U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

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Economix Blog: Bernanke Defends Stimulus as Necessary and Effective

The Federal Reserve’s chairman, Ben S. Bernanke, picked an unusual time to offer his most recent defense of the Fed’s campaign to stimulate the economy: 7 p.m. on a Friday night in San Francisco, 10 p.m. back home on the East Coast.

The basic message was the same as Mr. Bernanke delivered to Congress earlier this week: The Fed regards its current efforts as necessary and effective, and the risks, while real, are under control.

“Commentators have raised two broad concerns surrounding the outlook for long-term rates,” Mr. Bernanke told a conference at the Federal Reserve Bank of San Francisco. “To oversimplify, the first risk is that rates will remain low, and the second is that they will not.”

If rates remain low, it may drive investors to take excessive risks. If rates jump, investors could lose money – not least the Fed.

Regarding the first possibility, Mr. Bernanke said that the Fed was keeping a careful eye on financial markets. But he noted that rates were low in large part because the economy was weak, and that keeping rates low was the best way to encourage stronger growth. “Premature rate increases would carry a high risk of short-circuiting the recovery, possibly leading — ironically enough — to an even longer period of low long- term rates,” he said.

At the other extreme, Mr. Bernanke said the Fed could “mitigate” any jump in rates by prolonging its efforts to hold rates down, for example by keeping some of its investments in Treasury and mortgage-backed securities.

Three more highlights from the question-and-answer session after the speech.

1. Mr. Bernanke, asked about the outlook for the Washington Nationals, responded by accurately quoting the “Las Vegas odds” of a World Series appearance: 8/1.

2. Although the decision may be made under a future chairman, Mr. Bernanke said the Fed should continue to offer “forward guidance” — predicting its policies — even after it concludes its long effort to revive the economy.

“Providing information about the future path of policy could be useful, probably would be useful, under even normal circumstances,” he said in response to a question. “I think we need to keep providing information.”

3. Not surprisingly, Mr. Bernanke often is asked to reflect on the financial crisis. He offered something a little different than his normal response on Friday night.

“In many ways, in retrospect, the crisis was a normal crisis,” he said. “It’s just that the intuitional framework in which it occurred was much more complex.”

In other words, there was a panic, and a run, and a collapse – but rather than a run on bank deposits, the run was in the money markets. Improving the stability of those markets is something regulators have yet to accomplish.

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India Ink: How Will India Pay for the Perks in the New Budget?

Characteristic of a party headed for the polls, the Congress party’s budget Thursday morning had a lengthy list of handouts from increased spending on healthcare, education, rural and tribal welfare to a tax benefit for first-time home buyers and women’s development funds. Yet with all the additional spending adding up to a staggering 2.3 trillion rupees (about $42 billion), the minister projects that the country’s closely-watched fiscal deficit will be reined to 4.8 percent in 2013-14.

While appearing fiscally balanced, the question is how exactly does P. Chidambaram, the finance minister, plan to pay for it all?

Sure, he proposed tax increases on the rich, increased corporation tax and pared-down subsidies, but these sums add up to a paltry 450 billion rupees (about $8 billion) in contrast with his requirements of 2.3 trillion rupees in the coming year. Instead, he expects to make up the difference from non-tax sources, including the sale of telecommunication spectrum. This, he calculates, will add 1.7 trillion rupees (about $31 billion) to government coffers, which balances the budget. But in the current economic environment the minister’s expectations of non-tax revenues seem optimistic and difficult to achieve.

The government expects 408 billion rupees (about $7 billion) from sales of telecom spectrum while sales of shares from public-sector companies are expected to add 400 billion rupees to its coffers. These contribute just under half to the required total, but the investment climate is tough and these figures seem hopeful.

Take for the instance, the lackluster sale of telecom spectrum just last week. After cancelling licenses following a corruption investigation into the sector, the government had hoped to raise 582 billion rupees (about $10 billion) from sales of telecoms spectrum sales in the budget last year. These have been revised downward markedly this year; it now expects to get only 194 billion rupees (about $3.5 billion) this year, a third of the figure it originally expected to receive. Today, the marketplace for such sales is tougher, which is likely to put a dent in government’s plans to raise money.

Moreover, the government’s projected growth figures, released on Tuesday in the economic survey, show overly optimistic revenues ahead. A growth of 6.1-6.7 per cent is more than a full percentage point over this year’s growth, thereby buttressing the numbers of tax and non-tax revenues, making fiscal consolidation elusive.

Whether growth can really pick up depends on a rise in the rate of savings and investment. The middle classes might benefit from a lower inflation rate, but in a difficult financial environment disposable incomes will remain strained until investment picks up. As for investments, the budget has not instilled a sense of confidence in many investors, yet it has not rocked their faith either. The markets seem to have grudgingly accepted the pre-election profligacy, but the environment may not improve considerably in the coming few months. Mr. Chidambaram’s optimistic growth numbers have only given analysts a pause for thought, but not caused a much-feared downgrade of the country’s credit rating.

India has made improvements in the fiscal deficit this year, Standard & Poor’s said in a note to investors issued Thursday, which said ratings will remain unchanged. Still, the note said, “there is little progress in structural reforms to reduce the vulnerability of the government’s fiscal position.”

India remains vulnerable to spikes in oil and commodity prices, the rating agency said, and although the budget contains measures aimed at encouraging infrastructure projects, the effectiveness of attracting “much-needed investment is uncertain at this stage.”

Still, the finance minister has managed to pull a feat of balancing the books while pleasing rural vote banks and financial sector pundits in his last budget before the elections early next year. Like his predecessor, he managed to dodge the important questions of retrospective taxation and further financial sector reforms. The Congress Party rested its hope of economic salvation and electoral gains of the kind he delivered before 2009 and led to the election victory. So far, it seems he might have succeeded on the first, on the second it remains to be seen.

The author is a Research Associate at the Indian Council for Research on International Economic Relations. The views expressed are her own, not the organization’s.

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No. 2 Gonzaga survives scare from BYU 70-65

PROVO, Utah (AP) — No. 2 Gonzaga knew Brigham Young wouldn't be a pushover this time.

On Thursday night, the Cougars even threw a converted football player at Bulldogs star Kelly Olynyk.

Olynyk withstood the hit and Gonzaga withstood a furious rally for a 70-65 victory before a raucous crowd of 19,731.

Olynyk scored 19 points, Gary Bell Jr. hit four 3-pointers and Gonzaga won its 10th outright West Coast Conference title.

It certainly wasn't as easy as the 20-point win at the Kennel four weeks ago.

"There was a lot of clawing, scratching, pushing, shoving and that's what the score (shows)," Olynyk said. "That's what you live for and what we want to play like.

"This place was rocking and everyone was getting all excited, in the end it was a great game."

The Bulldogs (28-2, 15-0 WCC) host Portland on Saturday and a win there could mean Gonzaga's first-ever No. 1 ranking.

"Our guys really want to finish up the conference really strong and go undefeated," Gonzaga coach Mark Few said. "This game was going to be hard for us whether we were ranked, 10th, 12th or 20th or whatever. We knew that when we looked at it on the schedule."

Gonzaga led by 11 points with 10:51 left but BYU fought back.

Consecutive 3-pointers by Brock Zylstra, another by Craig Cusick and two free throws by Brandon Davies tied it at 60 with 4:18 remaining.

Olynyk hit a key jumper with 43 seconds remaining and Kevin Pangos made two free throws to give Gonzaga a little breathing room.

After Cusick was fouled on a 3-point attempt and made all three free thows, BYU had one final chance with 6.6 seconds remaining and down three points. Gonzaga fouled Cusick before he could attempt a 3, and Elias Harris' free throws at the other end provided the final margin.

Tyler Haws, who was 0 for 9 in the first meeting, scored 19 points to lead BYU (20-10, 9-6).

Davies added 12 points and 11 rebounds in his final home game for the Cougars despite being plagued by foul trouble.

"It's crazy," said Davies, who returned after being thrown off the team two years ago for violating the school honor code just as BYU had climbed to No. 3 in the rankings. "It didn't really hit me that this was my last home game until I was walking out with my family and my fellow seniors."

Davies had two fouls in the first 2 1/2 minutes.

"That hurt us. You have to be smart," he said.

Olynyk was nearly perfect in the first game, going 9 of 9 from the field and 8 of 8 from the free throw line for 26 points.

This time, he probably felt as if he were in a football game as it was rough-and-tumble from the start, with a Cougars football player — 6-foot-7 freshman Bronson Kaufusi — even called for an intentional foul on Olynyk as he drove the lane.

He finished 7 of 10 from the field despite battling Davies and Kaufusi inside.

Bell was the lone Gonzaga player to have any success from the perimeter.

Pangos was 1 of 12 from beyond the arc and the Bulldogs 6 of 30 overall from 3-point range.

"It was there zone," Few said of taking so many 3s. "Their zone was very, very content on taking away (Olynyk) in the high post. They were really squeezing him there. They played so hard in their zone that it was tough to find any openings. We tried to attack it inside out, and those were good shots.

Pangos said he was trying to get BYU's D to respect him rather than packing it inside.

"If I had to do it over again, I'd take the same shots," he said.

"This just shows what this team is all about. We kept grinding for the whole 40 minutes and never let up, even through the ups and downs."

Gonzaga held BYU to 36.5 percent shooting and had a marked advantage at the free throw line. The Bulldogs made 20 of 34 attempts, compared to 13 of 22 for BYU.

BYU's hopes of a seventh straight NCAA appearance may come down to winning the WCC tourney in Las Vegas. The Cougars also could see their streak of six consecutive 25-win seasons end.

At least the Cougars know they pushed Gonzaga to the limit.

"I knew it was going to be an incredible environment and I knew BYU was going to give us everything we could handle," Few said.

"They play unbelievably hard. They not only did that tonight, but they stepped up and made big shots. Give them a lot of credit for taking it down to the wire."

Should Gonzaga ascend to the top spot, the question remains whether the Bulldogs would garner a No. 1 seed in the NCAA tournament — something they have never achieved.

Their only losses this season were to Butler and Illinois when both were ranked No. 13.

Provided they defeat Portland, they will have won 12 straight heading into the WCC tournament.

Do they deserve to be No. 1?

"I have no clue," Olynyk said. "I haven't looked into it at all. If they vote us that, great for us. If not, we're still going to come out and play the next game."

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Jane C. Wright, Pioneering Oncologist, Dies at 93

Dr. Jane C. Wright, a pioneering oncologist who helped elevate chemotherapy from a last resort for cancer patients to an often viable treatment option, died on Feb. 19 at her home in Guttenberg, N.J. She was 93.

Her death was confirmed by her daughter Jane Jones, who said her mother had dementia.

Dr. Wright descended from a distinguished medical family that defied racial barriers in a profession long dominated by white men. Her father, Dr. Louis T. Wright, was among the first blacks to graduate from Harvard Medical School and was reported to be the first black doctor appointed to the staff of a New York City hospital. His father was an early graduate of what became the Meharry Medical College, the first medical school in the South for African-Americans, founded in Nashville in 1876.

Dr. Jane Wright began her career as a researcher working alongside her father at a cancer center he established at Harlem Hospital in New York.

Together, they and others studied the effects of a variety of drugs on tumors, experimented with chemotherapeutic agents on leukemia in mice and eventually treated patients, with some success, with new anticancer drugs, including triethylene melamine.

After her father died in 1952, Dr. Wright took over as director of the center, which was known as the Harlem Hospital Cancer Research Foundation. In 1955, she joined the faculty of the New York University Medical Center as director of cancer research, where her work focused on correlating the responses of tissue cultures to anticancer drugs with the responses of patients.

In 1964, working as part of a team at the N.Y.U. School of Medicine, Dr. Wright developed a nonsurgical method, using a catheter system, to deliver heavy doses of anticancer drugs to previously hard-to-reach tumor areas in the kidneys, spleen and elsewhere.

That same year, Dr. Wright was the only woman among seven physicians who, recognizing the unique needs of doctors caring for cancer patients, founded the American Society of Clinical Oncologists, known as ASCO. She was also appointed by President Lyndon B. Johnson to the President’s Commission on Heart Disease, Cancer and Stroke, led by the heart surgeon Dr. Michael E. DeBakey. Its recommendations emphasized better communication among doctors, hospitals and research institutions and resulted in a national network of treatment centers.

In 1967, Dr. Wright became head of the chemotherapy department and associate dean at New York Medical College. News reports at the time said it was the first time a black woman had held so high a post at an American medical school.

“Not only was her work scientific, but it was visionary for the whole science of oncology,” Dr. Sandra Swain, the current president of ASCO, said in a telephone interview. “She was part of the group that first realized we needed a separate organization to deal with the providers who care for cancer patients. But beyond that it’s amazing to me that a black woman, in her day and age, was able to do what she did.”

Jane Cooke Wright was born in Manhattan on Nov. 30, 1919. Her mother, the former Corinne Cooke, was a substitute teacher in the New York City schools.

Ms. Wright attended the Ethical Culture school in Manhattan and the Fieldston School in the Bronx (now collectively known Ethical Culture Fieldston School) and graduated from Smith College, where she studied art before turning to medicine. She received a full scholarship to New York Medical College, earning her medical degree in 1945. Before beginning research with her father, she worked as a doctor in the city schools.

Dr. Wright’s marriage, in 1947, to David D. Jones, a lawyer, ended with his death in 1976. She is survived by their two daughters, Jane and Alison Jones, and a sister, Barbara Wright Pierce, who is also a doctor.

As both a student and a doctor, Dr. Wright said in interviews, she was always aware that as a black woman she was an unusual presence in medical institutions. But she never felt she was a victim of racial prejudice, she said.

“I know I’m a member of two minority groups,” she said in an interview with The New York Post in 1967, “but I don’t think of myself that way. Sure, a woman has to try twice as hard. But — racial prejudice? I’ve met very little of it.”

She added, “It could be I met it — and wasn’t intelligent enough to recognize it.”

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F-35 Jets Returned to Service by Pentagon

The Pentagon lifted its grounding of the new F-35 jet fighter on Thursday after concluding that a turbine blade had cracked on a single plane after it was overused in test operations.

The office that runs the program said no other cracks were found in inspections of the other engines made so far, and no engine redesign was needed.

It said the engine in which the blade cracked was in a plane that “had been operated at extreme parameters in its mission to expand the F-35 flight envelope.”

The program office added that “prolonged exposure to high levels of heat and other operational stressors on this specific engine were determined to be the cause of the crack.”

All flights were suspended last week for the 64 planes built so far once the crack, which stretched for six-tenths of an inch, was found during a routine inspection.

Pratt & Whitney, which makes the engines, investigated the problem with military experts. The company, a unit of United Technologies, said on Wednesday that the crack occurred after that engine was operated more than four times longer in a high-temperature flight environment than the engines would in normal use.

The F-35, a supersonic jet meant to evade enemy radar, is the Pentagon’s most expensive program and has been delayed by various technical problems. The program could cost $396 billion if the Pentagon builds 2,456 jets by the late 2030s.

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Benedict XVI Begins Final Day as Pope

VATICAN CITY — A day after blessing the faithful for the last time as pope, Benedict XVI prepared on Thursday to meet the cardinals who will elect his successor. After a nearly eight-year papacy that he said was filled with “light and joy” but also darker moments, Benedict will later leave the Vatican by helicopter for the papal summer residence where his retirement will formally take effect at 8 p.m. local time.

Benedict, the first pope to step down willingly for six centuries, was expected to greet the cardinals individually, but not offer any public remarks.

In an emotional and unusually personal message on Wednesday, his final public audience in St. Peter’s Square, Benedict said that sometimes he felt that “the waters were agitated and the winds were blowing against” the church, and other days when “the Lord seemed to be sleeping.”

Benedict shocked the world on Feb. 11 when he announced that, feeling his age and diminishing strength, he would retire, a dramatic step that sent the members of the Vatican hierarchy into a tailspin. He reassured the faithful on Sunday that he was not “abandoning” the church, but would continue to serve, even in retirement.

Starting Thursday night, Benedict will be called “pope emeritus” and will don a white cassock and brown shoes from Mexico, replacing the red slippers that he and other popes have traditionally worn, the red symbolizing the blood of the martyrs.

The conclave to elect the next pope, which is expected to start by mid-March, will begin amid a swirl of scandal. On Monday, Cardinal Keith O’Brien, Britain’s senior Roman Catholic cleric said that he would not participate in the conclave, after having been accused of “inappropriate acts” with several priests, charges that he denies. Other cardinals have also come under fire in sex abuse scandals, but only Cardinal O’Brien has recused himself.

On Monday, Benedict met with three cardinals he had asked to conduct an investigation into the “VatiLeaks” scandal in which hundreds of confidential documents were leaked to the press and published in a tell-all book last May, the worst security breach in the church’s modern history. The three cardinals compiled a hefty dossier on the scandal, which Benedict has entrusted only to his successor, not to the cardinals entering the conclave, the Vatican spokesman said earlier this week.

On Thursday, Panorama, a weekly magazine, reported that the Vatican secretary of state, Cardinal Tarcisio Bertone, had been conducting his own investigation into the leaks scandal, including requesting wiretaps on the phones of some members of the Vatican hierarchy.

A shy theologian who appeared to have little interest in the internal politics of the Vatican, Benedict has said that he is retiring “freely, and for the good of the church,” entrusting it to a successor who has more strength than he. But shadows linger. The next pope will inherit a hierarchy buffeted by crises of governance as well as power struggles over the Vatican Bank, which has struggled to conform to international transparency norms.

Many faithful have welcomed Benedict’s gesture as a sign of humility and humanity, a rational decision taken by a man who no longer feels up to the job.

As he stood near St. Peter’s Square on Wednesday after attending the pope’s last public audience, Vincenzo Petrucci, 26, said he had come to express “not so much solidarity, but more like closeness” to the pope. “At first we felt astonished, shocked and disoriented,” he said. “But then we saw what a weighty decision it must have been. He seemed almost lonely.”

Many in the Vatican hierarchy, known as the Roman Curia, are still reeling from the news. Many are bereaved and others seem almost angry. “We are terribly, terribly, terribly shocked,” one senior Vatican official said, speaking on condition of anonymity.

There is also hushed concern about what it will mean to have two popes residing in the Vatican. On Thursday evening, Benedict will initially reside in Castel Gandolfo, a hilltop town outside Rome where popes have summered for centuries.

He is expected to stay there for several months before returning to the Vatican, where he will live in a convent with a fountain and gardens that look out with a perfect view of the dome of St. Peter’s Basilica.

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Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

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Rules and Regulations: Post your questions and diagnosis in the Comments section below. The correct answer will appear tomorrow 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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European Union Agrees on Plan to Cap Banker Bonuses

BRUSSELS — The European Union moved a step closer early on Thursday to imposing strict curbs on bonus pay for bankers, which has been blamed by many politicians for inciting the risk-taking behavior that triggered the recent financial crisis.

A provisional agreement struck between the European Parliament, the European Commission and national representatives could mean that the coveted bonuses many bankers receive are capped at the level of their annual salaries starting next year.

The agreement, as it stands, would be a blow to Britain, which partly relies on generous remuneration packages to ensure that the City of London remains the biggest financial center in Europe.

A majority of E.U. states still must give their final approval for the legislation to go into force and there are expected to be more discussions on the rules at the European Parliament and among governments.

The goal of the bonus cap proposal is to balance many different interests, including “the desire to limit bankers pay while maintaining a competitive European banking sector,” Michael Noonan, the finance minister of Ireland, which holds the rotating E.U. presidency, said in a statement after the talked ended.

Under the proposal, the bonus rules would also apply to bankers employed by E.U. banks but working outside the bloc, for example in New York. E.U. authorities are drafting separate rules that could restrict remuneration at private equity firms and hedge funds.

Mr. Noonan said he would present the plan at a meeting of finance ministers next week.

An E.U. diplomat stressed that a significant amount of technical work still needed to be done before the rules were finalized by governments.

The diplomat, who spoke on customary condition of anonymity, also said the rules would contain a review clause requiring. authorities to assess whether the rules were having damaging effects on the banking sector.

The proposal would also allow higher bonuses if a sufficient number of shareholders agreed.

It is part of a set of laws requiring higher capital requirements for banks, called the Basel III rules, which the E.U. officials also approved early Thursday.

Mr. Noonan said the Basel III package would “make sure that banks in the future have enough capital, both in terms of quality and quantity, to withstand shocks” and that “will ensure that taxpayers across Europe are protected into the future.”

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Iran and Six Nations Agree to Two More Rounds of Nuclear Talks

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The European Union foreign policy chief, Catherine Ashton, and Iran’s chief negotiator, Saeed Jalili, at the start of the talks.

ALMATY, Kazakhstan — Talks between Iran and six world powers over its nuclear program ended on Wednesday with an agreement to convene technical experts in Istanbul on March 18 and return to Almaty for full negotiations among the delegations on April 5 and 6, a senior Western diplomat said.

Iran’s chief negotiator, Saeed Jalili, said that modest progress had been achieved. The participants “had come back with more realistic proposals that come a little closer to Iran’s position,” he said. “Their proposals seem more realistic and positive.” He added that there have been “some changes in their viewpoint.”

The two days of talks here had been convened to to get a clear response from Tehran to an offer of step-by-step sanctions relief in return for confidence-building measures from Iran, Western diplomats said.

They cautioned that there was little substantive progress other than Iran’s willingness to study the proposals delivered here and added that the technical meeting in Istanbul is to explain the proposals in detail before returning to Almaty to hear Iran’s response. Senior Western diplomats have said that this week’s meeting would be a low-level success if it produced a specific agreement to meet again soon so that there would be an element of momentum to the negotiations. The talks have been intermittent since beginning in October 2009, with the last meeting eight months ago in Moscow.

The six powers want Iran, as a first step, to stop enriching uranium to 20 percent and to export its stockpile of that more highly enriched uranium, which can be more quickly turned into bomb-grade material. The six also want Iran to shut down its Fordo enrichment facility, built deep into a mountain, which Iran has steadily refused to do. In return, the six — the five permanent members of the Security Council, plus Germany — have offered Iran further sanctions relief, reportedly including permission to resume its gold and precious metals trade as well as some international banking activity and petroleum trade.

The ultimate goal of talks with Iran is to get the country to comply with Security Council resolutions demanding that it stop enrichment altogether until it can satisfy the International Atomic Energy Agency that it has no weapons program and no hidden enrichment sites. In return, all sanctions — which have so far cost Iran 8 percent of its gross domestic product, sharply increased inflation and collapsed the value of the Iranian currency, the rial — would be lifted.

No one expected that kind of breakthrough in this round, especially with Iranian presidential elections coming in June and any major concession likely to be perceived as weakness. But the hope was for an incremental movement toward Iranian compliance in return for a modest lifting of sanctions.

The six nations talking with Iran have remained united and share an impatience over what they perceive to be its delaying tactics. The Russian envoy, Deputy Foreign Minister Sergei Ryabkov, who has been most opposed to increasing sanctions, said Tuesday that time was running out for the talks. He told the Interfax news agency that easing sanctions would be possible only if Iran could assure the world that its nuclear program was for exclusively peaceful purposes.

“There is no certainty that the Iranian nuclear program lacks a military dimension, although there is also no evidence that there is a military dimension,” he said.

He said Moscow hoped the talks would now move into a phase of “bargaining,” rather than just offering proposals. “There needs to be a political will to move into that phase,” Mr. Ryabkov said. “We call on all participants not to lose any more time.”

Tuesday’s talks began at 1:30 p.m. with a plenary session that lasted about 2 hours, 30 minutes, largely taken up with the six laying out their latest modified proposal to the Iranians. The European Union’s foreign policy chief, Catherine Ashton, is the chairwoman and speaks for the six. There was also discussion of the proposal by the Iranians and some questions asked, the diplomats said.

There were a few brief bilateral meetings with the Iranian delegation by the Russians, British and Germans, diplomats said, but not with the French or the Americans. The one and only bilateral meeting between the Americans and the Iranians in the course of the talks was in October 2009 in Geneva, although the chief American negotiator now, Wendy R. Sherman, the under secretary for political affairs in the State Department, has repeatedly said that she is open to another such meeting.

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