40 Years After Roe v. Wade, Thousands March to Oppose Abortion

Drew Angerer/The New York Times

Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.

WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.

On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.

Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.

“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”

Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.

“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”

Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”

The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.

Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.

“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”

Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”

“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.

The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”

Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.

Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.

“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”

This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.

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China's smog taints economy, health

BEIJING — When a thick quilt of smog enveloped swaths of China earlier this month, it set in motion a costly chain reaction for the world's No. 2 economy.

Authorities canceled flights across northern China and ordered some factories shut. Hospitals were flooded with hacking patients.

A fire in an empty furniture factory in eastern Zhejiang province went undetected for hours because the smoke was indistinguishable from the haze. In coastal Shandong province, most highways were closed for fear that low visibility would cause motorists to crash. And in Beijing, the local government urged residents to remain indoors and told construction sites to scale back activity.

"These are emergency measures that have the same economic impact as a strike or severe weather," said Louis Kuijs, a Hong Kong-based economist with the Royal Bank of Scotland and formerly of the World Bank. "They're very painful."

Residents in the capital have taken to mocking their famously filthy air and its attendant health hazards with the expression "Beijing cough." Meanwhile, Shanghai's Environmental Protection Bureau has introduced a cartoon mascot to communicate daily air quality on its website: a pig-tailed girl who bursts into tears when smog reaches hazardous levels.

But economists say China's smog is no joke. As air pollution continues to obscure China's cities, the cost to the nation in lost productivity and health problems is soaring. The World Bank estimates sickness and early death sapped China of $100 billion in 2009, or just under 3% of gross domestic product. China is now home to seven of the 10 most-polluted cities in the world, according to a report by the Asian Development Bank and Beijing's Tsinghua University.

A study by Greenpeace and Peking University's School of Public Health put the cost of healthcare to treat pollution-related ailments in Beijing, Shanghai, Guangzhou and Xian at more than $1 billion last year.

Beijing resident Zhang Jian takes his 2-year-old son to a doctor regularly to treat the toddler's chronic sinus infection.

"It's definitely related to the pollution," said Zhang, 35, who wore a disposable mask at an overcrowded children's hospital recently. "My son snores and his nose is blocked constantly. It's a problem because he's too young to clear his nose like adults."

The doctor's visit and treatment cost Zhang about $320 — nearly a week's pay for the IT professional.

The Beijing government says it's considering a host of emergency measures to clear the air. Among them: limiting vehicle usage, spraying building sites to reduce dust and restricting outdoor barbecue grills.

Even China's next premier, Li Keqiang, weighed in recently on the issue. "This is a problem accumulated over a long period of time, and solving the problem will also require a long time. But we need to take action."

China's smog crisis is not unlike those experienced in London and Los Angeles in the 1950s. Public outcry ultimately led to cleaner air and tougher environmental regulations.

Environmental activists hope the same happens in China. The official response in recent weeks has raised optimism that authorities will begin addressing pollution more openly.

Until recently, state media was loathe to use the word "pollution," opting instead for the euphemism "fog."

But popular pressure is building, making it harder for policymakers to ignore the foul air in many of China's largest cities.

After the staggeringly bad bout of air pollution in the middle of this month, micro-bloggers took to posting pictures of themselves online wearing masks.

Some held handwritten signs that read, "I don't want to be a human vacuum cleaner."

The phrase became the top-trending topic on the Twitter-like Sina Weibo, attracting several million hits.

"Return my blue sky and white clouds," wrote a blogger named Xiao Yu. "If economic development needs to come with the price of such heavy pollution, I would rather go back to the 1980s."

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Palmdale woman accused of torturing her children

Neighbors of a Palmdale woman charged with assaulting and torturing two of her children said Thursday that they never even realized she had kids.

The siblings — a boy, 8, and girl, 7 — did not play outside and were rarely seen, said Cynthia Otero, who runs a day care center at a home opposite the house in the 39000 block of Clear View Court where Ingrid Brewer is alleged to have mistreated the youngsters.

Otero said that when she recently spotted the children getting out of a car, she thought Brewer, 50, "might be baby-sitting."

So neighbors in the suburban cul-de-sac were the more shocked when word spread that Brewer was arrested on suspicion of crimes against her children, she said. Brewer is being charged with eight felony counts, including torture, assault with a deadly weapon and cruelty to a child.

According to authorities, Brewer reported the children missing Jan. 15, prompting a search by deputies from the Los Angeles County Sheriff's Palmdale Station. The youngsters were found hours later hiding under a blanket near a parked car on a street close to their home. They were without winter clothes in 20-degree weather, authorities said.

Sgt. Brian Hudson, a spokesman for the sheriff's Special Victims Bureau, said the children told investigators they ran away because Brewer deprived them of food, locked them in separate bedrooms when she went to work each day, bound their hands behind their backs with zip ties and beat them with electrical cords and a hammer. The youngsters also said that when they were locked in the bedrooms and needed to use the bathroom, they instead had to use wastebaskets, Hudson said.

They fled because "they were tired of being tied up and beaten," Hudson said.

Hudson said both children had injuries consistent with the alleged abuse, including marks on their wrists indicating they had been restrained and "numerous bruising and abrasions over their bodies." They told investigators the mistreatment had been happening since Halloween.

Neighbors interviewed by authorities said they had never noticed anything suspicious but "hardly ever saw the two children," Hudson said. Otero and another neighbor said Brewer did not make friends on the block.

Otero said Brewer was "unfriendly" and typically ignored verbal greetings and waves.

According to sheriff's officials, Brewer, a certified nursing assistant who works in Los Angeles and has adult children, adopted the young siblings about a year ago from foster care. They were home schooled.

Neil Zanville, a spokesman for the county Department of Children and Family Services, said his agency was legally prohibited from disclosing any case-specific information about past or present clients. But in a written statement, the agency's director, Philip Browning, called the report disturbing.

"While we cannot confirm or deny whether this family is under our supervision, I am personally looking into this situation to determine what role, if any, our department had in these children's lives," Browning said.

Sheriff's officials said Thursday that the children were "doing great" despite their injuries.

Otero lamented that they had been made to suffer.

"It's just so sad," said the neighbor, who has a 5-year-old daughter and 8-year-old twins. "I wish they would have knocked on my door. I would have helped them."

Brewer is in the custody of the Sheriff's Department, with bail set at $2 million. She is scheduled to appear in court Thursday, Hudson said.

ann.simmons@latimes.com

Times staff writer Kate Mather contributed to this report.

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Damon 'hijacks' Kimmel's ABC show

NEW YORK (AP) — Matt Damon had his revenge.

The butt of a long-running joke on ABC's "Jimmy Kimmel Live," the actor opened Thursday night's show as a kidnapper who tied Kimmel to a chair with duct tape and gagged him with his own tie.

"There's a new host in town and his initials are M.D.," Damon said. "That's right, the doctor is in."

For years, Kimmel has joked at the end of his show that he ran out of time and was unable to bring Damon on as a guest. Kimmel was the silent one Thursday, watching from the back of the stage as Damon did his job.

Damon tormented Kimmel by bringing on a succession of big-name guests. Robin Williams stopped by to finish the monologue. Ben Affleck had a walk-on role. Sheryl Crow was the bandleader and performed her new single. Nicole Kidman, Gary Oldman, Amy Adams, Reese Witherspoon and Demi Moore all crowded the talk show's couch.

"I've been waiting for this moment for a long, long time," Damon said. "This is like when I lost my virginity, except this is going to last way longer than one second."

Damon's guest hosting turn came at a key time for Kimmel. ABC earlier this month moved the show to 11:35 p.m. ET and PT after a decade of airing it a half hour later, putting him in direct competition with Jay Leno and David Letterman.

Thursday's special program aimed for the same water-cooler status as a memorably lewd short film Damon made for the show a few years ago with Kimmel's then-girlfriend, Sarah Silverman. It went viral and remains probably the best-known skit in the show's history.

To twist the knife even further, Damon brought Silverman on as his final guest Thursday night, with Kimmel looking on forlornly as she likened their five-year relationship to an unfortunate trip to a hot dog vendor.

"Is there anything you'd like to say to Jimmy?" Damon asked.

"No, I'm good," Silverman replied.

Then came the sweetest revenge of all, with Damon promising to ungag Kimmel in the show's final minutes.

"Wait," he said. "I'm sorry. We're out of time."

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The New Old Age Blog: Time to Recognize Mild Cognitive Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by.

It can make it easier or harder to get an insurance company or Medicare to cover treatments, for example. It factors into a variety of legal and governmental decisions.

And on a personal basis, a psychiatric diagnosis may be welcome (having a name and a treatment plan for what’s bothering us can be comforting) or not (are we really suffering from a mental disorder if we seem depressed after a family member dies?).

That last question refers to a change in the new DSM5, to be published in May, that has generated considerable controversy and that I discussed in an earlier post: the removal of the “bereavement exclusion,” once part of the diagnosis of Major Depressive Disorder.

Another element of the revised DSM could also affect readers: It will include something called Mild Neurocognitive Disorder. The task force revising the manual wanted to align psychiatry with the rest of medicine, which has already begun to distinguish between levels of impairment, said its chairman, David Kupfer, a University of Pittsburgh psychiatrist.

True enough, as we have reported before. Neurologists call it Mild Cognitive Impairment, a stage where cognitive decline becomes noticeable enough to affect daily functioning, yet people can still live independently and have not progressed to dementia.

In fact, a large proportion of people with mild cognitive problems never will develop dementia — but doctors and researchers cannot yet determine who will and who won’t. Biomarkers that could identify the biological brain changes that presage dementia are still years away.

Will it be helpful, then, for health professionals using the DSM5 — most of them not psychiatrists, but primary care doctors — to begin diagnosing Mild Neurocognitive Disorder? Particularly as there is no treatment that can reverse it or reliably slow its progression, if it would progress?

Dr. Ronald Petersen, director of the Mayo Clinic’s Alzheimer’s Disease Research Center and a member of the working group that developed the new DSM5 criteria, said he thought the newly recognized disorder would be useful. “The predementia phase is becoming increasingly important,” he told me in an interview.

Counseling could help people compensate for the memory loss and other deficits they are experiencing, for example. With a DSM-recognized diagnosis, those approaches are more likely to be covered by insurers.

Besides, “one argument against Alzheimer’s therapies is that we wait too late, when there’s too much damage to the central nervous system to repair,” Dr. Petersen said, referring to several recent disappointing drug trials. In the future, with earlier diagnoses, “you may be able to intervene, stop the process and forestall the dementia.”

But as we have seen with screening tests for other diseases, early detection does not always lead to better health or longer lives. It can, however, lead to unnecessary treatments and procedures involving risks of their own. Could that happen with Mild Neurocognitive Disorder?

“It will lead to wild overdiagnosis,” predicted Allen Frances, an emeritus professor of psychiatry at Duke and the chairman of the task force that developed the previous DSM edition. Indeed, about a quarter of people initially diagnosed with mild cognitive impairment are later determined to be normal, a prominent researcher told my colleague Judy Graham last year.

“People will get unnecessary tests and start getting weird treatments that have no proven efficacy,” said Dr. Frances, who has criticized a number of DSM5 changes. “They’re going to worry like crazy about being demented.”

Dr. Petersen agreed that it was a legitimate concern, but “by and large, we’re becoming better at distinguishing between the normal cognitive effects of aging and disease.” (The American Psychiatric Association will publish a specialized DSM for primary care physicians, Dr. Kupfer pointed out, to help guide them through diagnoses.)

It is hard for patients and families to know how to react when experts disagree. But keep in mind that contemporary health care aims for what is called shared decision-making. That means patients and professionals discuss options and weigh the risks and benefits of treatments and procedures, their likely outcomes, patients’ preferences, and come to agreement on how to proceed. This essay in the New England Journal of Medicine calls shared decision-making “the pinnacle of patient-centered care.”

So when Dr. Frances refers to the DSM5 as “a guide, not a bible,” and urges skepticism about some of its diagnoses, he is advocating an approach that patients and families should probably bring to any medical decision.

Seeking further information, asking questions, assessing options — those are reasonable responses if, a few weeks after a loved one’s death, a doctor says you may have major depression. Or if she thinks your memory loss could mean Mild Neurocognitive Disorder.

“The shorter the evaluation, the less the person knows you, the less he or she can explain and justify the diagnosis, the more tests and treatments that will result, the more a person should be cautious and get a second opinion,” Dr. Frances said.

Whatever the DSM5 says, it’s hard to argue with that.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Lawmaker questions Disney's plan for wristband data

A congressman from Massachusetts raised questions Thursday about how Walt Disney Co. will use information it collects when it gives parkgoers new wristbands embedded with computer chips.

Edward J. Markey (D-Mass), who co-chairs a congressional panel on privacy, asked Walt Disney Co. Chairman and Chief Executive Robert A. Iger in a letter what information the park will collect with the so-called MagicBand and how it will be used.

"Widespread use of MagicBand bracelets by park guests could dramatically increase the personal data Disney can collect about its guests," he said, adding that he is particularly concerned at the prospects of Disney collecting information about children.

Disney announced recently that it plans to unveil this spring at Walt Disney World in Florida a wristband embedded with radio frequency identification chips. A unique code in each chip lets parkgoers pay to enter the park, check into Disney hotels and buy food and souvenirs, among other things.

Disney officials promoted the wristbands as a way to make visiting the park easier. The wristbands will let Disney use the data to customize future offerings and marketing pitches.

Disney officials say they have no plans yet to introduce the wristbands at Disneyland or Disney California Adventure Park in Anaheim.

In a three-page letter, Markey said he is "deeply concerned that Disney's proposal could potentially have a harmful impact on our children." He asked whether parkgoers will have a chance to opt out of sharing their information and, if not, whether Disney will share the data with other companies.

A spokesman for Markey said his office had not received a response from Disney on Thursday, but in a statement to The Times, the company said participation in the wristband program was optional.

"In addition, guests control whether their personal information is used for promotional purposes, and no data collected is ever used to market to children," the statement said.

If parkgoers agree to release such information it can be used for marketing, Disney officials confirmed.

hugo.martin@latimes.com

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California unions grow, bucking U.S. trend

The latest snapshot of the U.S. working class shows that unions are in trouble, their ranks thinning amid a backlash against organized labor and a still sputtering economy.

But California and a few nearby states in the Southwest are showing a vastly different picture — labor's ranks are on an upswing. The Golden State's union organizers signed up more than 100,000 new members last year, while the nation as a whole shed 400,000, according to data released Wednesday.

The reason: Latino workers.

After working hard to get here, many Latino immigrants demand respect in the workplace and are more willing to join unions in a tough economic environment, organizers say.

"There's an appetite among these low-wage workers to try and get a collective voice to give themselves opportunity and a middle-class lifestyle," said Steve Smith, a spokesman for the California Labor Federation.

Just 12.5% of the workforce was represented by unions nationwide in 2012, down from 13% the year before. But 18.4% of California's workforce was represented by a union last year, according to data from the Bureau of Labor Statistics.

The nation is paying attention to labor's ability to gain traction in states such as California.

Strong membership in California could help unions negotiate higher wages, lobby the Legislature and fend off anti-labor attacks that have become common in the Midwest. Unions in once pro-labor states like Wisconsin and Michigan have been put on the defensive by legislation aimed at eroding the bargaining power of public-sector unions.

Labor's more optimistic proponents say that California could serve as a blueprint for unions across the country as they seek to stem membership declines. The trend comes amid forecasts that the Latino population in the U.S. is likely to double in two decades.

"This has a lot to do with the changing demographics of the workforce in these states," said Ruben Garcia, a labor law professor at the University of Nevada Las Vegas. "The big campaigns in the carwash industry in L.A., the janitors in Houston and the people who work on the Strip here tend to be an immigrant Latino workforce that's willing to stand up at the workplace, sometimes with great risks."

Workers fed up with years of stagnant wages may be motivated to join a union for financial reasons. Last year, union members made $943 a week, on average, while non-union members made $742, according to the BLS.

With the economy still shaky, many California workers are also looking for more job security.

Jackie McKay, 48, is one of the new crop of California union members. A nurse in the intensive-care unit at Community Hospital Long Beach, McKay said she and colleagues decided to try to organize after a new company took over the hospital and nurses weren't comfortable with the way they were being treated.

"We were sort of seeking out someone that we felt was on our side," she said. "We needed some backup."

The Long Beach nurses voted 94 to 30 to unionize in December.

"California is doing far better than most other states and far better than the national trend" in union membership, said John Logan, a professor of labor and employment at San Francisco State University. "Unions have had both dynamic organizing efforts and very effective political influence."

Employees are often hesitant to do anything risky at work when the economy is bad and jobs are scarce. Organizers say they were successful because they harnessed frustration with growing nationwide inequality to engage members during the recession.

"To be successful in organizing unions in the United States in 2013, it's not enough just to appeal to workers on the basis of their own individual problems," said David Johnson, organizing director of the California Nurses Assn., which added five new hospitals last year. "There has to be a broader vision set forth so that people see unions and the labor movement as an answer to the corporate domination and the Wall Street greed that has devastated our country."

Still, the labor movement faces significant challenges in applying moderate successes in California to the rest of the country.

Michigan and Indiana both became "right to work" states last year, meaning unions can't collect dues as a condition of employment. Legislators in Wisconsin and Ohio recently supported bills restricting the bargaining rights of public-sector unions, though the law in Ohio was reversed by referendum.

Those actions were reflected in the numbers put out by the Bureau of Labor Statistics. The percentage of people represented by unions last year in Wisconsin fell to 12%, from 14.1% in 2011, while Indiana experienced a significant drop in union membership, to 10% of the workforce, from 12.4% the previous year.

Union membership fell fairly consistently in Rust Belt states as manufacturing jobs, once a labor stronghold, were sent overseas. The decline in unionized manufacturing isn't likely to shift as companies make efforts to return manufacturing to the United States. Auto companies, for instance, have built new plants in the South, an area traditionally resistant to unionization.

Unions don't have the same appeal to workers who change jobs frequently and think of themselves as independent workers, said Michael Lotito, a partner at the labor law firm Littler Mendelson.

"Unions are really struggling to find a message that resonates with individuals such as it did with my father's generation," he said.

But demographic shifts can be only positive for unions in the next few years, said Harley Shaiken, a labor professor at UC Berkeley. Labor has built new alliances and is going into a new, proactive phase, he said.

"Reports of labor's death have been greatly exaggerated," he said.

alana.semuels@latimes.com

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Paris Opera Ballet names Millepied of 'Black Swan'

PARIS (AP) — Benjamin Millepied, the "Black Swan" choreographer who helped transform Natalie Portman into an obsessed, paranoid ballerina for the film and later married the actress, was named director of the Paris Opera Ballet on Thursday.

Millepied, 35, is a former principal dancer with the New York City Ballet who left in 2011 to create his own dance company in Los Angeles, L.A. Dance Project. He'll start at the Paris company in October 2014, when the current dance director, Brigitte Lefevre, retires.

Millepied and Portman, who have a son, met during the making of "Black Swan," Darren Aronofsky's psychological thriller that stars Portman as a ballet dancer.

Portman won the best actress Academy Award or her performance in the movie.

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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Francis, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Apple shares tumble after relatively unimpressive earnings report

Apple Inc. may still make products customers love, but its latest earnings report appears to have broken investors' hearts.

For the third quarter in a row, Apple reported revenue and profit that were impressive by normal standards, but short of what analysts had expected. Investors reacted harshly, driving Apple's stock price down more than 10% in after-hours trading Wednesday.

If that trend holds when trading opens Thursday, Apple will have lost almost $50 billion in market value in the blink of an eye, and its stock will have given up almost all the extraordinary gains it had made in the last year. Investors' and fund managers' belief in one of the world's most widely held stocks will be severely tested in the coming days.

More fundamentally, despite upbeat talk by Apple Chief Executive Tim Cook, the performance is unlikely to quell growing worries that Apple's remarkable run of dominance might be over.

"Overall, compared to other companies, it's impressive. But for Apple's standards, it's not great," said Patrick Moorhead of Moor Insights & Strategy. "I do think this somewhat fuels the perception that Apple is slowing down a bit.... And it's driven by the fact that some of its competitors are catching up, and in some markets have already caught up."

Apple executives did their best during an hourlong conference call with analysts to project optimism and excitement about both the last quarter and the months ahead. They noted that the company had trouble meeting demand for both iPads and Macs, and could have sold many more had they been able to build enough.

They also pointed to a growing business in China and the expansion of iTunes, which is now available in 119 countries.

"Apple is in one of the most prolific periods of innovation in its history," Cook said. "We continue to believe our fundamentals, our remarkable people, our clear and focused strategy will serve us well in the coming months and years ahead."

Cook praised the record numbers posted by Apple. For the three months that ended in December, Apple said revenue increased 18% to a record $54.5 billion. Profit also set an all-time high but was up only slightly from the year-earlier quarter, rising to $13.08 billion, or $13.81 a share, from $13.06 billion, or $13.87.

Apple said it sold a record 47.8 million iPhones last quarter, up from 37 million iPhones in the same quarter of 2011. Despite that massive figure, some analysts had hoped to see stronger demand with sales exceeding 50 million.

"Meeting expectations is not enough for Apple," said Colin Gillis of BGC Financial. "So that's a little bit of a disappointment…. International sales were a little weaker than people expected. So we'll see how that shakes out."

Last quarter saw the introduction of the iPad mini, a 7.9-inch version of Apple's popular tablet computer. The Cupertino, Calif., company said it sold a total of 22.9 million iPads in the quarter, also a record, up from 15.4 million a year earlier. The company didn't break out iPad mini numbers from its total tablet sales, but Chief Financial Officer Peter Oppenheimer told analysts that the smaller version has been a hit and that the company experienced significant backlog getting the product to store shelves. The 22% lower average selling price for Apple's tablets suggests the mini has performed well but probably cannibalized some sales of its 9.7-inch version.

Historic comparisons were challenging this year because the most recent quarter had only 13 weeks, compared with 14 weeks for the same quarter of 2011.

Like many retailers and consumer electronics companies, the quarter from October to December is typically Apple's largest because of the holiday shopping season. Last year, Apple managed to stun investors by beating its own revenue estimates by more than 25% and earnings forecast by nearly 50%. That sent the stock soaring.

But even as Apple extended its lead as the world's most valuable company, and set a record in August for most valuable company ever when not adjusted for inflation, doubts began to creep into the minds of analysts and investors.

Shares have plummeted 27% in the last four months. On Wednesday, shares rose $9.24, or 1.8%, to $514.01 during regular trading.

Apple reported strong earnings in both the third and fourth quarters last year, but the numbers missed analysts' consensus estimates. Gradually, analysts began lowering their forecasts for Apple's earnings for the current fiscal year. At the same time,

Apple experienced some uncharacteristic gaffes. The new Apple Maps app that replaced Google Maps on iOS 6 devices had reliability problems, prompting a rare apology by Apple. And the iPhone 5 that went on sale in September faced long shipping delays as Apple suppliers struggled to adapt to the new, longer screen size.

The dismissal of iOS chief Scott Forstall, a favorite of the late Apple co-founder Steve Jobs, raised eyebrows. But so did a new strategy for launching products: Whereas Apple updates to products used to be few and far between, the company has lately begun increasing the number of products as well as the introduction of new versions.

The first quarter saw one of the busiest product launch cycles in the company's history. The quarter was the first full quarter of sales for the iPhone 5, a new iPod Touch and nano, the fourth iPad, a new 13-inch Retina MacBook Pro, and, of course, the first iPad mini.

Observers have pointed to this accelerated pace as an indication that Apple is facing more competitive pressure from rivals such as Samsung Electronics Co., which is now the world's biggest seller of smartphones, with its Galaxy series of phones. The concern is that the faster upgrade cycle plus the smaller iPad mini will cut into Apple's historically high profit margins.

Such fears over lower profits have also been stoked by the debate over whether Apple plans to release a cheaper iPhone aimed at capturing market share in emerging economies and the concern that Apple has not been able to strike a deal with China's largest carrier.

Now that the first-quarter numbers have been released, analysts will be busy recalibrating their projections over the next couple of days. But the focus is also likely to shift to renewed speculation about new products that investors are hoping will drive another big run for the stock.

chris.obrien@latimes.com

andrea.chang@latimes.com

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