting a possible line of defense for the portfolio manager and raising questions about whether the government will be able to build a case against Mr. Cohen, who has long been in the cross hairs of an investigation for insider trading on Wall Street.

Federal prosecutors have claimed that SAC dumped millions of shares of two pharmaceutical companies in 2008 after the former employee, Mathew Martoma, received secret information from a doctor about problems with a new Alzheimer’s drug.

In bringing its charges, the government said that SAC not only sold out of its position, but also bet against — or shorted — the drug companies’ stocks before the public announcement of the bad news. The SAC short position, according to prosecutors, allowed it to earn big profits after shares of the companies, Elan and Wyeth, plummeted.

“The fund didn’t merely avoid losses, it greedily schemed to profit further by shorting Elan and Wyeth stock,” said April Brooks, a senior F.B.I. official in New York, during a press conference on Nov. 20, the day Mr. Martoma was arrested.

Internal SAC trading records, according to people directly involved in the case, indicate that the hedge fund did not have a negative bet in place in advance of the announcement of the drug trial’s disappointing results. Instead, the records indicated that SAC, through a series of trades, including a complex transaction known as an equity swap, had virtually no exposure — neither long nor short — heading into the disclosure of the drug data.

A different narrative surrounding the firm’s trading could help Mr. Martoma, who has pleaded not guilty to securities fraud and conspiracy in what the government calls the most lucrative insider trading case ever charged.

The government, however, does have powerful evidence against Mr. Martoma. Prosecutors say the fund avoided losses by selling its roughly $700 million stake in Elan and Wyeth. If, as the government says, Mr. Martoma caused SAC to sell the shares — and then short them — while possessing important, nonpublic information, that would constitute an insider trading crime. And prosecutors have secured the testimony of the doctor who says he leaked the drug trial data to Mr. Martoma.

Still, perhaps more important, the trading records may complicate a government effort to pursue a case against Mr. Cohen. The SAC founder has not been accused of any wrongdoing, and has said he acted appropriately at all times.

In bringing charges against Mr. Martoma, prosecutors appeared to be circling nearer to Mr. Cohen. The criminal complaint against Mr. Martoma noted that Mr. Cohen had spent 20 minutes on the telephone with the portfolio manager the night before SAC began selling its shares. Prosecutors have not claimed that Mr. Cohen knew that Mr. Martoma had confidential information about the drug trials. (Mr. Martoma has refused so far to cooperate in helping the government build a case against his former boss.)

Yet if the 2008 trade is a possible avenue for the government, it is running out of time to bring a case against Mr. Cohen. Under the statute of limitations for insider trading crimes, the government would have to file a criminal case against him by mid-July. That deadline is the five-year anniversary of the trade in question, unless it could prove a conspiracy with Mr. Martoma that continued well past then.

Prosecutors have not sought to reach a “tolling agreement” with Mr. Cohen, which would allow the government additional time to bring a case past the statute of limitations, according to people briefed on the matter. The S.E.C., meanwhile, is weighing whether to file a civil fraud lawsuit against the fund connected to the drug-stock trades.

All this comes as a Feb. 14 cutoff approaches for SAC clients to ask for their money back. The fund has told employees that it expects at least $1 billion in withdrawals from the $14 billion fund amid the intensifying investigation. SAC has a standard quarterly redemption deadline.

Several other factors could make it difficult for the government to implicate Mr. Cohen. SAC is well known for its aggressive, rapid-fire trading style, and several former employees say that there is nothing unusual about the fund’s exiting a large position over just a few days.

“It’s one thing to bring an insider trading charge against a market novice who pours his 401(k) into a stock after hanging up the phone with an insider,” said Morris J. Fodeman, a former prosecutor and now a white-collar criminal defense lawyer at Wilson Sonsini Goodrich & Rosati. “But it’s far more difficult to make a case against a sophisticated hedge fund that routinely takes large positions and employs complex trading strategies.”

Moreover, both inside and outside SAC, there had been much controversy and debate surrounding the effectiveness of the Alzheimer’s drug, called bapineuzumab, leading up to the July 2008 release of the companies’ clinical results. Mr. Martoma’s colleagues in SAC’s health care group raised specific concerns with Mr. Cohen about the wisdom of holding such a large position in the two companies. And while preliminary data announced by Elan and Wyeth in June offered encouraging news, they also suggested potential problems.

“We believe potentially confounding factors will continue to fuel controversy over bapineuzumab,” wrote Caroline Y. Stewart, a drug stock analyst with Piper Jaffray, reacting to the preliminary results.

On July 11, another Wall Street analyst, Jonathan Aschoff at Brean Murray Carret & Company, raised red flags about a sharp run-up in the price of Elan’s shares heading into the presentation of the data.

“We have numerous concerns with the clinical development of bapineuzumab, and what we viewed to be underwhelming top-line Phase 2 results make us highly doubtful of success,” Mr. Aschoff wrote. “In our opinion, this strategy only serves to increase clinical risk and stoke our pessimism.”

The uncertainty relating to the Alzheimer drug’s clinical results could help explain what led Mr. Cohen to hedge SAC’s position so that it had “neutral exposure,” in Wall Street parlance, heading into disclosure of the trial results.

The short positions that SAC established in Elan and Wyeth were matched almost perfectly to offset an equity swap that effectively provided the fund with exposure to 12 million Wyeth shares, according to the SAC documents. An equity swap mimics ordinary shares and gives investors like hedge funds the benefits of stock ownership without actually owning the shares. Funds often use these complex derivatives to accumulate a large position but not tip off the market.

When government officials announced the case against Mr. Martoma, they made no mention of the swap. Instead, they emphasized how SAC had jettisoned its Elan and Wyeth shares and then brazenly accumulated short positions in both companies.

“The charges unsealed today describe cheating — coming and going,” Preet Bharara, the United States attorney in Manhattan, said in opening remarks during the press conference. “Specifically, insider trading first on the long side, and then on the short side.”

The government noted the swap position in its court papers, but did not factor it into SAC’s overall gains and losses in Elan and Wyeth. Because SAC did not trade the Wyeth swap, instead leaving the position in place, it could not be part of any insider trading charge.

Representatives for the United States attorney’s office and the S.E.C. declined to comment. An SAC spokesman declined to comment, as did Charles A. Stillman, the lawyer for Mr. Martoma.

Prosecutors have built their case against Mr. Martoma by securing the cooperation of Dr. Sidney Gilman, a neurology professor who ostensibly leaked to him the confidential data about the drug being jointly developed by Elan and Wyeth. The companies hired Dr. Gilman to oversee the clinical trials. SAC paid Dr. Gilman about $108,000 as a consultant.

The government said that Mr. Cohen’s fund accumulated a roughly $700 million combined stake in Elan and Wyeth based on Mr. Martoma’s recommendation. SAC’s equity swap with respect to Wyeth, however, added $566 million in exposure.

On Thursday, July 17, 2008, as the drug trials neared completion, Dr. Gilman told Mr. Martoma that patients were experiencing serious side effects, the government said. Three days later, on a Sunday, with the markets closed, Mr. Martoma had the 20-minute conversation with Mr. Cohen, according to telephone records cited in the criminal complaint. Prosecutors said that Mr. Martoma told his boss that he was no longer “comfortable” with the investments.

On Monday morning, July 21, at Mr. Cohen’s direction, SAC’s head trader began selling the fund’s 10.5 million shares of Elan and 7.1 million shares of Wyeth. By July 29 — the day that the companies announced the trial results — SAC had not only sold out of its Elan and Wyeth holdings but also established short positions in the stocks. SAC was short about 4.5 million shares of Elan and 3.3 million shares of Wyeth. The fund also purchased a small number of Elan put options, a bet that the company’s shares would decline.

The 12 million-share equity swap position in Wyeth, however, counterbalanced the short exposure. SAC was short 4.5 million shares of Elan but, taking the swap into account, effectively long about 8.7 million shares of Wyeth. On July 30, the first trading day after the companies disclosed the negative trial results, Elan’s stock fell about 42 percent and Wyeth’s stock dropped about 12 percent.

Federal prosecutors said that SAC’s trading ahead of the announcement allowed the fund to avoid $194 million in losses by exiting the Elan and Wyeth positions, and then also earn about $83 million on the short trades. But SAC also had paper losses of about $70 million on its Wyeth swap, almost entirely negating any gains from the short sales.

While such details would seem to contradict how authorities have described the trading, prosecutors could argue that SAC had little choice but to leave the swaps in place, and that was part of the strategy to trade on inside information. That is because selling a swap would be difficult to do without attracting attention in the marketplace. If SAC had sold its swaps, it would have had to notify the Wall Street bank that it entered into the swap transaction with and, in turn, the bank’s trader would have most likely sold the shares on the open market.

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Medicines Co. Licenses Rights to Cholesterol Drug

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

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

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

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

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

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

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

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

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

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

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

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Broad Powers Seen for Obama in Cyberstrikes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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IHT Rendezvous: IHT Quick Read: Feb. 4

NEWS A secret legal review on the use of the United States’ growing arsenal of cyberweapons has concluded that President Barack Obama has the broad power to order a pre-emptive strike if the United States detects credible evidence of a major digital attack looming from abroad, according to officials involved in the review. David E. Sanger and Thom Shanker report from Washington.

As a Russian loan runs out and Cyprus seeks aid, Germany finds itself in a fierce debate over whether to help bail out the island nation. Liz Alderman reports from Paris.

Accounts from captives held in the siege of a Saharan gas plant in Algeria last month reveal that militants sought to orchestrate a spectacular, deadly explosion. Adam Nossiter reports from Tiguentourine, Algeria, and Nicholas Kulish from Berlin.

A sometimes frustrated figure who prized her role as a team player, Secretary of State Hillary Rodham Clinton’s instincts were often more activist than those of a White House that has kept a tight grip on foreign policy. Michael R. Gordon and Mark Landler report from Washington.

Prime Minister Mariano Rajoy of Spain is pledging to make public this week his tax returns and financial assets to refute what he described over the weekend as ‘‘apocryphal’’ documents showing that he and other senior conservative politicians had received payouts from a secret account maintained by their party. Raphael Minder reports from Madrid.

In the aftermath of the financial crash, Britain’s politicians acknowledged that they had put too much faith in a bloated financial sector that plunged the country into crisis. But rebalancing the skills of the British labor force may require a shift that is as much social and cultural as it is economic. Stephen Castle reports from North Shields, England.

In France, companies have their wings clipped by onerous social charges paid to the government and severance packages that make companies think twice before hiring and firing– but some entrepreneurs are still figuring out ways to succeed. Kimiko de Freytas-Tamura reports from Paris.

ARTS With wit and ingenuity, the British graphic designer David Pearson is rekindling interest in paperbacks. Alice Rawsthorn reviews from London.

SPORTS The Baltimore Ravens won Super Bowl XLVII. For the latest, visit http://www.nytimes.com/pages/sports/football/index.html.

The Six Nations rugby tournament kicked off with Ireland getting a hard-earned victory over the reigning champion Wales, while England scored a home victory over Scotland and Italy beat France. Huw Richards reports.

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Iceland, Prosecutor of Bankers, Sees Meager Returns

Ilvy Njiokiktjien for The New York Times

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andrea Mohin/The New York Times

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

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

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

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

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

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

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

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

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

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

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

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

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

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

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

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

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

Andrea Mohin/The New York Times

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

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

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

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

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

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

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

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

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

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

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

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

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

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

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Slipstream: Consumer Data Protection Laws, an Ocean Apart

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

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

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

Europe begs to differ.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail: slipstream@nytimes.com.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And so the grass-roots support goes on.

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

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

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

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

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

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

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

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

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

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

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

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

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