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 to finance 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: March 1, 2013

An article on Tuesday about a coming measles-rubella vaccination campaign in Rwanda misstated the source of the vaccine and some financing for the campaign. The vaccine and financing are being provided by the GAVI Alliance, not by the Measles and Rubella Initiative.

Read More..

DealBook: Breuer Reflects on Prosecutions That Were, and Weren’t

After spending four years under the microscope as he led investigations of some of the world’s biggest banks, Lanny A. Breuer hasn’t lost his swagger.

The 54-year-old prosecutor, with a Rolodex as thick as his Queens dialect, will leave the Justice Department on Friday, emboldened after mounting recent cases against banking giants. But Mr. Breuer, the department’s criminal division chief, also leaves somewhat bruised, having taken criticism for not throwing Wall Street executives behind bars after the financial crisis.

In short, it has been grueling.

“I think he’s handled the pressure very well,” said former Attorney General Michael B. Mukasey, who is now a defense lawyer at Debevoise & Plimpton and has gone up against Mr. Breuer in corporate bribery cases.

For his part, Mr. Breuer highlights his unit’s crackdown on money laundering; the prosecution of Allen Stanford, who was sentenced to 110 years in prison for a Ponzi scheme; and the criminal cases against BP for the Gulf of Mexico oil spill.

Mr. Breuer won perhaps his biggest victory when a Japanese subsidiary of UBS pleaded guilty to manipulating the London interbank offered rate, or Libor. It was the first unit of a big global bank to plead guilty in two decades.

But the Occupy Wall Street crowd, among others, has been critical. When the Justice Department stopped short of indicting HSBC on money laundering charges, choosing instead to press a record fine against the bank, it prompted a tirade in Rolling Stone magazine. A recent “Frontline” documentary featuring Mr. Breuer took aim at his decision not to charge banks that sold toxic mortgage securities before the crisis.

In a recent interview, Mr. Breuer reflected on his crisis cases, his days defending President Bill Clinton from impeachment and his upbringing as the son of Holocaust survivors who settled in Elmhurst, Queens.

The following are edited excerpts from the interview:

When you joined the Justice Department, the nation was reeling and people wanted Wall Street to pay. Back then, didn’t you expect to mount charges against bank executives?

I understand and share the public’s outrage about the financial crisis. Of course we want to make these cases. I can tell you that I assigned the top, most talented lawyers to investigate them, and I know that U.S. attorneys’ offices across the country assigned aggressive prosecutors to these cases as well. I assigned people from my fraud section and my own front office to look at them. And I approached these cases exactly the same way I approached BP, the same way I approached Libor, the same way I approach every case. If there had been a case to make, we would have brought it. I would have wanted nothing more, but it doesn’t work that way.

You agreed to go on “60 Minutes” and “Frontline” to discuss the lack of crisis cases. Why open yourself to such scrutiny?

People have been asking legitimate questions about what happened in the wake of the financial crisis, and they deserve answers. Someone had to go on television to explain the Justice Department’s point of view, and it was appropriate that, as head of the criminal division, I would do it.

But federal prosecutors in New York and elsewhere also played big roles in the crisis cases. Why you?

As you point out, the U.S. attorneys don’t report to me, but someone had to tell the public how hard prosecutors across the department have been investigating these cases. I was willing to talk about these issues, to continue to talk about them in the face of criticism, and I’m still willing to talk about them.

Given that you’ve taken a beating on crisis cases, what is your legacy here?

The criminal division is now at the center of criminal law enforcement, both in prosecutions and policy. I don’t think that was ever the case before.

And now you’re leaving. You must feel relieved.

I have very mixed emotions. I’ve loved this job so very much, and I’m incredibly proud of what we’ve accomplished over the last four years. But I’m a big believer in change, and I think the timing is about right to move on.

What’s next?

I’m probably going to take a few months off. I’m also going to start talking to law firms and the like and make a decision about where I’m going to go.

The interviews are just a formality, right? The legal world assumes you’re heading back to Covington & Burling.

I love Covington. But I’m going to look at Covington; I’ll look at other firms. It’s certainly not a formality.

For years, you’ve moved in and out of government service, like many prosecutors. Does the revolving door compromise objectivity?

For me, it’s been a pretty effortless transition. I think it’s made me a better public servant, but I think it’s also made me a better private lawyer.

You’ve had no shortage of interesting clients: Roger Clemens, President Clinton, Sandy Berger. What was the most fascinating assignment?

There’s nothing like representing the president of the United States. Representing people like that in general can be gratifying, because you’re getting people often who are incredibly proud of their careers, and you’re dealing with them at their most vulnerable time.

What gear did you assemble from your ex-Yankee client?

Balls, posters — we’ve got a lot of Clemens memorabilia. You need to recognize, I was a lifelong Mets fan.

You were raised in Queens.

My dad was an intellectual. He had been a writer in Vienna before the Anschluss. During my childhood, he was one of the editors of Aufbau, which was a German-Jewish newspaper in New York. In our house there was opera always blaring. It was a very sort of ethnically rich, warm home.

So why did you pursue the law?

I was the mediator in a lot of family issues, even at a young age.

How did your family react to your decision to become a junior district attorney in Manhattan after a pricey education at Columbia?

My parents just never made any money at all. I called up my mother to break the news that her son was not going to a law firm: “Mom, you’ve just got to remember that Cy Vance Jr. — who, of course, is now the D.A. — he’s in the D.A.’s office. And Dan Rather Jr., he’s in the D.A.’s office. And Andrew Cuomo, the son of the governor, he’s in the D.A.’s office.” There was a long pause. And my mother said: “Them? They should go to the D.A.’s office. You? You should go to a firm.”

Read More..

Santa Cruz hit hard by officers' deaths

SANTA CRUZ — Flags throughout this sparkling beach town flew at half-staff Wednesday. The entire Police Department was meeting with grief counselors. Handmade signs cropped up, sympathy cards to a stunned city.

"Thank you for your service Santa Cruz Police Department. RIP Detective Baker. RIP Detective Butler." That's what Mary Gregg wrote in neat black letters on yellow construction paper, hanging her message in the window of the downtown check-cashing store where she works.

"Something," she felt, "had to be said today."

Best known for its surfing museum and a roller coaster that Bay Area newspaper columnist Herb Caen described as "one long shriek," Santa Cruz is not used to the kind of pain that rippled through town the day after a gunfight left two veteran officers — and the man they were investigating — dead.

The city's Police Department, which has less than 100 sworn officers, had operated for 150 years without losing a single one in the line of duty. Until Tuesday afternoon, when two veteran detectives in plainclothes walked up to Jeremy Goulet's house as part of a misdemeanor sexual assault investigation.

Sgt. Loran "Butch" Baker, 51, and Det. Elizabeth Butler, 38, were killed on Goulet's doorstep, Santa Cruz County Sheriff Phil Wowak said during a news conference near an impromptu memorial at police headquarters.

"We don't know all that happened when they came into contact with Goulet," said Wowak, whose department is leading the investigation so Santa Cruz police can mourn. "We do know what was left in the aftermath."

The 35-year-old Goulet, who had a long history of run-ins with the law, killed and disarmed the detectives before fleeing in Baker's car, Wowak said. Law enforcement officers from throughout the region began a sweep of the Santa Cruz neighborhood where Baker and Butler were slain. A short time later, Goulet ditched the car and tried to flee on foot.

In the ensuing gun battle, Wowak said, Goulet shot up a firetruck, sending firefighters, medical personnel and passersby scrambling. After killing the suspect, authorities discovered Goulet had been wearing body armor and had three guns.

"It is our belief that two of the three weapons belonged to the Santa Cruz Police Department, but we haven't confirmed it," said Wowak, adding that it was still unclear whether Goulet had taken the body armor from Baker's car or had it on before the shooting broke out.

"We know now that he was distraught," the sheriff said. "We know now that he had the intention of harming himself and possibly the police.… There's no doubt in anyone's mind that the officers who engaged Goulet stopped an imminent threat to the community."

Goulet had been arrested Friday on suspicion of disorderly conduct. Local news accounts said he had broken into the home of a co-worker and been fired from his job at The Kind Grind coffeehouse Saturday. A manager at the beachfront shop declined to comment Wednesday.

According to Goulet's father, the barista — who recently had moved from Berkeley to Santa Cruz — was a ticking time bomb who held police and the justice system in deep contempt. Ronald Goulet, 64, told the Associated Press that his son had had numerous run-ins with the law and had sworn he would never go back to jail.

But the elder Goulet said he never thought his troubled son would turn to such violence.

Goulet said his son undermined any success in the military (he reportedly was a member of the Marine Corps Reserves and later the Army) or college because of an insatiable desire to peep in the windows of women as they showered or dressed.

"He's got one problem, peeping in windows," his father said. "I asked him, 'Why don't you just go to a strip club?' He said he wants a good girl that doesn't know she's being spied on, and said he couldn't stop doing it."

In 2008, a Portland, Ore., jury convicted Jeremy Goulet on misdemeanor counts of unlawful possession of a firearm and invasion of personal privacy after he peeked into a woman's bathroom as she showered, said Don Rees, a chief deputy district attorney in Multnomah County.

Goulet faced additional charges, including attempted murder, after he allegedly fired a gun at the woman's boyfriend. The two had fought after Goulet was spotted outside the woman's condo, but a jury acquitted him of those charges, Rees said.

During the trial, Goulet admitted that he liked to use his cellphone to record unsuspecting women undressing, according to the Oregonian newspaper. Prosecutors alleged he had peeped at women "hundreds of times" without getting caught.

Goulet was given three years' probation, Rees said, but spent time in jail after his probation was revoked.

Read More..

Meet the Common Man's Robot: Headless and Adorable

LONG BEACH, California — Go into the typical American home and you’ll find a television, a computer, perhaps a videogame console, and even an iPad. But you won’t find a robot. What’s wrong with us?

We haven’t found the right robot. Or at least that’s Keller Rinaudo’s take on the problem, presented at the TED conference Tuesday along with his creation: A $150 robot named Romo, which can stream video, wheel around in response to remote control, and be custom programmed.

Except that Romo isn’t so much a robot as an iPhone accessory, a base with tracked a wheels for movement. You plug your Apple smartphone into Romo’s movable hinge, and the iPhone forms Romo’s face, as well as its brain, eyes, ears, and means of remote control and communication.

“By leveraging the power of the iPhone’s processor we can create a robot that is Wi-Fi enabled and computer-vision capable for $150, which is about 1 percent of what these kinds of robots would cost in the past,” Rinaudo told the audience at TED.

This makes Romo just one of the most ambitious members of an entire generation of cheap, rapidly developed hardware devices that owe their existence to smartphones and their ability to leverage the processors, screens, and sensors that come along with those devices.

To the Romo, the iPhone supplies a camera with which to detect your face; a display to show Romo’s eyes, which follow the user; and a Wi-Fi connection, which is used to beam video to a different Apple device, which can be used to drive the Romo around. The iPhone’s processor, meanwhile, is used to evaluate command logic that can be set up by the user ahead of time using a simplified, drag-and-drop programming interface.

Rinaudo keeps coming back to the lively animated face, complete with a goofy smile, which he hopes will help Romo sell when it comes on the market this June.

“It has to be something people want to take home and have around their kids,” Rinaudo says. “It should be friendly and it should be cute.”

That cuteness will be enough to get the Romo in the door, but whether it appeals to the common man or woman will have more to do with its functionality. Maybe future versions can be adorable while also being able to fetch drinks from the fridge.

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 to finance 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 vaccine and some financing for the campaign. The vaccine and financing is being provided by the GAVI Alliance, not the Measles and Rubella Initiative.

Read More..

Advertising: Paper Finds a Fit in a Wi-Fi Society

AN effort by a giant paper maker to promote the value of using paper is turning to everyday situations after spending more than two years at the office.

The switch in subject matter began last week, when the Domtar Corporation and its agency, the Charlotte, N.C., office of Eric Mower & Associates, added four video clips-cum-commercials to a campaign that carries the theme “Paper because.” The humorous videos are billed as entries in a series of “Really, Really Short Films” that started with the introduction of the campaign, aimed at so-called thought leaders in fields like business and education, in September 2010.

The first batch of videos, as well as the second, released in December 2011, offered wacky vignettes in a workplace where a crusade to go “paperless” was carried to extremes. For instance, in one video, titled “Black Market,” an office worker begs her colleague for “more of that stuff you got me last week,” which turns out to be 20 sheets of paper. The new videos, by contrast, take place in locations like homes and restaurants.

The videos are in addition to other elements of the “Paper because” campaign, which include, of course, print advertisements. Those ads make “Paper because” points like “A lot of places worth going to don’t get a signal, and hopefully never will.”

Estimates are that Domtar has spent more than $10 million on the campaign.

The new videos are indicative of how marketers and agencies approach long-running campaigns. How long should ads continue as they are? When ought changes come? Ads may run past the point they are effective, but they may be replaced before consumers have absorbed the pitch because those who were involved in making them have had their fill.

“When you work on a project, sometimes you’re tired of it before it goes out,” said Kathy Wholley, director for advertising and communications at the Domtar operations center in Fort Mill, S.C.

It is important to remember that “this campaign is still reaching people for the first time,” she added, noting messages on Twitter that say something like this: “ ‘Look what I just found. This video is hilarious.’ ”

Still, taking a fresh look at a continuing campaign makes sense, Ms. Wholley said, as in this instance, when a thought emerged about how “there are times and places” outside the office world “where paper is appropriate and useful.”

In one new video, “Anniversary,” a couple is seated in a restaurant. The wife gives a card to her husband, who, it turns out, sent her an e-card she did not receive. At the end, the scene fades to black and the husband’s plaintive voice is heard as the wife leaves: “Honey? Where are you going? Did you check your spam filter? Did you?”

Another commercial, “Waiter,” takes place at a restaurant table being waited on by a waiter without pad, pen or pencil. “I got it,” he insists, referring to the customers’ orders, which he recites back twice — wrong each time.

A third commercial, “Bridal Shower,” takes place in the home of a bride-to-be who receives an ugly vase as a gift. She is glum until she learns the gift-giver included the receipt. The video ends with these words: “Paper can make any gift, the perfect gift.”

A fourth commercial, “Tech Support,” brings to life a Catch-22 for the 21st century. A man is at home, talking to a woman in a call center about a router he bought.

“I’m having trouble connecting to the Internet,” says the man, who is upset there is no manual. The woman replies, somewhat bored, “You have to download the PDF from the Web site.”

The man is incredulous. “So you want me to get on the Internet to download a PDF from your Web site so I can get on the Internet?” he asks.

The first two video series were “focused on office situations,” said Patrick Short, partner and creative director at Mower in Charlotte, because “a lot of sales” for Domtar are made “with office paper.” For the next iteration, “we thought to open it up and take it out of that environment,” he added, using “ideas and concepts coming from personal experiences.”

“I’ve been in restaurants where the waiter” who refused to write down the orders “comes back three times,” Mr. Short said, and he was once frustrated when “I bought something from Apple and there was no manual with it.”

Mr. Short, an art director, works on the campaign with Ruben Lopez, an associate creative director at Mower who is a copywriter. Whereas the first videos were “a little bit over the top,” Mr. Short said, the new videos are “more like ‘Seinfeld’ moments,” making them more “relatable” to viewers.

At the coming South by Southwest Music and Media Conference in Austin, Tex., Mr. Short said, Domtar and Mower will offer attendees “a ‘paper hot spot’ instead of a Wi-Fi hot spot.”

The new videos appear as ads on the Web sites of publications like National Geographic and The New York Times. The new videos, and their predecessors, can also be watched on the Web site of the campaign, paperbecause.com; the Domtar corporate Web site, Domtar.com; the Domtar fan page on Facebook; and the campaign’s channel on YouTube, youtube.com/paperbecause.

As for gibes about a campaign that uses video to promote the merits of paper, Ms. Wholley said: “We actually think it gives us a little more credibility. It shows we don’t have our heads in the sand.”

Read More..

Tribune Co. hires advisors to explore sale of newspaper unit

Tribune Co. has hired investment bankers to advise the media company on the potential sale of its newspaper publishing unit.

The company announced that it has retained JPMorgan Chase & Co. and Evercore Partners to assess whether to sell the division that includes the Los Angeles Times, Chicago Tribune and six other daily newspapers.

The bankers will analyze bids from suitors, but their hiring does not necessarily mean that the assets would be sold.

"There is a lot of interest in our newspapers, which we haven't solicited," Gary Weitman, a Tribune spokesman, said in a statement. "Hiring outside financial advisors will help us determine whether that interest is credible, allow us to consider all of our options, and fulfill our fiduciary responsibility to our shareholders and employees."

Tribune hopes to sell the newspaper group intact instead of selling each paper individually, according to a person familiar with the matter.

The Chicago company has a healthy balance sheet and doesn't feel financial pressure to sell the properties, according to the person. It's unclear how long the process could take.

There has been widespread speculation that Tribune would attempt to unload the newspaper business to focus on its more promising television operations. Rupert Murdoch's News Corp. is among the possible bidders for the newspaper assets.

Tribune emerged from its four-year bankruptcy at the end of 2012 and appointed broadcasting veteran Peter Liguori as chief executive in January.

JPMorgan Chase holds an ownership stake in Tribune.

Evercore Partners, a boutique investment bank, also is working for the parent company of the New York Times on its planned divestiture of the Boston Globe.

walter.hamilton@latimes.com

andrew.tangel@latimes.com

Read More..

Cablevision Sues Viacom Over Bundled Channels

You pay too much for pay TV because your cable company is forced to purchase channels in bundles from media companies like Viacom — if it wants to offer MTV, it has to pay for CMT Pure Country and Teen Nick as well. Now one cable provider has had enough, and is suing for the right to purchase channels à la carte.

Cablevision, a New York-based cable TV provider, filed an antitrust lawsuit against Viacom on Tuesday in federal court hoping to stop the media conglomerate from forcing Cablevision to pay for channels its customers don’t watch. In order to secure rights to broadcast Nickelodeon, Comedy Central, and MTV, the company states that Viacom has unfairly bundled less-popular ancillary channels.

The pay-TV provider names 14 channels that it says Viacom coerced it into including in its lineup by threatening massive financial penalties. By forcing the company to buy all the channels, Cablevision says Viacom is unlawfully “block booking” — a form of tying that conditions of the sale of a package of rights on the purchaser’s taking of other rights.

The actual lawsuit isn’t available yet, but Cablevision released the following statement:

“The manner in which Viacom sells its programming is illegal, anti-consumer, and wrong. Viacom effectively forces Cablevision’s customers to pay for and receive little-watched channels in order to get the channels they actually want. Viacom’s abuse of its market power is not only illegal, but also prevents Cablevision from delivering the programming that its customers want and that competes with Viacom’s less popular channels.”

Viacom isn’t the only media company that forces pay-TV providers to purchase bundles of channels in order to secure high-value offerings. Disney’s ESPN network comes with a slew of ESPN channels that providers need to purchase.

The 14 channels Cablevision feels it shouldn’t have to carry are: Centric
, CMT,
 MTV Hits,
 MTV Tr3s,
 Nick Jr., 
Nicktoons, 
Palladia, 
Teen Nick, 
VH1 Classic, 
VH1 Soul, 
Logo, 
CMT Pure Country, 
Nick 2, and 
MTV Jams.

Cablevision is seeking a permanent injunction against Viacom making the licensing of ancillary channels part of the deal when licensing the channels people actually watch.

Viacom has responded to the legal action by Cablevision with the following statement:

“At the request of distributors, Viacom and other programmers have long offered discounts to those who agree to provide additional network distribution. Many distributors take advantage of these win-win and pro-consumer arrangements. Reflecting the highly competitive cable programming business, these arrangements have been upheld by a number of federal courts and on appeal. Viacom will vigorously defend this transparent attempt by Cablevision to use the courts to renegotiate our existing two month old agreement.”

This isn’t the first time bundled channels have been dragged into the courts. A group of pay-TV subscribers filed a class-action suit against programmers alleging that consumers were forced to accept bundled packages of channels. The suit was thrown out because the plaintiffs had failed to allege cognizable injury to competition.

If Cablevision’s lawsuit succeeds, it may be the end of unwatched channels filling your subscription lineup and could potentially lower your pay-TV bill. It’ll also be bad news for fans of Centric. Whatever that is.

Read More..

Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

Read More..

DealBook: 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.

Read More..