Coptic Church Chooses Pope Who Rejects Politics

Tara Todras-Whitehill for The New York Times

Coptic clergymen at a ceremony on Sunday for choosing a pope.

CAIRO — A blindfolded 6-year-old reached into a glass bowl on Sunday to pick the first new Coptic pope in more than 40 years, a patriarch who promises a new era of integration for Egypt’s Christian minority as it grapples with a wave of sectarian violence, new Islamist domination of politics, and internal pressures for reform.

Tara Todras-Whitehill for The New York Times

The acting Coptic pope, before a banner of Bishop Tawadros, held up the names of other candidates to show that the selection was fair.

Speaking to the television cameras that surrounded him at his monastery in a desert town, the pope-designate, Bishop Tawadros, indicated that he planned to reverse the explicitly political role of his predecessor, Pope Shenouda III, who died in March. For four decades, Shenouda acted as the Copts’ chief representative in public life, won special favors for his flock by publicly endorsing President Hosni Mubarak, and last year urged in vain that Copts stay away from the protests that ultimately toppled the strongman.

“The most important thing is for the church to go back and live consistently within the spiritual boundaries because this is its main work, spiritual work,” the bishop said, and he promised to begin a process of “rearranging the house from the inside” and “pushing new blood” after his installation later this month as Pope Tawadros II. Interviewed on Coptic television recently, he struck a new tone by including as his priorities “living with our brothers, the Muslims” and “the responsibility of preserving our shared life.”

“Integrating in the society is a fundamental scriptural Christian trait,” Bishop Tawadros said then. “This integration is a must — moderate constructive integration,” he added. “All of us, as Egyptians, have to participate.”

Coptic activists and intellectuals said the turn away from politics signaled a sweeping transformation in the Christian minority’s relationship to the Egyptian state but also addressed a firm demand by the Christian laity to claim a voice in a more democratic Egypt.

“It can’t continue the way it used to be,” said Youssef Sidhom, editor of the Coptic newspaper Watani. “It is not in the interests of the Copts, if they are trying to speak for themselves as full and equal citizens, to have an intermediary speaking for them, and especially if he is a religious authority. I think the church has gotten this message loud and clear.”

In Egypt’s first free elections for Parliament and president, Christians voted overwhelmingly along sectarian lines, seeking to pool their votes around the most secular candidates — only to see their favorites fall under the Islamist tide. After the Muslim Brotherhood’s political party won parliamentary leadership and then the presidency, many Egyptians joked that the group put a candidate up for Coptic pope, too.

In recent interviews, intellectuals and activists, and churchgoers leaving Mass after the selection of the pope, all said they had concluded that Christians would have to build alliances with Muslims who shared their goal of nonsectarian citizenship.

“We are not the Muslim Brotherhood,” said Tarek Samir, a sales manager leaving the cathedral after the selection of Bishop Tawadros. “Politics is a dirty word to us, and we do not think it should be mixed with religion. But there are moderate Muslims who live the same life we do, who go to work with us, who live together with us, and if I am in trouble they will help me.”

Copts, often estimated to make up about 10 percent of Egypt’s 80 million people, trace their roots here to centuries before the birth of the Prophet Muhammad. They consider St. Mark their first pope; Tawadros II will be the 118th. In some ways, they are now at the spearhead of a challenge confronting Christian minorities across the region amid the tumult of the Arab Spring. In Iraq, Lebanon, Syria and elsewhere, Christian minorities had made peace with authoritarian rulers in the hope of protection from the Muslim majorities. But now the old bargains have broken, leaving Christians to fend for themselves.

In Egypt, the revolution last year coincided with by far the deadliest 12 months of sectarian violence in decades, including the bombing of an Alexandria church weeks before the revolt, the destruction of at least three churches in sectarian feuds, and the killing of about two dozen Coptic demonstrators by Egyptian soldiers squashing a protest — the single bloodiest episode of sectarian violence in at least half a century.

Known as the Maspero massacre after a nearby television building, the slaughter elicited attempts by top generals to blame the Copts and scant sympathy from the main Islamist groups, crystallizing Coptic anxieties.

Mayy El Sheikh and Mai Ayyad contributed reporting.

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Google's Android software in 3 out of 4 smartphones

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Colts follow Luck's lead past Miami 23-20

INDIANAPOLIS (AP) — Andrew Luck and Ryan Tannehill put on a memorable show for Chuck Pagano on Sunday.

The rookie quarterbacks traded jab for jab, hook for hook and TD pass for TD pass. When the duel finally ended, it was Luck who had the records — and another win for his ailing coach.

Luck threw for 433 yards and two TD passes, breaking Cam Newton's single-game passing record (422 yards) for a rookie as he led the Colts to a 23-20 victory over Miami.

The matchup was everything people expected from the two first-round draft picks, who had gotten their teams off to surprising starts.

And this one will go down as yet another memorable chapter in Indy's bittersweet season.

Pagano, the Colts coach who had been watching the games on television since Sept. 26 after being diagnosed with a form of leukemia, walked into the coaches' box about 5 minutes before kickoff and after speaking to the team.

Luck took the cue, throwing for 273 yards in the first half — the fourth highest first-half total in franchise history — and it didn't take much longer for the No. 1 overall draft pick to join Peyton Manning as the only players in league history with four 300-yard games in their rookie seasons.

Luck finished 30 of 48 and made big play after big play for the Colts (5-3), who have won three straight and are 4-1 at home.

Tannehill was just as impressive despite not being 100 percent. He was questionable all week with left knee and thigh injuries, was limited in practice and wasn't picked as the starter until about 90 minutes before kickoff. He wound up going 22 of 38 for 290 yards with one touchdown.

But it wasn't quite enough to prevent Miami (4-4) from losing for the first time in four games.

The difference: Luck made bigger plays.

He continually escaped pressure, hooked up on long throws, converted third downs and made two uncanny TD passes — a 9-yard throw to Reggie Wayne, who made a beautiful toe-tap in the back of the end zone in the first quarter and a 36-yard scoring pass into double coverage that rookie T.Y. Hilton hauled in with a terrific leaping catch to give Indy a 20-17 lead late in the third quarter.

Miami tied the score at 20 when Dan Carpenter made a 31-yard field goal with 13:12 to go, but Luck led the Colts on a 13-play, 69-yard drive to set up Adam Vinatieri for the decisive 43-yard field goal with 6:03 to go.

The Dolphins got the ball back two more times, but never got into scoring position and Luck ran out the clock.

___

Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Chelation Therapy Shows Slight Benefit in Heart Disease Clinical Trial

LOS ANGELES — To the surprise of many cardiologists, a controversial alternative therapy proved beneficial to people with heart disease, reducing the rate of death and cardiovascular problems in a clinical trial, researchers said on Sunday.

The benefit of the treatment, known as chelation therapy, barely reached statistical significance, and there were questions about the reliability of the study. Even the investigators in the trial said the results were insufficient by themselves to justify recommending use of the treatment.

Still, the unexpected finding should provide some vindication to the National Institutes of Health for sponsoring the $30 million study, which was plagued by delays and problems.

“There may be a biological effect and that biological effect should be taken seriously,” and “pursued with additional research,” Dr. Gervasio A. Lamas of Mount Sinai Medical Center in Miami, the lead investigator, said at a news conference here at the annual scientific meeting of the American Heart Association.

Dr. Elliott Antman, representing the heart association, applauded the National Institutes of Health for sponsoring the study while also expressing caution. “Intriguing as these results are, they are unexpected and should not be interpreted as an indication to adopt chelation therapy into clinical practice,” said Dr. Antman, a cardiologist at Brigham and Women’s Hospital in Boston.

Chelation therapy involves the infusion of agents that remove metals from the bloodstream.

More than 100,000 Americans with heart disease undergo chelation therapy each year, at a cost of about $5,000 per course of treatment, experts here said. The hypothesis is that chelation can remove the calcium that is a contributor to arterial plaques.

But skeptics said there was not enough evidence backing chelation therapy to even begin a clinical trial. Proponents of the study said that since chelation therapy was already widely used, it should be subject to the same rigorous scientific testing used to study conventional pharmaceuticals.

And some skeptics were not persuaded at all. Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, said the study was “fatally flawed,” with many of the doctors involved being on the fringes of medicine and many patients dropping out of the trial. He said if people got the mistaken idea from the study that chelation was beneficial “it would be a public health catastrophe.”

The study, which began enrolling patients in 2003, was plagued by problems from the start. It fell way behind its goal of recruiting nearly 2,400 patients in three years. The trial was also suspended in 2008 for investigations by government agencies, one over conduct at trial sites and the other about whether patients were being adequately informed that chelation can cause death. The study was allowed to resume the next year, after some changes were made.

The trial ended up with 1,708 patients at 134 centers in the United States and Canada. The patients all had had previous heart attacks.

Half the patients received the chelation therapy, a synthetic amino acid called disodium ethylene diamine tetra acetic acid, or EDTA, as well as other substances. These were given by infusion every week for 30 weeks, followed by 10 more infusions at intervals of two to eight weeks. The other half received infusions of placebo.

After a follow-up of 55 months, 26 percent of those who received chelation therapy had died, suffered a heart attack or stroke, had a procedure to reopen a coronary artery or had been hospitalized for angina. That was less than the 30 percent for those who received a placebo, a difference that was barely statistically significant.

Doctors said there were reasons for caution.

Virtually all the of difference between the treatment and the placebo groups occurred in the third of patients who had diabetes. The placebo contained some sugar, which conceivably could have harmed the diabetics. Also, at least within the first two years, the chelation therapy did not improve physical functioning or psychological well being, according to surveys of the patients.

Dr. Mark A. Creager, a cardiologist at Brigham and Women’s Hospital who was not involved in the study, said the chelation infusion also contained a high dose of vitamin C and the blood thinner heparin. It could be that one of those ingredients, not the chelation agent, were responsible for any benefit, he said.

Dr. Lamas, the lead investigator, said the chelation treatment was well tolerated. But he said investigators did not yet know why some patients receiving the therapy dropped out of the trial.

Another study presented at the heart meeting on Sunday found coronary bypass surgery superior to the use of stents for patients with diabetes and multiple heart blockages.

The trial involved 1,900 patients followed for five yeas. About 27 percent of those who received stents either died or had a heart attack or stroke, compared with about 19 percent of those undergoing bypass surgery. There was an increase in stroke risk with surgery, but that was outweighed by fewer deaths and heart attacks.

Previous studies had already suggested that surgery was better for diabetic patients with severe coronary disease, and practice guidelines already say it is “reasonable” to choose surgery. But the new study, sponsored by the National Institutes of Health, shows the same result even using modern drug-covered stents.

About 700,000 Americans undergo artery opening procedures for more than one blood vessel each year, and about 25 percent of them have diabetes, according to the investigators.

The study results were also published online by the New England Journal of Medicine. Johnson & Johnson and Boston Scientific provided the stents used in the study.

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Fight Growing Over Online Royalties

The debate playing out in Washington has echoes of a presidential race. One side says businesses will suffer unless the government steps in to lower costs. The other accuses jet-set industrialists of a ploy that will cheat the middle class.

These attacks, however, are not between candidates for the White House. They are being made in a battle over the obscure but increasingly vital issue of royalty rates for streaming music online. The issue pits the survival of Pandora Media and other Internet radio services against the diminished paychecks of musicians in the digital age.

This fight has raged on and off for more than a decade, and it was renewed recently with a bill in Congress that would change the way digital royalty rates are set. But with streaming music starting to account for a significant chunk of the music industry’s revenue, and Pandora now a scrutinized public company, the issue has touched a nerve as never before.

“This is not just about our present; it is about our future, our ability to make it in the digital age,” said Cary Sherman, chief executive of the Recording Industry Association of America. “Artists and labels and the entire music community need to earn a fair return on the creative works that are the reason companies like Pandora exist.”

Tim Westergren, the founder and public face of Pandora, has denounced the current system’s “discrimination” and urged the service’s 175 million users to contact their representatives in Washington. Music industry groups and labor unions have also gone public, casting it as a fair-pay issue.

Rates are set by three judges on the federal Copyright Royalty Board, but they apply a different standard to Internet radio services like Pandora than they do to satellite and cable radio outlets like Sirius XM and Music Choice.

Sirius, for example, pays 8 percent of its revenue to record companies and artists. Pandora pays a fraction of a cent each time a song is streamed, which last year amounted to about 54 percent of its revenue, or $149 million.

“The rate being too high dramatically depresses how much music gets played,” Mr. Westergren said in a recent interview. “It has really suffocated the industry.”

The Internet Radio Fairness Act, introduced in September, would move Internet radio companies from their “willing buyer, willing seller” standard — which critics like Pandora say results in an unrealistically high rate — to the one used for satellite and cable radio. To determine a fair rate, that standard directs the judges to consider factors including whether the prices will have a “disruptive impact” on the industry.

Music industry groups also want one standard, but one that keeps rates high. For years they have also been pushing for laws that would require terrestrial stations to pay royalties to labels and artists. (In the United States — and almost nowhere else in the world — radio stations pay royalties only to music publishers.)

Representative Jason Chaffetz, a Republican of Utah who co-sponsored the bill, said in a phone interview that the bill was meant to encourage growth in the streaming business. But when Mr. Chaffetz, whose campaign committee has received $2,000 from Pandora, was asked to respond to complaints that the changes would hurt musicians, he could not resist taunting a bit.

“The old-school dinosaurs are trying to help, but they’re stuck in the tar,” he said. “They can go talk to the pterodactyls.”

Pandora has been down this road before, and in 2009 reached an agreement for a temporary discount of about 40 percent off the royalty board’s rates; that deal expires in 2015.

This time Pandora is a different beast: a company with a $1.4 billion market capitalization. Each month, 58 million people use it to stream more than 1.1 billion hours of music.

Streaming is now on every horizon in the music industry. SoundExchange, which collects royalties from Internet and satellite radio, recently announced that it had crossed the $1 billion benchmark in payments to labels and artists.

The royalties issue, Mr. Westergren said, has become a question about the wider health of the streaming business, which he believes has been stunted by royalties.

“This is not an argument about going out of business,” he said. “A fix here would be for the whole industry.”

But there is wide anger in the music industry that the bill would enrich technology companies at the expense of musicians. MusicFirst Coalition, which includes the recording industry association, SoundExchange and others, says it believes that if Pandora gets everything it wants, it could cut its royalty bill by up to 85 percent.

For Pandora, the critical question is whether streaming businesses can be successful at all in the current system. Digital music services have proliferated over the years, but just as many have died, and popular arrivals like Spotify have yet to turn a profit.

Clear Channel Communications, the radio giant, has recently moved more aggressively into streaming with its iHeartRadio app. Robert W. Pittman, its chief executive — who has been outspoken on the royalty issue — said in an interview that a change could generate more money for the music industry by allowing streaming businesses to thrive.

“It’s not so much about rates as about how much dollars you spend,” Mr. Pittman said. “The amount of dollars to artists is rate times volume. If the rate suppresses the volume, there’s less money. If it encourages volume, there’s more money.”

Mr. Westergren is revered as a self-made success with real musical bona fides; he is fond of telling stories about his years of scraping by as a touring musician. But the controversy over the Internet Radio Fairness Act threatens to tarnish that image.

The music industry says that if Pandora needs to improve its bottom line, it should sell more ads. When asked to respond, Mr. Westergren makes a gesture of banging his head on a table.

“It’s an easy thing to say,” he said. “But no one has yet explained to us why Internet radio is under a different standard. No one responds to that fundamental premise.”

Advertising sales, which make up almost 90 percent of Pandora’s revenue, doubled in the company’s last fiscal year.

For Mr. Westergren, though, the most difficult aspect of this battle has been the accusation that Pandora wants to take advantage of musicians.

“This adversarial reaction toward Internet radio is counterproductive,” he said. “It’s causing other businesses to sit on the sidelines, and that is hurting musicians. Ultimately, you want to have many boats in the harbor.”

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Gays in Pakistan Move Cautiously to Gain Acceptance

Max Becherer for the International Herald Tribune

HIDING IN PLAIN SIGHT Ali, a gay man who lives in Lahore, is in a support group for lesbian, gay, bisexual and transgender Pakistanis. “The gay scene here is very hush-hush,” he says.

LAHORE, Pakistan — The group meets irregularly in a simple building among a row of shops here that close in the evening. Drapes cover the windows. Sometimes members watch movies or read poetry. Occasionally, they give a party, dance and drink and let off steam.

The group is invitation only, by word of mouth. Members communicate through an e-mail list and are careful not to jeopardize the location of their meetings. One room is reserved for “crisis situations,” when someone may need a place to hide, most often from her own family. This is their safe space — a support group for lesbian, gay, bisexual and transgender Pakistanis.

“The gay scene here is very hush-hush,” said Ali, a member who did not want his full name used. “I wish it was a bit more open, but you make do with what you have.”

That is slowly changing as a relative handful of younger gays and lesbians, many educated in the West, seek to foster more acceptance of their sexuality and to carve out an identity, even in a climate of religious conservatism.

Homosexual acts remain illegal in Pakistan, based on laws constructed by the British during colonial rule. No civil rights legislation exists to protect gays and lesbians from discrimination.

But the reality is far more complex, more akin to “don’t ask, don’t tell” than a state-sponsored witch hunt. For a long time, the state’s willful blindness has provided space enough for gays and lesbians. They socialize, organize, date and even live together as couples, though discreetly.

One journalist, in his early 40s, has been living as a gay man in Pakistan for almost two decades. “It’s very easy being gay here, to be honest,” he said, though he and several others interviewed did not want their names used for fear of the social and legal repercussions. “You can live without being hassled about it,” he said, “as long as you are not wearing a pink tutu and running down the street carrying a rainbow flag.”

The reason is that while the notion of homosexuality may be taboo, homosocial, and even homosexual, behavior is common enough. Pakistani society is sharply segregated on gender lines, with taboos about extramarital sex that make it almost harder to conduct a secret heterosexual romance than a homosexual one. Displays of affection between men in public, like hugging and holding hands, are common. “A guy can be with a guy anytime, anywhere, and no one will raise an eyebrow,” the journalist said.

For many in his and previous generations, he said, same-sex attraction was not necessarily an issue because it did not involve questions of identity. Many Pakistani men who have sex with men do not think of themselves as gay. Some do it regularly, when they need a break from their wives, they say, and some for money.

But all the examples of homosexual relations — in Sufi poetry, Urdu literature or discreet sexual conduct — occur within the private sphere, said Hina Jilani, a human rights lawyer and activist for women’s and minority rights. Homoeroticism can be expressed but not named.

“The biggest hurdle,” Ms. Jilani said, “is finding the proper context in which to bring this issue out into the open.”

That is what the gay and lesbian support group in Lahore is slowly seeking to do, even if it still meets in what amounts to near secrecy.

The driving force behind the group comes from two women, ages 30 and 33. They are keenly aware of the oddity that two women, partners no less, have become architects of the modern gay scene in Lahore; if gay and bisexual men barely register in the collective societal consciousness of Pakistan, their female counterparts are even less visible.

“The organizing came from my personal experience of extreme isolation, the sense of being alone and different,” the 30-year-old said.

She decided that she needed to find others like her in Pakistan. Eight people, mostly the couple’s friends, attended the first meeting in January 2009.

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Google's Android software in 3 out of 4 smartphones

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NYC Marathon runners fill unexpected free time

NEW YORK (AP) — Sue Johnson refuses to give New York City any more money.

She preferred to shell out for the change fee to move her flight home to Pittsburgh up by 24 hours — leaving on the day she was supposed to run the New York City Marathon.

Many of the runners who had descended on the city from all over the globe worked out their frustrations with a jog Saturday through Central Park, site of a finish line that will never be crossed. Some scrambled to rebook return flights. Others made sightseeing plans for the unexpected free time.

Whether from Europe, South America or elsewhere, their sentiment was the same. Sympathy for the victims of Superstorm Sandy. Understanding of why city officials canceled Sunday's race. But bitterness that the decision was made Friday instead of earlier in the week, before they boarded planes.

And some, like Johnson, voiced suspicions that the last-minute announcement was a ploy by city officials to lure entrants to New York so they would still spend money at local businesses.

"They get the best of both worlds," she said after wrapping up a run Saturday.

The runners had dragged their bodies through months of training, often making preparations years in advance and saving money for what costs thousands of dollars for many international entrants.

Diego Pellegrino and his wife kept their plans to stay in New York through Friday. But he had imagined biking around, shopping and eating well all week with the sense of accomplishment of completing his first marathon.

"The illusion is broken," he said.

Pellegrino will still take part in a sporting event midday Sunday: With no race to run, he'll make his first visit to Madison Square Garden for an NBA game, cheering on fellow Argentine Pablo Prigioni of the Knicks against the Philadelphia 76ers.

On a crisp, sunny Saturday, Central Park looked the part of the usual telegenic backdrop to the marathon's final miles. Other than some downed branches, the runners who chugged along the paths saw no evidence of the storm that knocked out power and flooded homes all over the metropolitan area.

More New Yorkers got electricity Saturday, but frustrations mounted over gasoline shortages as refueling sites turned into traffic jams of horn-honking confusion. Gas rationing went into effect in northern New Jersey, while crowds lined up at free fuel distribution sites in New York's boroughs.

The blue and orange structure above the finish line remained up, though nobody could run under it. Barricades kept people a few yards away, creating the feel of a tourist attraction: Runners stood against them to have their photo taken with "Finish" in the background. Many wore NYC Marathon gear, souvenirs from an event that never occurred.

Susan Bourque was in the car, halfway between Boston and New York, when her father called Friday evening to say the race was canceled. Still on the road, Bourque started researching whether she could enter a different marathon in the next couple weeks so as not to waste her training. Sure enough, Sunday's race in Manchester, N.H., had extended its registration deadline to attract jilted New York runners.

Bourque and her husband kept on driving because their two children had never been to the Big Apple. They arrived at 9:30 p.m. and squeezed in visits to the Empire State Building and Times Square before heading back to New England at midday Saturday, pleasantly surprised their hotel refunded the rate with their early departure.

Francesco Caielli, Mario Di Sabato and Luciano Sala were two hours from landing in New York on Friday when they saw the news on the plane's video screens. At least their trip was smooth: A friend whose initial flight was canceled flew from their native Italy to Hong Kong then New York, determined to make the marathon.

And now there's no race.

Di Sabato scoffed that if the same thing happened in his home country, outsiders would accuse the Italians of stereotypical disorganization. But this fiasco took place under the watch of New York City Mayor Michael Bloomberg.

In his first comments since canceling the race, Bloomberg told WCBS-TV on Saturday his message to out-of-town runners was: "I'm sorry. I fought the battle, and sometimes things don't work out."

Some runners vowed to never again enter the New York race. Pia Nielsen, who flew in from Copenhagen, said city and race officials would have to regain her trust.

But Lucy Marquez said she would come back, even as tears filled her eyes at the thought of the three young children she left at home in Mexico to race what would have been her first marathon.

"Shock. Denial. Rage," is how Marquez described the stages of digesting the news that the race had been scrapped. Twelve years ago, she watched her father run the course.

"I love New York City," she said. "This is the marathon I want to run."

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Opinion: Seeing Things? Hearing Things? Many of Us Do

HALLUCINATIONS are very startling and frightening: you suddenly see, or hear or smell something — something that is not there. Your immediate, bewildered feeling is, what is going on? Where is this coming from? The hallucination is convincingly real, produced by the same neural pathways as actual perception, and yet no one else seems to see it. And then you are forced to the conclusion that something — something unprecedented — is happening in your own brain or mind. Are you going insane, getting dementia, having a stroke?

In other cultures, hallucinations have been regarded as gifts from the gods or the Muses, but in modern times they seem to carry an ominous significance in the public (and also the medical) mind, as portents of severe mental or neurological disorders. Having hallucinations is a fearful secret for many people — millions of people — never to be mentioned, hardly to be acknowledged to oneself, and yet far from uncommon. The vast majority are benign — and, indeed, in many circumstances, perfectly normal. Most of us have experienced them from time to time, during a fever or with the sensory monotony of a desert or empty road, or sometimes, seemingly, out of the blue.

Many of us, as we lie in bed with closed eyes, awaiting sleep, have so-called hypnagogic hallucinations — geometric patterns, or faces, sometimes landscapes. Such patterns or scenes may be almost too faint to notice, or they may be very elaborate, brilliantly colored and rapidly changing — people used to compare them to slide shows.

At the other end of sleep are hypnopompic hallucinations, seen with open eyes, upon first waking. These may be ordinary (an intensification of color perhaps, or someone calling your name) or terrifying (especially if combined with sleep paralysis) — a vast spider, a pterodactyl above the bed, poised to strike.

Hallucinations (of sight, sound, smell or other sensations) can be associated with migraine or seizures, with fever or delirium. In chronic disease hospitals, nursing homes, and I.C.U.’s, hallucinations are often a result of too many medications and interactions between them, compounded by illness, anxiety and unfamiliar surroundings.

But hallucinations can have a positive and comforting role, too — this is especially true with bereavement hallucinations, seeing the face or hearing the voice of one’s deceased spouse, siblings, parents or child — and may play an important part in the mourning process. Such bereavement hallucinations frequently occur in the first year or two of bereavement, when they are most “needed.”

Working in old-age homes for many years, I have been struck by how many elderly people with impaired hearing are prone to auditory and, even more commonly, musical hallucinations — involuntary music in their minds that seems so real that at first they may think it is a neighbor’s stereo.

People with impaired sight, similarly, may start to have strange, visual hallucinations, sometimes just of patterns but often more elaborate visions of complex scenes or ranks of people in exotic dress. Perhaps 20 percent of those losing their vision or hearing may have such hallucinations.

I was called in to see one patient, Rosalie, a blind lady in her 90s, when she started to have visual hallucinations; the staff psychiatrist was also summoned. Rosalie was concerned that she might be having a stroke or getting Alzheimer’s or reacting to some medication. But I was able to reassure her that nothing was amiss neurologically. I explained to her that if the visual parts of the brain are deprived of actual input, they are hungry for stimulation and may concoct images of their own. Rosalie was greatly relieved by this, and delighted to know that there was even a name for her condition: Charles Bonnet syndrome. “Tell the nurses,” she said, drawing herself up in her chair, “that I have Charles Bonnet syndrome!”

Rosalie asked me how many people had C.B.S., and I told her hundreds of thousands, perhaps, in the United States alone. I told her that many people were afraid to mention their hallucinations. I described a recent study of elderly blind patients in the Netherlands which found that only a quarter of people with C.B.S. mentioned it to their doctors — the others were too afraid or too ashamed. It is only when physicians gently inquire (often avoiding the word “hallucination”) that people feel free to admit seeing things that are not there — despite their blindness.

Rosalie was indignant at this, and said, “You must write about it — tell my story!” I do tell her story, at length, in my book on hallucinations, along with the stories of many others. Most of these people have been reluctant to admit to their hallucinations. Often, when they do, they are misdiagnosed or undiagnosed — told that it’s nothing, or that their condition has no explanation.

Misdiagnosis is especially common if people admit to “hearing voices.” In a famous 1973 study by the Stanford psychologist David Rosenhan, eight “pseudopatients” presented themselves at various hospitals across the country, saying that they “heard voices.” All behaved normally otherwise, but were nonetheless determined to be (and treated as) schizophrenic (apart from one, who was given the diagnosis of “manic-depressive psychosis”). In this and follow-up studies, Professor Rosenhan demonstrated convincingly that auditory hallucinations and schizophrenia were synonymous in the medical mind.

WHILE many people with schizophrenia do hear voices at certain times in their lives, the inverse is not true: most people who hear voices (as much as 10 percent of the population) are not mentally ill. For them, hearing voices is a normal mode of experience.

My patients tell me about their hallucinations because I am open to hearing about them, because they know me and trust that I can usually run down the cause of their hallucinations. For the most part, these experiences are unthreatening and, once accommodated, even mildly diverting.

David Stewart, a Charles Bonnet syndrome patient with whom I corresponded, writes of his hallucinations as being “altogether friendly,” and imagines his eyes saying: “Sorry to have let you down. We recognize that blindness is no fun, so we’ve organized this small syndrome, a sort of coda to your sighted life. It’s not much, but it’s the best we can manage.”

Mr. Stewart has been able to take his hallucinations in good humor, since he knows they are not a sign of mental decline or madness. For too many patients, though, the shame, the secrecy, the stigma, persists.

Oliver Sacks is a professor of neurology at the N.Y.U. School of Medicine and the author, most recently, of the forthcoming book “Hallucinations.”

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Google Casts a Big Shadow on Smaller Web Sites

Annie Tritt for The New York Times

Jeffrey G. Katz, the chief executive of Wize Commerce, seen with employees. He says that about 60 percent of the traffic for the company’s Nextag comparison-shopping site comes from Google.

In a geeky fire drill, engineers and outside consultants at Nextag scrambled to see if the problem was its own fault. Maybe some inadvertent change had prompted Google’s algorithm to demote Nextag when a person typed in shopping-related search terms like “kitchen table” or “lawn mower.”

But no, the engineers determined. And traffic from Google’s search engine continued to decline, by half.

Nextag’s response? It doubled its spending on Google paid search advertising in the last five months.

The move was costly but necessary to retain shoppers, Mr. Katz says, because an estimated 60 percent of Nextag’s traffic comes from Google, both from free search and paid search ads, which are ads that are related to search results and appear next to them. “We had to do it,” says Mr. Katz, chief executive of Wize Commerce, owner of Nextag. “We’re living in Google’s world.”

Regulators in the United States and Europe are conducting sweeping inquiries of Google, the dominant Internet search and advertising company. Google rose by technological innovation and business acumen; in the United States, it has 67 percent of the search market and collects 75 percent of search ad dollars. Being big is no crime, but if a powerful company uses market muscle to stifle competition, that is an antitrust violation.

So the government is focusing on life in Google’s world for the sprawling economic ecosystem of Web sites that depend on their ranking in search results. What is it like to live this way, in a giant’s shadow? The experience of its inhabitants is nuanced and complex, a blend of admiration and fear.

The relationship between Google and Web sites, publishers and advertisers often seems lopsided, if not unfair. Yet Google has also provided and nurtured a landscape of opportunity. Its ecosystem generates $80 billion a year in revenue for 1.8 million businesses, Web sites and nonprofit organizations in the United States alone, it estimates.

The government’s scrutiny of Google is the most exhaustive investigation of a major corporation since the pursuit of Microsoft in the late 1990s.

The staff of the Federal Trade Commission has recommended preparing an antitrust suit against Google, according to people briefed on the inquiry, who spoke on the condition they not be identified. But the commissioners must vote to proceed. Even if they do, the government and Google could settle.

Google has drawn the attention of antitrust officials as it has moved aggressively beyond its dominant product — search and search advertising — into fields like online commerce and local reviews. The antitrust issue is whether Google uses its search engine to favor its offerings like Google Shopping and Google Plus Local over rivals.

For policy makers, Google is a tough call.

“What to do with an attractive monopolist, like Google, is a really challenging issue for antitrust,” says Tim Wu, a professor at Columbia Law School and a former senior adviser to the F.T.C. “The goal is to encourage them to stay in power by continuing to innovate instead of excluding competitors.”

SPEAKING at a Google Zeitgeist conference in Arizona last month, Larry Page, the company’s co-founder and chief executive, said he understood the government scrutiny of his company, given Google’s size and reach. “There’s very many decisions we make that really impact a lot of people,” he acknowledged.

The main reason is that Google is continually adjusting its search algorithm — the smart software that determines the relevance, ranking and presentation of search results, typically links to other Web sites.

Google says it makes the changes to improve its service, and has long maintained that its algorithm weeds out low-quality sites and shows the most useful results, whether or not they link to Google products.

“Our first and highest goal has to be to get the user the information they want as quickly and easily as possible,” says Matt Cutts, leader of the Web spam team at Google.

But Google’s algorithm is secret, and changes can leave Web sites scrambling.

Consider Vote-USA.org, a nonprofit group started in 2003. It provides online information for voters to avoid the frustration of arriving at a polling booth and barely recognizing half the names on the ballot. The site posts free sample ballots for federal, state and local elections with candidates’ pictures, biographies and views on issues.

In the 2004 and 2006 elections, users created tens of thousands of sample ballots. By 2008, traffic had fallen sharply, says Ron Kahlow, who runs Vote-USA.org, because “we dropped off the face of the map on Google.”

As founder of a search-engine optimization company and a recipient of grants that Google gives nonprofits to advertise free, Mr. Kahlow knows a thing or two about how to operate in Google’s world. He pored over Google’s guidelines for Web sites, made changes and e-mailed Google. Yet he received no response.

“I lost all donations to support the operation,” he said. “It was very, very painful.”

A breakthrough came through a personal connection. A friend of Mr. Kahlow knew Ed Black, chief executive of the Computer & Communications Industry Association, whose members include Google. Mr. Black made an inquiry on Mr. Kahlow’s behalf, and a Google engineer investigated.

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