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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Although Google is scrambling to meet consumers as they flock to mobile devices, the question is whether it is moving fast enough.
When Google announced its fourth-quarter earnings on Tuesday, investors were watching closely for positive signals of Google’s progress in the evolution to a mobile world.
They received a disappointing sign: The price that advertisers paid Google each time someone clicked on an ad, known as cost per click, decreased 6 percent from the year-ago quarter, falling for the fifth consecutive quarter, year over year. It has been declining in large part because mobile ads cost advertisers less, and more people are using Google on their mobile devices and fewer on their desktop computer.
Still, there was some evidence that Google was making progress in solving the mobile challenge. The price for clicks on ads rose 2 percent from last quarter.
Analysts had mixed reactions to Google’s financial report. The company exceeded their expectations on profit, but disappointed on revenue. That was at least in part because analysts are still figuring out how to account for Motorola Mobility, the struggling cellphone maker that Google acquired last year.
Larry Page, Google’s chief executive and co-founder, was optimistic in a statement.
“In today’s multi-screen world we face tremendous opportunities as a technology company focused on user benefit,” he said. “It’s an incredibly exciting time to be at Google.”
The company reported fourth-quarter revenue of $14.42 billion, an increase of 36 percent over the year-ago quarter. Net revenue, which excludes payments to the company’s advertising partners, was $11.34 billion, up from $8.13 billion.
Net income rose 13 percent to $$10.65 a share.
The fourth quarter is generally Google’s brightest because it makes much of its money on retail ads that run during the holiday shopping season. Analysts had expected revenue of $10.47 a share, on revenue of $12.3 billion. Google warned last week that analysts’ expectations were off target because Google sold Motorola’s set-top box division during the quarter so it did not include it in the quarterly results. Still, even including that division of Motorola, Google’s revenue would have missed expectations.
Shares of Google, which fell slightly during the day, were up 4 percent in after-hours trading. “This is supposed to be Google’s quarter to shine, the December quarter, and we’re going to have it all mucked up by Motorola,” said Colin Gillis, an analyst at BGC Partners.
This holiday season was the first that Google charged e-commerce companies to be included in its comparison shopping engine, and these so-called product listing ads contributed to its bottom line.
“Q4 retail is absolutely crucial for Google’s earnings,” said Sid Shah, director of business analytics at Adobe, which handles $2 billion in annual advertising spending. “Despite talk about retail having a weak season, Google’s product listing ad program has taken off quite successfully.”
Nonetheless, Google’s mobile challenge overhung even its usual holiday shopping sparkle. Consumers are increasingly shopping on phones and tablets, yet Google and other companies have not yet figured out how best to profit from mobile users.
“You would expect Google to be a key player benefiting from mobile, but that hasn’t played out in the last year,” said Jordan Rohan, an analyst at Stifel Nicolaus.
One problem is that advertisers pay about half as much for an ad on a mobile device, in part because they are not yet sure how effective mobile ads can be.
Another challenge for Google is that consumers increasingly use apps, like Yelp or Kayak, to search on mobile devices instead of using Google. Even when consumers use Google for mobile searches, they are often doing so on Apple devices like iPhones, for which Google has to pay Apple a fee.
This shift is happening as Google’s biggest, most lucrative business — desktop search — is slowing. The share of clicks on Google results that happen on desktop computers has fallen to 73 percent from 77 percent in the last six months, while the share of clicks on tablets and smartphones has increased to 27 percent from 23 percent, according to data from Adobe.
Meanwhile, Google has a new competitor in search: Facebook, which last week introduced a new form of personalized social search on the site.
Google has also recently become a maker of mobile devices, both by acquiring Motorola and by producing the line of Nexus devices with manufacturer partners. In the fourth quarter, Google sold about 1.5 million Nexus phones and tablets, not including those sold by other retailers, according to estimates from JPMorgan.
In the fourth quarter, a weight was lifted from Google when the Federal Trade Commission closed its antitrust investigation of Google’s search practices. But it remains under investigation in Europe, where the outcome is expected to be harsher.
Fifteen years before the clergy sex abuse scandal came to light, Archbishop Roger M. Mahony and a top advisor discussed ways to conceal the molestation of children from law enforcement, according to internal Catholic church records released Monday.
The archdiocese's failure to purge pedophile clergy and reluctance to cooperate with law enforcement has previously been known. But the memos written in 1986 and 1987 by Mahony and Msgr. Thomas J. Curry, then the archdiocese's chief advisor on sex abuse cases, offer the strongest evidence yet of a concerted effort by officials in the nation's largest Catholic diocese to shield abusers from police. The newly released records, which the archdiocese fought for years to keep secret, reveal in church leaders' own words a desire to keep authorities from discovering that children were being abused.
In the confidential letters, filed this month as evidence in a civil court case, Curry proposed strategies to prevent police from investigating three priests who had admitted to church officials that they abused young boys. Curry suggested to Mahony that they prevent them from seeing therapists who might alert authorities and that they give the priests out-of-state assignments to avoid criminal investigators.
One such case that has previously received little attention is that of Msgr. Peter Garcia, who admitted preying for decades on undocumented children in Spanish-speaking parishes. After Garcia's discharge from a New Mexico treatment center for pedophile clergy, Mahony ordered him to stay away from California "for the foreseeable future" in order to avoid legal accountability, the files show. "I believe that if Monsignor Garcia were to reappear here within the archdiocese we might very well have some type of legal action filed in both the criminal and civil sectors," the archbishop wrote to the treatment center's director in July 1986.
The following year, in a letter to Mahony about bringing Garcia back to work in the archdiocese, Curry said he was worried that victims in Los Angeles might see the priest and call police.
"[T]here are numerous — maybe twenty — adolescents or young adults that Peter was involved with in a first degree felony manner. The possibility of one of these seeing him is simply too great," Curry wrote in May 1987.
Garcia returned to the Los Angeles area later that year, but the archdiocese did not allow him to work in any church because he refused to take medication to suppress his sexual urges. He left the priesthood in 1989, according to the church.
Garcia was never prosecuted and died in 2009. The files show he admitted to a therapist that he had sexually abused boys "on and off" since his 1966 ordination. He assured church officials his victims were unlikely to come forward because of their immigration status. In at least one case, according to a church memo, he threatened to have a boy he had raped deported if he went to police.
The memos are from personnel files for 14 priests submitted to a judge on behalf of a man who claims he was abused by one of the priests, Father Nicholas Aguilar Rivera. The man's attorney, Anthony De Marco, wrote in court papers the files show "a practice of thwarting law enforcement investigations" by the archdiocese. It's not always clear from the records whether the church followed through on all its discussions about eluding police, but it did in some cases.
Mahony, who retired in 2011, has apologized repeatedly for errors in handling abuse allegations. In a statement Monday, he apologized once again and recounted meetings he's had with "some 90" victims of abuse.
"I have a 3 x 5 card for every victim I met with on the altar of my small chapel. I pray for them every single day," he wrote. "As I thumb through those cards I often pause as I am reminded of each personal story and the anguish that accompanies that life story."
"It remains my daily and fervent prayer that God's grace will flood the heart and soul of each victim, and that their life-journey continues forward with ever greater healing," he added. "I am sorry."
Curry did not return calls seeking comment. He currently serves as the archdiocese's auxiliary bishop for Santa Barbara.
The confidential files of at least 75 more accused abusers are slated to become public in coming weeks under the terms of a 2007 civil settlement with more than 500 victims. A private mediator had ordered the names of the church hierarchy redacted from those documents, but after objections from The Times and the Associated Press, a Superior Court judge ruled that the names of Mahony, Curry and others in supervisory roles should not be blacked out.
Garcia's was one of three cases in 1987 in which top church officials discussed ways they could stymie law enforcement. In a letter about Father Michael Wempe, who had acknowledged using a 12-year-old parishioner as what a church official called his "sex partner," Curry recounted extensive conversations with the priest about potential criminal prosecution.
"He is afraid ... records will be sought by the courts at some time and that they could convict him," Curry wrote to Mahony. "He is very aware that what he did comes within the scope of criminal law."
Curry proposed Wempe could go to an out-of-state diocese "if need be." He called it "surprising" that a church-paid counselor hadn't reported Wempe to police and wrote that he and Wempe "agreed it would be better if Mike did not return to him."
Perhaps, Curry added, the priest could be sent to "a lawyer who is also a psychiatrist" thereby putting "the reports under the protection of privilege."
Curry expressed similar concerns to Mahony about Father Michael Baker, who had admitted his abuse of young boys during a private 1986 meeting with the archbishop.
In a memo about Baker's return to ministry, Curry wrote, "I see a difficulty here, in that if he were to mention his problem with child abuse it would put the therapist in the position of having to report him … he cannot mention his past problem."
Mahony's response to the memo was handwritten across the bottom of the page: "Sounds good —please proceed!!" Two decades would pass before authorities gathered enough information to convict Baker and Wempe of abusing boys.
Federal and state prosecutors have investigated possible conspiracy cases against the archdiocese hierarchy. Former Dist. Atty. Steve Cooley said in 2007 that his probe into the conduct of high-ranking church officials was on hold until his prosecutors could access the personnel files of all the abusers. The U.S. attorney's office convened a grand jury in 2009, but no charges resulted.
During those investigations, the church was forced by judges to turn over some but not all of the records to prosecutors. The district attorney's office has said its prosecutors plan to review priest personnel files as they are released.
Mahony was appointed archbishop in 1985 after five years leading the Stockton diocese. While there, he had dealt with three allegations of clergy abuse, including one case in which he personally reported the priest to police.
In Los Angeles, he tapped Curry, an Irish-born priest, as vicar of clergy. The records show that sex abuse allegations were handled almost exclusively by the archbishop and his vicar. Memos that crossed their desks included graphic details, such as one letter from another priest accusing Garcia of tying up and raping a young boy in Lancaster.
Mahony personally phoned the priests' therapists about their progress, wrote the priests encouraging letters and dispatched Curry to visit them at a New Mexico facility, Servants of the Paraclete, that treated pedophile priests.
"Each of you there at Jemez Springs is very much in my prayers and I call you to mind each day during my celebration of the Eucharist," Mahony wrote to Wempe.
The month after he was named archbishop, Mahony met with Garcia to discuss his molestation of boys, according to a letter the priest wrote while in therapy. Mahony instructed him to be "very low key" and assured him "no one was looking at him for any criminal action," Garcia recalled in a letter to an official at Servants of the Paraclete.
In a statement Monday on behalf of the archdiocese, a lawyer for the church said its policy in the late 1980s was to let victims and their families decide whether to go to the police.
"Not surprisingly, the families of victims frequently did not wish to report to police and have their child become the center of a public prosecution," lawyer J. Michael Hennigan wrote.
He acknowledged memos written in those years "sometimes focused more on the needs of the perpetrator than on the serious harm that had been done to the victims."
"That is part of the past," Hennigan wrote. "We are embarrassed and at times ashamed by parts of the past. But we are proud of our progress, which is continuing."
Hennigan said that the years in which Mahony dealt with Garcia were "a period of deepening understanding of the nature of the problem of sex abuse both here and in our society in general" and that the archdiocese subsequently changed completely its approach to reports of abuse.
"We now have retired FBI agents who thoroughly investigate every allegation, even anonymous calls. We aggressively assist in the criminal prosecution of offenders," Hennigan wrote.
Mahony and Curry have been questioned under oath in depositions numerous times about their handling of molestation cases. The men, however, have never been questioned about attempts to stymie law enforcement, because the personnel files documenting those discussions were only provided to civil attorneys in recent months.
In a 2010 deposition, Mahony acknowledged the archdiocese had never called police to report sexual abuse by a priest before 2000. He said church officials were unable to do so because they didn't know the names of the children harmed.
"In my experience, you can only call the police when you've got victims you can talk to," Mahony said.
When an attorney for an alleged victim suggested "the right thing to do" would have been to summon police immediately, Mahony replied, "Well, today it would. But back then that isn't the way those matters were approached."
Since clergy weren't legally required to report suspected child abuse until 1997, Mahony said, the people who should have alerted police about pedophiles like Baker and Wempe were victims' therapists or other "mandatory reporters" of child abuse.
"Psychologists, counselors … they were also the first ones to learn [of abuse] so they were normally the ones who made the reports," he said.
In Garcia's 451-page personnel file, one voice decried the church's failures to protect the victims and condemned the priest as someone who deserved to be behind bars. Father Arturo Gomez, an associate pastor at a Spanish-speaking church near Olvera Street, wrote to a regional bishop in 1989, saying he was "angry" and "disappointed" at the church's failure to help Garcia's victims. He expressed shock that the bishop, Juan A. Arzube, had told the family of two of the boys that Garcia had thought of taking his own life.
"You seemed to be at that moment more concern[ed] for the criminal rather than the victum! (sic)" Gomez wrote to Arzube in 1989.
Gomez urged church leaders to identify others who may have been harmed by Garcia and to get them help, but was told they didn't know how.
"If I was the father … Peter Garcia would be in prison now; and I would probably have begun a lawsuit against the archdiocese," the priest wrote in the letter. "The parents … of the two boys are more forgiving and compassionate than I would be."
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NEW YORK (AP) — The second inauguration of President Barack Obama gave television networks a chance to bask in the majesty of a Washington event that unites Americans of all beliefs and ideologies — at least for a moment.
Then it was back to business as usual: the dissemination of widely divergent views on what people had just seen for themselves.
ABC, CBS and NBC, along with the cable news networks, cast aside regular programming on Monday to carry the ceremonial swearing-in and Obama’s inaugural address. It didn’t carry the same sense of history that Obama’s first inauguration did. In 2009, even ESPN and MTV covered the swearing-in. This year, ESPN stuck to talk about the upcoming Super Bowl, and MTV aired “Catfish: The TV Show.”
Until the ceremony actually began, the networks were all challenged with the television equivalent of vamping for time. On MSNBC, Andrea Mitchell interviewed singer John Legend, who noted that one of his songs was on Obama’s Spotify playlist. NBC discussed first lady Michelle Obama’s new hairstyle.
“Well, what else are we going to talk about?” anchor Brian Williams said apologetically.
Obama’s inaugural address lasted about 18 minutes, seemingly only slightly longer than the inaugural poem and definitely shorter than the evaluations of on-air pundits paid to dissect it.
CBS veteran Washington hand Bob Schieffer, sifting through a transcript of Obama’s speech after it was delivered, said he “didn’t hear a line that kind of sums it all up.” His colleague, Scott Pelley, called it a civil rights speech and noted Obama’s citation of key moments in fights for equality among black Americans, women and gays.
“I felt during much of the speech, I felt like I was listening to a Democratic Ronald Reagan,” said ABC News correspondent Jonathan Karl. “Where Reagan was unabashedly conservative, Obama was unabashedly progressive.”
While Karl’s colleague, conservative commentator George Will, said too much of the speech reprised campaign themes, he found links in language used by Obama and inaugural addresses by Abraham Lincoln and John F. Kennedy.
On CNN, historian and Obama biographer David Marannis said Obama’s address was much more positive and active than his first inaugural speech four years ago. “I could feel his heart beating this time,” he said.
Chris Matthews said on MSNBC that parts of the speech were “going to drive the right crazy.” A click away on the TV remote at Fox News Channel, analyst Charles Krauthammer was proving it.
“I found this sort of unrelenting,” Krauthammer said. “You get a sense of a man who said, ‘Alright, I’ve won my second election. I never have to face the electorate again. I’m going to be who I want to be, and I’m going to change the ideological trajectory of this country. That’s my job, and that’s why I’m here historically.’”
Fox’s Brit Hume drew a joking rebuke from a colleague when the camera showed a picture of Beyonce, and he said, “She looks stunning, doesn’t she?”
“Watch out,” Chris Wallace quickly said. “Brent Musburger got in trouble for that, my friend.” After the recent college football national championship, ESPN announcer Musburger was scolded by his bosses for lingering on the beauty of Alabama quarterback AJ McCarron’s girlfriend, the 2012 Miss Alabama USA.
Beyonce “is an incredibly beautiful woman, and there’s nothing wrong with pointing it out,” Fox’s Megyn Kelly said.
When the inauguration festivities moved indoors and cameras panned over politicians circling through the crowd, MSNBC’s Rachel Maddow struck a note that a regular cable news viewer might question as too hopeful.
“I think the ceremony is cool, and the usual celebration is cool,” she said. “It is also really nice to see Republicans and Democrats, and liberals and conservatives, chatting very casually with each other without talking politics.”
As she spoke, the cameras focused on Supreme Court Chief Justice John Roberts smiling but standing alone.
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“Go Beyond Your Father’s Annual Physical. Live Longer, Feel Better”
This sales pitch for the Princeton Longevity Center’s “comprehensive exam” promises, for $5,300, to take “your health beyond the annual physical.” But it is far from certain whether this all-day checkup, and others less inclusive, make a meaningful difference to health or merely provide reassurance to the worried well.
Among physicians, researchers and insurers, there is an ongoing debate as to whether regular checkups really reduce the chances of becoming seriously ill or dying of an illness that would have been treatable had it been detected sooner.
No one questions the importance of regular exams for well babies, children and pregnant women, and the protective value of specific exams, like a Pap smear for sexually active women and a colonoscopy for people over 50. But arguments against the annual physical for all adults have been fueled by a growing number of studies that failed to find a medical benefit.
Some experts note that when something seemingly abnormal is picked up during a routine exam, the result is psychological distress for the patient, further testing that may do more harm than good, and increased medical expenses.
“Part of the problem of looking for abnormalities in perfectly well people is that rather a lot of us have them,” Dr. Margaret McCartney, a Scottish physician, wrote in The Daily Mail, a British newspaper. “Most of them won’t do us any harm.”
She cited the medical saga of Brian Mulroney, former prime minister of Canada. A CT scan performed as part of a checkup in 2005 revealed two small lumps in Mr. Mulroney’s lungs. Following surgery, he developed an inflamed pancreas, which landed him in intensive care. He spent six weeks in the hospital, then was readmitted a month later for removal of a cyst on his pancreas caused by the inflammation.
The lumps on his lungs, by the way, were benign. But what if, you may ask, Mr. Mulroney’s lumps had been cancer? Might not the discovery during a routine exam have saved his life?
Logic notwithstanding, the question of benefits versus risks from routine exams can be answered only by well-designed scientific research.
Defining the value of a routine checkup — determining who should get one and how often — is especially important now, because next year the Affordable Care Act will add some 30 million people to the roster of the medically insured, many of whom will be eligible for government-mandated preventive care through an annual exam.
Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine, who directed a study of annual physicals in 2007, reported that an estimated 44.4 million adults in the United States undergo preventive exams each year. He concluded that if every adult were to receive such an exam, the health care system would be saddled with 145 million more visits every year, consuming 41 percent of all the time primary care doctors spend with patients.
There is already a shortage of such doctors and not nearly enough other health professionals — physician assistants and nurse practitioners — to meet future needs. If you think the wait to see your doctor is too long now, you may want to stock up on some epic novels to keep you occupied in the waiting room in the future.
Few would challenge the axiom that an ounce of prevention is worth a pound of cure. Lacking incontrovertible evidence for the annual physical, this logic has long been used to justify it:
¶ If a thorough exam and conversation about your well-being alerts your doctor to a health problem that is best addressed sooner rather than later, isn’t that better than waiting until the problem becomes too troublesome to ignore?
¶ What if you have a potentially fatal ailment, like heart disease or cancer, that may otherwise be undetected until it is well advanced or incurable?
¶ And wouldn’t it help to uncover risk factors like elevated blood sugar or high cholesterol that could prevent an incipient ailment if they are reversed before causing irreparable damage?
Even if there is no direct medical benefit, many doctors say that having their patients visit once a year helps to maintain a meaningful relationship and alert doctors to changes in patients’ lives that could affect health. It is also an opportunity to give patients needed immunizations and to remind them to get their eyes, teeth and skin checked.
But the long-sacrosanct recommendation that everyone should have an annual physical was challenged yet again recently by researchers at the Nordic Cochrane Center in Copenhagen.
The research team, led by Dr. Lasse T. Krogsboll, analyzed the findings of 14 scientifically designed clinical trials of routine checkups that followed participants for up to 22 years. The team found no benefit to the risk of death or serious illness among seemingly healthy people who had general checkups, compared with people who did not. Their findings were published in November in BMJ (formerly The British Medical Journal).
In introducing their analysis, the Danish team noted that routine exams consist of “combinations of screening tests, few of which have been adequately studied in randomized trials.” Among possible harms from health checks, they listed “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, adverse psychosocial effects due to labeling, and difficulties with getting insurance.”
Furthermore, they wrote, “general health checks are likely to be expensive and may result in lost opportunities to improve other areas of health care.”
In summarizing their results, the team said, “We did not find an effect on total or cause-specific mortality from general health checks in adult populations unselected for risk factors or disease. For the causes of death most likely to be influenced by health checks, cardiovascular mortality and cancer mortality, there were no reductions either.”
What, then, should people do to monitor their health?
Whenever you see your doctor, for any reason, make sure your blood pressure is checked and get new blood tests, if a year or more has elapsed since your last ones.
Keep immunizations up to date, and get the screening tests specifically recommended based on your age, gender and known risk factors, including your family and personal medical history.
And if you develop a symptom, like unexplained pain, shortness of breath, digestive problems, a lump, a skin lesion that doesn’t heal, or unusual fatigue or depression, consult your doctor without delay. Seek further help if the initial diagnosis and treatment fails to bring relief.
On a recent business trip to New York, Joe Pullin of Novi, Mich., did something he would have considered unthinkable not long ago.
Rather than rush off the plane and into a cab headed into Manhattan, he lingered at the arrival gate at La Guardia Airport, stopping for a leisurely lunch at Bisoux, a French bistro, and using the iPad mounted on his table to order his meal, check his e-mail and pay the bill.
“I’m very impressed. I think it adds another dimension to this airport that never existed before,” said Mr. Pullin, a consumer electronics executive and frequent business traveler.
About 38,000 travelers pass through Delta Air Lines’ two terminals at La Guardia each day. That they may be glad to spend more time there is good news for Delta and OTG Management, the airport restaurant company that owns and operates all the concessions in Terminals C and D.
With two dozen restaurants, cafes, food courts and bars in the terminals, sales per passenger are well above other airports, said Rick Blatstein, chief executive of OTG. “We’re in the $9, $10 and $11 range,” he said.
That is about $3 to $5 above the $5.80 spent, on average, by travelers at other large airports in the United States, according to Airport Revenue News.
Mr. Blatstein attributed the higher passenger spending to several things, including new restaurants linked to locally known chefs, dining and shopping areas incorporated throughout the terminal and waiting-area iPads that give travelers easier access to it all.
If he so chose, Mr. Pullin could have used his table-mounted screen to order reading material from a nearby newsstand and have it delivered to the restaurant.
“We wanted to create the desire to go to the airport early, not because you need to get to the airport early but because you think, ‘I’ll get there early, plug my laptop in, get a glass of wine and relax before my flight,’ ” Mr. Blatstein said.
The upscale features are part of a global trend, and even small airports are getting in on the act. Long Beach Airport in California is completing work on a $45 million project to give its waiting areas more of a resort feel. There’s a wine bar by the outdoor fire pit and the restaurants are local establishments overseen by an airport executive chef.
“Our mission is to provide services above our customers’ expectation,” said Mario Rodriguez, the airport’s director. “We want to make sure this is a proper first impression and a wonderful final impression of the city.”
The upgrading at airports large and small could mitigate the deteriorating experience of air travel, said Curtis Fentress, an architect who has designed many large airports over the last 20 years.
“We’re trying to put the romance of travel back into the passenger experience,” Mr. Fentress said. “Increasing amenities with retail, bringing retail that is not just food or fast food, but food that is appealing and upscale, I think there is a trend toward that.”
At La Guardia, the interior space in Delta’s two terminals was reconfigured and food and shops were brought all the way into the gate area. Most of the rows of fixed plastic upholstered seats were replaced with bar-height stools that tuck into clean white countertops fitted with electrical outlets and USB ports.
There are cafe tables where travelers can face one another. All the new seating includes space to tuck away luggage from traffic areas and every one of the new seats has an iPad so passengers can play games, browse the Internet or see what’s available for sale nearby.
OTG paid $50 million to remake the terminals, as part of its deal to be Delta’s exclusive concessionaire. Mr. Blatstein said he was intrigued by the revenue potential of all that space at the boarding gates, previously filled with people with nothing to do but wait. Along with rent, OTG pays an undisclosed percentage of its total revenue to Delta.
The U.S., Britain and other countries sought to learn the fate of their citizens Sunday after Algeria announced that the death toll from a hostage crisis at a remote gas refinery was expected to rise beyond a previous estimate of 23.
It was another painstaking day for security officials trying to determine how a band of Islamist militants overran the gas complex last week, and for families and nations awaiting word of new deaths. Britain confirmed that three of its citizens were killed and three are unaccounted for.
Algerian officials said security teams defusing mines and explosive booby-traps at the Sahara Desert site had found “numerous” bodies, according to the Associated Press. Algerian communications minister Mohamed Said Belaid was quoted by the state news agency as saying: "I am afraid unfortunately to say that the death toll will go up."
As many as seven U.S. hostages are missing, along with about 14 Japanese. Other captives included Norwegians, Malaysians and French. Algerian officials said a final death count would be released in the coming hours.
Nearly 700 Algerians and 107 foreigners had been freed or had escaped from the gas field in eastern Algeria during the four-day, bloody ordeal that ended Saturday. Officials said at least 23 hostages and 32 militants had been killed. But discrepancies remained over the nationalities of the dead and the exact number of those who died.
“The priority now must be to get everybody home from Algeria," said British Prime Minister David Cameron. "This is a stark reminder once again of the threat we face from terrorism the world over. We have had successes in recent years in reducing the threat from some parts of the world, but the threat has grown particularly in northern Africa.”
Cameron, who had earlier appeared irritated that the Algerians did not inform foreign capitals before troops first stormed the refinery Thursday, tempered his criticism.
"People will ask questions about the Algerian response to these events,” he said. “But I would just say that the responsibility for these deaths lies squarely with the terrorists who launched this vicious and cowardly attack. And I'd also say that when you’re dealing with a terrorist incident on this scale, with up to 30 terrorists, it is extremely difficult to respond and to get this right in every respect.”
The natural gas complex at In Amenas -- near the Libyan border -- is operated by BP, Statoil and Sonatrach, the Algerian national oil company. BP said four of its employees were missing.
Militants linked to Al Qaeda in the Islamic Maghreb raided the facility before dawn Wednesday. They claimed it was to avenge French airstrikes on Islamic rebels in neighboring Mali. But officials from the U.S. and other countries indicated the attack was planned ahead of this month’s French military action.
Belaid said the militants were "nationals of Arab and African countries, and of non-African countries."
jeffrey.fleishman@latimes.com
(Times staff writer Henry Chu in London contributed to this report)
Informally known as the "Soap Bubble Nebula", this planetary nebula (officially known as PN G75.5+1.7) was discovered by amateur astronomer Dave Jurasevich on July 6th, 2008. It was noted and reported by Keith Quattrocchi and Mel Helm on July 17th, 2008. This image was obtained with the Kitt Peak Mayall 4-meter telescope on June 19th, 2009 in the H-alpha (orange) and [OIII] (blue) narrowband filters. In this image, north is to the left and east is down.
PN G75.5+1.7 is located in the constellation of Cygnus, not far from the Crescent Nebula (NGC 6888). It is embedded in a diffuse nebula which, in conjunction with its faintness, is the reason it was not discovered until recently. The spherical symmetry of the shell is remarkable, making it very similar to Abell 39.
Image: T. A. Rector/University of Alaska Anchorage, H. Schweiker/WIYN and NOAO/AURA/NSF [high-resolution] Read NOAO Conditions of Use before downloading
NEW YORK (Reuters) – Television’s Katie Couric will interview Notre Dame football star Manti Te’o, the linebacker entangled in a girlfriend hoax, and his parents on her daytime talk show, “Katie,” ABC News said on Sunday.
The interview will be his first on camera since news broke last week that his story about his girlfriend’s cancer death – and her existence altogether – was exposed as a fraud.
The tragic story of his girlfriend and her injuries from a car accident and death from leukemia was one of the most widely recounted U.S. sports stories last year as Notre Dame made a drive toward the college football national championship game.
Te’o has denied being in on the elaborate hoax, telling ESPN on Friday he had believed his relationship was real with a woman who turned out to be an online fabrication.
Te’o and his parents, Brian and Ottilia Te’o, will appear in an interview on “Katie” to be broadcast on Thursday, January 24, ABC said.
“I wasn’t faking it,” Te’o said in the off-camera ESPN interview, excerpts of which were posted on ESPN.com. “I wasn’t part of this.”
The ESPN interview was Te’o's first since the sports blog Deadspin.com on Wednesday exposed the tale of his girlfriend, Lennay Kekua, and her death as a hoax and that a friend of Te’o's named Ronaiah Tuiasosopo was behind it.
Te’o acknowledged in a statement on Wednesday and the ESPN interview that he had never met the woman in person, although he considered her to be his girlfriend, and said he had been duped.
Notre Dame, one of the most powerful institutions in U.S. collegiate athletics, held a news conference within hours of the Deadspin.com article to say that Te’o had been duped.
(Editing by Ellen Wulfhorst and Vicki Allen)
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Nobody knows how it happened: an indoor housecat who got lost on a family excursion managing, after two months and about 200 miles, to return to her hometown.
Even scientists are baffled by how Holly, a 4-year-old tortoiseshell who in early November became separated from Jacob and Bonnie Richter at an R.V. rally in Daytona Beach, Fla., appeared on New Year’s Eve — staggering, weak and emaciated — in a backyard about a mile from the Richters’ house in West Palm Beach.
“Are you sure it’s the same cat?” wondered John Bradshaw, director of the University of Bristol’s Anthrozoology Institute. In other cases, he has suspected, “the cats are just strays, and the people have got kind of a mental justification for expecting it to be the same cat.”
But Holly not only had distinctive black-and-brown harlequin patterns on her fur, but also an implanted microchip to identify her.
“I really believe these stories, but they’re just hard to explain,” said Marc Bekoff, a behavioral ecologist at the University of Colorado. “Maybe being street-smart, maybe reading animal cues, maybe being able to read cars, maybe being a good hunter. I have no data for this.”
There is, in fact, little scientific dogma on cat navigation. Migratory animals like birds, turtles and insects have been studied more closely, and use magnetic fields, olfactory cues, or orientation by the sun.
Scientists say it is more common, although still rare, to hear of dogs returning home, perhaps suggesting, Dr. Bradshaw said, that they have inherited wolves’ ability to navigate using magnetic clues. But it’s also possible that dogs get taken on more family trips, and that lost dogs are more easily noticed or helped by people along the way.
Cats navigate well around familiar landscapes, memorizing locations by sight and smell, and easily figuring out shortcuts, Dr. Bradshaw said.
Strange, faraway locations would seem problematic, although he and Patrick Bateson, a behavioral biologist at Cambridge University, say that cats can sense smells across long distances. “Let’s say they associate the smell of pine with wind coming from the north, so they move in a southerly direction,” Dr. Bateson said.
Peter Borchelt, a New York animal behaviorist, wondered if Holly followed the Florida coast by sight or sound, tracking Interstate 95 and deciding to “keep that to the right and keep the ocean to the left.”
But, he said, “nobody’s going to do an experiment and take a bunch of cats in different directions and see which ones get home.”
The closest, said Roger Tabor, a British cat biologist, may have been a 1954 study in Germany which cats placed in a covered circular maze with exits every 15 degrees most often exited in the direction of their homes, but more reliably if their homes were less than five kilometers away.
New research by the National Geographic and University of Georgia’s Kitty Cams Project, using video footage from 55 pet cats wearing video cameras on their collars, suggests cat behavior is exceedingly complex.
For example, the Kitty Cams study found that four of the cats were two-timing their owners, visiting other homes for food and affection. Not every cat, it seems, shares Holly’s loyalty.
KittyCams also showed most of the cats engaging in risky behavior, including crossing roads and “eating and drinking substances away from home,” risks Holly undoubtedly experienced and seems lucky to have survived.
But there have been other cats who made unexpected comebacks.
“It’s actually happened to me,” said Jackson Galaxy, a cat behaviorist who hosts “My Cat From Hell” on Animal Planet. While living in Boulder, Colo., he moved across town, whereupon his indoor cat, Rabbi, fled and appeared 10 days later at the previous house, “walking five miles through an area he had never been before,” Mr. Galaxy said.
Professor Tabor cited longer-distance reports he considered credible: Murka, a tortoiseshell in Russia, traveling about 325 miles home to Moscow from her owner’s mother’s house in Voronezh in 1989; Ninja, who returned to Farmington, Utah, in 1997, a year after her family moved from there to Mill Creek, Wash.; and Howie, an indoor Persian cat in Australia who in 1978 ran away from relatives his vacationing family left him with and eventually traveled 1,000 miles to his family’s home.
Professor Tabor also said a Siamese in the English village of Black Notley repeatedly hopped a train, disembarked at White Notley, and walked several miles back to Black Notley.
Still, explaining such journeys is not black and white.
In the Florida case, one glimpse through the factual fog comes on the little cat’s feet. While Dr. Bradshaw speculated Holly might have gotten a lift, perhaps sneaking under the hood of a truck heading down I-95, her paws suggest she was not driven all the way, nor did Holly go lightly.
“Her pads on her feet were bleeding,” Ms. Richter said. “Her claws are worn weird. The front ones are really sharp, the back ones worn down to nothing.”
Scientists say that is consistent with a long walk, since back feet provide propulsion, while front claws engage in activities like tearing. The Richters also said Holly had gone from 13.5 to 7 pounds.
Holly hardly seemed an adventurous wanderer, though her background might have given her a genetic advantage. Her mother was a feral cat roaming the Richters’ mobile home park, and Holly was born inside somebody’s air-conditioner, Ms. Richter said. When, at about six weeks old, Holly padded into their carport and jumped into the lap of Mr. Richter’s mother, there were “scars on her belly from when the air conditioner was turned on,” Ms. Richter said.
Scientists say that such early experience was too brief to explain how Holly might have been comfortable in the wild — after all, she spent most of her life as an indoor cat, except for occasionally running outside to chase lizards. But it might imply innate personality traits like nimbleness or toughness.
“You’ve got these real variations in temperament,” Dr. Bekoff said. “Fish can by shy or bold; there seem to be shy and bold spiders. This cat, it could be she has the personality of a survivor.”
He said being an indoor cat would not extinguish survivalist behaviors, like hunting mice or being aware of the sun’s orientation.
The Richters — Bonnie, 63, a retired nurse, and Jacob, 70, a retired airline mechanics’ supervisor and accomplished bowler — began traveling with Holly only last year, and she easily tolerated a hotel, a cabin or the R.V.
But during the Good Sam R.V. Rally in Daytona, when they were camping near the speedway with 3,000 other motor homes, Holly bolted when Ms. Richter’s mother opened the door one night. Fireworks the next day may have further spooked her, and, after searching for days, alerting animal agencies and posting fliers, the Richters returned home catless.
Two weeks later, an animal rescue worker called the Richters to say a cat resembling Holly had been spotted eating behind the Daytona franchise of Hooters, where employees put out food for feral cats.
Then, on New Year’s Eve, Barb Mazzola, a 52-year-old university executive assistant, noticed a cat “barely standing” in her backyard in West Palm Beach, struggling even to meow. Over six days, Ms. Mazzola and her children cared for the cat, putting out food, including special milk for cats, and eventually the cat came inside.
At Paws2Help, Ms. Mazzola said, “I almost didn’t want to ask, because I wanted to keep her, but I said, ‘Just check and make sure she doesn’t have a microchip.’” When told the cat did, “I just cried.”
The Richters cried, too upon seeing Holly, who instantly relaxed when placed on Mr. Richter’s shoulder. Re-entry is proceeding well, but the mystery persists.
“We haven’t the slightest idea how they do this,” Mr. Galaxy said. “Anybody who says they do is lying, and, if you find it, please God, tell me what it is.”
