Obama Wins New Term as Electoral Advantage Holds

Damon Winter/The New York Times

Americans voted to give President Obama a second chance to change Washington.

Barack Hussein Obama was re-elected president of the United States on Tuesday, overcoming powerful economic headwinds, a lock-step resistance to his agenda by Republicans in Congress and an unprecedented torrent of advertising as a divided nation voted to give him more time.

In defeating Mitt Romney, the president carried Colorado, Iowa, Ohio, New Hampshire, Virginia and Wisconsin, a near sweep of the battleground states, and was holding a narrow advantage in Florida. The path to victory for Mr. Romney narrowed as the night wore along, with Mr. Obama winning at least 303 electoral votes.

A cheer of jubilation sounded at the Obama campaign headquarters in Chicago when the television networks began projecting him as the winner at 11:20 p.m., even as the ballots were still being counted in many states where voters had waited in line well into the night. The victory was far narrower than his historic election four years ago, but it was no less dramatic.

“Tonight in this election, you, the American people, reminded us that while our road has been hard, while our journey has been long, we have picked ourselves up, we have fought our way back,” Mr. Obama told his supporters early Wednesday. “We know in our hearts that for the United States of America, the best is yet to come.”

Mr. Obama’s re-election extended his place in history, carrying the tenure of the nation’s first black president into a second term. His path followed a pattern that has been an arc to his political career: faltering when he seemed to be at his strongest — the period before his first debate with Mr. Romney — before he redoubled his efforts to lift himself and his supporters to victory.

The evening was not without the drama that has come to mark so many recent elections: For more than 90 minutes after the networks projected Mr. Obama as the winner, Mr. Romney held off calling him to concede. And as the president waited to declare victory in Chicago, Mr. Romney’s aides were prepared to head to the airport, suitcases packed, potentially to contest several close results.

But as it became increasingly clear that no amount of contesting would bring him victory, he called Mr. Obama to concede shortly before 1 a.m.

“I wish all of them well, but particularly the president, the first lady and their daughters,” Mr. Romney told his supporters in Boston. “This is a time of great challenges for America, and I pray that the president will be successful in guiding our nation.”

Hispanics made up an important part of Mr. Obama’s winning coalition, preliminary exit poll data showed. And before the night was through, there were already recriminations from Republican moderates who said Mr. Romney had gone too far during the primaries in his statements against those here illegally, including his promise that his get-tough policies would cause some to “self-deport.”

Mr. Obama, 51, faces governing in a deeply divided country and a partisan-rich capital, where Republicans retained their majority in the House and Democrats kept their control of the Senate. His re-election offers him a second chance that will quickly be tested, given the rapidly escalating fiscal showdown.

For Mr. Obama, the result brings a ratification of his sweeping health care act, which Mr. Romney had vowed to repeal. The law will now continue on course toward nearly full implementation in 2014, promising to change significantly the way medical services are administrated nationwide.

Confident that the economy is finally on a true path toward stability, Mr. Obama and his aides have hinted that he would seek to tackle some of the grand but unrealized promises of his first campaign, including the sort of immigration overhaul that has eluded presidents of both parties for decades.

But he will be venturing back into a Congressional environment similar to that of his first term, with the Senate under the control of Democrats and the House under the control of Republicans, whose leaders have hinted that they will be no less likely to challenge him than they were during the last four years.

Michael Cooper contributed reporting.

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DealBook Column: The Election Won't Solve All Puzzles

Here comes more uncertainty.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Recipes for Health: Quinoa and Cauliflower Kugel — Recipes for Health

Andrew Scrivani for The New York Times NYTCREDIT: Andrew Scrivani for The New York Times

Cauliflower, steamed until tender then finely chopped, combines beautifully here with quinoa and cumin. Millet would also be a good grain choice.

 

2 tablespoons extra virgin olive oil

1/2 medium onion, finely chopped

1/2 cup quinoa

1 1/4 cups water

Salt to taste

1 pound cauliflower (1/2 medium head), broken into florets

1 cup low-fat cottage cheese

2 eggs

1 scant teaspoon cumin seeds, lightly toasted and crushed

Freshly ground pepper

 

1. Heat 1 tablespoon of the olive oil in a medium saucepan and add the onion. Cook, stirring, until just about tender, 3 to 5 minutes, and add the quinoa. Cook, stirring, for another 2 to 3 minutes, until the quinoa begins to smell toasty and the onion is tender. Add the water and salt to taste and bring to a boil. Cover, reduce the heat and simmer 15 to 20 minutes, until the quinoa is tender and the grains display a threadlike spiral. If any water remains in the pot, drain the quinoa through a strainer, then return to the pot. Place a dish towel over the pot, then return the lid and let sit undisturbed for 10 to 15 minutes.

2. Meanwhile, steam the cauliflower over 1 inch of boiling water for 10 minutes, or until tender. Remove from the heat.

3. Preheat the oven to 375 degrees and oil a 2-quart baking dish or gratin.

4. Finely chop the steamed cauliflower, either with a chef’s knife or using a food processor fitted with the steel blade. Place in a large mixing bowl. In a food processor fitted with the steel blade, purée the cottage cheese until smooth. Add the eggs and process until the mixture is smooth. Add salt (I suggest about 1/2 teaspoon), pepper and the cumin seeds and mix together. Scrape into the bowl with the cauliflower. Add the quinoa and stir everything together. Scrape into the oiled baking dish. Drizzle the remaining oil over the top and place in the oven.

5. Bake 35 to 40 minutes, until the top is lightly browned. Remove from the oven and allow to cool for at least 15 minutes before serving. Serve warm or at room temperature, cut into squares or wedges.

Yield: 6 servings.

Advance preparation: The quinoa can be prepared through Step 1 up to 3 days ahead (it also freezes well). The kugel will keep for 3 days in the refrigerator. Reheat in a medium oven.

Nutritional information per serving (6 servings): 166 calories; 8 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 64 milligrams cholesterol; 15 grams carbohydrates; 3 grams dietary fiber; 151 milligrams sodium (does not include salt to taste); 10 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Recipes for Health: Quinoa and Cauliflower Kugel — Recipes for Health

Andrew Scrivani for The New York Times NYTCREDIT: Andrew Scrivani for The New York Times

Cauliflower, steamed until tender then finely chopped, combines beautifully here with quinoa and cumin. Millet would also be a good grain choice.

 

2 tablespoons extra virgin olive oil

1/2 medium onion, finely chopped

1/2 cup quinoa

1 1/4 cups water

Salt to taste

1 pound cauliflower (1/2 medium head), broken into florets

1 cup low-fat cottage cheese

2 eggs

1 scant teaspoon cumin seeds, lightly toasted and crushed

Freshly ground pepper

 

1. Heat 1 tablespoon of the olive oil in a medium saucepan and add the onion. Cook, stirring, until just about tender, 3 to 5 minutes, and add the quinoa. Cook, stirring, for another 2 to 3 minutes, until the quinoa begins to smell toasty and the onion is tender. Add the water and salt to taste and bring to a boil. Cover, reduce the heat and simmer 15 to 20 minutes, until the quinoa is tender and the grains display a threadlike spiral. If any water remains in the pot, drain the quinoa through a strainer, then return to the pot. Place a dish towel over the pot, then return the lid and let sit undisturbed for 10 to 15 minutes.

2. Meanwhile, steam the cauliflower over 1 inch of boiling water for 10 minutes, or until tender. Remove from the heat.

3. Preheat the oven to 375 degrees and oil a 2-quart baking dish or gratin.

4. Finely chop the steamed cauliflower, either with a chef’s knife or using a food processor fitted with the steel blade. Place in a large mixing bowl. In a food processor fitted with the steel blade, purée the cottage cheese until smooth. Add the eggs and process until the mixture is smooth. Add salt (I suggest about 1/2 teaspoon), pepper and the cumin seeds and mix together. Scrape into the bowl with the cauliflower. Add the quinoa and stir everything together. Scrape into the oiled baking dish. Drizzle the remaining oil over the top and place in the oven.

5. Bake 35 to 40 minutes, until the top is lightly browned. Remove from the oven and allow to cool for at least 15 minutes before serving. Serve warm or at room temperature, cut into squares or wedges.

Yield: 6 servings.

Advance preparation: The quinoa can be prepared through Step 1 up to 3 days ahead (it also freezes well). The kugel will keep for 3 days in the refrigerator. Reheat in a medium oven.

Nutritional information per serving (6 servings): 166 calories; 8 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 64 milligrams cholesterol; 15 grams carbohydrates; 3 grams dietary fiber; 151 milligrams sodium (does not include salt to taste); 10 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Egyptian Vigilantes Crack Down on Abuse of Women

Tara Todras-Whitehill for The New York Times

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Asmaa Al Zohairy contributed reporting.

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Fight Growing Over Online Royalties

The debate playing out in Washington has echoes of a presidential race. One side says businesses will suffer unless the government steps in to lower costs. The other accuses jet-set industrialists of a ploy that will cheat the middle class.

These attacks, however, are not between candidates for the White House. They are being made in a battle over the obscure but increasingly vital issue of royalty rates for streaming music online. The issue pits the survival of Pandora Media and other Internet radio services against the diminished paychecks of musicians in the digital age.

This fight has raged on and off for more than a decade, and it was renewed recently with a bill in Congress that would change the way digital royalty rates are set. But with streaming music starting to account for a significant chunk of the music industry’s revenue, and Pandora now a scrutinized public company, the issue has touched a nerve as never before.

“This is not just about our present; it is about our future, our ability to make it in the digital age,” said Cary Sherman, chief executive of the Recording Industry Association of America. “Artists and labels and the entire music community need to earn a fair return on the creative works that are the reason companies like Pandora exist.”

Tim Westergren, the founder and public face of Pandora, has denounced the current system’s “discrimination” and urged the service’s 175 million users to contact their representatives in Washington. Music industry groups and labor unions have also gone public, casting it as a fair-pay issue.

Rates are set by three judges on the federal Copyright Royalty Board, but they apply a different standard to Internet radio services like Pandora than they do to satellite and cable radio outlets like Sirius XM and Music Choice.

Sirius, for example, pays 8 percent of its revenue to record companies and artists. Pandora pays a fraction of a cent each time a song is streamed, which last year amounted to about 54 percent of its revenue, or $149 million.

“The rate being too high dramatically depresses how much music gets played,” Mr. Westergren said in a recent interview. “It has really suffocated the industry.”

The Internet Radio Fairness Act, introduced in September, would move Internet radio companies from their “willing buyer, willing seller” standard — which critics like Pandora say results in an unrealistically high rate — to the one used for satellite and cable radio. To determine a fair rate, that standard directs the judges to consider factors including whether the prices will have a “disruptive impact” on the industry.

Music industry groups also want one standard, but one that keeps rates high. For years they have also been pushing for laws that would require terrestrial stations to pay royalties to labels and artists. (In the United States — and almost nowhere else in the world — radio stations pay royalties only to music publishers.)

Representative Jason Chaffetz, a Republican of Utah who co-sponsored the bill, said in a phone interview that the bill was meant to encourage growth in the streaming business. But when Mr. Chaffetz, whose campaign committee has received $2,000 from Pandora, was asked to respond to complaints that the changes would hurt musicians, he could not resist taunting a bit.

“The old-school dinosaurs are trying to help, but they’re stuck in the tar,” he said. “They can go talk to the pterodactyls.”

Pandora has been down this road before, and in 2009 reached an agreement for a temporary discount of about 40 percent off the royalty board’s rates; that deal expires in 2015.

This time Pandora is a different beast: a company with a $1.4 billion market capitalization. Each month, 58 million people use it to stream more than 1.1 billion hours of music.

Streaming is now on every horizon in the music industry. SoundExchange, which collects royalties from Internet and satellite radio, recently announced that it had crossed the $1 billion benchmark in payments to labels and artists.

The royalties issue, Mr. Westergren said, has become a question about the wider health of the streaming business, which he believes has been stunted by royalties.

“This is not an argument about going out of business,” he said. “A fix here would be for the whole industry.”

But there is wide anger in the music industry that the bill would enrich technology companies at the expense of musicians. MusicFirst Coalition, which includes the recording industry association, SoundExchange and others, says it believes that if Pandora gets everything it wants, it could cut its royalty bill by up to 85 percent.

For Pandora, the critical question is whether streaming businesses can be successful at all in the current system. Digital music services have proliferated over the years, but just as many have died, and popular arrivals like Spotify have yet to turn a profit.

Clear Channel Communications, the radio giant, has recently moved more aggressively into streaming with its iHeartRadio app. Robert W. Pittman, its chief executive — who has been outspoken on the royalty issue — said in an interview that a change could generate more money for the music industry by allowing streaming businesses to thrive.

“It’s not so much about rates as about how much dollars you spend,” Mr. Pittman said. “The amount of dollars to artists is rate times volume. If the rate suppresses the volume, there’s less money. If it encourages volume, there’s more money.”

Mr. Westergren is revered as a self-made success with real musical bona fides; he is fond of telling stories about his years of scraping by as a touring musician. But the controversy over the Internet Radio Fairness Act threatens to tarnish that image.

The music industry says that if Pandora needs to improve its bottom line, it should sell more ads. When asked to respond, Mr. Westergren makes a gesture of banging his head on a table.

“It’s an easy thing to say,” he said. “But no one has yet explained to us why Internet radio is under a different standard. No one responds to that fundamental premise.”

Advertising sales, which make up almost 90 percent of Pandora’s revenue, doubled in the company’s last fiscal year.

For Mr. Westergren, though, the most difficult aspect of this battle has been the accusation that Pandora wants to take advantage of musicians.

“This adversarial reaction toward Internet radio is counterproductive,” he said. “It’s causing other businesses to sit on the sidelines, and that is hurting musicians. Ultimately, you want to have many boats in the harbor.”

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Chelation Therapy Shows Slight Benefit in Heart Disease Clinical Trial

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

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

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

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

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

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

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

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

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

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

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

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

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

Doctors said there were reasons for caution.

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

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

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

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

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

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

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

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

Read More..

Chelation Therapy Shows Slight Benefit in Heart Disease Clinical Trial

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

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

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

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

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

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

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

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

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

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

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

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

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

Doctors said there were reasons for caution.

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

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

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

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

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

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

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

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

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

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

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

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

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

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Coptic Church Chooses Pope Who Rejects Politics

Tara Todras-Whitehill for The New York Times

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

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

Tara Todras-Whitehill for The New York Times

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

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

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

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

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

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

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

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

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

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

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

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

Mayy El Sheikh and Mai Ayyad contributed reporting.

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