Lens Blog: The Largely Unknown Photography of Lola Álvarez Bravo

The year 2007 was a pretty good one for rediscovering long-forgotten images in Mexico. Most people already know about Robert Capa’s Mexican suitcase, a trove of his work from the Spanish Civil War. But that same year an unknown archive of vintage prints by Mexico’s greatest photographers was also discovered, left behind in the longtime home of Lola Álvarez Bravo.

The find, known as the Gonzalez-Rendon archive, had prints and original photomontages by Lola, as well as some beautifully printed images by Manuel Álvarez Bravo, to whom she had been married for several years. The find also included work by some of Lola’s students who had gone on to become noted photographers, Mariana Yampolsky and Raul Conde, among them.

Though overshadowed by her more famous partner, who had resisted her foray into photography, Lola ranks among Mexico’s most celebrated photographers, having done portraits of fellow artists and intellectuals as well as work among the indigenous and poor, whom she portrayed with a sense of compassion and social criticism. Her images provide a window in what she — a working photographer and teacher most of her life — valued as an artistic statement.

“It’s what an art historian dreams about, finding the missing pieces,” said James Oles, a lecturer at Wellesley College who was among the first to inspect the images in Mexico. “The material fleshes out some aspects of her work, giving us original titles and dates that radically change the meaning and interpretation of a work of art. And the original photomontages give an idea how she created them.”

Adriana Zavala, an associate professor of Latin American Art at Tufts University, was also among those who got an early look at the trove, which she now thinks consisted of things Lola forget she even had. Since then, she and Rachael Arauz, a specialist in modernist photography, have curated three exhibitions drawn from the archive, including a show that will begin in late March at the Center for Creative Photography in Tucson, Ariz., which will combine the more recent finds with previously held vintage work.

“It was like the Antiques Roadshow when we found this stuff, went through it carefully and got an opportunity to understand Lola in an ‘unauthorized’ way,” Ms. Zavala said. “This allows us to talk about the encounter between the two different bodies of material.”

Born Dolores Concepcion Martinez in 1903, she grew up in a wealthy family, although she had to move in with relatives when her father died. She first met Manuel in her youth, marrying him in 1925. As an accountant, he was sent to work in Oaxaca, where the couple began to take pictures, Mr. Oles wrote in the recently-published catalog, “Lola Álvarez Bravo and the Photography of an Era,” which he edited and which also includes essays by Ms. Arauz and Ms. Zavala.

The area’s poverty struck her, and it elicited a compassion in her work that was different from her husband’s more complex images.

“Lola was maybe a little more natural,” Mr. Oles said. “She was interested in more candid and less intrusive images. She was certainly more interested in people than things.”

The couple separated in 1934, divorcing in 1949. Throughout, she kept his name and did not remarry. She supported herself as a photographer working for government agencies, as well as teaching, where she influenced many.

“I think Lola was a remarkable photographer, especially given all the challenges she faced,” said Elizabeth Ferrer, who published “Lola Álvarez Bravo” with Aperture. “There were women artists, though women were not supposed to be working in the street but in the studio. But the kind of photography done at the time involved a greater public interface, and the fact that she did that showed her incredible strength and desire to photograph the world around her.”

Although she found her own path apart from her more famous husband — she was more gregarious, enjoying the company of artists, writers and intellectuals — work and circumstance worked against her. It was not until the 1980s, Mr. Oles said, that her work as an artist came to the fore.

Mr. Oles visited her in the early 1990s, around the time when the Center for Creative Photography at the University of Arizona acquired an archive of her work. Lola was moved by her son to another apartment, and she died in 1993.

Fourteen years later, Mr. Oles got a call from a museum in Mexico City. Relatives of one of Lola’s friends, who had bought her old apartment, had been safeguarding several boxes that had been left behind. One of them had taken the time to preserve and order the prints.

“She didn’t sell anything or have it framed in her apartment, but just organized it,” Mr. Oles said. “When I went there, it was amazing. It showed what had been separated at some time by Lola, and God knows when or why, there were a lot of her own photos. Many were by students of hers as well as a group of extraordinary vintage photos by Manuel Álvarez Bravo.”

Her photos — including some vintage prints that were exhibited in Philadelphia in 1943 — shed new light on her work. In some cases, original titles gave new meaning to old images. One shot of an indigenous woman seated against a wrought-iron fence that had long been titled “By the Fault of Others” turned out to have “Death Penalty” (Slide 6) as its original title.

“That changes how we interpret this photo of this woman who looks trapped by this grille,” Mr. Oles said. “You can go into the archive of any major photographer and find images they never printed and exhibit them after their death without knowing what they mean. Finding this material tells us these are the photos she chose which she thought were the key images that she was interested in during that era.”

While her photomontages are well known, the archive has the originals, which she made by gluing together cut-out images she would later photograph for the final montage.

“In Mexico, photomontage was mainly a strategy of media and advertising, not an artistic project,” Mr. Oles said. “What Lola was trying to do was elevate it to the realm of high art and view it as equivalent to muralism. The multiple perspectives of photomontage and the fragmented images resolved into a whole are what a muralist like Diego Rivera does when he shows multiple perspectives of a factory and resolving them together. Lola understood that.”

Among the greatest finds in the archive are works by her students. Even in death, though, Lola’s own images prove to affect a current generation. Mr. Oles said her photos of prostitutes, titled “Triptych of the Martyrs,” has a powerful element of feminist criticism.

“Their faces are obscured with wound-like shadows,” he said. “There is this undercurrent of social critique. Whenever my students see those pictures, they are moved sometimes to the point of tears. I don’t think any of Manuel Álvarez Bravos’s photos move them to tears.”


The exhibit “Lola Álvarez Bravo and the Photography of an Era” will be on view at the Center for Creative Photography in Tucson from March 30 through June 23.

Follow @dgbxny and @nytimesphoto on Twitter. Lens is also on Facebook.


This post has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this post incorrectly implied that James Oles was the author of "Lola Alvarez Bravo and the Photography of an Era." He edited the catalog, though he also contributed an essay.

Read More..

Gadgetwise Blog: A Wireless Speaker With a Wi-Fi Connection

When we talk wireless speakers, we still generally mean speakers that connect to players by Bluetooth.

There is nothing wrong with Bluetooth, but Wi-Fi, which can carry a lot more information, can sound a lot better. That is part of the reason we are seeing more Wi-Fi and Apple AirPlay speakers on store shelves.

Among them is the Libratone Zipp, a 10-inch tall canister with a fuzzy cover that makes it look like a small, colorful roll of carpet.

The Zipp’s Wi-Fi connection is supposed to be Apple- and Android-friendly. The connection with the iPhone was easy; in my test I set the iPhone’s Wi-Fi network to Libratone, then went to the music player, hit the AirPlay button, picked Libratone again and was connected through the play direct feature. That feature broadcasts directly from the phone to the speaker without going through your larger Wi-Fi network.

Connecting with a Android phone was did not work so easily, which is to say at all. Even with help from support and a software update, I was unable to get a Motorola RAZR Maxx to connect. Support said the problem seemed to be a faulty speaker.

The Zipp says it also supports DLNA, which should make it work with Windows, but I didn’t test that feature.

The Zipp is portable – it claims four hours of battery life when using Wi-Fi – but it isn’t exactly light weight, tipping the scales at four pounds.

The sound quality is good, thanks partially to a 4-inch woofer and a pair of 1-inch ribbon speakers, although I don’t know if it’s fair to call a monaural speaker “high fidelity,” as Libratone does.

There is one major drawback to using Wi-Fi to connect a player and speaker. Once the Wi-Fi is occupied by the Zipp, you can’t use it to connect to your Pandora, Slacker or other streaming audio account. So no streaming audio. You could get around this by connecting the device using a USB cable, which also doubles the Zipp’s battery life.

The Zipp, which comes in any of eight colors, starts at $400 list price online.

Read More..

Global Health: After Measles Success, Rwanda to Get Rubella Vaccine


Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.


On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.


Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping financing the upcoming one.


Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.


Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.


Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.


The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)


More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.


The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.


In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.


Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.


Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.


This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.




Read More..

Global Health: After Measles Success, Rwanda to Get Rubella Vaccine


Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.


On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.


Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping financing the upcoming one.


Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.


Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.


Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.


The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)


More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.


The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.


In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.


Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.


Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.


This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.




Read More..

DealBook: Obama’s Nominee for S.E.C. Tries to Allay Skepticism

Mary Jo White’s path to the Securities and Exchange Commission has reached a crucial juncture: the Congressional charm campaign.

Lawmakers are scrutinizing Ms. White ahead of her Senate confirmation hearing, raising questions about the former prosecutor’s lack of regulatory experience and the challenge of policing Wall Street firms she recently defended in private practice. But Ms. White is seeking to quell concerns about potential conflicts of interest.

She recently scheduled meetings with Senate Banking Committee members, who must clear her nomination, and answered a 20-page boilerplate questionnaire detailing her qualifications, according to a copy provided to The New York Times. The document sheds new light on her list of Wall Street clients, including little-known work performed for HSBC’s former chief executive. It also describes her ties to New York Democratic causes and laurels she earned both as a defense lawyer and federal prosecutor.

The questionnaire, created by the banking committee, focused significant attention on her movement through the revolving door between government service and private practice, a concern that has loomed since President Obama nominated Ms. White in January.

“As a government official, I believe I have an established track record and the reputation of being tough, but fair,” she said in the document.

Ms. White also offered a previously undisclosed concession, vowing “as far as can be foreseen,” never to return to Debevoise & Plimpton, where she had built a lucrative legal practice. To avert potential conflicts stemming from her work on behalf of Wall Street giants, Ms. White had already agreed to recuse herself for one year from most matters that involve former clients.

While Ms. White’s nomination is expected to sail through the committee before receiving full Senate approval, four Congressional officials who spoke anonymously warned that some Democrats have lingering reservations.

The Democrats note that her husband, John W. White, is co-chairman of the corporate governance practice at Cravath, Swaine & Moore, where he represents many of the companies that the S.E.C. regulates. They also question whether Ms. White’s recusals, even if well-intentioned, could cripple her ability to run the agency.

In a meeting on Tuesday with Senator Sherrod Brown, Democrat of Ohio, Ms. White did little to alleviate the fears.

“Senator Brown respects Ms. White’s credentials and experience, but is concerned with Washington’s long-held bias toward Wall Street,” his spokeswoman, Meghan Dubyak, said in a statement. “He pushed Ms. White,” to explain “whether her previous employment or her spouse’s current employment could cause her to recuse herself from key business facing the S.E.C.” The agency has already fallen behind in writing dozens of new rules for Wall Street.

Ms. White’s supporters counter that, before the White House announced the appointment, the Office of Government Ethics vetted her disclosures. The nonpartisan officials concluded that, even with her recusals, Ms. White could effectively run the agency.

Her supporters also trumpet her long tenure as a tenacious prosecutor. During stints as a federal prosecutor in Brooklyn and as the first woman United States attorney in Manhattan, she helped oversee the prosecution of the crime figure John Gotti and directed the case against those responsible for the 1993 World Trade Center bombing. The cases won her praise from several lawmakers.

Ms. White still has time to win over remaining skeptics. Her confirmation hearing is not expected until the week of March 11, Congressional officials briefed on the matter said.

Until then, Ms. White is blitzing through the halls of Congress, a routine practice for nominees. She began her charm offensive at the top of the banking committee’s roster, visiting this month with the Democratic chairman, Senator Tim Johnson, of South Dakota. A Congressional official briefed on the matter said Ms. White performed well at the gathering, and no major issues arose.

In the next round of meetings, she will face off with a more liberal arm of the committee known to scrutinize nominees. After meeting Mr. Brown, Ms. White is scheduled to see Senator Jeff Merkley, Democrat of Oregon. She also will meet Elizabeth Warren, the Massachusetts Democrat who is an outspoken critic of Wall Street, Ms. Warren’s office confirmed on Tuesday.

Even if Ms. White fails to satisfy lawmakers’ concerns, the meetings are an important step in clearing the way for her appointment.

“Senators will have a chance to size Mary Jo up, and I believe will come away with a great sense of comfort that she’s a candidate of true quality,” said Harvey Pitt, who passed through the confirmation process in 2001 to lead the S.E.C.

He noted that additional disclosures could bolster her candidacy. “I do think she will need to provide a level of comfort to the committee that she is aware of the issue, has a definitive plan for navigating through the potential conflict issues, and will be completely open about when she has a potential recusal issue, and how she has handled it,” he said.

Ms. White, a political independent, assured lawmakers in her questionnaire that she was “completely independent of political or personal influences.” She did disclose, however, $13,000 in campaign donations to Democratic candidates. She also served on the campaign committee of a Democrat who had run for New York attorney general.

Her ties to Debevoise — and its clients — are more significant; she represented JPMorgan Chase, UBS and Michael Geoghegan, the former head of HSBC.

Ms. White, 65, said this month said that she would retire from Debevoise after taking over the S.E.C. and would forgo the firm’s typical retirement perks: office space and a free BlackBerry. She also will sever financial ties to the firm during her term at the S.E.C., taking an upfront lump-sum retirement payment rather than collecting a monthly installment of $42,500.

Her husband has also offered concessions. He agreed to convert his partnership at Cravath, Swaine & Moore from equity to nonequity status and promised not to “communicate directly” with the S.E.C. about rule-making. Ms. White will not participate in a matter with a direct effect on his compensation.

In line with a standard move for federal appointees, Ms. White further agreed to recuse herself for one year from voting on enforcement cases involving Debevoise clients. There are limitations to the policy, though, in case it is “in the public interest” and a “reasonable” person would not object.

Some lawmakers dismiss questions about her potential conflicts, but still question her mastery of regulatory minutiae. While Ms. White is a skilled litigator, she lacks experience in financial rule-writing, unlike a predecessor, Mary Schapiro, a lifelong regulator who ran the S.E.C. for nearly four years.

In her questionnaire, Ms. White highlighted her role as a director of the Nasdaq exchange and other experiences that she said gave her “a firm grounding” in securities laws.

She also, inadvertently, drew a connection to Ms. Schapiro. Like Ms. Schapiro, Ms. White is an animal lover, currently serving as a board member of the American Society for the Prevention of Cruelty to Animals.

She agreed to step down from the board once she is sworn in at the S.E.C.

A version of this article appeared in print on 02/27/2013, on page B1 of the NewYork edition with the headline: Nominee For S.E.C. Tries to Allay Skepticism.
Read More..

Benedict XVI to Keep His Name and Become Pope Emeritus





VATICAN CITY — Pope Benedict XVI will keep the name Benedict XVI and become the Roman pontiff emeritus or pope emeritus, the Vatican announced Tuesday, putting an end to days of speculation on how the pope will be addressed once he ceases to be the leader of the world’s 1.1 billion Roman Catholics on Thursday.




Benedict, the first pope to resign voluntarily in six centuries, will dress in a simple white cassock, forgoing the mozzetta, the elbow-length cape worn by some Catholic clergymen, the Vatican spokesman, the Rev. Federico Lombardi, told reporters at a news briefing.


And he will no longer wear the red shoes typically worn by popes, symbolizing the blood of the martyrs, Father Lombardi said, opting instead for a more quotidian brown. “Mexicans will be happy to know that the pope very much appreciated the shoes” he received as a gift last year in León, Mexico, he added. “He finds them very comfortable.” It was after the grueling trip in March 2012 that the pope began to seriously consider resigning, the Vatican said after the pope announced his resignation on Feb. 11.


Father Lombardi said the pope had decided on his couture in consultation with other Vatican officials. Benedict will also stop using the so-called fisherman’s ring to seal documents. It will be destroyed by the cardinal camerlengo, the acting head of state of Vatican City during the “sede vacante,” the canon law term used when the papacy is vacant.


As his staff finishes packing up his personal belongings, the pope will hold his scheduled weekly audience Wednesday — to which 50,000 tickets have already been requested — and then meet with several dignitaries, including the presidents of Slovakia and of the German region of Bavaria, who have traveled to Rome to bid their respects.


Thursday will be a day of goodbyes, to the cardinals already present in Rome, and later to some members of the Curia. In the afternoon, he will depart for Castel Gandolfo, the summer residence of popes, where he will remain until restorations are complete on the convent inside the Vatican where he will live out his days.


Father Lombardi said the College of Cardinals would probably begin meeting next Monday to discuss various issues, like the problems facing the church and the qualities required of its next leader, and determine the date of the start of the conclave to choose Benedict’s successor.


Gaia Pianigiani reported from Vatican City, and Elisabetta Povoledo from Rome.



Read More..

Gadgetwise Blog: Q&A: Staying Safe From Java Threats

I hear lots of scary stuff about hackers getting into computers thru Java. What do I need to do to make my Mac and PC safe? Any worries about tablets?

Java is a computing platform with its own programming language that is used in many games, business applications and other utilities. It runs on more than 850 million computers worldwide and is used often by Web browsers. Recent attacks on Apple and Facebook used a flaw in the Java Web browser plug-in to infect computers with malicious software when visiting certain sites, and the Department of Homeland Security even issued a warning about Java back in January.

Computers running Windows, Mac OS X and Linux are most at risk. Tablets running systems like Android and iOS are not generally affected; mobile browsers have a setting for the JavaScript programming language, but JavaScript is basically unrelated to Java and its not subject to the current malware issues.

Disabling Java in your Web browser should protect your computer from the recent types of security threats, although you may not be able to play certain games or use Java-dependent applications. Oracle, which develops Java, has instructions for disabling Java in several browsers on Windows, Mac and Linux systems. Independent security sites, like Krebs on Security and Sophos, have additional information.

Apple released its own Mac OS X update to deal with the Java problem on Feb. 19, and the Macworld site has an article on going beyond the browser plug-in and removing Java altogether. Oracle has instructions for uninstalling Java completely on a Windows system, as well as on a Mac.

Read More..

The ConsUmer: Questions About a Robotic Surgery

Ever since it was approved by the Food and Drug Administration in 2005, robotic surgery for hysterectomy has been heavily advertised. Surgeons promise that using the da Vinci robotic device will bring better results and an easier recovery, and many hospitals claim that patients will experience less pain and fewer complications, getting back on their feet faster.

The company that makes da Vinci robotic surgery equipment promoted it last May at free health workshops organized by the federal Office on Womens’ Health. On Sunday, the Liberty Science Museum in Jersey City will host its first “Let’s Operate Day,” offering guests “hands-on” practice peering into video monitors and using da Vinci’s robot arms to pick up and manipulate small objects.

The cost of the new technology is rarely mentioned. But last week, a new study that evaluated outcomes in more than a quarter of a million American women raised questions about the manufacturer’s claims. The paper, published in The Journal of the American Medical Association, compared outcomes in 264,758 women who had either laparoscopic or robotically assisted hysterectomy at 441 hospitals between 2007 and 2010. Both methods are minimally invasive and involve smaller incisions than open abdominal surgery.

The researchers found no overall difference in complication rates between the two groups, and no difference in the rates of blood transfusion, even though one of the claims regarding robotic surgery is that it causes less blood loss.

But the researchers did find a big difference in cost. Robotically assisted surgery for hysterectomy costs on average about one-third more than laparoscopic surgery.

“It’s important to separate the marketing from the data,” said Dr. Jason D. Wright, the study’s lead author, an assistant professor of obstetrics and gynecology at Columbia University Medical Center. “For the surgeon, there is a greater degree of movement and control of the instruments and the visualization is better.

“But the ultimate question is, does this change outcomes for patients? This study suggests that there really is not a lot of difference as far as quantifiable outcomes.”

The majority of patients in both groups left the hospital in less than two days, though patients who had robotic surgery were slightly more likely to go home that early: 80 percent went home in less than two days, compared with 75 percent of those who had laparoscopic surgery.

But the cost of robotic surgeries was significantly higher, with a median cost to the hospital of $8,868, compared with $6,679 for laparoscopic hysterectomy. The study did not look at the difference in patients’ bills, but according to Newchoicehealth.com, the average patient price for a laparoscopic hysterectomy ranges from $7,700 in Dallas to $11,600 in Los Angeles.

With laparoscopic surgery — sometimes called keyhole surgery — narrow instruments and a small video camera are inserted through tiny incisions; the surgeon sees the image on a monitor and can cut and sew tissue with the instruments. With robotically assisted surgery, the surgeon sits at a console with a 3-dimensional view of the surgical site, and computer technology translates his or her hand movements into precise, scaled movements of the instruments.

Even without offering clear advantages the proportion of hysterectomies performed robotically has increased rapidly, up to nearly 10 percent of hysterectomies in 2010 from less than 1 percent in 2007, Dr. Wright said. Minimally invasive surgeries for hysterectomies are increasing across the board, he found, even at hospitals not performing robotic surgery.

Dr. Myriam J. Curet, chief medical adviser to Intuitive Surgical, which makes the da Vinci systems, did not dispute the study’s findings, but said the important message was that more women were able to receive minimally invasive surgeries because more options were available.

“That’s good for patients and for the health care system,” Dr. Curet said. Women who are not candidates for laparoscopic surgery might still be candidates for robotically-assisted surgery, she added.

Right now, however, it is not clear how to identify which women would benefit from robotic surgery and which would do well with a less expensive method.

The growing use of robotic surgery in hospitals will continue to drive up health costs, said Joel S. Weissman, of Brigham and Women’s Hospital and a co-author of an editorial published with the study.

“Once you have that robot, the tendency is to use it for all kinds of things, for which it may or may not have great value,” Dr. Weissman said. Studies like this one, he said, demonstrate the waste of health care dollars on “something that costs a lot more and doesn’t offer any added benefit over current treatment options.”

Each year approximately 600,000 American women have hysterectomies, according to the Centers for Disease Control and Prevention. By age 60, one in three American women has had her uterus removed, often along with her ovaries and cervix.

Critics who say far too many hysterectomies are done in the United States worry that all the attention to surgical method distracts from the question of whether patients should be having the surgery at all.

Most hysterectomies are prescribed for conditions that are not life-threatening, and advocates worry that women are not fully informed of the long-term harms, which may include a loss of sexual responsiveness, depression and chronic constipation, and higher risk for osteoporosis and heart disease, said Nora W. Coffey, the founder of the nonprofit Hysterectomy Educational Resources and Services Foundation.

“That’s the conversation we should be having,” Ms. Coffey said.


Nora W. Coffey and other experts emphasize that women considering a hysterectomy should discuss all options with their doctors.

¶Ask what the alternatives are and whether watchful waiting is an option. Remember that it is irreversible, regardless of how the surgery is done.

¶Learn about the nonreproductive functions of the uterus, ovaries and cervix, and the potential long-term consequences associated with their removal, as well as the function of the ovaries and cervix.

¶If you proceed, discuss the advantages and disadvantages of different surgical methods with your doctor. Interview several surgeons and inquire about the cost and how much insurance will cover. Your co-pay may vary depending on the surgical method.

¶Tell your surgeon if you do not want your ovaries and cervix removed.

Read More..

The ConsUmer: Questions About a Robotic Surgery

Ever since it was approved by the Food and Drug Administration in 2005, robotic surgery for hysterectomy has been heavily advertised. Surgeons promise that using the da Vinci robotic device will bring better results and an easier recovery, and many hospitals claim that patients will experience less pain and fewer complications, getting back on their feet faster.

The company that makes da Vinci robotic surgery equipment promoted it last May at free health workshops organized by the federal Office on Womens’ Health. On Sunday, the Liberty Science Museum in Jersey City will host its first “Let’s Operate Day,” offering guests “hands-on” practice peering into video monitors and using da Vinci’s robot arms to pick up and manipulate small objects.

The cost of the new technology is rarely mentioned. But last week, a new study that evaluated outcomes in more than a quarter of a million American women raised questions about the manufacturer’s claims. The paper, published in The Journal of the American Medical Association, compared outcomes in 264,758 women who had either laparoscopic or robotically assisted hysterectomy at 441 hospitals between 2007 and 2010. Both methods are minimally invasive and involve smaller incisions than open abdominal surgery.

The researchers found no overall difference in complication rates between the two groups, and no difference in the rates of blood transfusion, even though one of the claims regarding robotic surgery is that it causes less blood loss.

But the researchers did find a big difference in cost. Robotically assisted surgery for hysterectomy costs on average about one-third more than laparoscopic surgery.

“It’s important to separate the marketing from the data,” said Dr. Jason D. Wright, the study’s lead author, an assistant professor of obstetrics and gynecology at Columbia University Medical Center. “For the surgeon, there is a greater degree of movement and control of the instruments and the visualization is better.

“But the ultimate question is, does this change outcomes for patients? This study suggests that there really is not a lot of difference as far as quantifiable outcomes.”

The majority of patients in both groups left the hospital in less than two days, though patients who had robotic surgery were slightly more likely to go home that early: 80 percent went home in less than two days, compared with 75 percent of those who had laparoscopic surgery.

But the cost of robotic surgeries was significantly higher, with a median cost to the hospital of $8,868, compared with $6,679 for laparoscopic hysterectomy. The study did not look at the difference in patients’ bills, but according to Newchoicehealth.com, the average patient price for a laparoscopic hysterectomy ranges from $7,700 in Dallas to $11,600 in Los Angeles.

With laparoscopic surgery — sometimes called keyhole surgery — narrow instruments and a small video camera are inserted through tiny incisions; the surgeon sees the image on a monitor and can cut and sew tissue with the instruments. With robotically assisted surgery, the surgeon sits at a console with a 3-dimensional view of the surgical site, and computer technology translates his or her hand movements into precise, scaled movements of the instruments.

Even without offering clear advantages the proportion of hysterectomies performed robotically has increased rapidly, up to nearly 10 percent of hysterectomies in 2010 from less than 1 percent in 2007, Dr. Wright said. Minimally invasive surgeries for hysterectomies are increasing across the board, he found, even at hospitals not performing robotic surgery.

Dr. Myriam J. Curet, chief medical adviser to Intuitive Surgical, which makes the da Vinci systems, did not dispute the study’s findings, but said the important message was that more women were able to receive minimally invasive surgeries because more options were available.

“That’s good for patients and for the health care system,” Dr. Curet said. Women who are not candidates for laparoscopic surgery might still be candidates for robotically-assisted surgery, she added.

Right now, however, it is not clear how to identify which women would benefit from robotic surgery and which would do well with a less expensive method.

The growing use of robotic surgery in hospitals will continue to drive up health costs, said Joel S. Weissman, of Brigham and Women’s Hospital and a co-author of an editorial published with the study.

“Once you have that robot, the tendency is to use it for all kinds of things, for which it may or may not have great value,” Dr. Weissman said. Studies like this one, he said, demonstrate the waste of health care dollars on “something that costs a lot more and doesn’t offer any added benefit over current treatment options.”

Each year approximately 600,000 American women have hysterectomies, according to the Centers for Disease Control and Prevention. By age 60, one in three American women has had her uterus removed, often along with her ovaries and cervix.

Critics who say far too many hysterectomies are done in the United States worry that all the attention to surgical method distracts from the question of whether patients should be having the surgery at all.

Most hysterectomies are prescribed for conditions that are not life-threatening, and advocates worry that women are not fully informed of the long-term harms, which may include a loss of sexual responsiveness, depression and chronic constipation, and higher risk for osteoporosis and heart disease, said Nora W. Coffey, the founder of the nonprofit Hysterectomy Educational Resources and Services Foundation.

“That’s the conversation we should be having,” Ms. Coffey said.


Nora W. Coffey and other experts emphasize that women considering a hysterectomy should discuss all options with their doctors.

¶Ask what the alternatives are and whether watchful waiting is an option. Remember that it is irreversible, regardless of how the surgery is done.

¶Learn about the nonreproductive functions of the uterus, ovaries and cervix, and the potential long-term consequences associated with their removal, as well as the function of the ovaries and cervix.

¶If you proceed, discuss the advantages and disadvantages of different surgical methods with your doctor. Interview several surgeons and inquire about the cost and how much insurance will cover. Your co-pay may vary depending on the surgical method.

¶Tell your surgeon if you do not want your ovaries and cervix removed.

Read More..

British Government Seeks to Limit Disclosure in Litvinenko Case





The British government sought on Tuesday to limit the information it is ready disclose at a planned inquest into the death of Alexander V. Litvinenko, a former officer in the K.G.B. who died of radiation poisoning in London more than six years ago, and the coroner hearing the case said it may now be postponed.




“Due to the complexity of the investigation which necessarily precedes the hearings” Sir Robert Owen, the coroner said, the planned May 1 start date for the hearings could represent “a timetable to which it may not be possible to adhere.”


The inquest would be the first — and likely the only — public forum at which witnesses would testify under oath about the killing, which strained Britain’s relationship with the Kremlin and kindled memories of the cold war.


The prospect of a postponement brought charges from Ben Emmerson, a lawyer representing Mr. Litvinenko’s widow, Marina Litvinenko, that the British government was trying to gag the inquiry in order to protect lucrative trade deals with Russia.


Referring to Prime Minister David Cameron, Mr. Emmerson said on Tuesday that “the British government, like the Russian government, is conspiring to get this inquest closed down in exchange for substantial trade interests which we know Mr. Cameron is pursuing."


He added: "One has to ask what is going on at the highest level of Her Majesty’s Government, particularly when the highest levels are building bridges with the Kremlin."


The British government, he said, had “no right to say to an independent judiciary, ’you may not investigate these issues’. That happens in Russia, for sure.”


“This has all the hallmarks of a situation which is shaping up to be a stain on British justice,” the lawyer said.


Sir Robert, the coroner, said he would rule on Wednesday on the government’s application for a so-called Public Interest Immunity Certificate, usually issued on the grounds of national security, which would prevent the inquest from hearing information on topics without explaining what those issues were.


British analysts say they believe Britain is keen to avoid disclosing any information that might link Mr. Litvinenko to the British security services.


Last December, Mr. Emmerson, the lawyer, told a preparatory hearing that that Mr. Litvinenko was a “registered and paid agent and employee of MI6,” as the British Secret Intelligence Service is known. Mr. Litvinenko also worked for the Spanish intelligence service, Mr. Emmerson said, and both the British and Spanish spy agencies made payments into a joint account with his wife. The lawyer added that the inquest should consider whether MI6 failed in its duty to protect the onetime KGB officer against a “real and immediate risk to life.”


Mr. Litvinenko, who fled Russia in 2000 and styled himself a whistle-blower and foe of the Kremlin, died in November 2006, aged 43, weeks after he secured British citizenship. He had ingested polonium 210 — a rare radioactive isotope — at the Pine Bar of the Millennium Hotel in London’ central Grosvenor Square.


Britain’s Crown Prosecution Service is seeking the extradition from Russia of Andrei K. Lugovoi, another former K.G.B. officer, to face trial on murder charges. Mr. Lugovoi denies the accusation and Russia says its Constitution forbids it from sending its citizens to other countries to face trial.


The coroner has said in previous hearings that he will examine what was known about threats to Mr. Litvinenko and would also seek to determine whether the Russian state bore responsibility. In a deathbed statement, Mr. Litvinenko directly blamed President Vladimir V. Putin, who dismissed the accusation. Mr. Emmerson, the lawyer, complained on Tuesday that the preparations for the inquest were becoming “bogged down” by “the government’s attempt to keep a lid on the truth.”


“It is the government’s secret files that are delaying this inquest.”


British media outlets including the BBC and The Guardian newspaper are opposing the government’s effort to restrict evidence. The Guardian said that “the public and media are faced with a situation where a public inquest into a death may have large amounts of highly relevant evidence excluded from consideration by the inquest. Such a prospect is deeply troubling.”


But the Foreign Office said the authorities had made their application in line with their “duty to protect national security” and the coroner would rule according to “the overall public interest.”


Read More..