Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.

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Catherine Saint Louis speaks about using SimplyThick in premature infants.

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Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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Zynga at a Crossroads in Mobile Quest

SAN FRANCISCO — Zynga has been on a monumental losing streak. Hits have been rare, profits nonexistent and crucial employees are fleeing.

The story of the company, which developed the notion of social gaming and persuaded tens of millions of people to try it out on Facebook, illustrates how suddenly the fortunes of hot Internet companies can shift. Two years ago, as Zynga was first being pushed for a public offering, it was said to be worth $20 billion.

By the time the offering took place, a little over a year ago, it was for less than $10 billion. And Zynga has spent most of the time since then sliding downhill. The value of the company Tuesday, as it released mediocre but nevertheless better than expected fourth-quarter results, was about $2 billion.

In the next few months, Zynga faces a crucial test that will determine if even that sum is excessive: Can it successfully put its most popular Web games, starting with Farmville, on mobile devices?

“Do I wish that we would have gone all-in on mobile and made a bigger commitment to it earlier?” Mark Pincus, Zynga’s founder and chief executive officer said in an interview after the earnings release. “Yes.”

Mr. Pincus called 2013 “a year of investment and transition.”

“While we are excited about the long-term growth opportunity on mobile, and the opportunity to make games even more accessible to people in more parts of their day, we need to build a compelling network around it,” he said.

That is because social gaming on mobile is not necessarily social.

“It’s kind of ironic, isn’t it?” Mr. Pincus said. “You’re holding a phone, an inherently social device. Yet the experience we have is a more fragmented one.”

The pain accompanying Zynga’s transition to mobile was evident in the company’s fourth-quarter earnings report. Revenue was $311 million, flat with the year before. Daily users of the games were down 6 percent from the third quarter, a clear measure of flagging interest. More casual users dropped as well.

Earnings per share were a penny, better than the 3-cent loss that analysts had been expecting on an adjusted basis. And Zynga’s cash hoard of $1.65 billion was untouched.

For the full year, revenue was $1.28 billion, up 12 percent from 2011. Not exactly what you would expect from a growth company. Nor were its immediate prospects cheerful. Zynga warned that it would release few new games in the first quarter and that its revenue would drop from 2012.

Weak as the results were, however, they were not as bad as some feared. Zynga shares immediately rose in after-hours trading by 7 percent. In regular trading they were also up 7 percent to $2.73. That jump was fueled by an analyst upgrade from Merrill Lynch, which said the stock was so beaten down it now accurately reflected the company prospects.

Many online stock sites, by contrast, have been portraying the company as going the way of Pets.com or MySpace. “Zynga’s Earnings May Reveal Its Impending Demise” read the headline at one.

Michael Pachter, a managing director of Wedbush Securities, wrote in an e-mail that Zynga management was “definitely saying the right things, now all they have to do is execute.”

Aside from Mr. Pincus, it is a largely new team. Just last week, Zynga suffered another defection when its chief games designer, Brian Reynolds, quit, saying he wanted to experiment “more than might be appropriate for a publicly traded company.”

As recently as two years ago, Zynga had only 20 people working on mobile issues. Then the team ballooned into the hundreds. In the last few months, the team members have integrated into each game.

The central issue overshadowing even the mobile transition is whether Zynga first became successful merely because it was in the right place at the right time, a condition also known as dumb luck. Zynga’s rise was inseparable from Facebook, which gave the developer preferential treatment.

That era is over. In March, Zynga will lose its special status on Facebook.

There are other perils for Zynga, plenty of them. Analysts have been pointing to the rise of King.com’s games, including Candy Crush, which makes the latest version of Farmville look as complicated as advanced physics.

“Who thought crushing candy would have been popular?” said Brian Blau, a Gartner analyst.

King.com is touting itself as a new, improved Zynga, which underscores the volatile nature of the gaming business. “This is a hits driven industry, and Zynga could not sustain their hits,” Mr. Blau said. “Game players are fickle.”

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Afghan Airline, Kam Air, No Longer Under U.S. Ban

KABUL, Afghanistan — The American military on Monday reversed a recent decision to blacklist one of Afghanistan’s main airlines, Kam Air, on suspicion of drug smuggling, and it agreed to share details of its accusations with the Afghan government.

The turnaround came after days of Afghan criticism and what some Western officials described as a disagreement between the military and the American Embassy on the prudence of the ban, which would have forbidden any American military contracts with Kam Air. The prohibition came to light in news reports last week, and it was an embarrassment after a positive meeting between President Obama and President Hamid Karzai in Washington in which Mr. Karzai stressed the importance of Afghan sovereignty.

According to a statement released late Monday evening by United States Forces-Afghanistan, the military said that senior officials met with senior Afghan officials at the Foreign Ministry on Saturday, explaining the reasons behind the blacklisting and offering information about the company that led to the ban.

In return, the statement said, the Afghan government agreed to investigate Kam Air and take further action, if needed. Afghan officials could not be reached for comment.

The statement noted deference to the Afghan government’s sovereignty as one reason that it had lifted the ban. The United States military does not directly contract with Kam Air, but the lines are somewhat blurry because the military pays for many activities by the Afghan government. Banning Kam Air from military contracts cast a shadow over the company and posed difficulties for Mr. Karzai’s travel plans. He frequently charters Kam Air planes for official visits abroad, but he was forced to make other plans for his current visit in Europe, officials said.

On Monday, he met in London with Prime Minister David Cameron and President Asif Ali Zardari of Pakistan to discuss halting efforts to restart the peace process with the Taliban. The leaders reaffirmed support for establishing an office in Qatar to aid in talks with Taliban delegates there, and set a six-month deadline for progress, officials said.

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Live action: Twitter grabs Super Bowl spotlight

NEW YORK (AP) — Beyonce’s splashy show, a freak power outage, and —oh, yeah— a captivating game of football combined to generate a record 24.1 million posts on Twitter during Sunday night’s Super Bowl.

That’s up from 13.7 million last year — and that doesn’t even include chatter surrounding the ads.

Twitter said in a late Sunday blog post that about half of the more than 50 national TV spots that aired during the game included a “hashtag,” a word or phrase preceded by a number sign that’s used to organize subjects on the short messaging site. During last year’s game, only one in five ads included one. Brands ranging from Oreo to Tide and Budweiser, meanwhile, captured online buzz by linking the blackout to their brands in humorous tweets.

Super Bowl XLVII, like the London Summer Olympics and the U.S. presidential election, was yet another moment in which Twitter became the platform for millions of people to share quick reactions and participate in a massive, public conversation. Though it’s not as popular as Facebook Inc. or its buttoned-up cousin LinkedIn Corp., Twitter’s surging popularity during big events is a testament to its reach and utility. The question is whether these moments can translate into revenue for the 7-year-old company.

The company makes money by charging advertisers to promote individual tweets, accounts or trends designed to spark a conversation. Research firm eMarketer estimates that Twitter will book advertising revenue of $ 545.2 million this year, up 89 percent from 2012. Next year, worldwide ad revenue is expected to hit $ 807.5 million, a 48 percent increase from 2013.

Tweetable events such as the 34-minute Super Bowl power outage are ripe with marketing potential, provided that brands act quickly.

“It’s really clear right now that Twitter has a lock on real-time conversation on the Internet,” says eMarketer analyst Debra Aho Williamson.

To capitalize on this, Twitter has to show advertisers that it pays to promote their tweets — even though fans are likely to spread the catchiest slogans on their own, free of charge.

That’s what happened with a certain cream-filled cookie on Sunday.

It took Oreo’s marketers roughly 10 minutes after the power went out to tweet a picture of an Oreo cookie in the half-dark with the words: “You can still dunk in the dark.” As of Monday afternoon, the image had been shared on Twitter more than 15,000 times. Tide followed suit with the slogan “we can’t get your blackout. But we can get your stains out” with more limited success. The message was re-tweeted about 1,300 times. Calvin Klein, meanwhile, tweeted a video of a shirtless, chiseled male model doing crunches “since the lights are still out…”

Such “real-time marketing” is still in its infancy, but Williamson expects this to change, as more companies develop the ability to respond to events immediately.”

“To do what Oreo did actually takes a lot of pre-planning,” she says.

Laurie Guzzinati, spokeswoman for Oreo owner Mondelez says the power outage was a natural moment to engage consumers. The cookie’s TV ad had a planned social media component asking people to follow Oreo on Twitter and post photos on Instagram. The company had set up a “social media command center” that included people from Oreo’s brand team, the ad agency 360i and other partners whose job was to follow the Super Bowl and interact with fans on Facebook, Twitter and elsewhere.

Mondelez likely spent the going rate of as much as $ 4 million on its Super Bowl television spot. But Guzzinati says the company didn’t pay Twitter anything for the “dunk in the dark” picture. Still, Twitter says advertisers moved quickly following the outage.

Matt McGee, editor-in-chief of the blog Marketing Land, counted 26 Twitter mentions in the 52 national spots that aired during the game. Facebook, meanwhile, got only four shout-outs, while Google Plus walked away with zero (though Google Inc.’s YouTube scored one mention from Hyundai).

“When it comes to second-screen advertising, it’s Twitter’s world now and there’s no close second place,” McGee wrote in a blog post late Sunday night. “Last year, brands split their focus on Twitter and Facebook with eight mentions each. This year, brands recognize that Twitter is where they need to try to attract the online conversation around one of the world’s biggest events.”

David Berkowitz, vice president of emerging media at 360i, which worked on the Oreo campaign, says Twitter has done a good job tying itself into major television events.

“If you look at (Twitter’s) trending topics any day especially during prime time or major events, they’re heavily fueled by television,” he says. “So TV is responsible for Twitter’s growth in general.”

He thinks Twitter has done a better job than other social media sites like Tumblr and Pinterest in proving it’s the place to be when it comes to talking about big events online.

“A large part of it right now is just showing this is where the conversation is happening and building their brand around that,” he says. “Even with other very successful social media sites, no one is better at conversation than Twitter.”

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AP Retail Writer Mae Anderson contributed to this story.

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Cause of Super Bowl power outage remains unclear

NEW ORLEANS (AP) — Who turned out the lights?

The day after the 34-minute blackout at the Super Bowl, the exact cause — and who's to blame — were unclear, though a couple of potential culprits had been ruled out.

It wasn't Beyonce's electrifying halftime performance, according to Doug Thornton, manager of the state-owned Superdome, since the singer had her own generator. And it apparently wasn't a case of too much demand for power. Meters showed the 76,000-seat stadium was drawing no more electricity than it does during a typical New Orleans Saints game, Thornton said.

The lights-out game Sunday proved an embarrassment for the Big Easy just when it was hoping to show the rest of the world how far it has come since Hurricane Katrina in 2005. But many fans and residents were forgiving, and officials expressed confidence that the episode wouldn't hurt the city's hopes of hosting the championship again.

To New Orleans' great relief, NFL Commissioner Roger Goodell said the city did a "terrific" job hosting its first pro football championship in the post-Katrina era, and added: "I fully expect that we will be back here for Super Bowls."

Fans watching from their living rooms weren't deterred, either. An estimated 108.4 million people saw the Baltimore Ravens beat the San Francisco 49ers 34-31, making it the third most-viewed program in television history. Both the 2010 and 2011 games hit the 111 million mark.

The problem that caused the outage was believed to have happened around the spot where a line that feeds current from the local power company, Entergy New Orleans, connects with the Superdome's electrical system, officials said. But whether the fault lay with the utility or with the Superdome was not clear.

Determining the cause will probably take days, according to Dennis Dawsey, a vice president for distribution and transmission for Entergy. He said the makers of some of the switching gear have been brought in to help figure out what happened.

An attorney for the state board that oversees the Superdome said the blackout did not appear to be related to the replacement in December of electrical equipment connecting the stadium to Entergy. Officials with the utility and the Superdome noted that an NFL game, the Sugar Bowl and another bowl game were played there in recent weeks with no apparent problems.

The blackout came after a nearly flawless week of activity for football fans in New Orleans leading up to the big game.

"I hope that's not what they'll remember about this Super Bowl," French Quarter artist Gloria Wallis said. "I hope that what they'll remember is they had a great time here and that they were welcomed here."

Ravens fan Antonio Prezioso, a Baltimore native who went to the game with his 11-year-old son, said the outage just extended the experience.

"The more time we could spend at the game was a good thing, as long as it ended the way it did," he said, laughing.

The city last hosted the Super Bowl in 2002, and officials were hoping this would serve as the ultimate showcase for the city's recovery. The storm tore holes in the roof of the Superdome and caused water damage to its electrical systems, and more than $330 million was spent repairing and upgrading the stadium.

Sunday's Super Bowl was New Orleans' 10th as host, and officials plan to make a bid for an 11th in 2018.

Mayor Mitch Landrieu told WWL-AM on Monday that the outage won't hurt the city's chances, and he joked that the game got better after the blackout: "People were leaving and the game was getting boring, so we had to do a little something to spice it up."

Jarvis DeBerry, a columnist for nola.com and The Times-Picayune, wrote that the power outage gave the media "an opportunity to laugh at the apparent ineptitude or suggest that the ghosts of Hurricane Katrina were haunting the Superdome."

"That's not the kind of attention the city was looking for, obviously," he wrote, "but it's certainly too soon to say if people will remember the power shortage over San Francisco's furious comeback attempt against Baltimore or if this will harm the city's future opportunities to host the Super Bowl."

Bjorn Hanson, dean of New York University's Center for Hospitality and Sports Management, said the episode shouldn't hurt the city's reputation as a big convention destination. "I think people view it for what it was: an unusual event with a near-record power draw," he said. "It was the equivalent of a circuit breaker flipping."

The American Association of Neurological Surgeons will meet in New Orleans from April 27 to May 1. Patty Anderson, director of meetings for the group, said of the blackout: "I never even gave it a second thought. To me, the city is bigger, stronger and more vibrant than it's ever been."

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Associated Press writers Beth Harpaz, Brett Martel, Stacey Plaisance and Barry Wilner contributed to this report.

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Well: Expressing the Inexpressible

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another is “Barn Wish” by Kim Knedler Hewett.

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

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

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Have you written a poem about cancer? Please share them with us in the comments section below.

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DealBook: Suit to Accuse S.&P. of Fraud in Mortgage Bond Ratings

The Justice Department, along with state prosecutors, plans to file civil charges against Standard & Poor’s Ratings Service, accusing the firm of fraudulently rating mortgage bonds that led to the financial crisis, people briefed on the plan said Monday.

A suit against S.&P. — expected to filed this week — would be the first the government has brought against the credit ratings agencies related to the financial crisis, despite continued questions about the agencies’ conflicts of interest and role in creating a housing bubble.

Several state prosecutors are expected to join the federal suit. The New York State attorney general is conducting a separate investigation, an official in that office said. The official declined to say whether New York State’s action involved other ratings agencies besides Standard & Poor’s.

Up until last last week, the Justice Department had been in settlement talks with S.&P., these people said. But the negotiations broke down after the Justice Department said it would seek a settlement in excess of “10 figures,” or at least $1 billion, these people said. Such an amount would wipe out the profits of S.&P.’s parent, the McGraw-Hill Company, for an entire year. McGraw-Hill earned $911 million last year.

During settlement negotiations, the Justice Department held out the threat of a criminal case against S.&P., the people said. Ultimately, the government plans to bring a civil suit, which has a lower burden of proof than a criminal case.

The case is expected to be brought in California, these people said. The state suffered disproportionately during the housing bubble, and the government is hoping the venue will yield more sympathetic jurors.

The case is focusing on about 30 collateralized debt obligations, an exotic type of mortgage security. According to S&P, the mortgage securities were created in 2007 at the height of the housing boom.

Prosecutors, according to the people, have uncovered troves emails by S&P, employees, which the government considers damaging. Portions of those emails are likely to be disclosed in the government’s complaint against S&P, these people said.

In a statement on Monday, S.&P. said it had received notice from the Justice Department over a pending lawsuit. The ratings agency argued any such legal action would be baseless, since it downgraded plenty of mortgage-backed investments, including in the two years leading up to the financial crisis. It also contended that other observers of the debt markets, including government officials, believed at the time that any problems within the housing sector could be contained.

“A D.O.J. lawsuit would be entirely without factual or legal merit,” the agency said in its statement. “With 20/20 hindsight, these strong actions proved insufficient – but they demonstrate that the D.O.J. would be wrong in contending that S.&P. ratings were motivated by commercial considerations and not issued in good faith.”

Shares of McGraw-Hill closed down nearly 14 percent on Monday, at $50.30.

Mary Williams Walsh contributed reporting.

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The Lede Blog: Two Iranian Space Monkeys Got Confused, an Official Says

A senior official at Iran’s space agency confirmed on Saturday that state media reports on the launching of a monkey into the thermosphere had used images of two different monkeys. The official insisted, however, that the monkey had survived the journey and that Iran was not trying to cover up a failed flight.

As The Lede explained on Friday, doubts about Iran’s claim that the monkey had survived the journey spread after journalists noticed that the monkey pictured in the first reports from state-run news organizations had a prominent mole over its right eye, before the launch, but had clear skin when it showed up at postflight celebrations broadcast on Iranian television the next day.

Video from Iranian television of the monkey that Iran says it launched into space.

The space agency official, Mohammad Ebrahimi, told The Associated Press in Tehran that the first images provided to Iran’s official news outlets to illustrate their reports had mistakenly shown another of the five monkeys that trained for the flight at the space agency — the one with the mole — and not the one that had actually taken part.

A report from Press TV, Iran’s English-language satellite news channel, broadcast on Monday used the still images of the first monkey.

A report on simian space travel broadcast on Monday on Press TV, Iran’s state-run news channel.

The second monkey was featured in a Press TV report broadcast on Tuesday.

A report on Iran’s space monkey broadcast on Tuesday by Press TV.

In his interview with The A.P., Mr. Ebrahimi insisted that the monkey that had made the flight was in good health and said that of several monkeys that had been trained for the flight, the one that seems least stressed for the journey had been chosen at the last moment. One of the photographs of the monkey with the mole over its eye did appear to show the monkey in distress while strapped into a launch seat.

The space agency did not, apparently, offer to disprove rumors that one of the monkeys had died by showing them both to the A.P. reporter on Saturday.

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Ravens lead 49ers 14-3 in Super Bowl 2nd quarter

NEW ORLEANS (AP) — Playing nearly perfectly in his Super Bowl debut, Joe Flacco threw two early touchdown passes to help the Baltimore Ravens take a 14-3 lead over the mistake-prone San Francisco 49ers in the second quarter Sunday.

The 49ers turned over the ball twice in about a 5-minute span of the second quarter: Rookie running back LaMichael James fumbled — leading to a Ravens TD — and safety Ed Reed tied an NFL record with his ninth career postseason interception by picking off Colin Kaepernick.

After Reed stole the ball, a group of players from both teams engaged in a scrum and penalties were called.

Instead of adding more points after Reed's pick, Baltimore eventually gave the ball back after failing to convert a first down on a fake field goal.

Flacco connected with Anquan Boldin from 13 yards out less than 4½ minutes into the game on Baltimore's first possession, then found tight end Dennis Pitta for a 1-yard score midway through the second quarter after James' error.

He fumbled at Baltimore's 25-yard line while straining to gain extra yards. Linebacker Courtney Upshaw punched the ball loose, and defensive lineman Arthur Jones recovered it, and the Ravens headed the other way.

The 49ers also began the game with an illegal formation penalty on the very first play, then needed to punt.

A good return by Jacoby Jones set up the Ravens near midfield, and they promptly drove 51 yards in six plays. Another 49ers penalty on third down at the 18 came right before Flacco's nice scoring pass over the middle to Boldin with less than 4½ minutes gone in the game.

His scoring pass later to Pitta gave Flacco 10 touchdown passes and zero interceptions this postseason. He's only the third QB with that many TDs in a single postseason.

Flacco, who led the Ravens past Denver's Peyton Manning and New England's Tom Brady for two of his league-record six career postseason road victories by a quarterback, was making the most of a chance to impress before heading into an offseason that could land him a $20 million-per-year contract in free agency.

Kaepernick was making only his 10th start the NFL, having taken over the job after Alex Smith got a concussion during a game.

It was the first Super Bowl coaching matchup between brothers: Baltimore's John Harbaugh is 15 months older than San Francisco's Jim Harbaugh.

San Francisco scored in the first quarter on a 36-yard field goal by David Akers, who tied an NFL record with a 63-yarder this season but also had a league-high 13 misses. The big gain was a 24-yard pass from Kaepernick to Vernon Davis. Reed, in coverage on that play, left to have his knee examined, but then returned.

The NFC champion 49ers (13-4-1) were seeking their record-tying sixth Super Bowl title — but first since 1995 — and brought in a 5-0 record from their previous appearances. Only the Pittsburgh Steelers have won six Super Bowls.

The AFC champion Ravens (13-6), a franchise that moved from Cleveland to Baltimore 17 years ago, also came in unbeaten in Super Bowls, albeit only 1-0, thanks to their championship in 2001, when linebacker Ray Lewis was voted the game's MVP.

All eyes were going to be on Lewis this time again, as he played his final game before retirement after a 17-year career that is expected to land him in the Pro Football Hall of Fame. Lewis missed 10 games this season with a torn right triceps muscle — and spent two days in the past week dismissing a report that he had used, of all things, deer-antler spray to enhance his performance.

About 45 minutes before the opening kickoff, Lewis gathered his teammates in the end zone painted the Ravens' purple team color. As they encircled him, Lewis — large triangles of eye black covering his entire cheeks — delivered his usual rousing pregame speech, and other players whooped it up, too.

Not long after, 49ers linebacker Patrick Willis — who, like Lewis, wears No. 52 — delivered his own fiery words, surrounded by the rest of his team near the red, white and blue NFL shield logo at midfield.

Before the game began, with 100 million or so Americans expected to tune in on TV, a chorus of 26 children from Sandy Hook Elementary School in Newtown, Conn. — where 20 students and six adults were killed in a shooting rampage in December — sang "America the Beautiful," accompanied by "American Idol" alum Jennifer Hudson. Grammy winner Alicia Keys performed the national anthem.

This was the 10th time New Orleans hosted the big game — tying Miami for most in a city — and first since Hurricane Katrina devastated the Big Easy in August 2005.

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Follow Howard Fendrich on Twitter at http://twitter.com/HowardFendrich

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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.

Matt Eich for 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.”

This article has been revised to reflect the following correction:

Correction: February 3, 2013

An earlier version of a quote appearing with the home page presentation of this article misspelled the name of a medication. It is Adderall, not Aderall.

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