Generic color switch tied to not taking pills

NEW YORK (Reuters Health) – People seem less likely to take their medications if the pill color changes between prescriptions, which can happen when switching from a brand-name to generic drug, says a new study.

“I have a lot of experience when patients of mine come and say, ‘I was taking a green pill and now it’s pink. What’s going on?’” said Dr. Aaron Kesselheim, the study’s lead author from Brigham and Women’s Hospital and Harvard Medical School in Boston.

That confusion may lead to patients being unsure about their medications and end with them not taking the drugs, write the researchers in JAMA Internal Medicine, formerly known as the Archives of Internal Medicine.

The researchers used a national database of medical claims from the early 2000s to compare people who got their seizure drugs refilled on time to those who did not.

Overall, they had information on about 61,000 people who were taking one of eight drugs, which were offered in 37 colors and four shapes.

The researchers found that changes in pill color between prescriptions rarely occurred, but there was a difference between those who filled their orders and those who did not.

Of the approximately 11,500 people who did not fill their prescriptions, 1.2 percent had their drugs change color. That compared to 0.97 percent of people who got their prescriptions filled on time.

Kesselheim admitted the raw numbers are “pretty small,” but he said they can add up.

“Patients fill medications multiple times a year… The chance of these changes happening gets to be much higher,” he said, adding that even a small gap between prescriptions can spell trouble for seizure patients.

As for the shape of the pill changing between prescriptions, that was an even more rare event and did not seem to be linked to people skipping medicine.

Also, the researchers can’t prove a change in a pill’s color stopped someone from filling their prescription or if it was something else, such as a doctor discontinuing the drug.

‘SENSELESS AND ABSURD’

“If they are taking nine medicines, they get at least 36 ‘opportunities’ a year to experience a color change. This seemingly small risk then starts to appear very substantial,” wrote Dr. Kenneth Covinsky, associate editor of JAMA Internal Medicine, in a note accompanying the study.

Covinsky adds that it’s “absolutely senseless and absurd” to expose patients to that risk. “Equivalent generic medicines should be required to look like their brand-name counterparts,” he writes.

Currently, the U.S. allows cheaper generic drugs to be sold to patients after a brand-name counterpart’s market exclusivity ends. The U.S. Food and Drug Administration (FDA) says those generics must be essentially as effective as the brand-name drugs, but may be different colors, shapes and sizes.

One reason for the same drug having different appearances is that brand-name manufacturers may claim legal ownership of their drugs’ physical appearances.

“A patient taking five medicines, each produced by five generic manufacturers, theoretically faces over 3,000 possible arrays of pill appearances for what are, chemically and clinically speaking, the same drugs,” write the study’s authors.

In a statement to Reuters Health, the Generic Pharmaceutical Association, which represents generic drug manufacturers and distributors, said they are committed to working with the FDA to ensure their products meet all quality standards and are safe, effective and accessible to all patients who need them.

“We manufacture our products and receive approval from the FDA based on consistency with the regulations and standards established by the FDA,” said the statement.

In an accompanying editorial, Lawrence Yu and Dr. Gregory Geba of the FDA’s Office of Generic Drugs write that they’ve started to include a drug’s physical appearance in reviews.

“It will be interesting to see how the results of the authors’ study… will compare with studies of other drug classes,” they add.

Kesselheim said that until there is a better solution, it’s important for patients to know that a pill’s clinical impact doesn’t change just because it looks different.

SOURCE:, and JAMA Internal Medicine, online December 31, 2012.

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“Fiscal cliff” crisis heads to resolution in Congress

WASHINGTON (Reuters) – A months-long battle over the U.S. “fiscal cliff” headed to a close on Tuesday as the House of Representatives moved toward final approval of a bipartisan deal meant to prevent Washington from pushing the world’s biggest economy into recession.

The Republican-controlled House was expected to back a tax hike on the top U.S. earners shortly before midnight on Tuesday, ending weeks of high-stakes budget brinkmanship that threatened to spook consumers and throw financial markets into turmoil.

Approval of the bill would be a victory for President Barack Obama, who campaigned for re-election last November on a promise to raise taxes on the wealthiest but faced stiff opposition from congressional Republicans.

Republicans had earlier considered adding hundreds of billions of dollars in spending cuts after the bill had already passed the Senate with strong bipartisan support. That would have triggered further partisan warfare and pushed the crisis well past a self-imposed January 1 deadline.

But party leaders abandoned the effort after determining they lacked the votes.

“We’ve gone as far as we can go and I think people are ready to bring it to a conclusion,” Republican Representative Jack Kingston of Georgia said. “We fought the fight.”

Rules Committee Chairman David Dreier, a Republican, predicted the House would back the Senate bill, which also postpones for two months $ 109 billion in spending cuts on military and domestic programs set for 2013.

The bill easily cleared a procedural hurdle by a bipartisan vote of 408 to 10.

Lawmakers have struggled to find a way to head off across-the-board tax hikes and spending cuts that began to take effect at midnight, a legacy of earlier failed budget deals that is known as the fiscal cliff.

Strictly speaking, the United States went over the cliff in the first minutes of the New Year because Congress failed to produce legislation to halt $ 600 billion of tax hikes and spending cuts scheduled for this year.

TAX HIKES FOR WEALTHIEST

While many Republicans were uneasy with the tax hikes and wanted more spending cuts in the bill, they seemed to realize that the fiscal cliff would begin to damage the economy once financial markets and federal government offices returned to work on Wednesday. Opinion polls show the public would blame Republicans if a deal were to fall apart.

House Republicans had earlier considered adding $ 330 billion in spending cuts over 10 years to the Senate bill, which raises taxes on the wealthiest U.S. households by $ 620 billion over the same period.

But Senate Democrats refused to consider any changes to their bill, which passed 89 to 8 in a rare display of unity early Tuesday.

That measure, which passed the Senate at around 2 a.m., would raise income taxes on families earning more than $ 450,000 per year and limit the amount of deductions they can take to lower their tax bill.

Low temporary rates that have been in place for the past decade would be made permanent for less-affluent taxpayers, along with a range of targeted tax breaks put in place to fight the 2009 economic downturn.

However, workers would see up to $ 2,000 more taken out of their paychecks annually with the expiration of a temporary payroll tax cut.

The non-partisan Congressional Budget Office said the Senate bill would increase budget deficits by nearly $ 4 trillion over the coming 10 years, compared to the budget savings that would occur if the extreme measures of the cliff were to kick in.

But the bill would actually save $ 650 billion during that time period when measured against the tax and spending policies that were in effect on Monday, according to the Committee for a Responsible Federal Budget, an independent group that has pushed for more aggressive deficit savings.

(Additional reporting by Rachelle Younglai, Thomas Ferraro and David Lawder; Writing by Andy Sullivan; Editing by Alistair Bell and Eric Beech)

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Hillary Clinton, Hospitalized with a Blood Clot, Faces New Decisions

Yesterday evening Secretary of State Hillary Rodham Clinton was hospitalized for treatment and monitoring of a blood clot. Earlier this month, the 65 year old Secretary collapsed and hit her head while suffering from a stomach virus. At that point, she sustained a concussion. This may have contributed to the new problem, according to State Department notices. The location of her blood clot, in terms of what body part is affected, has not been disclosed.This is the Secretary and former First Lady’s second reported blood clot, or thrombosis. In a previous interview with the New York Daily News, Mrs. Clinton related an episode in 1998 when her foot became swollen and painful. It was a time when she was campaigning and frequently traveling on airplanes. Her doctors diagnosed a blood clot. “That is the most significant health scare I’ve ever had,” she told the Daily News in October, 2007.The most common kind of blood clot, a deep venous thrombosis, or DVT, tends to arise when flow slows down within a vein, typically in a person’s leg. Clots arise when platelets and fibrous proteins clump and stick to a vessel wall. This can be a normal, healthy response to trauma – whether that’s a nick upon shaving or surgical incision. In people disposed to DVT, the small clots don’t dissolve properly or may form in the absence of trauma. If a clot expands and propagates from below the knee, for example, to a more central position in the body, that’s called an embolism. Clots are most dangerous when and if they spread to arteries in the lungs, causing pulmonary embolism, or to vessels in the brain.The CDC estimates that between 300,000 and 600,000 individuals sustain DVTs and pulmonary embolism in the United States each year, and that between 60, 000 and 100,000 of those are events are lethal. Some people inherit a disposition to clotting that can be evaluated by blood tests. Clots are most common in people who’ve been immobilized, such as after surgery, or are bed-bound with illness. Dehydration compounds the risk. Coach class syndrome refers to the proclivity of some to develop clots upon long-distance travel in a cramped position.Other risk factors for DVT include some malignancies. Cancer, depending on its position, can impede blood flow from the lower body, promoting stasis in the leg veins, or otherwise interfere with clot-dissolving proteins. Some women with autoimmune conditions, like lupus and other syndromes, may be disposed to clotting in veins or arteries. Some medications pose a risk, too. Those include estrogen-containing oral contraceptives and hormone replacement therapy. In general, high-estrogen states dispose to pathologic blood clots. In younger women, the disposition to blood clotting can manifest during pregnancy.As far as we know, the cause of Mrs. Clinton’s blood clot is uncertain. She is in the hospital being treated with blood thinners. Usually people who have significant blood clots in a deep vein or artery take an anti-coagulant for a period of months. Until recent years, the standard treatment involved injections of heparin, or similar blood thinners, followed by Coumadin, an oral anticoagulant that requires frequent blood checks. Now, there are more options for therapy, including heparin-like agents that can be injected at home.On November 2 of this year, the FDA approved Xarelto (rivaroxaban) for treatment of deep venous thrombosis. This new drug, a pill, works by inhibiting a clotting factor called Xa. While several oral anticoagulants have received approval for prevention of clots in people undergoing surgery, and for prevention of strokes in people with disposing heart problems, Xarelto is the first in this new class of drugs that might be prescribed for treatment of DVT or pulmonary embolism.Before her recent admission to the hospital, the Secretary of State hadn’t said much about what she’ll do when she exits her official office. Popular views include that she’ll get more rest, exercise, spend time with her family, write a book and, possibly, run for President in 2016. Today, she’s presumably resting and, together with her doctors, sorting out the factors that led to her developing a significant blood clot. Good to know that she, like any other informed patient, has several treatment options to consider.Update: The U.S. State Department issued an update on Mrs. Clinton’s condition, clarifying that the Secretary of State has a blood clot in a vein near the inside of the skull, on the right side. According to their statement, she has not suffered a stroke or neurological damage. Photo: State Department’s Tumblr

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New Year’s Resolutions For Better Health

New Year’s resolutions are typically so singular, self-focused and private. How about making a resolution or two this year that has benefits beyond yourself? Here are some suggestions with lots of links to get you started.

You can help stop the spread of disease. Resolve to get up-to-date on your vaccines. While children have a full slate of vaccines, many adults don’t realize they have regular immunization obligations, too. Getting flu, pertussis, human papillomavirus and other vaccines can protect you and help stop the spread of diseases that harm others. Here’s a great guide to adult immunizations from the federal government. If the cost of vaccines is an issue, check into free or low-cost immunizations through your county’s public health department. Here’s a guide to finding your local office. Volunteer with an organization that needs your help. A group called Catchafire matches professionals who wish to volunteer their skills to organizations that need the help — including many important health organizations. The idea is to give great organizations access to top talent while respecting the professionals’ schedules and making their volunteer work meaningful. Here’s the link. Influence a healthier food climate. Americans spend about half of their food budgets eating out. So we had better demand thorough nutritional information about what we’re getting. Under healthcare reform, many restaurant chains will soon carry nutritional information. But the law has loopholes. If you don’t see the information you’re looking for on salt, fat, calories or other nutrients, ask the restaurant’s manager where you can find it. Nutritional information should be easy to access. Until it is, speak up and ask for it. Do your part to keep down healthcare costs. The Affordable Care Act will bring many consumers into the insurance healthcare system for the first time. But that doesn’t mean we can ignore the cost of care. Rising healthcare costs remain a huge issue that could drag down the economy and bedevil some reform efforts. You can help by being a wise healthcare consumer. Read your insurance policy and know what it does and doesn’t cover. Take advantage of free preventive care services and screening tests under the ACA. Shop around for prescriptions to find the cheapest prices. Ask your doctor for generic equivalents. Finally, use your health savings account if your employer offers one. These accounts provide incentives for using your money wisely, shopping around to find the best healthcare prices and weighing the costs and benefits of certain drugs, tests or procedures.  Here’s a guide to understanding how HSAs work. Be responsible about the prescription drugs you store at home. You can reduce your own risk of addiction and lower the risk for others, too, if you are careful about medications kept in your home. This year marked a turning point in the nation’s epidemic of prescription-drug abuse and addiction.  Admissions to addiction treatment centers for use of narcotic painkillers rose 569 percent in the past decade, according to the federal government. More people now die from drug overdoses than from traffic accidents. More than six million Americans abuse prescription drugs, and more than 70 percent of addicts get their drugs through family or friends or by raiding a home medicine cabinet. Dispose of unused medications. The Drug Enforcement Agency operates a National Prescription Drug Take-Back Day a few times a year (the next one is in April), that makes it easy to dispose of dangerous substance.  Go through your home today and collect unused medications. You can take them to a pharmacy for disposal or even flush them down the toilet. Some drugs carry disposal instructions on the label. Here’s information on how to dispose of prescription medications. Be a safe driver. One of the biggest safety issues on the nation’s roads these days is driver distraction. A large share of the distractions come from talking on a hand-held cell phone or text messaging while driving. You’re 23 times more likely to crash if you text while driving. Most states now prohibit texting while driving, but there are still many people who do it while knowing it’s unsafe. Break yourself of this terrible habit. The federal government has a website that provides people with information and tools to discourage distracted driving. Included in this package is a simple pledge sheet you can print out, sign and post on your refrigerator door or bathroom to help you make the commitment. There are a couple of other things you can do, too. Speak out if the driver you’re riding with is distracted. Encourage family and friends to drive phone-free. Run a race for the greater good. Who doesn’t love a good 5K walk or run? You benefit from the exercise and, if you choose a charity race, others reap rewards, too. There are thousands of charity races each year. Pick one and invite your friends to participate with you. Here’s a website to help you find a race.  Apply for a grant. There’s money out there for doing good. Saucony’s Run for Good Foundation aims at preventing child obesity by promoting running as part of a healthy lifestyle for kids. The foundation issues grant money to organizations that want to organize a kids’ running group. You can find information on how to apply at the foundation website. Sign a petition. Concerned about flame retardants in consumer products? Gun safety? Funding for research to fight a particular disease? There’s probably a petition for that. It’s an easy way to make your voice heard. Both change.org and thepetitionsite.com are good places to look to find a petition close to your heart.

Question: What resolutions can you make to help others? Tell us what you think in the comments.

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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.

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Analysis: After “fiscal cliff” dive, more battles, new cliffs

WASHINGTON (Reuters) – Whether or not the “fiscal cliff” impasse is broken before the New Year’s Eve deadline, there will be no post-cliff peace in Washington.

With the political climate toxic in Congress as the cliff’s steep tax hikes and spending cuts approach, other partisan fights loom, all over the issue that has paralyzed the capital for the past two years: federal spending.

The first will come in late February when the Treasury Department runs out of borrowing authority and has to come to Congress to get the debt ceiling raised.

The next is likely in late March, when a temporary bill to fund the government runs out, confronting Congress with a deadline to act or face a government shutdown. The third will possibly be whenever the temporary bill replacing the temporary bill expires.

While Congress is supposed to pass annual spending bills before the start of each fiscal year, it has failed to complete that process since 1996, resorting to stopgap funding ever since.

Influential anti-tax activist Grover Norquist predicted in an interview with Reuters that conservatives would wage repeated battles with President Barack Obama to demand budget savings every time the government needs a temporary funding bill or more borrowing capacity.

The so-called “continuing resolutions” to which a divided Congress has increasingly resorted to keep the government operating, provide a “very powerful tool” to pry out spending cuts, said Norquist, president of Americans for Tax Reform.

Republican Senator Bob Corker of Tennessee said he will not be satisfied until there are substantial cuts to federal retirement and healthcare benefits known as entitlements, producing savings in the $ 4.5 trillion to $ 5 trillion range.

“Unfortunately for America,” said Corker, “the next line in the sand will be the debt ceiling.”

Most observers see the $ 16.4 trillion debt limit as the true fiscal cliff in the new year because if not increased, it would eventually lead to a default on U.S. Treasury debt, an event that could prove cataclysmic for financial markets.

The Treasury Department said on Wednesday it would start taking extraordinary measures by December 31 to extend its borrowing capacity for about two more months.

‘POISONOUS CLIMATE’

It was a deadlock over raising the debt ceiling in August 2011 that prompted a deficit reduction deal that led to a key fiscal cliff component, the $ 109 billion in automatic spending cuts on military and domestic programs.

If the fiscal cliff’s spending cuts or tax increases are left even partly unresolved on December 31, the political combat over them will carry over into the new Congress, possibly simultaneously with the debt ceiling debate.

“We would be pessimistic of a quick fix” if the deadline is missed, Sean West, head U.S. analyst at Eurasia Group, a political risk consultancy, said in a note to clients. “The political climate will be poisoned. The new Congress will need time to settle in.”

“We are concluding one of the most unsuccessful Congresses in history,” Democratic Representative John Dingell of Michigan declared in a statement on Saturday, “noteworthy not only for its failure to accomplish anything of importance, but also for the poisonous climate of the institution.”

Dingell, 86, is the longest serving member of the House, elected first in 1955.

Historically, bitter struggles in Congress like that over the fiscal cliff lead to further resentment and strife in a cycle of cumulative grudges that now spans nearly 30 years.

Many analysts and lobbyists in Washington believe the strife could get even worse because the new Congress convening on January 3 will include fewer members from moderate or swing districts and more from districts tilted heavily to the left or the right.

Republicans in particular are likely to face their most serious re-election challenges in 2014 not from Democrats but from conservative Republicans challenging them in primary elections.

“Ironically,” said a post-election analysis published by the law firm Patton Boggs, “the voters have elected a 113th Congress that may be even more partisan than the 112th.”

(Reporting by David Lawder and Fred Barbash; Editing by Eric Beech)

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Senate leaders to make last-ditch “fiscal cliff” effort

WASHINGTON (Reuters) – President Barack Obama and U.S. congressional leaders agreed on Friday to make a final effort to prevent the United States from going over the “fiscal cliff,” setting off intense bargaining over Americans’ tax rates as a New Year’s Eve deadline looms.

With only days left to avoid steep tax hikes and spending cuts that could cause a recession, two Senate veterans will try to forge a deal that has eluded the White House and Congress for months.

Obama said he was “modestly optimistic” an agreement could be found. But neither side appeared to give much ground at a White House meeting of congressional leaders on Friday.

What they did agree on was to task Harry Reid, the Democratic Senate majority leader, and Mitch McConnell, who heads the chamber’s Republican minority, with reaching a budget agreement by Sunday at the latest.

“The hour for immediate action is here. It is now. We’re now at the point where in just four days, every American’s tax rates are scheduled to go up by law. Every American’s paycheck will get considerably smaller. And that would be the wrong thing to do,” Obama told reporters.

A total of $ 600 billion in tax hikes and automatic cuts to government spending will start kicking in on Tuesday – New Year’s Day – if politicians cannot reach a deal. Economists fear the measures will push the U.S. economy into a recession.

Pessimism about the fiscal cliff helped push U.S. stocks down on Friday for a fifth straight day. The Dow Jones industrial average dropped 158.20 points, or 1.21 percent. Retailers are blaming worries about the “fiscal cliff” for lackluster Christmas season shopping.

Under the plan hashed out on Friday, any agreement between McConnell and Reid would be backed by the Senate and then approved in the Republican-controlled House of Representatives before the end of the year.

But the House could well be the graveyard of any accord.

A core of fiscal conservatives there strongly opposes Obama’s efforts to raise taxes for the wealthiest as part of a plan to close America’s budget deficit. House Republicans also want to see Obama commit to major spending cuts.

Talks between Obama and Republican House Speaker John Boehner collapsed last week when several dozen Republicans defied their leader and rejected a plan to raise rates for those earning $ 1 million and above.

A Democratic aide said Boehner stuck mainly to “talking points” in Friday’s White House meeting, with the message that the House had acted on the budget and it was now time for the Senate to move.

TALKS ON ‘BIG NUMBERS’

The two Senate leaders and their aides will plunge into talks on Saturday that will focus mainly on the threshold for raising income taxes on households with upper-level earnings, a Democratic aide said. Analysts say both sides could agree on raising taxes for households earning more than $ 400,000 or $ 500,000 a year.

The pair will also discuss whether the estate tax should be kept at current low levels or allowed to rise, the aide said.

Democrat Reid warned of tough talks.

“It’s not easy, we’re dealing with big numbers, and some of that stuff we do is somewhat complicated,” he said.

McConnell described Friday’s White House summit, also attended by Democratic House Minority Leader Nancy Pelosi, as “a good meeting.”

“So we’ll be working hard to try to see if we can get there in the next 24 hours. So I’m hopeful and optimistic,” he said.

If things cannot be worked out between the Senate leaders, Obama said he wanted both chambers in Congress to vote on a backup plan that would increase taxes only for households with more than $ 250,000 of annual income.

The plan would also extend unemployment insurance for about 2 million Americans and set up a framework for a larger deficit reduction deal next year.

There are signs in the options market that investor fear is taking hold. The CBOE Volatility Index, or the VIX, the market’s favored anxiety indicator, has remained at relatively low levels throughout this process, but it moved on Friday above 22, the highest level since June.

But some in the market were resigned to Washington going beyond the New Year’s Day deadline, as long as a serious agreement on deficit reduction comes out of the talks in early January.

“Regardless of whether the government resolves the issues now, any deal can easily be retroactive. We’re not as concerned with January 1 as the market seems to be,” said Richard Weiss, a senior money manager at American Century Investments.

Another component of the “fiscal cliff” – $ 109 billion in automatic spending cuts to military and domestic programs – is set to kick in on Wednesday.

S&P rating agency said on Friday the fiscal cliff impasse did not affect the U.S. sovereign rating.

That lifted the immediate threat of a downgrade from the agency, which cut the United States’ triple-A rating in August, 2011 in an unprecedented move after a similar partisan budget fight.

(Additional reporting by David Lawder, Thomas Ferraro, Rachelle Younglai and Mark Felsenthal; Writing by Alistair Bell; Editing by Peter Cooney)

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Former President George H.W. Bush remains in intensive care

AUSTIN, Texas (Reuters) – Former President George H.W. Bush remained in the intensive care unit of a Houston hospital on Thursday, but his longtime chief of staff issued a reassuring message, urging the media and the public to “put the harps back in the closet.”

Bush, 88, a Republican who during his one term in office led a coalition of nations that ejected Iraqi forces from Kuwait in 1991, was admitted to Methodist Hospital November 23 for bronchitis.

He was transferred to intensive care on Sunday after setbacks including a persistent fever, family spokesman Jim McGrath has said.

“I don’t have any guidance so far today except to say no news is good news,” McGrath said on Thursday. Hospital spokesman George Kovacik added that the former president remained in intensive care on Thursday.

But in a statement addressed to the “national media” on Bush’s condition on Thursday, chief of staff Jean Becker sought to strike an upbeat tone.

“Yes, President Bush is in ICU where he is getting the best medical care in the world,” she wrote. “Is he sick? Yes. Does he plan on going anywhere soon? No. He has every intention of staying put.

“He would ask me to tell you to please ‘put the harps back in the closet,’” she said.

On a more serious note, Becker said her boss was expected to remain in the hospital for “a while,” adding, “He is 88 years old, he had a terrible case of bronchitis which then triggered a series of complications.” She did not elaborate.

McGrath on Wednesday described Bush as alert and talking to medical staff.

On Thursday evening, McGrath released a statement from Bush mourning the death of retired Army General Norman Schwarzkopf, commander of the U.S. and allied forces that routed Iraqi ruler Saddam Hussein’s military from Kuwait during a six-week war in 1991.

He said the four-star general, who died at age 78, “epitomized the ‘duty, service, country’ creed that has defended our freedom and seen this great nation through our most trying international crises.”

Bush has lower-body parkinsonism, which causes a loss of balance, and has used wheelchairs for more than a year.

The 41st U.S. president and father of former President George W. Bush, he served as a congressman, ambassador to the United Nations, envoy to China, CIA director and vice president for two terms under Ronald Reagan during a political career spanning four decades.

(Reporting by Corrie MacLaggan; Writing by Steve Gorman; Editing by Paul Thomasch, Phil Berlowitz and Paul Simao)

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Meningitis, West Nile occupy U.S. health officials in 2012

NEW YORK (Reuters) – The year started in the United States with a mild flu season but ended up being marked by deadly outbreaks of fungal meningitis, West Nile virus and Hantavirus.

Tainted steroid medication has been cited as the cause of the meningitis outbreak that killed 39 people.

Weather contributed to the worst outbreak of West Nile virus since 2003 and an unusual outbreak of Hantavirus in California’s Yosemite National Park.

Transmitted by infected mice, Hantavirus is a severe, sometimes fatal syndrome that affects the lungs. West Nile can cause encephalitis or meningitis, infection of the brain and spinal cord or their protective covering.

As of December 11, 5,387 cases of West Nile virus had been reported in 48 states, resulting in 243 deaths, the CDC said in its final 2012 update on the outbreak. The 2003 outbreak left 264 dead from among nearly 10,000 reported cases.

A large number of cases this year occurred in Texas, Louisiana and Mississippi where there are large mosquito populations.

CDC and state officials have said that rainfall in the spring and record high summer temperatures contributed to the severity of the outbreak by affecting mosquito populations, which transmit the disease by biting humans and animals.

Health officials said that only a small percentage of cases of West Nile virus are reported because most people have no symptoms and about 20 percent have mild symptoms such as aches and fever. One in 150 people with West Nile virus develop other illnesses such as meningitis and encephalitis.

The biggest outbreak in nearly two decades of Hantavirus, which emerges in dry and dusty environments, cropped up during the summer in 1,200-square-mile (3,100-square-km) Yosemite National Park, killing three of 10 infected visitors.

The National Park issued warnings to 22,000 people who may have been exposed to the rare disease, and 91 Curry Village cabins in the park were closed in late August.

In early September, a 78-year-old judge named Eddie Lovelace was rushed to a hospital in Nashville, Tennessee. Thought to have had a stroke, he died a few days later.

After a large outbreak of fungal meningitis was linked to tainted steroid injections, Lovelace’s cause of death was revised. He became the first documented death in a meningitis outbreak that has infected 620 people and killed 39 in 19 states.

The New England Compounding Center in Framingham, Massachusetts, was closed after investigators found that it had shipped thousands of fungus-tainted vials of methylprednisolone acetate to medical facilities around the United States. The steroid was typically used to ease back pain.

More than 14,000 people were warned that they may have had an injection of the tainted steroid. Doctors continue to see new cases of spinal infections related to the steroid, and cases of achnoiditis, an inflammation of nerve roots in the spine.

The outbreak led two Democratic lawmakers in the U.S. House of representatives to introduce legislation to increase government oversight of compounded drugs.

And what lies ahead in 2013?

“While there are some trends we can predict, the most reliable trend is that the next threat will be unpredictable,” said Centers for Disease Control and Prevention (CDC) Director Thomas Frieden.

(This refile corrects paragraph two to 39 instead of 243)

(Reporting by Adam Kerlin; Editing by Paul Thomasch)

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Early Childhood Obesity Rates Might Be Slowing Nation-Wide

About one in three children in the U.S. are now overweight, and since the 1980s the number of children who are obese has more than tripled. But a new study of 26.7 million young children from low-income families shows that in this group of kids, the tidal wave of obesity might finally be receding.Being obese as a child not only increases the risk of early-life health problems, such as joint problems, pre-diabetes and social stigmatization, but it also dramatically increases the likelihood of being obese later in life, which can lead to chronic diseases, including cancer, type 2 diabetes and heart disease. Children as young as 2 years of age can be obese–and even extremely obese. Early childhood obesity rates, which bring higher health care costs throughout a kid’s life, have been especially high among lower-income families.”This is the first national study to show that the prevalence of obesity and extreme obesity among young U.S. children may have begun to decline,” the researchers noted in a brief report published online December 25 in JAMA, The Journal of the American Medical Association. (Reports earlier this year suggested that childhood obesity rates were dropping in several U.S. cities.)The study examined rates of obesity (body mass index calculated by age and gender to be in the 95th percentile or higher–for example, a BMI above 20 for a 2-year-old male–compared with reference growth charts) and extreme obesity (BMI of more than 120 percent above that of the 95th percentile of the reference populations) in children ages 2 to 4 in 30 states and the District of Columbia. The researchers, led by Liping Pan, of the Division of Nutrition, Physical Activity and Obesity at the U.S. Centers for Disease Control and Prevention, combed through 12 years of data (1998 to 2010) from the Pediatric Nutritional Surveillance System, which includes information on roughly half of all children on the U.S. who are eligible for federal health care and nutrition assistance.A subtle but important shift in early childhood obesity rates in this low-income population seems to have begun in 2003. Obesity rates increased from 13.05 percent in 1998 to 15.21 percent in 2003. Soon, however, obesity rates began decreasing, reaching 14.94 percent by 2010. Extreme obesity followed a similar pattern, increasing from 1.75 percent to 2.22 percent from 1998 to 2003, but declining to 2.07 percent by 2010.Although these changes might seem small, the number of children involved makes for huge health implications. For example, each drop of just one tenth of a percentage point represents some 26,700 children in the study population alone who are no longer obese or extremely obese. And if these trends are occurring in the rest of the population, the long-term health and cost implications are massive.Public health agencies and the Obama Administration have made battling childhood obesity a priority, although these findings suggest that early childhood obesity rates, at least, were already beginning to decline nearly a decade ago. Some popular prevention strategies include encouraging healthier eating (by reducing intake of highly processed and high-sugar foods and increasing fruit and vegetable consumption) and increased physical activity (both at school and at home).The newly revealed trends “indicate modest recent progress of obesity prevention among young children,” the authors noted. “These finding may have important health implications because of the lifelong health risks of obesity and extreme obesity in early childhood.”

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Kuwait urges Iran to address worries on nuclear plant

MANAMA (Reuters) – Kuwait urged neighboring Iran on Monday to cooperate more with the U.N. nuclear watchdog to allay Gulf Arab concerns about the safety of an Iranian nuclear power plant that lies just across the waterway from the emirate.

The emir, Sheikh Sabah al-Ahmed al-Sabah, said a recent shutdown at the Bushehr plant indicated Tehran had to work with the Vienna-based International Atomic Energy (IAEA) to ensure the safety of the facility near the coastal town of Bushehr.

He was speaking in Bahrain at the annual summit of the Gulf Cooperation Council (GCC), a grouping of six oil-exporting Gulf Arab countries at odds with Tehran over a series of issues and who see the Islamic Republic as a rival for regional influence.

Bushehr, a Russian-built symbol of what Iran calls its peaceful nuclear ambitions, was shut down in October to limit any damage after stray bolts were found beneath its fuel cells, a Russian nuclear industry source said in November.

The explanation for the procedure at the 1,000-megawatt plant contradicted assurances by Iran that nothing unexpected had happened and that removing nuclear fuel from the plant was part of a normal procedure.

Sheikh Sabah said: “The news that was reported recently about the technical failure that hit the Bushehr reactor confirms what we mentioned about the importance of Iranian cooperation with the IAEA, and committing to its criteria and rule, to ensure the safety of the region’s states and its people from any effect of radioactivity.”

LONG-STANDING DISPUTE

Iran is the only country with an operating nuclear power plant that is not part of the 75-nation Convention on Nuclear Safety, which was negotiated after the 1986 nuclear disaster at the Chernobyl nuclear plant.

Although the West suspects the Islamic Republic of trying to develop the means to build nuclear arms – a charge it denies – Bushehr is not considered a major proliferation risk by Western states, whose fears are focused on sites where Iran has defied global pressure by enriching uranium beyond levels needed to fuel civilian atomic power plants.

Nevertheless Western officials voiced concern in November about what they described as an unexpected unloading of fuel at Bushehr and said Tehran, which has dismissed it as a normal step, must clarify the issue.

Iran’s ambassador to the IAEA said in November that Tehran was determined to make sure safety at Bushehr was guaranteed after the plant is turned over to Iranian operators.

The plant, whose start-up has been delayed for years, was finally plugged into Iran’s national grid in September 2011, a move intended to end protracted delays in its construction. The plant’s Russian builder was quoted in October as saying Bushehr would be formally “handed over for use” to Iran in March 2013.

Sheikh Sabah also appealed to Iran to resolve separate long-standing disputes with GCC members, who comprise Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman and Kuwait.

“We renew our calls to our brothers in Iran to respond to our invitations to put an end to pending issues between the GCC countries and Iran … through direct negotiations or by resorting to international arbitration,” he said.

Bahrain has repeatedly accused Tehran of meddling in its internal politics. Saudi Arabia has complained about alleged border breaches by Iran, and the UAE has a long-standing dispute with the Shi’ite Muslim power over three Gulf islands. Iran denies seeking subvert Bahrain or any other Gulf Arab state, and says its intentions in the region are purely peaceful.

(Reporting by Asma Alsharif, Writing by William Maclean; Editing by Mark Heinrich)

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Federal judge blocks Missouri law to deny birth control coverage

(Reuters) – A federal judge on Friday blocked a new Missouri law that requires health insurers to offer plans that exclude contraception coverage if employers or individuals object to birth control on moral or religious grounds.

U.S. District Judge Audrey Fleissig granted a temporary restraining order preventing the enforcement of the law, writing that it appears to conflict with the new federal health care law.

Republican lawmakers in Missouri drafted the law in response to President Barack Obama‘s policy of requiring insurers to cover birth control for free as part of the new federal health care law, even if they work for a church or other employer that has a moral objection.

State lawmakers in September overrode a veto by Democratic Governor Jay Nixon to enact the law.

The Missouri Insurance Coalition, a nonprofit whose members include health insurers that do business in the state, asked the judge to block the state law, arguing that it conflicts with federal law and is therefore invalid.

Fleissig wrote that the coalition is likely to succeed on that claim “given what appears to be an irreconcilable conflict” between the federal and state laws.

At a hearing, the judge wrote, the Missouri Department of Insurance “could offer no response to how there would not be a direct conflict” between the federal and state laws if an insurer offered a health insurance plan “that acquiesced to an employer’s decision not to offer contraceptive coverage.”

She is expected to schedule a hearing on a preliminary injunction.

(Reporting By Corrie MacLaggan; editing by Todd Eastham)

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Physician Launches Black Health Website

NATIONWIDE – The glaring realities facing the Black community’s health and well-being are in a state of emergency. Whether it is high blood pressure, diabetes, HIV/AIDS, various forms of cancer or obesity, Blacks in many cases have the unfortunate distinction as the leading sufferers of these health maladies. Dr. Corey Hebert aims to help tackle these dilemmas via cyberspace, with the launch of BlackHealthTV.com, an online social media and video website geared toward a community overwrought with preventable and treatable ailments and diseases. Launched in October, Dr. Hebert hopes by making health information available online in an interactive format more people will be privy to information that can save their lives or at the very least help them make more well-informed health decisions. “I was sitting at a table in New York with a bunch of very educated African Americans and one of the guys at the table had a Ph.D. from MIT (Massachusetts Institute of Technology) and he burned himself with a plate at the table,” explained Dr. Hebert when asked what inspired him to launch BlackHealthTV.com. health_care_12-18-2012_1.jpg “The first thing he told me was, ‘Man let me get some butter so I can put it on this burn.’ And I explained to him that’s the worst thing that you could ever put on a burn. You should never put butter on a burn,” Dr. Herbert told The Final Call in an exclusive interview. Applying butter on a burn can cause infection. The man continued to insist butter was the answer telling Dr. Hebert, “trust me.” “I said trust you? I’m a medical doctor and I’m telling you that you’re not supposed to put butter on a burn … everybody at the table disagreed with me,” said Dr. Hebert. That encounter led him to conduct a poll of 1,000 Black people across the country of varying socio-economic status and education levels. The results said Dr. Hebert was 85 percent thought butter was the correct first-aid remedy. “The lack of information is appalling and we know that whatever was out there is not working because the health disparities are increasing. If they’re increasing I just felt I had to do something,” continued Dr. Hebert, an award-winning medical journalist and regular contributor on the Dr. OZ Show. Indeed, the statistics are daunting. According to the Center for Disease Control (CDC), the news regarding Black Americans and optimum health is not good. Black men have higher rates of getting and dying from prostate cancer. Black women are 1.4 times more likely to die from breast cancer than White women. Blacks are more likely to die from asthma. An estimated 3.7 million or 14.7 percent of all non-Hispanic Blacks age 20 and older have diabetes, the leading cause of heart disease, stroke and kidney disease. In 2009 a staggering 44 percent of all new HIV infections were Black, despite being only 14 percent of the total U.S. population, and 45 percent of Black adults are obese. What makes BlackHealthTV.com unique is that it is not text heavy, but features video presentations with health tips, health news, recipes, and information on children’s health. Visitors to the site can also sign up to receive “health tips of the day” via email. Using modern technology is an opportunity for more access to information, and though Blacks still lag somewhat behind when it comes to the “digital divide,” the gap is closing. The Pew Research Center notes that 44 percent of Blacks are smart phone users and are more likely than Whites to use their cell phones for accessing Internet and multimedia content. The percentage of Blacks that use the Internet increased from 35 percent in 2000 to 71 percent in 2011, according to Pew. It is this reason; BlackHealthTV.com is formatted different than other health websites explained Dr. Hebert. “African Americans search for “health” more than any other group on the Internet and have downloaded more health apps for iPhones than any other group,” said Dr. Hebert, co-founder and CEO of the site. Other health sites are mostly written word, which can be intimidating to many, he explained. “I have friends that are Master’s degree people that really can’t decipher some of the stuff on WEB M.D., so the only way that an African American or any minority group or any majority group for that matter can get information and really understand it is if it’s delivered in a way that makes them feel very comfortable,” said Dr. Hebert. The online video concept grew from there he explained. “When I start off my videos about diabetes and they start off by saying, ‘You got sugar. Let me tell you what sugar is.’ It puts African Americans at rest about the anxiety about his or her diabetes because I’m speaking to them in a way that they understand and they can appreciate,” said the Baton Rouge, La. native who was raised by a single mother and went on to graduate Morehouse College and Meharry Medical College. Dr. Hebert said the most important thing to him is that for the first time, a Black person who may not be able to read can now access health information on demand. Through BlackHealthTV.com, Dr. Hebert plans to link up with other Black organizations. “That’s my goal. To partner with every Black organization in America and have our content be available to them on their website and any other way that they’d like to get it. We also envision in the long term to be able to have an actual television network called Black Health TV where we have all health content for African Americans, twenty-four seven,” said Dr. Hebert who specializes in pediatrics and emergency medicine. Making sure the Black community has easy to access information to guide them toward making wiser choices when it comes to their health is what drives Dr. Hebert, who has been featured also on the Discovery Channel, The Oprah Winfrey Show and other major networks. “I had never been to a classroom with Black people until I got to Morehouse College and that really changed my life and I knew at that point that I was going to have to take care of my people, at all cost. I don’t care what I have to do, I’m going to make sure that at the very least that an African American man or woman can make a poor choice but that poor choice that they make is based on the education that they have and that’s a choice that they’ve really made,” he explained. The poor health and dietary choices Black people continue to make, said Dr. Hebert are not based on education or fact, something he hopes will eventually change. “Before I die, you’re going to have all the facts in your mind and if you want to choose to do the wrong thing, that’s your choice. That’s what White people have; that’s what Hispanic people are being able to get right now; that’s what we need to have too and that’s the goal for me. To make sure that I empower every African American, or African for that matter, to have the health information that they need to make the right decisions for their health,” said Dr. Hebert. _____

By Starla Muhammad Special to the NNPA from The Final Call

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Allscripts names new CEO to spearhead recovery

(Reuters) – Embattled healthcare technology firm Allscripts named its board member and former chief operating officer of rival Cerner Corp Paul Black as its CEO, replacing Glen Tullman, and said it ended a review of strategic alternatives.

The move, effective immediately, raises new questions for the direction of Allscripts Healthcare Solutions Inc after activist shareholder HealthCor Management installed three of its nominees to the company’s board last summer, following a bitter fight with Tullman.

Allscripts has struggled to boost new business following its acquisition of Eclipsys Corp in 2010. It had hoped to expand into software and equipment for hospitals and healthcare systems with that purchase but ended up losing business to Cerner Corp and closely held Epic Systems Corp.

The company, which has been the subject of takeover interest, also said on Wednesday that Lee Shapiro would step down as president.

Allscripts shares, which have nearly halved in value this year, were down 19 percent at $ 8.70 in extended trade on Wednesday. They had closed at $ 10.68 earlier on the Nasdaq.

“Both Glen and the board of directors believe that after Glen’s 15 years of leadership, it is the right time now for a new leader to focus on execution, position the company to deliver shareholder value and lead Allscripts through its next phase of growth,” Allscripts spokeswoman Ariana Nikitas said.

Tullman’s resignation comes months after Healthcor cited problems with his leadership and demanded his ouster.

“I think Glen has been under a lot of pressure since the attempted coup by former board members and HealthCor demanded some changes and Allscripts agreed to put some of HealthCor’s appointees on the board,” said Anthony Vendetti, an analyst at Maxim Group, adding he has personally known Tullman since he became CEO.

Black left Cerner in 2007 after more than 12 years with the company, helping to make it a market leader with more than $ 1.5 billion of annual revenues and playing an instrumental role in its double-digit organic growth, Allscripts said.

“I think (Black) is the ideal candidate for CEO,” said Vendetti, who has a “buy” rating on Allscripts stock and a price target of $ 15.

“We view this news positively as Mr. Black is well regarded in the industry. With that said, we maintain our neutral rating for the time being,” Steven Halper of Lazard Capital Markets wrote in a note.

LONG ROAD TO GROWTH

Allscripts stock has fallen more than 42 percent this year amid weak bookings that hampered sales and profit.

The company withdrew its full-year outlook in November, as it began to consider strategic alternatives. Later that month, Reuters reported that Blackstone Group LP had emerged as the frontrunner to buy the company but that the two sides were far apart on price and a deal was highly uncertain, according to people familiar with the matter.

Black is no stranger to the buyout industry, having served as operating executive of Genstar Capital LLC, a private equity firm, and senior advisor at New Mountain Finance Corporation, an investment management company.

His background may come in handy as he seeks to turn around the company’s financial performance in a difficult environment for healthcare IT firms. These companies face a dwindling customer base as hospitals consolidate physician practices into their existing vendors.

“The expectation is that it will take some time (for the company) to fundamentally turn around its business,” analyst Vendetti said. He added that Allscripts’ main goal should be to re-establish client trust in their products and the ability to integrate their product portfolio.

A comment in the Allscripts statement from Tullman, who had been CEO since 1997, made no reference to the reasons for his departure. He said he was confident that Allscripts was in good hands and had a bright future ahead.

Analyst Halper said he remained concerned about the long-term growth prospects of the company.

“With the selection of Paul Black, hopefully the company can redefine its strategic direction,” Halper said.

(Additional reporting by Ransdell Pierson and Greg Roumeliotis in New York; Editing by Gary Hill, Saumyadeb Chakrabarty and Muralikumar Anantharaman)

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French psychiatrist sentenced after patient commits murder

MARSEILLES, France (Reuters) – A French psychiatrist whose patient hacked an elderly man to death was found guilty of manslaughter on Tuesday in a groundbreaking case that could affect the way patients are treated.

A court in Marseilles said Daniele Canarelli, 58, had committed a “grave error” by failing to recognize the public danger posed by Joel Gaillard, her patient of four years.

Gaillard hacked to death 80-year-old Germain Trabuc with an axe in March 2004 in Gap, in the Alps region of southeastern France, 20 days after fleeing a consultation with Canarelli at Marseilles’s Edouard Toulouse hospital.

Canarelli was handed a one-year prison sentence and ordered to pay 8,500 euros to the victim’s children, in the first case of its kind in France. Defense lawyers said the ruling would have serious repercussions for treatment of the mentally ill.

“If a psychiatrist lives in fear of being sentenced, it will have very real consequences and probably lead to harsher treatment of patients,” said Canarelli’s lawyer, Sylvain Pontier.

The court said Canarelli should have requested Gaillard be placed in a specialized medical unit or referred him to another medical team, as one of her colleagues suggested. Her stubborn refusal had equated to a form of “blindness”, the court president Fabrice Castoldi said.

Gaillard had already been forcibly committed to a secure hospital on several occasions for a series of increasingly dangerous incidents.

The victim’s son, Michel Trabuc, said he hoped the case would set a legal precedent.

“There’s no such thing as zero risk, but I hope this will move psychiatry forward and, above all, that it will never happen again,” he said.

Gaillard was not held responsible for his actions and was freed under medical supervision.

(Reporting by Jean-François Rosnoblet; Writing by Vicky Buffery; Editing by Alison Williams)

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Bird flu kills 4-year-old boy in Indonesia

JAKARTA, Indonesia (AP) — A 4-year-old Indonesian boy has died from bird flu, bringing the death toll to 160 in the world’s hardest-hit country.

Health Ministry official Rita Kusriastuti said Tuesday that the boy died Dec. 6 in Tangerang city, just west of Jakarta, the capital. He developed symptoms of a cold and fever on Nov. 30 and was treated at a public health center before being hospitalized the same day he died.

Kusriastuti said the boy, from the West Java district of Bogor, was believed to have been infected with the H5N1 virus after having direct contact with dead fowl around his house.

Bird flu has killed at least 360 people worldwide since 2003. It remains hard for people to catch, but experts fear it could mutate into a more deadly form.

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Boehner opens door to tax hikes, shifts U.S. fiscal cliff talks

WASHINGTON (Reuters) – U.S. House of Representatives Speaker John Boehner‘s offer to accept a tax rate increase for the wealthiest Americans knocks down a key Republican road block to a deal resolving the year-end “fiscal cliff.”

The question now boils down to what President Barack Obama offers in return. Such major questions, still unanswered so close to the end of the year suggest, however, that no spending and tax agreement is imminent.

A source familiar with the Obama-Boehner talks confirmed that Boehner proposed extending low tax rates for everyone who has less than $ 1 million in net annual income, meaning tax rates would rise on all above that line.

Under current law, the 35 percent top tax rate is scheduled to expire on January 1, and would automatically go to 39.6 percent. Boehner’s proposal would allow that rate to rise as scheduled at a threshold of $ 1 million – putting it back to where it was during the Clinton administration.

The White House has not accepted the proposal and the source could not confirm any additional talks were held on Sunday between Obama and Boehner.

With just over two weeks before the fiscal cliff’s $ 600 billion in automatic tax hikes and spending cuts are triggered, threatening a new recession, there is little time to craft a comprehensive deal that will satisfy both Democrats and Republicans.

Until the latest Republican offer, made on Friday, Boehner had insisted on extending all of the Bush era’s lower tax rates, resisting Obama’s demand to let the marginal rates rise on income above $ 250,000. A rising chorus of business executives also had urged Republicans to agree to this.

Some lawmakers and congressional aides had predicted that Republicans, once serious negotiations began, might try to raise the $ 250,000 threshold, say to $ 500,000 or $ 1 million. They also speculated that Republicans, if forced into a tax rate hike on the upper-income groups, might seek a smaller increase, say to around 37 percent.

Although the White House has not accepted Boehner’s gambit, it could push negotiations away from entrenched, ideological positions.

“Boehner has now accepted the premise of higher rates. So now we’re just arguing over details. I think it’s a significant step,” said Greg Valliere, chief political strategist at Potomac Research Group.

A framework deal spelling out tax revenue and spending cut targets to be finalized in the new year could be possible, Valliere said.

“Boehner’s offer to allow tax rates to go up for taxpayers earning over $ 1 million fundamentally transforms fiscal cliff negotiations,” added Sean West, U.S. policy analyst at Eurasia Group, a political risk consultancy.

In a note to clients, West wrote that it signals, significantly, that Boehner ultimately believes a deal to avoid the cliff is still possible.

“The political burden is now shifted back to the president, who must be willing to take on his party in order to get a deal Boehner can ultimately pass. We do not think the president will overreach: Obama will work with Boehner to get to a deal.”

There are still several critical elements to a deal besides a tax rate increase on the wealthy, including Republican demands to cut spending on social programs.

Changes to the expensive Medicare and Medicaid health care programs for the elderly and the poor could be central to any deal, which must also include an increase in the federal debt limit needed by the end of February.

DEMANDS SOCIAL PROGRAM CUTS

Boehner conditioned his tax rate increase offer on Obama’s agreement to cuts in social program spending, often called entitlements.

Many Republican lawmakers want to raise the eligibility age for Medicare to 67 from 65. They also want to link Medicare to the income of recipients, making wealthier retirees pay more for their care.

Currently, Medicare does have some means testing, charging higher premiums for coverage of doctors visits and prescription drugs to individuals earning more than $ 85,000 and married couples earning more than $ 170,000. Only about 5 percent of recipients pay these higher premiums.

Thus far, Obama has offered only about $ 400 billion in 10-year entitlement savings, mostly through small adjustments in reining in health care costs – not fundamental changes such as raising the eligibility age.

And just as Boehner faces opposition in his own party to raising any tax rates, Obama faces opposition to cuts to Medicare, Medicaid and Social Security from Democrats, who pledged in election campaigns they would protect these programs.

A major bloc of congressional Democrats has already signaled they will not accept major cutbacks in Medicare as part of any fiscal cliff deal.

House Minority Leader Nancy Pelosi of California and Maryland Representative Chris Van Hollen of Maryland are among the high ranking Democrats in the House who have come out forcefully in recent days against raising the age for eligibility for Medicare to 67 years of age.

“Given the level of savings that is being talked about from Medicare, you can’t get it all from providers and drug makers,” said Paul Heldman, an analyst at Potomac Research, which tracks Washington policy for investors.

“So opponents of raising the eligibility age have reason to believe beneficiaries will take some sort of hit if a mega-deal is cut,” he said.

If Republicans are not successful in securing entitlement program cuts in exchange for a tax-rate increase on the wealthy, they are adamant about using a debt-limit increase as leverage to overhaul Social Security and Medicare.

The U.S. Treasury expects to reach its $ 16.4 trillion statutory debt cap by year-end, and will exhaust its remaining borrowing capacity around mid-February, risking a potential default.

Louisiana Republican Representative John Fleming, a member of the conservative Tea Party caucus who has never voted to increase the debt ceiling, said he would support a debt limit hike if it were part of a deal to make Medicare and Social Security sustainable.

The pace of activity could pick up the coming week.

House Republicans were told to prepare for a possible weekend session next week, potentially interrupting travel plans for the long Christmas holiday weekend.

House Majority Leader Eric Cantor scheduled “possible legislation related to expiring provisions of law,” a reference to the expiring tax cuts, for the end of the week, portending a weekend session. Cantor has said the House would meet through the Christmas holidays and beyond.

(This story was fixed to correct current top tax rate to 35 percent from 36 percent)

(Additional reporting by Thomas Ferraro, Richard Cowan and Kim Dixon; Editing by Fred Barbash, Todd Eastham and Jackie Frank)

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White House won’t accept new tax offer from Republican leader

WASHINGTON (Reuters) – President Barack Obama is not ready to accept a new offer from the Republican leader of the U.S. the House of Representatives to raise taxes on top earners in exchange for major cuts in entitlement programs, a source said late Saturday.

The shape and details of Boehner‘s offer were uncertain Saturday night, as was the exact reason the president was prepared to reject it.

The source said Obama sees the offer made on Friday by U.S. House Speaker John Boehner as a sign of progress, but simply believes it is not enough and there is much more to be worked out before Obama can reciprocate.

Tax rates and entitlements are the two most difficult issues in the so-far unproductive negotiations to avert the “fiscal cliff” of steep tax hikes and spending cuts set for the new year unless Congress and the president reach a deal to avoid them.

The Boehner offer is the first significant sign of a shift in the Republican insistence that low tax rates set to expire on December 31 be extended for all taxpayers, and comes at some risk to the speaker.

Conservatives, particularly Tea Party-supported Republicans, see opposition to tax increases for anyone as an abandonment of party principles, and of the Republican base.

Obama wants high earners – those earning roughly $ 250,000 a year or more – to pay higher taxes in order to put the burden of deficit reduction on those he says can best afford it.

Republicans have privately spoken of coming back at Obama with a threshold of $ 1 million. Obama has previously called that unacceptable because it would not raise enough money on its own to cut the deficit significantly or provide enough money to avert across-the-board spending cuts.

On entitlements, the president faces pressures of his own from Democrats, who see protecting Medicare, the government health insurance program for seniors, as a bedrock principle.

A major bloc of congressional Democrats has already signaled they will not accept major cutbacks in Medicare as part of any deal.

It was unclear on Saturday if the president had communicated his response to Boehner.

NOT A COMPLETE SURPRISE

Boehner’s shift did not come as a complete surprise. Recent polls have suggested little public support for his position and he has been getting pressure from Senate Republicans to be more flexible.

The massacre in Connecticut silenced fiscal cliff talk in public on Saturday as the both sides got ready for a final scramble, with sessions of the House now scheduled just days before Christmas.

Obama canceled a trip he had planned to make next Wednesday to Portland, Maine, to press his case for tax hikes for the wealthy. He is heading on Sunday to Newtown, the site of Friday’s school shootings, in which a gunman killed 20 children and six adults before taking his own life. The gunman also killed his mother, according to police.

Boehner of Ohio canceled the standard Republican radio response on Saturday to Obama “so that President Obama can speak for the entire nation at this time of mourning,” he said in a statement issued late on Friday.

The moratorium on cliff pronouncements masked a growing recognition the two sides could remain deadlocked at the end of the year on the key sticking points – taxes and entitlements.

Senate Republicans prodded their counterparts in the House to beat a retreat on tax hikes, in a fashion that would allow Obama’s proposal to pass the Republican-controlled House while allowing Republicans to cast a face-saving vote against it.

Republicans could then shift the debate onto territory they consider more favorable to them, cutting government spending to reduce the deficit.

“Just about everyone is throwing stuff on the wall to see if anything sticks,” one Republican aide said in reference to various proposals being discussed on how to proceed.

Alluding to public opinion polls, the aide added: “We know if there is no deal, we will get blamed.”

“We could win the argument on spending cuts,” said a Republican senator who asked not to be identified. “We aren’t winning the argument on taxes.”

However, Republican leaders in both chambers are leery about seeming to cave on taxes. “There’s concern that if we did that, Obama would simply declare victory and walk away and not address spending,” said one aide. “We don’t trust these guys.”

‘A BALANCED PLAN’

Some of the prodding was coming from Senate Minority Leader Mitch McConnell of Kentucky.

Don Stewart, a McConnell spokesman, said the minority leader in the Democratic-controlled Senate hasn’t embraced any single plan, but has discussed and circulated measures offered by fellow Senate Republicans.

“Senator McConnell does not advocate raising taxes on anybody or anything,” Stewart said.

“We’re focused on getting a balanced plan from the White House that will begin to solve the problem of our debt and deficit to improve the economy and create American jobs,” said Boehner spokesman Michael Steel.

“Right now, all the president is offering is massive tax hikes with little or no spending cuts and reforms,” Steel said.

House Majority Leader Eric Cantor scheduled “possible legislation related to expiring provisions of law,” a reference to the expiring tax cuts, for the end of the week, portending a weekend session.

Cantor has said the House would meet through the Christmas holidays and beyond.

Hopes expressed after the November 6 general election of some “grand bargain” on deficit reduction have all but disappeared, at least for this year.

This is partly because time is running out and partly the result of growing warnings from Democrats in Congress that they would not support big changes in the Medicare program, the government-run health insurance program for seniors that is a major contributor to the government’s debt.

House Democratic Minority Leader Nancy Pelosi of California ruled out one frequently mentioned proposal – raising the age of eligibility for Medicare, in a December 12 CBS television interview.

Asked if she was drawing a “red line” around that idea, Pelosi said her comments were “something that says, ‘don’t go there,’ because it doesn’t produce money.

(Reporting by Thomas Ferraro, Richard Cowan and Kim Dixon; Editing by Fred Barbash and Todd Eastham)

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How to talk to your children about a school shooting

(Reuters) – When parents ask how they can comfort and reassure their children after a tragedy that receives extensive news coverage, the usual advice is to be supportive and reassuring but don’t offer false assurance, experts say.

“Children want to know they’re safe and will stay safe. Parents can convey that by what they say and how they behave,” said Dr. Victor Fornari, director of child and adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, New York.

But after a school shooting – especially one as horrific as that in Newtown, Connecticut, on Friday – the challenge of helping kids cope is enormously greater than after, say, a tornado wipes out a distant town. It also poses a much greater risk that children who hear about it will suffer a traumatic reaction.

“Schools are supposed to be safe and nurturing environments for children,” said Fornari. “This shatters that belief. Restoring the sense of security in school will take time.”

The way to do that isn’t to offer false assurances, experts say.

“I wouldn’t lie, because your credibility is very, very important,” said Dr. Michael Brody, a child psychiatrist and chairman of the Television and Media Committee of the American Academy of Child and Adolescent Psychiatry. “To say this would never happen to you, I don’t think that is reasonable.”

But while parents need to be honest, they should also make clear that such tragedies are exceedingly rare.

“Parents can say emphatically, ‘your school is a very safe place,’” said David Finkelhor, professor of sociology and director of the Crimes Against Children Research Center at the University of New Hampshire in Durham. “It’s a vanishingly rare occurrence, and schools are still the safest places kids can hang out in terms of violence.”

Parents should not let young children watch news coverage of the shootings, and might warn older children and teenagers away from looking for news and disturbing video of the tragedy on Twitter, Facebook and other sites they can access via smartphones.

AVOID UPSETTING DETAILS

As parents talk to their children about Newtown, they should avoid dwelling on upsetting details, such as exactly what the gunman did where and to whom. Younger children should be reassured that the shooting is over. With older children, parents might talk about their school’s safety protocols and emergency plans.

If a teenager argues that school wasn’t safe for Newtown’s children, parents can offer statistics. U.S. Centers for Disease Control and Prevention data show that school homicides have fallen in the last 20 years from about 30 a year in the 1990s to 17 in 2010, the last year with complete data.

If the child has questions, parents should answer directly and in a straightforward way, said Dr. Joshua Kellman, clinical associate of psychiatry at the University of Chicago Medicine, matching the level of the response to the level of the child. If an 8 year old asks how someone could open fire on little kids sitting at their school desks, simply explaining that “sometimes something goes wrong with people and they are not thinking right,” should suffice, he said.

It can also be helpful to show children that normalcy prevails. The best way to do that is by sticking to standard weekend activities, said child psychologist Dr. Harold Koplewicz, president of Child Mind Institute, a nonprofit treatment, research and education organization in New York City. “Go Christmas shopping, go to church or synagogue, play a game, watch a video.”

Parents should keep in mind that grief, distress, anxiety and worse are normal human reactions to news that little children have been gunned down in their classroom, not signs of psychological illness. In other words, don’t assume that children who become clingy or withdrawn, who demand more parental attention, stop doing schoolwork, have trouble sleeping or regress (parents can expect young children to ask to sleep in their beds, said Fornari) need counseling.

“If their reactions do not seriously interfere with their lives, you shouldn’t necessarily seek out professional help,” said Fornari. “Children are resilient. Most will be able to cope with this traumatic event and be fine.”

The children who will have the hardest time coping are the 10 percent or so who already suffer from anxiety, typically as a result of an earlier trauma such as witnessing violence or losing a close relative, said Fornari. “Parents know if this describes their child, and should expect stronger reactions.”

That, of course, holds especially true for the survivors of the shooting. These children — and adults — are more likely to be psychologically traumatized, suffering flashbacks, nightmares and intrusive thoughts, re-living the sounds of gunshots and the chaos of being rushed out of their classrooms by police officers.

For them, said Fornari, “their lives will forever be marked as before and after December 14.”

(Reporting by Julie Steenhuysen and Sharon Begley; Editing by Julian Mincer and Lisa Shumaker)

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