Lashkar-e-Taiba Founder Takes Less Militant Tone in Pakistan

Diego Ibarra Sanchez for The New York Times

“I move about like an ordinary person — that’s my style,” said Hafiz Muhammad Saeed. “My fate is in the hands of God, not America.”

LAHORE, Pakistan — Ten million dollars does not seem to buy much in this bustling Pakistani city. That is the sum the United States is offering for help in convicting Hafiz Muhammad Saeed, perhaps the country’s best-known jihadi leader. Yet Mr. Saeed lives an open, and apparently fearless, life in a middle-class neighborhood here.

“I move about like an ordinary person — that’s my style,” said Mr. Saeed, a burly 64-year-old, reclining on a bolster as he ate a chicken supper. “My fate is in the hands of God, not America.”

Mr. Saeed is the founder, and is still widely believed to be the true leader, of Lashkar-e-Taiba, the militant group that carried out the 2008 attacks in Mumbai, India, in which more than 160 people, including six Americans, were killed. The United Nations has placed him on a terrorist list and imposed sanctions on his group. But few believe he will face trial any time soon in a country that maintains a perilous ambiguity toward jihadi militancy, casting a benign eye on some groups, even as it battles others that attack the state.

Mr. Saeed’s very public life seems more than just an act of mocking defiance against the Obama administration and its bounty, analysts say. As American troops prepare to leave Afghanistan next door, Lashkar is at a crossroads, and its fighters’ next move — whether to focus on fighting the West, disarm and enter the political process, or return to battle in Kashmir — will depend largely on Mr. Saeed.

At his Lahore compound — a fortified house, office and mosque — Mr. Saeed is shielded not only by his supporters, burly men wielding Kalashnikovs outside his door, but also by the Pakistani state. On a recent evening, police officers screened visitors at a checkpoint near his house, while other officers patrolled an adjoining park, watching by floodlight for intruders.

His security seemingly ensured, Mr. Saeed has over the past year addressed large public meetings and appeared on prime-time television, and is now even giving interviews to Western news media outlets he had previously eschewed.

He says that he wants to correct “misperceptions.” During an interview with The New York Times at his home last week, Mr. Saeed insisted that his name had been cleared by the Pakistani courts. “Why does the United States not respect our judicial system?” he asked.

Still, he says he has nothing against Americans, and warmly described a visit he made to the United States in 1994, during which he spoke at Islamic centers in Houston, Chicago and Boston. “At that time, I liked it,” he said with a wry smile.

During that stretch, his group was focused on attacking Indian soldiers in the disputed territory of Kashmir — the fight that led the military’s Inter-Services Intelligence Directorate to help establish Lashkar-e-Taiba in 1989. But that battle died down over the past decade, and Lashkar began projecting itself through its charity wing, Jamaat-ud-Dawa, which runs a tightly organized network of hospitals and schools across Pakistan.

The Mumbai attacks propelled Lashkar-e-Taiba to notoriety. But since then, Mr. Saeed’s provocations toward India have been largely verbal. Last week he stirred anger there by suggesting that Bollywood’s highest-paid actor, Shah Rukh Khan, a Muslim, should move to Pakistan. In the interview, he said he prized talking over fighting in Kashmir.

“The militant struggle helped grab the world’s attention,” he said. “But now the political movement is stronger, and it should be at the forefront of the struggle.”

Pakistan analysts caution that Mr. Saeed’s new openness is no random occurrence, however. “This isn’t out of the blue,” said Shamila N. Chaudhary, a former Obama administration official and an analyst at the Eurasia Group, a consulting firm. “These guys don’t start talking publicly just like that.”

What it amounts to, however, may depend on events across the border in Afghanistan, where his group has been increasingly active in recent years. In public, Mr. Saeed has been a leading light in the Defense of Pakistan Council, a coalition of right-wing groups that lobbied against the reopening of NATO supply routes through Pakistan last year. More quietly, Lashkar fighters have joined the battle, attacking Western troops and Indian diplomatic facilities in Afghanistan, intelligence officials say.

This article has been revised to reflect the following correction:

Correction: February 7, 2013

An earlier version of this article misspelled the surname of a former Obama administration official who is now an analyst at the Eurasia Group, a consulting firm. She is Shamila N. Chaudhary, not Chaudhry.

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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His blue eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

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Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

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Profound Weight of Layoffs Seen in Survey

Layoffs have touched nearly every American household in some fashion over the last few years, according to new survey data to be released Thursday by the John J. Heldrich Center for Workforce Development at Rutgers University.

Joe Raedle/Getty Images

Lissette Marquez, center, and Amiel Ali looked for jobs last week in Miami with the help of a South Florida Workforce customer service representative, Nelson Munoz, left.

While about 8 percent of Americans are unemployed, nearly a quarter of Americans say they were laid off at some point during the recession or afterward, according to the survey. More broadly, nearly eight in 10 say they know someone in their circle of family and friends who has lost a job.

“This to me is why the recession was so all-consuming and is likely to influence the American psyche,” said Cliff Zukin, a public policy and political science professor at Rutgers and co-author of the report. “Almost everyone, four out of five, were directly or one step removed from unemployment and all that goes with it financially, socially, psychologically.”

The survey presented a bleak view of the economic future.

A majority of Americans say they think it will be at least six years before the economy is made whole again, if ever. Three in 10 said the economy would never fully recover from the Great Recession.

“Despite significant improvements in the nation’s labor market, American workers’ concerns about unemployment, the job market, job security and the future of the economy have not changed much since we conducted a similar survey in August 2010,” the report said.

Just a third of Americans surveyed in this poll, conducted from Jan. 9-16, said they thought the economy would be better next year, the same share that said so two years earlier.

Of those laid off in recent years, nearly a quarter said they still had not found a job. Re-employment rates for older workers have been particularly bad, with nearly two-thirds of unemployed people 55 and older saying they actively sought a job for more than a year before finding one or had still not found work.

Not surprisingly, those who are unemployed are especially downbeat about many economic issues in addition to their own finances. Of those who were jobless and looking for work, 31 percent said their jobless benefits had run out and 58 percent said they were concerned their benefits would run out before they found work.

Of those who have found work, nearly half say their current job is a step down from the one they lost, and a slim majority say they earn less than they did in their previous job. A quarter of those re-employed said they thought that the hit to their standard of living would be permanent.

The reliance on one’s personal network and savings rather than the social safety net showed up frequently in the survey data.

More people reported borrowing money from friends and family than reported using food stamps. A third cut back on doctors’ visits or medical treatment. A quarter of the unemployed said they had enrolled in retraining programs of some kind; half of them reported paying for the education on their own or through family assistance. Twenty-three percent received some type of government financing for their training programs.

Unemployed workers were more likely than employed workers to say that the government is primarily responsible for helping the jobless. But even then, a majority of the unemployed thought that workers and employers were more responsible for getting people back to work than the government was.

Americans over all were also somewhat less critical of bankers this time than they were two years earlier. About one in three (35 percent) respondents attributed high unemployment levels to the actions of Wall Street, compared with 45 percent in 2010.

Americans were most likely to attribute high unemployment to cheap foreign labor. Four in 10 also said they believed illegal immigrants were taking Americans’ job opportunities — which does not bode well for political support for an amnesty program now being discussed in Washington.

Most people surveyed lost at least some of their savings. Asked about their financial health, six in 10 Americans said their finances would not improve in the next few years; just 16 percent said their family finances were already back to prerecession levels or suffered no loss in the first place.

More educated, better-off people were substantially more likely to report being as financially secure as they were before the recession began.

Responses are based on an online survey conducted by GfK using a nationally representative sample of 1,090 adults. The margin of sampling error is plus or minus three percentage points.

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Ally of Ahmadinejad Freed Amid Political Fight, Reports Say

TEHRAN — As President Mahmoud Ahmadinejad escalated a bitter political fight this week with Iran’s most influential political family by disclosing secret film recordings of what he purported were fraudulent business deals, Iran’s political maneuvring took a new turn Wednesday when an imprisoned associate of the president was reported to have been freed.

The release of Saeed Mortazavi, reported by two Iranian news agencies, came as the latest chapter in several days of political drama playing out with prominence in the public eye.

During a Sunday session of Parliament, broadcast on state radio, Mr. Ahmadinejad singled out the head of the Parliament, Ali Larijani, a political rival with strong links to influential Shiite Muslim clerics and one of several brothers who have held top positions in the Iranian government.

His younger brother Sadegh, 52, heads Iran’s judiciary, while his oldest brother, Mohammad Javad, a Berkeley-educated mathematician, is also a judiciary official.

On Monday, a conservative newspaper, Kayhan, hinted that the nation’s supreme leader, Ayatollah Ali Khamenei, had been forced to step in to prevent both men from giving potentially damaging news conferences, which were both canceled at the last minute.

This was not the first time Ayatollah Khamenei has been forced to intervene in this feud. In October, he issued an edict aimed at stopping the infighting, saying that those creating divisions before the June 14 presidential elections “betray” the country.

Mr. Ahmadinejad, who went to the Parliament in a failed attempt to head off the impeachment of his labor minister, Abdolreza Sheikholeslami, said Mr. Larijani and his fellow lawmakers had obstructed the government, stepped beyond their constitutional boundaries and written letters ordering the annulment of government decisions.

Instructed by Mr. Larijani to stick to the subject of the impeachment, Mr. Ahmadinejad said, “Don’t order me to close my mouth because you say it’s the law.”

With that, Mr. Ahmadinejad, who for years has threatened to reveal the names of corrupt officials, played a video clip of a conversation in which another of Mr. Larijani’s brothers, Fazel, appeared to discuss the purchase of a state company under favorable terms, the semiofficial Tabnak Web site reported. While Fazel Larijani used to head a medical association in Iran, his current position is unclear.

The public accusation, rare in Iran, could signal a new phase in an already intense conflict between Mr. Ahmadinejad, who represents a powerful group of young, ambitious politicians, and Mr. Larijani, who is the official representative of the holy city of Qum, the center of Shiite scholarship in Iran.

Mr. Ahmadinejad said his associate, Mr. Mortazavi, 45, was also at the taped meeting. In January, Mr. Mortazavi was dismissed as the head of Iran’s enormous social welfare organization under pressure from Parliament. Some days later, however, he was rehired by the president in the same position, this time as official caretaker.

During the conversation, read out in part by Mr. Ahmadinejad to astonished lawmakers, Fazel Larijani appears to try to use his family connections to buy a factory from the social welfare organization. He promises leniency for Mr. Mortazavi, the former Tehran prosecutor who faces several criminal proceedings over accusations that he played a role in the deaths of three protesters in a substandard prison in 2009.

Mr. Mortazavi was arrested Monday evening, the Fars news agency reported, though no reason was given. But, in a new turn to what is likely to be a protracted saga, he was freed on Wednesday, news reports quoted Iranian media as saying. The terms of his release were unclear.

In Parliament on Sunday, the Iranian Students’ News Agency said, Mr. Ahmadinejad declared: “These are audio and video, and the tape is clear.”

He added: “If the honorable Parliament speaker sees fit, we can turn over the 24 to 25 hours to you,” he said of the recordings. On Monday, Iran’s Islamic Republic News Agency, a mouthpiece for Mr. Ahmadinejad, deepened the split by publishing the audiotape on its Web site.

Ali Larijani, cheered on by the Parliament, which has lost nearly every serious political battle with the president, silenced the room, saying: “Let him tell his words. If there is anything about my family, then let him talk about it.”

Mr. Larijani called the video a “mafia film” and recalled how he had a meeting with Mr. Ahmadinejad’s estranged brother, Davoud. “He said many things against you,” Mr. Larijani told the president, “about economic corruption, about your inner circle and your relations with foreign countries.”

For his part, Fazel Larijani strongly denied any wrongdoing, saying that while he did appear in the clip, the words were not his, but rather had been added in a voiceover. Calling Mr. Ahmadinejad and Mr. Mortazavi “mafialike individuals,” he said he would sue them both for “spreading lies and disturbing public opinion.”

On Monday, several officials criticized Mr. Ahmadinejad and Ali Larijani, accusing them of lacking self-control and bringing shame on the country. “They broke the leader’s heart and gave the friends of the Islamic republic almost a seizure,” said Mojtaba Zolnour, a special consultant to the supreme leader, Ayatollah Khamenei, the semiofficial Iranian Labor News Agency reported. “They provided ammunition for the foreign media on the eve of our election.”

Alan Cowell contributed reporting from Paris.

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Braun says he used Fla clinic owner as consultant

NEW YORK (AP) — Milwaukee Brewers slugger Ryan Braun said the person who ran the Florida clinic being investigated by Major League Baseball was used only as a consultant on his drug suspension appeal last year.

"I have nothing to hide," Braun said in a statement released by his representatives on Tuesday night.

Earlier in the day, Yahoo Sports reported the 2011 NL MVP's name showed up three times in records of the Biogenesis of America LLC clinic. Yahoo said no specific performance-enhancing drugs were listed next to his name.

The Miami New Times recently released clinic documents that purportedly linked Alex Rodriguez, Gio Gonzalez, Melky Cabrera and other players to purchases of banned drugs from the now-closed anti-aging center.

Rodriguez and Cabrera were on the list with Braun that also included New York Yankees catcher Francisco Cervelli and Baltimore Orioles infielder Danny Valencia.

Braun said his name was in the Biogenesis records because of an issue over payment to Anthony Bosch, who ran the clinic near Miami.

"There was a dispute over compensation for Bosch's work, which is why my lawyer and I are listed under 'moneys owed' and not on any other list," Braun said.

"I have nothing to hide and have never had any other relationship with Bosch," he said. "I will fully cooperate with any inquiry into this matter."

On Tuesday, MLB officials asked the Miami New Times for the records the alternative newspaper obtained for its story.

Asked specifically about Braun's name in the documents before the five-time All-Star released his statement, MLB spokesman Pat Courtney said: "Aware of report and are in the midst of an active investigation in South Florida."

Braun tested positive during the 2011 postseason for elevated testosterone levels. He maintained his innocence and his 50-game suspension was overturned during spring training last year when arbitrator Shyam Das ruled in favor of Braun due to chain of custody issues involving the sample.

With that, Braun became the first major leaguer to have a drug suspension overturned.

"During the course of preparing for my successful appeal last year, my attorneys, who were previously familiar with Tony Bosch, used him as a consultant. More specifically, he answered questions about T/E ratio and possibilities of tampering with samples," Braun said.

The T/E ratio is a comparison of the levels of testosterone to epitestosterone.

Braun led the NL in homers (41), runs (108) and slugging percentage (.595) last season while batting .319 with 112 RBIs and 30 stolen bases. He finished second to San Francisco catcher Buster Posey in MVP balloting."

Cervelli, who spent nearly all of last season in Triple-A, posted a statement on Twitter later Tuesday night.

"Following my foot injury in March 2011, I consulted with a number of experts, including BioGenesis Clinic, for (cont)," Cervelli posted, "(cont)legal ways to aid my rehab and recovery. I purchased supplements that I am certain were not prohibited by Major League Baseball."

An email sent to Valencia's agent was not returned.

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Ipswich Journal: Paul Mason Is One-Third the Man He Used to Be

Paul Nixon Photography

Paul Mason in 2012, two years after gastric bypass surgery stripped him of the unofficial title of “the world’s fattest man.”

IPSWICH, England — Who knows what the worst moment was for Paul Mason — there were so many awful milestones, as he grew fatter and fatter — but a good bet might be when he became too vast to leave his room. To get him to the hospital for a hernia operation, the local fire department had to knock down a wall and extricate him with a forklift.

That was nearly a decade ago, when Mr. Mason weighed about 980 pounds, and the spectacle made him the object of fascinated horror, a freak-show exhibit. The British news media, which likes a superlative, appointed him “the world’s fattest man.”

Now the narrative has shifted to one of redemption and second chances. Since a gastric bypass operation in 2010, Mr. Mason, 52 years old and 6-foot-4, has lost nearly two-thirds of his body weight, putting him at about 336 pounds — still obese, but within the realm of plausibility. He is talking about starting a jewelry business.

“My meals are a lot different now than they used to be,” Mr. Mason said during a recent interview in his one-story apartment in a cheerful public housing complex here. For one thing, he no longer eats around the clock. “Food is a necessity, but now I don’t let it control my life anymore,” he said.

But the road to a new life is uphill and paved with sharp objects. When he answered the door, Mr. Mason did not walk; he glided in an electric wheelchair.

And though Mr. Mason looks perfectly normal from the chest up, horrible vestiges of his past stick to him, literally, in the form of a huge mass of loose skin choking him like a straitjacket. Folds and folds of it encircle his torso and sit on his lap, like an unwanted package someone has set there; more folds encase his legs. All told, he reckons, the excess weighs more than 100 pounds.

As he waits to see if anyone will agree to perform the complex operation to remove the skin, Mr. Mason has plenty of time to ponder how he got to where he is. He was born in Ipswich and had a childhood marked by two things, he says: the verbal and physical abuse of his father, a military policeman turned security guard; and three years of sexual abuse, starting when he was 6, by a relative in her 20s who lived in the house and shared his bed. He told no one until decades later.

After he left school, Mr. Mason took a job as a postal worker and became engaged to a woman more than 20 years older than him. “I thought it would be for life, but she just turned around one day and said, ‘No, I don’t want to see you anymore — goodbye,’ ” he said.

His father died, and he returned home to care for his arthritic mother, who was in a wheelchair. “I still had all these things going around in my head from my childhood,” he said. “Food replaced the love I didn’t get from my parents.” When he left the Royal Mail in 1986, he said, he weighed 364 pounds.

Then things spun out of control. Mr. Mason tried to eat himself into oblivion. He spent every available penny of his and his mother’s social security checks on food. He stopped paying the mortgage. The bank repossessed their house, and the council found them a smaller place to live. All the while, he ate the way a locust eats — indiscriminately, voraciously, ingesting perhaps 20,000 calories a day. First he could no longer manage the stairs; then he could no longer get out of his room. He stayed in bed, on and off, for most of the last decade.

Social service workers did everything for him, including changing his incontinence pads. A network of local convenience stores and fast-food restaurants kept the food coming nonstop — burgers, french fries, fish and chips, even about $22 worth of chocolate bars a day.

“They didn’t deliver bags of crisps,” he said of potato chips. “They delivered cartons.”

His life became a cycle: eat, doze, eat, eat, eat. “You didn’t sleep a normal sleep,” he said. “You’d be awake most of the night eating and snacking. You totally forgot about everything else. You lose all your dignity, all your self-respect. It all goes, and all you focus on is getting your next fix.”

He added, “It was quite a lonely time, really.”

He got infections a lot and was transported to the hospital — first in a laundry van, then on the back of a truck and finally on the forklift. For 18 months after a hernia operation in 2003, he lived in the hospital and in an old people’s home — where he was not allowed to leave his room — while the local government found him a house that could accommodate all the special equipment he needed.

This article has been revised to reflect the following correction:

Correction: February 6, 2013

The headline on an earlier version of this article misstated Paul Mason’s current weight relative to what he weighed nearly a decade ago. He is now about one-third, not two-thirds, the weight he was then.

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Economic Scene: Immigration Reform Issue: The Effect on the Budget

The stars could hardly have shone brighter on the prospects for immigration reform than in the early months of 2007.

The coalition pushing for change included the oddest of bedfellows — roping together business groups like the United States Chamber of Commerce with the Service Employees International Union, the fastest-growing union in the country. It had an impeccable bipartisan pedigree, including President George W. Bush and Senator Jon Kyl, a staunchly conservative Republican, as well as the Democrats’ liberal lion, Senator Ted Kennedy.

The economy was growing. The unemployment rate was at its lowest level since the dot-com bubble burst six years before. And the flaws of our immigration laws — impotent to stop a river of unauthorized immigrants drawn across the border by job opportunities — were obvious to all.

Immigration reform, however, was not to be.

Immigrants’ rights groups balked at the hurdles put in immigrants’ path toward legalization. The A.F.L.-C.I.O. hated a provision creating temporary work visas, arguing that it was a license for businesses to bring in cheap foreign labor. Then, a Senate Democrat, Byron Dorgan, offered the coup de grâce with an amendment to phase out the worker visa program after five years. Though proposed at the behest of organized labor, the amendment got the support of some of the most anti-union Republicans in the Senate. And it killed the entire enterprise, stripping away corporate America’s main reason to support a deal.

Today, the economy is not growing much. Unemployment remains stubbornly high. Yet President Obama thinks the stellar alignment may be  better than six years ago. He is proposing a wholesale change to the same flawed immigration laws. He trusts that Republicans, who lost the Hispanic vote by an enormous margin in November, cannot afford to further alienate Hispanics by voting against their top priority.

Despite the strong case for an overhaul, however, changing our immigration laws may be tougher than the president appears to believe. While we may have overcome some of the obstacles of 2007, reform will probably face deep-seated opposition from many Americans — including most conservative Republicans — to what they will view as a potentially large expansion of welfare.

President Obama’s proposal is based on principles similar to those of the 2007 attempt: a path to citizenship for millions of illegal immigrants in the country, a legal channel for future immigrant workers and their families, and a plan to better enforce the nation’s borders and immigration laws.

Yet immigration reform today means something quite different than it did in 2007. Notably, the elements needed to stop the flow of illegal immigrants north are much less important to the enterprise. The Obama administration has already spent huge amounts of money on border enforcement. Today, border policing costs about $18 billion a year — nearly 50 percent more than it did in 2006. And deportations have soared. What’s more, illegal immigration has slowed to a trickle, as Mexico has grown more robustly than the United States. The illegal immigrant population has even been shrinking in the last few years. And it may continue to do so as the Mexican population of prime migration-age people stops growing.

Also, many employers have already gotten some of what they wanted: the number of workers entering the United States on temporary visas for low-end jobs in agriculture and other industries has increased sharply.

“The discussion is in a different environment,” said Gordon H. Hanson, an expert on the economics of immigration at the University of California, San Diego. “The flow of new immigrants is not the story anymore.”

This might help the cause of reform in some ways. It could allow the discussion about work visas to focus on the highly educated workers coveted by technology companies and pre-empt the kind of argument between business and labor over visas for cheap immigrant workers that sank reform in 2007. The A.F.L.-C.I.O., for instance, has heartily embraced President Obama’s plan.

But what supporters of an overhaul of immigration law seem to be overlooking is that these very changes could also make it more difficult to build a coalition across the political divide. If reform is mainly about granting citizenship to 11 million mostly poor illegal immigrants with relatively little education, it is going to land squarely in the cross hairs of our epic battle about taxes, entitlements and the role of government in society.

It’s hard to say with precision what impact offering citizenship would have on the budget, but the chances are good that it would cost the government money. Half to three-quarters of illegal immigrants pay taxes, according to studies reviewed in a 2007 report by the Congressional Budget Office. And they are relatively inexpensive, compared with Americans of similar incomes. Their children can attend public schools at government expense — putting a burden on state and local budgets. But they are barred from receiving federal benefits like the earned-income tax credit, food stamps and Medicaid. Only their American-born children can get those.

Government revenue might not change much with legalization. Most illegal immigrants who don’t pay taxes probably work in the cash economy — as nannies or gardeners — where tax compliance among citizens is low. Costs, of course, would increase. Once they became citizens, immigrants would be entitled to the same array of government benefits as other Americans. For Social Security and Medicare alone, offering citizenship to illegal immigrants would mean losing a subsidy worth several billion dollars a year in payroll taxes from immigrants who can’t collect benefits in old age.

The White House and other backers of reform have made much of a 2007 Congressional Budget Office analysis concluding that the failed immigration overhaul would have increased government revenue by $48 billion over a decade while adding only $23 billion to direct spending on entitlements and other programs. But the report also said that including the costs of carrying out the new law would actually increase the budget deficit by $18 billion over the decade and several billion a year after that. What’s more, it noted that most of the expected new tax revenue came from new immigrant workers, not from the newly legalized population.

Our history suggests we could have much to gain by turning illegal immigrants into citizens and putting an end to unauthorized immigration. The last time we permitted illegal immigrants to legalize, in 1986, incomes jumped for those who took advantage of the opportunity. Their children became more proficient in English and completed more years of school — becoming more productive and paying more taxes over their lifetimes.

But the same history underscores how immigration sets off fears about further sharing of government resources. Ten years after the immigration reform of 1986, reeling from some public anger, Congress passed a law barring legal immigrants from means-tested government services. The same issue is likely again to be a major flash point. Professor Hanson pointed to “the older white man who sees his entitlements at risk because of the demands placed by legalization on our fiscal resources.”

Conservative Republicans set on cutting government spending share those concerns. And for all their reasons to reach out to Hispanics, they might not find making illegal immigrants legal politically advantageous. On Tuesday, Republicans in the House argued against granting citizenship to illegal immigrants at all.

Hispanics are more liberal than the general population on economic matters, polls suggest, and more supportive of Big Government initiatives. Granting them citizenship would give them the vote.

As Steven A. Camarota, director of research at the Center for Immigration Studies, an advocacy group in Washington that favors more limits on immigration, said, “They will see legalization as a voter-registration drive for Democrats.”

E-mail: eporter@nytimes.com; Twitter: @portereduardo

This article has been revised to reflect the following correction:

Correction: February 5, 2013

An earlier version misspelled the first name of one of the two United States senators from Arizona.  His name is Jon Kyl, not John.

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British Ministers Seek Support for Gay Marriage Law

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Superdome officials worried about a power outage

NEW ORLEANS (AP) — The cause of a 34-minute blackout at the Super Bowl remains under investigation, but public records released Monday show that Superdome officials were worried about a power outage several months before the big game.

An Oct. 15 memo released by the Louisiana Stadium & Exposition District, which oversees the Superdome, says tests on the dome's electrical feeders showed they had "some decay and a chance of failure."

Entergy New Orleans, the company that supplies the stadium with power, and the structure's engineering staff "had concerns regarding the reliability of the Dome service from Entergy's connection point to the Dome," the memo says. Those concerns were due in part to "circumstances that have previously occurred with the electrical service regarding transient spikes and loads."

The memo also cites 2011 blackouts that struck Candlestick Park, where the San Francisco 49ers were playing a nationally televised Monday night football game, as a reason for ordering the tests.

The board later authorized spending nearly $1 million on Superdome improvements, including more than $600,000 for upgrading the dome's electrical feeder cable system.

"As discussed in previous board meetings, this enhancement is necessary to maintain both the Superdome and the New Orleans Arena as top tier facilities, and to ensure that we do not experience any electrical issues during the Super Bowl," says a LSED document dated Dec. 19.

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 exact cause of Sunday night's blackout — and who's to blame — remained unclear late Monday, 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-Hurricane 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 television viewers 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 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.

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 since Hurricane Katrina in 2005. 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."

The chairwoman of the New Orleans City Council's Utility Committee has called an emergency meeting for Friday to discuss the power outage.

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."

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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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