World’s Population Living Longer, New Report Suggests

A sharp decline in deaths from malnutrition and diseases like measles and tuberculosis has caused a shift in global mortality patterns over the past 20 years, according to a new report, with far more of the world’s population now living into old age and dying from diseases more associated with rich countries, like cancer and heart disease.

The shift reflects improvements in sanitation, medical services and access to food throughout the developing world, as well as the success of broad public health efforts like vaccine programs. The results are dramatic: infant mortality has declined by more than half between 1990 and 2010, and malnutrition, the No. 1 risk factor for death and years of life lost in 1990, has fallen to No. 8.

At the same time, chronic diseases like cancer now account for about two out of every three deaths worldwide, up from just over half in 1990. Eight million people died of cancer in 2010, 38 percent more than in 1990. Diabetes claimed 1.3 million lives in 2010, double the number in 1990.

But while developing countries made big strides – the average age of death in Brazil and Paraguay, for example, jumped to 63 in 2010, up from 28 in 1970 – the United States stagnated. American women registered the smallest gains in life expectancy of all high-income countries between 1990 and 2010. The two years of life they gained was less than in Cyprus, where women gained 2.3 years of life and Canada, where women gained 2.4 years. The slow increase caused American women to fall to 36th place in the report’s global ranking of life expectancy, down from 22nd in 1990.

“It’s alarming just how little progress there has been for women in the United States,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation, a health research organizationfinanced by the Bill and Melinda Gates Foundation at the University of Washington that coordinated the report. Rising rates of obesity among American women and the legacy of smoking, a habit women in this country formed later than men, are among the factors contributing to the stagnation, he said.

The World Health Organization issued a statement Thursday saying that some of the estimates in the report differ substantially from those done by United Nations agencies, though others are similar. All comprehensive estimates of global mortality rely heavily on statistical modeling because only 34 countries – representing about 15 percent of the world’s population – produce quality cause-of-death data.

Health experts from more than 300 institutions contributed to the report, which measured disease and mortality for populations in more than 180 countries. It was published Thursday in the Lancet, a British health publication.

The one exception to the trend was sub-Saharan Africa, where infectious diseases, childhood illnesses and maternal causes of death still account for about 70 percent of all illness. In contrast, they account for just one-third in South Asia, and less than a fifth in all other regions. Sub-Saharan Africa also lagged in mortality gains, with the average age of death there rising by fewer than 10 years from 1970 to 2010, compared to a more than 25-year increase in Latin America, Asia and North Africa.

The change means that people are living longer, an outcome that public health experts praised. But it also raises troubling questions. Behavior affects people’s risks of developing noncommunicable diseases like cancer, heart disease and diabetes, and public health experts say it is far harder to get people to change their ways than to administer a vaccine that protects children from an infectious disease like measles.

“Adult mortality is a much harder task for the public health systems in the world,” said Colin Mathers, a senior scientist at the World Health Organization in Geneva. “It’s not something that medical services can address as easily.”

Read More..

World’s Population Living Longer, New Report Suggests

A sharp decline in deaths from malnutrition and diseases like measles and tuberculosis has caused a shift in global mortality patterns over the past 20 years, according to a new report, with far more of the world’s population now living into old age and dying from diseases more associated with rich countries, like cancer and heart disease.

The shift reflects improvements in sanitation, medical services and access to food throughout the developing world, as well as the success of broad public health efforts like vaccine programs. The results are dramatic: infant mortality has declined by more than half between 1990 and 2010, and malnutrition, the No. 1 risk factor for death and years of life lost in 1990, has fallen to No. 8.

At the same time, chronic diseases like cancer now account for about two out of every three deaths worldwide, up from just over half in 1990. Eight million people died of cancer in 2010, 38 percent more than in 1990. Diabetes claimed 1.3 million lives in 2010, double the number in 1990.

But while developing countries made big strides – the average age of death in Brazil and Paraguay, for example, jumped to 63 in 2010, up from 28 in 1970 – the United States stagnated. American women registered the smallest gains in life expectancy of all high-income countries between 1990 and 2010. The two years of life they gained was less than in Cyprus, where women gained 2.3 years of life and Canada, where women gained 2.4 years. The slow increase caused American women to fall to 36th place in the report’s global ranking of life expectancy, down from 22nd in 1990.

“It’s alarming just how little progress there has been for women in the United States,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation, a health research organizationfinanced by the Bill and Melinda Gates Foundation at the University of Washington that coordinated the report. Rising rates of obesity among American women and the legacy of smoking, a habit women in this country formed later than men, are among the factors contributing to the stagnation, he said.

The World Health Organization issued a statement Thursday saying that some of the estimates in the report differ substantially from those done by United Nations agencies, though others are similar. All comprehensive estimates of global mortality rely heavily on statistical modeling because only 34 countries – representing about 15 percent of the world’s population – produce quality cause-of-death data.

Health experts from more than 300 institutions contributed to the report, which measured disease and mortality for populations in more than 180 countries. It was published Thursday in the Lancet, a British health publication.

The one exception to the trend was sub-Saharan Africa, where infectious diseases, childhood illnesses and maternal causes of death still account for about 70 percent of all illness. In contrast, they account for just one-third in South Asia, and less than a fifth in all other regions. Sub-Saharan Africa also lagged in mortality gains, with the average age of death there rising by fewer than 10 years from 1970 to 2010, compared to a more than 25-year increase in Latin America, Asia and North Africa.

The change means that people are living longer, an outcome that public health experts praised. But it also raises troubling questions. Behavior affects people’s risks of developing noncommunicable diseases like cancer, heart disease and diabetes, and public health experts say it is far harder to get people to change their ways than to administer a vaccine that protects children from an infectious disease like measles.

“Adult mortality is a much harder task for the public health systems in the world,” said Colin Mathers, a senior scientist at the World Health Organization in Geneva. “It’s not something that medical services can address as easily.”

Read More..

Most Pakistani Lawmakers Don’t File Tax Returns, Study Finds

ISLAMABAD, Pakistan — Fewer than a third of Parliament members in Pakistan file annual tax returns, according to a report published on Wednesday, lending new focus to longstanding complaints from foreign donors and ordinary Pakistanis about tax evasion at the highest levels of society.

The report, which was published jointly by two civil society organizations — the Center for Peace and Development Initiatives and the Center for Investigative Reporting in Pakistan — found that just 126 of the country’s 446 federal lawmakers filed income tax returns in 2011. Among the leaders who did not was President Asif Ali Zardari, the report said.

The report does not take into account the tax paid by politicians on their parliamentary salaries, which is automatically deducted by the government. Instead, it focuses on the lawmakers’ declarations of supplemental income from property, professional practices and other sources of revenue.

Nevertheless, in a country where many politicians enjoy lifestyles that far exceed their official salaries, the report raises new questions about the dedication of top lawmakers in Pakistan to enforcing the tax laws they are supposed to oversee.

“Tax evasion has become a social norm in our country,” said Umar Cheema, an investigative journalist who compiled the report. “People don’t consider it a crime. But this tax demand established a bond between the people and the state. That’s how you become a stakeholder in society.”

Pakistan has a chronically low rate of income tax collection. Of the country’s 180 million people, only 2 percent are registered to pay tax, and fewer than a quarter of those actually do so, according to the report.

Income tax evasion is particularly high among the wealthiest Pakistanis, leaving the country with the lowest ratio of tax to gross domestic product in South Asia.

Meanwhile, the poor bear a disproportionately high tax burden, experts say, because of indirect taxes on electricity, food and other goods.

The country’s flawed tax system has long been an issue for Western donors, who have given the Pakistani government billions of dollars in humanitarian and development aid over the past decade and supported bailout programs from multinational institutions like the International Monetary Fund.

Addressing a Congressional hearing in 2010, Secretary of State Hillary Rodham Clinton said: “They don’t tax income. They don’t tax land. And a lot of the wealth is held in these huge feudal estates.”

“They have no public education system to speak of, and it’s because the very well off, of whom there is a considerable number, do not pay their fair share,” she said.

The report found that tax evasion was spread evenly across the political spectrum, with low rates among the governing Pakistan Peoples Party, the opposition Pakistan Muslim League and other religious and regional parties.

In the Senate, it found that the lawmaker who paid the most in taxes last year — $133,000 — was Aitzaz Ahsan, a lawyer who helped oust President Pervez Musharraf from office in 2008. The least of those who filed was paid by Mushahid Hussain, a former Musharraf adviser, who paid 84 cents.

Mr. Cheema said his findings were based on a combination of publicly available data and questionnaires he sent to members of both houses of Parliament — though just two members responded to his queries.

But some politicians and tax experts questioned Mr. Cheema’s findings, saying they did not take into account the wider failings of the country’s tax laws.

Ikram ul Haq, a lawyer and tax expert, said it was incorrect to describe two-thirds of Parliament members as “tax dodgers,” because they automatically pay tax on their salaries. But, he added, there is a serious problem with the declaration of income from land and other assets. Some politicians do not declare their extra income, or grossly underestimate it, he said.

And others legally avoid taxation because their income is largely derived from agriculture, a sector that is exempt from federal taxation — a longstanding complaint of the country’s urban middle classes.

Ayaz Amir, a lawmaker and landowner from Punjab Province, who said he had filed his tax returns, said the main problem lay with the broken system of tax enforcement. “The point is not that 70 percent don’t file their returns,” he said. “It’s that those who do file fictitious returns and do not declare the true extent of their income.” The problem is not limited to lawmakers, he added. “It’s the entire prosperous class of Pakistan. Their lifestyles are totally out of sync with their declared income.”

Another difficulty is that, even when breaches of the tax laws are discovered, the rich and politically connected are rarely prosecuted. “Law enforcement is in general very weak,” said Ahmed Bilal Mehboob, executive director of the Pakistan Institute of Legislative Development and Transparency. “And if you happen to be an influential and powerful person like a politician,” he said, “then it is even weaker.”

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The New Old Age: The Gift of Reading

This is the year of the tablet, David Pogue of The Times has told us, and that may be good news for seniors who open holiday wrappings to find one tucked inside. They see better with tablets’ adjustable type size, new research shows. Reading becomes easier again.

This may seem obvious — find me someone over 40 who doesn’t see better when fonts are larger — but it’s the business of science to test our assumptions.

Dr. Daniel Roth, an eye specialist and clinical associate professor at the Robert Wood Johnson Medical School in New Brunswick, N.J., offered new evidence of tablets’ potential benefits last month at the annual meeting of the American Academy of Ophthalmology.

His findings, based on tests conducted with 66 adults age 50 and over: older people read faster (a mean reading speed of 128 words per minute) when using an iPad, compared to a newspaper with the same 10-point font size (114 words per minute).

When the font was increased to 18 points — easy to do on an iPad — reading speed increased to 137 words per minute.

“If you read more slowly, it’s tedious,” Dr. Roth said, explaining why reading speed is important. “If you can read more fluidly, it’s more comfortable.”

What makes the real difference, Dr. Roth theorizes, is tablets’ illuminated screen, which heightens contrast between words and the background on which they sit.

Contrast sensitivity — the visual ability to differentiate between foreground and background information — becomes poorer as we age, as does the ability to discriminate fine visual detail, notes Dr. Kevin Paterson, a psychologist at the University of Leicester, who recently published a separate study on why older people struggle to read fine print.

“There are several explanations for the loss of sensitivity to fine detail that occurs with older age,” Dr. Paterson explained in an e-mail. “This may be due to greater opacity of the fluid in the eye, which will scatter incoming light and reduce the quality of the projection of light onto the retina. It’s also hypothesized that changes in neural transmission affect the processing of fine visual detail.”

Combine these changes with a greater prevalence of eye conditions like macular degeneration and diabetic retinopathy in older adults, and you get millions of people who cannot easily do what they have done all their lives — read and stay connected to the world of ideas, imagination and human experience.

“The No. 1 complaint I get from older patients is that they love to read but can’t, and this really bothers them,” Dr. Roth said. The main option has been magnifying glasses, which many people find cumbersome and inconvenient.

Some words of caution are in order. First, Dr. Roth’s study has not been published yet; it was presented as a poster at the scientific meeting and publicized by the academy, but it has not yet gone through comprehensive, rigorous peer review.

Second, Dr. Roth’s study was completed before the newest wave of tablets from Microsoft, Google, Samsung and others became available. The doctor made no attempt to compare different products, with one exception. In the second part of his study, he compared results for the iPad with those for a Kindle. But it was not an apples to apples comparison, because the Kindle did not have a back-lit screen.

This section of his study involved 100 adults age 50 and older who read materials in a book, on an iPad and on the Kindle. Book readers recorded a mean reading speed of 187 words per minute when the font size was set at 12; Kindle readers clocked in at 196 words per minute and iPad readers at 224 words per minute at the same type size. Reading speed improved even more drastically for a subset of adults with the poorest vision.

Again, Apple’s product came out on top, but that should not be taken as evidence that it is superior to other tablets with back-lit screens and adjustable font sizes. Both the eye academy and Dr. Roth assert that they have no financial relationship with Apple. My attempts to get in touch with the company were not successful.

A final cautionary note should be sounded. Some older adults find digital technology baffling and simply do not feel comfortable using it. For them, a tablet may sit on a shelf and get little if any use.

Others, however, find the technology fascinating. If you want to see an example that went viral on YouTube, watch this video from 2010 of Virginia Campbell, then 99 years old, and today still going strong at the Mary’s Woods Retirement Community in Lake Oswego, Ore.

Ms. Campbell’s glaucoma made it difficult for her to read, and for her the iPad was a blessing, as she wrote in this tribute quoted in an article in The Oregonian newspaper:

To this technology-ninny it’s clear
In my compromised 100th year,
That to read and to write
Are again within sight
Of this Apple iPad pioneer

Caregivers might be delighted — as Ms. Campbell’s daughter was — by older relatives’ response to this new technology, a potential source of entertainment and engagement for those who can negotiate its demands. Or, they might find that old habits die hard and that their relatives continue to prefer a book or newspaper they can hold in their hands to one that appears on a screen.

Which reading enhancement products have you used, and what experiences have you had?

Read More..

The New Old Age: The Gift of Reading

This is the year of the tablet, David Pogue of The Times has told us, and that may be good news for seniors who open holiday wrappings to find one tucked inside. They see better with tablets’ adjustable type size, new research shows. Reading becomes easier again.

This may seem obvious — find me someone over 40 who doesn’t see better when fonts are larger — but it’s the business of science to test our assumptions.

Dr. Daniel Roth, an eye specialist and clinical associate professor at the Robert Wood Johnson Medical School in New Brunswick, N.J., offered new evidence of tablets’ potential benefits last month at the annual meeting of the American Academy of Ophthalmology.

His findings, based on tests conducted with 66 adults age 50 and over: older people read faster (a mean reading speed of 128 words per minute) when using an iPad, compared to a newspaper with the same 10-point font size (114 words per minute).

When the font was increased to 18 points — easy to do on an iPad — reading speed increased to 137 words per minute.

“If you read more slowly, it’s tedious,” Dr. Roth said, explaining why reading speed is important. “If you can read more fluidly, it’s more comfortable.”

What makes the real difference, Dr. Roth theorizes, is tablets’ illuminated screen, which heightens contrast between words and the background on which they sit.

Contrast sensitivity — the visual ability to differentiate between foreground and background information — becomes poorer as we age, as does the ability to discriminate fine visual detail, notes Dr. Kevin Paterson, a psychologist at the University of Leicester, who recently published a separate study on why older people struggle to read fine print.

“There are several explanations for the loss of sensitivity to fine detail that occurs with older age,” Dr. Paterson explained in an e-mail. “This may be due to greater opacity of the fluid in the eye, which will scatter incoming light and reduce the quality of the projection of light onto the retina. It’s also hypothesized that changes in neural transmission affect the processing of fine visual detail.”

Combine these changes with a greater prevalence of eye conditions like macular degeneration and diabetic retinopathy in older adults, and you get millions of people who cannot easily do what they have done all their lives — read and stay connected to the world of ideas, imagination and human experience.

“The No. 1 complaint I get from older patients is that they love to read but can’t, and this really bothers them,” Dr. Roth said. The main option has been magnifying glasses, which many people find cumbersome and inconvenient.

Some words of caution are in order. First, Dr. Roth’s study has not been published yet; it was presented as a poster at the scientific meeting and publicized by the academy, but it has not yet gone through comprehensive, rigorous peer review.

Second, Dr. Roth’s study was completed before the newest wave of tablets from Microsoft, Google, Samsung and others became available. The doctor made no attempt to compare different products, with one exception. In the second part of his study, he compared results for the iPad with those for a Kindle. But it was not an apples to apples comparison, because the Kindle did not have a back-lit screen.

This section of his study involved 100 adults age 50 and older who read materials in a book, on an iPad and on the Kindle. Book readers recorded a mean reading speed of 187 words per minute when the font size was set at 12; Kindle readers clocked in at 196 words per minute and iPad readers at 224 words per minute at the same type size. Reading speed improved even more drastically for a subset of adults with the poorest vision.

Again, Apple’s product came out on top, but that should not be taken as evidence that it is superior to other tablets with back-lit screens and adjustable font sizes. Both the eye academy and Dr. Roth assert that they have no financial relationship with Apple. My attempts to get in touch with the company were not successful.

A final cautionary note should be sounded. Some older adults find digital technology baffling and simply do not feel comfortable using it. For them, a tablet may sit on a shelf and get little if any use.

Others, however, find the technology fascinating. If you want to see an example that went viral on YouTube, watch this video from 2010 of Virginia Campbell, then 99 years old, and today still going strong at the Mary’s Woods Retirement Community in Lake Oswego, Ore.

Ms. Campbell’s glaucoma made it difficult for her to read, and for her the iPad was a blessing, as she wrote in this tribute quoted in an article in The Oregonian newspaper:

To this technology-ninny it’s clear
In my compromised 100th year,
That to read and to write
Are again within sight
Of this Apple iPad pioneer

Caregivers might be delighted — as Ms. Campbell’s daughter was — by older relatives’ response to this new technology, a potential source of entertainment and engagement for those who can negotiate its demands. Or, they might find that old habits die hard and that their relatives continue to prefer a book or newspaper they can hold in their hands to one that appears on a screen.

Which reading enhancement products have you used, and what experiences have you had?

Read More..

Michigan Legislature Approves Labor Limit

Fabrizio Costantini for The New York Times

Protesters argued on the steps of the Michigan Capitol on Tuesday as state lawmakers considered right to work legislation.

LANSING, Mich. — The Michigan Legislature approved sweeping legislation on Tuesday that vastly reduces the power of organized labor in a state that has been a symbol of union dominance and served as an incubator for union activity over decades of modern American labor history.

The two bills, approved by the House of Representatives over the shouts of thousands of angry union protesters who gathered on the lawn outside the Capitol building, will among other things, bar both public and private sector union workers from being required to pay fees as a condition of their employment.

The bills have already been approved by the State Senate, and Gov. Rick Snyder has said he intends to sign the legislation as soon as this week. Procedural maneuvering could still briefly delay the bill through calls for reconsideration.

Lisa Posthumus, a House Republican, who said her family included union members, said the legislation gave workers the freedom to make their own choices. “Yes, we are witnessing history,” she said. “This is the day when Michigan freed its workers.”

Mark Meadows, a House Democrat, had a different take. “I was hoping that this day would never come,” he said. “In the last two years there’s been a chipping away at bargaining. But today, the corporations delivered the coup de grâce.”

From a distance, there would seem no more unlikely a success for such legislation than Michigan, where labor, hoping to demonstrate strength after a series of setbacks, asked voters last month to enshrine collective bargaining into the State Constitution.

But that ballot measure failed badly, and suddenly a reverse drive was under way that has brought the state to a moment startling in its symbolism. How the home of the United Automobile Workers finds itself on the cusp of becoming the 24th state to ban compulsory union fees — and only the second state to pass such legislation in a decade — is the latest chapter in a larger battle over the role of unions in the industrial heart of the nation.

As the debate over the bills intensified Tuesday, the authorities closed the Capitol after saying the building had reached its capacity of more than 2,000. That left thousands of noisy union members — many dressed in red — on the lawn outside, although the doors to the building were opened again later in the morning.

Streets around the Capitol were also closed to traffic and clusters of state police, some equipped with riot gear, kept posts throughout the building and along nearby streets.

At least two school districts around the state announced that they would close for the day, as word spread that teachers and other workers planned to protest in Lansing.

As Republicans in the state House moved uncommonly swiftly to pass the measures, union demonstrators outside — the sound of their drumbeats becoming progressively louder inside the chamber — chanted, “Kill the bill! Kill the bill!”

Once the first bill — related to public employees — was approved by a 58-to-51 vote, union supporters cried out from the gallery, “Recall! Recall! Recall!”

Republicans hold a 64-to-46 majority in the state House, and aside from a few dissenters, the vote was generally along party lines.

The second bill, covering private sector unions, was passed by the House about an hour and a half later by a 58-to-52 vote.

Democrats around the nation, including President Obama, have denounced the measures in recent days.

“You know, these so-called right-to-work laws, they don’t have to do with economics,” said Mr. Obama, during a visit to a truck factory outside Detroit on Monday. “They have everything to do with politics. What they’re really talking about is giving you the right to work for less money.”

Before the first House vote Tuesday, Democrats had sought to slow down the proceedings by employing whatever tactics they could dream up. One was to offer an array of amendments with the idea of destabilizing the bill by a thousand cuts. Among the suggestions: Send the question to a public vote. Each amendment however, was quickly rejected.

Mary M. Chapman contributed reporting in Lansing, and Steven Yaccino in Chicago.

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News Analysis: A Debate on Coated Aspirins and Aspirin Resistance

Millions of Americans take low-dose aspirin every day to prevent heart attacks and strokes. But a study published last week challenges some cherished beliefs about the familiar remedy, leaving some consumers to wonder if they should throw out their coated pills and others concerned that they unnecessarily may be taking expensive substitutes.

The study, published in the journal Circulation, by researchers at the University of Pennsylvania, tested 400 healthy people for evidence that aspirin did not work in them, a phenomenon called “aspirin resistance.” Aspirin prevents blood platelets from sticking together, which can lead to heart attacks and strokes. Previous studies have estimated that anywhere from 5 to 40 percent of the population is resistant to aspirin’s effects.

But the study essentially found that the condition doesn’t exist: they could not document a single case of true aspirin resistance in their sample. What had appeared to be aspirin resistance, they said, actually was caused by the coating commonly used on aspirin pills intended to protect the stomach. The coating slowed the drug’s absorption into the body.

The study didn’t evaluate whether coated aspirin was less likely to prevent heart attacks or strokes, said Dr. Garret FitzGerald, one of the authors. And people who took the coated aspirin in his study eventually showed a response to it.

But people who seek out coated aspirin may be doing so unnecessarily, he said, especially since previous studies have not consistently shown that the coating even prevents gastric problems.

“There’s no rationale for you to be on coated aspirin,” said Dr. FitzGerald, who is a cardiologist and chairman of pharmacology at the University of Pennsylvania.

Some cardiologists have begun advising patients to seek out uncoated aspirin because other studies have suggested that the uncoated type may be more effective. But finding it isn’t so easy. Even cheaper store brands, like those sold by CVS and Wal-Mart, come with a so-called enteric coating. One of the few uncoated aspirins on the market is St. Joseph’s chewable variety — the old orange-flavored baby aspirin.

But other experts, like Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic, see no real harm in taking coated aspirin, which is cheap and readily available. Many major studies of aspirin have been conducted using the coated variety.

The new study also calls into question the very idea of aspirin resistance. Testing for the condition became more widespread in the early 2000s, as expensive prescription alternatives like the blood thinner Plavix (also called clopidogrel) gained popularity. Many cardiologists suspected that the timing was not a coincidence.

“Before clopidogrel, we had never heard of aspirin resistance,” said Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles. “It seemed to be that this was driven mostly by marketing considerations.” The new study raises the possibility that many patients may have been falsely told that aspirin doesn’t work on them, Dr. Kaul and other experts said.

The University of Pennsylvania study was partially financed by Bayer, the world’s largest manufacturer of branded aspirin, much of which is coated. In a statement, Bayer challenged some of the study’s conclusions and methods, and also said there was evidence that the enteric coating can reduce gastric side effects.

Critics of Dr. FitzGerald’s study also argue that he should have studied aspirin resistance in patients with conditions like heart disease, rather than in healthy people.

But even these critics acknowledge that testing for resistance is probably not worthwhile. Dr. Nissen, who is critical of Dr. FitzGerald’s study, doesn’t test his patients for aspirin resistance. But he said he would be reluctant to switch a patient from another drug back to aspirin now if a test had previously shown they were aspirin-resistant. Changing treatments is always risky, he said.

“If the patient is not bleeding, is not having a complication, am I going to take it away?” Dr. Nissen wondered. “That’s the dilemma we face.”

Read More..

News Analysis: A Debate on Coated Aspirins and Aspirin Resistance

Millions of Americans take low-dose aspirin every day to prevent heart attacks and strokes. But a study published last week challenges some cherished beliefs about the familiar remedy, leaving some consumers to wonder if they should throw out their coated pills and others concerned that they unnecessarily may be taking expensive substitutes.

The study, published in the journal Circulation, by researchers at the University of Pennsylvania, tested 400 healthy people for evidence that aspirin did not work in them, a phenomenon called “aspirin resistance.” Aspirin prevents blood platelets from sticking together, which can lead to heart attacks and strokes. Previous studies have estimated that anywhere from 5 to 40 percent of the population is resistant to aspirin’s effects.

But the study essentially found that the condition doesn’t exist: they could not document a single case of true aspirin resistance in their sample. What had appeared to be aspirin resistance, they said, actually was caused by the coating commonly used on aspirin pills intended to protect the stomach. The coating slowed the drug’s absorption into the body.

The study didn’t evaluate whether coated aspirin was less likely to prevent heart attacks or strokes, said Dr. Garret FitzGerald, one of the authors. And people who took the coated aspirin in his study eventually showed a response to it.

But people who seek out coated aspirin may be doing so unnecessarily, he said, especially since previous studies have not consistently shown that the coating even prevents gastric problems.

“There’s no rationale for you to be on coated aspirin,” said Dr. FitzGerald, who is a cardiologist and chairman of pharmacology at the University of Pennsylvania.

Some cardiologists have begun advising patients to seek out uncoated aspirin because other studies have suggested that the uncoated type may be more effective. But finding it isn’t so easy. Even cheaper store brands, like those sold by CVS and Wal-Mart, come with a so-called enteric coating. One of the few uncoated aspirins on the market is St. Joseph’s chewable variety — the old orange-flavored baby aspirin.

But other experts, like Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic, see no real harm in taking coated aspirin, which is cheap and readily available. Many major studies of aspirin have been conducted using the coated variety.

The new study also calls into question the very idea of aspirin resistance. Testing for the condition became more widespread in the early 2000s, as expensive prescription alternatives like the blood thinner Plavix (also called clopidogrel) gained popularity. Many cardiologists suspected that the timing was not a coincidence.

“Before clopidogrel, we had never heard of aspirin resistance,” said Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles. “It seemed to be that this was driven mostly by marketing considerations.” The new study raises the possibility that many patients may have been falsely told that aspirin doesn’t work on them, Dr. Kaul and other experts said.

The University of Pennsylvania study was partially financed by Bayer, the world’s largest manufacturer of branded aspirin, much of which is coated. In a statement, Bayer challenged some of the study’s conclusions and methods, and also said there was evidence that the enteric coating can reduce gastric side effects.

Critics of Dr. FitzGerald’s study also argue that he should have studied aspirin resistance in patients with conditions like heart disease, rather than in healthy people.

But even these critics acknowledge that testing for resistance is probably not worthwhile. Dr. Nissen, who is critical of Dr. FitzGerald’s study, doesn’t test his patients for aspirin resistance. But he said he would be reluctant to switch a patient from another drug back to aspirin now if a test had previously shown they were aspirin-resistant. Changing treatments is always risky, he said.

“If the patient is not bleeding, is not having a complication, am I going to take it away?” Dr. Nissen wondered. “That’s the dilemma we face.”

Read More..

Digital Domain: Air Force Stumbles Over Software Modernization Project

IN policy circles, problems that are mind-bogglingly difficult or impossible to solve, like global warming, are formally termed “wicked.”

For the United States Air Force, installing a new software system has certainly proved to be a wicked problem. Last month, it canceled a six-year-old modernization effort that had eaten up more than $1 billion. When the Air Force realized that it would cost another $1 billion just to achieve one-quarter of the capabilities originally planned — and that even then the system would not be fully ready before 2020 — it decided to decamp.

Silicon Valley sees its share of software projects that end unhappily. The most expensive failures, however, involve acquisitions of entire companies with software assets that turn out to be far less valuable than thought. Those can lead to stunning write-downs in the billions, as Hewlett-Packard has been forced to take recently.

But the Air Force’s software was not some mystery package, nor was it written from scratch. It was commercial off-the-shelf software, or “COTS” (the military can’t seem to resist any chance to use an acronym).

Installing COTS to run an enterprise is not a straightforward matter. The Air Force would have to make myriad adjustments to accommodate its individual needs, and in a military setting that would mean meetings and more meetings, unlike anything ever experienced in a Silicon Valley company. Still, it is hard to understand how the Defense Department blew a billion dollars before the plug was pulled.

The software initiative, called the Expeditionary Combat Support System, was supposed to manage logistics using software from Oracle. In 2006, the Air Force announced that it had awarded a $628 million contract to the Computer Sciences Corporation to serve as lead system integrator; its job would be to “configure, deploy and conduct training and change management activities” before the launch.

Four years later, in 2010, the Air Force said it had pilot programs under way at two bases. In remarks made at the time by Grover Dunn, the Air Force director of transformation, we can see just how unrealistic the project was: “We’ve never tried to change all the processes, tools and languages of all 250,000 people in our business at once, and that’s essentially what we’re about to do.”

Signs that such comprehensive change could not, in fact, be done “at once” were visible last spring. Last April, Jamie M. Morin, assistant secretary of the Air Force, testified before a subcommittee of the Senate’s Armed Services Committee about E.C.S.S.: “The total cost on the system is now over $1 billion,” he said, adding, “I am personally appalled at the limited capabilities that program has produced relative to that amount of investment.”

With the cancellation of the system last month, a spokeswoman said that the Air Force would continue to rely on its legacy logistics systems, some of which have been in use since the 1970s.

THE Defense Department says that the way the system was conceived was flawed. “We started with a Big Bang approach and put every possible requirement into the program, which made it very large and very complex,” says Elizabeth McGrath, the department’s deputy chief management officer.

E.C.S.S. was restructured many times, including three separate times in the last three years, Ms. McGrath says. “Each time, we chunked it down, breaking it into smaller pieces, focusing on specific capabilities.” But this was not enough to save the system, she says, because program managers did not succeed in imposing the short deadlines of 18 to 24 months that the department now requires for similar projects. Tight deadlines will certainly go a long way toward avoiding future billion-dollar fiascos. But much more needs to change before the department’s older software systems can be replaced.

In 2011, the nonprofit Institute for Defense Analyses, which performs independent research for the government on national security issues, issued a lengthy report on Defense Department software initiatives like E.C.S.S. It noted that modernization of the department’s software systems had been a priority for nearly 15 years, and that more than $5.8 billion had been spent through 2009 on large operational software systems, most of which were behind schedule. It recommended that the department suspend deployment of all new systems until reviews were completed.

The report cited many concerns, but the main one was a failure to meet a basic requirement for successful implementation: having “a single accountable leader” who “has the authority and willingness to exercise the authority to enforce all necessary changes to the business required for successful fielding of the software.”

I spoke last week with Paul K. Ketrick and Graeme R. Douglas, two institute researchers who were among the co-authors of the study. They said some small-scale operational systems in the Defense Department had drawn praise for successful unveilings, in the Navy and in the Defense Logistics Agency, for example.

“They got there because they had strong leadership who committed to the program and had the authority to make the changes necessary for success,” said Mr. Douglas. But “it’s rare that a single leader in the Department of Defense has the authority over the span of activities” affected by the systems, he said.

Pat Phelan, a research vice president at Gartner, the information technology research company, also calls attention to the difficult and time-consuming nature of decision-making within the department. She advocates empowering small groups to make necessary decisions, as is done in the private sector, but she does not expect the department to change. “That mind-set, that cultural shift, is not something I expect to happen in my lifetime,” she said.

The record of software modernization at the Department of Defense is discouraging. In Silicon Valley, software projects can run aground, but they don’t fail because of endless meetings and complex bureaucratic requirements, not to mention the constant need to be ready to fight wars. As Mr. Ketrick says, “Replacing the systems that run the Department of Defense is a wicked problem.”

Randall Stross is an author based in Silicon Valley and a professor of business at San Jose State University. E-mail: stross@nytimes.com.

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Euro Watch: Bonds in Spain and Italy Shaken by Italian Politics

ROME — Italian stock and bond prices fell on Monday after a weekend of political turmoil in Italy gave rise to fears that the country was headed for renewed instability.

Shares of Italian banks, which are big holders of the government’s bonds, were among the hardest hit.

The action occurred in the first day of trading after Prime Minister Mario Monti said over the weekend that he would soon step down after his predecessor, Silvio Berlusconi, withdrew his party’s support from Mr. Monti and said he would again seek election as prime minister.

Mr. Berlusconi, who was elected prime minister three times, left office a year ago as markets pushed Italy to the brink of financial collapse. Mr. Monti, an economist who was appointed as his temporary successor, has restored Italy’s credibility with investors, who have given the country a break on its borrowing costs. But those gains have come at the cost of painful austerity measures that have worsened the country’s economic situation and given Mr. Berlusconi an opening to attack.

The Milan benchmark index, MIB, fell more than 2 percent on Monday. Italian banks, which remain sensitive to declines in the country’s bond prices, were among the big losers. Intesa Sanpaolo, the most active stock, fell 5.2 percent, as did UniCredit.

Mr. Monti, who joined other leaders in Oslo on Monday to receive the Nobel Peace Prize awarded to the European Union, said at a news conference that the market reactions “need not be dramatized.”

“I am confident,” he said, that the Italian elections would result in a government “that will be responsible and oriented toward the E.U. and this will be in line with efforts the Italian government has made so far.”

The decline in bond prices sent their yields, or interest rates, higher — an indicator of the Italian government’s borrowing costs. The spread between interest rates on Italian 10-year sovereign bonds and equivalent German securities, the European benchmark for safety, grew to 3.5 percentage points on Monday. That was up from 3.25 percentage points late Friday, suggesting that investors were growing more wary of holding Italian debt.

The yield on Italian 10-year bonds, which breached 7 percent this year, ended trading on Monday at 4.8 percent, up 29 basis points. A basis point is one-hundredth of a percent.

Bonds of Spain, which is the other big economy of concern in the euro zone, also came under renewed pressure on Monday after Mr. Monti’s announcement.

The spread between Spanish 10-year bonds and equivalent German bonds widened to 4.27 percentage points from 4.16 points on Friday. The yield on the benchmark Spanish 10-year rose 10 basis points, to 5.5 percent; it reached 7.1 percent in July amid concerns that Spain would be forced into a full bailout after having to negotiate a 100 billion euro, or $129 billion, rescue package for its banks in June.

Luis de Guindos, the Spanish economy minister, warned that Italy’s political turmoil would affect his country.

“When doubts emerge over the stability of a neighboring country like Italy, which is also seen as vulnerable, there’s an immediate contagion for us,” he said Monday morning on Spanish national radio.

Asked whether Spain would itself seek further European rescue funding, he instead said, “The help that Spain needs is that the doubts over the future of the euro be removed.”

Speaking before the Nobel ceremony on Monday, the European Commission president, José Manuel Barroso, said Italy must “continue on the road of structural reforms.” The elections, Mr. Barroso said on Sky News, “must not be used to postpone reforms.”

A dismal economic report on Monday served as a reminder that despite Mr. Monti’s success with investors, the real economy continues to suffer. Italian industrial production fell a seasonally adjusted 1.1 percent in October from September, and by 6.2 percent from a year earlier, Istat, the national statistics agency, said.

Some analysts said they thought that Mr. Berlusconi’s re-emergence as a political leader was as responsible for unnerving investors as Mr. Monti’s unexpected decision to resign. Nicholas Spiro, managing director of Spiro Sovereign Strategy, a research firm, wrote on Monday in a note that Mr. Berlusconi remained “the boogeyman of investors,” who “epitomizes the dysfunctional nature of Italian politics.”

Angela Merkel, the German chancellor, was to meet on Monday with Mr. Monti on the sidelines of the Nobel ceremony, said Georg Streiter, a spokesman for the chancellor.

Ms. Merkel pushed to have Mr. Monti succeed Mr. Berlusconi. But she ended up facing Mr. Monti’s own ideas for economic change, which focused more on growth and job creation than on the austere fiscal discipline championed by Ms. Merkel.

As a rule, the German government does not comment on its partners’ domestic politics, but Foreign Minister Guido Westerwelle warned that an attempt to scale back Italy’s reform push could result in further destabilization in the euro zone.

“Italy cannot remain stagnant on two-thirds of its reform process,” Mr. Westerwelle said through a spokesman. “This would throw not only Italy but the rest of Europe into turbulence.”

Elisabetta Povoledo reported from Rome and David Jolly from Paris. Raphael Minder contributed reporting from Madrid and Melissa Eddy from Berlin.

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