IHT Rendezvous: Romany Were European 500 Years Earlier Than Previously Thought

LONDON — The Romany people constitute Europe’s largest and, arguably, now its most persecuted minority.

A new genetic study published this week suggests their ancestors arrived in Europe from northwestern India in a single wave around 1,500 years ago, half a millennium earlier than previously thought.

The international authors of the peer-reviewed paper in Current Biology journal said their study is the most comprehensive ever of the demographic history of the Romany. They said it reveals the origins of a people who “constitute a mosaic of languages, religions, and lifestyles while sharing a distinct social heritage.”

Scientific American noted that earlier studies of the Romany language and cursory analysis of genetic patterns had determined India was the group’s place of origin. But the new study points to a single migration from northwestern India around 500 CE.

Previous studies largely overlooked the place of Europe’s 11 million Romany in the Continent’s gene pool. That was partly a consequence of their continued isolation and marginalization, and partly due to a history of oppression that in many countries continues to this day.

The prejudice has historically been most evident in Eastern European countries with large Romany populations. But recent tensions have spread, including to Romany families seeking a new life in the west.

In one incident in late September, a mob in Marseille, France set fire to an encampment of 35 foreign Roma. As many as 20,000 foreign Roma are said to live in France, most of them Romanians or Bulgarians.

Thousands were deported and their encampments razed during the presidency of Nicolas Sarkozy, as my colleague Scott Sayare recalled in an article in August, although François Hollande, his successor, has promised to better integrate the newcomers into French society.

A more activist Romany population has found a voice, however, showing it is no longer prepared to take the old prejudices lying down.

Some even reject the word Gypsy because of its historically negative connotations, a perception borne out when Lindsay Lohan used the term last week as an allegedly racial slur during a nightclub altercation.

Romany protestors last year turned out in Rome to demand better living conditions after four children died in a fire that destroyed their illegal camp.

And Romany families last month won a pledge from the Czech education ministry that it would finally end widespread discrimination against their children in schools after a landmark 2007 case in the European Court of Human Rights.

The European Roma Rights Center, based in Budapest, is active in pushing similar cases in European courts to combat anti-Romany racism.

My colleague Chris Cottrell wrote in October of continuing discrimination in a report on a ceremony in Berlin to unveil a memorial commemorating an estimated half million Romany who died in the Holocaust.

He quoted Chancellor Angela Merkel of Germany saying, “Let’s not beat around the bush. Sinti and Roma suffer today from discrimination and exclusion.”

The latest genetic study may at least contribute to establishing the Romany’s rightful place in European history — for the last millennium and a half.

The scientists, who revealed a strong admixture of non-Romany genes in northern and western countries during their migrations, said further studies would help define the identity of their Indian ancestors and provide further details of their migration and subsequent history in Europe.

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In Private Manning Case, Jailers Become the Accused


Patrick Semansky/Associated Press


Pfc. Bradley Manning faces a potential life sentence if convicted of leaking documents.







FORT MEADE, Md. — In a half-empty courtroom here, with a crew of fervent supporters in attendance, Pfc. Bradley Manning and his lawyer have spent the last two weeks turning the tables on the government.




Private Manning faces a potential life sentence if convicted on charges that he gave WikiLeaks, the antisecrecy organization, hundreds of thousands of confidential military and diplomatic documents. But for now, he has been effectively putting on trial his former jailers at the Quantico, Va., Marine Corps base. His lawyer, David E. Coombs, has grilled one Quantico official after another, demanding to know why his client was kept in isolation and stripped of his clothing at night as part of suicide-prevention measures.


Mr. Coombs, a polite but relentless interrogator who stands a foot taller than his client, has laid bare deep disagreements inside the military: psychiatrists thought the special measures unnecessary, while jail commanders ignored their advice and kept the suicide restrictions in place. In a long day of testimony last week, Private Manning of the Army, vilified as a dangerous traitor by some members of Congress but lauded as a war-crimes whistle-blower on the political left, heartened his sympathizers with an eloquent and even humorous performance on the stand.


“He was engaged, chipper, optimistic,” said Bill Wagner, 74, a retired NASA solar physicist who is a courtroom regular, dressed in the black “Truth” T-shirt favored by Private Manning’s supporters.


Private Manning, who turns 25 on Dec. 17 and looks much younger, was quietly attentive during Friday’s court session, in a dress uniform, crew-cut blond hair and wire-rimmed glasses. If his face were not already familiar from television news, he might have been mistaken for a first-year law student assisting the defense team.


It seemed incongruous that he has essentially acknowledged responsibility for the largest leak of classified material in history. The material included a quarter-million State Department cables whose release may have chilled diplomats’ ability to do their work discreetly but also helped fuel the Arab Spring; video of American helicopter crews shooting people on the ground in Baghdad who they thought were enemy fighters but were actually Reuters journalists; field reports on the wars in Iraq and Afghanistan; and confidential assessments of the detainees locked up at Guantánamo Bay, Cuba.


As the military pursues the case against Private Manning, the Justice Department continues to explore the possibility of charging WikiLeaks’ founder, Julian Assange, or other activists with the group, possibly as conspirators in Private Manning’s alleged offense. Federal prosecutors in Alexandria, Va., are still assigned to that investigation, according to law enforcement officials, but it is not clear how active they have been lately in presenting evidence to a grand jury.


The current tone of the legal proceedings against Private Manning is most likely temporary. His lawyer is asking the judge overseeing the case to throw out the charges on the ground that his pretrial treatment was unlawful, but that outcome appears unlikely.


As a fallback, Mr. Coombs is hoping the court will at least give Private Manning extra credit against any ultimate sentence for the time he spent held under harsh conditions at Quantico and earlier in Kuwait, where he was kept in what he described as “an animal cage.” After the uproar about his treatment, including public criticism from the State Department’s top spokesman and the United Nations’ top torture expert, military officials moved Private Manning in April 2011 from Quantico to a new prison at Fort Leavenworth, Kan., where he has not faced the same restrictions on clothing, sleeping conditions and conversation with other inmates.


As if to underscore the gravity of his legal predicament, Private Manning offered last month to plead guilty to lesser charges that could send him to prison for 16 years. Prosecutors have not said whether they are interested in such a deal, which would mean they would have to give up seeking a life sentence for the most serious charges: aiding the enemy and violating the Espionage Act.


Friday’s court session was attended by a dozen Manning loyalists, including Thomas A. Drake, the former National Security Agency official who was accused of leaking documents and pleaded guilty to a minor charge last year. They heard the commander of the Quantico brig, or military jail, explain why she refused Private Manning’s request to be taken off “prevention of injury” status.


Scott Shane reported from Fort Meade, and Charlie Savage from Washington.



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Khaled Meshal, the Leader of Hamas, Makes First Visit to Gaza


Wissam Nassar for The New York Times


Khaled Meshal, left, the head of the political bureau of Hamas, arrived for a visit to the Gaza Strip on Friday. With him is Ismail Haniya, Hamas's prime minister in Gaza.







RAFAH, Gaza Strip — Khaled Meshal, whom the Israelis tried to assassinate in Jordan in 1997, arrived for his first visit to the Gaza Strip on Friday as head of the political bureau of Hamas, which has established a ministate here.




For Mr. Meshal, 56, it was a triumphant visit, and Hamas fighters, armed with rifles and wearing balaclavas, lined the streets where he was to travel. He entered from Egypt, through the Rafah crossing, an indication of a new alliance with Cairo.


“Gaza, with its martyrs, cannot be described in words,” he said as he arrived here in Rafah, with tears in his eyes. “There are no words to describe Gaza, to describe the heroes, the martyrs, the blood, the mothers who lost their sons.


“I say I return to Gaza even if I never have been here. It has always been in my heart.”


Mr. Meshal fled the West Bank with his family after the 1967 Arab-Israeli war and had never returned to Palestinian territory. In 1997, when he was in Amman, Jordan, agents from the Israeli intelligence service, posing as Canadian tourists, tried to kill him by injecting him with poison. The agents were captured by Jordanian authorities, and Mr. Meshal lay in a coma until the agents handed over the antidote.


He arrived in Gaza to celebrate the 25th anniversary on Saturday of the founding of Hamas, the Palestinian branch of the Muslim Brotherhood, which has also risen to power in neighboring Egypt and has been a key to the Arab “awakening” that has shaken old alliances throughout the Middle East.


“This is my third birth,” Mr. Meshal said. “The first was my natural birth. The second was when I recovered from the poisoning. I ask God that my fourth birth will be the day we liberate all of Palestine.”


Mr. Meshal also plans to celebrate what Hamas considers a victory over Israel in the recent conflict here, eight days of fighting featuring Israeli airstrikes and shelling and Hamas rocket launches against Israel. The Israeli government claims that it sharply reduced Hamas’s military capacity, destroying storehouses of rockets and weapons and killing the operational commander of the Hamas forces, Ahmed al-Jaabari, at the outset of the fighting.


Still, Hamas negotiated a cease-fire with Israel through the agency of the Egyptians, and for the movement it may represent an important step toward becoming a more recognized international player and representative of at least a portion of the Palestinian people.


Mr. Meshal was expected to visit the homes of Mr. Jaabari; the Dalu family, who lost 10 members in an Israeli airstrike in the November fighting; and Sheik Ahmed Yassin, an assassinated Hamas spiritual leader.


The Fatah movement controls the West Bank, which Israel still occupies, and the rivalry between Fatah and Hamas is the defining principle of Palestinian politics, despite continuing efforts by Egypt to bring about a reconciliation. The uprising in Syria drove Mr. Meshal and the Hamas political bureau out of its offices in the Syrian capital, Damascus, to resettle in Egypt, pulling Hamas farther from Shiite Iran, which continues to help sponsor it, and closer to its Sunni Muslim roots. That has also made Hamas potentially more attractive to Egypt and Israel as a negotiating partner, however indirect, in trying to preserve stability in the region.


But Hamas, which considers itself a fighting force in contrast to Fatah, which has engaged in direct negotiations with Israel, is proud of its accomplishments in Gaza, even as it has put a more repressive and Islamist stamp on society here.


Decorating the stage where the anniversary celebration will be held is a mock-up of a large rocket, called the M-75, that Hamas claims it has built on its own and can reach almost 50 miles, close to Tel Aviv. The M stands for a dead founder of Hamas, Ibrahim Maqadma, killed in an Israeli airstrike in 2003.


In fact the Hamas anniversary is Dec. 14, but the organization moved the celebration forward a week to honor the first intifada against Israel.


Fares Akram contributed reporting.



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In Shift of Jobs, Apple Will Make Some Macs in U.S.





Apple plans to join a small but growing number of companies that are bringing some manufacturing jobs back to the United States, drawn by the growing economic and political advantages of producing in their home market.




On Thursday, Apple’s chief executive, Timothy D. Cook, who built its efficient Asian manufacturing network, said the company would invest $100 million in producing some of its Mac computers in the United States, beyond the assembly work it already does in the United States. He provided little detail about how the money would be spent or what kinds of workers might benefit.


Apple, which long manufactured parts in the United States but stopped about a decade ago, has been under pressure to create more jobs here given its market power. It sold 237 million iPods, iPads, Macs and other devices in the year ended in September.


“I don’t think we have a responsibility to create a certain kind of job,” Mr. Cook told Bloomberg Businessweek. “But I think we do have a responsibility to create jobs.”


Some analysts are hopeful that the move by a big, innovative company like Apple could inspire a broader renaissance in American manufacturing, but a number of experts remain skeptical.


“I find it hard to see how the supply chains that drive manufacturing are going to move back here,” said Andre Sharon, a professor at Boston University and director of the Fraunhofer Center for Manufacturing Innovation. “So much of the know-how has been lost to Asia, and there’s no compelling reason for it to return. It’s great when a company says they want to create American jobs — but it only really helps the country if those are jobs that belong here, if it starts a chain reaction or is part of a bigger economic shift.”


Over the last few years, companies across various industries, including electronics, automotive and medical devices, have announced that they are “reshoring” jobs after decades of shipping them abroad. Lower energy costs in America, rising wages in developing countries like China and Brazil, quality control issues and the desire to keep the supply chain close to the gigantic American consumer base have all factored into these decisions.


“Companies were going abroad in pursuit of cost reduction, and it turns out there were a lot of unintended costs,” said Diane Swonk, chief economist at Mesirow Financial. “America has been looking a lot more competitive lately.”


Even so, the impact on the American job market has been modest so far. Much of the work brought back has been high-value-added, automated production that requires few actual workers, which is part of the reason America’s higher wages are not scaring off companies.


American manufacturing has been growing in the last two years, but the sector still has two million fewer jobs than it had when the recession began in December 2007. Worldwide manufacturing appears to be growing much faster, even for many of the American-owned companies that are expanding at home. General Electric, for example, has hired American workers to build water heaters, refrigerators, dishwashers and high-efficiency topload washers, but continues to add more jobs overseas as well.


Apple has not announced plans to move the complex, faster-growing portions of its product lines. Macs now represent a relatively small part of Apple’s business, accounting for less than 20 percent of its nearly $36 billion in revenue in its most recent quarter. The company’s iPad and iPhone products, which amount to nearly 70 percent of its sales, will continue to be made in low-cost centers of manufacturing like China, mostly on contract with outside companies like Foxconn.


Mr. Cook’s statements suggested Apple was planning to build more of the Mac’s components domestically, but with partners. He told Bloomberg Businessweek that the plan “doesn’t mean that Apple will do it ourselves, but we’ll be working with people, and we’ll be investing our money.”


Whether Apple’s newly announced plan might help create other higher-paying jobs along the supply line depends on the nature of the manufacturing.


Other computer manufacturing has been trickling back to the United States after largely shifting overseas in the 1990s.


Charles Duhigg and Quentin Hardy contributed reporting.



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3 Charged With Plotting to Export Carbon Fiber to Iran





Three people have been charged with conspiring to illegally export to Iran and China a superstrong material called carbon fiber that can be used to make machines that can enrich uranium, federal prosecutors in Manhattan said on Wednesday.




Iran has been pursuing carbon-fiber technology for years, and has had difficulty in obtaining the material. Enriched uranium can be used as fuel for nuclear reactors and atom bombs.


Another man was charged in a purported scheme to illegally export to Iran via South Korea components for helicopters that could be used for military purposes, the authorities said.


Three of the four men have been arrested. One of them, Hamid Reza Hashemi, 52, a dual United States and Iranian citizen who runs a company in Tehran that the United States government says has been trying to obtain carbon-fiber technology, was arrested on Saturday at Kennedy International Airport as he entered the country, prosecutors said.


Another defendant, Peter Gromacki, 48, of Middletown, N.Y., was accused of arranging for the export of more than 6,000 pounds of carbon fiber from the United States to China via Belgium, in violation of federal law, the government said.


“The law prohibits the exportation of goods to Iran and certain goods to China,” said George Venizelos, who heads the Federal Bureau of Investigation’s New York office.


A third defendant, Amir Abbas Tamimi, 40, an Iranian accused in the purported helicopter-component deal, was arrested at Kennedy Airport in October, the authorities said. He and Mr. Hashemi are being held without bond, while Mr. Gromacki was released on bond, the government said.


The fourth defendant, Murat Taskiran, a Turk accused in the purported carbon-fiber scheme, has not yet been arrested.


The charges do not specify precisely what the government believes the carbon-fiber technology was going to be used for in Iran.


But Preet Bharara, the United States attorney in Manhattan, whose office is prosecuting the men, said “carbon fiber in the wrong hands poses a serious threat” to the national security of the United States.


“Two of these defendants are charged with arranging its export to Iran, where it most assuredly had the potential to end up in the wrong hands,” Mr. Bharara said.


The government charged that in March and April 2008, Mr. Hashemi and Mr. Taskiran worked with an unidentified European broker to arrange for the shipment of carbon fiber from the United States to Iran through Europe and Dubai.


Carbon fiber is used to make rotors for centrifuges, which are used to enrich uranium.


The government also charged that this year Mr. Hashemi sent messages to the European broker, indicating that he wanted to travel to the United States to see a carbon-fiber-winding machine that he wanted to buy. Such machines can be used to make the rotors.


Lawyers for the three men who have been arrested could not be reached for comment Wednesday evening.


William J. Broad contributed reporting.



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McAfee Antivirus Software Pioneer Arrested in Guatemala City





MEXICO CITY — The antivirus software pioneer John McAfee was arrested in Guatemala City on Wednesday after he slipped over the border from his home in Belize where police want to question him in their investigation of the murder of his neighbor.







Jorge Dan Lopez/Reuters

John McAfee spoke during an interview in Guatemala City on Wednesday.








The interior minister, Mauricio Lopez Bonilla, told The Associated Press that Mr. McAfee, 67, had been arrested on charges of entering Guatemala illegally. He said that Mr. McAfee had been arrested at a hotel in the capital and taken to a detention center for migrants who are in the nation illegally.


Mr. McAfee had been on the run for almost a month since his neighbor, Gregory Faull, on the Belizean island of Ambergris Caye was found dead at his home on Nov. 11. Police there cited Mr. McAfee as a “person of interest” in their investigation, but Mr. McAfee disapppeared.


But he did not disappear from the Internet. He kept up a continuous stream of comment on his blog and on Twitter, accusing the Belizean authorities of persecuting him.


On Tuesday, he resurfaced in Guatemala, dressed in a suit, his blond curls dyed dark brown.


Accompanied by his 20-year-old Belizean girlfriend, Samantha Venagas, and his Guatemalan lawyer, Telésforo Guerra, Mr. McAfee said that he would seek political asylum in Guatemala. Mr. Guerra, a former Guatemalan attorney general, told reporters at a chaotic news conference outside the Supreme Court that his client was being persecuted because he refused to pay Belizean authorities off any longer.


Mr. McAfee has not been associated with the software company that bears his name since 1994, when he sold it and began to pursue his other interests. He ran a yoga retreat and then built a complex in New Mexico to indulge his hobby of flying motorized ultralight airplanes.


He moved to Belize about four years ago, buying properties on the mainland and on Ambergris Caye. It was there that he clashed with Mr. Faull, who complained about the unleashed dogs that Mr. McAfee kept on his property.


On Nov. 9, several of the dogs were found dead. They had been poisoned.


During his time in Belize, Mr. McAfee had apparently become interested in developing a designer drug called MDPV. He posted extensively about his experiments on a Web site.


But he attracted the attention of Belizean authorities, who raided one of his properties in April. He spent a night in jail, but law enforcement officials found no evidence that he was producing methamphetamine and dropped the charges.


After that experience, though, Mr. McAfee appeared to become increasingly convinced that he was being persecuted by the Belizean government. Officials deny that they are persecuting him.


Mr. Guerra told Guatemalan reporters late Wednesday that since there was no warrant for Mr. McAfee’s arrest and since his client was not a fugitive, he would seek to have his client released and returned to the hotel where he would remain under guard.


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Antismoking Outlays Drop Despite Tobacco Revenue





Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.







Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.







States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.


The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.


“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.


Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.


Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.


The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.


The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.


Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.


“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”


Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.


The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.


An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.


Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.


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Antismoking Outlays Drop Despite Tobacco Revenue





Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.







Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.







States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.


The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.


“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.


Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.


Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.


The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.


The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.


Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.


“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”


Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.


The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.


An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.


Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.


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DealBook: Trail to a Hedge Fund, From a Cluster of Cases

In April 2009, an F.B.I. agent visited the Silicon Valley home of Richard Choo-Beng Lee, a hedge fund manager with deep contacts inside technology companies. The government, the agent said, had overwhelming proof that Mr. Lee had engaged in insider trading. Within weeks, Mr. Lee confessed and began cooperating.

A year and a half later, in the parking lot of a New England prep school, the same agent approached Noah Freeman, a Harvard-educated money manager turned teacher. After the agent played a secretly recorded conversation of Mr. Freeman swapping illegal tips, Mr. Freeman admitted to crimes and started assisting the authorities.

Last winter, another agent confronted Mathew Martoma, a pharmaceutical-industry analyst, at his 8,000-square-foot Florida mansion. As they stood on the front lawn, with Mr. Martoma’s wife and children inside, the agent told him that they had evidence that he had broken the law.

Overcome with stress, Mr. Martoma passed out.

Three criminal defendants — Mr. Lee, Mr. Freeman and Mr. Martoma — have a common denominator: Each had worked for SAC Capital Advisors, the hedge fund run by Steven A. Cohen, one of the most powerful figures in finance. By posting impressive annual returns averaging 30 percent across two decades, Mr. Cohen, a 56-year-old Long Island native, has amassed a fortune estimated at nearly $9 billion.

Mr. Cohen has not been accused of any wrongdoing and he may never be charged, but he has become a central focus of the government’s sprawling investigation into criminal conduct at hedge funds. A picture of the inquiry has emerged from interviews with people involved with the case.

The trail leading to SAC has emerged out of a cluster of cases, many of them connected to the prosecution of the fallen titan Raj Rajaratnam. Investigators heard SAC traders on incriminating wiretaps; in other instances, cooperators and informants accused the fund of misconduct. As the authorities painstakingly pieced together dozens of cases across multiple, overlapping conspiracies, again and again one name kept popping up: Mr. Cohen’s SAC.

Complete Coverage: Insider Trading at a Top Hedge Fund

Investigators have penetrated SAC and other funds by aggressively deploying techniques — wiretaps, cooperators and informants — once reserved for infiltrating the Mafia and narcotics rings. Government lawyers have reviewed millions of pages of documents and taken hundreds of depositions. Securities watchdogs, meanwhile, have developed more sophisticated methods to detect insider trading, which is defined as trading based on material, nonpublic information.

The long-running inquiry has linked six former SAC employees to insider trading while at the fund; three, including Jon Horvath, who has implicated one of Mr. Cohen’s top lieutenants, have pleaded guilty. At least six other former employees have been tied to insider trading after leaving SAC. Several more have received subpoenas, people briefed on the case say.

Since 2002, the financial industry’s self-regulatory groups have referred about 80 instances of suspicious SAC trading activity to federal authorities for further investigation. In 2007, as the citations piled up, the self-regulatory groups took a more aggressive tone, noting that the hedge fund had been “repeatedly” flagged for suspicious trading. (An SAC spokesman has said that the fund trades in thousands of stocks each day, so given its level of activity it is not surprising that the fund would show up in referrals.)

“Government lawyers go where the facts take them,” said H. David Kotz, a former inspector general at the Securities and Exchange Commission now with Berkeley Research, a consulting firm. “With so many disparate strands of the investigation leading to SAC, it makes perfect sense that they would be closely looking at the guy in charge.”

And they are looking very closely. A few years ago, the F.B.I. secretly recorded the telephone line at Mr. Cohen’s Greenwich, Conn., estate, said two people briefed on the investigation. It is unclear what precipitated the wiretapping and whether any evidence was collected. Federal securities regulators have had previous brushes with SAC in 2003 and Mr. Cohen in 1986, but neither inquiry resulted in any action. Last summer, S.E.C. lawyers deposed him.

Speaking to his roughly 1,000 employees last week, Mr. Cohen expressed confidence that he acted appropriately. In defending the fund, SAC cites its strong culture of compliance and says it is “outraged” and “deeply disturbed” by the conduct of former employees.

But with Mr. Martoma’s arrest Nov. 20 — the first case that directly ties Mr. Cohen to questionable trades — the investigation has entered a more serious phase. The S.E.C. warned the fund that it was preparing a civil fraud lawsuit against SAC related to Mr. Martoma’s case. A lawyer for Mr. Martoma, Charles A. Stillman, said that he expected his client to be exonerated.

And just as it did in the investigation of Mr. Rajaratnam and in the landmark 1980s prosecutions of the financial giants of that era, Michael R. Milken and Ivan F. Boesky, the government is pursuing lower-level employees and then seeking their cooperation in the hopes of building a case against the boss.

C. B. Lee

Had he made different career choices, Richard Choo-Beng Lee might have been an engineer at Apple or Intel. Instead, armed with a computer science degree and a knack for numbers, Mr. Lee became a star technology analyst on Wall Street.

Known as C. B., Mr. Lee worked in the 1990s at the brokerage firm Needham & Company alongside Mr. Rajaratnam. In 1999, Mr. Lee landed at SAC, where he earned millions working for a team of tech-stock traders. After five years, he left, and in 2008 started his own California-based hedge fund, Spherix Capital.

That same year, a government informant taped incriminating calls with Mr. Rajaratnam, who by then had become a billionaire running the Galleon Group. On the basis of those calls, prosecutors received a judge’s approval to wiretap Mr. Rajaratnam’s cellphone. They also received permission to eavesdrop on Danielle Chiesi, a close associate of Mr. Rajaratnam. Ms. Chiesi was heard on calls with Mr. Lee passing inside information.

B. J. Kang, an F.B.I. agent, showed up at Mr. Lee’s modest San Jose, Calif., home in 2009. After pleading guilty, he closed Spherix Capital and became a cooperator, recording conversations that helped ensnare several defendants.

Securing Mr. Lee’s cooperation proved to be a major breakthrough because he helped them better understand SAC’s trading practices and culture. As part of Mr. Lee’s plea agreement, he agreed to share information about illegal conduct that he saw while working for Mr. Cohen.

He also provided investigators with detailed insights into expert-network firms, a growing business that connected traders with sources at publicly traded companies. Mr. Lee said SAC and other funds aggressively used these matchmaking firms, some of which were cesspools of inside information.

A few months after Mr. Lee “flipped,” the F.B.I. directed him to try to get rehired by SAC, said a person briefed on the case. Mr. Cohen entertained his request but ultimately rebuffed him, leery that Mr. Lee had abruptly closed his fund, this person said.

Jeffrey Bornstein, a lawyer for Mr. Lee, 56, said that his client continues to cooperate with the government.

Noah Freeman

When Noah Freeman graduated from Harvard in 1999, the stock market was roaring. After a stint in management consulting, Mr. Freeman tried his hand at hedge funds. He started at Brookside Capital, a unit of Bain Capital.

Mr. Freeman joined SAC in 2008, lured by a two-year, $2 million-a-year guarantee. The fund gave him several hundred millions of dollars to manage.

Mr. Freeman routinely shared his best ideas with Mr. Cohen. Unlike hedge funds with one manager making investment decisions, SAC has about 140 teams — each controlling several hundred millions of dollars. The teams give their “high conviction ideas” to Mr. Cohen, who directly manages only about 10 percent of the fund. SAC compensates employees based on a percentage of the winnings they generate for the fund, as well as on profits they make for Mr. Cohen’s portfolio.

An accomplished speed skater and triathlete, Mr. Freeman thrived in the high-stress world of hedge funds. But the pressure to perform was immense. To help gain an edge, Mr. Freeman became a big user of expert networks, especially Primary Global Research. His principal contact at Primary Global was Winifred Jiau.

Mr. Lee and other informants had told government investigators that Primary Global was especially dirty, and investigators began listening to its phone calls. On one call in May 2008, Ms. Jiau was heard giving Mr. Freeman inside tips about Marvell Technology. Mr. Freeman shared the information with another SAC colleague, Donald Longueuil, who used it to earn more than $1 million in profits.

SAC fired Mr. Freeman in 2010 for poor performance, according to a fund spokesman. Disillusioned with Wall Street, Mr. Freeman went into education. He took a job teaching honors economics at the Winsor School, a prestigious all-girls school in Boston. One day, in November 2010, Mr. Kang, the F.B.I. agent, was waiting for Mr. Freeman in the parking lot of Winsor.

As a government cooperator, Mr. Freeman wore a wire and secretly recorded conversations with Mr. Longueuil, who had been the best man at his wedding. Mr. Longueuil is serving a two-and-a-half year sentence.

In a Dec. 16, 2010 interview, Mr. Freeman told investigators that he thought that trafficking in corporate secrets was part of his job description at SAC, according to an F.B.I. agent’s notes of the interview, which were in a court filing and first reported by Bloomberg News.

“Freeman and others at SAC Capital understood that providing Cohen with your best trading ideas involved providing Cohen with inside information,” the agent wrote.

Prosecutors announced charges against Mr. Freeman and Mr. Longueuil in February 2011. Primary Global has closed. Ms. Jiau, who was found guilty at trial, is in prison. At her trial, Mr. Freeman testified that he gave investigators the names of at least a dozen people who he believed were involved in criminal conduct.

Mr. Freeman, 36, who has yet to be sentenced, is currently a stay-at-home father, and his cooperation could spare him prison time. His lawyer, Benjamin E. Rosenberg, declined to comment.

Jon Horvath

In November 2010, the F.B.I. raided two hedge funds that heavily used expert-network firms: Level Global Investors and Diamondback Capital Management. Both had strong ties to Mr. Cohen; each was started by SAC alumni.

Fourteen months after the raid, prosecutors charged seven traders — including two each from Level Global and Diamondback — in what it called a “criminal club” that made nearly $70 million trading on secret information gleaned from sources inside technology companies.

Among those arrested was Jon Horvath, an SAC tech-stock analyst who once worked at Lehman Brothers. Low key and analytic, Mr. Horvath lacked the swagger of many of his peers. For months, he maintained his innocence.

But in September, a month before trial, Mr. Horvath admitted to insider trading while at SAC and agreed to cooperate. In court, Mr. Horvath said that he — along with his SAC manager — traded on confidential financial results. “In each instance I provided the information to the portfolio manager I worked for and we executed trades in the stocks based on that information,” he said.

The portfolio manager is Michael S. Steinberg, according to two people briefed on the inquiry. Prosecutors have not charged him, but have named him an unindicted co-conspirator.

Barry Berke, a lawyer for Mr. Steinberg, 40, and Steven Peikin, a lawyer for Mr. Horvath, 42, declined to comment.

Though recently placed on leave, Mr. Steinberg is one of SAC’s longest-tenured employees. He joined in 1997, when it was just Mr. Cohen and several dozen traders; for years, he sat near Mr. Cohen on the trading floor and the two grew close. When Mr. Steinberg was married in 1999 at the Plaza Hotel, Mr. Cohen attended the black-tie affair.

Mathew Martoma

In 2008, a team of S.E.C. enforcement lawyers in New York, led by Sanjay Wadhwa, noticed a pattern in the “suspicious trading reports.” CR Intrinsic Investors, a unit of SAC Capital, had made an uncanny string of immensely profitable, well-timed trades in technology and health care stocks. Their suspicions raised, the team requested more trading reports from the regulatory arm of the New York Stock Exchange. Huge bets by CR Intrinsic on the pharmaceutical companies Elan and Wyeth, placed just before they announced disappointing results from a drug trial, jumped off the page.

The S.E.C. issued a subpoena requesting that SAC produce documents — e-mails, instant messages, phone and trading records — connected to the unusual trades. As they combed through e-mails, S.E.C. lawyers discovered reams of correspondence between Mathew Martoma, a drug stock specialist at CR Intrinsic, and Dr. Sidney Gilman, a neurologist.

Two days before Thanksgiving, federal agents arrested Mr. Martoma. Prosecutors said that Dr. Gilman had leaked him secret data about clinical trials that he was overseeing for an Alzheimer’s drug being jointly developed by Elan and Wyeth.

The case was a turning point in the investigation of SAC because, for the first time, the government linked Mr. Cohen to trades that it contends were illegal. Mr. Martoma and Mr. Cohen collaborated on the Elan and Wyeth transactions, prosecutors said, earning SAC profits and avoiding losses totaling $276 million. After Mr. Martoma learned from Dr. Gilman — whom he met through an expert network — that there were problems with the trials, he reached out to his boss, the government said.

“Is there a good time to catch up with you this morning? It’s important,” Mr. Martoma e-mailed Mr. Cohen in July 2008, just days before Elan and Wyeth announced their findings.

An hour later, Mr. Martoma and Mr. Cohen had a 20-minute telephone conversation. SAC promptly sold a $700 million position in Elan and Wyeth and then made a big negative bet. After the drug companies released the negative data, their shares plummeted.

An S.E.C. lawyer interviewed Mr. Cohen about the Elan and Wyeth trades this summer, according to a person briefed on the case. In sworn testimony, he said that SAC sold the stocks because Mr. Martoma told him that he had lost conviction in the position, this person said. Otherwise, Mr. Cohen had little recall of their conversation.

Federal agents paid a house call to Mr. Martoma a year ago, pressuring him to “flip” and help build a case against Mr. Cohen. While speaking with the agents in his front yard, Mr. Martoma fainted. After picking himself up, he declined to cooperate. When the S.E.C. deposed him earlier this year, Mr. Martoma refused to answer questions, invoking his Fifth Amendment right against self-incrimination.

The government has said it will not prosecute Dr. Gilman, who has agreed to testify against Mr. Martoma.

SAC continues to operate during the intensifying investigation. The negative attention and controversy aggravates and angers Mr. Cohen, said a friend, but his ability to compartmentalize allows him to maintain a focus on investing.

An SAC spokesman said Wednesday that Mr. Cohen is cooperating with the government’s inquiry.

During market hours, Mr. Cohen can be found at the center of his football field-size trading floor in Stamford, Conn., sitting among his traders, sifting through information, and buying and selling stocks. SAC, which manages $14 billion, is up about 12 percent this year through the end of last month.

“None of this stuff is material to his returns and it’s all just a lot of noise,” said Ed Butowsky, managing partner of Chapwood Investments, a longtime SAC client. “Steve Cohen is the Michael Jordan of the hedge fund business. When people are successful everyone likes to take shots at them.”

Ben Protess contributed reporting.

A version of this article appeared in print on 12/06/2012, on page A1 of the NewYork edition with the headline: Trail to a Hedge Fund, From a Cluster of Cases.
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Typhoon Kills Hundreds in Philippines


Bullit Marquez/Associated Press


A resident hung clothing amid fallen trees and debris on Wednesday, a day after Typhoon Bopha made landfall in the village of Andap, in southern Philippines.







MANILA — Rescue teams were trying to reach isolated villages in the southern Philippines on Wednesday after a powerful out-of-season typhoon tore through the region, leaving more than 270 people dead, officials said.









Erik De Castro/Reuters

Residents transported the body of victim in the southern Philippines on Wednesday.






Karlos Manlupig/Associated Press

Relatives mourned in New Bataan on Wednesday.






Typhoon Bopha packed winds of up to 100 miles per hour when it struck Tuesday, bringing torrential rains that flattened entire villages, leaving thousands homeless, as well as washing out roads and bridges needed by rescue personnel trying to reach stricken regions.


A national disaster official, Benito Ramos, said at a news conference Wednesday afternoon that 274 deaths had been confirmed, with 339 people known to be injured and 279 missing.


The storm was weakening and leaving the Philippines on Wednesday. The Philippines is hit by more than 20 powerful tropical storms per year, but this typhoon struck remote communities off the usual storm path that are not accustomed to such strong storms.


In December of last year, Tropical Storm Washi killed more than 1,200 people and left hundreds of thousands homeless. Officials this year called for mandatory early evacuations of vulnerable communities.


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Law Students in Austria Challenge Facebook Privacy Policy





BERLIN — An Austrian student group said Tuesday that it planned to challenge Facebook’s privacy policies in Irish court, alleging that the social networking giant had failed, despite repeated requests and formal complaints made by its members, to adapt to the restrictions of European data protection law.







Herwig Prammer/Reuters

Max Schrems, a student at the University of Vienna, said Facebook’s privacy policies were too broad and violated European law.







The group, which calls itself Europe vs. Facebook, said it would begin collecting donations to challenge the policy in Ireland, where the company’s European business is incorporated. Max Schrems, an Austrian law student at the University of Vienna who organized the effort, said Facebook had no interest in adapting its service to meet stricter European privacy requirements.


“We have been pursing this for more than a year with Facebook, but the company has done only about 10 percent of what we had asked them to do,” said Mr. Schrems, 25. “Therefore, we are preparing to go to court.”


Facebook, in a statement, said its European privacy policy had been vetted and approved by Irish regulators and was in compliance with European law.


“The way Facebook Ireland handles personal data has been subject to thorough review by the Irish Data Protection Commissioner over the past year,” the company said. “Nonetheless, we have some vocal critics who will never be happy whatever we do and whatever the D.P.C. concludes.”


Mr. Schrems’s group, which he said was made up of about 10 students at the University of Vienna, filed 22 complaints in 2010 with the Office of the Data Protection Commissioner in Ireland, which regulates Facebook’s European business because it is incorporated there.


As a result of those complaints, the regulator conducted a public audit of Facebook’s privacy policies. In September it announced an agreement with the company that required, among other changes, that Facebook shorten the time it retained consumer data and refrain from building a photo archive on individuals without their prior consent.


But Mr. Schrems said in an interview that Facebook was still violating European law in many areas, including a requirement that Facebook provide users who request it with a full copy of all the data the company has collected on them. Mr. Schrems, a Facebook user since 2007, said he requested his own summary file from Facebook in 2010.


The company, whose global headquarters is in Menlo Park, California, responded by creating a self-service tool for users to extract the data, which Mr. Schrems said supplied him only with information going back to 2010. In addition, he alleged that Facebook’s privacy policy, which users are required to agree to before they can use the service, is too broad and violates European law.


“It is basically a collection of American legalese, which is intentionally vague and gives the company adequate leeway to do basically anything they want with your data,” Mr. Schrems said.


Thilo Weichert, the data protection supervisor for the German state of Schleswig-Holstein, which has also brought legal action against Facebook, said he supported the Austrian student group’s efforts.


“Facebook’s policy is much too vague and broad and does not conform with German or European law,” Mr. Weichert said in an interview. “We think that European privacy officials need to take common action on this.”


Mr. Weichert issued an administrative order in August 2011 that barred businesses in the state, which is located along Germany’s northern border with Denmark, from using Facebook’s social plug-ins like the Like button and Fan pages. The rationale for the order: Those applications collect information on users without their consent by inserting cookies, which track individual computers, through a user’s Web browser.


In November of last year, Mr. Weichert sued several local business organizations, including the state’s own Industrie- und Handelskammer, the equivalent of the local chamber of commerce, for creating their own fan pages on Facebook. The chamber and businesses that have not been identified have challenged that suit, which is pending in court in Kiel.


The privacy policies of Facebook, Google and some other U.S.-based Web companies have come under increasing criticism in Europe.


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Extended Use of Breast Cancer Drug Suggested


The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.


In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.


“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.


Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.


“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”


Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.


Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.


About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.


The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.


In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing ten years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.


About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.


There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.


Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.


“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.


Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.


Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.


“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.


Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.


Read More..

Extended Use of Breast Cancer Drug Suggested


The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.


In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.


“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.


Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.


“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”


Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.


Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.


About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.


The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.


In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing ten years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.


About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.


There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.


Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.


“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.


Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.


Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.


“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.


Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.


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DealBook: Freeport to Buy Plains Exploration and McMoRan

Freeport-McMoRan Copper and Gold said on Wednesday that it would buy two oil and natural gas companies, Plains Exploration and Production and the McMoRan Exploration Company, in a return to the energy business.

The two transactions will create a natural resources titan worth about $60 billion, including debt, and will formally reunite Freeport with McMoRan, the oil exploration company it spun off in 1994.

Under the terms of the deals, Freeport will pay about $6.9 billion in cash and stock for Plains. That offer consists of $25 a share in cash and 0.6531 of a Freeport share, worth about $50 a share based on Tuesday’s closing prices.

And Freeport will pay $14.75 a share in cash and 1.15 units of a trust that will hold a 5 percent interest in future production of McMoRan’s deepwater exploration operations. Freeport and Plains together already own about 36 percent of the smaller exploration company.

“This transaction will enable us to add assets with exceptional exploration and development potential to a world-class mining company to create a premier minerals and oil and gas business focused on value creation for shareholders,” James R. Moffett, Freeport’s chairman, said in a statement.

JPMorgan Chase is providing $9.5 billion to help pay for the cash portion of the deal and to repay some of Plains’s existing debt.

Freeport was advised by Credit Suisse and the law firm Wachtell, Lipton, Rosen & Katz. Plains was advised by Barclays and the law firm Latham & Watkins. McMoRan was advised by Evercore Partners and the law firm Weil, Gotshal & Manges.

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Assad Suffering Reversals in Fighting and Diplomacy


Thair Al-Khalidieh/Shaam News Network, via Reuters


A Free Syrian Army fighter battled government forces in Homs, Syria, on Monday.







BEIRUT, Lebanon — Fierce fighting on the battlefield and setbacks on the diplomatic front increased pressure on the embattled Syrian government as fresh signs emerged on Tuesday of a sustained battle for control of the capital, Damascus.




News reports quoted activists as saying that fighting was raging in the southern suburbs of Damascus and near the international airport for a fifth straight day as government forces sought to dislodge rebels and reverse their recent gains.


While the government has superior firepower and rebels are reporting heavy losses, loyalist forces have been carrying out a serious counteroffensive in the suburbs without being able to subdue the insurgents.


The latest reports followed developments on Monday when a senior Turkish official said that Russia had agreed to a new diplomatic approach to seek ways to persuade President Bashar al-Assad to relinquish power, a possible weakening in Russia’s steadfast support for the Syrian government.


In Damascus, a prominent Foreign Ministry spokesman was said to have left the country amid reports of his defection, and President Obama and Secretary of State Hillary Rodham Clinton issued warnings that any use of chemical weapons by a desperate government would be met with a strong international response. The NATO secretary general, Anders Fogh Rasmussen, echoed this warning on Tuesday.


“The possible use of chemical weapons would be completely unacceptable to the whole international community,” Mr. Rasmussen said, according to Agence France-Presse.


A Western diplomat confirmed that there were grave concerns in United States intelligence circles that Syrian leaders could resort to the use of the weapons as their position deteriorates.


The Syrian Foreign Ministry, repeating earlier statements, told state television that the government “would not use chemical weapons, if it had them, against its own people under any circumstances.”


The United Nations said it was withdrawing nonessential international staff from Syria, and the European Union said it was reducing activities in Damascus “to a minimum,” as security forces pummeled the suburbs with artillery and airstrikes in a struggle to seal off the city from its restive outskirts and control the airport road. A senior Russian official spoke for the first time in detail about the possibility of evacuating Russian citizens.


The United Nations World Food Program reported on Tuesday that “the recent escalation of violence in Syria is making it more difficult to reach the country’s hardest-hit areas.”


“Food insecurity is on the rise due to bread shortages and higher food prices in many parts of the country. High prices are also affecting neighboring countries hosting Syrian refugees,” the organization said in a statement.


“Road access to and from Damascus has become more dangerous, making it difficult to dispatch food from World Food Program warehouses to some parts of the country, the organization said, adding that there had been increasing indiscriminate attacks on its trucks in different parts of the country.


It also said it would relocate seven nonessential staff members to neighboring Jordan while about “20 international and 100 national W.F.P. staff remain in the country to carry out the emergency operation to feed 1.5 million vulnerable Syrians.” Mr. Assad has held on longer than many had predicted at the start of the 21-month uprising. He still has a strong military advantage and undiminished support from his closest ally, Iran. Military analysts doubt the rebels are capable of taking Damascus by force, and one fighter interviewed on Monday said the government counteroffensive was taking a heavy toll. There were still no firm indications from Russia that it was ready to join Turkey and Western nations in insisting on Mr. Assad’s immediate departure.


But the latest grim developments follow a week of events that suggested the Assad government was being forced to fight harder to keep its grip on power. Rebels threatened its vital control of the skies, using surface-to-air missiles to down a fighter plane and other aircraft. The opposition also gained control of strategic military bases and their arsenals, and forced the government to shut down the Damascus airport periodically. The Internet was off for two days.


A Russian political analyst with contacts at the Foreign Ministry said that “people sent by the Russian leadership” who had contact with Mr. Assad two weeks ago described a man who has lost all hope of victory or escape.


“His mood is that he will be killed anyway,” Fyodor Lukyanov, editor of a Russian foreign affairs journal and the head of an influential policy group, said in an interview in Moscow, adding that only an “extremely bold” diplomatic proposal could possibly convince Mr. Assad that he could leave power and survive.


“If he will try to go, to leave, to exit, he will be killed by his own people,” Mr. Lukyanov said, speculating that security forces dominated by Mr. Assad’s minority Alawite sect would not let him depart and leave them to face revenge. “If he stays, he will be killed by his opponents. He is in a trap. It is not about Russia or anybody else. It is about his physical survival.”


Anne Barnard reported from Beirut, Lebanon, and Ellen Barry from Moscow. Reporting was contributed by Alan Cowell in London, Sebnem Arsu in Istanbul, Peter Baker in Washington, Hwaida Saad, Neil MacFarquhar and Hania Mourtada in Beirut, and Christine Hauser in New York.



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Software Programs Help Doctors Diagnose, but Can’t Replace Them





SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.




At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.


Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.


The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.


To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.


Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?


The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.


And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.


In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.


Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.


Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.


Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.


When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.


Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”


He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”


Clinical Precision


Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.


One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.


There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.


“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.


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National Briefing | New England: New Hampshire: Not Guilty Plea in Hepatitis Case



A traveling hospital technologist accused of stealing drugs and infecting patients with hepatitis C through contaminated syringes pleaded not guilty in federal court on Monday. The technologist, David Kwiatkowski, whom prosecutors described as a “serial infector,” was indicted last week on charges of tampering with a consumer product and illegally obtaining drugs. Until May, Mr. Kwiatkowski worked as a cardiac technologist at Exeter Hospital, where 32 patients were given diagnoses of the same strain of hepatitis C he carries. Before that, he worked in 18 hospitals in seven states, moving from job to job despite having been fired twice over accusations of drug use and theft. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Mr. Kwiatkowski carries.


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National Briefing | New England: New Hampshire: Not Guilty Plea in Hepatitis Case



A traveling hospital technologist accused of stealing drugs and infecting patients with hepatitis C through contaminated syringes pleaded not guilty in federal court on Monday. The technologist, David Kwiatkowski, whom prosecutors described as a “serial infector,” was indicted last week on charges of tampering with a consumer product and illegally obtaining drugs. Until May, Mr. Kwiatkowski worked as a cardiac technologist at Exeter Hospital, where 32 patients were given diagnoses of the same strain of hepatitis C he carries. Before that, he worked in 18 hospitals in seven states, moving from job to job despite having been fired twice over accusations of drug use and theft. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Mr. Kwiatkowski carries.


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Generic Drug Makers Facing Squeeze on Revenue


They call it the patent cliff.


Brand-name drug makers have feared it for years. And now the makers of generic drugs fear it, too.


This year, more than 40 brand-name drugs — valued at $35 billion in annual sales — lost their patent protection, meaning that generic companies were permitted to make their own lower-priced versions of well-known drugs like Plavix, Lexapro and Seroquel — and share in the profits that had exclusively belonged to the brands.


Next year, the value of drugs scheduled to lose their patents and be sold as generics is expected to decline by more than half, to about $17 billion, according to an analysis by Crédit Agricole Securities.“The patent cliff is over,” said Kim Vukhac, an analyst for Crédit Agricole. “That’s great for large pharma, but that also means the opportunities theoretically have dried up for generics.”


In response, many generic drug makers are scrambling to redefine themselves, whether by specializing in hard-to-make drugs, selling branded products or making large acquisitions. The large generics company Watson acquired a European competitor, Actavis, in October, vaulting it from the fifth- to the third-largest generic drug maker worldwide.


“They are certainly saying either I need to get bigger, or I need to get ‘specialer,’ ” said Michael Kleinrock, director of research development at the IMS Institute for Healthcare Informatics, a health industry research group. “They all want to be special.”


As one consequence of the approaching cliff, executives for generic drug companies say, they will no longer be able to rely as much on the lucrative six-month exclusivity periods that follow the patent expirations of many drugs. During those periods, companies that are the first to file an application with the Food and Drug Administration, successfully challenge a patent and show they can make the drug win the right to sell their version exclusively or with limited competition.


The exclusivity windows can give a quick jolt to companies. During the first nine months of 2012, sales of generic drugs increased by 19 percent over the same period in 2011, to $39.1 billion from $32.8 billion, according to Michael Faerm, an analyst for Credit Suisse. Sales of branded drugs, by contrast, fell 4 percent during the same period, to $174.2 billion from $181.3 billion.


But those exclusive periods also make generic drug makers vulnerable to the fickle cycle of patent expiration. “The only issue is it’s a bubble, too,” said Mr. Kleinrock. He said next year, the generic industry would enter a drought that was expected to last about two years.  Of the drugs that are becoming generic, fewer have exclusivity periods dedicated to a single drug maker.


In 2013, for example, the antidepressant Cymbalta, sold by Eli Lilly, is scheduled to be available in generic form. But more than five companies are expected to share in sales during the first six months, according to a report by Ms. Vukhac.


Heather Bresch, the chief executive of Mylan, the second-largest generics company in the United States, said Wall Street analysts were obsessed with the issue. “I can’t go anywhere without being asked about the patent cliff, the patent cliff, the patent cliff,” she said. “The patent cliff is one aspect of a complex, multilayered landscape, and I think each company is going to face it differently.”


Jeremy M. Levin, the chief executive of Teva Pharmaceuticals, the largest global maker of generic drugs, agreed. “The concept of exclusivity — where only one generic player could actually make money out of the unique moment — has diminished,” he said. “In the absence of that, many companies have had to really ask the question, ‘How do I really play in the generics world?’ ”


For Teva, Mr. Levin said, he believes the answer will be both its reach  — it sells 1,400 products, and one in six generic prescriptions in the United States is filled with a Teva product  — and what he says is a reputation for making quality products. That focus will be increasingly important, he said, given recent statements by the F.D.A. that it intends to take a closer look at the quality of generic drugs. Mr. Levin also said he planned to cut costs, announcing last week that he intended to trim from $1.5 to $2 billion in expenses over the next five years.


This article has been revised to reflect the following correction:

Correction: December 4, 2012

An earlier version of this article misstated the country in which the pharmaceutical company Endo is based. It is an American company, not Japanese.



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