DealBook Column: The Election Won't Solve All Puzzles

Here comes more uncertainty.

It may sound counterintuitive, but whatever the outcome of the election — whether President Obama or Mitt Romney wins — the economy and markets are likely to face more uncertainty, not less, over the coming year.

“Uncertainty” has become the watchword over the last several years for many chief executives, politicians and economists as an explanation — or perhaps an excuse — for the economy’s slow growth, for the lack of hiring by business and for the volatility in the stock market.

“The claim is that businesses and households are uncertain about future taxes, spending levels, regulations, health care reform and interest rates. In turn, this uncertainty leads them to postpone spending on investment and consumption goods and to slow hiring, impeding the recovery,” a group of professors from Stanford University and the University of Chicago wrote in a study that found “current levels of economic policy uncertainty are at extremely elevated levels compared to recent history.” (The professors have created a Web site, policyuncertainty.com, where you can track the “uncertainty” levels.)

Come Wednesday morning, we should know who our president will be. But the uncertainty hardly ends there.

Almost immediately after the elections, the next big talking point on Wall Street and in Washington is going to be the now infamous “fiscal cliff,” a series of automatic tax increases and spending cuts that was the result of a Congressional compromise reached last summer and is to take effect on Jan. 1, unless Congress finds an alternative. Some economists say the tax increases and spending cuts in the existing agreement could shave as much as 4 percent off G.D.P. if they are not renegotiated. Already, executives say that the uncertainty over the outcome of the fiscal cliff is causing them to hold back from making new investments.

But the greatest likelihood is that the fiscal cliff isn’t going to be resolved soon at all —the betting line of the political cognoscenti is that no matter who wins, Congress will find a way to kick the issue down the road, perhaps as far as the fall of 2013, providing a new cloud of uncertainty over the economy.

For investors, the fiscal cliff includes a tax increase on dividends (making them the equivalent of ordinary income, on which rates could rise to as high as 39.6 percent) and capital gains (up to 20 percent from 15 percent). In a note to clients sent out on Sunday night, Goldman Sachs said that it expected the rate for both dividends and capital gains to be negotiated to 20 percent in either a second Obama term or a Romney presidency. But more important, Goldman noted that when similar tax increases were on the table in 1970 and 1986, “the S.& P. 500 posted negative returns in the December prior to implementation as investors locked in the lower rate.” December, the report said, “has the second-highest average monthly return” since 1928.

Many investors have already begun selling stocks and companies in anticipation of tax increases. Speculation was rampant last week that one of the reasons for the timing of the sale of George Lucas’s company, Lucasfilm, to Disney for $4.1 billion in cash and stock, was the impending changes in tax policy. (Mr. Lucas has said that he plans to donate a majority of his wealth to charity.)

Once we get past the fiscal cliff, if we do at all, there is Europe. Remember Europe? The issues in Greece and Spain have managed to stay off the front pages during the election run-up, but they have not gone away. Some economists have argued that things have gotten worse. Angela Merkel, the chancellor of Germany, who will face election in 2013, said on Monday that the fiscal crisis in Europe was likely to last at least five years. “Whoever thinks this can be fixed in one or two years is wrong,” she said.

And don’t forget the Middle East. That “uncertainty” for the world — and the global economy — isn’t going away anytime soon either. Questions about a possible attack on Iran will persist under either candidate.

And finally, there is Ben Bernanke, chairman of the Federal Reserve, one of the biggest uncertainties of them all. As I reported in this column two weeks ago, the greatest likelihood is that Mr. Bernanke will step down at the end of his term in early 2014 no matter who wins the election.

It’s possible — though unlikely — that his departure could happen even sooner if Mr. Romney wins. Over the next year and a half, Mr. Bernanke’s future as the Fed chairman will feed a sense of uncertainty among investors who have become accustomed to his easy money policies. If President Obama wins, he is likely to appoint a successor to Mr. Bernanke who is dovish on monetary policy, and more likely to keep printing money as Mr. Bernanke has, a strategy that comes with its own risks. If Mr. Romney wins, he may appoint a more hawkish chairman, a move that could create a different sense of uncertainty about how the Federal Reserve will unwind itself from Mr. Bernanke’s policies.

None of these issues are new. President Obama took office facing a fiscal policy dispute that was not and probably could not be settled given the gridlock in Congress. No solution is in sight for Europe’s problems. Tension in the Middle East is escalating as fast as nuclear technology. And the Federal Reserve’s monetary policy is at its most opaque since the Reagan administration.

All of which shows that the comedian Jon Stewart is more on target than ever with the cheeky title of his election coverage on “The Daily Show” on Comedy Central. Carrying on a tradition, it is known as “Indecision 2012.”

Update that to 2013, and it’s good for another year.

A version of this article appeared in print on 11/06/2012, on page B1 of the NewYork edition with the headline: The Election Won’t Solve All Puzzles.

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Unlikely Model for H.I.V. Prevention: Adult Film Industry

Stephanie Diani for The New York Times

INDUSTRY DATABASE Shylar Cobi, right, a film producer, confirmed test results of the actors who perform as James Deen and Stoya.

LOS ANGELES — Before they take off all their clothes, the actors who perform as James Deen and Stoya go through a ritual unique to the heterosexual adult film industry.

First, they show each other their cellphones: Each has an e-mail from a laboratory saying he or she just tested negative for H.I.V., syphilis, chlamydia and gonorrhea.

Then they sit beside the film’s producer, Shylar Cobi, as he checks an industry database with their real names to confirm that those negative tests are less than 15 days old.

Then, out on the pool terrace of the day’s set — a music producer’s hilltop home with a view of the Hollywood sign — they yank down their pants and stand around joking as Mr. Cobi quickly inspects their mouths, hands and genitals for sores.

“I’m not a doctor,” Mr. Cobi, who wears a pleasantly sheepish grin, says. “I’m only qualified to do this because I’ve been shooting porn since 1990 and I know what looks bad.”

Bizarre as the ritual is, it seems to work.

The industry’s medical consultants say that about 350,000 sex scenes have been shot without condoms since 2004, and H.I.V. has not been transmitted on a set once.

Outside the world of pornography, the industry’s testing regimen is not well known, and no serious academic study of it has ever been done. But when it was described to several AIDS experts, they all reacted by saying that there were far fewer infections than they would have expected, given how much high-risk sex takes place.

“I don’t think there’s any question that it works,” said Dr. Allan Ronald, a Canadian AIDS specialist who did landmark studies of the virus in prostitutes in a Nairobi slum. “I’m a little uncomfortable, because it’s giving the wrong message — that you can have multiple sex partners without condoms — but I can’t say it doesn’t work.”

Despite the regimen’s apparent success, California health officials and an advocacy group, the AIDS Healthcare Foundation, are trying to make it illegal to shoot without condoms. They argue that other sexually transmitted diseases are rampant in the industry, though the industry trade group disputes that.

In January, the city of Los Angeles passed a law requiring actors to wear condoms. A measure to do the same for the whole county is on the ballot on Tuesday.

Producers say the condom requirement will drive them out of business since consumers will not buy such films. Local newspapers like The Los Angeles Times oppose the ballot measure, calling it well-intentioned but unenforceable, and warning that it could drive up to 10,000 jobs out of state.

Very frequent testing makes it almost impossible for an actor to stay infected without being caught, said Dr. Jacques Pepin, the author of “The Origins of AIDS” and an expert on transmission rates. “And if you are having sex mostly with people who themselves are tested all the time, this must further reduce the risk.”

When the virus first enters a high-risk group like heroin users, urban prostitutes or habitués of gay bathhouses, it usually infects 30 to 60 percent of the cohort within a few years, studies have shown. The same would be expected in pornography, where performers can have more than a dozen partners a month, but the industry says self-policing has prevented it.

“Our talent base has sex exponentially more than other people, but we’re all on the same page about keeping it out,” said Steven Hirsch, the founder of Vivid Entertainment, one of the biggest studios.

Performers have to test negative every 28 days, although some studios recently switched to every 14.

If a test is positive, all the studios across the country that adhere to standards set by the Free Speech Coalition, an industry trade group, are obliged to stop filming until all the on-screen partners of that performer, all their partners, and all their partners’ partners, are found and retested. In 2004, the industry shut down for three months to do that.

It has had briefer shutdowns in each of the last four years.

In 2009 and 2010, no other infected performers were found. Coalition representatives said an infected woman in 2009, from Nevada, may have had an infected boyfriend, and offered evidence that a man infected in 2010 in Florida had worked outside the industry as a prostitute. The 2011 test was a false positive.

A shutdown in August came after several actors got syphilis, not H.I.V. All performers were given a choice: Take antibiotics, or pass two back-to-back syphilis tests 14 days apart.

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Unlikely Model for H.I.V. Prevention: Adult Film Industry

Stephanie Diani for The New York Times

INDUSTRY DATABASE Shylar Cobi, right, a film producer, confirmed test results of the actors who perform as James Deen and Stoya.

LOS ANGELES — Before they take off all their clothes, the actors who perform as James Deen and Stoya go through a ritual unique to the heterosexual adult film industry.

First, they show each other their cellphones: Each has an e-mail from a laboratory saying he or she just tested negative for H.I.V., syphilis, chlamydia and gonorrhea.

Then they sit beside the film’s producer, Shylar Cobi, as he checks an industry database with their real names to confirm that those negative tests are less than 15 days old.

Then, out on the pool terrace of the day’s set — a music producer’s hilltop home with a view of the Hollywood sign — they yank down their pants and stand around joking as Mr. Cobi quickly inspects their mouths, hands and genitals for sores.

“I’m not a doctor,” Mr. Cobi, who wears a pleasantly sheepish grin, says. “I’m only qualified to do this because I’ve been shooting porn since 1990 and I know what looks bad.”

Bizarre as the ritual is, it seems to work.

The industry’s medical consultants say that about 350,000 sex scenes have been shot without condoms since 2004, and H.I.V. has not been transmitted on a set once.

Outside the world of pornography, the industry’s testing regimen is not well known, and no serious academic study of it has ever been done. But when it was described to several AIDS experts, they all reacted by saying that there were far fewer infections than they would have expected, given how much high-risk sex takes place.

“I don’t think there’s any question that it works,” said Dr. Allan Ronald, a Canadian AIDS specialist who did landmark studies of the virus in prostitutes in a Nairobi slum. “I’m a little uncomfortable, because it’s giving the wrong message — that you can have multiple sex partners without condoms — but I can’t say it doesn’t work.”

Despite the regimen’s apparent success, California health officials and an advocacy group, the AIDS Healthcare Foundation, are trying to make it illegal to shoot without condoms. They argue that other sexually transmitted diseases are rampant in the industry, though the industry trade group disputes that.

In January, the city of Los Angeles passed a law requiring actors to wear condoms. A measure to do the same for the whole county is on the ballot on Tuesday.

Producers say the condom requirement will drive them out of business since consumers will not buy such films. Local newspapers like The Los Angeles Times oppose the ballot measure, calling it well-intentioned but unenforceable, and warning that it could drive up to 10,000 jobs out of state.

Very frequent testing makes it almost impossible for an actor to stay infected without being caught, said Dr. Jacques Pepin, the author of “The Origins of AIDS” and an expert on transmission rates. “And if you are having sex mostly with people who themselves are tested all the time, this must further reduce the risk.”

When the virus first enters a high-risk group like heroin users, urban prostitutes or habitués of gay bathhouses, it usually infects 30 to 60 percent of the cohort within a few years, studies have shown. The same would be expected in pornography, where performers can have more than a dozen partners a month, but the industry says self-policing has prevented it.

“Our talent base has sex exponentially more than other people, but we’re all on the same page about keeping it out,” said Steven Hirsch, the founder of Vivid Entertainment, one of the biggest studios.

Performers have to test negative every 28 days, although some studios recently switched to every 14.

If a test is positive, all the studios across the country that adhere to standards set by the Free Speech Coalition, an industry trade group, are obliged to stop filming until all the on-screen partners of that performer, all their partners, and all their partners’ partners, are found and retested. In 2004, the industry shut down for three months to do that.

It has had briefer shutdowns in each of the last four years.

In 2009 and 2010, no other infected performers were found. Coalition representatives said an infected woman in 2009, from Nevada, may have had an infected boyfriend, and offered evidence that a man infected in 2010 in Florida had worked outside the industry as a prostitute. The 2011 test was a false positive.

A shutdown in August came after several actors got syphilis, not H.I.V. All performers were given a choice: Take antibiotics, or pass two back-to-back syphilis tests 14 days apart.

Read More..

Egyptian Vigilantes Crack Down on Abuse of Women

Tara Todras-Whitehill for The New York Times

A self-appointed citizens patrol that tries to protect women on Cairo’s streets spray-painted a youth for identification last month.

CAIRO — The young activists lingered on the streets around Tahrir Square, scrutinizing the crowds of holiday revelers. Suddenly, they charged, pushing people aside and chasing down a young man. As the captive thrashed to get away, the activists pounded his shoulders, flipped him around and spray-painted a message on his back: “I’m a harasser.”

Egypt’s streets have long been a perilous place for women, who are frequently heckled, grabbed, threatened and violated while the police look the other way. Now, during the country’s tumultuous transition from authoritarian rule, more and more groups are emerging to make protecting women — and shaming the do-nothing police — a cause.

“They’re now doing the undoable?” a police officer joked as he watched the vigilantes chase down the young man. The officer quickly went back to sipping his tea.

The attacks on women did not subside after the uprising. If anything, they became more visible as even the military was implicated in the assaults, stripping female protesters, threatening others with violence and subjecting activists to so-called virginity tests. During holidays, when Cairenes take to the streets to stroll and socialize, the attacks multiply.

But during the recent Id al-Adha holiday, some of the men were surprised to find they could no longer harass with impunity, a change brought about not just out of concern for women’s rights, but out of a frustration that the post-revolutionary government still, like the one before, was doing too little to protect its citizens.

At least three citizens groups patrolled busy sections of central Cairo during the holiday. The groups’ members, both men and women, shared the conviction that the authorities would not act against harassment unless the problem was forced into the public debate. They differed in their tactics: some activists criticized others for being too quick to resort to violence against suspects and encouraging vigilantism.  One group leader compared the activists to the Guardian Angels in the United States.

“The harasser doesn’t see anyone who will hold him accountable,” said Omar Talaat, 16, who joined one of the patrols.

The years of President Hosni Mubarak’s rule were marked by official apathy, collusion in the assaults on women, or empty responses to the attacks, including police roundups of teenagers at Internet cafes for looking at pornography.

“The police did not take harassment seriously,” said Madiha el-Safty, a sociology professor at the American University in Cairo. “People didn’t file complaints. It was always underreported.”

Mr. Mubarak’s wife, Suzanne, who portrayed herself as a champion of women’s rights, pretended the problem hardly existed. As reports of harassment grew in 2008, she said, “Egyptian men always respect Egyptian women.”

Egypt’s new president, Mohamed Morsi, has presided over two holidays, and many activists say there is no sign that the government is paying closer attention to the problem. But the work by the citizens groups may be having an effect: Last week, after the Id al-Adha holiday, Mr. Morsi’s spokesman announced that the government had received more than 1,000 reports of harassment, and said that the president had directed the Interior Ministry to investigate them.

“Egypt’s revolution cannot tolerate these abuses,” the spokesman quoted Mr. Morsi as saying.

Azza Soliman, the director of the Center for Egyptian Women’s Legal Assistance, dismissed the president’s words as “weak.” During the holiday, she said, one of her sons was beaten on the subway after he tried to stop a man who was groping two foreign women. The police tried to stop him from filing a complaint. “The whole world is talking about harassment in our country,” Ms. Soliman said. “The Interior Ministry takes no action.”

For years, anti-harassment activists have worked to highlight the problems in Egypt, but the uprising seemed to give the effort more energy and urgency.

Asmaa Al Zohairy contributed reporting.

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A Media Vow of Election Night Restraint Despite Social Media Clamor

This has been the year of the big media gaffe.

NBC News edited a 911 tape of George Zimmerman in a way that implied race as a factor in the Trayvon Martin shooting. CNN and Fox News falsely reported that the Supreme Court had struck down the individual mandate at the heart of the Obama administration’s health care law. ABC News wrongly suggested a link between a mass shooting in Colorado and the Tea Party. Just last week during the storm, CNN repeated a false rumor about flooding at the New York Stock Exchange.

Now the media are gearing up for election night, the finale of the year’s biggest story. It’s a chance to regain some credibility — presuming, of course, that television networks and other news organizations get their state-by-state projections right. They all say they will, still mindful of the mistakes made in 2000, when the networks prematurely called Florida for Al Gore and then George W. Bush.

The same precautions that were put in place after 2000 will be in place again this Tuesday. At NBC, for instance, the statisticians at the “decision desk” that makes projections “are literally sealed off from the rest of us,” said Mark Lukasiewicz, the senior vice president of specials for NBC News.

Different this time will be the level of noise on the Web, where armchair and professional pundits alike will react to the election results in real time. On election night in 2008, a few Web sites, including Slate and Time.com, stated the obvious — that Barack Obama was going to win the presidency — well before the TV networks and major newspapers said so. In large part that’s because the networks and newspapers were waiting for the polls to close on the West Coast.

They will abide by the same principle again on Tuesday night, ruling out any such pronouncement before 11 p.m. Eastern. But more Web sites and individual users will most likely try to call the race early, creating a cacophony on social networking sites like Facebook and Twitter.

A memo on Saturday to employees of The Associated Press, the country’s biggest news wire service, asked them to refrain from adding to the noise by posting to Twitter about other news outlets’ calls. “If A.P. has not called a particular state or race, it’s because we have specifically decided not to, based on the expertise and data we have spent years developing,” the memo read.

In calling a state for Mr. Obama or Mitt Romney, news organizations will consider several data sources, including exit poll results and raw vote totals — “a brain trust of data,” said Ingrid Ciprian-Matthews, the vice president for news for CBS News.

Executives at the major networks said in interviews that they don’t expect to be able to project a winner at 11 p.m. this year, given the closeness of the presidential race in several swing states. “I’m not even going to guess what time it will be,” said Marc Burstein, the senior executive producer for special events at ABC News. He predicted an abundance of caution this year because of the trend of early voting in many states.

For election night ABC is uniquely situated in Times Square, which filled up with supporters of Mr. Obama on election night in 2008. This time, too, “I expect a gigantic crowd,” Mr. Burstein said. NBC is expecting the same at Rockefeller Plaza, which it has re-christened Democracy Plaza with exhibits and video screens, just as it did in 2004 and 2008.

All of the executives interviewed said they would be entirely comfortable making projections after their competitors. “In a close contest, we’ll simply wait,” said Sam Feist, the Washington bureau chief for CNN. And all of them cited the journalism chestnut that it’s better to be right than first. “It’s always lovely when the two coincide,” said Ms. Ciprian-Matthews of CBS, “but everybody here is absolutely on the same page: accuracy comes first.”

Fox News did not respond to an interview request.

CNN, which was criticized for crowding its studio with anchors and analysts in 2008, will have more reporters in the field this time, including a half-dozen in Ohio alone. Reprising what it called “ballot cams” on primary nights, CNN will have crews at “key voting and vote-counting locations” in battleground states, Mr. Feist said.

“We proved during the primaries that doing real reporting on those nights can make a difference,” he said.

No matter the outcome, some partisans will claim that the election is illegitimate, if the election year rhetoric is to be believed. Continuing an effort that started in 2004, networks and other news outlets will ask the public to alert them to voter irregularities and allegations of voter suppression. “We have an entire team working on those stories,” Mr. Lukasiewicz of NBC said.

Dozens of news and opinion Web sites will offer essentially live coverage on election night, some with TV-like newscasts and others with live blogs. But the biggest audiences are still expected to tune to the big three broadcast networks, ABC, CBS and NBC, and the big three cable news networks, Fox News, MSNBC and CNN.

Four years ago, Brian Williams was the anchor on NBC, Charles Gibson on ABC and Katie Couric on CBS. Mr. Williams is back for his second presidential election night as anchor, but Mr. Gibson, who retired three years ago, will not; heading the coverage instead will be the pair that sat alongside him in 2008, Diane Sawyer and George Stephanopoulos. Ms. Couric, now of ABC, will join them from time to time with social media reaction — a role that did not exist on the network’s coverage last time.

On CBS, Scott Pelley will anchor his first presidential election night. It’s also the first time for Rachel Maddow, on MSNBC, and Bret Baier and Megyn Kelly, on Fox News. On PBS, Gwen Ifill and Judy Woodruff will make up national television’s first two-woman anchor team on election night.

Half a dozen smaller channels will also have hours of live election talk, as will countless local stations — paid for in part by the revenue from innumerable election ads. Discussing the extent of the coverage, Mr. Feist of CNN said, “You cannot find an available high-definition satellite path for Tuesday night in this country. There are none left. The country is at capacity.”

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Chelation Therapy Shows Slight Benefit in Heart Disease Clinical Trial

LOS ANGELES — To the surprise of many cardiologists, a controversial alternative therapy proved beneficial to people with heart disease, reducing the rate of death and cardiovascular problems in a clinical trial, researchers said on Sunday.

The benefit of the treatment, known as chelation therapy, barely reached statistical significance, and there were questions about the reliability of the study. Even the investigators in the trial said the results were insufficient by themselves to justify recommending use of the treatment.

Still, the unexpected finding should provide some vindication to the National Institutes of Health for sponsoring the $30 million study, which was plagued by delays and problems.

“There may be a biological effect and that biological effect should be taken seriously,” and “pursued with additional research,” Dr. Gervasio A. Lamas of Mount Sinai Medical Center in Miami, the lead investigator, said at a news conference here at the annual scientific meeting of the American Heart Association.

Dr. Elliott Antman, representing the heart association, applauded the National Institutes of Health for sponsoring the study while also expressing caution. “Intriguing as these results are, they are unexpected and should not be interpreted as an indication to adopt chelation therapy into clinical practice,” said Dr. Antman, a cardiologist at Brigham and Women’s Hospital in Boston.

Chelation therapy involves the infusion of agents that remove metals from the bloodstream.

More than 100,000 Americans with heart disease undergo chelation therapy each year, at a cost of about $5,000 per course of treatment, experts here said. The hypothesis is that chelation can remove the calcium that is a contributor to arterial plaques.

But skeptics said there was not enough evidence backing chelation therapy to even begin a clinical trial. Proponents of the study said that since chelation therapy was already widely used, it should be subject to the same rigorous scientific testing used to study conventional pharmaceuticals.

And some skeptics were not persuaded at all. Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, said the study was “fatally flawed,” with many of the doctors involved being on the fringes of medicine and many patients dropping out of the trial. He said if people got the mistaken idea from the study that chelation was beneficial “it would be a public health catastrophe.”

The study, which began enrolling patients in 2003, was plagued by problems from the start. It fell way behind its goal of recruiting nearly 2,400 patients in three years. The trial was also suspended in 2008 for investigations by government agencies, one over conduct at trial sites and the other about whether patients were being adequately informed that chelation can cause death. The study was allowed to resume the next year, after some changes were made.

The trial ended up with 1,708 patients at 134 centers in the United States and Canada. The patients all had had previous heart attacks.

Half the patients received the chelation therapy, a synthetic amino acid called disodium ethylene diamine tetra acetic acid, or EDTA, as well as other substances. These were given by infusion every week for 30 weeks, followed by 10 more infusions at intervals of two to eight weeks. The other half received infusions of placebo.

After a follow-up of 55 months, 26 percent of those who received chelation therapy had died, suffered a heart attack or stroke, had a procedure to reopen a coronary artery or had been hospitalized for angina. That was less than the 30 percent for those who received a placebo, a difference that was barely statistically significant.

Doctors said there were reasons for caution.

Virtually all the of difference between the treatment and the placebo groups occurred in the third of patients who had diabetes. The placebo contained some sugar, which conceivably could have harmed the diabetics. Also, at least within the first two years, the chelation therapy did not improve physical functioning or psychological well being, according to surveys of the patients.

Dr. Mark A. Creager, a cardiologist at Brigham and Women’s Hospital who was not involved in the study, said the chelation infusion also contained a high dose of vitamin C and the blood thinner heparin. It could be that one of those ingredients, not the chelation agent, were responsible for any benefit, he said.

Dr. Lamas, the lead investigator, said the chelation treatment was well tolerated. But he said investigators did not yet know why some patients receiving the therapy dropped out of the trial.

Another study presented at the heart meeting on Sunday found coronary bypass surgery superior to the use of stents for patients with diabetes and multiple heart blockages.

The trial involved 1,900 patients followed for five yeas. About 27 percent of those who received stents either died or had a heart attack or stroke, compared with about 19 percent of those undergoing bypass surgery. There was an increase in stroke risk with surgery, but that was outweighed by fewer deaths and heart attacks.

Previous studies had already suggested that surgery was better for diabetic patients with severe coronary disease, and practice guidelines already say it is “reasonable” to choose surgery. But the new study, sponsored by the National Institutes of Health, shows the same result even using modern drug-covered stents.

About 700,000 Americans undergo artery opening procedures for more than one blood vessel each year, and about 25 percent of them have diabetes, according to the investigators.

The study results were also published online by the New England Journal of Medicine. Johnson & Johnson and Boston Scientific provided the stents used in the study.

Read More..

Chelation Therapy Shows Slight Benefit in Heart Disease Clinical Trial

LOS ANGELES — To the surprise of many cardiologists, a controversial alternative therapy proved beneficial to people with heart disease, reducing the rate of death and cardiovascular problems in a clinical trial, researchers said on Sunday.

The benefit of the treatment, known as chelation therapy, barely reached statistical significance, and there were questions about the reliability of the study. Even the investigators in the trial said the results were insufficient by themselves to justify recommending use of the treatment.

Still, the unexpected finding should provide some vindication to the National Institutes of Health for sponsoring the $30 million study, which was plagued by delays and problems.

“There may be a biological effect and that biological effect should be taken seriously,” and “pursued with additional research,” Dr. Gervasio A. Lamas of Mount Sinai Medical Center in Miami, the lead investigator, said at a news conference here at the annual scientific meeting of the American Heart Association.

Dr. Elliott Antman, representing the heart association, applauded the National Institutes of Health for sponsoring the study while also expressing caution. “Intriguing as these results are, they are unexpected and should not be interpreted as an indication to adopt chelation therapy into clinical practice,” said Dr. Antman, a cardiologist at Brigham and Women’s Hospital in Boston.

Chelation therapy involves the infusion of agents that remove metals from the bloodstream.

More than 100,000 Americans with heart disease undergo chelation therapy each year, at a cost of about $5,000 per course of treatment, experts here said. The hypothesis is that chelation can remove the calcium that is a contributor to arterial plaques.

But skeptics said there was not enough evidence backing chelation therapy to even begin a clinical trial. Proponents of the study said that since chelation therapy was already widely used, it should be subject to the same rigorous scientific testing used to study conventional pharmaceuticals.

And some skeptics were not persuaded at all. Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, said the study was “fatally flawed,” with many of the doctors involved being on the fringes of medicine and many patients dropping out of the trial. He said if people got the mistaken idea from the study that chelation was beneficial “it would be a public health catastrophe.”

The study, which began enrolling patients in 2003, was plagued by problems from the start. It fell way behind its goal of recruiting nearly 2,400 patients in three years. The trial was also suspended in 2008 for investigations by government agencies, one over conduct at trial sites and the other about whether patients were being adequately informed that chelation can cause death. The study was allowed to resume the next year, after some changes were made.

The trial ended up with 1,708 patients at 134 centers in the United States and Canada. The patients all had had previous heart attacks.

Half the patients received the chelation therapy, a synthetic amino acid called disodium ethylene diamine tetra acetic acid, or EDTA, as well as other substances. These were given by infusion every week for 30 weeks, followed by 10 more infusions at intervals of two to eight weeks. The other half received infusions of placebo.

After a follow-up of 55 months, 26 percent of those who received chelation therapy had died, suffered a heart attack or stroke, had a procedure to reopen a coronary artery or had been hospitalized for angina. That was less than the 30 percent for those who received a placebo, a difference that was barely statistically significant.

Doctors said there were reasons for caution.

Virtually all the of difference between the treatment and the placebo groups occurred in the third of patients who had diabetes. The placebo contained some sugar, which conceivably could have harmed the diabetics. Also, at least within the first two years, the chelation therapy did not improve physical functioning or psychological well being, according to surveys of the patients.

Dr. Mark A. Creager, a cardiologist at Brigham and Women’s Hospital who was not involved in the study, said the chelation infusion also contained a high dose of vitamin C and the blood thinner heparin. It could be that one of those ingredients, not the chelation agent, were responsible for any benefit, he said.

Dr. Lamas, the lead investigator, said the chelation treatment was well tolerated. But he said investigators did not yet know why some patients receiving the therapy dropped out of the trial.

Another study presented at the heart meeting on Sunday found coronary bypass surgery superior to the use of stents for patients with diabetes and multiple heart blockages.

The trial involved 1,900 patients followed for five yeas. About 27 percent of those who received stents either died or had a heart attack or stroke, compared with about 19 percent of those undergoing bypass surgery. There was an increase in stroke risk with surgery, but that was outweighed by fewer deaths and heart attacks.

Previous studies had already suggested that surgery was better for diabetic patients with severe coronary disease, and practice guidelines already say it is “reasonable” to choose surgery. But the new study, sponsored by the National Institutes of Health, shows the same result even using modern drug-covered stents.

About 700,000 Americans undergo artery opening procedures for more than one blood vessel each year, and about 25 percent of them have diabetes, according to the investigators.

The study results were also published online by the New England Journal of Medicine. Johnson & Johnson and Boston Scientific provided the stents used in the study.

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Gadgetwise Blog: Q&A: Declining a Kindle's Special Offers

How do I turn off the ads on my Kindle e-reader?

If you purchased a Kindle labeled “With Special Offers,” you bought a model that was discounted because of the advertisements shown on the reader’s screen saver and along the bottom of the home screen. If you want to remove the ads, you can do so — but Amazon requires you to make up the price difference (usually $15 to $30, depending on the model) between what you paid for a “Special Offers” Kindle and the same model that was more expensive, but ad-free.

To turn off the ads (or as Amazon calls it, “unsubscribe from special offers”), log onto the Manage Your Kindle page with your Amazon user name and password. In the Manage Your Devices area, find your Kindle model and click the plus (+) icon to show additional details. In the Special Offers area, click Edit and follow along to turn off the ads. You should see how much the bill will be for turning off the advertisements.

When you have adjusted your Kindle preferences online, connect the e-reader to your wireless network so it can update itself. Amazon will then send you an e-mail notification to confirm that you have opted out and paid for it.

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Coptic Church Chooses Pope Who Rejects Politics

Tara Todras-Whitehill for The New York Times

Coptic clergymen at a ceremony on Sunday for choosing a pope.

CAIRO — A blindfolded 6-year-old reached into a glass bowl on Sunday to pick the first new Coptic pope in more than 40 years, a patriarch who promises a new era of integration for Egypt’s Christian minority as it grapples with a wave of sectarian violence, new Islamist domination of politics, and internal pressures for reform.

Tara Todras-Whitehill for The New York Times

The acting Coptic pope, before a banner of Bishop Tawadros, held up the names of other candidates to show that the selection was fair.

Speaking to the television cameras that surrounded him at his monastery in a desert town, the pope-designate, Bishop Tawadros, indicated that he planned to reverse the explicitly political role of his predecessor, Pope Shenouda III, who died in March. For four decades, Shenouda acted as the Copts’ chief representative in public life, won special favors for his flock by publicly endorsing President Hosni Mubarak, and last year urged in vain that Copts stay away from the protests that ultimately toppled the strongman.

“The most important thing is for the church to go back and live consistently within the spiritual boundaries because this is its main work, spiritual work,” the bishop said, and he promised to begin a process of “rearranging the house from the inside” and “pushing new blood” after his installation later this month as Pope Tawadros II. Interviewed on Coptic television recently, he struck a new tone by including as his priorities “living with our brothers, the Muslims” and “the responsibility of preserving our shared life.”

“Integrating in the society is a fundamental scriptural Christian trait,” Bishop Tawadros said then. “This integration is a must — moderate constructive integration,” he added. “All of us, as Egyptians, have to participate.”

Coptic activists and intellectuals said the turn away from politics signaled a sweeping transformation in the Christian minority’s relationship to the Egyptian state but also addressed a firm demand by the Christian laity to claim a voice in a more democratic Egypt.

“It can’t continue the way it used to be,” said Youssef Sidhom, editor of the Coptic newspaper Watani. “It is not in the interests of the Copts, if they are trying to speak for themselves as full and equal citizens, to have an intermediary speaking for them, and especially if he is a religious authority. I think the church has gotten this message loud and clear.”

In Egypt’s first free elections for Parliament and president, Christians voted overwhelmingly along sectarian lines, seeking to pool their votes around the most secular candidates — only to see their favorites fall under the Islamist tide. After the Muslim Brotherhood’s political party won parliamentary leadership and then the presidency, many Egyptians joked that the group put a candidate up for Coptic pope, too.

In recent interviews, intellectuals and activists, and churchgoers leaving Mass after the selection of the pope, all said they had concluded that Christians would have to build alliances with Muslims who shared their goal of nonsectarian citizenship.

“We are not the Muslim Brotherhood,” said Tarek Samir, a sales manager leaving the cathedral after the selection of Bishop Tawadros. “Politics is a dirty word to us, and we do not think it should be mixed with religion. But there are moderate Muslims who live the same life we do, who go to work with us, who live together with us, and if I am in trouble they will help me.”

Copts, often estimated to make up about 10 percent of Egypt’s 80 million people, trace their roots here to centuries before the birth of the Prophet Muhammad. They consider St. Mark their first pope; Tawadros II will be the 118th. In some ways, they are now at the spearhead of a challenge confronting Christian minorities across the region amid the tumult of the Arab Spring. In Iraq, Lebanon, Syria and elsewhere, Christian minorities had made peace with authoritarian rulers in the hope of protection from the Muslim majorities. But now the old bargains have broken, leaving Christians to fend for themselves.

In Egypt, the revolution last year coincided with by far the deadliest 12 months of sectarian violence in decades, including the bombing of an Alexandria church weeks before the revolt, the destruction of at least three churches in sectarian feuds, and the killing of about two dozen Coptic demonstrators by Egyptian soldiers squashing a protest — the single bloodiest episode of sectarian violence in at least half a century.

Known as the Maspero massacre after a nearby television building, the slaughter elicited attempts by top generals to blame the Copts and scant sympathy from the main Islamist groups, crystallizing Coptic anxieties.

Mayy El Sheikh and Mai Ayyad contributed reporting.

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Google Casts a Big Shadow on Smaller Web Sites

Annie Tritt for The New York Times

Jeffrey G. Katz, the chief executive of Wize Commerce, seen with employees. He says that about 60 percent of the traffic for the company’s Nextag comparison-shopping site comes from Google.

In a geeky fire drill, engineers and outside consultants at Nextag scrambled to see if the problem was its own fault. Maybe some inadvertent change had prompted Google’s algorithm to demote Nextag when a person typed in shopping-related search terms like “kitchen table” or “lawn mower.”

But no, the engineers determined. And traffic from Google’s search engine continued to decline, by half.

Nextag’s response? It doubled its spending on Google paid search advertising in the last five months.

The move was costly but necessary to retain shoppers, Mr. Katz says, because an estimated 60 percent of Nextag’s traffic comes from Google, both from free search and paid search ads, which are ads that are related to search results and appear next to them. “We had to do it,” says Mr. Katz, chief executive of Wize Commerce, owner of Nextag. “We’re living in Google’s world.”

Regulators in the United States and Europe are conducting sweeping inquiries of Google, the dominant Internet search and advertising company. Google rose by technological innovation and business acumen; in the United States, it has 67 percent of the search market and collects 75 percent of search ad dollars. Being big is no crime, but if a powerful company uses market muscle to stifle competition, that is an antitrust violation.

So the government is focusing on life in Google’s world for the sprawling economic ecosystem of Web sites that depend on their ranking in search results. What is it like to live this way, in a giant’s shadow? The experience of its inhabitants is nuanced and complex, a blend of admiration and fear.

The relationship between Google and Web sites, publishers and advertisers often seems lopsided, if not unfair. Yet Google has also provided and nurtured a landscape of opportunity. Its ecosystem generates $80 billion a year in revenue for 1.8 million businesses, Web sites and nonprofit organizations in the United States alone, it estimates.

The government’s scrutiny of Google is the most exhaustive investigation of a major corporation since the pursuit of Microsoft in the late 1990s.

The staff of the Federal Trade Commission has recommended preparing an antitrust suit against Google, according to people briefed on the inquiry, who spoke on the condition they not be identified. But the commissioners must vote to proceed. Even if they do, the government and Google could settle.

Google has drawn the attention of antitrust officials as it has moved aggressively beyond its dominant product — search and search advertising — into fields like online commerce and local reviews. The antitrust issue is whether Google uses its search engine to favor its offerings like Google Shopping and Google Plus Local over rivals.

For policy makers, Google is a tough call.

“What to do with an attractive monopolist, like Google, is a really challenging issue for antitrust,” says Tim Wu, a professor at Columbia Law School and a former senior adviser to the F.T.C. “The goal is to encourage them to stay in power by continuing to innovate instead of excluding competitors.”

SPEAKING at a Google Zeitgeist conference in Arizona last month, Larry Page, the company’s co-founder and chief executive, said he understood the government scrutiny of his company, given Google’s size and reach. “There’s very many decisions we make that really impact a lot of people,” he acknowledged.

The main reason is that Google is continually adjusting its search algorithm — the smart software that determines the relevance, ranking and presentation of search results, typically links to other Web sites.

Google says it makes the changes to improve its service, and has long maintained that its algorithm weeds out low-quality sites and shows the most useful results, whether or not they link to Google products.

“Our first and highest goal has to be to get the user the information they want as quickly and easily as possible,” says Matt Cutts, leader of the Web spam team at Google.

But Google’s algorithm is secret, and changes can leave Web sites scrambling.

Consider Vote-USA.org, a nonprofit group started in 2003. It provides online information for voters to avoid the frustration of arriving at a polling booth and barely recognizing half the names on the ballot. The site posts free sample ballots for federal, state and local elections with candidates’ pictures, biographies and views on issues.

In the 2004 and 2006 elections, users created tens of thousands of sample ballots. By 2008, traffic had fallen sharply, says Ron Kahlow, who runs Vote-USA.org, because “we dropped off the face of the map on Google.”

As founder of a search-engine optimization company and a recipient of grants that Google gives nonprofits to advertise free, Mr. Kahlow knows a thing or two about how to operate in Google’s world. He pored over Google’s guidelines for Web sites, made changes and e-mailed Google. Yet he received no response.

“I lost all donations to support the operation,” he said. “It was very, very painful.”

A breakthrough came through a personal connection. A friend of Mr. Kahlow knew Ed Black, chief executive of the Computer & Communications Industry Association, whose members include Google. Mr. Black made an inquiry on Mr. Kahlow’s behalf, and a Google engineer investigated.

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