Wider Chaos Feared as Syrian Rebels and Kurds Clash

Lynsey Addario for The New York Times

Syrian Kurds in Ras al-Ain are seeking refuge across the border in Ceylanpinar, Turkey.

CEYLANPINAR, Turkey — In plain view of the patrons at an outdoor cafe here in this border town, the convoy of gun trucks waving the flag of the Syrian rebels whizzed through the Syrian village of Ras al-Ain. They had not come to fight their primary enemy, the soldiers of Bashar al-Assad’s government. They had rushed in to battle the ethnic Kurds.

The confrontation spoke not only to the violence that has enveloped Syria, but also to what awaits if the government falls. The fear — already materializing in these hills — is that Syria’s ethnic groups will take up arms against one another in a bloody, post-Assad contest for power.

The Kurdish militias in northern Syria had hoped to stay out of the civil war raging in Syria. They were focused on preparing to secure an autonomous enclave for themselves within Syria should the rebels succeed in toppling the government. But slowly, inexorably, they have been dragged into the fighting and now have one goal in mind, their autonomy, which also means the balkanization of the state.

“We want to have a Kurdish nation,” said Divly Fadal Ali, 18, who fled the fighting and was recently staying in a local community center here for Kurdish refugees. “We want our own schools, our own hospitals. We want the government to admit our existence. We want recognition of our Kurdish identity.”

These skirmishes between Kurds and Arabs take on a darker meaning for Syria as the rebels appear each day to gain momentum, and the government appears less and less able to restore control. The rebels have taken over military bases, laid siege to Damascus and forced the shutdown of the airport.

But the rebels are largely Sunni Arabs, and the most effective among them are extremists aligned with Al Qaeda, a prospect that worries not only the West, but the Christians, Shiites, Druze — and Kurds — of Syria.

The fighting in Ras al-Ain, which came after a fierce battle between rebel and government forces last month, demonstrated the complexity of a bloody civil war that has already claimed more than 40,000 lives. Like the sectarian battles in Iraq after the American invasion, the recent violence between Arabs and Kurds in Syria indicates the further unraveling of a society whose mix of sects, identities and traditions were held together by the yoke of a dictator.

Analysts fear this combustible environment could presage a bloody ethnic and sectarian conflict that will resonate far beyond Syria’s borders, especially if it involves the Kurds. There is concern that Iraq’s Kurds, who are already training Syrian Kurds to fight, may jump into the Syria fight to protect their ethnic brethren. That could also pull in Turkey, which fears that an autonomous Kurdish region in Syria would become a haven for Kurdish militants to carry out cross-border attacks in the Kurdish areas in southeastern Turkey.

“The fear that an Arab-Kurdish confrontation has been ignited might lead the Kurds to ask for additional security forces to protect their lands,” said Maria Fantappie, Iraq analyst at the International Crisis Group, who is helping to prepare a report on the Syrian Kurds.

She said that the Syrian Kurdish fighters being trained in northern Iraq were on standby and could be sent to Syria, which would escalate the situation.

Before the uprising in Syria, the Kurds in Ras al-Ain lived peacefully with their Arab neighbors, they say. But the war has shredded those old bonds just as surely as the revolutions in the region have prompted the Kurds to dream of an independent nation uniting the Kurds in Syria, Iraq, Turkey and Iran, and put their own stamp on the great contest for power under way in the Middle East.

“Our time has come after so much suffering and persecution,” said Barham Salih, the former prime minister of Iraq’s regional Kurdish government. “The 20th century was cruel to the Kurds. Our rights, identity and culture were brutally suppressed.”

Sebnem Arsu contributed reporting from Ceylanpinar, and an employee of The New York Times contributed reporting from Ras al-Ain, Syria.

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Software Founder John McAfee Is Denied Asylum

GUATEMALA CITY (AP) — Software company founder John McAfee was hospitalized Thursday after being denied political asylum in Guatemala and his lawyers said they were making a last-ditch effort to keep him from being flown back to Belize for questioning about the killing of a fellow American expatriate.

McAfee told The Associated Press that he suffered chest pains overnight but didn't believe he had a heart attack. A government doctor who examined him agreed, saying that McAfee's heart rhythm and blood pressure were normal and that he appeared to be suffering from high stress.

McAfee was moved from an immigration center to a police-run hospital Thursday afternoon after Guatemalan authorities said McAfee's request for asylum had been denied. They did not explain why. Shortly after the decision was announced, McAfee issued a plea on his blog for the public to petition Guatemalan President Otto Perez Molina to let him stay.

"Please email the President of Guatemala and beg him to allow the court system to proceed, to determine my status in Guatemala, and please support the political asylum that I am asking for," the post read.

McAfee's legal team said they were preparing to appeal the denial of asylum to the country's constitutional court, a process that could give McAfee perhaps another day or two in Guatemala. The court would have to issue a decision within 48 hours.

McAfee's complaints of chest pain prompted authorities to move him from the immigration center where he had been held overnight. He had been taken to the center after his arrest for illegally entering the country after a bizarre weekslong journey as a self-styled fugitive with an active blog and constant contact with the press.

During an exclusive interview with the AP Thursday morning from inside his private room at the center, McAfee said he was refusing to travel to a hospital because he had been using Chinese herbal medicine since suffering a heart attack in 1993.

"Last night I had a little bit of pain, but I am fine this morning," he said. "I don't like Western medicine ... if the people around me are kind and compassionate, that's all that matters in life. The people of Guatemala are very kind people, so I have no complaints."

A couple of hours later, an AP reporter returned to McAfee's room and found him changed into a suit but lying on the floor as he was examined by a doctor. Shortly after, he was taken to the police hospital.

Belizean police spokesman Raphael Martinez said officials expected McAfee to be flown back to his country's capital. Police want to question him about the fatal shooting of killing of Gregory Viant Faull, who was shot to death in early November on the Belize island where both men lived.

There is no warrant for McAfee's arrest, so it is possible his self-initiated flight from Belizean authority could end up with him free to roam the Caribbean island where he lived for years, often clashing with neighbors and authorities over allegations he kept aggressive dogs, weapons and drug paraphernalia on his property.

The Faull family has said through a representative that the murder of their loved one on Ambergris Caye has gotten lost in the media frenzy provoked by McAfee's manipulation of the media through phone calls, emails and blog posts detailing his life on the lam.

McAfee updated his blog Thursday after being given a computer by the warden at the immigration center in Guatemala City, a three-story building with mesh-covered windows and barbed-wire on the roof.

McAfee said U.S. Embassy officials had said they couldn't help him with a request to be returned to the United States instead of Belize. McAfee said he had formally requested asylum in Guatemala because he fears for his safety in Belize because he has sensitive information about official corruption and refused to donate to local politicians.

Guerra warned Wednesday night that the 67-yeard-old McAfee's life would be in danger if he is sent back to Belize.

"He will be in danger if he is returned to Belize, where he has denounced authorities," Guerra said. "From the moment he asked for asylum he has to have the protection of the Guatemalan government."

Police in Belize deny they are persecuting McAfee and say there is no warrant for his arrest. The country's prime minister has questioned McAfee's mental state.

McAfee went on the run last month after officials tried to question him about the killing of Faull, who was shot to death in early November.

McAfee acknowledges that his dogs were bothersome and that Faull had complained about them, but denies killing Faull. Faull's home was a couple of houses down from McAfee's compound.

McAfee, the creator of the McAfee antivirus program, has led an eccentric life since he sold his stake in the anti-virus software company that is named after him in the early 1990s and moved to Belize about three years ago to lower his taxes.

He told The New York Times in 2009 that he had lost all but $4 million of his $100 million fortune in the U.S. financial crisis. However, a story on the Gizmodo website quoted him as calling that claim "not very accurate at all." He has dabbled in yoga, ultra-light aircraft and producing herbal medications.

___

Associated Press writers Patrick E. Jones in Belize City and Michael Weissenstein in Mexico City contributed to this report.

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Extended Use of Breast Cancer Drug Suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

Read More..

Extended Use of Breast Cancer Drug Suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

Read More..

Software Founder John McAfee Is Denied Asylum

GUATEMALA CITY (AP) — Software company founder John McAfee was hospitalized Thursday after being denied political asylum in Guatemala and his lawyers said they were making a last-ditch effort to keep him from being flown back to Belize for questioning about the killing of a fellow American expatriate.

McAfee told The Associated Press that he suffered chest pains overnight but didn't believe he had a heart attack. A government doctor who examined him agreed, saying that McAfee's heart rhythm and blood pressure were normal and that he appeared to be suffering from high stress.

McAfee was moved from an immigration center to a police-run hospital Thursday afternoon after Guatemalan authorities said McAfee's request for asylum had been denied. They did not explain why. Shortly after the decision was announced, McAfee issued a plea on his blog for the public to petition Guatemalan President Otto Perez Molina to let him stay.

"Please email the President of Guatemala and beg him to allow the court system to proceed, to determine my status in Guatemala, and please support the political asylum that I am asking for," the post read.

McAfee's legal team said they were preparing to appeal the denial of asylum to the country's constitutional court, a process that could give McAfee perhaps another day or two in Guatemala. The court would have to issue a decision within 48 hours.

McAfee's complaints of chest pain prompted authorities to move him from the immigration center where he had been held overnight. He had been taken to the center after his arrest for illegally entering the country after a bizarre weekslong journey as a self-styled fugitive with an active blog and constant contact with the press.

During an exclusive interview with the AP Thursday morning from inside his private room at the center, McAfee said he was refusing to travel to a hospital because he had been using Chinese herbal medicine since suffering a heart attack in 1993.

"Last night I had a little bit of pain, but I am fine this morning," he said. "I don't like Western medicine ... if the people around me are kind and compassionate, that's all that matters in life. The people of Guatemala are very kind people, so I have no complaints."

A couple of hours later, an AP reporter returned to McAfee's room and found him changed into a suit but lying on the floor as he was examined by a doctor. Shortly after, he was taken to the police hospital.

Belizean police spokesman Raphael Martinez said officials expected McAfee to be flown back to his country's capital. Police want to question him about the fatal shooting of killing of Gregory Viant Faull, who was shot to death in early November on the Belize island where both men lived.

There is no warrant for McAfee's arrest, so it is possible his self-initiated flight from Belizean authority could end up with him free to roam the Caribbean island where he lived for years, often clashing with neighbors and authorities over allegations he kept aggressive dogs, weapons and drug paraphernalia on his property.

The Faull family has said through a representative that the murder of their loved one on Ambergris Caye has gotten lost in the media frenzy provoked by McAfee's manipulation of the media through phone calls, emails and blog posts detailing his life on the lam.

McAfee updated his blog Thursday after being given a computer by the warden at the immigration center in Guatemala City, a three-story building with mesh-covered windows and barbed-wire on the roof.

McAfee said U.S. Embassy officials had said they couldn't help him with a request to be returned to the United States instead of Belize. McAfee said he had formally requested asylum in Guatemala because he fears for his safety in Belize because he has sensitive information about official corruption and refused to donate to local politicians.

Guerra warned Wednesday night that the 67-yeard-old McAfee's life would be in danger if he is sent back to Belize.

"He will be in danger if he is returned to Belize, where he has denounced authorities," Guerra said. "From the moment he asked for asylum he has to have the protection of the Guatemalan government."

Police in Belize deny they are persecuting McAfee and say there is no warrant for his arrest. The country's prime minister has questioned McAfee's mental state.

McAfee went on the run last month after officials tried to question him about the killing of Faull, who was shot to death in early November.

McAfee acknowledges that his dogs were bothersome and that Faull had complained about them, but denies killing Faull. Faull's home was a couple of houses down from McAfee's compound.

McAfee, the creator of the McAfee antivirus program, has led an eccentric life since he sold his stake in the anti-virus software company that is named after him in the early 1990s and moved to Belize about three years ago to lower his taxes.

He told The New York Times in 2009 that he had lost all but $4 million of his $100 million fortune in the U.S. financial crisis. However, a story on the Gizmodo website quoted him as calling that claim "not very accurate at all." He has dabbled in yoga, ultra-light aircraft and producing herbal medications.

___

Associated Press writers Patrick E. Jones in Belize City and Michael Weissenstein in Mexico City contributed to this report.

Read More..

Typhoon Bopha Kills Hundreds in Philippines

Bullit Marquez/Associated Press

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

MANILA — With many roads and bridges washed away, rescue teams struggled Wednesday to reach isolated villages in the southern Philippines after a powerful out-of-season typhoon tore through the region, leaving more than 270 people dead and hundreds more missing, officials said.

Typhoon Bopha packed winds of up to 100 miles per hour when it struck Tuesday, bringing torrential rains that washed away villages and left thousands homeless.

The deaths were concentrated in the province of Compostela Valley, a mountainous gold mining area, and the neighboring province of Davao Oriental, on the eastern coast of the southern Philippine island of Mindanao, Lt. Col. Lyndon Paniza, a military spokesman, said in a telephone interview late Wednesday afternoon.

A national disaster official, Benito Ramos, said at a news conference on Wednesday afternoon that 274 people had died, 339 were injured and 279 were missing. Those figures were likely to rise, he suggested, since rescue workers had not yet reached several villages in the hardest-hit areas and the casualties there were not known.

Most of the dead appeared to have drowned or been hit by falling trees or flying debris, officials said.

“There is debris in the road, so our soldiers are moving by foot,” Colonel Paniza said. “They are crossing rivers and landslides. I don’t want to speculate, but we don’t know what they will find when they reach those cut off areas.”

Three soldiers are known to have died, and eight are missing, he said. Some of the soldiers died when a landslide washed out their patrol base, and others disappeared while on search-and-rescue operations.

Local television crews broadcast grisly footage of mud-covered bodies being loaded into trucks in villages that appeared flattened by the storm. In some areas, not a single structure could be seen standing.

In areas where roads were washed out, the government sent seagoing vessels to take relief goods to remote coastal areas from the provincial capital of Davao Oriental, Mati.

“I have thus authorized the local government of Mati, its mayor and the provincial governor to use their calamity funds to hire all available large, local fishing boats for an immediate sea-lift transfer of goods to the affected areas,” Manuel Roxas, the interior secretary, said in a statement.

The eastern coast of Mindanao, which was the area hardest hit by the storm, is a remote, impoverished agricultural area. Mr. Roxas told reporters on Wednesday that during his visit to the area, he had seen tens of thousands of fallen coconut trees and many acres of destroyed banana plantations.

In New Bataan, the town hit hardest by the storm, Virgilia Babaag had been waiting nervously in her home before dawn on Tuesday as hard rain from the approaching typhoon pounded her small village.

“My neighbors started yelling, ‘The water is coming fast! Run! Run!’ ” she said Wednesday by telephone.

Ms. Babaag gathered up her three young nieces staying with her and ran through the night toward high ground. There she stayed with dozens of others as winds ripped through the town.

“When I came back, my roof was gone,” she said from her devastated home. “The houses around my place are destroyed. There are so many who have died here. The soldiers are still finding more.”

The Philippines is hit by as many as 20 powerful tropical storms each year, but this one struck remote communities south of the usual typhoon path.

“This is the first time that the people in this area have experienced a storm like this,” Colonel Paniza said. “They aren’t accustomed to big storms.”

Last December, Tropical Storm Washi — another out-of-season storm that hit south of the usual Philippine typhoon belt — killed more than 1,200 people and left hundreds of thousands homeless.

This year, officials put out strong warnings days in advance and carried out mandatory early evacuations of vulnerable communities.

President Benigno S. Aquino III, stung by criticism last year that the national government had not done enough to prepare for Tropical Storm Washi, went on television the day before the storm hit and pleaded with people to follow the instructions of local government officials.

“I am facing you now because the incoming storm is no laughing matter,” Mr. Aquino said, adding later, “We expect the cooperation of everyone so that nobody gets in harm’s way.”

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State of the Art: Reviewing All-in-One Luxury PCs From Vizio, H.P. and Apple - State of the Art

Try this simple test at home: What’s the name of Dell’s best-selling PC? Anybody? Anybody?

Right. Nobody knows.

And nobody cares. Today, it’s all about phones and tablets, baby. Nobody buzzes about the PC anymore. Innovation is dead. Sales are down, right?

Actually, there’s one pocket of surging sales and innovation in PC land: the luxury all-in-one computer, of the type made famous by the iMac.

I took a look at three silver, high-design, screen-on-a-stalk competitors: Apple’s new iMac ($1,300 and up), Hewlett-Packard’s SpectreOne ($1,300 and up), and the Vizio All-in-One Touch PC ($1,000 and up). (Lenovo, Dell, Samsung and Acer also offer, or soon will offer, very similar all-in-ones.)

What characterizes these computers? First, a tremendous emphasis on looks. They’re shiny, sleek, futuristic, uncluttered and cordless (they come with Bluetooth wireless keyboard and trackpad or mouse). They’re sculpture. In your kitchen or on your desk, they contribute to the décor even when they’re turned off.

The usual box of innards is missing. In the iMac, the guts are concealed behind the screen. In the Vizio, they’re in the foot of the monitor. In the H.P., they’re inside the stalk that supports the screen.

The second common trait is state-of-the-art components. These computers offer gorgeous, vivid, high-definition screens. And they’re fast; they’re powered by the latest Intel chips and lots of memory.

Third characteristic: no DVD drive.

What? Do these companies really think that the era of the disc is over? That nobody will ever again want to digitize music from a CD? Or burn some files to a disc to hand to a colleague? Or borrow a DVD from the library?

Apple, H.P. and Vizio seem to believe that everything is online now. Well, it’s not. Want to rent an Indiana Jones movie, “Jurassic Park” or “Schindler’s List”? How about “Star Wars,” “A Beautiful Mind,” “Bridget Jones’s Diary,” or “My Big Fat Greek Wedding”? Too bad; they’re not available to rent online.

You can, of course, buy an external DVD drive. But aren’t these called “all in ones”? An external drive just looks stupid.

Now, on a laptop, eliminating the DVD drive is understandable. You carry laptops. Weight matters. Bulk matters. But why eliminate DVD drives on computers that stay in one place?

All right, end of rant.

The new iMac, clad in its traditional aluminum, is stunning. The stand is still a thin, curved L of metal — but now, the screen appears to be just as thin (0. 2 inches). Where are the guts?

Turns out it’s a trick — an illusion. Behind the screen, you see a substantial bulge; Apple tapered the aluminum as it approaches the screen, so that from front angles it seems that the whole screen is razor thin.

Apple has also eliminated much of the glare that has long dogged today’s glossy screens. Viewed side-by-side with its rivals, the iMac is a lot less reflective.

There are two iMac sizes: 21.5 and 27 inches. The $1,300 and $1,800 base models come with a 1-terabyte hard drive, 8 gigabytes of memory and an i5 Intel processor. Each has four USB 3.0 jacks, two Thunderbolt jacks (for video input or output or external hard drives), and camera memory-card slot, awkwardly positioned on the back. Apple has ditched the FireWire jack it spent so many years promoting.

On the 21.5-incher, you can’t upgrade the memory yourself; what you buy is what you’ll have forever, unless you take it into the shop.

On the 27-inch model, you can install as much as 32 gigabytes yourself, through an easily opened door. (That, for the record, is about 262,144 times the memory as the original Macintosh.) Online, you can order your iMac with a 3-terabyte hard drive, 32 gigabytes of memory, a 768-gigabyte flash-memory drive and a $3,700 invoice.

Vizio isn’t a company you expect to be in the PC business; it made its mark selling high-quality, low-price TV sets. And sure enough, by far the best part of the All-in-One Touch PC is its lovely touch screen, available in 24- and 27-inch versions. .

A nontouch version is also available, but the Vizio comes with Windows 8, which is far more pleasant to use with a touch screen.

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Extended Use of Breast Cancer Drug Suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read More..

Extended Use of Breast Cancer Drug Suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Obama Tells G.O.P. Not to Tie Debt Ceiling to Fiscal Debate

Doug Mills/The New York Times

President Obama spoke to members of the Business Roundtable in Washington on Wednesday.

WASHINGTON — President Obama warned Republicans on Wednesday not to use the debt ceiling as leverage on spending and tax decisions, saying he refused to engage again in the sort of brinkmanship that brought the country close to default last year and damaged its credit rating.

In a speech to the Business Roundtable, Mr. Obama called that irresponsible. “That is a bad strategy for America, it’s a bad strategy for your businesses and it is not a game that I will play,” he said. “Everybody here is concerned about uncertainty. There’s no uncertainty like the prospect that the United States of America, the largest economy, that holds the world’s reserve currency, potentially defaults on its debts.”

While saying he would not “play that game,” a phrase he repeated, Mr. Obama did not say what he would do in response, but some Democrats have urged him in the past to simply raise the borrowing limit using his own executive authority and let the courts determine if he overstepped his constitutional bounds.

He seemed to embrace a suggestion by John Engler, the Business Roundtable president, to raise the debt ceiling enough to last five years. “John is exactly right when he says that the only thing that the debt ceiling is good for as a weapon is just to destroy your credit rating,” Mr. Obama said.

Mr. Obama was reacting to reports that Republican leadership officials were looking for a fallback in the current debate to avert an end-of-the-year fiscal crisis. Some Republicans foresee accepting Mr. Obama’s call to extend Bush-era tax cuts for the middle class while allowing them to expire for the wealthiest Americans, and then taking up the fight again when the nation’s debt rises to the point that the statutory borrowing limit needs to be raised again, which could be in late January or February.

Republicans view any vote to raise the debt ceiling as a chance to enforce more fiscal discipline on Mr. Obama. Speaker John A. Boehner has said any increase in borrowing capacity should be offset by spending cuts that exceed the increased debt. Mr. Obama has responded by proposing to take away the Congressional power to approve increases in the debt ceiling, but Mr. Boehner said last weekend that “Congress is never going to give up this power.”

Appearing before reporters on Wednesday, Mr. Boehner and other House Republican leaders implored Mr. Obama to sit down with them and begin negotiating in earnest to head off the looming fiscal crisis, but with flattery and aggravation, they made it clear that they were now playing on his turf.

Mr. Boehner and his leadership team did not give an inch on their opposition to raising tax rates on the wealthy or their insistence that any deficit-reduction plan emphasize spending cuts. But the speaker sounded exasperated as he insisted that he had moved toward the president’s position by agreeing to $800 billion in higher tax revenue over 10 years.

“The revenues we’re putting on the table will come from guess who? The rich,” he said, his voice rising. “There are ways to limit deductions, close loopholes and have the same people pay more of their money to the federal government without raising tax rates.”

Representative Peter Roskam of Illinois, a member of the Republican leadership, appealed to Mr. Obama’s own view of himself as a politician able to rise above partisanship, a characterization Republicans have rarely, if ever, agreed with.

“I’ve seen an attribute in President Obama when we served together in the Illinois State Senate, where he was able to rise above donkeys and elephants and transform some very controversial issues in a way that was powerful,” Mr. Roskam said, imploring the president to eschew the politics of the victor and seize “an unbelievable opportunity to be a transformational president, that is to bring the country together.”

The dueling public appearances underscored how far apart the two sides were, at least as a matter of principle. Mr. Obama’s plan calls for $1.6 trillion in new taxes over 10 years, mainly through allowing rates to rise on income above $200,000 a year for individuals or $250,000 for families. He has also revived a year-old plan to trim health care and other mandatory spending by $600 billion over 10 years, but he also wants to spend $50 billion in the short term to help the economy.

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