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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Obama Turns Up Pressure for Deal on Budget Cuts

Seeking to Avoid the Sequester:
The Times’s Michael D. Shear on how President Obama put pressure on Congress to avoid the across-the-board budget cuts.

WASHINGTON — Days away from another fiscal crisis and with Congress on vacation, President Obama began marshaling the powers of the presidency on Tuesday to try to shame Republicans into a compromise that could avoid further self-inflicted job losses and damage to the fragile recovery. But so far, Republicans were declining to engage.

To turn up the pressure on the absent lawmakers, Mr. Obama warned in calamitous terms of the costs to military readiness, domestic investments and vital services if a “meat-cleaver” approach of indiscriminate, across-the-board spending cuts takes effect on March 1. Surrounding him in a White House auditorium were solemn, uniformed emergency responders, invited to illustrate the sort of critical services at risk.

The president plans to keep up the pressure through next week for an alternative deficit-reduction deal that includes both spending cuts and new revenues through closing tax loopholes. He will have daily events underscoring the potential ramifications of the automatic cuts, aides said, and next week will travel outside Washington to take his case to the public, as he did late last year in another fiscal fight on which he prevailed.

In stern tones, Mr. Obama said that the automatic cuts, known in budget terms as a sequester, would “affect our responsibility to respond to threats in unstable parts of the world” and “add thousands of Americans to the unemployment rolls.”

He framed the debate in the way that he hopes will force Republicans into accepting some higher tax revenues, something they so far refuse to do.

“Republicans in Congress face a simple choice,” Mr. Obama said. “Are they willing to compromise to protect vital investments in education and health care and national security and all the jobs that depend on them, or would they rather put hundreds of thousands of jobs and our entire economy at risk just to protect a few special-interest tax loopholes that benefit only the wealthiest Americans and biggest corporations?”

Mr. Obama once again finds himself in a budget showdown with the opposing party, and numerous polls show his position to be more popular than Republican calls for spending cuts only, including cuts in Medicare. Mr. Obama and senior aides hardly disguised their sense of political advantage.

“We are trouncing them,” said one senior administration official about the Republicans.

Still, the president’s leverage might in fact be limited, since by all appearances he seems to want a deal far more than Republicans do. As the leader of the nation, Mr. Obama is eager to see an end to the repeated evidence of Washington dysfunction, or what he referred to again on Tuesday as the cycle of “manufactured crisis.” And with his legacy ultimately at stake, he needs to lift the fiscal uncertainty that since 2011 has held down economic growth.

Despite the risks of an impasse for Republicans, those who control the House have all but forfeited this battle to Mr. Obama and seem poised to let the automatic cuts take effect. Many Republicans, particularly newer members elected with Tea Party support, have pushed party leaders to accept the sequester and lock in the spending cuts rather than compromise. The leaders seem to have decided to wage battle later this spring in the larger fight over the annual federal budget.

Contributing to Republican calculations is the fact that at least in the short term, an impasse over the sequester is not as potentially catastrophic as the threats that loomed in past partisan showdowns, like a full shutdown of government or the nation’s first-ever default on its global debt obligations.

The potential impact is potentially hazardous nonetheless, both economically and politically. As Mr. Obama noted, the prospect of the sequester has already affected military deployments and hiring by military contractors, and threatens layoffs of teachers, air traffic controllers and researchers, among others.

Hours after the president’s remarks, economic forecasters at Macroeconomic Advisers, based in St. Louis, projected that sequestration would reduce the firm’s forecast of growth this year by nearly a quarter, 0.6 percent, and cost roughly 700,000 civilian and military jobs through 2014, with heightened unemployment lingering for several years.

“By far the preferable policy,” the analysis said, “is a credible long-term plan to shrink the deficit more slowly through some combination of revenue increases within broad tax reform” as well as “more carefully considered cuts” in spending programs, including Medicare and Medicaid. That prescription for both long-term spending reductions and revenue increases, as an alternative to immediate deep spending cuts that inhibit job growth, generally tracks Mr. Obama’s approach.

He has proposed $1.5 trillion in spending cuts over 10 years and revenue increases that would build on the roughly $2.5 trillion over the decade that he and Congress have agreed to in the past two years. The total, $4 trillion, is the minimum reduction that many economists say is necessary to stabilize the growth of the nation’s debt at a time when the population is aging and health care costs are rising.

That approach mixing spending cuts and increased revenues got another endorsement on Tuesday when the chairmen of Mr. Obama’s 2010 debt-reduction commission — former Senator Alan K. Simpson, a Republican, and Erskine B. Bowles, a Democrat and former chief of staff to President Bill Clinton — released a revised fiscal plan that would reduce annual deficits by $2.4 trillion in a decade through spending cuts, including in Medicare and Social Security benefits, and an overhaul of the tax system.

But Republicans say they will not consider additional tax increases since Mr. Obama in January won more than $600 billion over 10 years in higher revenues from the wealthiest taxpayers. “The revenue debate is now closed,” Speaker John A. Boehner said in a statement reacting to the president’s remarks.

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Briefs | Middle East: Iran: Rivals Forced to Apologize to Supreme Leader

Rival politicians apologized to Ayatollah Ali Khamenei over the weekend for having been embroiled in an unusually public feud involving secret tapes and a tit-for-tat impeachment. On Sunday, President Mahmoud Ahmadinejad; the Parliament speaker, Ali Larijani; his brother, Sadegh Larijani; the chief of Iran’s judiciary; and all members of Parliament sent letters expressing sorrow and promising renewed allegiance to Ayatollah Khamenei, the supreme leader of Iran. The written apologies, reported by the state-run press, came a day after the ayatollah had criticized both Mr. Ahmadinejad and the Larijanis for letting their own mutual animosity become public, raising speculation of irreparable rifts. The ayatollah had said in a speech that the whole matter “made me feel sad.”

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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 global 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 star-studded, trophy-winning Lakers became Southern California's most beloved sports franchise and a signature cultural representation of Los Angeles. Buss acquired, nurtured and befriended a staggering array of talented players and basketball minds during his Hall of Fame tenure, from Magic Johnson, Kareem Abdul-Jabbar and James Worthy 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 with little regard to its financial cost.

"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 cause of death was kidney failure, Steiner said.

"When someone as celebrated and charismatic as Jerry Buss dies, we are reminded of two things," said Abdul-Jabbar, the leading scorer in NBA history. "First, just how much one person with vision and strength of will can accomplish. Second, how fragile each of us is, regardless of how powerful we were. Those two things combine to inspire us to reach for the stars, but also to remain with our feet firmly on the ground among our loved ones. ... The man may be gone, but he has made us all better people for knowing him."

With his condition worsening in recent months, several prominent former Lakers visited Buss to say goodbye. Even rivals such as Dallas Mavericks owner Mark Cuban and Clippers owner Donald Sterling hailed the passion and bonhomie of the former chemist and mathematician who lived his own Hollywood dream.

"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.

"Jerry Buss was more than just an owner. He was one of the great innovators that any sport has ever encountered," Riley said. "He was a true visionary, and it was obvious with the Lakers in the 80's that 'Showtime' was more than just Magic Johnson and Kareem Abdul-Jabbar. It was really the vision of a man who saw something that connected with a community."

Ownership of the Lakers is now in a trust controlled by Buss' six children, who all have worked for the Lakers in various capacities for several years. 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.

"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 turned the Lakers' games into a must-see event. He used the Laker Girls, a brass band and promotions to keep Lakers fans interested during all four quarters. 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.

"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."

Buss paid the Lakers' bills 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."

Showtime couldn't last forever, but after a rough stretch in the 1990s, Buss rekindled the Lakers' mystique by paying top dollar to hire Jackson, who led O'Neal and Bryant to a three-peat from 2000-02. Bryant and Pau Gasol won two more titles under Jackson in 2009 and 2010.

The current Lakers (25-29) have struggled mightily despite adding Howard and Steve Nash in a couple of moves that were typical of Buss' big, brash style. Los Angeles could miss the playoffs this spring 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."

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 Southern California 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. With his failing health, 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 from USC 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, and he received 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 because he loved its sports teams. He also became a chemistry professor and worked in the missile division of defense contractor McDonnell Douglas before carving out a path to wealth and sports prominence.

His real-estate portfolio grew out of a $1,000 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 along with a 13,000-acre ranch in Kern County. Buss 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."

With showmanship, fearless spending and a little drafting luck, Buss quickly succeeded: 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. He 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.

"I was privileged to be part of that for 10 years and even more grateful for the friendship that has lasted all these many years," Riley said. "I have always come to realize that if it weren't for Dr. Buss, I wouldn't be where I am today."

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 the stuff of Los Angeles legends, 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 went through seven coaches and made just one conference finals appearance in an eight-year stretch of the 1990s 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.

Buss' children have pledged to continue his commitment to the Lakers' distinctive success, although their efforts haven't been rewarded in the past three years while Jerry Buss ceded many decision-making responsibilities to Jim Buss, the Lakers' executive vice president of player personnel and the second-oldest child. While daughter Jeanie runs the franchise's business side, Jim Buss now has the final say on basketball decisions.

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.

"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."

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.

___

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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In Russia, Property Ruined and Spared by Meteor Share Space

CHELYABINSK, Russia — The shock wave from a meteor that exploded above Siberia last week somehow sheared the roof off a brick and steel factory building while leaving a nearby glass facade unscathed.

In some high-rises in this city, the first modern urban community to have felt the breath of a cosmic close encounter, every window blew out on the top floor; elsewhere, the ground floors suffered.

More ominously, reports came in to local news media over the weekend of stranger phenomena: behind unshattered apartment windows, glass jugs were said to explode into shards, dishes to crack, electronics to die. Balconies rattled. One man said a bottle broke right in his hand.

Anna V. Popova was at home with her daughter when she saw the flash, then heard explosions, then found the windows of her enclosed balcony blown in; her neighbor, with identical windows, escaped without property damage.

“A lot of people suffered, not us alone,” Ms. Popova said, but added that there seemed to be randomness in whose property was damaged. “Who are we supposed to blame for all this? Nobody of course.”

Scientists believe the space rock that tore through the atmosphere on Friday morning and blew apart here was the largest to have entered the atmosphere since 1908 and that it was unusual as well for the scale of its effects: more than 1,200 people injured and broad property damage.

Indeed, the event is providing a first indication of the type of structural and infrastructural costs meteors can exact from a highly industrialized society. NASA scientists say a meteor of this size strikes the Earth about once every hundred years.

Shattered glass caused most of the damage and injuries here in Chelyabinsk, a sprawling industrial city of about a million people.

What shattered the glass, scientists say, was both the explosion as the meteor fragmented and the waves of pressure created as it decelerated. Such low-frequency waves — called infrasound — are sometimes detected by cold-war era nuclear blast sensors in remote parts of the Pacific Ocean or Alaska, according to meteor experts.

The waves can bounce off buildings and be stronger in some places than others; they can also resonate with glass, explaining why bottles and dishes might have shattered inside undamaged kitchens, as if crushed by the airy hand of the meteor itself.

“A shock wave is like a ball,” Aleksandr Y. Dudorov, director of the theoretical physics department at Chelyabinsk State University, said in an interview. “Throw a ball into a room and it will bounce from one wall to another.”

Russia has mobilized 24,000 emergency officials to inspect roads, railroads, hospitals, factories and military facilities. Most are undamaged, including 122 sites identified as particularly critical, including nuclear power plants, dams and chemical factories, and a space launching site called Strela.

Also Sunday, Russia’s consumer safety inspection agency, Rospotrebnadzor, released a statement saying the water in Lake Chebarkul, where a hole in the ice appeared on Friday, was not radioactive.

It was unclear why the agency released this finding only Sunday, or whether the tests were conducted to assuage popular concerns or out of any real official uncertainty over what happened on Friday. In any case, the agency said a mobile laboratory quietly dispatched to the lake tested for but did not discover cesium 137 and strontium 90, isotopes created in nuclear explosions.

Infrasound waves have not previously been studied in a cityscape, Richard P. Binzel, a professor of planetary science at the Massachusetts Institute of Technology and an author of a textbook on asteroids and meteorites, said in a telephone interview. But he noted that the apparent randomness of the damage was consistent with the way such waves function.

“A shock wave can be coming from a particular direction, and if you face that direction you are more susceptible,” Dr. Binzel said.

“One building might shadow another, or you may have a street that is optimally aligned to channel the wave, either in a fortunate or unfortunate way.”

Peter Brown, a professor of physics at the University of Western Ontario, wrote in an e-mail that an infrasound wave “is very efficient at traveling long distances,” and that “windows, structures or even glass jars susceptible to resonate at this frequency could be a factor to seemingly random damage at widely disparate locations.”

Dr. Brown studied a similar, though smaller, explosion of a meteor over the Pacific Ocean on Oct. 8, 2009, which also sent out low-frequency waves, though too remote to affect homes or industry.

They were, though, registered by a network of infrasound sensors established to monitor compliance with the international ban on nuclear tests, according to Dr. Brown.

Alekdander V. Anusiyev, the spokesman for the governor of Chelyabinsk region, characterized the damage here as without a discernible pattern. “It is impossible to say more glass broke in one part of the city or another,” he said. “Glass broke everywhere.”

The roof of the zinc factory that collapsed was reinforced with a lattice of steel beams and supported by concrete joists that are now broken, jutting upward with mangled re-bar protruding. Windows on a neighboring house blew in with such force that the frames went with them.

Yet a few yards away on Sverdlovsky Street, the cosmos spared a seemingly vulnerable Hundai dealership, a three-story cube sheathed in glass, with glistening display models inside. Not a window broke.

“People can consider Feb. 15 their second birthday,” the governor of Chelyabinsk, Mikhail Yurevich, told reporters, referring to the day of the meteor strike. “God directed danger away.”

Ellen Barry contributed reporting from Moscow.

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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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The Media Equation: In Omaha Manhole Fire Photo, Logging Off in Search of Some Clues

Stephanie Sands

This image, which was taken after an underground fire cut power in half of downtown Omaha, captivated the Web last month.

When photographs of spontaneous events miraculously appear on the Web, it generally prompts two responses: wonder and skepticism.

So it was with an image of exploding manhole covers in Omaha that took over the Web last month. On Sunday, Jan. 27, an underground fire cut power in half of downtown. A vivid photograph of unknown provenance, showing fire shooting out of manholes on a city street, began popping up on Reddit, where it had 1.5 million views, and Gawker.

The photo — an indifferently composed shot of an event that looks very far away — would not win any Pulitzers, but something incredible seems to be under way at the precise moment it was taken. You can almost hear the sequential explosions emanating below the street: boom, boom, boom as flames appear to shoot up from hell itself.

In this age of Photoshop, it wasn’t long before the debates cropped up, on the Web and in Omaha, about the picture’s authenticity.

Matthew Hansen, a columnist at The Omaha World-Herald, wondered the same thing, and one night found himself in a bar engaged in the real-versus-fake debate. Like many photos on the Web, this one came from everywhere — forwarded, tweeted and blogged — and nowhere — there was no name on the image nor any text to indicate its origin.

Mr. Hansen, intrepid journalist that he is, solved the mystery and wrote a column about it. The photo was real, it turned out, but not in the way people thought. (More on that later.) So, did Mr. Hansen use deep photo analytics or examine metadata to peel back the truth?

Nope. There was a notebook involved, a lawyer, some phone calls, a cursory digital investigation and some street reporting, which included an interview with a man with no pants.

Shoe leather never looked or smelled so good.

Mr. Hansen’s first step in solving what he called the “Great Omaha Manhole Fire Photo of 2013” was to determine from the angle of the photo that it could have been taken from only one apartment building — called the Kensington Tower. He then used an architectural detail to conclude that it was shot from the top floor, on the west side.

He managed to gain entry to the building — that is, he sneaked in — and made his way to the top floor, where he began knocking on doors.

Mr. Hansen found a man named Kenneth who would not let Mr. Hansen in because he was indisposed — he became “Pantsless Kenneth” in the column — but said that he knew the photo in question and thought his neighbor had taken it.

But the neighbor wasn’t home, so Mr. Hansen stuck his business card in the door jamb and left.

When he returned to the office, Mr. Hansen jumped onto Reddit, found the person who had originally posted the photo there and through him found the person, Gwendolyn Olney, who had posted the photo on her Facebook page, the source for the Reddit posting.

Ms. Olney happened to be the associate counsel for The World-Herald. “Omaha is indeed a small town,” Mr. Hansen wrote in his column. He began to follow the pixilated bread crumbs.

“Gwen didn’t take the photo,” he added. “She got it from Rebecca, who didn’t take the photo. She got it from Brandon, who didn’t take the photo. They led me to Gwen’s friend Andrea, who didn’t take the photo, who led me to ... well, she couldn’t remember who she had gotten the photo from.”

Reading the column, you could almost hear his sigh when he wrote, “Dead end.”

Then his phone rang. “I took that photo,” the voice said.

The caller was Stephanie Sands, a graduate student at the University of Nebraska at Omaha. She said that the day after she took the photo, which she had no idea had become a sensation, she learned from her friends that a reporter was asking about it.

“I was impressed that he had sneaked upstairs and put a card in my door, so I called him,” she said in an interview by phone.

Ms. Sands agreed to meet Mr. Hansen and told him that she had heard the explosion and took two photos with her phone. She sent one to friends and thought nothing more of it.

“I was actually disappointed in how it turned out,” she told me. “Because I was shooting at a distance with an iPhone, it didn’t really capture the severity of what I saw and heard.”

This article has been revised to reflect the following correction:

Correction: February 17, 2013

An earlier version of this column misidentified the author of a profile of Edna Buchanan. The writer was Calvin Trillin, not Gay Talese. 

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