The Lede Blog: Clinton Testifies on Benghazi Attacks

The Lede followed Secretary of State Hillary Rodham Clinton’s testimony Wednesday before the House Foreign Affairs Committee and Senate Foreign Relations Committee about the Sept. 11, 2012, attacks on the American Consulate in the eastern city of Benghazi, Libya, that killed Ambassador Chris Stevens and three other Americans.

At a House Committee hearing last October investigating the attack, as reported on The Lede, State Department officials and security experts who served on the ground offered conflicting assessments about what resources were requested and made available to deal with growing security concerns in Tripoli and Benghazi.

Mrs. Clinton had been scheduled to testify before Congress last month, but an illness, a concussion and a blood clot near her brain forced her to postpone her appearance.

As our colleagues Michael R. Gordon and Eric Schmitt reported, four State Department officials were removed from their posts on last month after an independent panel criticized the “grossly inadequate” security at a diplomatic compound in Benghazi.

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Let’s Welcome Back Hockey with This ESPN Commercial






We realize there’s only so much time one can spend in a day watching new trailers, viral video clips, and shaky cell phone footage of people arguing on live television. This is why every day The Atlantic Wire highlights the videos that truly earn your five minutes (or less) of attention. Today:  


RELATED: Cookie Monster Batman and the Dog You Wish You Had






Hockey, schmockey. As a whole, the Atlantic Wire staff is sort of ambivalent that the NHL is finally back. (Our Canadian correspondent, however, is thrilled.) But you know what we are thankful for? The ESPN commercial reminding us that the NHL is finally back: 


RELATED: Behold the Power of ‘Gangnam Style’


RELATED: The Robot That Performs Gangnam Style Better Than You


These people are awesome (and, hey, maybe some of them play hockey):


RELATED: The Uncle You Wish You Had and the Joy of Human Jukeboxes


RELATED: How to Ride an Impossibly Tiny Bicycle; One Adorable Jam Session


People are awesome, and also quite strange. Like this guy, who offers the world a video review of the Astor CB-100 (totally SFW), and the 33,000+ views his video has already gotten:


And finally, these are ponies in sweaters. Ponies in sweaters, people:


Wireless News Headlines – Yahoo! News





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Seau's family sues NFL over brain injuries


Add Junior Seau's family to the thousands of people who are suing the NFL over the long-term damage caused by concussions.


Seau's ex-wife and four children sued the league Wednesday, saying the former linebacker's suicide was the result of brain disease caused by violent hits he sustained while playing football.


The wrongful death lawsuit, filed in California Superior Court in San Diego, blames the NFL for its "acts or omissions" that hid the dangers of repetitive blows to the head. It says Seau developed chronic traumatic encephalopathy (CTE) from those hits, and accuses the NFL of deliberately ignoring and concealing evidence of the risks associated with traumatic brain injuries.


Seau died at age 43 of a self-inflicted gunshot in May. He was diagnosed with CTE, based on posthumous tests, earlier this month.


An Associated Press review in November found that more than 3,800 players have sued the NFL over head injuries in at least 175 cases as the concussion issue has gained attention in recent years. The total number of plaintiffs is 6,000 when spouses, relatives and other representatives are included.


Scores of the concussion lawsuits have been brought together before U.S. District Judge Anita B. Brody in Philadelphia.


"Our attorneys will review it and respond to the claims appropriately through the court," the NFL said in a statement Wednesday.


Helmet manufacturer Riddell Inc., also is a defendant, with the Seau family saying Riddell was "negligent in their design, testing, assembly, manufacture, marketing, and engineering of the helmets" used by NFL players. The suit says the helmets were unreasonably dangerous and unsafe.


Riddell issued a statement saying it is, "confident in the integrity of our products and our ability to successfully defend our products against challenges."


Seau was one of the best linebackers during his 20 seasons in the NFL, retiring in 2009.


"We were saddened to learn that Junior, a loving father and teammate, suffered from CTE," the family said in a statement released to the AP. "While Junior always expected to have aches and pains from his playing days, none of us ever fathomed that he would suffer a debilitating brain disease that would cause him to leave us too soon.


"We know this lawsuit will not bring back Junior. But it will send a message that the NFL needs to care for its former players, acknowledge its decades of deception on the issue of head injuries and player safety, and make the game safer for future generations."


Plaintiffs are listed as Gina Seau, Junior's ex-wife; Junior's children Tyler, Sydney, Jake and Hunter, and Bette Hoffman, trustee of Seau's estate.


The lawsuit accuses the league of glorifying the violence in pro football, and creating the impression that delivering big hits "is a badge of courage which does not seriously threaten one's health."


It singles out NFL Films and some of its videos for promoting the brutality of the game.


"In 1993's 'NFL Rocks,' Junior Seau offered his opinion on the measure of a punishing hit: 'If I can feel some dizziness, I know that guy is feeling double (that)," the suit says.


The NFL consistently has denied allegations similar to those in the lawsuit.


"The NFL, both directly and in partnership with the NIH, Centers for Disease Control and other leading organizations, is committed to supporting a wide range of independent medical and scientific research that will both address CTE and promote the long-term health and safety of athletes at all levels," the league told the AP after it was revealed Seau had CTE.


The lawsuit claims money was behind the NFL's actions.


"The NFL knew or suspected that any rule changes that sought to recognize that link (to brain disease) and the health risk to NFL players would impose an economic cost that would significantly and adversely change the profit margins enjoyed by the NFL and its teams," the Seaus said in the suit.


The National Institutes of Health, based in Bethesda, Md., studied three unidentified brains, one of which was Seau's, and said the findings on Seau were similar to autopsies of people "with exposure to repetitive head injuries."


"It was important to us to get to the bottom of this, the truth," Gina Seau told the AP then. "And now that it has been conclusively determined from every expert that he had obviously had CTE, we just hope it is taken more seriously. You can't deny it exists, and it is hard to deny there is a link between head trauma and CTE. There's such strong evidence correlating head trauma and collisions and CTE."


In the final years of his life, Seau went through wild behavior swings, according to Gina and to 23-year-old son, Tyler. There also were signs of irrationality, forgetfulness, insomnia and depression.


"He emotionally detached himself and would kind of 'go away' for a little bit," Tyler Seau said. "And then the depression and things like that. It started to progressively get worse."


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Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

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Novartis Profit Rises; Its Chairman Will Step Down





Daniel Vasella, the longtime chairman and former chief executive of Novartis, the Swiss drug maker, plans to step down next month, the company said on Wednesday, when it also reported a jump in fourth-quarter profit.




The board is proposing that Jörg Reinhardt, the chairman of the German rival Bayer HealthCare, succeed Mr. Vasella. Joseph Jimenez will remain as chief executive.


Novartis said that its profit rose in the fourth quarter but that sales were flat because of price cuts and competition from cheaper drugs. Net income was $2.08 billion, compared with $1.21 billion in the period a year earlier, when it took a $900 million charge from ending its clinical study into wider uses of the hypertension drug Tekturna.


The results were slightly above most analysts’ expectations.


Mr. Jimenez said Novartis had a strong range of new products coming from research and development — including an infant vaccine for meningitis — and predicted net sales to grow after 2013.


Fourth-quarter sales were almost flat at $14.83 billion, compared with $14.78 billion in the period a year earlier, and sales in 2013 are expected to suffer from the expiration of patents on the hypertension drug Diovan.


Novartis said Gilenya, its once-a-day pill against multiple sclerosis, attained what it called “blockbuster status,” with full-year sales of $1.2 billion in 2012.


Novartis expects the Food and Drug Administration to carry out an inspection in the coming months at its plant in Lincoln, Neb., which was shut down at the end of 2011 after officials found numerous problems with quality control. Mr. Jimenez told reporters in a conference call that in the meantime, the company was relying on third-party manufacturers to ensure the continued supply of products like Excedrin across the United States.


Separately, Abbott Laboratories said on Wednesday that its profit fell 35 percent in the fourth quarter on costs from the spinoff of its drug business into the new company AbbVie.


Abbott completed the split on Jan. 1, leaving it with a business model built around generic drugs, medical implants and nutritional formula. AbbVie will market the company’s branded prescription drugs, including the popular anti-inflammatory drug Humira.


In Abbott’s last quarter as a combined unit, the company earned $1.05 billion, or 66 cents a share, compared with $1.62 billion, or $1.02 a share, in the period a year earlier.


Earnings were weighed down by a number of one-time charges, including $265 million in separation costs. Excluding that and other charges, Abbott would have earned $1.51 a share. Revenue increased 4 percent, to $10.84 billion.


Analysts polled by FactSet expected, on average, earnings per share of 70 cents a share on revenue of $10.61 billion.


Finally, Amgen, the maker of the anemia treatments Aranesp and Epogen, posted a 16 percent drop in fourth-quarter profit as higher costs for production, marketing, research and other items offset higher sales for many of its biologic medicines. The results fell short of Wall Street expectations.


Net income was $788 million, or $1.01 a share, compared with $934 million, or $1.08 a share, in the period a year earlier.


Excluding one-time items, net income would have been $1.40 a share, 4 cents less than analysts expected, on average, according to FactSet.


Revenue rose 11 percent, to $4.42 billion.


Sales were led by the immune disorder treatment Enbrel, up 23 percent, to $1.16 billion, and Neulasta and Neupogen for fighting infection in cancer patients. They had a combined $1.31 billion in sales, down 1 percent.


Sales of Aranesp and Epogen fell 9 percent and 1 percent, to a combined $968 million.


Several newer drugs, like Prolia, Xgeva and Sensipar, had double-digit jumps in revenue.


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Russians Fleeing Syria Cross Into Lebanon


Lucie Parsaghian/European Pressphoto Agency


Russian nationals who were evacuated from Damascus at the Masnaa border with Lebanon on Tuesday.







MOSCOW — About 80 Russian citizens crossed the Syrian border into Lebanon, boarded government-chartered planes and flew to Moscow on Tuesday, a small-scale evacuation that may signal the dwindling Russian hopes that President Bashar al-Assad will regain control of the country. The move came as a United Nations’ humanitarian official emerged after a rare mission through the conflict zone to express shock at the scale of devastation.




Russia took pains to issue assurances that the departures of its citizens was not a large-scale evacuation, seeking to avoid sending a dire message to Mr. Assad and his circle. One top Foreign Ministry official said that the two Emergency Services planes had been sent to Beirut to deliver humanitarian aid and had simply offered a free trip to Russia for those “wishing to go.”


The number of people who left was small, considering that more than 30,000 Russians are believed to live in Syria. Still, the flights had symbolic weight.


“Now we have reached this stage when everything gradually falls apart, and this is one of the manifestations,” said Aleksandr Shumilin, a Middle East analyst at the Russian Academy of Science’s Institute for Canada and the United States. “It is an important moment and important signal and an important fact. But it is formulated like a small, private incident.”


Briefing reporters in Beirut, Lebanon, the United Nations humanitarian official, John Ging, said conditions inside Syria were “appalling” and that he was “shocked on so many levels” by the scarcity of food, medication, clean water and sanitation. The United Nations mission, which was given access by both pro-government and rebel forces, found that after 22 months of conflict, Syria’s grain production had been cut in half, with many farmers unable to harvest because they could safely reach their land.


“Every mother we met was appealing for us to understand the effects of this conflict on their children,” Mr. Ging said.


He said Syrians’ primary concern was to find a way to end the conflict. “We appeal to those who do have the political power to end this,” he said.


But a negotiated solution appears no closer. Ban Ki-moon, the United Nations’ secretary general, told a news conference at his New York headquarters that after discussions with Lakhdar Brahimi, the United Nations and Arab League envoy seeking to negotiate a political transition, that he was not optimistic.


“The situation is very dire, very difficult,” Mr. Ban said of the bitter fighting, in which roughly 60,000 people have died. “We don’t see much prospect of a resolution at this time.”


The United Nations is helping organize a donor conference in Kuwait on Jan. 30 in hopes of raising some of the $1.5 billion needed for humanitarian aid for the refugees and displaced Syrians over the next six months. Mr. Ban lamented that previous appeals from the United Nations had raised far less than was needed. In rebel areas, opposition forces are scrambling to raise money and broaden their donor base. Another official on Mr. Ging’s mission, Ted Chaiban, director of emergency programs for Unicef, said grass-roots activists — many of them young men and women straight out of college — were conducting most humanitarian aid efforts.


Noting that the crisis would enter its third year in March, Mr. Ban said it was time for the Security Council to overcome its disagreements on Syria.


“The international community, and in particular the Security Council, has a grave responsibility to act to bring the desperate suffering of the Syrian people to an end,” he said.


Russia and China have blocked repeated Security Council efforts to coerce Mr. Assad to step down. But Moscow has begun to publicly acknowledge Mr. Assad’s losses on the battlefield and to prepare to protect its interests during a chaotic transition. Russia’s top Middle East envoy, Deputy Foreign Minister Mikhail Bogdanov, said Tuesday that Russian negotiators were interested in establishing closer contact with “several new opposition groups, with those we have not been in touch with yet.”


“You know at first the forecasts were two to three months, four, and it is already two years,” Mr. Bogdanov told Russian news agencies, forecasting the likelihood of an even more protracted conflict .


About a dozen Russian warships have been sent to maneuver off the Syrian port of Tartus, where they could also help to evacuate Russians from the coastal areas where many of them live. Any decision to leave would be particularly wrenching for the tens of thousands of Russian-speaking women who met and married Syrian men who were sent to study in the former Soviet Union and who now live across Syria.


Nina Sergeyeva, who until recently led an organization of Russian expatriates from her home in Latakia, Syria, said that judging from Tuesday’s operation, the number of Russians seeking to leave Syria was insignificant. There is no talk of evacuation in Latakia, she said.


Ellen Barry reported from Moscow, and Hania Mourtada from Beirut, Lebanon. Andrew Roth contributed reporting from Moscow, and Neil MacFarquhar from the United Nations.



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‘Atari’ Is in Trouble Again






Atari is declaring bankruptcy — twice. Both the U.S. video game company and its French parent have done so, the latest twist for the company which largely invented the video game industry and remains synonymous with it, despite having seen its glory days end by the mid-1980s.


But wait. Even though the Atari name celebrated its fortieth anniversary last year, it’s a mistake to talk about Atari as if it’s a corporate entity which has been around for four decades. (The Los Angeles Times’ Ben Fritz, for instance, refers to it as an “iconic but long-troubled video game maker.”) Instead, it’s a famous name which has drifted from owner to owner. It keeps being applied to different businesses, and yes, for all its fame, it does seem to be a bit of a jinx.






Here’s a quick rundown of what “Atari” has meant at different times (thanks, Wikipedia, for refreshing my memory):


1972-1976: It’s an up-and-coming, innovative startup cofounded by Nolan Bushnell and Ted Dabney.


1976-1984: It’s part of Warner Communications (which, years later, merged with Time Inc. to form Time Warner, overlord of this website). It’s a massively successful maker of video games and consoles, but then it crashes, along with the rest of the industry.


1984-1996: Atari morphs into a semi-successful maker of PCs when it’s acquired by Tramel Technology, a company started by Jack Tramiel, the ousted founder of Commodore.


1996-1998: Tramiel runs Atari into the ground. After merging with hard-disk maker JTS, the company and brand are largely dormant.


1998-2000: Atari resurfaces under the ownership of  toy kingpin Hasbro as a line of games published under the Atari Interactive name.


2000-present: It becomes a corporate entity controlled by French game publisher Infogrames, which increasingly emphasizes the Atari moniker over its own and takes over completely in 2008. In recent years, it’s focused on digital downloads, mobile games and licensing of its familiar brand and logo.


The above chronology doesn’t account for Atari’s original business: arcade games. As far as I can tell, the arcade arm was owned at different times by Warner Communications/Time Warner (twice!), Pac-Man purveyor Namco and arcade icon Midway, among other companies. But use of the Atari brand on arcade hardware petered out in 2001.


Basically, Atari has never been one well-defined thing for more than twelve years, max, at a time. That the name has survived at all is a testament to its power and appeal. And even though the current Atari has fallen on hard times, I’ll bet that the brand survives for at least a few more decades, in one form or another. Several forms, probably.


Gaming News Headlines – Yahoo! News





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Djokovic getting the hang of winning in Australia


MELBOURNE, Australia (AP) — Novak Djokovic is really starting to get the hang of how to handle himself at the Australian Open.


An expression often used Down Under — "Keep your shirt on" — is designed to discourage anyone from becoming unnecessarily overexcited.


Djokovic took it literally after his 6-1, 4-6, 6-1, 6-4 win Tuesday night over fifth-seeded Tomas Berdych, advancing to the semifinals at an 11th consecutive Grand Slam tournament.


The 2-hour, 31-minute victory took exactly half the time of his five-set, fourth-round win two nights previously against Stanislas Wawrinka. In the early hours of Monday morning, Djokovic ripped his sweat-drenched shirt off and flexed his muscles, mimicking his victory celebration after the 5:53 victory over Rafael Nadal in the 2012 Australian Open final.


That was acceptable at the time to the Rod Laver Arena crowd, which was still abuzz at 1:40 a.m. following five sets of high-level tennis.


After the Berdych match, however, he realized there was no need to raise the roof. Djokovic calmly pumped his fist once and walked to the net; he later joked about the ice baths he'd taken in between matches on the advice of local hero Lleyton Hewitt.


"It was a great performance. I was hoping to have a shorter match ... just not to go over 5 hours," Djokovic said, in a comparatively subdued mood after a considerably more routine victory. "It's always going to be tough against Tomas; he's an established player. He has a big game, big serve. He can compete against anyone on any surface."


In the semifinals, Djokovic will meet No. 4-seeded David Ferrer.


Ferrer survived a quarterfinal battle with fellow Spaniard Nicolas Almagro. Almagro had three chances to serve for the match, but Ferrer broke each time.


A usually mild-mannered pro, Ferrer showed his aggression at times when he threatened to spike his racket and even smashed his water bottle in the changeover after he'd dropped serve in a frustrating fourth set that featured eight breaks of serve.


He'd never lost to Almagro in 12 previous meetings and, as the No. 1 Spaniard in the draw in the absence of 11-time major winner Rafael Nadal, felt a responsibility to reach the semis.


"It was (a) miracle I won this match," Ferrer said of his comeback 4-6, 4-6, 7-5, 7-6 (4), 6-2 win. "I tried to fight every point; that's my game. I always fight."


Ferrer survived once in the third set and twice in the fourth when Almagro was serving for the match, but held his nerve and finally advanced to his third semifinal in the last four Grand Slam events.


"In the important moments, I played more consistent in my game," Ferrer said. "Of course, in the next round, the semifinals, I need to play my best tennis, better than today."


Djokovic acknowledged Ferrer's work ethic, saying the 30-year-old Spaniard was "one of the most respected guys on the tour because he never gives up."


"He plays every single match of his career with 100 percent," Djokovic said.


"I'm expecting a long one," he added.


Ferrer has never been past a major semifinal.


There are only three men left in the draw who have won Grand Slam titles — Djokovic has won five, including the last two in Australia. He's aiming to be the first man in the Open era to win three consecutive Australian titles.


The other two are in action Wednesday, with 17-time Grand Slam winner Roger Federer against 2008 Australian finalist Jo-Wilfried Tsonga of France. Andy Murray, who broke the 76-year drought for British men at the major tournaments by winning the U.S. Open last year, will play Jeremy Chardy of France.


On the women's side, defending champion Victoria Azarenka faces Svetlana Kuznetsova, who has won the U.S. Open and the French Open, and 15-time major winner Serena Williams is against 19-year-old American Sloane Stephens, who is playing her first quarterfinal at a Grand Slam.


Maria Sharapova completed a career Grand Slam last year by winning the French Open, a few months after losing the Australian Open final to Azarenka. After her 6-2, 6-2 quarterfinal win over Ekatrina Makarova on Tuesday, she has conceded only nine games in five matches — a record in Australia.


"To be honest, those are not the stats you want to be known for," Sharapova said.


After opening with a pair of 6-0, 6-0 wins, Sharapova thrashed seven-time major winner Venus Williams 6-1, 6-3 in the third round and Belgian Kristen Flipkens 6-0, 6-1 in the fourth.


Li Na has reached the semifinals in three of the last four years at Melbourne Park after beating Agnieszka Radwanska 7-5, 6-3. The 30-year-old Chinese player lost the 2011 final in Australia to Kim Clijsters, then won her breakthrough Grand Slam at the French Open a few months later. She hasn't been back to a major final since.


Djokovic won his first major title in Australia in 2008, then didn't make another final in his next 11 Grand Slam events. He's won four since then and is the top-ranked man in tennis, crediting the lessons from his experiences back then.


"At the start of my career, I went through a lot of different kinds of challenges physically, mentally," he said. "Everybody makes mistakes. I was aware of the fact that I need to improve because I wasn't feeling well, especially in the heat. I had lots of health issues.


"I don't want to go through it again. I am aware of the importance of an everyday practice and recovery basis. So as long as it's like that, I think I'll be all right."


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The Well Column: Facing Cancer, a Stark Choice

In the 1970s, women’s health advocates were highly suspicious of mastectomies. They argued that surgeons — in those days, pretty much an all-male club — were far too quick to remove a breast after a diagnosis of cancer, with disfiguring results.

But today, the pendulum has swung the other way. A new generation of women want doctors to take a more aggressive approach, and more and more are asking that even healthy breasts be removed to ward off cancer before it can strike.

Researchers estimate that as many as 15 percent of women with breast cancer — 30,000 a year — opt to have both breasts removed, up from less than 3 percent in the late 1990s. Notably, it appears that the vast majority of these women have never received genetic testing or counseling and are basing the decision on exaggerated fears about their risk of recurrence.

In addition, doctors say an increasing number of women who have never had a cancer diagnosis are demanding mastectomies based on genetic risk. (Cancer databases don’t track these women, so their numbers are unknown.)

“We are confronting almost an epidemic of prophylactic mastectomy,” said Dr. Isabelle Bedrosian, a surgical oncologist at M. D. Anderson Cancer Center in Houston. “I think the medical community has taken notice. We don’t have data that say oncologically this is a necessity, so why are women making this choice?”

One reason may be the never-ending awareness campaigns that have left many women in perpetual fear of the disease. Improvements in breast reconstruction may also be driving the trend, along with celebrities who go public with their decision to undergo preventive mastectomy.

This month Allyn Rose, a 24-year-old Miss America contestant from Washington, D.C., made headlines when she announced plans to have both her healthy breasts removed after the pageant; both her mother and her grandmother died from breast cancer. The television personality Giuliana Rancic, 37, and the actress Christina Applegate, 41, also talked publicly about having double mastectomies after diagnoses of early-stage breast cancer.

“You’re not going to find other organs that people cut out of their bodies because they’re worried about disease,” said the medical historian Dr. Barron H. Lerner, author of “The Breast Cancer Wars” (2001). “Because breast cancer is a disease that is so emotionally charged and gets so much attention, I think at times women feel almost obligated to be as proactive as possible — that’s the culture of breast cancer.”

Most of the data on prophylactic mastectomy come from the University of Minnesota, where researchers tracked contralateral mastectomy trends (removing a healthy breast alongside one with cancer) from 1998 to 2006. Dr. Todd M. Tuttle, chief of surgical oncology, said double mastectomy rates more than doubled during that period and the rise showed no signs of slowing.

From those trends as well as anecdotal reports, Dr. Tuttle estimates that at least 15 percent of women who receive a breast cancer diagnosis will have the second, healthy breast removed. “It’s younger women who are doing it,” he said.

The risk that a woman with breast cancer will develop cancer in the other breast is about 5 percent over 10 years, Dr. Tuttle said. Yet a University of Minnesota study found that women estimated their risk to be more than 30 percent.

“I think there are women who markedly overestimate their risk of getting cancer,” he said.

Most experts agree that double mastectomy is a reasonable option for women who have a strong genetic risk and have tested positive for a breast cancer gene. That was the case with Allison Gilbert, 42, a writer in Westchester County who discovered her genetic risk after her grandmother died of breast cancer and her mother died of ovarian cancer.

Even so, she delayed the decision to get prophylactic mastectomy until her aunt died from an aggressive breast cancer. In August, she had a double mastectomy. (She had her ovaries removed earlier.)

“I feel the women in my family didn’t have a way to avoid their fate,” said Ms. Gilbert, author of the 2011 book “Parentless Parents,” about how losing a parent influences one’s own style of parenting. “Here I was given an incredible opportunity to know what I have and to do something about it and, God willing, be around for my kids longer.”

Even so, she said her decisions were not made lightly. The double mastectomy and reconstruction required an initial 11 1/2-hour surgery and an “intense” recovery. She got genetic counseling, joined support groups and researched her options.

But doctors say many women are not making such informed decisions. Last month, University of Michigan researchers reported on a study of more than 1,446 women who had breast cancer. Four years after their diagnosis, 35 percent were considering removing their healthy breast and 7 percent had already done so.

Notably, most of the women who had a double mastectomy were not at high risk for a cancer recurrence. In fact, studies suggest that most women who have double mastectomies never seek genetic testing or counseling.

“Breast cancer becomes very emotional for people, and they view a breast differently than an arm or a required body part that you use every day,” said Sarah T. Hawley, an associate professor of internal medicine at the University of Michigan. “Women feel like it’s a body part over which they totally have a choice, and they say, ‘I want to put this behind me — I don’t want to worry about it anymore.’ ”


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DealBook: Can Britain Forge Looser Ties to Europe Without Losing Influence?

LONDON — Last year, Prime Minister David Cameron of Britain used his appearance at the World Economic Forum to vent frustration with the European Union, listing some of the policies he would ditch if he could throw off Europe’s regulatory shackles.

“In the name of social protection, the E.U. has promoted unnecessary measures that impose burdens on businesses and governments, and can destroy jobs,” he argued, adding a list of directives that he would like to scrap.

One year later, Mr. Cameron is following through on that pledge. He is promising to renegotiate Britain’s ties to the 27-nation bloc, forge a new and looser relationship, and is expected to say on Wednesday that he would put the outcome of those talks to a referendum.

A speech on Europe, planned for last week, was postponed because of the crisis in Algeria. It has been rescheduled for Wednesday, ahead of a possible visit by Mr. Cameron to Davos, Switzerland.

It was unclear whether Mr. Cameron would attend Davos this year and speak on the same theme. But his tough line on Europe echoes growing British disenchantment with a bloc whose single currency union, which the British never joined, has been in crisis for three years.

Yet, supposing Mr. Cameron were to succeed in scaling down Britain’s involvement, some central questions will arise. Can Britain play a more limited role in Brussels and still retain significant influence there? And what might that mean for Britain’s full participation in one of the world’s biggest single markets?

In their 40-year history of engagement with a unifying Europe, Britons have never embraced the ideal of unity; instead they have seen their ties to the Continent in pragmatic terms. Increasingly, London’s conclusion seems to be that the costs in terms of regulatory burdens and financial contributions are not outweighed by clear benefits.

Mr. Cameron argues that to stabilize support for the European Union in Britain, the relationship must be loosened and focused more on the bloc’s single market of almost 500 million people.

Britain, which is in the second tier of European Union membership, not only stayed out of the euro — and unlike most of the others on the sidelines has no intention of joining — but also does not participate in Europe’s Schengen passport-free travel zone. The British government also announced last year that it would opt out of a range of justice and security policy areas.

A group of Conservative lawmakers argued last week for five treaty changes, including those that would allow any country to block new European Union legislation on financial services, and would repatriate social and employment laws to national capitals. Britain’s euro skeptics are also blunt in their criticism of the bloc’s agricultural, fisheries and regional aid programs

Many would ideally like to keep just one element of European Union membership, access to the single market, though achieving such status looks highly improbable.

Even those who sympathize with Mr. Cameron’s stance argue that a more detached position comes at the price of reduced influence, though they contend the cost of not changing would be higher. They also argue that leverage in some of the policy areas is of limited value anyway.

“There is a trade-off, there is no doubt,” said Mats Persson, director of Open Europe, a research organization that favors a change in Britain’s relationship with the union. “If you reduce the level of E.U. influence in the British economy and society, you will lose some influence over some policy areas.”

But Mr. Persson argues that “if there is no change in Britain’s E.U. relationship, its membership is in question, which would really reduce its influence.”

Others worry that Britain is weakening its own position. Charles Grant, director of the Center for European Reform, a research institute in London, says that already “British influence in Brussels is at its lowest level in the 25 years I have been following the E.U.”

And critics argue that standing back from more policy arenas would increase the country’s sense of alienation from the bloc and fuel popular sentiment that things are stacked against Britain. A more detached relationship could also prove a disadvantage in the deal-making culture that prevails in Brussels.

Officially, decisions on legislation in Brussels are made by national governments under a complex series of rules before going to the European Parliament, whose approval is also required. In some cases, like tax policy, all 27 national governments need to agree, though in many others a weighted majority is required.

But relatively few decisions are actually put to a vote by governments. In practice, countries strike informal agreements and compromises, often trading support on one issue for a reciprocal agreement, sometimes in an unrelated area of policy.

For example, Britain once supported Germany, which wanted to water down planned rules on takeovers, in exchange for help from Berlin to soften new European Union legislation on workers’ rights.

The fewer areas in which a country participates, the less influence it has to barter.

Something similar affects another area of unofficial influence: control of crucial positions in Brussels. When the last round of top European Union jobs was decided, Tony Blair, a former British prime minister, was a contender to become the president of the European Council, the body in which national governments meet. But Britain’s absence from the euro currency and the Schengen zone made this a nonstarter.

The prime minister at the time, Gordon Brown, wanted a top economic post for Britain in the European Commission, the executive of the bloc. Instead, he got a foreign policy position for Catherine Ashton, reflecting the fact that Britain remained an engaged player in that area.

The euro has dominated the agenda in Brussels for the last three years, but Britons have reduced prospects of making big careers in this policy area because London has no power to lobby for them.

“If you are in the Treasury in London, why the hell would you go to Brussels?” said one European Union official not authorized to speak publicly.

That trend now looks likely to extend to justice and security policy. Britain recently held the most senior position in the justice and home affairs directorate of the European Commission, partly because the British used to be enthusiastic about cooperation in that forum. A Briton, Rob Wainwright, is currently the director of Europol, the bloc’s law enforcement agency.

But given the government’s decision to distance itself, it will be harder for Britons to get such top jobs in the future.

Declining career prospects for British officials are reflected in staff recruitment figures, released in April 2011. They showed that the European Commission now employed more Poles than Britons, though Britain has a larger population and joined the European Union’s forerunner more than 30 years before Polish accession in 2004.

Britain has fewer than half France’s number of European Commission officials, and the situation seems destined to deteriorate because relatively few Britons are applying for entry-level jobs.

All this risks creating a downward spiral in British influence, which the country would need to counter by being more effective in the areas in which it remains.

“I think Britain still could have clout in more limited areas if it keeps friends and allies,” Mr. Grant said. “But the fact that we are not, for example, so engaged in justice and home affairs weakens our bargaining power across policy areas and weakens the career prospects of British officials.”

Mr. Grant added, “There has been a steady diminution in the last few years, which you could plot on a graph: the more you distance yourself the less influence you have.”

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