DealBook: Allergan to Buy MAP Pharmaceuticals for $958 Million

Allergan has agreed to pay nearly $1 billion to acquire MAP Pharmaceuticals and gain full control of its experimental treatment for migraine headaches, the two companies announced Tuesday night.

The purchase price of $25 a share in cash is a 60 percent premium over MAP’s closing price on Tuesday of $15.58 a share. The deal, valued at $958 million in total, suggests that Allergan has considerable faith that MAP’s new migraine treatment will win regulatory approval from the Food and Drug Administration by the agency’s deadline of April 15.

The two companies said the deal had been unanimously approved by the boards of both companies and was expected to close in the second quarter.

Allergan already had the rights to help market the migraine drug, known as Levadex, in the United States and Canada, but after an acquisition it would have control of all the profits and costs globally.

Allergan is most known for Botox, a form of the botulinum toxin, which is used for cosmetic purposes as well as medical ones, including the treatment of chronic migraines with the goal of reducing the frequency of headaches. By contrast, Levadex is meant to treat migraines after they occur, making it complementary to Botox, Allergan said.

Levadex is actually a new form of an old drug, known as dihydroergotamine, or DHE, which has been used to treat severe migraine attacks for decades. DHE is typically given by intravenous infusion, requiring patients to get to a hospital at a time when many would rather remain in a dark quiet room.

Levadex, by contrast, is breathed into the lungs using an inhaler similar to one used for asthma, allowing people to use it at home.

The F.D.A. declined to approve Levadex last March, though MAP said the rejection was related to manufacturing and questions about use of the inhaler, not the safety and efficacy of the drug. It resubmitted its application, with additional data and answers to questions from the F.D.A., in October.

Levadex would be the first approved product for MAP, which is based in Mountain View, Calif.

Allergan said that if Levadex is approved by April, the transaction would dilute earnings by about 7 cents a share in 2013 and add to earnings in the second half of 2014.

Allergan was advised by Goldman Sachs and the law firm Gibson, Dunn & Crutcher. MAP was advised by Centerview Partners and the law firm Latham & Watkins.

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County official calls car leasing contract procedure 'embarrassing'









Auditors reviewing a $1.75-million car leasing contract given to a company with a politically connected lobbying firm found that Los Angeles County officials had failed to create a "truly competitive" process, but that there was no evidence of improper influence.


Investigators with the county auditor-controller's office reviewed the Enterprise Rent-a-Car contract at the request of Supervisor Michael D. Antonovich. A report by KCET-TV had raised questions about the way the business was awarded.


Enterprise was given a sole-source, five-year deal in March to provide 60 leased  vehicles to the county's Community Development Commission and to maintain the agency's existing fleet. Commission staff projected that outsourcing the fleet services would save about $300,000 a year.





The Nov. 28 report on KCET's "SoCal Connected" focused on the lobbying firm Englander Knabe & Allen and questioned whether its clients — including Enterprise — got an unfair advantage because partner Matt Knabe is the son of county Supervisor Don Knabe, who voted along with all the other supervisors to award the contract.


Both Knabes have said that their relationship has never posed a conflict, and a spokesman for the Englander firm has said Matt Knabe never lobbies his father directly.


The auditor-controller found no evidence of attempts to influence the rental car award. Matt Knabe told investigators that no one from his firm had lobbied on the contract, and the commission's executive director said he was "100% confident" the supervisor's son did not influence the process.


"The report shows that Matt acted professionally and used no undue influence in his dealings with the county," said Englander partner Eric Rose.


But the review did find that county staff did an "inadequate" job of trying to find other potential bidders.


Asked by KCET what vendors had been contacted and given a chance to compete for the business, a county analyst created a list to make it appear the department had reached out to 50 companies. In fact, only 16 firms had been contacted, auditors found. Enterprise was the only company that responded to the email request, and staff made no follow-up attempt to contact the other firms.


According to the auditor's report, the count of 50 vendors was originally used as a "place holder" in a template document and never corrected. By the time the contract was awarded, the contract analyst "felt he could not correct the number without embarrassment."


Investigators also found that the agency violated its own policy by not advertising the contract on the commission's or the county's websites, and that the contract should have gone through a full bidding process.


In addition, several vendors that contract officials emailed to invite interest had no "realistic potential" to provide a leased fleet to the county in the first place, the review concluded.


Investigators wrote that they couldn't determine whether the commission could have gotten a better deal but said "the potential for greater savings from a more competitive process appears to be plausible."


County auditor-controller Wendy Watanabe called the situation "embarrassing" but chalked up the issues to incompetence rather than intentional steering.


"I think they got lazy, they took a shortcut, and they didn't think it was that big of a deal," she said.


Watanabe said the investigation had focused on the Enterprise contract, so she could not say whether there was a broader issue with the agency's contracting process.


Commission representatives could not be reached Monday. The commission was slated to respond to the report's findings within 30 days.


abby.sewell@latimes.com





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Fitness Trackers Are Long on Hype, Short on Credibility



We are awash in personal data trackers. There are wristbands, headbands, watches, smart scales, helmets and even forks to help us track our weight, heart rate, blood pressure and glucose level while logging how far we walk and how many calories we burn. All this information is supposed to give us behavior-morphing insights into our personal health habits.


Trouble is, no one can say for sure that any of it makes us healthier. Oh sure, these gadgets might get us psyched up to exercise, and they might encourage us to take the stairs instead of the elevator, but there has not yet been any scientific exploration of whether fitness gadgets, like the Fitbit Flex or Withings Smart Activity Monitor, actually work like they should.


“The durability of the effect is still in question,” said Dr. Eric Topol, the director of the Scripps Translational Science Institute. “We don’t have randomized [clinical] trials showing improved outcomes or durability in influencing behavior.”


You wouldn’t know that walking through the South Hall of the Las Vegas Convention Center during CES, where more than 220 companies showed off their digital health gadgets. They all used pictures of youthful, happy, svelte people lacing up running shoes, eating salads and playing outdoors. Their booths were filled with attractive, fit gals and guys.



The message is clear: These devices will help improve your health and physique.


But so far there aren’t many studies or trials testing the effectiveness of activity trackers or health monitors at getting us to move more and eat better foods or whether digital sensors are any better than old-school approaches like Weight Watchers.


Many of these devices have been developed by startups or Kickstarter campaigns and simply don’t have the deep pockets necessary to finance expensive clinical trials, says Topol.


Some researchers, Topol included, are following the wave of health technology with studies testing how activity monitors and other digital health sensors influence outcomes for chronic illnesses like cardiac disease and diabetes.


Other scientists at the University of California, San Francisco; Mayo Clinic; Massachusetts General Hospital; and Aurora Health Care are conducting trials to determine how digital data trackers affect activity levels, obesity and dietary intake in various populations. Some of these trials are just now recruiting patients or recently finished collecting data.


Dr. Anne Thorndike, a researcher at Harvard Medical School, is wrapping up a study of Fitbit’s effect on activity levels among medical residents. She couldn’t share all her findings because she’s still submitting her study for publication, but said there was some fatigue over the course of her 12-week study, suggesting the motivating effect of information, badges and notifications might be short-lived. That’s to be expected. As with any new toy or gadget, the novelty wears off.


A 2007 study in the Journal of the American Medical Association found that using pedometers, activity monitors and step counters was associated with being more physically active and having a lower body mass index and blood pressure. But the authors note that “whether these changes are durable over the long term is undetermined.”


The key to prolonging people’s engagement with their trackers might be to harness the social networking features built into the devices. Some research has shown social networks can impact health outcomes for patients with migraine, obesity and ALS, but whether that will translate to sensor-based social networks remains to be seen.


At this point, the connection between sensor-collected data and a patient’s official (electronic) health record also is not well defined. There’s no simple interface to upload data collected by biometric sensors into medical health records short of printing out your data, scanning it and converting it into a PDF you can send to your doctor.


That might become more of an issue as personal data trackers mature from pedometers pimped out with great user interfaces into hardware that’s being added to mobile devices to gather data typically collected by physicians, like electrocardiograms, galvanic skin response and blood oxygenation and glucose levels, says Topol. And that democratization of health care is what he sees as the biggest benefit of these devices. He predicts 2013 will see more “medical wearables,” which will make studying conditions like sleep apnea more comfortable and less expensive for patients.


The next step is the commercialization of sensors floating around in our bloodstreams or implanted in our skin, teeth or brains.


As these medical sensors become more pervasive, companies also will have to be conscious of how they market their products. For example, the Masimo iSpO2 pulse oximeter is approved for consumers to measure their own blood oxygen levels and pulse rates using the similar technology used in hospitals. But because it’s not approved for medical use, doctors can’t use it or have their patients use products like this until they are approved by the Food and Drug Administration. AliveCor, which makes a portable electrocardiogram built into an iPhone case, faced similar issues until it was approved by the FDA in December.


“It’s like the wild, wild West,” said Dr. Atul Butte of the Stanford School of Medicine, who just started using a Fitbit and an Aria Scale. “For a drug company, there’s such a burden to show how [their product] works better. A gadget maker is … not required to show that data and that’s kind of unfair.”


“Probably, like most gadgets, these devices help those folks on the borderline, [those] ready to make behavioral changes and looking for something to tip them into healthy behaviors,” he added.


After a few days of using his own trackers, Butte admits he’s “already making changes like switching from lattes to more espressos.”


Will those changes last more than a few weeks? Only time will tell.


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Beyonce, Hudson do star turns at inauguration






WASHINGTON (AP) — Beyonce drew a loud cheer at the inauguration Monday even before her impressive rendition of the national anthem. But in the role she played four years ago singing for the president and first lady at the inaugural ball was her “Dreamgirls” co-star Jennifer Hudson.


If President Barack Obama’s first inaugural theme seemed to be summed up by Beyonce’s “At Last,” this time it was Hudson’s version of Al Green’s “Let’s Stay Together.”






Hudson was among the entertainment at Monday night’s inaugural balls, joined by Stevie Wonder and Alicia Keys, who modified her hit “Girl on Fire” to sing “He’s the president and he’s on fire … Obama’s on fire. Obama’s on fire.”


The crowd at the official Inaugural Ball joined in with the Grammy-nominated fun. anthem “We Are Young.”


And Wonder got small knots of dancers going with crowd-pleasers such as “Signed, Sealed, Delivered I’m Yours.”


Earlier in the day, the applause for Beyonce started when she took her place with Jay-Z at the Capitol to watch President Barack Obama take the oath for his second term in office. The two stopped to chat with the Rev. Al Sharpton.


James Taylor kicked off the musical performances, strumming his guitar and singing “America the Beautiful.” Kelly Clarkson followed with a different arrangement of “My Country ‘Tis of Thee.” Then Beyonce was introduced and the crowd again roared its approval.


Beyonce had a definite fan in Supreme Court Justice Clarence Thomas, who applauded eagerly after she finished singing the national anthem. She offered R&B-esque vocal riffs as she sang on and the crowd seemed to love it, cheering loudly as she finished. Clarkson, too, hit high notes.


Beyonce may have been the star musical attraction, but she had plenty of company from Hollywood at the Capitol on Monday. Katy Perry and John Mayer sat side-by-side, with Perry in an orange-striped coat and wide hat, and Mayer in dark sunglasses. Singer-songwriter Ke$ ha was there, too.


People flocked to the colorful pop star, snapping photos. And Perry did the same, taking shots of “Girls” actress and daughter of news anchor Brian Williams, Allison Williams.


Actress Eva Longoria was seated on the platform outside the Capitol after making an appearance at a Kennedy Center performance Sunday night. Perry sang at the children’s concert the night before.


Former Boston Celtics great Bill Russell was in the crowd, too, along with actor Marlon Wayans.


___


AP writers Donna Cassata, Darlene Superville, Josh Lederman and Jocelyn Noveck contributed to this report.


__


Follow Mesfin Fekadu on Twitter at http://twitter.com/MusicMesfin


Entertainment News Headlines – Yahoo! News





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The New Old Age Blog: The Brutal Truth of 'Amour'

It has been a few days since I left the movie theater in a bit of a daze, and I’m still thinking about “Amour.”

So much of this already much-honored film rings utterly true: the way a long-married Parisian couple’s daily routines, their elegant life of books and music and art, can be upended in a moment. The tender care that Georges (Jean-Louis Trintignant) provides for Anne (Emmanuelle Riva) as multiple strokes claim her body and her mind, and the inexorable way that care wears them both down. Their withdrawal into a proud dyad that seeks and accepts little help from outsiders, even family. “We’ve always coped, your mother and I,” Georges tells their daughter.

The writer and director Michael Haneke’s previous movies, which I haven’t seen, tend to be described as shocking, violent, even punitive. “Amour,” which Times critic Manohla Dargis called a masterpiece, includes one brief spasm of violence, but the movie remains restrained, not graphic. It’s brutal only because life, and death, can be brutal.

Is popular culture paying more attention to aging and caregiving? In the last couple of years, I have written about these subjects surfacing in a YouTube series (“Ruth & Erica”), in movies like “The Iron Lady,” in novels like Walter Mosley’s “The Last Days of Ptolemy Grey.”

A couple of weeks back, watching a play called “The Other Place,” starring the remarkable Laurie Metcalfe, I suddenly realized that the dynamic physician and businesswoman onstage had some sort of early-onset dementia. Dementia seems a particularly popular subject, in fact. Intrinsically dramatic, it suffuses the Mosley novel and Alice LaPlante’s “Turn of Mind,” and some of my favorite movies about aging, “Away From Her,” “Iris” and “The Savages.”

“Kings Point,” Sari Gilman’s compelling documentary about a retirement community in Florida where nobody seemed to expect to grow old, just won an Oscar nomination for best short-subject documentary and will be shown on HBO in March. And “Amour,” which won the Palme d’Or at Cannes, is up for five Academy Awards, including best picture, best director and a best actress nomination for the 85-year-old Ms. Riva. (Academy voters: Just give it to her.)

A number of these artists, Mr. Haneke included, have spoken about their own experiences with aged relatives. Perhaps, as the population ages and more people confront the consequences, the stories our culture tells itself have evolved to include more old people, more caregivers. Or maybe I just want that to be true.

“Do not go see this,” my movie-going buddy had been warned, probably because her mother has dementia and friends who had seen the film wanted to spare her. I know some people found “Amour” too slow-paced or claustrophobic — like many elderly couples’ lives, it basically takes place in four rooms — or too grim. (If you’ve seen it, tell us what you thought.)

If you’re a full-time caregiver or you’re coping with a relative with dementia, perhaps you would prefer to spend your 2 hours 7 minutes of precious time off watching something funny. Escapism has its virtues.

But I found “Amour” unflinching and provocative and beautiful.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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DealBook: Atari's U.S. Division Files for Bankruptcy, Hoping for a Sale

Nearly three decades after Atari closed the doors on its first iteration, the video game pioneer is trying another reinvention. It just had to file for bankruptcy first.

The company’s United States subsidiary, Atari Interactive, filed for Chapter 11 protection on Monday as part of an effort to cleave itself from its French parent, Atari S.A.

The move, made in the Bankruptcy Court for the Southern District of New York, is meant to pave the way for a sale of the division, including its distinctive logo and rights to the staples from the childhoods of many members of Generation X: Pong, Asteroids and Centipede, among other games. The company will continue to operate normally during the bankruptcy case.

If successful, the move will be the latest chapter for a company that introduced video games to millions by letting them thwack a crude virtual ball back and forth across a television screen.

Atari first faltered during the bursting of the video game bubble in 1983 and has made periodic efforts to remake itself since. Its latest phase is more in keeping with the times: the company now focuses on producing mobile and online games, including remakes of its top titles for iOS and Android devices.

Beginning in 2000, the company began its absorption into Infogrames, a French video game producer that in 2008 adopted the name of its prominent subsidiary. But Atari S.A., as the newly rechristened company is now known, has struggled financially. Several weeks ago, the company lost access to new money from its primary lender, BlueBay Asset Management.

Atari S.A.’s shares have tumbled nearly 49 percent over the last 12 months, closing on Monday at just 86 euro cents.

Now, Atari is seeking to sell its American operations through what is known as a 363 sale, allowing a buyer to gain control of the company’s core assets free of any liabilities.

“In light of the current situation with BlueBay, we have decided to take what we think is the best decision to protect the company and its shareholders,” Jim Wilson, Atari S.A.’s chief executive, said in a statement. “Through these ongoing procedures, and especially the auction process in the U.S., we will seek to maximize the proceeds in the best interest of the company and all of its shareholders.”

In a court filing, Atari listed having less than $50 million in assets and less than $500,000 in liabilities. It has obtained about $5.25 million in bankruptcy financing from Tenor Capital Management.

Atari Interactive's bankruptcy filing by

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With Obama fundraising, Latinos demonstrate growing clout









WASHINGTON — Cecilia Soto-Loftus, co-founder of a Malibu party services company, was new to presidential politics when she started raising money for President Obama's reelection bid last year.


After pulling in more than $400,000, she is getting the red carpet treatment at this weekend's inaugural festivities, with invitations to a strategy briefing for top fundraisers, a VIP candlelight reception and the official inaugural ball.


The special access reflects the unusual role Soto-Loftus and other Latino fundraisers played in Obama's 2012 campaign, the first to focus on tapping Latino celebrities, lawyers, business owners and community leaders for cash. The effort, called the Futuro Fund, aimed to raise $6 million — and brought in more than $30 million.





"It really sent a strong message that we shouldn't be overlooked," said Soto-Loftus, a Boyle Heights native who hopes to be considered for an ambassadorship, perhaps to Costa Rica or the Bahamas. "And I think we have only hit the tip of the iceberg."


Though $30 million was a small slice of Obama's record $1.1-billion haul, the Futuro Fund inducted a new cohort of donors into national politics, and created a Latino fundraising network that other politicians are clamoring to access. Most importantly, the group's work demonstrated the growing clout of Latinos beyond the ballot box.


"This is practically the final frontier in terms of what we need to be doing as political players in this country," said Arturo Vargas, executive director of the National Assn. of Latino Elected and Appointed Officials. "We've had the elected officials. We've had the activists. We've had the voters. And now we have the donors."


Democrats are using the inauguration to cement ties with the new class of donors.


Obama named actress Eva Longoria, a co-founder of the Futuro Fund, as co-chairwoman of his inaugural committee. And on Sunday night, Vice President Joe Biden made a surprise appearance at a gala performance of legendary Latino artists including Jose Feliciano, Rita Moreno and Chita Rivera that Longoria hosted at the Kennedy Center. The event was the culmination of Latino Inaugural 2013, a three-day celebration organized by the Futuro Fund.


"In this election, you spoke in a way that the world — and I mean the world, as well as the United States — could not fail to hear," Biden said as he thanked the black-tie crowd.


The proximity to power has given Latino fundraisers a new avenue to push their policy agenda. During the campaign, Longoria and others pressed Obama to overhaul immigration laws. Now they aim to continue advocating for immigration reform, for more Latinos in the administration, and for a host of other issues.


"We're going to be able to have influence on what affects our communities, whether it's the economy or jobs or education or healthcare," Longoria said before taking the stage Sunday night.


"The work begins now," noted Henry R. Muñoz III, owner of a San Antonio architecture firm. "It's all about how we harness and leverage what we have been able to achieve."


He and Longoria started the fund with San Juan lawyer Andres Lopez, an early backer of Obama who was frustrated when few other Latino fundraisers participated in the 2008 campaign. "We hadn't shown our financial muscle and hadn't earned the respect at that very important table we thought we could earn," Lopez said.


In mid-2011, the trio made their pitch to Obama campaign manager Jim Messina and finance chairman Matthew Barzun during a meeting in Chicago: Make time for us on the president's fundraising schedule, and we will bring in money.


"We originally offered [to raise] $6 million, and they said, 'Do you think you can do 12?' And we said, 'We'll try,'" Muñoz recalled.


A large share came at high-dollar events, such as a fundraiser Obama headlined at the Los Angeles home of actors Antonio Banderas and Melanie Griffith. But organizers also worked the phones. Concern about the GOP presidential challengers, who quarreled in the primaries over who would be tougher on illegal immigrants, helped spur contributions.


Latino donors "just didn't feel that the Republicans even understood their point of view," Lopez said. "And frankly, a lot of them said, 'I've never been asked,' which was our hunch."


Alex Nava, a 36-year-old commercial litigation lawyer in San Antonio, had given a few hundred dollars to Obama's 2008 campaign. He felt little incentive to give more, he said, because "any money I gave would be lost in the larger shuffle."


Then Muñoz called and explained how they hoped to demonstrate Latino fundraising power.


"I wanted to be part of that," said Nava, who donated the $5,000 maximum to the 2012 campaign.


A similar sentiment motivated Amalia Perea Mahoney, a 59-year-old art gallery owner in Chicago. Mahoney volunteered for Obama's campaign in 2008, but had never raised money. That changed after she attended a Futuro Fund briefing at Obama headquarters.


"I thought it was a great tool to get the Latinos a seat at the table," said Mahoney, who ultimately brought in between $200,000 and $500,000.


Some of the wooing was done by Obama, who met with about 20 prominent Latinos at a Washington hotel in early 2012.


"We felt part of the process, not just on the bleachers watching," said Ralph Patino, a 55-year-old trial lawyer in Coral Gables, Fla. He now has a photo of Obama with the group displayed in his law firm.


He and his wife, Elizabeth, gave more than $150,000 to the campaign and the Democratic Party, along with nearly $10,000 to the inaugural committee. They were among top donors who met the president and first lady, as well as Biden and his wife, at the White House on Friday.


Elizabeth Patino, a 37-year-old lawyer, said she was now contemplating jumping into politics, perhaps running for city commissioner this spring.


"I didn't know that I had this piece in me that really likes the political world," she said. "I was always somewhat afraid of it. But seeing how Latinos could come together and make such a great impact on a national level — it's just intoxicating."


matea.gold@latimes.com





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A 'Courage Board' for All Conditions






Rating: 9/10 Nearly flawless; buy it now






It’s easy to guess what The Hovercraft was built for just by looking at it: The short swallowtail and the big blunted nose all scream “powder hound.”


I did my first series of tests in early December up in Lake Tahoe, and there was a lot more crust, ice and grooms than powder, so I took it out without expecting much. I got waaay more than I figured I would: The board held its edge just fine in the groomers, but there was no surprise there. The shock came when I crossed over to the shaded side of the mountain, when the soft groomers turned into icy crud. I was fully expecting the Jones to sketch out and leave me butt-checking all over the place, but The Hovercraft’s edge sliced right into the ice and held it as well as it did the soft stuff. No transition, no adjustments — the board just went from soft snow to ice without skipping a beat.


It was so odd that it took me most of the morning before I really trusted it. But by lunchtime, I was flying down the mountain at speeds I wouldn’t dare with any of the other boards we tested. The board’s great bite is thanks to the Jones’ underfoot camber and so-called Magne-Traction edges, which essentially act like a serrated blade to bite into hard snow. These features combine to give the board a huge amount of precision and control in hard snow.


A few weeks later, I was finally able to take it out on Mt. Shasta’s backcountry to hit some deep stuff. It excelled there as well (entirely as expected) thanks to the rockered and blunted nose, which let the board float on top of the soft stuff, while the short, stiff tail made it easy to kick back and keep the nose up.


Bottom line: I’ve never seen a board perform so well in such a wide range of snow conditions. During my multi-mountain testing session of The Hovercraft snowboard, I let one of my friends ride it. He echoed my own thoughts with one simple statement: “This thing just does whatever you ask it to do.”


WIRED Simply some of the best all-mountain performance I’ve seen. Great float on powder, plus a locked-in grip on ice and crud. Seamlessly transitions from soft to hard snow. Shockingly lightweight construction.


TIRED Blunt nose and swallowtail design means you’re not gonna be riding a lot of switch.







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Journalist Barbara Walters hospitalized after fall at Washington party






(Reuters) – Veteran journalist Barbara Walters was admitted to a Washington. D.C., hospital over the weekend after she fell and cut her head at the British ambassador’s residence, a spokesman for the ABC television network said on Sunday.


Jeffrey Schneider, a senior vice president with ABC News, said Walters fell on the stairs on Saturday evening while attending an event.






“Out of an abundance of caution,” Walters, 83, went to the hospital, where she remained for observation on Sunday, Schneider said.


“Barbara is alert (and telling everyone what to do), which we all take as a very positive sign,” Schneider said in a written statement.


(Reporting by James B. Kelleher, editing by Stacey Joyce)


Celebrity News Headlines – Yahoo! News





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Well: A Check on Physicals

“Go Beyond Your Father’s Annual Physical. Live Longer, Feel Better”

This sales pitch for the Princeton Longevity Center’s “comprehensive exam” promises, for $5,300, to take “your health beyond the annual physical.” But it is far from certain whether this all-day checkup, and others less inclusive, make a meaningful difference to health or merely provide reassurance to the worried well.

Among physicians, researchers and insurers, there is an ongoing debate as to whether regular checkups really reduce the chances of becoming seriously ill or dying of an illness that would have been treatable had it been detected sooner.

No one questions the importance of regular exams for well babies, children and pregnant women, and the protective value of specific exams, like a Pap smear for sexually active women and a colonoscopy for people over 50. But arguments against the annual physical for all adults have been fueled by a growing number of studies that failed to find a medical benefit.

Some experts note that when something seemingly abnormal is picked up during a routine exam, the result is psychological distress for the patient, further testing that may do more harm than good, and increased medical expenses.

“Part of the problem of looking for abnormalities in perfectly well people is that rather a lot of us have them,” Dr. Margaret McCartney, a Scottish physician, wrote in The Daily Mail, a British newspaper. “Most of them won’t do us any harm.”

She cited the medical saga of Brian Mulroney, former prime minister of Canada. A CT scan performed as part of a checkup in 2005 revealed two small lumps in Mr. Mulroney’s lungs. Following surgery, he developed an inflamed pancreas, which landed him in intensive care. He spent six weeks in the hospital, then was readmitted a month later for removal of a cyst on his pancreas caused by the inflammation.

The lumps on his lungs, by the way, were benign. But what if, you may ask, Mr. Mulroney’s lumps had been cancer? Might not the discovery during a routine exam have saved his life?

Logic notwithstanding, the question of benefits versus risks from routine exams can be answered only by well-designed scientific research.

Defining the value of a routine checkup — determining who should get one and how often — is especially important now, because next year the Affordable Care Act will add some 30 million people to the roster of the medically insured, many of whom will be eligible for government-mandated preventive care through an annual exam.

Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine, who directed a study of annual physicals in 2007, reported that an estimated 44.4 million adults in the United States undergo preventive exams each year. He concluded that if every adult were to receive such an exam, the health care system would be saddled with 145 million more visits every year, consuming 41 percent of all the time primary care doctors spend with patients.

There is already a shortage of such doctors and not nearly enough other health professionals — physician assistants and nurse practitioners — to meet future needs. If you think the wait to see your doctor is too long now, you may want to stock up on some epic novels to keep you occupied in the waiting room in the future.

Few would challenge the axiom that an ounce of prevention is worth a pound of cure. Lacking incontrovertible evidence for the annual physical, this logic has long been used to justify it:

¶ If a thorough exam and conversation about your well-being alerts your doctor to a health problem that is best addressed sooner rather than later, isn’t that better than waiting until the problem becomes too troublesome to ignore?

¶ What if you have a potentially fatal ailment, like heart disease or cancer, that may otherwise be undetected until it is well advanced or incurable?

¶ And wouldn’t it help to uncover risk factors like elevated blood sugar or high cholesterol that could prevent an incipient ailment if they are reversed before causing irreparable damage?

Even if there is no direct medical benefit, many doctors say that having their patients visit once a year helps to maintain a meaningful relationship and alert doctors to changes in patients’ lives that could affect health. It is also an opportunity to give patients needed immunizations and to remind them to get their eyes, teeth and skin checked.

But the long-sacrosanct recommendation that everyone should have an annual physical was challenged yet again recently by researchers at the Nordic Cochrane Center in Copenhagen.

The research team, led by Dr. Lasse T. Krogsboll, analyzed the findings of 14 scientifically designed clinical trials of routine checkups that followed participants for up to 22 years. The team found no benefit to the risk of death or serious illness among seemingly healthy people who had general checkups, compared with people who did not. Their findings were published in November in BMJ (formerly The British Medical Journal).

In introducing their analysis, the Danish team noted that routine exams consist of “combinations of screening tests, few of which have been adequately studied in randomized trials.” Among possible harms from health checks, they listed “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, adverse psychosocial effects due to labeling, and difficulties with getting insurance.”

Furthermore, they wrote, “general health checks are likely to be expensive and may result in lost opportunities to improve other areas of health care.”

In summarizing their results, the team said, “We did not find an effect on total or cause-specific mortality from general health checks in adult populations unselected for risk factors or disease. For the causes of death most likely to be influenced by health checks, cardiovascular mortality and cancer mortality, there were no reductions either.”

What, then, should people do to monitor their health?

Whenever you see your doctor, for any reason, make sure your blood pressure is checked. If a year or more has elapsed since your last blood test, get a new one.

Keep immunizations up to date, and get the screening tests specifically recommended based on your age, gender and known risk factors, including your family and personal medical history.

And if you develop a symptom, like unexplained pain, shortness of breath, digestive problems, a lump, a skin lesion that doesn’t heal, or unusual fatigue or depression, consult your doctor without delay. Seek further help if the initial diagnosis and treatment fails to bring relief.

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