Phys Ed: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

Fitness Tracker

Marathon, half-marathon, 10k and 5K training plans to get you race ready.

A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.

For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.

One group began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.

Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.

The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.

The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.

The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.

Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.

To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.

By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.

There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.

However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.

The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.

But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.

“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable” after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.

The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.

But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,” a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,” he says. But those working out only twice a week “weren’t far behind.”

Read More..

Cardinal Dolan a Dark Horse to Succeed Pope



But suddenly, he found himself in even more rarefied company, with his name mentioned alongside those of more long-serving cardinals as a potential next pope, even though, by all accounts, his chances are slim.


The news on Monday of Pope Benedict XVI’s resignation came as a surprise to Cardinal Dolan, as it did to most of the world. But within hours, his life was already changed. As he continued to go about his regular business as archbishop, he found himself even more in the spotlight to which he has become accustomed, facing a glare that will quite likely continue at least through the conclave in Rome next month.


On Monday, when he dedicated a chapel in Rockland County and attended a prayer meeting in the Bronx, he also ricocheted between media appearances, beginning at 7 a.m. on “Today,” the NBC show, then holding a news conference, writing an op-ed, and granting interviews to ABC and CBS. He was still talking to reporters as night fell, holding an impromptu news conference outside the New York Athletic Club on Central Park South before going inside for a fund-raiser. Both Mayor Michael R. Bloomberg and Gov. Andrew M. Cuomo fielded questions from reporters about the possibility that Cardinal Dolan could become pope; on late-night television, Stephen Colbert offered his endorsement (what he called a “Colbert bump”) for Cardinal Dolan for pope.


Through it all, the cardinal approached the speculation about “Pope Dolan” with his typical self-deprecating humor. Asked what he would do if he found himself among the finalists, he said, “I’ll tell them they have the wrong guy.”


“Don’t bet your lunch money on that one,” he added of his steep odds. “Bet on the Mets.”


On Tuesday, Cardinal Dolan’s schedule returned to a relative normal, as he headed to Camden, N.J., to attend the installation of his former deputy, Dennis J. Sullivan, as bishop. On Wednesday, he plans to visit the bread line at the Church of St. Francis of Assisi in Manhattan in the morning, bestow ashes on the faithful for Ash Wednesday at St. Patrick’s Cathedral at noon, and then attend a wake on Staten Island.


“Honestly, we could do nothing but media — all day, every day — at this point,” said his spokesman, Joseph Zwilling. “He understands the value of it, he likes to do it. But he knows that as archbishop of New York, he’s got a lot of other things he has to attend to.”


The likelihood of Cardinal Dolan becoming the next pope is low, many observers say. “I would put him in the — what’s less than a dark horse?”  category, said Christopher M. Bellitto, a papal historian at Kean University in New Jersey.


“He is arguably going to be, if he is not already, the voice and face of the American church, though whether he can translate that to higher office is another matter,” Professor Bellitto said.


The Rev. Thomas J. Reese, a senior fellow at the Woodstock Theological Center at Georgetown University, put Cardinal Dolan’s odds at “100 to 1.” But, he added, “Anything can happen.”


Cardinal Dolan is considered an unlikely pope for several reasons. Most obviously, he is a citizen of the United States, and the College of Cardinals has been reluctant to choose a pope from a superpower. This year, some Vatican watchers believe the cardinals might choose someone from North America as a compromise between taking the historic step to electing a pope from the developing world and the more conventional choice of someone from Europe. But even if that is the case, Cardinal Marc Ouellet, a Canadian who heads the influential Congregation for Bishops in Rome, seems “a more logical choice,” Professor Bellitto said.


Also, although Cardinal Dolan once served as the rector of the Pontifical North American College in Rome, a seminary for priests, he has never headed a Vatican department, which has often been a credential of a future pope. And, while Cardinal Dolan speaks Italian well enough to converse and deliver speeches, his Spanish is much more basic; many candidates for pope speak multiple languages.


But Cardinal Dolan has strengths as well. He “left an enormously positive impression when he was in Rome last February for the consistory, when he became a cardinal,” said John L. Allen Jr., the senior correspondent for The National Catholic Reporter. For the first time in memory, Italian newspapers were raising the possibility of an American pope, charmed by the “backslapping, baby-kissing, beer-swilling freak-of-nature that is Cardinal Dolan,” Mr. Allen said.


“I think he is a long shot, probably a remote possibility,” Mr. Allen added, “but I do think he will be in the conversation. And that, in and of itself, is something of a novelty for an American cardinal.”


Cardinal Dolan said that, when he first heard about Pope Benedict’s resignation Monday morning, he was in the middle of reading one of the pope’s books on the life of Christ. “That’s how much of my day he is,” he recalled that evening. “So I haven’t really thought to the next one, but I will sure miss him.”


He said he expected to be headed to Rome for the conclave as early as the beginning of March, but like everyone else, was still waiting to hear the exact date. “ ’Cause first of all, I’m a rookie,” Cardinal Dolan said, and also because the church itself is still working out how to handle the rare circumstance of a pope stepping down. “So what will happen now?” he wondered aloud. “I don’t know.”


Read More..

Body slam for wrestling: Sport cut from Olympics


LAUSANNE, Switzerland (AP) — For wrestling, this may have been the ultimate body slam: getting tossed out of the Olympic rings.


The vote Tuesday by the IOC's executive board stunned the world's wrestlers, who see their sport as popular in many countries and steeped in history as old as the Olympics themselves.


While wrestling will be included at the 2016 Olympics in Rio de Janeiro, it was cut from the games in 2020, which have yet to be awarded to a host city.


2004 Olympic Greco-Roman champion Khasan Baroev of Russia called the decision "mind-boggling."


"I just can't believe it. And what sport will then be added to the Olympic program? What sport is worthy of replacing ours?" Baroev told the ITAR-Tass news agency. "Wrestling is popular in many countries — just see how the medals were distributed at the last Olympics."


American Rulan Gardner, who upset three-time Russian Olympic champion Alexander Karelin at the Sydney Games in an epic gold-medal bout known as the "Miracle on the Mat," was saddened by the decision to drop what he called "a beloved sport."


"It's the IOC trying to change the Olympics to make it more mainstream and more viewer-friendly instead of sticking to what they founded the Olympics on," Gardner told The Associated Press in a telephone interview from Logan, Utah.


The executive board of the International Olympic Committee reviewed the 26 sports on its summer program in order to remove one of them so it could add one later this year. It decided to cut wrestling and keep modern pentathlon — a sport that combines fencing, horse riding, swimming, running and shooting — and was considered to be the most likely to be dropped.


The board voted after reviewing a report by the IOC program commission report that analyzed 39 criteria, including TV ratings, ticket sales, anti-doping policy and global participation and popularity. With no official rankings or recommendations contained in the report, the final decision by the 15-member board was also subject to political, emotional and sentimental factors.


"This is a process of renewing and renovating the program for the Olympics," IOC spokesman Mark Adams said. "In the view of the executive board, this was the best program for the Olympic Games in 2020. It's not a case of what's wrong with wrestling; it is what's right with the 25 core sports."


According to IOC documents obtained by the AP, wrestling ranked "low" in several of the technical criteria, including popularity with the public at the London Games — just below 5 on a scale of 10. Wrestling sold 113,851 tickets in London out of 116,854 available.


Wrestling also ranked "low" in global TV audience with a maximum of 58.5 million viewers and an average of 23 million, the documents show. Internet hits and press coverage were also ranked as low.


NBC, which televises the Olympics in the U.S., declined comment.


The IOC also noted that FILA — the international wrestling federation — has no athletes on its decision-making bodies, no women's commission, no ethics rules for technical officials and no medical official on its executive board.


Modern pentathlon also ranked low in general popularity in London, with 5.2 out of 10. The sport also ranked low in all TV categories, with maximum viewership of 33.5 million and an average of 12.5 million.


FILA has 177 member nations, compared to 108 for modern pentathlon.


Modern pentathlon, which has been on the Olympic program since the 1912 Stockholm Games, was created by French baron Pierre de Coubertin, the founder of the modern Olympic movement.


It also benefited from the work of Juan Antonio Samaranch Jr., the son of the former IOC president who is a UIPM vice president and member of the IOC board.


"We were considered weak in some of the scores in the program commission report but strong in others," Samaranch told the AP. "We played our cards to the best of our ability and stressed the positives."


Klaus Schormann, president of governing body UIPM, lobbied hard to protect his sport's Olympic status and it paid off in the end.


"We have promised things and we have delivered," he said after Tuesday's decision. "That gives me a great feeling. It also gives me new energy to develop our sport further and never give up."


The IOC executive board will meet in May in St. Petersburg, Russia, to decide which sport or sports to propose for 2020 inclusion. The final vote will be made at the IOC session, or general assembly, in September in Buenos Aires, Argentina.


Wrestling will now join seven other sports in applying for 2020, but it is extremely unlikely that it would be voted back in so soon after being removed by the executive board.


The other sports vying for a single opening in 2020 are a combined bid from baseball and softball, karate, squash, roller sports, sport climbing, wakeboarding and wushu, a martial art.


"Today's decision is not final," Adams said. "The session is sovereign and the session will make the final decision."


Wrestling featured 344 athletes competing in 11 medal events in freestyle and seven in Greco-Roman at last year's London Olympics, with Russia dominating the podium but Iran and Azerbaijan making strong showings. Women's wrestling was added to the Olympics at the 2004 Athens Games.


Tuesday's decision came via secret ballot over four rounds, with 14 members voting each time on which sport should not be included in the core group. IOC President Jacques Rogge did not vote.


Three sports were left in the final round: wrestling, field hockey and modern pentathlon. Eight members voted against wrestling and three each against the other two sports. Taekwondo and canoe kayaking survived the previous rounds.


"I was shocked," said IOC board member Rene Fasel of Switzerland.


"It was an extremely difficult decision to take," added IOC Vice President Thomas Bach of Germany. "The motivation of every member is never based on a single reason. There are always several reasons. It was a secret vote. There will always be criticism, but I think the great majority will understand that we took a decision based on facts and for the modernization of the Olympic Games."


Wrestling was featured in the first modern Olympics in Athens in 1896. Along with Russia's Karelin, it has produced such American stars as Gardner, Bruce Baumgartner, Jeff Blatnick and Jordan Burroughs.


U.S. Olympic Committee CEO Scott Blackmun also expressed surprise at the IOC decision, citing "the history and tradition of wrestling, and its popularity and universality."


"It is important to remember that today's action is a recommendation, and we hope that there will be a meaningful opportunity to discuss the important role that wrestling plays in the sports landscape both in the United States and around the world," Blackmun said in a statement. "In the meantime, we will fully support USA Wrestling and its athletes."


FILA said in a statement that it was "greatly astonished" by the decision, adding that the federation "will take all necessary measures to convince the IOC executive board and IOC members of the aberration of such decision against one of the founding sports of the ancient and modern Olympic Games."


It said it has always complied with IOC regulations and is represented in 180 countries, with wrestling the national sport in some of them.


The federation, which is headed by Raphael Martinetti and based in Corsier-sur-Vevey, Switzerland, said it would meet next week in Thailand to discuss the matter.


Gardner cited wrestling's worldwide popularity and urged a campaign to keep it in the Olympics.


"It just seems like wrestling — if we don't fight, we're going to die," he said. "At this point, it's time for everybody to man up and support the program."


The decision hit hard in Russia, which has long been a power in the sport.


Mikhail Mamiashvili, president of the Russian Wrestling Federation, suggested FILA had not done enough to keep the sport in the games.


"We want to hear what was done to prevent this issue from even being discussed at the board," he said on the Rossiya TV channel.


In comments carried by ITAR-Tass, Mamiashvili added: "I can say for sure that the roots of this problem is at the FILA. I believe that Martinetti's task was to work hard, socialize and defend wrestling's place before the IOC."


Alexander Leipold, a 2000 Olympic champion from Germany and former freestyle German team coach, said he was shocked.


"We are a technical, tactical martial sport where the aim is not to harm the opponent," he said. "Competing at the Olympics is the greatest for an athlete."


Wrestling's long history in the Olympics has featured some top names and moments:


— Karelin won the super-heavyweight gold in Greco-Roman over three straight Olympics — 1988, 1992 and 1996 — until his streak was ended by Gardner, who beat him for the gold in 2000.


— Baumgartner won four Olympic medals, including golds in 1984 and 1992.


— Blatnick overcame cancer to win gold in Greco-Roman at the 1984 Los Angeles Games, bursting into tears after the match. Blatnick died last year at age 55.


— Burroughs emerged as the star of the sport in London, where he won the 74-kilogram gold.


The last sports removed from the Olympics were baseball and softball, voted out by the IOC in 2005 and off the program since the 2008 Beijing Games. Golf and rugby will be joining the program at the 2016 Games in Rio.


Among those in Lausanne were the leaders of the recently created World Baseball Softball Confederation. The two sports agreed last year to merge in a joint bid to return to the games.


Don Porter, the American who heads international softball, and Riccardo Fraccari, the Italian who leads baseball, are working out the final details of their unified body ahead of their presentation to the IOC in May.


A major hurdle remains the lack of a commitment from Major League Baseball to release top players for the Olympics.


Porter and Fraccari said they hope to have another meeting with MLB officials in April in Tokyo.


"The next thing is to sit down with them and see how they can help us," Porter said. "It all depends on the timing, the timing of the season. It's not an easy decision to allow players a week off."


___


Associated Press writers Lynn Berry in Moscow and Luke Meredith in Des Moines, Iowa, contributed to this story.


Read More..

Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.


Katherine Bouton speaks about her own experience with hearing loss.


A transcript of this interview can be found here.


Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.



Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.


This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

Read More..

WellPoint Hires Joseph Swedish of Trinity Health as C.E.O.





WellPoint, one of the nation’s largest health insurers, announced on Tuesday that it had chosen an experienced hospital executive to lead it through sweeping changes created by the federal health care overhaul law.




Joseph R. Swedish, the 61-year-old chief executive of a major nonprofit Catholic-owned health system, Trinity Health, will become WellPoint’s chief executive on March 25. He will be responsible for leading the company, which operates profit-making Blue Cross plans in 14 states, into a future in which health insurers will sell insurance through state and federal exchanges and to work in new ways with hospitals and doctors.


“It truly is a transformational period,” said Mr. Swedish, who helped build Trinity Health into a $9 billion health system with 47 hospitals in 10 states. He became chief executive at Trinity Health in 2004.


WellPoint “has aggressively examined the marketplace,” he said, and is getting ready to compete for customers in highly regulated exchanges, where it must offer coverage even to people with serious medical conditions. WellPoint also bought a large insurer specializing in Medicaid, Amerigroup, last year, in its effort to adapt to the Affordable Care Act that expands the program.


Mr. Swedish succeeds Angela F. Braly, the former chief whose trouble with regulators and uneven performance led to her departure last August. WellPoint, which has a significant national share in providing insurance to individuals and small businesses, has struggled to prove to investors that it can capitalize on its Blue Cross brand in the new business environment.


“Joe’s background, in concert with our management’s insurance market expertise, creates a team uniquely qualified to manage all facets of our evolving health care system,” Jackie M. Ward, chairwoman of WellPoint’s board, said in a statement.


WellPoint’s decision to name a hospital executive “is a natural choice these days,” said Jaime A. Estupiñán, a partner at Booz & Company, a consulting firm. Given the changing nature of the business, both as a result of the health care law and the pressure to find ways to offer better care at lower cost, large health systems “are the biggest threats to insurers,” he said, and the lines between those systems and traditional insurers are blurring.


While choosing a hospital executive is not completely out of the ordinary, Mr. Swedish’s experience will be helpful as WellPoint works more closely with doctors and hospitals, analysts said.


Read More..

With Pope’s Resignation, Focus Shifts to a Successor


L'Osservatore Romano, via Associated Press


Pope Benedict XVI announcing his resignation on Monday at the Vatican. At left is Msgr. Franco Camaldo, a papal aide.







VATICAN CITY — Pope Benedict XVI’s surprise announcement on Monday that he will resign on Feb. 28 sets the stage for a succession battle that is likely to determine the future course of a church troubled by scandal and declining faith in its traditional strongholds around the world.




Citing advanced years and infirmity, Benedict became the first pope in six centuries to resign. Vatican officials said they hoped to have a new pope in place by Easter, while expressing shock at a decision that some said had been made as long as a year ago.


Saying he had examined his conscience “before God,” Benedict said he felt that he was not up to the challenge of guiding the world’s one billion Catholics. That task will fall to his successor, who will have to contend not only with a Roman Catholic Church marred by the sexual abuse crisis, but also with an increasingly secular Europe and the spread of Protestant evangelical movements in the United States, Latin American and Africa.


The resignation sets up a struggle between the staunchest conservatives, in Benedict’s mold, who advocated a smaller church of more fervent believers, and those who feel the church can broaden its appeal in small but significant ways, like allowing divorced Catholics to receive communion or loosening restrictions on condom use to prevent AIDS. There are no plausible candidates who would move on issues like ending celibacy for priests, or the ordination of women.


Many Vatican watchers suspect the cardinals will choose someone with better management skills and a more personal touch than the bookish Benedict, someone who can extend the church’s reach to new constituencies, particularly to the young people of Europe, for whom the church is now largely irrelevant, and to Latin America and Africa, where evangelical movements are fast encroaching.


“They want somebody who can carry this idea of new evangelization, relighting the missionary fires of the church and actually make it work, not just lay it out in theory,” said John L. Allen, a Vatican expert at the National Catholic Reporter and author of many books on the papacy. Someone who will be “the church’s missionary in chief, a showman and salesman for the Catholic faith, who can take the reins of government more personally into his own hands,” he added.


The other big battle in the church is over the geography of Catholicism, which has spread decisively to the developing world. Today, 42 percent of its adherents come from Latin America, and about 15 percent from Africa, versus only 25 percent from Europe. That has led many in the church to say that the new pope should represent a part of the world where membership is growing quickly, while others say that spiritual vision should be paramount.


But while most of the world’s Catholics live outside Europe, most of the cardinals come from Europe, pointing to a central tension: while the Vatican is a global organization, it is often run like an Italian village.


Under normal circumstances, the cardinals would descend on Rome after the death of the reigning pope. In this case, said the Vatican spokesman, the Rev. Federico Lombardi, the pope will carry out his duties until Feb. 28 at 8 p.m., with a successor probably elected by Easter, which this year falls on March 31. But he said the timing for an election of a new pope is “not an announcement, it’s a hypothesis.”


Already, speculation is rife about who best fills the perceived needs of the church. Cardinal Angelo Scola, the powerful archbishop of Milan, is seen as the strongest Italian contender. A conservative theologian with an interest in bioethics and Catholic-Muslim relations, he is known for his intellect, his background in the same theological tradition as Benedict, his media savvy and his strong ties with the Italian political establishment. Vatican experts laud his popular touch, even if his writings are often opaque.


Cardinal Marc Ouellet, a dogmatic theologian and a Canadian, is widely seen as a favorite of Benedict, who named him head of the Vatican’s influential Congregation for Bishops to help select bishops around the world. Critics in his native Quebec said that he was out of step with the province’s more progressive bishops, but that is not necessarily a drawback in today’s church.


Nicholas Kulish contributed reporting from Berlin, and Alan Cowell from London.



Read More..

Indiana stays at No. 1 in AP Top 25 despite loss


Indiana coach Tom Crean used an analogy to the state's second favorite sport after the Hoosiers remained No. 1 in The Associated Press' Top 25 for a second straight week.


It had been over a month since a team managed to stay on top, and Indiana broke that trend despite losing a game last week, leading Crean to bring up auto racing.


"I had a good friend tell me that in-season rankings are the barometer of representing what lane you're in and the direction and how far you are moving towards your goals," Crean said Monday. "We want to stay in the left lane and keep working on our team and pace because we know there are quite a few others in the left lane as well."


The Hoosiers (21-3) lost to Illinois on a last-second basket Thursday but rebounded with a win at then-No.10 Ohio State on Sunday. In a week when four of the top five teams and six of the top 10 lost, it was enough to keep the No. 1 ranking.


"They were really disappointed on Thursday night. And instead of carrying that disappointment into a 'woe is me' mentality, they really did trigger how to get better. And I think it was in the sense of closing games," Crean said.


"I think there was a different level, a sense of urgency because of the way we didn't finish it off, combined with the fact that we knew we were playing a team that it is outstanding."


This ends a stretch of five consecutive weeks with a new No. 1, two weeks short of the longest such stretch in 1993-94. Duke started the run followed by Louisville, Duke again, Michigan and Indiana.


The Hoosiers received 26 first-place votes from the 65-member national media panel Monday, while Duke, the only member of the top five not to lose last week, moved up two spots to second after getting 20 first-place votes.


The last time a No. 1 team lost and kept the ranking the next week was the final poll of last season. Kentucky fell to Vanderbilt in the Southeastern Conference tournament championship game, but Nos. 2-4 also went down that week, so the Wildcats were No. 1 heading into the NCAA tournament.


Miami, which received 17 No. 1 votes, jumped from eighth to No. 3, the Hurricanes' highest ranking ever.


"I've never really thought that Miami could be a top 10 program," center Reggie Johnson said. "I didn't think we'd be here in February. It's surreal. The votes are cool, but we've still got work to do."


The Hurricanes are the last team from a major conference to still be unbeaten in league play.


"It's what every program strives for," coach Jim Larranaga said. "Carolina and Duke have this every year. It's a little different for us. These guys are hungry. They remain very, very humble."


Michigan dropped one spot to fourth, while Gonzaga, which got the other two first-place votes, moved up one spot to fifth.


Syracuse was sixth, followed by Florida, Michigan State, Arizona and Kansas State.


Along with Indiana and Ohio State, the other top 10 teams to lose last week were No. 2 Florida, No. 3 Michigan, No. 5 Kansas and No. 7 Arizona.


There were four newcomers to the rankings: No. 20 Wisconsin, No. 22 Memphis, No. 24 Colorado State and No. 25 Kentucky.


Wisconsin, Memphis and Kentucky, the defending national champion, were all ranked early in the season, while Colorado State makes it first appearance in the poll since March 9, 1954.


They replace Creighton, Cincinnati, Minnesota and Missouri, the only one of the four not to lose two games last week.


In all, 14 ranked teams lost at least once, with five losing twice.


___


AP Sports Writer Steve Wine in Miami contributed to this report.


Read More..

Health Testing on Mice Is Found Misleading in Some Cases


Evan McGlinn for The New York Times


Dr. H. Shaw Warren is one of the authors of a new study that questions the use of laboratory mice as models for all human diseases.







For decades, mice have been the species of choice in the study of human diseases. But now, researchers report evidence that the mouse model has been totally misleading for at least three major killers — sepsis, burns and trauma. As a result, years and billions of dollars have been wasted following false leads, they say.




The study’s findings do not mean that mice are useless models for all human diseases. But, its authors said, they do raise troubling questions about diseases like the ones in the study that involve the immune system, including cancer and heart disease.


“Our article raises at least the possibility that a parallel situation may be present,” said Dr. H. Shaw Warren, a sepsis researcher at Massachusetts General Hospital and a lead author of the new study.


The paper, published Monday in Proceedings of the National Academy of Sciences, helps explain why every one of nearly 150 drugs tested at a huge expense in patients with sepsis has failed. The drug tests all were based on studies in mice. And mice, it turns out, can have something that looks like sepsis in humans, but is very different from the condition in humans.


Medical experts not associated with the study said that the findings should change the course of research worldwide for a deadly and frustrating condition. Sepsis, a potentially deadly reaction that occurs as the body tries to fight an infection, afflicts 750,000 patients a year in the United States, kills one-fourth to one-half of them, and costs the nation $17 billion a year. It is the leading cause of death in intensive-care units.


“This is a game changer,” said Dr. Mitchell Fink, a sepsis expert at the University of California, Los Angeles, of the new study.


“It’s amazing,” said Dr. Richard Wenzel, a former chairman at the department of internal medicine at Virginia Commonwealth University and a former editor of The New England Journal of Medicine. “They are absolutely right on.”


Potentially deadly immune responses occur when a person’s immune system overreacts to what it perceives as danger signals, including toxic molecules from bacteria, viruses, fungi, or proteins released from cells damaged by trauma or burns, said Dr. Clifford S. Deutschman, who directs sepsis research at the University of Pennsylvania and was not part of the study.


The ramped-up immune system releases its own proteins in such overwhelming amounts that capillaries begin to leak. The leak becomes excessive, and serum seeps out of the tiny blood vessels. Blood pressure falls, and vital organs do not get enough blood. Despite efforts, doctors and nurses in an intensive-care unit or an emergency room may be unable to keep up with the leaks, stop the infection or halt the tissue damage. Vital organs eventually fail.


The new study, which took 10 years and involved 39 researchers from across the country, began by studying white blood cells from hundreds of patients with severe burns, trauma or sepsis to see what genes were being used by white blood cells when responding to these danger signals.


The researchers found some interesting patterns and accumulated a large, rigorously collected data set that should help move the field forward, said Ronald W. Davis, a genomics expert at Stanford University and a lead author of the new paper. Some patterns seemed to predict who would survive and who would end up in intensive care, clinging to life and, often, dying.


The group had tried to publish its findings in several papers. One objection, Dr. Davis said, was that the researchers had not shown the same gene response had happened in mice.


“They were so used to doing mouse studies that they thought that was how you validate things,” he said. “They are so ingrained in trying to cure mice that they forget we are trying to cure humans.”


“That started us thinking,” he continued. “Is it the same in the mouse or not?”


The group decided to look, expecting to find some similarities. But when the data were analyzed, there were none at all.


“We were kind of blown away,” Dr. Davis said.


The drug failures became clear. For example, often in mice, a gene would be used, while in humans, the comparable gene would be suppressed. A drug that worked in mice by disabling that gene could make the response even more deadly in humans.


Even more surprising, Dr. Warren said, was that different conditions in mice — burns, trauma, sepsis — did not fit the same pattern. Each condition used different groups of genes. In humans, though, similar genes were used in all three conditions. That means, Dr. Warren said, that if researchers can find a drug that works for one of those conditions in people, it might work for all three.


This article has been revised to reflect the following correction:

Correction: February 11, 2013

An earlier version of this article misstated the position of Dr. Richard Wenzel. He is a former chairman of the department of internal medicine at Virginia Commonwealth University. He is not currently the chairman.



Read More..

Media Decoder: A CBS Deal Bolsters Amazon's Challenge to Netflix

Slowly but confidently, Amazon is building a library of television shows and movies to rival that of Netflix, much to the satisfaction of media companies like Time Warner and CBS, whose executives love to see the competition.

Although Amazon will not unveil its own original television shows until the fall at the earliest, it is spending hundreds of millions of dollars to have the exclusive Web rights to shows it can brag about on its Amazon Prime streaming service, like “Downton Abbey,” from PBS, and “Falling Skies,” from TNT.

The latest example came on Monday, when Amazon announced an unusual arrangement with CBS, the country’s most-watched television network, to carry episodes of “Under the Dome” just days after the series makes its debut on TV in June.

“This deal is yet another sign that the streaming marketplace is becoming more and more robust,” said Scott Koondel, the chief content licensing officer for CBS, a position that was created two months ago. “Advances in user-friendly technology from companies like Amazon and Netflix are a boon for premium content owners.”

Amazon has a long way to go to rival Netflix in terms of TV and movie selection. But in some corners of the media business, it is already perceived to be Pepsi to Netflix’s Coke. And many other companies — among them Google, Sony, Intel and a new joint venture between Redbox and Verizon — are trying to come up with a Red Bull or a Snapple they can call their own.

While Netflix has won attention for unveiling a high quality show, “House of Cards,” on its streaming service, “it is increasingly hard to ignore the progress Amazon has made in a relatively short amount of time,” Richard Greenfield, an analyst at BTIG Research, wrote two weeks ago. He predicted that Amazon would quietly spend more than $500 million on video this year.

Amazon declined to comment on that figure. Its nearly two-year-old streaming service, called Prime Instant Video, is bundled as part of its $79 annual Amazon Prime membership, which also provides two-day free shipping and a monthly Kindle e-book rental. The company says it has millions of Amazon Prime subscribers, but it will not disclose the precise number. Netflix has about 27 million streaming subscribers in the United States.

Instant Video started simply enough about two years ago, with relatively cheap acquisitions of older television shows from networks like CBS and nonexclusive rights to older films from studios like Universal. But Amazon’s recent deals have revealed the company’s ambitions.

When Netflix dropped the rights to some cable series like “Pawn Stars” last fall, Amazon swooped in and started streaming them. When Time Warner wanted to sell streams of some of its cable dramas, Amazon bought the exclusive rights to “The Closer” and “Falling Skies,” while Netflix bought “Dallas.”

“This emerging back end for cable originals is a very promising sign,” Jeffrey L. Bewkes, chief executive of Time Warner, told investors last week, “since it should result in production values for cable originals getting even better over time.”

Perhaps its biggest deal yet came last week, when it clinched the rights to past and future seasons of the PBS hit “Downton Abbey.” By July, “Downton” will be gone from Netflix.

Both streaming services mine the data of their users to determine what kinds of shows to license, and what not to. The first two seasons of “Downton” were the “most-streamed TV show on Prime Instant Video,” said Brad Beale, who oversees video acquisitions for Amazon, so it was a “pretty easy decision” to bid for seasons three and four (and five, if it is produced).

“Data is a great proxy for what our customers love,” Mr. Beale added in a telephone interview. “We’re blessed to have a platform that gives us a lot of insight into what our customers love.”

“Under the Dome” — based on the Stephen King novel and produced by Steven Spielberg’s Amblin Television — will be unique because each episode will go onto Amazon four days after its premiere on TV. CBS stands to make more money this way than it now does by streaming shows on CBS.com and attaching ads.

Analysts expect to see more such deals as broadcasters move away from the free online model made popular by Hulu. Hulu has a subscription component as well, but it has not announced any notable licensing deals the way Netflix and Amazon have done. Its owners are at odds over the future of the service, and its founding chief executive, Jason Kilar, will leave later this winter.

Netflix says it expects to compete with Amazon the way HBO and Showtime compete — with TV dramas and comedies of their own. “When it comes to competition, we not only have a superior content offering due to our larger budget, but we are further along the experience curve,” Netflix told investors last month. In other words, Amazon is cheap, off-brand Cola.

While Netflix has four more original series on tap this year, Amazon is trying out test episodes of six comedies and five children’s series. This year, Amazon will stream them and, after hearing from viewers, decide which ones will become series.

Roy Price, the head of Amazon Studios, said the pilot process will ensure quality, just as it does for traditional television networks, and make viewers and producers pay attention to Amazon’s video projects.

“All that matters is being great,” he said. “There’s no great benefit in being good; people don’t change their habits for good.”

Read More..

Syrian War Closes In on the Heart of Damascus


Goran Tomasevic/Reuters


Fighters from the Free Syrian Army's Tahrir al Sham brigade look at a Syrian Army base in the Arabeen neighborhood of Damascus.







DAMASCUS, Syria — Unkempt government soldiers, some appearing drunk, have been deployed near a rebel-held railway station in the southern reaches of this tense capital. Office workers on 29th of May Street, in the heart of the city, tell of huddling at their desks, trapped inside for hours by gun battles that sound alarmingly close.




Soldiers have swept through city neighborhoods, making arrests ahead of a threatened rebel advance downtown, even as opposition fighters edge past the city limits, carrying mortars and shelling security buildings. Fighter jets that pounded the suburbs for months have begun to strike Jobar, an outlying neighborhood of Damascus proper, creating the disturbing spectacle of a government’s bombing its own capital.


On Sunday, the government sent tanks there to battle rebels for control of a key ring road.


In this war of murky battlefield reports, it is hard to know whether the rebels’ recent forays past some of the capital’s circle of defenses — in an operation that they have, perhaps immodestly, named the “Battle of Armageddon” — will lead to more lasting gains than earlier offensives did. But travels along the city’s battlefronts in recent days made clear that new lines, psychological as much as geographical, had been crossed.


“I didn’t see my family for more than a year,” a government soldier from a distant province said in a rare outpouring of candor. He was checking drivers’ identifications near the railway station at a checkpoint where hundreds of soldiers arrived last week with tanks and other armored vehicles.


“I am tired and haven’t slept well for a week,” he said, confiding in a traveler who happened to be from his hometown. “I have one wish — to see my family and have a long, long sleep. Then I don’t care if I die.”


For months, this ancient city has been hunched in a defensive crouch as fighting raged in suburbs that curve around the city’s south and east. On the western edge of the city, the palace of the embattled president, Bashar al-Assad, sits on a steep, well-defended ridge.


In between, Damascus, with its walled Old City, grand diagonal avenues and crowded working-class districts, has remained the eye of the storm. People keep going to work, even as electric service grows sporadic and groceries dwindle, even as the road to the airport is often cut off by fighting outside the city, and even as smoke from artillery and airstrikes in suburbs becomes a regular feature on the horizon.


But after rebels took the railway station 10 days ago in a city district called Qadam and attacked Abassiyeen Square on an approach to the city center on Wednesday, a new level of alarm and disorder has suffused the city. Rebels have pushed farther into the capital than at any point since July, when they briefly held part of a southern neighborhood.


Near the Qadam railway station last week, many of the government soldiers, their hair and beards untrimmed, wore disheveled or dirty uniforms and smelled as if they had not had showers in a long time. Some soldiers and security officers even appeared drunk, walking unsteadily with their weapons askew — a shocking sight in Syria, where regimented security forces and smartly uniformed officers have long been presented as a symbol of national pride.


The deployment appeared aimed at stopping the rebels from advancing past Qadam, either across the city’s ring road and toward the downtown or to suburbs to the east to close a gap in the opposition’s front line.


But even stationed here in Damascus, the heart of the government’s power, the soldier at the checkpoint — who was steady on his feet — said he felt vulnerable.


“It is very scary to spend a night and you expect to be shot or slaughtered at any moment,” he said. “We spend our nights counting the minutes until daytime.”


The government has hit back hard, striking Qadam with artillery and airstrikes. It has also made pre-emptive arrests in Midan, the neighboring district, closer to downtown, where rebels gained a temporary foothold in July and which they said was their next target.


Anne Barnard reported from Beirut, Lebanon.



Read More..