Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Fair Game: Dell Shareholders Look Hard at Takeover Effort

IS Michael Dell trying to take over the computer company he founded on the cheap?

That’s what more and more Dell shareholders appear to believe about the $13.65 per-share price proposed on Feb. 5 by Mr. Dell and Silver Lake Partners, a technology investment firm. Initial objectors to the buyout have been joined by additional shareholders concerned about getting a fair shake.

The issue of fairness is a hazard of management-led buyouts, of course. Are insiders, who have an enormous information advantage owing to their deep knowledge of a company’s operations, trying to get control of an enterprise when its shares are perhaps temporarily depressed? Over the last year, Dell’s stock has lost 19 percent of its value.

Some investors wonder if Mr. Dell, who owns 14 percent of the shares outstanding, might have a hot new product on the drawing board that has the potential to make the company a highflier again.

Neither management nor Mr. Dell is saying much of anything about the company’s prospects. Last Tuesday, when Dell announced mixed earnings for the year, the company declined to make any projections for coming quarters on the conference call with investors and analysts. Its chief financial officer cited the pending deal as the reason no outlook was given.

As is the case with all insider deals, there’s great potential for outside shareholders to be treated unfairly. Making the deal even more problematic, Dell’s shareholders have little data upon which to assess its price. Dell’s regulatory filings say that the $13.65 per-share price is the result of extensive “bids and arms-length negotiations” between Silver Lake and the special committee of Dell’s board beginning in late October 2012.

Still, there’s no mention of how the $13.65 per-share offer stacks up against the company’s long-term enterprise value, an assessment of future earnings potential that is a typical measure in a takeover. Instead, the offer by Mr. Dell and Silver Lake seems based on the company’s recent stock price. Their $24.4 billion deal represents a 37 percent premium to the stock’s average price over the previous three months, they say.

Meanwhile, Southeastern Asset Management, one of Dell’s largest outside shareholders, estimates that the company is worth $23.72 a share, almost 75 percent more than the buyers are offering. Southeastern has come to that conclusion using publicly available information, however, because that’s all it has access to.

Naturally, both of these parties have a vested interest in getting their price in the deal. Mr. Dell and his group want to pay as little as possible, while long-suffering outside owners hope for more.

Trying to remedy this unsatisfying situation, an uninvolved investor organization has made an excellent suggestion: an independent, peer-reviewed analysis of Dell’s enterprise value should be done on behalf of its outside shareholders. Based on the same information Dell’s management has, such an assessment would assure investors that they are being bought out at a fair value.

This idea comes from the Shareholder Forum, a nonpartisan, independent creator of programs devised to provide the kind of information investors need to make astute decisions. The Forum, overseen by Gary Lutin, a former investment banker at Lutin & Company, suggests hiring a qualified expert to analyze the company’s operations. This would be similar to the so-called fairness opinions provided to shareholders in takeovers by outsiders. The analysis would be subject to confidentiality when necessary and would be reviewed by recognized analysts, academics and other investment professionals.

On Feb. 14, Mr. Lutin sent a letter to Mr. Dell and Alex Mandl, chairman of the special committee of Dell’s board charged with ensuring the deal’s fairness to all shareholders. In the letter, Mr. Lutin asked that the company support the independent analysis and provide assistance in its preparation.

Mr. Lutin said he had assumed that the board committee and Mr. Dell would want to support this project. “Shareholders have a very well-established right to any information relevant to their investment decisions under Delaware law,” Mr. Lutin said last week. “They also have the right to expect management to be responsible for addressing those interests.”

But last week, Mr. Lutin said that lawyers representing Mr. Mandl and his committee told him they would not be supporting the independent analysis.

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Palestinians Threaten to Boycott Sponsors of Jerusalem Marathon

JERUSALEM — A lawyer representing Palestinian government agencies sent letters this week to an American sneaker company and an international hotel chain threatening a boycott and legal action if they did not withdraw their sponsorship of the Jerusalem marathon, which the Palestinians say violates international law.

The letters to New Balance, a footwear company based in Boston, and the InterContinental Hotel Group, which includes the Crowne Plaza hotel in Jerusalem, say that the marathon, scheduled for March 1, is a “serious breach” of international law because it runs through East Jerusalem, territory that Israel captured during the 1967 war and later annexed. The Palestinians, and much of the world, consider East Jerusalem occupied territory, but the Israelis see it as part of their capital city.

“As the marathon neither caters to the needs of Palestinian civilians nor serves any genuine military purpose, the marathon constitutes an illegal activity in occupied East Jerusalem under international humanitarian law,” read the letters, sent on behalf of the Palestinian Olympic Committee, Athletics Federation, and Higher Council of Youth and Sport. Citing United Nations resolutions, the Fourth Geneva Convention, and an International Court of Justice ruling, the letters warn: “If your company does not immediately withdraw sponsorship of this illegal activity, my clients will be forced to pursue this matter legally.”

The letters do not specifically mention the United Nations General Assembly vote on Nov. 29 that upgraded Palestine to a nonmember observer state, but a senior Palestinian official said the companies could be targets if Palestinians leaders decide to use the new status to pursue claims in international courts. Another possibility is action by the Arab League, whose 22 member states have called for a boycott of Adidas last year over its sponsorship of the Jerusalem marathon.

The mayor of Jerusalem, Nir Barkat, has described the marathon, in its third year, as an effort to make his bitterly divided and contested city “normal.” But normalcy is a challenge in a city that both Israelis and Palestinians see as their capital, a place that Jews, Muslims and Christians worldwide all revere as holy, a sprawling 48 square miles where 500,000 Israelis and 300,000 Palestinians live mostly in separate neighborhoods. Virtually none of those Palestinians vote in municipal elections, for fear of “normalization,” and many Palestinians in recent years have refused to attend meetings or hold official events in parts of Jerusalem for the same reason.

This week, Senator Marco Rubio, Republican of Florida, made headlines during a visit here for an offhand reference to Jerusalem as Israel’s capital, which Washington generally avoids. American consular officials joke that part of their job is to make sure the mail is addressed simply to “Jerusalem,” not “Jerusalem, Israel.”

Asked about the letters to New Balance and Crowne Plaza, a spokesman for Mr. Barkat said on Friday that the Palestinians were “trying to drag the marathon into a political cause.”

“This is not politics, this is sport, this is culture,” said the spokesman, Barak Cohen. “This is a major international event in a major international city,” he added, noting that 2,000 of the more than 18,000 registered runners were from 52 countries. “Arab residents and Jewish residents are welcome to participate and celebrate together,” he added.

A spokeswoman for New Balance, whose logo is at the top of the marathon’s Web site next to the slogan, “Let’s Make Excellent Happen,” did not respond to inquiries on Friday.

A spokeswoman for the InterContinental Hotel Group said the company was unaware of the marathon sponsorship, which she said was by the Jerusalem Crowne Plaza, a franchisee. She said the hotel’s manager could not be reached for comment because of the Jewish Sabbath.

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Bits: Online Gambling Heats Up

The two big casino states, Nevada and New Jersey, are racing into online gambling as a way of protecting their turf. They will in essence become laboratories for what is and is not feasible in Internet wagering.

Nevada legislators, who previously authorized online poker, hurriedly passed a new bill this week that allows the state to enter into deals with other states to essentially pool their gambling populations. “This is the day we usher Nevada into the next frontier of gaming,” Brian Sandoval, Nevada’s governor, said on Thursday as he signed the bill.

In the year since online poker became a theoretical possibility in Nevada, no company has yet offered it. One problem: It’s too small a market, especially in a state where it is not exactly hard to gamble the old-fashioned way — by plunking your body down in a casino or, for that matter, just about anywhere else.

“We don’t have a universe of players,” Pete Ernaut, a Nevada political consultant, told The Las Vegas Review-Journal. “So for us, what we get to offer to a state like California or Texas is that we have the most mature regulatory infrastructure. We have the most mature financial, auditing and collection capabilities, much greater than some of those states, and they have the players.”

Meanwhile, New Jersey is also barreling ahead. Chris Christie, the governor, is likely to sign a revised bill permitting a variety of online gambling as soon as next week. All online ventures will be under the tight control of the Atlantic City casinos. Delaware, the smallest of the three states that are moving ahead with online gambling, also has ambitious plans.

In a harbinger of the new age, gamblers at the Borgata casino in Atlantic City will, as USA Today put it, “be able to lose their shirts without wearing one.” Gamblers staying in one of the casino’s 2,000 rooms can now place their bets right there without venturing onto the casino floor. From there it is only a small step to just staying home and gambling from the hammock.

Internet companies that make online games are watching all this with considerable interest. “Is 2013 going to be a game-changer?” asked Paul Thelen of Big Fish Studios, which began offering a gambling app in Britain last fall. “No. But in 2014, it starts getting interesting.”

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Question Mark: Acne Common in Baby Boomers Too

Pimples are no surprise on babies and teenagers, but boomers?

You no longer have to gaze over a school lunchroom, hoping to find a seat at a socially acceptable table. You don’t rush to get home at night before your junior license driving restrictions kick in. And you men no longer have to worry that your voice will skip an octave without warning.

But if adolescence is over, what is that horrid protuberance staring at you in the mirror from the middle of your forehead? Some speak of papules, pustules and nodules, but we will use the technical term: zit. That thing on your forehead now is the same thing that was there back in high school, or at least a close relative. Same as it ever was (cue “Once in a Lifetime”).

We get more than the occasional complaint here from baby boomers who want to know about this aging body part or that. So you would think people would be happy with any emblem of youth — even if it is sore and angry-looking and threatening to erupt at any second. But oddly, there are those who are not happy to see pimples again, and some have asked for an explanation.

Acne occurs when the follicles that connect the pores of the skin to oil glands become clogged with a mixture of hair, oils and skin cells, and bacteria in the plug causes swelling, experts say. A pimple grows as the plug breaks down.

According to the American Academy of Dermatology, a growing number of women in their 30s, 40s, 50s and even beyond are seeking treatment for acne. Middle-age men are also susceptible to breakouts, but less so, experts say.

In some cases, people suffer from acne that began in their teenage years and never really went away. Others had problems when they were younger and then enjoyed decades of mostly clear skin. Still others never had much of the way of pimples until they were older.

Whichever the case, the explanation for adult acne is likely to be the same as it is for acne found in teenagers and, for that matter, newborns: hormonal changes. “We know that all acne is hormonally driven and hormonally sensitive,” said Dr. Bethanee J. Schlosser, an assistant professor of dermatology at Northwestern.

Among baby boomers, the approach of menopause may result in a drop in estrogen, a hormone that can help keep pimples from forming, and increased levels of androgens, the male hormone. Women who stop taking birth control pills may also see a drop in their estrogen levels.

Debate remains over what role diet plays in acne. Some experts say that foods once thought to cause pimples, like chocolate, are probably not a problem. Still, while sugar itself is no longer believed to contribute to acne, some doctors think that foods with a high glycemic index – meaning they quickly elevate glucose in the body — might. White bread and sweetened cereals are examples. And for all ages, stress has also been found to play a role.

One message to acne sufferers has not changed over the years. Your mother was right: don’t pop it! It can cause scarring.

Questions about aging? E-mail boomerwhy@nytimes.com

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at booming@nytimes.com.

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Question Mark: Acne Common in Baby Boomers Too

Pimples are no surprise on babies and teenagers, but boomers?

You no longer have to gaze over a school lunchroom, hoping to find a seat at a socially acceptable table. You don’t rush to get home at night before your junior license driving restrictions kick in. And you men no longer have to worry that your voice will skip an octave without warning.

But if adolescence is over, what is that horrid protuberance staring at you in the mirror from the middle of your forehead? Some speak of papules, pustules and nodules, but we will use the technical term: zit. That thing on your forehead now is the same thing that was there back in high school, or at least a close relative. Same as it ever was (cue “Once in a Lifetime”).

We get more than the occasional complaint here from baby boomers who want to know about this aging body part or that. So you would think people would be happy with any emblem of youth — even if it is sore and angry-looking and threatening to erupt at any second. But oddly, there are those who are not happy to see pimples again, and some have asked for an explanation.

Acne occurs when the follicles that connect the pores of the skin to oil glands become clogged with a mixture of hair, oils and skin cells, and bacteria in the plug causes swelling, experts say. A pimple grows as the plug breaks down.

According to the American Academy of Dermatology, a growing number of women in their 30s, 40s, 50s and even beyond are seeking treatment for acne. Middle-age men are also susceptible to breakouts, but less so, experts say.

In some cases, people suffer from acne that began in their teenage years and never really went away. Others had problems when they were younger and then enjoyed decades of mostly clear skin. Still others never had much of the way of pimples until they were older.

Whichever the case, the explanation for adult acne is likely to be the same as it is for acne found in teenagers and, for that matter, newborns: hormonal changes. “We know that all acne is hormonally driven and hormonally sensitive,” said Dr. Bethanee J. Schlosser, an assistant professor of dermatology at Northwestern.

Among baby boomers, the approach of menopause may result in a drop in estrogen, a hormone that can help keep pimples from forming, and increased levels of androgens, the male hormone. Women who stop taking birth control pills may also see a drop in their estrogen levels.

Debate remains over what role diet plays in acne. Some experts say that foods once thought to cause pimples, like chocolate, are probably not a problem. Still, while sugar itself is no longer believed to contribute to acne, some doctors think that foods with a high glycemic index – meaning they quickly elevate glucose in the body — might. White bread and sweetened cereals are examples. And for all ages, stress has also been found to play a role.

One message to acne sufferers has not changed over the years. Your mother was right: don’t pop it! It can cause scarring.

Questions about aging? E-mail boomerwhy@nytimes.com

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at booming@nytimes.com.

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Pentagon Suspends F-35 Flights Due to Engine Blade Crack

WASHINGTON (Reuters) - The Pentagon on Friday suspended the flights of all 51 F-35 fighter planes after a routine inspection revealed a crack on a turbine blade in the jet engine of an F-35 test aircraft in California.

It was the second grounding of the warplane in two months and marked another setback for the $396 billion F-35 Joint Strike Fighter program, the Pentagon's biggest weapons program. The program has already been restructured three times in recent years and may face further cutbacks if Congress does not avert major budget reductions due to take effect on March 1.

The F-35 program office said it was too early to know if this was a fleet-wide issue, but it was suspending all flights until an investigation was completed. A total of 51 F-35 jets were affected, including 17 that are being used for testing and 34 in use for training in Florida and Arizona.

It said it was working closely with Pratt & Whitney, the United Technologies Corp unit that builds the engine, and Lockheed Martin Corp, the prime contractor for the radar-evading warplane, to ensure the integrity of the engine and return the F-35 fleet to flight as soon as possible.

The Pentagon's F-35 program office began notifying the chiefs of the U.S. Air Force, Navy and Marine Corps late on Thursday about the engine issue and decision to ground the planes, said Kyra Hawn, a spokeswoman for the program office.

She said that a routine inspection at Edwards Air Force Base in California on February 19 revealed a crack on a low pressure turbine blade that is part of the F-35's F135 engine. The blade was on an F-35 A-model, or Air Force variant, which takes off and lands from conventional runways.

Pratt spokesman Matthew said the inspection showed "an indication of a crack" on the third stage low pressure turbine airfoil. He said the company was working closely with the Pentagon, Lockheed and the military services to get the planes flying again.

Engineering teams are removing the turbine blade from the plane and plan to ship it to Pratt's engine facility in Middletown, Connecticut, for more thorough evaluation and root cause analysis, according to the Pentagon and Pratt.

Hawn said an initial analysis was expected next week.

The grounding comes on the heels of a nearly month-long grounding of the Marine Corps variant of the new warplane after a manufacturing defect caused a fuel line to detach just before a training flight in Florida.

The Marine Corps variant of the F-35, which takes off from shorter runways and lands like a helicopter, was grounded for nearly a month after a fuel line detached just before a training flight at Eglin Air Force Base in January.

That issue was later found to be caused by a manufacturing defect. The Pentagon and the U.S. Navy lifted flight restrictions on the B-model of the plane on February 13.

(Reporting By Andrea Shalal-Esa; Editing by Gerald E. McCormick and Leslie Adler)

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The Lede: Assad Denies Starting War in New Interview

Last Updated, Thursday, 3:48 p.m. The Syrian president, Bashar al-Assad, denied in an interview broadcast last week on German television that he was responsible for starting the bloody conflict tearing his country apart.

The interview, featured in a new documentary on the conflict in Syria by the filmmaker Hubert Seipel, was conducted in English but later overdubbed in German for broadcast on the network ARD. Mr. Seipel, whose previous film, “I, Putin,” was also a portrait of a strongman, provided The Lede with clips from the documentary in which Mr. Assad’s remarks can be heard in the original English.

The filmmaker said recently that he wanted to speak directly to Mr. Assad because “misinformation and psychological warfare make up a large part of the Syrian civil war.” He explained in an e-mail to The Lede that he was frustrated by watching Syria’s war unfold in YouTube clips selectively edited by the two sides. So, he said, “my intention was just to let Assad speak about his point of view, so that our viewers can make their own judgment in what kind of a separate world he lives.”

Below is a transcript of Mr. Assad’s remarks (in occasionally idiosyncratic English).

On Chemical Weapons: “Have you heard that any country used chemical weapon to fight terrorism? I haven’t heard about it. This is W.M.D weapon of mass destruction. How can I use it to fight groups, small groups of terrorists spreading everywhere, especially in the cities? You fight them in the suburbs. You just mentioned that you hear the shelling in the suburbs, you don’t hear it in the desert, or in far area from the cities. So this is not realistic and not logical. I think they use it as pretext maybe to have more pressure or to have an aggression against Syria.”

On Foreign Fighters: “You cannot talk about good situation while you have assassination and killings of innocent people by terrorists coming from abroad, and some of them are Syrian, to be frank and clear about the situation. But the most important thing is about do they have incubator in the society or not. This where it could be very bad or worse or where you don’t have no hope.”

‘We Didn’t Launch the War’: “We didn’t launch the war and we didn’t choose which kind of war because we didn’t choose it anyway. You have terrorists coming with very sophisticated armaments, nearly all kinds of armaments that they can carry with them and started killing people, destroying infrastructure, destroying public places, everything. How do you defend them? You defend them according to the aggressions that you have, according to the tactics that they use. So they use heavy weaponries. You have to retaliate in the same way.“

On Reforms: “Well the criteria that you used to talk about the speed of reform, nobody has criteria. When you drive your car you know that this is the law here, 100 kilometer, let’s say, per hour. Well about the reform, does anyone has criteria or certain meter? So it’s subjective.”

On Turkey’s Missile Defense: “This is part of the missile shield that they started a year ago in Turkey, but the Turkish didn’t want to say that this is a part of it because many Turks refuse that Turkey is part of this program. The second aspect of it that Erdogan has been trying hard to rally the Turks and to muster support to his policy against Syria, something that he failed. So he distributed the Patriot on our border just to give the impression that Turkey is in danger because Syria may think of attacking Turkey, which is not realistic.”

On Peace Talks: “We started right away discussing the conflict in Syria and I concentrated mainly on the violence. If you want to succeed (I mean I was talking to Kofi Annan at the time.) If you want to succeed, you have to focus on the violence part of your initiative. If you don’t stop the violence, if you don’t stop the terrorists coming to Syria through different countries, mainly Turkey and Qatar, if you don’t stop the money coming inside Syria in order to stoke the fire – the whole initiative will fail. So that was the core of our discussion in the first meeting.”

On His Future: “If it’s about me as president, the decision should be by the Syrian people. If the Syrian people doesn’t want you as president what would you do here? How can you succeed? It should be through national dialogue, and whatever this national dialogue decide, we are going to adopt as a government, of course including me.”

On the Houla Massacre: “The people who were killed in the massacres are state supporters loyal to the government, so how could a militia, loyal to the government, killing people, loyal to the government? This is contradiction, unrealistic. Actually militia of the terrorists coming to that city or to that village and committed the massacre, and they took the photos and put it on YouTube and on the TVs and they said this is the government, which was not realistic. Actually it was committed by the gangs, by the terrorists.”

The full film, with German narration, also includes interviews in English with Kofi Annan, the former United Nations envoy, and Sergey Lavrov, Russia’s foreign minister. After the documentary was broadcast, the Russian foreign ministry posted video and a transcript of Mr. Lavrov’s complete conversation with Mr. Seipel online.

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Tool Kit: Some Premium Headphones Amplify Celebrities Over Sound

If you are planning a $200 splurge on premium headphones — as millions of people are this year — who will give you the most for your money? Maybe a rapper like Dr. Dre, 50 Cent, Nick Cannon or Ludacris?

Or will you get better sound with headphones branded by rockers like Motörhead or inspired by the reggae artist Bob Marley?

Maybe headphones associated with the sports stars Tim Tebow and Michael Phelps or the reality television star Nicole Polizzi, better known as Snooki, produce even better sound?

This is how headphones are marketed these days — affinity headphones, if you will. The sequins, rhinestones, feathers and faux leopard print on Ms. Polizzi’s $60 headphones attract buyers as much as their sound quality does. Headphones are in high demand. The Consumer Electronics Association estimates 79 million were sold last year, and it predicts 10 percent more than that will be sold this year. But the category of headphones costing more than $100 is growing even faster — 64 percent, according to market analysts at the NPD Group.

That is wonderful news for retailers who feel their profit margins squeezed on laptops, televisions and most other electronic products. “Retailers can make more on a high-end pair of headphones than they can make selling a smartphone in many instances,” said Ross Rubin of Reticle Research, a consumer electronics research firm.

Knowing what’s behind the marketing can help a consumer avoid the hype when choosing a product. Headphone designers estimate the cost of making a “fashion headset” selling for $200 is as low as $14. “I would have guessed $20 to $22,“ said Tim Hickman, whose California Headphone Company and Fanny Wang Headphone Company brands are made in China.

“When you look at a $300 Beats headphone, how much does it cost to tool the enclosure, how much does it cost to stamp the thing out?” said John Chen, director of sales for the audio manufacturer Grado Labs. “Stamping it out is pennies.”

“I wish that were true,” said Noel Lee, founder of Monster Products, which until December produced Beats by Dr. Dre headphones. “I’m going to say it’s in the $40 and up range to make a quality product.” (Monster also makes those $80 HDMI cables at electronics stores, the ones that cost much less at Monoprice.com.)

The growth in pricey headphones is yoked to the growth of tablets and phones. IPods and other media players come with basic earphones, but the expanded menu of music and video apps now available encourage people to replace those with higher-quality headphones.

“What is really pushing premium headphones is not just the growth in mobile smartphones and tablets, but video and music services like Netflix and Spotify, that make people want a better listening device,” said Benjamin Arnold, a consumer electronics industry analyst for NPD. “It’s serious consumption rather than 30-second YouTube clips.”

The rush into premium headphones was set off in 2008 by the Beats by Dr. Dre brand, which marketed headphones like Air Jordan basketball shoes. (HTC, the Taiwanese cellphone maker, was once the majority shareholder of the Beats venture and still owns a 25 percent interest.) Headphones had traditionally been sold on technical specs like frequency response, but Beats created appealing designs in an array of colors. It also tweaked the headphones with brain-rattling bass.

Monster lost the rights to make the Beats, but has introduced 12 of its own headphones, none with a celebrity name on the brand, although some have celebrity endorsers. NPD found that celebrity endorsement was extremely or very important to 30 percent of consumers, and was the top factor driving purchases of headphones costing more than $100. Consumers say they want sound quality, but brand counts heavily too.

“Basically good-enough sound is good enough if everything else is in line, like brand and color,” Mr. Arnold said. “You see young people walking around the mall with them around their necks. They aren’t even on their ears.”

Not all headphones work on the same economics as the fashion brands. Classic brands like AKG, Shure, Audio-Technica, Grado and Klipsch still market based on realistic sound and value. With no celebrity endorsers to share profits and a nearly unlimited shelf life, because the style doesn’t change with fashion, the marketing model is different.

This article has been revised to reflect the following correction:

Correction: February 21, 2013

An earlier version of this article misstated the ownership stake of HTC, the Taiwanese cellphone maker, in the Beats venture. It is 25 percent, not a majority.

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Living With Cancer: Arrivals and Departures

After being nursed and handed over, the baby’s wails rise to a tremolo, but I am determined to give my exhausted daughter and son-in-law a respite on this wintry evening. Commiserating with the little guy’s discomfort — gas, indigestion, colic, ontological insecurity — I swaddle, burp, bink, then cradle him in my arms. I begin walking around the house, swinging and swaying while cooing in soothing cadences: “Yes, darling boy, another one bites the dust, another one bites the dust.”

I kid you not! How could such grim phrases spring from my lips into the newborn’s ears? Where did they come from?

I blame his mother and her best friend. They sang along as this song was played repeatedly at the skating rink to which I took them every other Saturday in their tweens. Why would an infatuated grandma croon a mordant lullaby, even if the adorable one happily can’t understand a single word? He’s still whimpering, twisting away from me, and understandably so.

Previously that day, I had called a woman in my cancer support group. I believe that she is dying. I do not know her very well. She has attended only two or three of our get-togethers where she described herself as a widow and a Christian.

On the phone, I did not want to violate the sanctity of her end time, but I did want her to know that she need not be alone, that I and other members of our group can “be there” for her. Her dying seems a rehearsal of my own. We have the same disease.

“How are you doing, Kim?” I asked.

“I’m tired. I sleep all the time,” she sighed, “and I can’t keep anything down.”

“Can you drink … water?” I asked.

“A little, but I tried a smoothie and it wouldn’t set right,” she said.

“I hope you are not in pain.”

“Oh no, but I’m sleeping all the time. And I can’t keep anything down.”

“Would you like a visit? Is there something I can do or bring?” I asked.

“Oh, I don’t think so, no thanks.”

“Well,” I paused before saying goodbye, “be well.”

Be well? I didn’t even add something like, “Be as well as you can be.” I was tongue-tied. This was the failure that troubles me tonight.

Why couldn’t I say that we will miss her, that I am sorry she is dying, that she has coped so well for so long, and that I hope she will now find peace? I could inform an infant in my arms of our inexorable mortality, but I could not speak or even intimate the “D” word to someone on her deathbed.

Although I have tried to communicate to my family how I feel about end-of-life care, can we always know what we will want? Perhaps at the end of my life I will not welcome visitors, either. For departing may require as much concentration as arriving. As I look down at the vulnerable bundle I am holding, I marvel that each and every one of us has managed to come in and will also have to manage to go out. The baby nestles, pursing his mouth around the pacifier. He gazes intently at my face with a sly gaze that drifts toward a lamp, turning speculative before lids lower in tremulous increments.

Slowing my jiggling to his faint sucking, I think that the philosopher Jacques Derrida’s meditation on death pertains to birth as well. Each of these events “names the very irreplaceability of absolute singularity.” Just as “no one can die in my place or in the place of the other,” no one can be born in this particular infant’s place. He embodies his irreplaceable and absolute singularity.

Perhaps we should gestate during endings, as we do during beginnings. Like hatchings, the dispatchings caused by cancer give people like Kim and me a final trimester, more or less, in which we can labor to forgive and be forgiven, to speak and hear vows of devotion from our intimates, to visit or not be visited by acquaintances.

Maybe we need a doula for dying, I reflect as melodious words surface, telling me what I have to do with the life left to be lived: “To love that well, which thou must leave ere long.”

“Oh little baby,” I then whisper: “Though I cannot tell who you will become and where I will be — you, dear heart, deliver me.”

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Susan Gubar is a distinguished emerita professor of English at Indiana University and the author of “Memoir of a Debulked Woman,” which explores her experience with ovarian cancer.

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