Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast-cancer data and a professor of biostatistics at the University of Texas’ M.D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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DealBook: Tribune Hire Banks to Weigh a Sale of Its Newspapers

4:43 p.m. | Updated

The Tribune Company has hired investment banks to weigh a sale of its top newspapers, including The Chicago Tribune and The Los Angeles Times, the media conglomerate said on Tuesday.

The media company, which emerged from bankruptcy late last year, has retained JPMorgan Chase and Evercore Partners as advisers, a spokesman for Tribune said.

The spokesman, Gary Weitman, added that the move was prompted by unsolicited expressions of interest in the newspapers from various suitors.

“Hiring outside financial advisors will help us determine whether that interest is credible, allow us to consider all of our options, and fulfill our fiduciary responsibility to our shareholders and employees,” he said in the statement.

Tribune’s move comes as little surprise. Speculation has been swirling around the media industry for some time that a number of potential suitors had emerged for the company’s holdings. That group may include News Corporation, which is in the middle of spinning off its newspaper holdings from its far bigger Fox entertainment operations. That new company may consider acquisitions as a way to gain more clout and reap cost savings.

Another potential buyer is Aaron Kushner, who owns a group of newspapers that include the Orange County Register and who has been publicly vocal about his interest in the Tribune properties.

Peter Liguori, Tribune’s recently appointed chief executive, told The Los Angeles Times last month that he had not ruled out a sale of the company’s newspaper brands but added that he wasn’t “going into this job with a fire-sale sign.”

Tribune is considered likely to hold onto its newspapers, which also include The Baltimore Sun and The Hartford Courant, if the price it fetches is not high enough.

A sale would help Tribune focus more on its bigger broadcasting operations, which includes WGN America and 24 stations across the country. Mr. Liguori himself is a television veteran, having formerly worked in News Corp.’s TV division and at Discovery Communications.

Tribune filed for bankruptcy protection in 2008, just one year after the media concern was taken over by the billionaire Samuel Zell in a deal that relied heavily on borrowed money.

The company emerged from Chapter 11 protection on Dec. 31, under the control of the investment firms Oaktree Capital and Angelo, Gordon, as well as JPMorgan.

It left bankruptcy in relatively healthy financial condition, reporting about $9.8 billion in assets and $1.3 billion in liabilities as of Dec. 30.

Evercore was hired earlier this month to advise The New York Times Company as it considers a sale of its New England media assets, principally The Boston Globe.

Shares in Tribune, which trade over the counter, were up 1.3 percent on Tuesday at $53.50. That values the media conglomerate at about $3 billion.

News of the hiring of the banks was reported earlier by CNBC.

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Skepticism Surrounds Resumption of Nuclear Talks With Iran

ALMATY, Kazakhstan — Talks between Iran and six world powers over its nuclear program resume here on Tuesday after a break of eight months, but there is a general atmosphere of gloom about their prospects for success, even if narrowly defined.

Since talks in Moscow last June, Iran has continued to increase its stockpile of uranium enriched to 20 percent purity, has begun to install a new generation of centrifuges and has not yet completed an agreement on inspection of suspect military sites with the International Atomic Energy Agency, a deal originally advertised as all but done last May.

With presidential elections in Iran scheduled for June, senior Western diplomats involved with these talks expressed skepticism that Tehran’s chief negotiator, Saeed Jalili, would be willing to make compromises that could be portrayed as weakness at home.

Mr. Jalili is the personal representative of Iran’s supreme leader, Ayatollah Ali Khamenei, considered the dominant voice on the nuclear issue. Ayatollah Khamenei has recently expressed continued mistrust of the United States and its intentions, saying that he would not allow the kind of bilateral talks between Washington and Tehran that most analysts think would be crucial to any resolution.

At the same time, Iran has taken some of its stockpile of 20 percent enriched uranium and converted it into reactor fuel, which cannot easily be turned back. The conversion means that Iran now has less of the uranium needed to make a bomb, reducing the sense of urgency among the six powers, and Israel, that its nuclear program needs to be slowed.

But the total Iranian stockpile of 20 percent enriched uranium has nonetheless grown since November to 167 kilograms from 135 kilograms, according to the most recent I.A.E.A. report — closer to, if still significantly below, the 240 kilograms or 250 kilograms many experts consider necessary, once enriched further, to produce a nuclear weapon.

Iran denies that its nuclear program has any military aim. The six world powers, the so-called P5-plus-1 group, which are the five permanent members of the United Nations Security Council — Britain, China, France, Russia and the United States — and Germany, want Iran to obey Security Council resolutions ordering it to suspend enrichment and open itself up fully to I.A.E.A. inspectors, to ensure that there is no effort to build a nuclear weapon.

To press Iran to comply, the Security Council, the United States and the European Union have created an increasingly painful set of economic sanctions on Iran, as part of a dual-track strategy — negotiations and sanctions. Iran has for its part insisted that as a precondition for serious negotiations, the world should lift all the sanctions and recognize Iran’s “right to enrich,” which Iran asserts it has as a signatory to the Nuclear Nonproliferation Treaty.

The negotiations have been tedious, with Iran appearing to be playing for time, diplomats say. The six powers had asked for a resumption of these talks as early as December, but Iran rejected dates and sites before finally suggesting and agreeing upon Almaty. The choice pleased Western diplomats for its symbolic value, since Kazakhstan, when it became independent of the Soviet Union, freely relinquished the nuclear weapons it had inherited from Moscow. American officials are holding up Kazakhstan, one of the world’s largest producers of uranium and a maker of nuclear fuel, as an example to Iran of the benefits of peaceful nuclear energy and compliance with the I.A.E.A.

President Nursultan Nazarbayev of Kazakhstan appealed to Tehran in a New York Times Op-Ed article in March 2012 to abandon what he suggested was its pursuit of nuclear power status. “Kazakhstan’s experience shows that nations can reap huge benefits from turning their backs on nuclear weapons,” he wrote.

While expectations are low, the six hope to leave here with some momentum and signs of Iranian willingness to engage in what all have agreed should be a reciprocal and step-by-step process of lifting sanctions in return for Iranian actions to comply.

“Iran needs to understand that there is an urgent need to make concrete and tangible progress” in these talks, said Michael Mann, the spokesman for Catherine Ashton, the European Union’s foreign policy chief and chairwoman of the P5-plus-1 group.

Mr. Mann said that the six powers have together “prepared a good and updated offer for the talks which we believe is balanced and a fair basis for constructive talks” and that is “also responsive to Iranian ideas.”

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HTC Settles F.T.C. Charges Over Security Flaws in Devices

WASHINGTON — More than 18 million smartphones and other mobile devices made by HTC, a Taiwanese company that is one of the largest sellers of smartphones in the United States, had security flaws that could allow location tracking of users against their will and the theft of personal information stored on their phones, federal officials said Friday.

The Federal Trade Commission charged HTC with customizing the software on its Android- and Windows-based phones in ways that let third-party applications install software that could steal personal information, surreptitiously send text messages or enable the device’s microphone to record the user’s phone calls.

The action is the first attempt by the commission to police a manufacturer of mobile devices. As smartphones and tablets become a common way for consumers to shop, bank and chat online, personal information and privacy will need to be guarded.

HTC America, based in Bellevue, Wash., agreed to settle the civil suit with the commission by issuing software patches that close the security holes, and by creating a security program that will be monitored by an independent party for the next 20 years. The F.T.C. does not have the authority to assess fines in consumer protection cases.

“The company didn’t design its products with security in mind,” Lesley Fair, a senior lawyer in the commission’s Bureau of Consumer Protection, wrote in a blog post. “HTC didn’t test the software on its mobile devices for potential security vulnerabilities, didn’t follow commonly accepted secure coding practices and didn’t even respond when warned about the flaws in its devices.”

An HTC official said Friday that the company had already started to update its software and distribute it to users of some, but not all, of the affected phones.

“Working with our carrier partners, we have addressed the identified security vulnerabilities on the majority of devices in the U.S. released after December 2010,” Sally Julien, an HTC spokeswoman, said in a statement. “We’re working to roll out the remaining software updates now and recommend customers download them once available.”

“Privacy and security are important,” the statement added, “and we are committed to improving practices that help safeguard our customers’ devices and data.”

The trade commission charged that the security flaws resulted from HTC’s modifying the operating system software used on most of the affected phones. In the case of Android, created by Google, the system is designed to protect sensitive information and phone functions through what is known as a permission-based security model.

That requires a user, when installing an application that is not a standard part of the operating system, to be notified and to agree that the application could gain access to certain information or functions.

HTC, however, preinstalled certain apps on its phones in a way that, in addition to preventing consumers from removing them, disabled the permission-based model and allowed newly installed apps to have immediate access to personal data.

“The analogy isn’t exact,” wrote Ms. Fair of the F.T.C., “but it’s like giving a friend the combination to a safe only to find out he’s handing it over to anyone who asks.”

That security hole could, for example, let the rogue software secretly record users’ phone conversations or track their location.

Flaws in the security system could also give third-party apps access to phone numbers, contents of text messages, browsing history and information like credit card numbers and banking transactions. Those flaws also affected HTC phones that used Windows-based operating systems.

While HTC’s actions introduced numerous security vulnerabilities to its phones, a commission official said it was not clear how many users experienced illegal incursions into their phones and personal information.

The flaw in the company’s phones has been known since at least 2011. HTC acknowledged the problems at that time and developed software patches for at least some of the deficiencies that year.

But the problems were far from minor. The F.T.C. said that text-message toll fraud, in which a hacker causes a phone to send text messages to a number that charges the user for delivery of the message, “is one of the most common types of Android malware,” or malicious software.

HTC’s user manuals either said or implied that a user was protected against malware because of the permission-based security, the commission said.

The commission will collect public comments on the proposed remedies for 30 days, after which it will decide whether to formally carry out the order. If HTC subsequently violates the order’s restrictions and requirements, it faces civil penalties of up to $16,000 a violation.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

A picture with an earlier version of this article was published in error. The settlement between HTC and the F.T.C. involves phones running Windows Mobile; it did not involve the later operating system Windows 8, which the phone in the picture was running.

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Books: Gauging Faces and Bodies in the Botox Age

You never know what a little vanity will do for a person’s health. Some people bloom in their quest for physical improvement, others wither, and a few are completely destroyed. Despite centuries’ worth of efforts to penetrate the complicated thickets where health and beauty intertwine, there is always more to explore, as two new books make clear.

Dr. Eric Finzi, a dermatologist in the Washington area, has produced what may be the first authorized biography of botulinum toxin, the fearsome poison that, bottled into mild-mannered Botox, enhances foreheads everywhere. This little molecule does its good work by paralyzing muscles: In the forehead it inactivates the frown-producing corrugators, while used elsewhere on the head and body it can alleviate migraine headaches, stop problem sweating and ease the spasticity associated with a range of neurological diseases.

But even those who know all about the drug’s physical effects will be intrigued by Dr. Finzi’s narrative, because it turns out that cosmetic Botox may not be all about vanity after all. Research studies, including some by Dr. Finzi, have found that the substance appears to alleviate depression more safely and perhaps more effectively than the usual treatments.

That result at first seems trivial and obvious: If you stop frowning at people, they’ll like you more  and treat you better, and you won’t feel so blue. But the process turns out to be considerably more sophisticated and complicated, because it appears to apply even to people without visible frown lines.

Dr. Finzi calls it “noncosmetic cosmetic surgery” and traces the postulated mechanism to some of the lesser-known work of William James and Charles Darwin. Both thinkers argued that facial expressions are not just the outward manifestations of emotion, but vital links in the unconscious neurological processes that create emotion. In other words, if you cannot smile, you will never be as happy as if you could, and if you cannot frown, you will be unable to experience the full intensity of the negative emotions manifested by frowning, depression included.

This “facial feedback hypothesis” has found some modern confirmation in a study showing that injections of Botox into the forehead seem to inhibit activation of the amygdala, the brain structure thought to regulate all gut-wrenching emotion.

Dr. Finzi expands his narrative with a discussion of the subtleties of common facial expressions, including homage to interested parties like Norman Cousins and his idea that laughter could cure disease.

But the book’s major focus is the frown: Dr. Finzi offers anecdotes suggesting that taming overactive corrugators may save marriages and boost careers, and then, spinning some of the still largely debatable theories linking depression and anger with chronic disease, he postulates that Botox treatments may someday prove to help forestall heart disease and cancer.

That’s quite a set of achievements for one bad little molecule, gram for gram the most potent toxin we know. Dr. Finzi is no stylist, but the momentum of his argument keeps the reader with him for the duration (and undoubtedly quite a few overactive corrugators will be soothed into submission as a result).

The complexities of the face almost pale in comparison with those of the torso, as Abigail C. Saguy makes clear in “What’s Wrong With Fat?” “Once you put down this book you will never hear the word ‘obesity’ the same way again,” she promises, and she is absolutely correct.

Dr. Saguy, a sociologist at U.C.L.A., methodically teases out all the overtones of the loaded words we use to describe big bodies. These bodies are, after all, neither good nor bad, just big.

But “fat” often implies the coexistence of sloth, gluttony and self-indulgence. “Obesity” equals disease to medical professionals, while in the world of public health it is a raging epidemic with substantial global mortality. Those immersed in the conventional ideals of beauty see being overweight as an aesthetic disaster, but others find it sexually irresistible, and to activists “fat” has become a rallying cry, with weight-based discrimination a violation of social justice as deplorable as that stemming from race or gender.

In fact, the concept of bigness has become so laden with overtones good and bad — guilt, blame, fear, anger and desire, among others — that finding a value-free way to describe men and women who are larger than average has become almost impossible. “Heavy,” “plus-size,” “corpulent” and “fleshy” all carry weighty implications in one sphere or another.

Dr. Saguy analyzes it all, and asks why. She winds up paying particular attention to the debate in the medical world over the actual health consequences of being fat: Studies keep confounding the reigning supposition that thin is best with evidence that modestly overweight may be even better. Meanwhile, those who are larger than average are routinely blamed for their size, a phenomenon augmented by deplorably simplistic media coverage (unlike anorexia, interestingly enough, which is remarkably free of the same connotations of personal fault).

Much of Dr. Saguy’s text is academic and requires some determination to penetrate, but she also provides immensely readable nuggets, notably a brief discussion of her experiences attending an annual convention of the National Association to Advance Fat Acceptance, where, seven months pregnant, she underwent a funhouse-mirror body-image transformation worthy of Alice in Wonderland. Like Dr. Finzi’s narrative deficiencies, hers fade into unimportance in the face of fascinating and illuminating material.

Read More..

Books: Gauging Faces and Bodies in the Botox Age

You never know what a little vanity will do for a person’s health. Some people bloom in their quest for physical improvement, others wither, and a few are completely destroyed. Despite centuries’ worth of efforts to penetrate the complicated thickets where health and beauty intertwine, there is always more to explore, as two new books make clear.

Dr. Eric Finzi, a dermatologist in the Washington area, has produced what may be the first authorized biography of botulinum toxin, the fearsome poison that, bottled into mild-mannered Botox, enhances foreheads everywhere. This little molecule does its good work by paralyzing muscles: In the forehead it inactivates the frown-producing corrugators, while used elsewhere on the head and body it can alleviate migraine headaches, stop problem sweating and ease the spasticity associated with a range of neurological diseases.

But even those who know all about the drug’s physical effects will be intrigued by Dr. Finzi’s narrative, because it turns out that cosmetic Botox may not be all about vanity after all. Research studies, including some by Dr. Finzi, have found that the substance appears to alleviate depression more safely and perhaps more effectively than the usual treatments.

That result at first seems trivial and obvious: If you stop frowning at people, they’ll like you more  and treat you better, and you won’t feel so blue. But the process turns out to be considerably more sophisticated and complicated, because it appears to apply even to people without visible frown lines.

Dr. Finzi calls it “noncosmetic cosmetic surgery” and traces the postulated mechanism to some of the lesser-known work of William James and Charles Darwin. Both thinkers argued that facial expressions are not just the outward manifestations of emotion, but vital links in the unconscious neurological processes that create emotion. In other words, if you cannot smile, you will never be as happy as if you could, and if you cannot frown, you will be unable to experience the full intensity of the negative emotions manifested by frowning, depression included.

This “facial feedback hypothesis” has found some modern confirmation in a study showing that injections of Botox into the forehead seem to inhibit activation of the amygdala, the brain structure thought to regulate all gut-wrenching emotion.

Dr. Finzi expands his narrative with a discussion of the subtleties of common facial expressions, including homage to interested parties like Norman Cousins and his idea that laughter could cure disease.

But the book’s major focus is the frown: Dr. Finzi offers anecdotes suggesting that taming overactive corrugators may save marriages and boost careers, and then, spinning some of the still largely debatable theories linking depression and anger with chronic disease, he postulates that Botox treatments may someday prove to help forestall heart disease and cancer.

That’s quite a set of achievements for one bad little molecule, gram for gram the most potent toxin we know. Dr. Finzi is no stylist, but the momentum of his argument keeps the reader with him for the duration (and undoubtedly quite a few overactive corrugators will be soothed into submission as a result).

The complexities of the face almost pale in comparison with those of the torso, as Abigail C. Saguy makes clear in “What’s Wrong With Fat?” “Once you put down this book you will never hear the word ‘obesity’ the same way again,” she promises, and she is absolutely correct.

Dr. Saguy, a sociologist at U.C.L.A., methodically teases out all the overtones of the loaded words we use to describe big bodies. These bodies are, after all, neither good nor bad, just big.

But “fat” often implies the coexistence of sloth, gluttony and self-indulgence. “Obesity” equals disease to medical professionals, while in the world of public health it is a raging epidemic with substantial global mortality. Those immersed in the conventional ideals of beauty see being overweight as an aesthetic disaster, but others find it sexually irresistible, and to activists “fat” has become a rallying cry, with weight-based discrimination a violation of social justice as deplorable as that stemming from race or gender.

In fact, the concept of bigness has become so laden with overtones good and bad — guilt, blame, fear, anger and desire, among others — that finding a value-free way to describe men and women who are larger than average has become almost impossible. “Heavy,” “plus-size,” “corpulent” and “fleshy” all carry weighty implications in one sphere or another.

Dr. Saguy analyzes it all, and asks why. She winds up paying particular attention to the debate in the medical world over the actual health consequences of being fat: Studies keep confounding the reigning supposition that thin is best with evidence that modestly overweight may be even better. Meanwhile, those who are larger than average are routinely blamed for their size, a phenomenon augmented by deplorably simplistic media coverage (unlike anorexia, interestingly enough, which is remarkably free of the same connotations of personal fault).

Much of Dr. Saguy’s text is academic and requires some determination to penetrate, but she also provides immensely readable nuggets, notably a brief discussion of her experiences attending an annual convention of the National Association to Advance Fat Acceptance, where, seven months pregnant, she underwent a funhouse-mirror body-image transformation worthy of Alice in Wonderland. Like Dr. Finzi’s narrative deficiencies, hers fade into unimportance in the face of fascinating and illuminating material.

Read More..

Media Decoder Blog: Online Piracy Alert System to Begin This Week

The Copyright Alert System, a program of escalating warnings and prods against people suspected of online copyright infringement, is finally going into effect this week, more than a year and a half after the plan was announced as part of an agreement between the entertainment industry and five major Internet service providers.

The Center for Copyright Information, the organization created to administer the system, announced on Monday that the Internet providers would begin putting it in place “over the course of the next several days,” though it gave no specifics. The Internet companies are AT&T, Cablevision, Comcast, Verizon and Time Warner Cable.

In the alert system, media companies monitor online traffic through a third party and can complain to Internet providers if a file is downloaded illegally. The suspected violator is then given the first of six warnings, some of which carry “educational” messages and must be acknowledged. After the fifth and sixth warnings, the customer’s Internet speed can be slowed to a crawl.

The Center for Copyright Information says it will not ask for repeat offenders’ Internet access to be blocked, but most service providers have the right to do that if a customer violates its terms of service. The findings can be contested for a $35 fee, to be refunded if an appeal is successful.

The introduction of the alert system has been notably slow. Nearly a year passed before the group had a leader in place, and its own prediction failed when it said in October that the system would be coming in two months. Part of the reason for that might be the relationships between media companies and Internet service providers, which in the past have often been adversarial over issues of piracy and control.

So-called graduated response programs like the Copyright Alert System have been tried in other countries, with mixed results. France’s Hadopi law, passed in 2009, set up a system of three “strikes,” culminating in a fine. More than a million warnings have been issued through that plan, but a recent government report said that its effects were “hard to evaluate precisely.”

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Palestinians Dispute Israeli Finding on Prisoner’s Death

JERUSALEM — The Israeli Health Ministry said Sunday night that preliminary autopsy findings could not determine the cause of death of a 30-year-old Palestinian prisoner, which Israeli officials had at first attributed to a heart attack. But Palestinian officials said the lack of heart damage coupled with bruising on the man’s chest, back and neck suggested that he was tortured during interrogation.

“The signs that appeared during the autopsy show clearly that he was subjected to severe torture that led immediately to his death,” Issa Qaraka, the Palestinian minister of prisoner affairs, said at an evening news conference in Ramallah, after being briefed by a Palestinian pathologist who attended the autopsy of the prisoner, Arafat Jaradat, who died Saturday.

“I hold Israel fully responsible for killing Arafat Jaradat,” added Mr. Qaraka, who earlier on Sunday called for an international investigation into the death. “The Israeli story was forged and full of lies.”

The 4,500 Palestinians in Israeli jails refused meals on Sunday to protest Mr. Jaradat’s death, and hundreds of Palestinians demonstrated in several cities and villages in the West Bank and Gaza Strip.

After days of such demonstrations, which have included violent clashes between Palestinians and Israeli soldiers and settlers, Prime Minister Benjamin Netanyahu’s special envoy, Isaac Molho, sent a message to the Palestinian leadership on Sunday that Israeli officials described as an “unequivocal demand to restore quiet.” Israel also transferred to the Palestinian Authority $100 million in tax revenue it had been withholding.

But a senior Israeli official said the government would not accede to Palestinian requests to release four prisoners who have been on a long-term hunger strike or 123 people who have been detained since before the signing of the Oslo Accords in 1993. “Some of these people are accused of very heinous crimes,” the official said, speaking on the condition of anonymity because he was not authorized to discuss the matter with the news media. “They’re saying that every Palestinian hunger striker should have a get-out-of-jail-free card. You can’t have a system like that. It’s not sustainable.”

After weeks of intensifying protests in solidarity with the hunger strikers, attention turned Sunday to Mr. Jaradat, who relatives said worked at a gas station, was the father of a 4-year-old girl and a 2-year-old boy, and came from a family in which all the men had spent time in Israeli jails. He was arrested last Monday over throwing stones at Israeli cars near a West Bank settlement during November’s conflict between Israel and the Gaza Strip.

Palestinian officials said that Mr. Jaradat admitted the stone-throwing but denied heaving fire bombs. He also confessed to tossing rocks in a 2006 protest, they said. His detention was extended 12 days at a hearing on Thursday, during which his lawyer said that Mr. Jaradat complained of severe pain in his back and neck that he attributed to his interrogation.

“When he was under interrogation, the interrogator told him, ‘Say goodbye to your kids,’ ” Mr. Jaradat’s uncle, Musa, said at a news conference on Sunday morning.

Mr. Qaraka, the prisoner affairs minister, said Sunday night that the autopsy showed “severe” bruising in multiple areas: the right side of the chest, the upper right part of the back, upper left shoulder and along the spine near the bottom of the neck. The pathologist reported no blood clotting or sign of heart damage, he added, but did see two broken ribs, an injury inside the lower lip and blood around the nostrils.

The Palestinian prime minister, Salam Fayyad, issued a statement expressing “deep sorrow and shock” over Mr. Jaradat’s death, saying there was a “need to promptly disclose the true reasons that led to his martyrdom.”

Few issues resonate more deeply in Palestinian society than the plight of prisoners: about 800,000 have been detained in Israeli jails since 1967, according to Palestinian leaders; Mr. Jaradat was the 203rd to die in that time.

Several leaders and commentators warned Sunday that the death, coming amid a severe financial crisis in the West Bank, could lead to extended protests, with most predicting a largely nonviolent movement of civil disobedience like the one Palestinians undertook from 1987 to 1993 rather than the campaign of suicide bombings that began in 2000.

“I know these guys and I see the signs,” Binyamin Ben-Eliezer, a left-leaning member of Israel’s Parliament and a former defense minister, said on Israel Radio.

Alex Fishman, a columnist, wrote on Sunday in the newspaper Yediot Aharanot, “The highway leading to an intifada is wide open,” adding that Mr. Jaradat’s death “is liable to become the opening shot.”

Ghassan Khatib, a Palestinian analyst, pointed out that in addition to mounting outrage over the treatment of prisoners and violence by Israeli settlers, the Palestinian Authority’s failure to issue paychecks on time had prompted teachers to call a strike starting Tuesday; health care workers are already in the middle of a two-week walkout.

Nabil A. Shaath, the Palestinian commissioner for international relations, said in an interview that the West Bank leadership was “doing our best to keep calm” and that “violent confrontation absolutely is not our plan.”

“I don’t know how much people can be contained,” Mr. Shaath said of the Jaradat case. “I don’t think anybody is planning an intifada. The question is how much accidents, incidents like this might lead to an anger that can explode.”

Jodi Rudoren reported from Jerusalem, and Khaled Abu Aker from Ramallah, West Bank. Fares Akram contributed reporting from the Gaza Strip.

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Bits: Online Gambling Heats Up

The two big casino states, Nevada and New Jersey, are racing into online gambling as a way of protecting their turf. They will in essence become laboratories for what is and is not feasible in Internet wagering.

Nevada legislators, who previously authorized online poker, hurriedly passed a new bill this week that allows the state to enter into deals with other states to essentially pool their gambling populations. “This is the day we usher Nevada into the next frontier of gaming,” Brian Sandoval, Nevada’s governor, said on Thursday as he signed the bill.

In the year since online poker became a theoretical possibility in Nevada, no company has yet offered it. One problem: It’s too small a market, especially in a state where it is not exactly hard to gamble the old-fashioned way — by plunking your body down in a casino or, for that matter, just about anywhere else.

“We don’t have a universe of players,” Pete Ernaut, a Nevada political consultant, told The Las Vegas Review-Journal. “So for us, what we get to offer to a state like California or Texas is that we have the most mature regulatory infrastructure. We have the most mature financial, auditing and collection capabilities, much greater than some of those states, and they have the players.”

Meanwhile, New Jersey is also barreling ahead. Chris Christie, the governor, is likely to sign a revised bill permitting a variety of online gambling as soon as next week. All online ventures will be under the tight control of the Atlantic City casinos. Delaware, the smallest of the three states that are moving ahead with online gambling, also has ambitious plans.

In a harbinger of the new age, gamblers at the Borgata casino in Atlantic City will, as USA Today put it, “be able to lose their shirts without wearing one.” Gamblers staying in one of the casino’s 2,000 rooms can now place their bets right there without venturing onto the casino floor. From there it is only a small step to just staying home and gambling from the hammock.

Internet companies that make online games are watching all this with considerable interest. “Is 2013 going to be a game-changer?” asked Paul Thelen of Big Fish Studios, which began offering a gambling app in Britain last fall. “No. But in 2014, it starts getting interesting.”

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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