Antismoking Outlays Drop Despite Tobacco Revenue





Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.







Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.







States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.


The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.


“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.


Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.


Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.


The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.


The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.


Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.


“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”


Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.


The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.


An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.


Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.


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DealBook: Trail to a Hedge Fund, From a Cluster of Cases

In April 2009, an F.B.I. agent visited the Silicon Valley home of Richard Choo-Beng Lee, a hedge fund manager with deep contacts inside technology companies. The government, the agent said, had overwhelming proof that Mr. Lee had engaged in insider trading. Within weeks, Mr. Lee confessed and began cooperating.

A year and a half later, in the parking lot of a New England prep school, the same agent approached Noah Freeman, a Harvard-educated money manager turned teacher. After the agent played a secretly recorded conversation of Mr. Freeman swapping illegal tips, Mr. Freeman admitted to crimes and started assisting the authorities.

Last winter, another agent confronted Mathew Martoma, a pharmaceutical-industry analyst, at his 8,000-square-foot Florida mansion. As they stood on the front lawn, with Mr. Martoma’s wife and children inside, the agent told him that they had evidence that he had broken the law.

Overcome with stress, Mr. Martoma passed out.

Three criminal defendants — Mr. Lee, Mr. Freeman and Mr. Martoma — have a common denominator: Each had worked for SAC Capital Advisors, the hedge fund run by Steven A. Cohen, one of the most powerful figures in finance. By posting impressive annual returns averaging 30 percent across two decades, Mr. Cohen, a 56-year-old Long Island native, has amassed a fortune estimated at nearly $9 billion.

Mr. Cohen has not been accused of any wrongdoing and he may never be charged, but he has become a central focus of the government’s sprawling investigation into criminal conduct at hedge funds. A picture of the inquiry has emerged from interviews with people involved with the case.

The trail leading to SAC has emerged out of a cluster of cases, many of them connected to the prosecution of the fallen titan Raj Rajaratnam. Investigators heard SAC traders on incriminating wiretaps; in other instances, cooperators and informants accused the fund of misconduct. As the authorities painstakingly pieced together dozens of cases across multiple, overlapping conspiracies, again and again one name kept popping up: Mr. Cohen’s SAC.

Complete Coverage: Insider Trading at a Top Hedge Fund

Investigators have penetrated SAC and other funds by aggressively deploying techniques — wiretaps, cooperators and informants — once reserved for infiltrating the Mafia and narcotics rings. Government lawyers have reviewed millions of pages of documents and taken hundreds of depositions. Securities watchdogs, meanwhile, have developed more sophisticated methods to detect insider trading, which is defined as trading based on material, nonpublic information.

The long-running inquiry has linked six former SAC employees to insider trading while at the fund; three, including Jon Horvath, who has implicated one of Mr. Cohen’s top lieutenants, have pleaded guilty. At least six other former employees have been tied to insider trading after leaving SAC. Several more have received subpoenas, people briefed on the case say.

Since 2002, the financial industry’s self-regulatory groups have referred about 80 instances of suspicious SAC trading activity to federal authorities for further investigation. In 2007, as the citations piled up, the self-regulatory groups took a more aggressive tone, noting that the hedge fund had been “repeatedly” flagged for suspicious trading. (An SAC spokesman has said that the fund trades in thousands of stocks each day, so given its level of activity it is not surprising that the fund would show up in referrals.)

“Government lawyers go where the facts take them,” said H. David Kotz, a former inspector general at the Securities and Exchange Commission now with Berkeley Research, a consulting firm. “With so many disparate strands of the investigation leading to SAC, it makes perfect sense that they would be closely looking at the guy in charge.”

And they are looking very closely. A few years ago, the F.B.I. secretly recorded the telephone line at Mr. Cohen’s Greenwich, Conn., estate, said two people briefed on the investigation. It is unclear what precipitated the wiretapping and whether any evidence was collected. Federal securities regulators have had previous brushes with SAC in 2003 and Mr. Cohen in 1986, but neither inquiry resulted in any action. Last summer, S.E.C. lawyers deposed him.

Speaking to his roughly 1,000 employees last week, Mr. Cohen expressed confidence that he acted appropriately. In defending the fund, SAC cites its strong culture of compliance and says it is “outraged” and “deeply disturbed” by the conduct of former employees.

But with Mr. Martoma’s arrest Nov. 20 — the first case that directly ties Mr. Cohen to questionable trades — the investigation has entered a more serious phase. The S.E.C. warned the fund that it was preparing a civil fraud lawsuit against SAC related to Mr. Martoma’s case. A lawyer for Mr. Martoma, Charles A. Stillman, said that he expected his client to be exonerated.

And just as it did in the investigation of Mr. Rajaratnam and in the landmark 1980s prosecutions of the financial giants of that era, Michael R. Milken and Ivan F. Boesky, the government is pursuing lower-level employees and then seeking their cooperation in the hopes of building a case against the boss.

C. B. Lee

Had he made different career choices, Richard Choo-Beng Lee might have been an engineer at Apple or Intel. Instead, armed with a computer science degree and a knack for numbers, Mr. Lee became a star technology analyst on Wall Street.

Known as C. B., Mr. Lee worked in the 1990s at the brokerage firm Needham & Company alongside Mr. Rajaratnam. In 1999, Mr. Lee landed at SAC, where he earned millions working for a team of tech-stock traders. After five years, he left, and in 2008 started his own California-based hedge fund, Spherix Capital.

That same year, a government informant taped incriminating calls with Mr. Rajaratnam, who by then had become a billionaire running the Galleon Group. On the basis of those calls, prosecutors received a judge’s approval to wiretap Mr. Rajaratnam’s cellphone. They also received permission to eavesdrop on Danielle Chiesi, a close associate of Mr. Rajaratnam. Ms. Chiesi was heard on calls with Mr. Lee passing inside information.

B. J. Kang, an F.B.I. agent, showed up at Mr. Lee’s modest San Jose, Calif., home in 2009. After pleading guilty, he closed Spherix Capital and became a cooperator, recording conversations that helped ensnare several defendants.

Securing Mr. Lee’s cooperation proved to be a major breakthrough because he helped them better understand SAC’s trading practices and culture. As part of Mr. Lee’s plea agreement, he agreed to share information about illegal conduct that he saw while working for Mr. Cohen.

He also provided investigators with detailed insights into expert-network firms, a growing business that connected traders with sources at publicly traded companies. Mr. Lee said SAC and other funds aggressively used these matchmaking firms, some of which were cesspools of inside information.

A few months after Mr. Lee “flipped,” the F.B.I. directed him to try to get rehired by SAC, said a person briefed on the case. Mr. Cohen entertained his request but ultimately rebuffed him, leery that Mr. Lee had abruptly closed his fund, this person said.

Jeffrey Bornstein, a lawyer for Mr. Lee, 56, said that his client continues to cooperate with the government.

Noah Freeman

When Noah Freeman graduated from Harvard in 1999, the stock market was roaring. After a stint in management consulting, Mr. Freeman tried his hand at hedge funds. He started at Brookside Capital, a unit of Bain Capital.

Mr. Freeman joined SAC in 2008, lured by a two-year, $2 million-a-year guarantee. The fund gave him several hundred millions of dollars to manage.

Mr. Freeman routinely shared his best ideas with Mr. Cohen. Unlike hedge funds with one manager making investment decisions, SAC has about 140 teams — each controlling several hundred millions of dollars. The teams give their “high conviction ideas” to Mr. Cohen, who directly manages only about 10 percent of the fund. SAC compensates employees based on a percentage of the winnings they generate for the fund, as well as on profits they make for Mr. Cohen’s portfolio.

An accomplished speed skater and triathlete, Mr. Freeman thrived in the high-stress world of hedge funds. But the pressure to perform was immense. To help gain an edge, Mr. Freeman became a big user of expert networks, especially Primary Global Research. His principal contact at Primary Global was Winifred Jiau.

Mr. Lee and other informants had told government investigators that Primary Global was especially dirty, and investigators began listening to its phone calls. On one call in May 2008, Ms. Jiau was heard giving Mr. Freeman inside tips about Marvell Technology. Mr. Freeman shared the information with another SAC colleague, Donald Longueuil, who used it to earn more than $1 million in profits.

SAC fired Mr. Freeman in 2010 for poor performance, according to a fund spokesman. Disillusioned with Wall Street, Mr. Freeman went into education. He took a job teaching honors economics at the Winsor School, a prestigious all-girls school in Boston. One day, in November 2010, Mr. Kang, the F.B.I. agent, was waiting for Mr. Freeman in the parking lot of Winsor.

As a government cooperator, Mr. Freeman wore a wire and secretly recorded conversations with Mr. Longueuil, who had been the best man at his wedding. Mr. Longueuil is serving a two-and-a-half year sentence.

In a Dec. 16, 2010 interview, Mr. Freeman told investigators that he thought that trafficking in corporate secrets was part of his job description at SAC, according to an F.B.I. agent’s notes of the interview, which were in a court filing and first reported by Bloomberg News.

“Freeman and others at SAC Capital understood that providing Cohen with your best trading ideas involved providing Cohen with inside information,” the agent wrote.

Prosecutors announced charges against Mr. Freeman and Mr. Longueuil in February 2011. Primary Global has closed. Ms. Jiau, who was found guilty at trial, is in prison. At her trial, Mr. Freeman testified that he gave investigators the names of at least a dozen people who he believed were involved in criminal conduct.

Mr. Freeman, 36, who has yet to be sentenced, is currently a stay-at-home father, and his cooperation could spare him prison time. His lawyer, Benjamin E. Rosenberg, declined to comment.

Jon Horvath

In November 2010, the F.B.I. raided two hedge funds that heavily used expert-network firms: Level Global Investors and Diamondback Capital Management. Both had strong ties to Mr. Cohen; each was started by SAC alumni.

Fourteen months after the raid, prosecutors charged seven traders — including two each from Level Global and Diamondback — in what it called a “criminal club” that made nearly $70 million trading on secret information gleaned from sources inside technology companies.

Among those arrested was Jon Horvath, an SAC tech-stock analyst who once worked at Lehman Brothers. Low key and analytic, Mr. Horvath lacked the swagger of many of his peers. For months, he maintained his innocence.

But in September, a month before trial, Mr. Horvath admitted to insider trading while at SAC and agreed to cooperate. In court, Mr. Horvath said that he — along with his SAC manager — traded on confidential financial results. “In each instance I provided the information to the portfolio manager I worked for and we executed trades in the stocks based on that information,” he said.

The portfolio manager is Michael S. Steinberg, according to two people briefed on the inquiry. Prosecutors have not charged him, but have named him an unindicted co-conspirator.

Barry Berke, a lawyer for Mr. Steinberg, 40, and Steven Peikin, a lawyer for Mr. Horvath, 42, declined to comment.

Though recently placed on leave, Mr. Steinberg is one of SAC’s longest-tenured employees. He joined in 1997, when it was just Mr. Cohen and several dozen traders; for years, he sat near Mr. Cohen on the trading floor and the two grew close. When Mr. Steinberg was married in 1999 at the Plaza Hotel, Mr. Cohen attended the black-tie affair.

Mathew Martoma

In 2008, a team of S.E.C. enforcement lawyers in New York, led by Sanjay Wadhwa, noticed a pattern in the “suspicious trading reports.” CR Intrinsic Investors, a unit of SAC Capital, had made an uncanny string of immensely profitable, well-timed trades in technology and health care stocks. Their suspicions raised, the team requested more trading reports from the regulatory arm of the New York Stock Exchange. Huge bets by CR Intrinsic on the pharmaceutical companies Elan and Wyeth, placed just before they announced disappointing results from a drug trial, jumped off the page.

The S.E.C. issued a subpoena requesting that SAC produce documents — e-mails, instant messages, phone and trading records — connected to the unusual trades. As they combed through e-mails, S.E.C. lawyers discovered reams of correspondence between Mathew Martoma, a drug stock specialist at CR Intrinsic, and Dr. Sidney Gilman, a neurologist.

Two days before Thanksgiving, federal agents arrested Mr. Martoma. Prosecutors said that Dr. Gilman had leaked him secret data about clinical trials that he was overseeing for an Alzheimer’s drug being jointly developed by Elan and Wyeth.

The case was a turning point in the investigation of SAC because, for the first time, the government linked Mr. Cohen to trades that it contends were illegal. Mr. Martoma and Mr. Cohen collaborated on the Elan and Wyeth transactions, prosecutors said, earning SAC profits and avoiding losses totaling $276 million. After Mr. Martoma learned from Dr. Gilman — whom he met through an expert network — that there were problems with the trials, he reached out to his boss, the government said.

“Is there a good time to catch up with you this morning? It’s important,” Mr. Martoma e-mailed Mr. Cohen in July 2008, just days before Elan and Wyeth announced their findings.

An hour later, Mr. Martoma and Mr. Cohen had a 20-minute telephone conversation. SAC promptly sold a $700 million position in Elan and Wyeth and then made a big negative bet. After the drug companies released the negative data, their shares plummeted.

An S.E.C. lawyer interviewed Mr. Cohen about the Elan and Wyeth trades this summer, according to a person briefed on the case. In sworn testimony, he said that SAC sold the stocks because Mr. Martoma told him that he had lost conviction in the position, this person said. Otherwise, Mr. Cohen had little recall of their conversation.

Federal agents paid a house call to Mr. Martoma a year ago, pressuring him to “flip” and help build a case against Mr. Cohen. While speaking with the agents in his front yard, Mr. Martoma fainted. After picking himself up, he declined to cooperate. When the S.E.C. deposed him earlier this year, Mr. Martoma refused to answer questions, invoking his Fifth Amendment right against self-incrimination.

The government has said it will not prosecute Dr. Gilman, who has agreed to testify against Mr. Martoma.

SAC continues to operate during the intensifying investigation. The negative attention and controversy aggravates and angers Mr. Cohen, said a friend, but his ability to compartmentalize allows him to maintain a focus on investing.

An SAC spokesman said Wednesday that Mr. Cohen is cooperating with the government’s inquiry.

During market hours, Mr. Cohen can be found at the center of his football field-size trading floor in Stamford, Conn., sitting among his traders, sifting through information, and buying and selling stocks. SAC, which manages $14 billion, is up about 12 percent this year through the end of last month.

“None of this stuff is material to his returns and it’s all just a lot of noise,” said Ed Butowsky, managing partner of Chapwood Investments, a longtime SAC client. “Steve Cohen is the Michael Jordan of the hedge fund business. When people are successful everyone likes to take shots at them.”

Ben Protess contributed reporting.

A version of this article appeared in print on 12/06/2012, on page A1 of the NewYork edition with the headline: Trail to a Hedge Fund, From a Cluster of Cases.
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Typhoon Kills Hundreds in Philippines


Bullit Marquez/Associated Press


A resident hung clothing amid fallen trees and debris on Wednesday, a day after Typhoon Bopha made landfall in the village of Andap, in southern Philippines.







MANILA — Rescue teams were trying to reach isolated villages in the southern Philippines on Wednesday after a powerful out-of-season typhoon tore through the region, leaving more than 270 people dead, officials said.









Erik De Castro/Reuters

Residents transported the body of victim in the southern Philippines on Wednesday.






Karlos Manlupig/Associated Press

Relatives mourned in New Bataan on Wednesday.






Typhoon Bopha packed winds of up to 100 miles per hour when it struck Tuesday, bringing torrential rains that flattened entire villages, leaving thousands homeless, as well as washing out roads and bridges needed by rescue personnel trying to reach stricken regions.


A national disaster official, Benito Ramos, said at a news conference Wednesday afternoon that 274 deaths had been confirmed, with 339 people known to be injured and 279 missing.


The storm was weakening and leaving the Philippines on Wednesday. The Philippines is hit by more than 20 powerful tropical storms per year, but this typhoon struck remote communities off the usual storm path that are not accustomed to such strong storms.


In December of last year, Tropical Storm Washi killed more than 1,200 people and left hundreds of thousands homeless. Officials this year called for mandatory early evacuations of vulnerable communities.


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Austrian farmers dip into Internet “milking” craze












VIENNA (Reuters) – Dumping a bottle of milk over your head and filming it for a video post on the Internet has become a popular youth craze, but Austrian farmers say the spillage is a crying shame.


“Milking”, as the trend is known, is among a variety of tongue-in-cheek stunts in which young people shoot pictures or videos of themselves posing as owls, planks of wood, or famous people and then share them on YouTube and other social media.












Austria’s AMA farm lobby on Wednesday launched its own “true milking” campaign to decry the wanton waste of dairy resources and to encourage consumers to drink it instead.


“At a time when too much food already lands in the trash, it is worth questioning dumping milk. This is a valuable product of nature that our farmers provide daily with lots of love and labor,” AMA milk marketing manager Peter Hamedinger said.


Milking has become an Internet hit, with one video from Newcastle in England getting more than half a million clicks on YouTube. http://www.youtube.com/watch?v=qtJPAv1UiAE


AMA’s marketing arm said the milking craze seemed to reflect a strange youthful protest against authority. It sought to one-up the video trend with its own clip featuring a young man who holds a carton of milk high above his head and drinks the contents without spilling a drop.


http://www.youtube.com/watch?v=EsJ3OsP1Fks&feature=youtu.be


“In line with the nature of the medium, this message is not communicated in a commercial way and absolutely not with finger pointing, but rather with a wink of the eye for the Internet generation,” the farm products board said in a statement.


(Reporting by Michael Shields, editing by Paul Casciato)


Internet News Headlines – Yahoo! News


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Let the debate end: Grammy noms anybody's guess


NASHVILLE, Tenn. (AP) — It's a brutal year to be in the Grammy nominations handicapping game.


Sure, there are a few safe bets. Mumford & Sons and Frank Ocean are expected to take a share of nominations when they're announced Wednesday night on national television during "The Grammy Nominations Concert Live!" in Nashville.


And popular songs by Gotye, fun., Taylor Swift and Carly Rae Jepsen may land those artists on the list as well, though Jepsen harbors some doubt her omnipresent song "Call Me Maybe" will net a nod.


"I would be so shocked," the 27-year-old singer said last week. "But this year has taught me to look forward to surprises and just be ready for anything. So, cross your fingers for me."


Viral songs like Jepsen's seemed to be the theme of the year, and with no watershed albums during the nominating period for the 2013 Grammys like Adele's "21" or Kanye West's "My Beautiful Dark Twisted Fantasy," it's not clear who will turn out as this year's top nominee.


Thus the guessing game.


The Grammy nominations period ended Sept. 30 and three of the year's top four debuting albums — from Swift, One Direction and Jason Aldean — came after that date. Rihanna also released a new album after the period ended. All could have songs nominated, but a popular album is the quickest way to accumulate multiple nods.


Mumford & Sons slipped in just under the deadline. Introduced to much of their burgeoning fan base through a 2011 appearance on the Grammys, the British folk-rock band could return with a flourish after selling 600,000 copies of "Babel" in the first week of release and setting streaming records on Spotify.


And Ocean showed the kind of bravery that might be rewarded by The Recording Academy's voters when he announced in liner notes for his album "channel ORANGE" that he'd had a same-sex encounter, causing an industry-wide discussion of the issue.


Questions surround many of the other artists who might be considered sure bets, however. Gotye should be a lock in multiple categories, but his viral song "Somebody That I Used to Know," featuring Kimbra, wasn't submitted in the song of the year category because of a sample, eliminating one of its most viable prospects.


Others who might be considered possible top nominees like Drake and The Black Keys released their platinum-selling, hit-spawning albums late last year and they'll have to overcome short-term memory issues among voters.


Sean Garrett, a producer for artists like Usher and Beyonce with multiple Grammy nominations, said a lack of clear trends during the nominating period made it difficult to guess going into the show.


"It was sort of an iffy kind of year in my opinion," Garrett said in a phone interview. "I'm going to be honest: I think the politics kind of slowed the music down."


He expects pop stars like Jepsen, Bieber, Swift and Korean sensation PSY to take home nominations, but doesn't see an artist accumulating a high number of nominations. That could leave room for newer acts, including fun., one of his favorites.


"They have a very clever sound," Garrett said. "The lead singer (Nate Reuss) has an amazing, amazing voice. I feel like they just came with something that was a bit different. It was mainstream pop music and it had some edge to it. And there was great songwriting there."


Fun., with their anthemic hit "We Are Young," are among the night's performers, joining Maroon 5, Ne-Yo, Luke Bryan, The Who, Hunter Hayes and others.


"It just feels like we spent the last 12 years pulling back the arrow and this year we just let it go," fun. guitarist Jack Antonoff said. "This last year has been incredible and amazing and hard and I don't even know what it would have been like if we didn't have 10 or 12 years of experience because it still feels like we're learning everything for the first time."


The nominations show is being held outside Los Angeles for the first time in its five-year history. LL Cool J returns, co-hosting the show live on CBS at 10 p.m. EST from Bridgestone Arena with Swift.


It's the first official Grammy activity in Music City since 1973, when the late Johnny Cash kicked off the live broadcast. He'll figure into Wednesday night's as well when Dierks Bentley and The Band Perry pay tribute to the man in black.


"So we're going to do that as a tribute to Johnny, a tribute to Nashville, a tribute to country music, a tribute to being back here," longtime Grammy producer Ken Ehrlich said. "And I think it will be magical."


___


AP Music Writer Mesfin Fekadu contributed to this report from New York City.


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Online:


http://grammy.com


___


Follow AP Music Writer Chris Talbott: http://twitter.com/Chris_Talbott.


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Extended Use of Breast Cancer Drug Suggested


The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.


In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.


“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.


Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.


“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”


Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.


Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.


About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.


The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.


In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing ten years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.


About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.


There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.


Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.


“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.


Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.


Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.


“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.


Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.


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DealBook: Freeport to Buy Plains Exploration and McMoRan

Freeport-McMoRan Copper and Gold said on Wednesday that it would buy two oil and natural gas companies, Plains Exploration and Production and the McMoRan Exploration Company, in a return to the energy business.

The two transactions will create a natural resources titan worth about $60 billion, including debt, and will formally reunite Freeport with McMoRan, the oil exploration company it spun off in 1994.

Under the terms of the deals, Freeport will pay about $6.9 billion in cash and stock for Plains. That offer consists of $25 a share in cash and 0.6531 of a Freeport share, worth about $50 a share based on Tuesday’s closing prices.

And Freeport will pay $14.75 a share in cash and 1.15 units of a trust that will hold a 5 percent interest in future production of McMoRan’s deepwater exploration operations. Freeport and Plains together already own about 36 percent of the smaller exploration company.

“This transaction will enable us to add assets with exceptional exploration and development potential to a world-class mining company to create a premier minerals and oil and gas business focused on value creation for shareholders,” James R. Moffett, Freeport’s chairman, said in a statement.

JPMorgan Chase is providing $9.5 billion to help pay for the cash portion of the deal and to repay some of Plains’s existing debt.

Freeport was advised by Credit Suisse and the law firm Wachtell, Lipton, Rosen & Katz. Plains was advised by Barclays and the law firm Latham & Watkins. McMoRan was advised by Evercore Partners and the law firm Weil, Gotshal & Manges.

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Pakistan’s Hazara Shiites Under Siege


Declan Walsh/The New York Times


Many members of the Hazara Shiite community killed by Sunni extremists are buried in a graveyard in Quetta, Pakistan.







QUETTA, Pakistan — Calligraphers linger at the gates of an ancient graveyard in this brooding city in western Pakistan, charged with a macabre and increasingly in-demand task: inscribing the tombstones of the latest victims of the sectarian death squads that openly roam these streets.




For at least a year now, Sunni extremist gunmen have been methodically attacking members of the Hazara community, a Persian-speaking Shiite minority that emigrated here from Afghanistan more than a century ago. The killers strike with chilling abandon, apparently fearless of the law: shop owners are gunned down at their counters, students as they play cricket, pilgrims dragged from buses and executed on the roadside.


The latest victim, a mechanic named Hussain Ali, was killed Wednesday, shot inside his workshop. He joined the list of more than 100 Hazaras who have been killed this year, many in broad daylight. As often as not, the gunmen do not even bother to cover their faces.


The bloodshed is part of a wider surge in sectarian violence across Pakistan in which at least 375 Shiites have died this year — the worst toll since the 1990s, human rights workers say. But as their graveyard fills, Hazaras say the mystery lies not in the identity of their attackers, who are well known, but in a simpler question: why the Pakistani state cannot — or will not — protect them.


“After every killing, there are no arrests,” said Muzaffar Ali Changezi, a retired Hazara engineer. “So if the government is not supporting these killers, it must be at least protecting them. That’s the only way to explain how they operate so openly.”


The government, already battling Taliban insurgents, insists it is taking the threat seriously. During the recent Mourning of Muhurram, when Shiites parade through the streets over 10 days, the Interior Ministry imposed stringent security measures such as blocking cellphone signals for up to 12 hours — to try to prevent remote bomb detonations — and banning doubled-up motorcycle riding. Even so, Sunni bombers struck at least five times, killing at least 50 Shiites and wounding several hundred. The Pakistani Taliban claimed responsibility for the biggest attacks, highlighting an emerging link between that group and traditional sectarian militants that has worried many.


Yet the unchecked killings have also raised wider questions about Pakistani society: about the spread of a cancerous sectarian ideology in a public that even just a decade ago seemed more tolerant, and about what might be spurring the growing audacity of the killers, some of whom are believed to have links to the country’s security services.


The murders in Quetta, for instance, involve remarkably little mystery. By wide consensus, the gunmen are based in Mastung, a dusty agricultural village 18 miles to the south that is the bustling local hub of Lashkar-e-Jhangvi, the country’s most notorious sectarian militant group.


Like so many Pakistani groups that combine guns with zealotry, Lashkar-e-Jhangvi thrives in a wink-and-nod netherworld: it is officially banned, but its leader, Malik Ishaq, was released from jail last year amid showers of rose petals thrown by supporters. Now Mr. Malik lives openly in southern Punjab Province, protected by armed men who loiter outside his door, allowing him to deliver hate-laced statements to visitors. Shiites are “the greatest infidels on earth,” he told a Reuters reporter last month.


In Quetta, his followers are similarly unfettered. In targeting the Hazara — who, with their distinctive Central Asian features, are easy to pick out — Lashkar-e-Jhangvi militants block busy highways as they search vehicles for Hazaras and daub walls with hate slogans. “The face is the target,” said Major Nadir Ali, a senior Hazara leader and retired army officer. “They see the face, then they shoot.”


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Fleetwood Mac readies tour and new music


NEW YORK (AP) — Fleetwood Mac is heading back on the road, and that means the top-selling group will release new music — sort of.


On its 34-city North American tour, which kicks off April 4 in Columbus, Ohio, the band will perform two new songs, and it could mean a new album will follow. Or not.


Stevie Nicks recently sang on tracks that Lindsey Buckingham, Mick Fleetwood and John McVie worked on, calling the sessions "great." But Nicks also says she's not sure where the band fits in today's music industry.


"Whether or not we're gonna do any more (songs), we don't know because we're so completely bummed out with the state of the music industry and the fact that nobody even wants a full record," she said. "Everybody wants two songs, so we're going to give them two songs."


Nicks said depending on the response to the new tracks — which Buckingham calls "the most Fleetwood Mac-y stuff ... in a long time" — more material could come next.


"Maybe we'll get an EP out of it or something," Buckingham said.


Nicks will continue to record solo albums, though. The group is celebrating the 35th anniversary of the best-selling "Rumours" album, which has moved some 20 million units in the United States. She knows that's not possible again, despite the success of Adele's "21," which has sold 10 million units in America in less than two years.


"This is Adele's 'Rumours,'" Nicks said. "She had a baby, she's going to take a year off to take care of her baby — that's why I never had any kids. She's going to go back and start writing again, you never know what the next record's going to be. Is it going to sell 10 million records? You don't know," she said.


Buckingham said he initially wanted to record a new album, but Nicks "wasn't too into that." But the guitarist and singer knows that new music isn't a priority for the band's fans.


"It wouldn't matter if they didn't hear anything new. In a way there's a freedom to that — it becomes not what you got, but what you do with what you got. Part of the challenge of this tour is figuring out a presentation that has some twists and turns to it without having a full album," he said.


Fleetwood Mac, which was formed in 1967, last released an album in 2003, though they hit the road in 2009. Nicks and Buckingham — who originally joined the band in 1974 as a couple — both released solo albums and toured last year. Buckingham had suggested that Fleetwood Mac tour last year, but says getting everyone to agree was tough.


"If you look at Fleetwood Mac as a group, you can make the case of saying we're a bunch of individuals who don't necessarily belong in the same group together, but it's the synergy of that that makes us so good. But it also makes the politics a little more tenuous," he said. "You can say that not only can it be a political minefield, someone's always causing trouble, right? I caused trouble for years so I can't point any fingers."


The tour also includes cities such as New York, Chicago, Boston, Las Vegas and Los Angeles, and will end June 12 in Detroit.


_____


Online:


http://www.fleetwoodmac.com/


You can follow Music Writer Mesfin Fekadu on Twitter at twitter.com/MusicMesfin


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National Briefing | New England: New Hampshire: Not Guilty Plea in Hepatitis Case



A traveling hospital technologist accused of stealing drugs and infecting patients with hepatitis C through contaminated syringes pleaded not guilty in federal court on Monday. The technologist, David Kwiatkowski, whom prosecutors described as a “serial infector,” was indicted last week on charges of tampering with a consumer product and illegally obtaining drugs. Until May, Mr. Kwiatkowski worked as a cardiac technologist at Exeter Hospital, where 32 patients were given diagnoses of the same strain of hepatitis C he carries. Before that, he worked in 18 hospitals in seven states, moving from job to job despite having been fired twice over accusations of drug use and theft. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Mr. Kwiatkowski carries.


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