DNA Analysis, More Accessible Than Ever, Opens New Doors

Matt Roth for The New York Times

Sam Bosley of Frederick, Md., going shopping with his daughter, Lillian, 13, who has a malformed brain and severe developmental delays, seizures and vision problems. More Photos »

Debra Sukin and her husband were determined to take no chances with her second pregnancy. Their first child, Jacob, who had a serious genetic disorder, did not babble when he was a year old and had severe developmental delays. So the second time around, Ms. Sukin had what was then the most advanced prenatal testing.

The test found no sign of Angelman syndrome, the rare genetic disorder that had struck Jacob. But as months passed, Eli was not crawling or walking or babbling at ages when other babies were.

“Whatever the milestones were, my son was not meeting them,” Ms. Sukin said.

Desperate to find out what is wrong with Eli, now 8, the Sukins, of The Woodlands, Tex., have become pioneers in a new kind of testing that is proving particularly helpful in diagnosing mysterious neurological illnesses in children. Scientists sequence all of a patient’s genes, systematically searching for disease-causing mutations.

A few years ago, this sort of test was so difficult and expensive that it was generally only available to participants in research projects like those sponsored by the National Institutes of Health. But the price has plunged in just a few years from tens of thousands of dollars to around $7,000 to $9,000 for a family. Baylor College of Medicine and a handful of companies are now offering it. Insurers usually pay.

Demand has soared — at Baylor, for example, scientists analyzed 5 to 10 DNA sequences a month when the program started in November 2011. Now they are doing more than 130 analyses a month. At the National Institutes of Health, which handles about 300 cases a year as part of its research program, demand is so great that the program is expected to ultimately take on 800 to 900 a year.

The test is beginning to transform life for patients and families who have often spent years searching for answers. They can now start the grueling process with DNA sequencing, says Dr. Wendy K. Chung, professor of pediatrics and medicine at Columbia University.

“Most people originally thought of using it as a court of last resort,” Dr. Chung said. “Now we can think of it as a first-line test.”

Even if there is no treatment, there is almost always some benefit to diagnosis, geneticists say. It can give patients and their families the certainty of knowing what is wrong and even a prognosis. It can also ease the processing of medical claims, qualifying for special education services, and learning whether subsequent children might be at risk.

“Imagine the people who drive across the whole country looking for that one neurologist who can help, or scrubbing the whole house with Lysol because they think it might be an allergy,” said Richard A. Gibbs, the director of Baylor College of Medicine’s gene sequencing program. “Those kinds of stories are the rule, not the exception.”

Experts caution that gene sequencing is no panacea. It finds a genetic aberration in only about 25 to 30 percent of cases. About 3 percent of patients end up with better management of their disorder. About 1 percent get a treatment and a major benefit.

“People come to us with huge expectations,” said Dr. William A. Gahl, who directs the N.I.H. program. “They think, ‘You will take my DNA and find the causes and give me a treatment.' ”

“We give the impression that we can do these things because we only publish our successes,” Dr. Gahl said, adding that when patients come to him, “we try to make expectations realistic.”

DNA sequencing was not available when Debra and Steven Sukin began trying to find out what was wrong with Eli. When he was 3, they tried microarray analysis, a genetic test that is nowhere near as sensitive as sequencing. It detected no problems.

“My husband and I looked at each other and said, ‘The good news is that everything is fine; the bad news is that everything is not fine,' ” Ms. Sukin said.

In November 2011, when Eli was 6, Ms. Sukin consulted Dr. Arthur L. Beaudet, a medical geneticist at Baylor.

“Is there a protein missing?” she recalled asking him. “Is there something biochemical we could be missing?”

By now, DNA sequencing had come of age. Dr. Beaudet said that Eli was a great candidate, and it turned out that the new procedure held an answer.

A single DNA base was altered in a gene called CASK, resulting in a disorder so rare that there are fewer than 10 cases in all the world’s medical literature.

“It really became definitive for my husband and me,” Ms. Sukin said. “We would need to do lifelong planning for dependent care for the rest of his life.”

This article has been revised to reflect the following correction:

Correction: February 19, 2013

An earlier version of this article misstated the name of a medicine taken by two teenagers who have a rare gene mutation. The drug is 5-hydroxytryptophan, not 5-hydroxytryptamine.

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Dell’s Revenue Falls 11 Percent

SAN FRANCISCO (Reuters) - Dell Inc on Tuesday reported a 31 percent drop in profit, hurt by a shrinking consumer business, as investors weighed founder Michael Dell's offer to buy out the world's No.3 maker of personal computers.

Michael Dell, teaming up with private equity firm Silver Lake and software maker Microsoft, is offering $13.65 a share to buy out the company, but at least four of its largest investors are opposed to the $24.4 billion deal.

The founder and CEO did not join in management discussion of the results in a conference call with analysts, given his participation in the buyout. Dell executives also did not comment on the buyout.

Analysts said Dell's rapidly shrinking business and murky prospects in a declining PC market may make the buyout a more attractive option for investors tired of waiting for a turnaround.

Since news of the proposed buyout emerged in January, the stock has gained almost 30 percent - a rally that analysts say may evaporate should the deal fall through.

On Tuesday, the company said sales across every business line, except servers and networking, declined in the fiscal fourth quarter. Revenue from servers and networking climbed 18 percent, driven by its datacenter business and revenue from recently acquired companies such as Quest Software and Sonic Wall.

Overall, however, revenue slid 11 percent.

"There isn't anything really to be super excited about," Brian Marshall, analyst with ISI Group, said, adding that declining revenue and profit doesn't bode well for the company.

"The (buyout) deal makes sense. It will go through," he said. "They will probably have to pay a little more than $13.65 to get it done but at the end of the day there aren't a lot of options out there."

The company gave no financial forecast for fiscal 2014 or the fiscal first quarter, citing the proposed buyout.

The company reiterated that it plans to file a proxy statement with the U.S. securities regulators on the merger agreement but made no other reference to the buyout in its earnings release.

Shareholders representing almost 14 percent of Dell shares not held by Michael Dell have now said they will vote against the deal. The billionaire, who created the computer maker from his college dorm room in 1984, holds a roughly 16 percent stake and needs a majority of shareholders - excluding him - to vote for the deal.

Some are holding out hope for a higher offer. Peter Misek, analyst with Jefferies, said a bumped-up offer of about $15 per share was a "fair price."

"The better-than-expected results means that's the fair thing to do, in our opinion, is to raise the bid to a price where current shareholders reap some of the rewards while the take-private consortium enjoys the prospect of a respectable return," Misek said.

SLIDING PC SALES

Dell posted net income of $530 million, or 30 cents a share, in its fiscal fourth quarter on revenue of $14.3 billion. That came in slightly higher than the average analyst estimate of revenue of $14.12 billion, according to Thomson Reuters I/B/E/S.

Excluding certain items, it earned 40 cents a share, compared to an average forecast for 39 cents.

Shares of the company edged 0.5 percent higher in after-hours trade to $13.87, from a close of $13.805 on the Nasdaq.

Dell has said it plans to stick to its current turnaround strategy to diversify away from personal computers following the buyout.

The company, once regarded as a model of innovation in the early 2000s for pioneering online ordering of custom-configured PCs, missed the big industry shift to tablet computers, smartphones and high-powered consumer electronics such as music players.

It is also had to defend its market share against hard-charging Asian rivals like Lenovo.

Dell has lost 40 percent of its value since last year's peak and is trying to reinvent itself as a seller of services to corporations - an internal overhaul that some analysts say may be better conducted away from public scrutiny.

The company, was also hurt by the slide in holiday-season sales of personal computers for the first time in more than five years despite the launch of Microsoft Corp's new Windows 8 operating system.

Dell's worldwide PC shipments fell nearly 21 percent to 9.48 million in the last three months of 2012 from 11.97 million in the same period a year ago, according to IDC.

The bright spot for Dell was its growing sales of its enterprise solutions and services revenue, which rose 6 percent to $5.2 billion, and accounted for 34 percent of revenue for fiscal year.

In contrast, consumer revenue plummeted 24 percent to $2.8 billion, underscoring the plight of the broader PC market while sales to large corporations declined 7 percent to $4.7 billion in the quarter.

Dell said it was seeing growth in tablets and low-end desktops and notebooks. It ended fiscal 2013 with $15.3 billion in cash and investments.

(Reporting by Poornima Gupta; Editing by Dale Hudson, Bernard Orr)

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For His Second Act, Japanese Premier Plays It Safe, With Early Results

Toru Hanai/Reuters

Prime Minister Shinzo Abe, whose policies have sent the Tokyo stock market up, will visit Washington this week.

TOKYO — Since taking office less than two months ago, Japan’s outspokenly hawkish new prime minister, Shinzo Abe, has been in what some political analysts are calling “safe driving mode.” He has carefully avoided saying or doing anything to provoke other Asian nations, while focusing instead on wooing voters with steps to revive the moribund domestic economy.

So far, his approach seems to be working. His plans for public-works projects, stimulus measures called “Abenomics,” have sent the Tokyo stock market surging along with Mr. Abe’s own approval rating, which is now at 71 percent, according to the latest poll by Yomiuri Shimbum. On Friday, he will seek to build on his strong start when he meets President Obama at a Washington summit meeting aimed at improving relations with the United States, which regards Japan as its most important ally in Asia.

Mr. Abe, 58, has said he wants to be what Japan has not seen in almost a decade: a steady-handed leader who lasts long enough in office to actually get things done. Analysts say his success hinges on whether he can lead his Liberal Democratic Party to victory in Upper House elections in July, and end the split Parliament that undermined many of his predecessors.

What is less clear is what he will do if he wins that election. One trait that makes Mr. Abe a bit of an enigma, some analysts say, is that he seems to have two sides: the realist and the right-wing ideologue. In analysts’ view, if he does jettison some of his current caution, for instance by trying to revise Japan’s antiwar Constitution to allow a full-fledged military instead of its current Self-Defense Force, he risks provoking a standoff with China over disputed islands, and possibly isolating Japan in a region still sensitive to its early-20th-century militarism.

“In his first six weeks, he has done everything he can to show he is a moderate,” said Andrew L. Oros, director of international studies at Washington College in Chestertown, Md. “But after July, he might feel he has a freer rein to do things that he thinks are justified.”

Part of the problem, Mr. Oros and others say, is that Mr. Abe faces conflicting political pressures. His base in the governing party’s most conservative wing expects bold steps to end what it sees as Japan’s overly prolonged displays of contrition for World War II. But he must also convince the broader public that he is a coolheaded, competent steward of a declining nation that also depends on China for its economic future.

There is also the ghost of his past failure. The last time he was prime minister, six years ago, he stepped down amid criticism that he had been “clueless” for having pursued a nationalistic agenda of revising the Constitution and history textbooks, and for not doing more to reduce unemployment and spur the economy.

This time, Mr. Abe is acting with the determined carefulness of a man given a second chance. He has focused on extricating Japan from its recession with steps that have quickly buoyed the country’s economy, the world’s third-largest. Since being named prime minister after his party’s election victory in December, Mr. Abe has promised $215 billion in public works spending to create jobs and promote growth.

He has also publicly pressured the central bank, the Bank of Japan, to move more aggressively to end years of corrosive price declines known as deflation — threatening, for example, to amend the law on the bank’s independence if it does not reach its target of 2 percent inflation. The bank’s governor, Masaaki Shirakawa, announced this month that he would step aside to allow Mr. Abe to appoint a new chief who will work more closely with the government by pumping more money into the economy to prompt banks to lend more and companies to spend more.

“Mr. Abe has clearly learned the lessons of his past failure,” said Norihiko Narita, a political scientist at Surugadai University, near Tokyo. “And the biggest lesson is that voters care more about the economy.”

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Jerry Buss, Lakers' flamboyant owner, dies at 80

Jerry Buss built a glittering life at the intersection of sports and Hollywood.

After growing up in poverty in Wyoming, he earned success in academia, aerospace and real estate before discovering his favorite vocation when he bought the Los Angeles Lakers in 1979. While Buss wrote the checks and fostered partnerships with two generations of basketball greats, the Lakers won 10 NBA titles and became a glamorous worldwide brand.

With a scientist's analytical skills, a playboy's flair, a businessman's money-making savvy and a die-hard hoops fan's heart, Buss fashioned the Lakers into a remarkable sports entity. They became a nightly happening, often defined by just one word coined by Buss: Showtime.

"His impact is felt worldwide," said Kobe Bryant, who has spent nearly half his life working for Buss.

Buss, who shepherded his NBA team from the Showtime dynasty of the 1980s to the current Bryant era while becoming one of the most important and successful owners in pro sports, died Monday. He was 80.

"Think about the impact that he's had on the game and the decisions he's made, and the brand of basketball he brought here with Showtime and the impact that had on the sport as a whole," Bryant said a few days ago. "Those vibrations were felt to a kid all the way in Italy who was 6 years old, before basketball was even global."

Under Buss' leadership, the Lakers became Southern California's most beloved sports franchise and a worldwide extension of Los Angeles glamour. Buss acquired, nurtured and befriended a staggering array of talented players and basketball minds during his Hall of Fame tenure, from Magic Johnson and Kareem Abdul-Jabbar to Bryant, Shaquille O'Neal and Dwight Howard.

Few owners in sports history can approach Buss' accomplishments with the Lakers, who made the NBA finals 16 times during his nearly 34 years in charge, winning 10 titles between 1980 and 2010. Whatever the Lakers did under Buss' watch, they did it big — with marquee players, eye-popping style and a relentless pursuit of success.

"His incredible commitment and desire to build a championship-caliber team that could sustain success over a long period of time has been unmatched," said Jerry West, Buss' longtime general manager and now a consultant with the Golden State Warriors. "With all of his achievements, Jerry was without a doubt one of the most humble men I've ever been around. His vision was second to none; he wanted an NBA franchise brand that represented the very best and went to every extreme to accomplish his goals."

Buss died at Cedars-Sinai Medical Center in Los Angeles, said Bob Steiner, his assistant and longtime friend. Buss had been hospitalized for most of the past 18 months while undergoing cancer treatment, but the immediate cause of death was kidney failure, Steiner said.

"Anybody associated with the NBA since 1980 benefited greatly from Jerry Buss' impact on the game," Steiner said. "He had a different way of looking at things than I did, and people who had been raised in basketball."

With his condition worsening in recent months, several prominent former Lakers visited Buss to say goodbye. Buss' list of basketball friends is long and stellar, with Johnson citing him as a role model and nearly all former Lakers considering him a friend.

"He was a great man and an incredible friend," Johnson tweeted.

Buss always referred to the Lakers as his extended family, and his players rewarded his fanlike excitement with devotion, friendship and two hands full of championship rings. Working with front-office executives West, Bill Sharman and Mitch Kupchak, Buss spent lavishly to win his titles despite lacking a huge personal fortune, often running the NBA's highest payroll while also paying high-profile coaches Pat Riley and Phil Jackson.

With 1,786 victories, the Lakers easily are the NBA's winningest franchise since he bought the club, which is now run largely by Jim Buss and Jeanie Buss, two of his six children.

"We not only have lost our cherished father, but a beloved man of our community and a person respected by the world basketball community," the Buss family said in a statement issued by the Lakers.

"It was our father's often-stated desire and expectation that the Lakers remain in the Buss family. The Lakers have been our lives as well, and we will honor his wish and do everything in our power to continue his unparalleled legacy."

Johnson and fellow Hall of Famers Abdul-Jabbar and Worthy formed lifelong bonds with Buss during the Lakers' run to five titles in nine years in the 1980s, when the Lakers earned a reputation as basketball's most exciting team with their flamboyant Showtime repartee.

The buzz extended throughout the Forum, where Buss used the Laker Girls, a brass band and promotions to keep Lakers fans interested in all four quarters of their games. Courtside seats, priced at $15 when he bought the Lakers, became the hottest tickets in Hollywood — and they still are, with fixture Jack Nicholson and many other celebrities attending every home game.

Worthy tweeted that Buss was "not only the greatest sports owner, but a true friend & just a really cool guy. Loved him dearly."

After a rough stretch of the 1990s for the Lakers, Jackson led O'Neal and Bryant to a three-peat from 2000-02, rekindling the Lakers' mystique, before Bryant and Pau Gasol won two more titles under Jackson in 2009 and 2010. The Lakers have struggled mightily during their current season despite adding Howard and Steve Nash, and could miss the playoffs for just the third time since Buss bought the franchise.

"Today is a very sad day for all the Lakers and basketball," Gasol tweeted. "All my support and condolences to the Buss family. Rest in peace Dr. Buss."

Always an innovative businessman, Buss paid for the Lakers through both their wild success and his groundbreaking moves to raise revenue. He co-founded a basic-cable sports television network and sold the naming rights to the Forum at times when both now-standard strategies were unusual, further justifying his induction to the Naismith Memorial Basketball Hall of Fame in 2010.

"The NBA has lost a visionary owner whose influence on our league is incalculable and will be felt for decades to come," NBA Commissioner David Stern said. "More importantly, we have lost a dear and valued friend."

Although Buss gained fame and another fortune with the Lakers, he also was a scholar, Renaissance man and bon vivant who epitomized California cool his entire public life.

Buss rarely appeared in public without at least one attractive, much younger woman on his arm — at USC football games, high-stakes poker tournaments, hundreds of boxing matches promoted by Buss at the Forum — and, of course, Lakers games from his private box at Staples Center, which was built under his watch. In failing health recently, Buss hadn't attended a Lakers game in the past two seasons.

After a rough-and-tumble childhood that included stints as a ditch-digger and a bellhop in the frigid Wyoming winters, Buss earned a Ph.D. in chemistry at age 24 and had careers in aerospace and real estate development before getting into sports. With money from his real-estate ventures and a good bit of creative accounting, Buss bought the then-struggling Lakers, the NHL's Los Angeles Kings and both clubs' arena — the Forum — from Jack Kent Cooke in a $67.5 million deal that was the largest sports transaction in history at the time.

Last month, Forbes estimated the Lakers were worth $1 billion, second most in the NBA.

Buss also helped change televised sports by co-founding the Prime Ticket network in 1985, receiving a star on the Hollywood Walk of Fame in 2006 for his work in television. Breaking the contemporary model of subscription services for televised sports, Buss' Prime Ticket put beloved broadcaster Chick Hearn and the Lakers' home games on basic cable.

Buss also sold the naming rights to the Forum in 1988 to Great Western Savings & Loan — another deal that was ahead of its time.

Born in Salt Lake City, Gerald Hatten Buss was raised in poverty in Wyoming before improving his life through education. He also grew to love basketball, describing himself as an "overly competitive but underly endowed player."

After graduating from the University of Wyoming, Buss attended USC for graduate school. He became a chemistry professor and worked as a chemist for the Bureau of Mines before carving out a path to wealth and sports prominence.

The former mathematician's fortune grew out of a $1,000 real-estate investment in a West Los Angeles apartment building with partner Frank Mariani, an aerospace engineer and co-worker.

Heavily leveraging his fortune and various real-estate holdings during two years of negotiations, Buss purchased Cooke's entire Los Angeles sports empire in 1979, including a 13,000-acre ranch in Kern County. Buss cited his love of basketball as the motivation for his purchase, and he immediately worked to transform the Lakers — who had won just one NBA title since moving west from Minneapolis in 1960 — into a star-powered endeavor befitting Hollywood.

"One of the first things I tried to do when I bought the team was to make it an identification for this city, like Motown in Detroit," he told the Los Angeles Times in 2008. "I try to keep that identification alive. I'm a real Angeleno. I want us to be part of the community."

Buss' plans immediately worked: Johnson, Abdul-Jabbar and coach Paul Westhead led the Lakers to the 1980 title. Johnson's ball-handling wizardry and Abdul-Jabbar's smooth inside game made for an attractive style of play, and the Lakers came to define West Coast sophistication.

Riley, the former broadcaster who fit the L.A. image perfectly with his slick-backed hair and good looks, was surprisingly promoted by Buss early in the 1981-82 season after West declined to co-coach the team. Riley became one of the best coaches in NBA history, leading the Lakers to four straight NBA finals and four titles, with Worthy, Michael Cooper, Byron Scott and A.C. Green playing major roles.

Overall, the Lakers made the finals nine times in Buss' first 12 seasons while rekindling the NBA's best rivalry with the Boston Celtics, and Buss basked in the worldwide celebrity he received from his team's achievements. His partying became Hollywood legend, with even his players struggling to keep up with Buss' lifestyle.

Johnson's HIV diagnosis and retirement in 1991 staggered Buss and the Lakers, the owner recalled in 2011. The Lakers struggled through much of the 1990s, going through seven coaches and making just one conference finals appearance in an eight-year stretch despite the 1996 arrivals of O'Neal, who signed with Los Angeles as a free agent, and Bryant, the 17-year-old high schooler acquired in a draft-week trade.

Shaq and Kobe didn't reach their potential until Buss persuaded Jackson, the Chicago Bulls' six-time NBA champion coach, to take over the Lakers in 1999. Los Angeles immediately won the next three NBA titles in brand-new Staples Center, AEG's state-of-the-art downtown arena built with the Lakers as the primary tenant.

After the Lakers traded O'Neal in 2004, they hovered in mediocrity again until acquiring Gasol in a heist of a trade with Memphis in early 2008. Los Angeles made the next three NBA finals, winning two more titles.

Through the Lakers' frequent successes and occasional struggles, Buss never stopped living his Hollywood dream. He was an avid poker player and a fixture on the Los Angeles club scene well into his 70s, when a late-night drunk-driving arrest in 2007 — with a 23-year-old woman in the passenger seat of his Mercedes-Benz — prompted him to cut down on his partying.

Buss owned the NHL's Kings from 1979-87, and the WNBA's Los Angeles Sparks won two league titles under Buss' ownership. He also owned Los Angeles franchises in World Team Tennis and the Major Indoor Soccer League.

Ownership of the Lakers is now in a trust controlled by Buss' six children, who all have worked for the Lakers organization in various capacities for several years. Jim Buss, the Lakers' executive vice president of player personnel and the second-oldest child, has taken over much of the club's primary decision-making responsibilities in the last few years, while daughter Jeanie runs the franchise's business side.

"I am blessed with a wonderful family who have helped me and guided me every step of the way," Buss said in 2010 at his Hall of Fame induction ceremony. "This support is the best anybody could ever have."

Jerry Buss still served two terms as president of the NBA's Board of Governors and was actively involved in the 2011 lockout negotiations, developing blood clots in his legs attributed to his extensive travel during that time.

Buss is survived by his six children: sons Johnny, Jim, Joey and Jesse, and daughters Jeanie Buss and Janie Drexel. He had eight grandchildren.

Arrangements are pending for a funeral and memorial service, likely at Staples Center or a nearby theatre in downtown Los Angeles.

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Associated Press writers Beth Harris and Andrew Dalton contributed to this report.

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Personal Health: Health Effects of Smoking for Women

The title of a recent report on smoking and health might well have paraphrased the popular ad campaign for Virginia Slims, introduced in 1968 by Philip Morris and aimed at young professional women: “You’ve come a long way, baby.”

Today that slogan should include: “. . . toward a shorter life.” Ten years shorter, in fact.

The new report is one of two rather shocking analyses of the hazards of smoking and the benefits of quitting published last month in The New England Journal of Medicine. The data show that “women who smoke like men die like men who smoke,” Dr. Steven A. Schroeder, a professor of health and health care at the University of California, San Francisco, wrote in an accompanying editorial.

That was not always the case. Half a century ago, the risk of death from lung cancer among men who smoked was five times higher than that among women smokers. But by the first decade of this century, that risk had equalized: for both men and women who smoked, the risk of death from lung cancer was 25 times greater than for nonsmokers, Dr. Michael J. Thun of the American Cancer Society and his colleagues reported.

Today, women who smoke are even more likely than men who smoke to die of lung cancer. According to a second study in the same journal, women smokers face a 17.8 times greater risk of dying of lung cancer, than women who do not smoke; men who smoke are at 14.6 times greater risk to die of lung cancer than men who don’t. Women who smoke now face a risk of death from lung cancer that is 50 percent higher than the estimates reported in the 1980s, according to Dr. Prabhat Jha of the Center for Global Health Research in Toronto and his colleagues.

After controlling for age, body weight, education level and alcohol use, the new analysis found something else: men and women who continue to smoke die on average more than 10 years sooner than those who never smoked.

Dramatic progress has been made in reducing the prevalence of smoking, which has fallen in the United States from 42 percent of adults in 1965 (the year after the first surgeon general’s report on smoking and health) to 19 percent in 2010. Yet smoking still results in nearly 200,000 deaths a year among people 35 to 69 years old in this country. A quarter of all deaths in this age group would not occur if smokers had the same risk of death as nonsmokers.

The risks are even greater among men 55 to 74 and women 60 to 74. More than two-thirds of all deaths among current smokers in these age groups are related to smoking. Over all, the death rate from all causes combined in these age groups “is now at least three times as high among current smokers as among those who have never smoked,” Dr. Thun’s team found.

While lung cancer is the most infamous hazard linked to smoking, the habit also raises the risk of death from heart disease, stroke, pulmonary disease and other cancers, including breast cancer.

Furthermore, changes in how cigarettes are manufactured may have increased the dangers of smoking. The use of perforated filters, tobacco blends that are less irritating, and paper that is more porous made it easier to inhale smoke and encouraged deeper inhalation to achieve satisfying blood levels of nicotine.

The result of deeper inhalation, Dr. Thun’s report suggests, has been an increased risk of chronic obstructive pulmonary disease, or C.O.P.D., and a shift in the kind of lung cancer linked to smoking. Among nonsmokers, the risk of death from C.O.P.D. has declined by 45 percent in men and has remained stable in women, but the death rate has more than doubled among smokers.

But there is good news, too: it’s never too late to reap the benefits of quitting. The younger you are when you stop smoking, the greater your chances of living a long and healthy life, according to the findings of Dr. Jha’s international team.

The team analyzed smoking and smoking-cessation histories of 113,752 women and 88,496 men 25 and older and linked them to causes of deaths in these groups through 2006.

Those who quit smoking by age 34 lived 10 years longer on average than those who continued to smoke, giving them a life expectancy comparable to people who never smoked. Smokers who quit between ages 35 and 44 lived nine years longer, and those who quit between 45 and 54 lived six years longer. Even quitting smoking between ages 55 and 64 resulted in a four-year gain in life expectancy.

The researchers emphasized, however, that the numbers do not mean it is safe to smoke until age 40 and then stop. Former smokers who quit by 40 still experienced a 20 percent greater risk of death than nonsmokers. About one in six former smokers who died before the age of 80 would not have died so young if he or she had never smoked, they reported.

Dr. Schroeder believes we can do a lot better to reduce the prevalence of smoking with the tools currently in hand if government agencies, medical insurers and the public cooperate.

Unlike the races, ribbons and fund-raisers for breast cancer, “there’s no public face for lung cancer, even though it kills more women than breast cancer does,” Dr. Schroeder said in an interview. Lung cancer is stigmatized as a disease people bring on themselves, even though many older victims were hooked on nicotine in the 1940s and 1950s, when little was known about the hazards of smoking and doctors appeared in ads assuring the public it was safe to smoke.

Raising taxes on cigarettes can help. The states with the highest prevalence of smoking have the lowest tax rates on cigarettes, Dr. Schroeder said. Also helpful would be prohibiting smoking in more public places like parks and beaches. Some states have criminalized smoking in cars when children are present.

More “countermarketing” of cigarettes is needed, he said, including antismoking public service ads on television and dramatic health warnings on cigarette packs, as is now done in Australia. But two American courts have ruled that the proposed label warnings infringed on the tobacco industry’s right to free speech.

Health insurers, both private and government, could broaden their coverage of stop-smoking aids and better publicize telephone quit lines, and doctors “should do more to stimulate quit attempts,” Dr. Schroeder said.

As Nicola Roxon, a former Australian health minister, put it, “We are killing people by not acting.”

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DealBook: Reader's Digest Files for Bankruptcy, Again

Executives at Reader’s Digest must be hoping that the magazine’s second trip to bankruptcy court in under four years will be its last.

The magazine’s parent, RDA Holding, filed for Chapter 11 protection late on Sunday in another effort to cut down the debt that has plagued the pocket-size publication for years. The company is hoping to convert about $465 million of its debt into equity held by its creditors.

In a court filing, Reader’s Digest said it held about $1.1 billion in assets and just under $1.2 billion in debt. It has provisionally lined up about $105 million in financing to keep it afloat during the Chapter 11 case.

This week’s filing is the latest effort by the 91-year-old publisher, whose magazine once resided on many American coffee tables, to fix itself in a difficult economic environment.

“After considering a wide range of alternatives, we believe this course of action will most effectively enable us to maintain our momentum in transforming the business and allow us to capitalize on the growing strength and presence of our outstanding brands and products,” Robert E. Guth, the company’s chief executive, said in a statement.

Reader’s Digest last filed for bankruptcy in 2009, emerging a year later under the control of lenders like JPMorgan Chase.

That reorganization substantially cut the publisher’s debt, and afterward the company worked to further shrink its footprint. It jettisoned nonessential publications in a series of deals, including the $180 million sale of Allrecipes.com and the $4.3 million sale of Every Day With Rachael Ray, both to the Meredith Corporation.

Most of the money from those transactions went to pay down a still significant debt burden. But the company remained pressured by what it described in a court filing as steep declines that still bedevil the media industry. Last year, the publisher began negotiating with its lenders, including Wells Fargo, about amending some of its debt obligations. That process eventually led to a “pre-negotiated agreement” with creditors, which will be put into effect by the bankruptcy filing.

This time, Reader’s Digest is hoping to spend even less time in court. Mr. Guth said in a court filing that the publisher aims to emerge from bankruptcy protection in about four months.

The company’s biggest unsecured creditors include firms represented by Luxor Capital. The Federal Trade Commission also contends that it is owed $8.8 million in a settlement claim.

Reader’s Digest is being advised by Evercore Partners and the law firm Weil, Gotshal & Manges.

Reader's Digest bankruptcy petition (2013) by

Declaration by Reader's Digest Chief Executive by

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Netanyahu Defends Israel’s Handling of Prisoner X Case

JERUSALEM — Prime Minister Benjamin Netanyahu on Sunday defended his government’s handling of an Australian-Israeli who was held under a pseudonym for months in a maximum-security prison until he committed suicide in 2010, suggesting that the threats his country faces justify the extraordinary measures and the secrecy shrouding the case.

“We are not like other countries,” Mr. Netanyahu told his cabinet, in his first public comments on the case of Prisoner X, which made headlines on at least three continents last week. “We are an exemplary democracy and maintain the rights of those under investigation,” he said. “However, we are more threatened and face more challenges; therefore, we must maintain proper activity of our security agencies.”

In the face of growing calls from politicians and the public for investigations into the prisoner’s death and a court order that barred the local news media from reporting about it for more than two years, the prime minister said, “Let the security forces do their work quietly so that we can continue to live in security and tranquillity in the state of Israel.”

Prisoner X, the subject of Israeli news reports in 2010 that were quashed by the broad court order, was identified by an Australian television report last week as Ben Zygier, a 34-year-old lawyer and father of two who grew up in the Melbourne area, immigrated to Israel as a young man, served in the military and may have worked for the Mossad, Israel’s intelligence agency. Arrested in February 2010, and held pending trial on charges that have been described only as serious and relating to national security, Mr. Zygier was considering a plea bargain when he apparently hanged himself with a shirt in the bathroom of his cell.

News reports here and in Australia have suggested that Israel detained him because he was about to reveal information about the Mossad’s use of foreign passports, and that he helped set up a Mossad front company in Europe that sold electronics equipment to Iran. A Kuwaiti report saying that he was involved in the 2010 assassination of a Hamas official in Dubai has been dismissed by several people with knowledge of the case.

An Israeli Justice Ministry investigation that declared Mr. Zygier’s death a suicide is expected to be released in the coming days, but several Israeli lawmakers and watchdog groups have demanded further inquiries by the attorney general and the state comptroller. And Australia’s foreign minister said Sunday that he had asked Israel to cooperate as he and his staff look into the matter.

“We want to give them an opportunity to submit to us an explanation of how this tragic death came about,” the minister, Bob Carr, told reporters in Sydney. “The key is to get all the information.”

Nahman Shai, a member of Parliament from the Labor Party, said Australia’s investigation should force Israel to look closer at the behavior of all involved. “We are witnessing oversights in various aspects of the case that include intelligence, legal, public, media and parliamentary,” Mr. Shai said Sunday. “The Australian government will publish the information it has and again make Israel appear irrelevant to the international community and the Israeli public.”

Two of Mr. Shai’s colleagues, meanwhile, called for the formation of a parliamentary committee to investigate the case. And many Israelis joined social-media campaigns that are demanding more information.

“No Israeli citizen will be able to sleep comfortably in a country in which an affair such as Prisoner X can take place,” wrote Uri Misgav, a blogger for the left-leaning newspaper Haaretz, in a lengthy post. “The Israeli public deserves to know whether the Israeli prisons are holding on to Prisoner Y and Prisoner Z,” he wrote. “The Israeli public deserves to be told how all of the monitoring mechanics failed and how such a systematic failure will not be repeated.”

But Mr. Netanyahu seemed untroubled by the affair. “I rely completely on the security forces,” he told the cabinet. “I also completely rely on the legal authorities.”

“The overexposure of security and intelligence activity could harm, sometimes severely, state security,” he added. “The security interest cannot be made light of, and in the reality in which the state of Israel lives, this must be a main interest.”

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Danica Patrick wins pole for NASCAR's Daytona 500

DAYTONA BEACH, Fla. (AP) — Danica Patrick has made history before — as a woman and a racer, in Indianapolis and Japan.

The spotlight is nothing new. But never has it been this bright before.

Patrick won the Daytona 500 pole Sunday, becoming the first woman to secure the top spot for any race in NASCAR's premier circuit. It's by far the biggest achievement of her stock-car career.

"I was brought up to be the fastest driver, not the fastest girl," she said. "That was instilled in me from very young, from the beginning. Then I feel like thriving in those moments, where the pressure's on, has also been a help for me. I also feel like I've been lucky in my career to be with good teams and have good people around me. I don't think any of it would have been possible without that.

"For those reasons, I've been lucky enough to make history, be the first woman to do many things. I really just hope that I don't stop doing that. We have a lot more history to make. We are excited to do it."

Her latest stamp in the history books came with a lap at 196.434 mph around Daytona International Speedway. Patrick went out eighth in the qualifying session, then had to wait about two hours as 37 fellow drivers tried to take her spot.

Only four-time Cup champion Jeff Gordon even came close to knocking her off. Gordon was the only other driver who topped 196 mph in qualifying. He locked up the other guaranteed spot in next week's season-opening Daytona 500.

"It's great to be a part of history with Danica being on the pole," said Gordon, who joked that at least he was the fastest guy. "I think we all know how popular she is, what this will do for our sport. Congratulations to her. Proud to be on there with her."

The rest of the field will be set in duel qualifying races Thursday.

However the lineup unfolds, all drivers will line up behind Patrick's No. 10 Chevrolet SS.

And she knows her latest achievement will mean more public relations work.

The routine is nothing new for Patrick, who was the first woman to lead laps in the Indianapolis 500. She finished third in 2009, the highest finish in that illustrious race for a woman. And she became the only woman to win an IndyCar race when she did it in Japan in 2008.

Hardly anyone witnessed that victory.

Leading the field to the green flag in NASCAR's showcase event should be must-watch television.

"That's a huge accomplishment," team owner and fellow driver Tony Stewart said. "It's not like it's been 15 or 20 years she's been trying to do this. It's her second trip to Daytona here in a Cup car. She's made history in the sport. That's stuff that we're proud of being a part of with her. It's something she should have a huge amount of pride in.

"It's never been done. There's only one person that can be the first to do anything. Doesn't matter how many do it after you do, accomplish that same goal. The first one that does always has that little bit more significance to it because you were the first."

Even before her fast lap Sunday, Patrick was the talk of Speedweeks. Not only did she open up about her budding romance with fellow Sprint Cup rookie Ricky Stenhouse Jr., but she was considered the front-runner for the pole after leading practice sessions Saturday.

And she didn't disappoint.

She kept her car at or near the bottom of the famed track and gained ground on the straightaways, showing lots of power from a Hendrick Motorsports engine.

"It's easy to come down here in your first or second year as a driver and clip the apron trying to run too tight a line or do something and scrub speed off," Stewart said. "That's something she did an awesome job. Watching her lap, she runs so smooth. ... She did her job behind the wheel, for sure."

The result surely felt good for Patrick, especially considering the former IndyCar driver has mostly struggled in three NASCAR seasons. Her best finish in 10 Cup races is 17th, and she has one top-five in 58 starts in the second-tier Nationwide Series.

She raced part-time in 2010 and 2011 while still driving a full IndyCar slate. She switched solely to stock cars last season and finished 10th in the Nationwide standings.

She made the jump to Sprint Cup this season and will battle Stenhouse for Rookie of the Year honors.

Starting out front in an unpredictable, 500-mile race doesn't guarantee any sort of result, but securing the pole will put her in the limelight for at least the rest of the week.

She also won the pole at Daytona for last year's Nationwide race.

This is considerably bigger.

The previous highest female qualifier in a Cup race was Janet Guthrie. She started ninth at Bristol and Talladega in 1977.

"It's obviously a history-making event that will last a long, long time," Guthrie said, praising Patrick's feat. "It's a different era, of course. Different times. I can't imagine what I would do with a spotter or somebody telling me how to drive. It's rather a different sport now. Back then, there was a much greater difference from the front of the field to the back."

Guthrie received a lukewarm reception from fellow drivers back then.

Patrick was much more welcomed, undoubtedly because of her background and popularity.

She's comfortable being in the spotlight, evidenced by her racing career, her television commercials and her sudden openness about her personal life.

"I think when pressure's on and when the spotlight's on, I feel like it ultimately ends up becoming some of my better moments and my better races and better results," Patrick said. "I just understand that if you put the hard work in before you go out there that you can have a little peace and a little peace of mind knowing that you've done everything you can and just let it happen."

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Cuomo Bucks Tide With Bill to Lift Abortion Limits

ALBANY — Bucking a trend in which states have been seeking to restrict abortion, Gov. Andrew M. Cuomo is putting the finishing touches on legislation that would guarantee women in New York the right to late-term abortions when their health is in danger or the fetus is not viable.

Mr. Cuomo, seeking to deliver on a promise he made in his recent State of the State address, would rewrite a law that currently allows abortions after 24 weeks of pregnancy only if the pregnant woman’s life is at risk. The law is not enforced, because it is superseded by federal court rulings that allow late-term abortions to protect a woman’s health, even if her life is not in jeopardy. But abortion rights advocates say the existence of the more restrictive state law has a chilling effect on some doctors and prompts some women to leave the state for late-term abortions.

Mr. Cuomo’s proposal, which has not yet been made public, would also clarify that licensed health care practitioners, and not only physicians, can perform abortions. It would remove abortion from the state’s penal law and regulate it through the state’s public health law.

Abortion rights advocates have welcomed Mr. Cuomo’s plan, which he outlined in general terms as part of a broader package of women’s rights initiatives in his State of the State address in January. But the Roman Catholic Church and anti-abortion groups are dismayed; opponents have labeled the legislation the Abortion Expansion Act.

The prospects for Mr. Cuomo’s effort are uncertain. The State Assembly is controlled by Democrats who support abortion rights; the Senate is more difficult to predict because this year it is controlled by a coalition of Republicans who have tended to oppose new abortion rights laws and breakaway Democrats who support abortion rights.

New York legalized abortion in 1970, three years before it was legalized nationally by the Supreme Court in Roe v. Wade. Mr. Cuomo’s proposal would update the state law so that it could stand alone if the broader federal standard set by Roe were to be undone.

“Why are we doing this? The Supreme Court could change,” said a senior Cuomo administration official, who spoke on the condition of anonymity because the governor had not formally introduced his proposal.

But opponents of abortion rights, already upset at the high rate of abortions in New York State, worry that rewriting the abortion law would encourage an even greater number of abortions. For example, they suggest that the provision to allow abortions late in a woman’s pregnancy for health reasons could be used as a loophole to allow unchecked late-term abortions.

“I am hard pressed to think of a piece of legislation that is less needed or more harmful than this one,” the archbishop of New York, Cardinal Timothy M. Dolan, wrote in a letter to Mr. Cuomo last month. Referring to Albany lawmakers in a subsequent column, he added, “It’s as though, in their minds, our state motto, ‘Excelsior’ (‘Ever Upward’), applies to the abortion rate.”

National abortion rights groups have sought for years to persuade state legislatures to adopt laws guaranteeing abortion rights as a backup to Roe. But they have had limited success: Only seven states have such measures in place, including California, Connecticut and Maryland; the most recent state to adopt such a law is Hawaii, which did so in 2006.

“Pretty much all of the energy, all of the momentum, has been to restrict abortion, which makes what could potentially happen in New York so interesting,” said Elizabeth Nash, state issues manager at the Guttmacher Institute, a research group that supports abortion rights. “There’s no other state that’s even contemplating this right now.”

In most statehouses, the push by lawmakers has been in the opposite direction. The past two years has seen more provisions adopted at the state level to restrict abortion rights than in any two-year period in decades, according to the Guttmacher Institute; last year, 19 states adopted 43 new provisions restricting abortion access, while not a single significant measure was adopted to expand access to abortion or to comprehensive sex education.

“It’s an extraordinary moment in terms of the degree to which there is government interference in a woman’s ability to make these basic health care decisions,” said Andrea Miller, the president of NARAL Pro-Choice New York. “For New York to be able to send a signal, a hopeful sign, a sense of the turning of the tide, we think is really important.”

Abortion rights advocates say that even though the Roe decision supersedes state law, some doctors are hesitant to perform late-term abortions when a woman’s health is at risk because the criminal statutes remain on the books.

“Doctors and hospitals shouldn’t be reading criminal laws to determine what types of health services they can offer and provide to their patients,” said M. Tracey Brooks, the president of Family Planning Advocates of New York State.

For Mr. Cuomo, the debate over passing a new abortion law presents an opportunity to appeal to women as well as to liberals, who have sought action in Albany without success since Eliot Spitzer made a similar proposal when he was governor. But it also poses a challenge to the coalition of Republicans and a few Democrats that controls the State Senate, the chamber that has in the past stood as the primary obstacle to passing abortion legislation in the capital.

The governor has said that his Reproductive Health Act would be one plank of a 10-part Women’s Equality Act that also would include equal pay and anti-discrimination provisions. Conservative groups, still stinging from the willingness of Republican lawmakers to go along with Mr. Cuomo’s push to legalize same-sex marriage in 2011, are mobilizing against the proposal. Seven thousand New Yorkers who oppose the measure have sent messages to Mr. Cuomo and legislators via the Web site of the New York State Catholic Conference.

A number of anti-abortion groups have also formed a coalition called New Yorkers for Life, which is seeking to rally opposition to the governor’s proposal using social media.

“If you ask anyone on the street, ‘Is there enough abortion in New York?’ no one in their right mind would say we need more abortion,” said the Rev. Jason J. McGuire, the executive director of New Yorkers for Constitutional Freedoms, which is part of the coalition.

Members of both parties say that the issue of reproductive rights was a significant one in November’s legislative elections. Democrats, who were bolstered by an independent expenditure campaign by NARAL, credit their victories in several key Senate races in part to their pledge to fight for legislation similar to what Mr. Cuomo is planning to propose.

Republicans, who make up most of the coalition that controls the Senate, have generally opposed new abortion rights measures. Speaking with reporters recently, the leader of the Republicans, Dean G. Skelos of Long Island, strenuously objected to rewriting the state’s abortion laws, especially in a manner similar to what the governor is seeking.

“You could have an abortion up until the day the child would be born, and I think that’s just wrong,” Mr. Skelos said. He suggested that the entire debate was unnecessary, noting that abortion is legal in New York State and saying that is “not going to be changed.”

The Senate Democratic leader, Andrea Stewart-Cousins of Yonkers, who is the sponsor of a bill that is similar to the legislation the governor is drafting, said she was optimistic that an abortion measure would reach the Senate floor this year.

“New York State’s abortion laws were passed in 1970 in a bipartisan fashion,” she said. “It would be a sad commentary that over 40 years later we could not manage to do the same thing.”

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Rem Vyakhirev, Former Chief of Gazprom, Dies at 78

MOSCOW — Rem I. Vyakhirev, who as chief executive of the huge Russian energy company Gazprom during the 1990s resisted efforts by reformers to break up and privatize it, only to end his tenure a billionaire owning valuable pieces of the company himself, died on Feb. 11. He was 78.

His death was confirmed by a Gazprom spokesman, who did not provide the cause or place of death.

Early in the post-Soviet period, Mr. Vyakhirev seized on the possibilities of exploiting the sheer power and scale of the Russian natural gas industry — both for the government and for private enrichment.

His career spanned the transformation of what had been the Soviet ministry of gas into the world’s largest natural gas company. By the time he left Gazprom, in 2001, forced out in a din of criticism over missing assets, Forbes magazine estimated his net worth at $1.5 billion.

All along, though, Mr. Vyakhirev, reflecting a strange cognitive dissonance that characterized his career, espoused the benefits of state ownership of natural gas fields and pipelines. Gazprom, which is controlled by the Russian government but is 50 percent owned by private investors, remained whole while the Russian oil industry was split up and sold piecemeal. The company supplies about a quarter of all gas consumed in Europe today.

“The gas industry should be in one pair of hands, in state hands,” Mr. Vyakhirev said in September in an interview with the Russian edition of Forbes. “There’s all this talk about gas being an addiction, how to get off the gas needle. That’s ridiculous. Gas is a wet nurse, not a needle.”

Rem Ivanovich Vyakhirev was born on Aug. 23, 1934, in a village in the Samara region of southern Russia. His given name is an acronym evoking socialist progress: Revolution, Engels and Marx.

By the late 1980s, he had risen to deputy minister of gas in the Soviet Union. He assumed control of Gazprom in 1992, when his patron, the former minister of gas, Viktor S. Chernomyrdon, was appointed prime minister under President Boris N. Yeltsin.

Mr. Vyakhirev and a tight group of associates held sway over Gazprom’s assets, including whole towns in Siberia. The company became an island of the old Soviet system in the new Russia, known as the state within the state, a paternalistic monopoly with tens of thousands of coddled employees.

The company’s staggering wealth and size made Mr. Vyakhirev one of Russia’s most powerful men. He was able to shrug off efforts by the tax ministry to collect billions in arrears from the company in the mid-1990s. He also aided the state by informally ladling out funds from the corporate budget.

Yevgeny Yasin, the minister of economy at the time, recalled Mr. Vyakhirev’s eagerness to help the government on such projects as rebuilding a cathedral in Moscow.

“He always helped,” Mr. Yasin said, as quoted by Public Post, a news Web site. “Gazprom was a second budget, in fact an ‘extra pocket’ for the government, to be used during especially difficult situations.”

All the while, beginning with a quiet deal soon after the company’s founding that allowed company executives to buy up to 30 percent of Gazprom shares at auctions they controlled, pieces of Gazprom slipped away to nonstate entities.

Public documents and financial records later showed that some assets went to Mr. Vyakhirev and members of his family, a sign of the rough and loose ways of early Russian capitalism. One deal, for example, transferred about $185 million worth of gas fields to Sibneftegaz, a subsidiary partly owned by Mr. Vyakhirev’s relatives.

As pressure mounted to oust Mr. Vyakhirev, Boris Fyodorov, a former minister of finance, disclosed that tens of billions of dollars worth of gas sales from Russia to former Soviet countries like Ukraine went through Itera, a trading company based in Jacksonville, Fla., and partly owned by Gazprom managers.

President Vladimir V. Putin, in consolidating political control over Russia early in his first term, ousted Mr. Vyakhirev in 2001 by having government appointees on the board cancel his contract. Mr. Vyakhirev stayed on as chairman for a year. The new director, Aleksey B. Miller, then set about unraveling the old management’s insider deals.

Gazprom’s stock rallied for a time before the global recession, but has been in a swoon for years. The company is losing market share in Europe because of price pressure from the gas industry in the United States.

Mr. Vyakhirev’s survivors include a son, Yuri, and a daughter, Tatyana Vyakhireva.

In the Forbes interview last year, Mr. Vyakhirev said he had taken up hobby farming in retirement. “I never wanted to be the head of a company,” he said. “But why refuse if the entire business is in your hands? If you give it to somebody, they would either drink it away or lose it.”

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