Make-or-break moment for fiscal cliff talks


WASHINGTON (AP) — President Barack Obama was preparing to present a limited fiscal proposal to congressional leaders at a White House meeting Friday, a make-or-break moment for negotiations to avoid across-the-board tax increases and deep spending cuts at the first of the year.


Lawmakers and White House officials held out a slim hope for a deal before the new year, but it remained unclear whether congressional passage of legislation palatable to both sides was even possible.


The Friday afternoon meeting among congressional leaders and the president — their first since Nov. 16 — was likely to center on which income thresholds would face higher tax rates, extending unemployment insurance, and preventing a cut in Medicare payments to doctors, among other issues.


For Obama, the eleventh-hour scramble represented a test of how he would balance strength derived from his re-election against an avowed commitment to compromise in the face of divided government. Despite early talk of a grand bargain between Obama and House Speaker John Boehner that would reduce deficits by more than $2 trillion, the expectations were now far less ambitious.


Although there were no guarantees of a deal, Republicans and Democrats said privately that any agreement would likely include an extension of middle-class tax cuts with increased rates at upper incomes, an Obama priority that was central to his re-election campaign.


A key question was whether Obama would agree to abandon his insistence during the campaign on raising taxes on households earning more than $250,000 a year and instead accept a $400,000 threshold like the one he offered in negotiations with Boehner. Another was whether Republicans would seek a higher income threshold.


The deal would also likely put off the scheduled spending cuts. Such a year-end bill could also include an extension of expiring unemployment benefits, a reprieve for doctors who face a cut in Medicare payments and possibly a short-term measure to prevent dairy prices from soaring, officials said.


If a deal was not possible, it would become evident at Friday's White House meeting, and Obama and the leaders would leave a resolution for the next Congress to address in January.


Such a delay could unnerve the stock market, which edged lower for a fifth day Friday amid worries that lawmakers would fail to reach a budget deal. Economists say that if the tax increases are allowed to hit most Americans and if the spending cuts aren't scaled back, the recovering but fragile economy could sustain a traumatizing shock.


Obama called for the meeting as top lawmakers on Thursday alternately cast blame on each other while portraying themselves as open to a reasonable last-minute bargain.


Senate Democratic Leader Harry Reid all but conceded that any effort at this late date was a long shot. "I don't know timewise how it can happen now," he said.


The No. 2 Senate GOP leader, Jon Kyl of Arizona, said it is "pretty unlikely" that Senate Republicans would agree to legislation averting the fiscal cliff if it wouldn't pass muster in the House.


"If you know the House isn't going to do something, why go through the charade?" he told reporters. "That becomes political gamesmanship."


Obama and Reid, D-Nev., would have to propose a package that Senate Republican Leader Mitch McConnell would agree not to block with procedural steps that require 60 votes to overcome.


Sen. Chuck Schumer of New York said he still thinks a deal could be struck.


The Democrat told NBC's "Today" show Friday that he believes the "odds are better than people think."


Schumer said he based his optimism on indications that McConnell has gotten "actively engaged" in the talks.


Appearing on the same show, Republican Sen. John Thune noted the meeting scheduled later Friday at the White House, saying "it's encouraging that people are talking."


But Sen. Bob Corker, R-Tenn., predicted that "the worst-case scenario" could emerge from Friday's talks.


"We will kick the can down the road," he said on "CBS This Morning."


"We'll do some small deal and we'll create another fiscal cliff to deal with the fiscal cliff," he said. Corker complained that there has been "a total lack of courage, lack of leadership," in Washington.


If a deal were to pass the Senate, Boehner would have to agree to take it to the floor in the Republican-controlled House.


Boehner discussed the fiscal cliff with Republican members in a conference call Thursday and advised them that the House would convene Sunday evening. Rep. Tom Cole, R-Okla., an ally of the speaker, said Boehner told the lawmakers that "he didn't really intend to put on the floor something that would pass with all the Democratic votes and few of the Republican votes."


But Cole did not rule out Republican support for some increase in tax rates, noting that Boehner had amassed about 200 Republican votes for a plan last week to raise rates on Americans earning $1 million or more. Boehner ultimately did not put the plan to a House floor vote in the face of opposition from Republican conservatives and a unified Democratic caucus.


"The ultimate question is whether the Republican leaders in the House and Senate are going to push us over the cliff by blocking plans to extend tax cuts for the middle class," White House communications director Dan Pfeiffer said. "Ironically, in order to protect tax breaks for millionaires, they will be responsible for the largest tax increase in history."


Boehner, McConnell, Reid and House Democratic Leader Nancy Pelosi are all scheduled to attend Friday's White House meeting with Obama. Vice President Joe Biden will also participate in the meeting, the White House said.


___


Associated Press writers Alan Fram, Charles Babington and David Espo contributed to this report.


___


Follow Jim Kuhnhenn on Twitter: http://twitter.com/jkuhnhenn


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C. African Republic president seeks foreign help






BANGUI, Central African Republic (AP) — The president of Central African Republic on Thursday urgently called on France and other foreign powers to help his government fend off rebels who are quickly seizing territory and approaching the capital, but French officials declined to offer any military assistance.


The developments suggest Central African Republic could be on the brink of another violent change in government, something not new in the history of this resource-rich, yet deeply impoverished country. The current president, Francois Bozize, himself came to power nearly a decade ago in the wake of a rebellion.






Speaking to crowds in Bangui, a city of some 600,000, Bozize pleaded with foreign powers to do what they could. He pointed in particular to France, Central African Republic’s former colonial ruler.


About 200 French soldiers are already in the country, providing technical support and helping to train the local army, according to the French defense ministry.


“France has the means to stop (the rebels) but unfortunately they have done nothing for us until now,” Bozize said.


French President Francois Hollande said Thursday that France wants to protect its interests in Central African Republic and not Bozize’s government. The comments came a day after dozens of protesters, angry about a lack of help against rebel forces, threw rocks at the French Embassy in Bangui and stole a French flag.


Paris is encouraging peace talks between the government and the rebels, with the French Foreign Ministry noting in a statement that negotiations are due to “begin shortly in Libreville (Gabon).” But it was not immediately clear what, if any, dates have been set for those talks.


French Foreign Minister Laurent Fabius, meanwhile, spoke via phone with Bozize, asking the president to take responsibility for the safety of French nationals and diplomatic missions in Central African Republic.


U.S. officials said Thursday the State Department would close its embassy in the country and ordered its diplomatic team to leave. The officials spoke on condition of anonymity because they were unauthorized to discuss the evacuation publicly.


The United Nations Security Council issued a press statement late Thursday reiterating its concern about the situation in the country and condemned the attacks.


“The members of the Security Council reiterate their demand that the armed groups immediately cease hostilities, withdraw from captured cities and cease any further advance towards the city of Bangui,” the statement reads.


Bozize’s government earlier reached out to longtime ally Chad, which pledged to send 2,000 troops to bolster Central African Republic’s own forces. But it was unclear if the Chadian troops had all arrived, and even then, it is far from certain if the combined government forces could withstand rebel attacks.


At least four different rebel groups are involved, though their overall numbers could not immediately be confirmed.


Central African Republic, a landlocked nation of some 4.4 million people, is roughly the size of France. It has suffered decades of army revolts, coups and rebellions since gaining independence in 1960 and remains one of the poorest countries in the world.


The rebels behind the most recent instability signed a 2007 peace accord allowing them to join the regular army, but insurgent leaders say the deal wasn’t fully implemented.


Already, the rebel forces have seized at least 10 towns across the sparsely populated north of the country, and residents in the capital now fear the insurgents could attack at any time, despite assurances by rebel leaders that they are willing to engage in dialogue instead of attacking Bangui.


The rebels have claimed that their actions are justified in light of the “thirst for justice, for peace, for security and for economic development of the people of Central African Republic.”


Despite Central African Republic’s wealth of gold, diamonds, timber and uranium, the government remains perpetually cash-strapped. Filip Hilgert, a researcher with Belgium-based International Peace Information Service, said rebel groups are unhappy because they feel the government doesn’t invest in their areas.


“The main thing they say is that the north of the country, and especially in their case the northeast, has always been neglected by the central government in all ways,” he said.


But the rebels also are demanding that the government make payments to ex-combatants, suggesting that their motives may also be for personal financial gain.


Bozize, a former military commander, came to power in a 2003 rebel war that ousted his predecessor, Ange-Felix Patasse. In his address Thursday, Bozize said he remained open to dialogue with the rebels, but he also accused them and their allies of financial greed.


Those allies, he implied, are outside Central African Republic.


“For me, there are individuals who are being manipulated by an outside hand, dreaming of exploiting the rich Central African Republic soil,” he said. “They want only to stop us from benefiting from our oil, our diamonds, our uranium and our gold.”


___


Larson reported from Dakar, Senegal. Associated Press writer Sarah DiLorenzo in Paris contributed to this report.


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Singer Travis pleads not guilty to assault






SAN ANTONIO (Reuters) – Country singer Randy Travis pleaded not guilty to misdemeanor assault in a municipal courtroom in the Dallas suburb of Plano on Friday, his lawyer said.


Lawyer Peter A. Schulte told Reuters his client is “absolutely not guilty of this crime.”






Police say Travis assaulted a man in a church parking lot in Plano in August while attempting to intervene in a disagreement between a woman he was with and the woman’s estranged husband.


“He was actually being a good Samaritan at the time, stepping in to save two women from being assaulted,” Schulte said. He said the woman Travis was with and his daughter were being harassed by two men.


The charge against Travis carries a maximum $ 500 fine and no jail time. The case is set for trial March 11.


The altercation occurred during a bad stretch for the 53-year-old Grammy winner. Earlier in August, Travis was arrested on suspicion of drunken driving after he was found lying naked near his wrecked car along a north Texas highway. He also was accused of threatening to shoot and kill the troopers investigating the case, according to a police report.


The North Carolina-born country singer, known for hits such as “Forever and Ever, Amen,” also was arrested in February for drunken driving while sitting in his car in the parking lot of another north Texas church.


Schulte said Travis has been doing well since the two August incidents. He said his client was upbeat as he left the courtroom Friday.


“He turned and wished everybody who was there a merry Christmas and a happy and healthy New Year,” he said.


(Editing by Corrie MacLaggan and Bill Trott)


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Brazil president, cancer survivor, pronounced healthy






BRASILIA (Reuters) – Brazilian President Dilma Rousseff, who survived lymphoma cancer in 2009, was pronounced healthy by doctors after a routine exam on Friday.


Rousseff’s health was “within normal levels,” according to a statement released by her office following the check-up at the Sirio-Libanes Hospital in Sao Paulo, one of South America‘s leading cancer treatment centers.






Rousseff underwent chemotherapy in 2009 and briefly wore a wig, but the cancer went into remission and she appeared to be in good health by the time she staged her winning campaign for the presidency in 2010.


Concerns over her health have faded since then, although a bout with pneumonia and a lengthy recovery in 2011 have kept the issue on some investors’ radar screens.


(Reporting by Ana Flor, Writing by Brian Winter; Editing by Doina Chiacu)


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Apple still said to account for 87% of North American tablet traffic as Kindle Fire, Nexus 7 gain






Apple’s (AAPL) share of the global tablet market is in decline now that low-cost Android slates are proliferating, but the iPad still appears to be the most used tablet by a huge margin. Ad firm Chitika regularly monitors tablet traffic in the United States and Canada and in its latest report, Apple’s iPad was responsible for almost 90% of all tablet traffic across the company’s massive network.


[More from BGR: Samsung looks to address its biggest weakness in 2013]






Using a sample of tens of millions of impressions served to tablets between December 8th and December 14th this year, Chitika determined that various iPad models collectively accounted for 87% of tablet traffic in North America. That figure is down a point from the prior month but still represents a commanding lead in the space.


[More from BGR: New purported BlackBerry Z10 specs emerge: 1.5GHz processor, 2GB RAM, 8MP camera]


The next closest device line, Amazon’s (AMZN) Kindle Fire tablet family, had a 4.25% share of tablet traffic during that period, up from 3.57% in November. Samsung’s (005930) Galaxy tablets made up 2.65% of traffic, up from 2.36%, and Google’s (GOOG) Nexus 7 and Nexus 10 tablets combined to account for 1.06% of tablet traffic in early December.


“Despite these gains by some of the bigger players in the tablet marketplace, there has been a negligible impact to Apple’s dominant usage share,” Chitika wrote in a post on its blog.


This article was originally published by BGR


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China tightening controls on Internet






BEIJING (AP) — China‘s new communist leaders are increasing already tight controls on Internet use and electronic publishing following a spate of embarrassing online reports about official abuses.


The measures suggest China’s new leader, Xi Jinping, and others who took power in November share their predecessors’ anxiety about the Internet’s potential to spread opposition to one-party rule and their insistence on controlling information despite promises of more economic reforms.






“They are still very paranoid about the potentially destabilizing effect of the Internet,” said Willy Lam, a politics specialist at the Chinese University of Hong Kong. “They are on the point of losing a monopoly on information, but they still are very eager to control the dissemination of views.”


This week, China’s legislature took up a measure to require Internet users to register their real names, a move that would curtail the Web’s status as a freewheeling forum to complain, often anonymously, about corruption and official abuses. The legislature scheduled a news conference Friday to discuss the measure, suggesting it was expected to be approved.


That comes amid reports Beijing might be disrupting use of software that allows Web surfers to see sites abroad that are blocked by its extensive Internet filters. At the same time, regulators have proposed rules that would bar foreign companies from distributing books, news, music and other material online in China.


Beijing promotes Internet use for business and education but bans material deemed subversive or obscene and blocks access to foreign websites run by human rights and Tibet activists and some news outlets. Controls were tightened after social media played a role in protests that brought down governments in Egypt and Tunisia.


In a reminder of the Web’s role as a political forum, a group of 70 prominent Chinese scholars and lawyers circulated an online petition this week appealing for free speech, independent courts and for the ruling party to encourage private enterprise.


Xi and others on the party’s ruling seven-member Standing Committee have tried to promote an image of themselves as men of the people who care about China’s poor majority. They have promised to press ahead with market-oriented reforms and to support entrepreneurs but have given no sign of support for political reform.


Communist leaders who see the Internet as a source of economic growth and better-paid jobs were slow to enforce the same level of control they impose on movies, books and other media, apparently for fear of hurting fledgling entertainment, shopping and other online businesses.


Until recently, Web surfers could post comments online or on microblog services without leaving their names.


That gave ordinary Chinese a unique opportunity to express themselves to a public audience in a society where newspapers, television and other media are state-controlled. The most popular microblog services say they have more than 300 million users and some users have millions of followers reading their comments.


The Internet also has given the public an unusual opportunity to publicize accusations of official misconduct.


A local party official in China’s southwest was fired in November after scenes from a videotape of him having sex with a young woman spread quickly on the Internet. Screenshots were uploaded by a former journalist in Beijing, Zhu Ruifeng, to his Hong Kong website, an online clearing house for corruption allegations.


Some industry analysts suggest allowing Web surfers in a controlled setting to vent helps communist leaders stay abreast of public sentiment in their fast-changing society. Still, microblog services and online bulletin boards are required to employ censors to enforce content restrictions. Researchers say they delete millions of postings a day.


The government says the latest Internet regulation before the National People’s Congress is aimed at protecting Web surfers’ personal information and cracking down on abuses such as junk e-mail. It would require users to report their real names to Internet service and telecom providers.


The main ruling party newspaper, People’s Daily, has called in recent weeks for tighter Internet controls, saying rumors spread online have harmed the public. In one case, it said stories about a chemical plant explosion resulted in the deaths of four people in a car accident as they fled the area.


Proposed rules released this month by the General Administration of Press and Publications would bar Chinese-foreign joint ventures from publishing books, music, movies and other material online in China. Publishers would be required to locate their servers in China and have a Chinese citizen as their local legal representative.


That is in line with rules that already bar most foreign access to China’s media market, but the decision to group the restrictions together and publicize them might indicate official attitudes are hardening.


That comes after the party was rattled by foreign news reports about official wealth and misconduct.


In June, Bloomberg News reported that Xi’s extended family has amassed assets totaling $ 376 million, though it said none was traced to Xi. The government has blocked access to Bloomberg’s website since then.


In October, The New York Times reported that Premier Wen Jiabao’s relatives had amassed $ 2.7 billion since he rose to national office in 2002. Access to the Times’ Chinese-language site has been blocked since then.


Previous efforts to tighten controls have struggled with technical challenges in a country with more than 500 million Internet users.


Microblog operators such as Sina Corp. and Tencent Ltd. were ordered in late 2011 to confirm users’ names but have yet to finish the daunting task.


Web surfers can circumvent government filters by using virtual private networks — software that encrypts Web traffic and is used by companies to transfer financial data and other sensitive information. But VPN users say disruptions that began in 2011 are increasing, suggesting Chinese regulators are trying to block encrypted traffic.


Curbs on access to foreign sites have prompted complaints by companies and Chinese scientists and other researchers.


In July, the American Chamber of Commerce in China said 74 percent of companies that responded to a survey said unstable Internet access “impedes their ability to do business.”


Chinese leaders “realize there are detrimental impacts on business, especially foreign business, but they have counted the cost and think it is still worthwhile,” said Lam. “There is no compromise about the political imperative of controlling the Internet.”


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Apple CEO’s pay takes big hit vs. record 2011 package






NEW YORK (Reuters) – Apple Inc CEO Tim Cook’s 2012 compensation package of just over $ 4 million is a huge cut on paper for the top executive of the most valuable U.S. corporation, after a 2011 package fattened by more than $ 376 million in long-term stock awards.


Cook received the largest single pay package awarded to a company CEO in about a decade when he replaced Apple‘s legendary co-founder, Steve Jobs, shortly before Jobs’ death in October 2011.






The maker of the iPhone and iPad made the 2012 compensation disclosures in a regulatory filing on Thursday. Cook, who is in his early 50s, joined Apple in 1998 and became CEO in August 2011.


Virtually all of Cook’s $ 376 million bonus in 2011 was in stock awards that will vest in two chunks – one in 2016 and the other in 2021. This structure was intended to keep Jobs’ longtime lieutenant at the helm for many years.


In terms of base salary, Cook actually received a 50 percent increase to $ 1.4 million for 2012, and the same 200 percent bonus that other top Apple executives like CFO Peter Oppenheimer earned, Apple said in a regulatory filing on Thursday.


The 2012 compensation package for Cook also pales in comparison with his 2010 pay, which was 14 times higher, when he served as chief operating officer.


But Tim Ghriskey, chief investment officer of Solaris Group – which counts Apple stock as the biggest holding among the approximately $ 2 billion it manages – said Cook’s package was “normal CEO compensation.”


For example, Yahoo Inc’s CEO, Marissa Mayer, a former Google Inc high-flyer hired this year to try to turn around the struggling Internet icon, won a pay package worth more than $ 70 million. Despite her lack of a CEO track record, her basic pay is comparable to Cook’s, with about $ 1 million in annual salary and up to $ 2 million in an annual bonus.


Oracle Corp’s Larry Ellison, one of the most highly paid chief executives in the United States – and also the world’s sixth-richest man, according to Forbes – received total compensation for the year ended May 31, 2012, of $ 96.2 million – almost all of it in stock options.


That compared with $ 77.6 million for Ellison in the prior year.


Cook’s longtime boss, Jobs, famously received $ 1 a year in salary in the three years before he stepped down, though in 2000 he too received a stock option that analysts say was valued at almost $ 600 million at the time.


Cook will not receive any stock awards for 2012, Apple said in Thursday’s filing.


The 2012 package includes a salary of $ 1.4 million and a nonequity bonus of $ 2.8 million. Cook’s base salary actually increased in 2012 from the $ 900,000 he earned in 2011.


While Apple’s shares are roughly 35 percent higher than when Cook became CEO, they have fallen more than 27 percent since October, when they hit a $ 700.10 high. The stock has declined amid investor worries about intensifying competition in the mobile phone market and growth prospects in important markets including China.


Apple shares were down 1.3 percent at $ 506.35 on the Nasdaq on Thursday afternoon.


(Reporting by Sinead Carew and Liana Baker in New York, Jim Finkle and Tim McLaughlin in Boston and Edwin Chan in San Francisco,; editing by Kenneth Barry and Matthew Lewis)


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Soprano Bartoli: My voice has more colors, shadow






LONDON (Reuters) – Italian mezzo-soprano Cecilia Bartoli has released a year-end blockbuster that is part mystery story, part research project and shows off a voice which only seems to improve with age.


Bartoli’s latest deluxe-packaged album “Mission” (Decca) is devoted to the music of the late 17th-century Italian composer, diplomat and perhaps spy, Agostino Steffani.






Steffani may have been a bit overlooked as a result of his appearance at the end of the Renaissance and at the beginning of the Baroque periods – until Bartoli’s interest alighted on him.


“The variety is amazing in the music of Steffani, the slow arias have very beautiful melodic lines, they are unbelievable, it’s quite hypnotic music,” Bartoli said in a telephone interview from Paris.


Since she burst upon the world in the 1990s, specializing mostly in Mozart and Rossini, Bartoli has gone from strength to strength, not only in digging up unusual repertoires, including another deluxe compilation in 2009 devoted to music sung by castrati, but also vocally.


Here’s what else Bartoli had to say about Steffani and his possible career as a spy, why she goes for the anti-diva look on her recent album covers, and what she calls a Fellini-esque experience at La Scala with conductor Daniel Barenboim:


Q: Is it true, then, that the voice improves with time?


A: “I think this is a very good time because of the maturity of the technique. When you are young, of course, you have to have a beautiful voice. This is a gift you receive, but you don’t have enough technique or experience. So this is a very good time because I can really paint with my voice with so many colors, like a painter. I love painting with the voice and I’m of an age when I do this definitely better than 20 years ago.”


Q: So this bit about Steffani being a spy, surely that was dreamt up by the Decca marketing department?


A: “He had an incredible life as a priest, a missionary and a diplomatic mission to arranging weddings between the royal princes of that period. And also he was a kind of spy, in fact he was a Catholic priest in the north of Germany, in the Protestant area, and he spent lots of years in that area – it was very unusual, very strange. Maybe he also had the mission to convert (people) to Catholicism, who knows? We have lots of speculation about him, all the mysterious things about this man. There’s still mystery.”


Q: There’s no mystery though that the cover for this album, showing you bald-headed and wielding a crucifix, is “non-diva” – like the cover on the “Sacrificium” album of castrati music, with your head superimposed on the torso of a male statue.


A: “The idea was to have a cover related to the project and it was a bit against the cliche of a diva who has to look beautiful all the time. In a project like ‘Sacrificium’, when at the beginning of the 18th century 3,000-4,000 boys were castrated every year in Italy…how can I make a CD project about this and make a cover with a beautiful, glamorous Vanity Fair picture? This would be more embarrassing…People realize there is a real story here to tell, it’s not a compilation of arias which you do for Christmas. And ‘Sacrificium’ was a huge success.”


Q: Your concert recital earlier this month singing Handel, Rossini and Mozart with Daniel Barenboim conducting at La Scala in Milan, with a chorus of boos and whistles in the second half, was perhaps less of a success?


A: “This story is repeating what happened to Carlos Kleiber, one of the greatest conductors of our lives, also to (Maria) Callas, (Luciano) Pavarotti. The concert was magnificent – Handel, Mozart, Rossini – and then I believe at the very end there was a very Fellinian situation. You think these things don’t happen anymore, that they only happen in the movies of (Federico) Fellini but actually, no, this is happening. And it seemed like a parody but the next morning I opened the newspaper and (Silvio) Berlusconi is back (in Italian politics). And so I said, ‘Yes, of course.’


I think living in Italy is difficult but living without Italy is impossible.”


(Editing by Michael Roddy)


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No fewer side effects for prostate proton therapy






NEW YORK (Reuters Health) – An expensive prostate cancer radiation treatment known as proton beam therapy has just as many side effects as a more common and cheaper radiation method, according to a new study.


In terms of side effects, “In the long term, there’s really no difference in outcomes between proton radiation and IMRT for men with prostate cancer,” said lead author Dr. James Yu, a radiation oncologist at Yale University School of Medicine in New Haven, Connecticut.






Proton therapy advocates argue that protons blast radiation directly to the tumor and therefore avoid side effects. The more common “intensity-modulated” radiotherapy (IMRT) exposes some healthy tissue to radiation that researchers hypothesized would increase side effects and even additional cancers.


After a year, however, the study found the same number of side effects among men who’d had both treatments.


Prostate cancer, the most common cancer in men, kills about 28,000 Americans each year. However, many men don’t die of the disease, because many tumors grow very slowly.


Treatments include chemotherapy, hormone therapy, surgery, and frequent surveillance – aka “watchful waiting.”


Although researchers are at odds over which treatment – proton therapy or IMRT – is the better option for men who choose radiation, that hasn’t stopped the growth of proton beam centers. There are ten such centers in the U.S., according to the National Association for Proton Therapy, with eight more under development or being built.


Each one can cost more than $ 125 million, and Medicare pays doctors about twice as much for proton therapy.


For the study in the Journal of the National Cancer Institute, researchers tracked Medicare claims in 2008 and 2009 for treatment-related complications in nearly 28,000 men with prostate cancer for up to a year. Only two percent of the prostate cancer patients underwent proton therapy and the remainder had IMRT.


After six months, nearly 10 percent of IMRT-treated patients, and six percent of proton therapy patients, had side effects including incontinence, a burning sensation while urinating or difficulty getting an erection. However, the difference disappeared a year after treatment, when nearly one in five patients suffered side effects regardless of which radiation treatment they had.


Yu and colleagues found that proton therapy costs nearly twice as much: $ 32,428 per course of treatment, versus $ 18,575 for IMRT. That difference was consistent with that found in other studies.


“The ball is in the court of the proton folks in terms of proving a benefit,” Yu told Reuters Health.


The study only looked at side effects, and did not compare the effectiveness of the treatments, which proton therapy advocates said was a significant weakness.


If Yu is “willing to make recommendation or clinical judgments based on this sort of data, I think he’s at risk to doing a disservice to his patients,” said Dr. Andrew Lee, director of the Proton Therapy Center at the University of Texas MD Anderson Cancer Center in Houston. “It’s like trying to read a license plate from 30 thousand feet up in the air.”


Lee, who was not involved in the new work, said that the study’s length – a year – wasn’t enough time to look at the full scope of side effects from either treatment. The study also failed to include side effects that didn’t require a hospital visit, and couldn’t say how long treatments lasted.


Proton therapy isn’t for everyone, both noted. Lee said the treatment was best for young healthy patients, while Yu said it is most useful for cancers in children or in sensitive areas where minimizing the radiation is critical.


Yu would not recommend it for prostate cancer.


“The cancer center next door or the radiation oncologist in the community will likely do just as good a job at treating prostate cancer with IMRT as a proton center three times out of the way,” Yu said.


SOURCE: http://bit.ly/V6PkLT Journal of the National Cancer Institute, online December 14, 2012.


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Reid: U.S. is poised to go off fiscal cliff


Senate Majority Leader Harry Reid (R) (D-NV) hugs Speaker of the House John Boehner as Senate Minority Leader Mitch …With a deal to avert the so-called "fiscal cliff" nowhere in sight, Senate Majority Leader Harry Reid on Thursday predicted a compromise would not be reached in time to avert the tax increases and automatic spending cuts set to be triggered on January 1. Reid also criticized Republican House Speaker John Boehner in unusually personal terms, accusing him of running the House as a “dictatorship” and blasting him for letting lawmakers out for vacation.


Boehner will be to blame “if we go over the cliff, and it looks like that’s where we’re headed,” Reid insisted as the Senate returned to work for a post-Christmas session focused on disaster relief for Sandy victims and renewing key government surveillance powers.


Reid's speech on the Senate floor came shortly before President Barack Obama returned to Washington from Hawaii to resume discussions of how to avoid the fiscal cliff. White House Spokesman Dan Pfeiffer said Obama had spoken to Reid, Boehner, House Democratic Leader Nancy Pelosi and Senate Republican Leader Mitch McConnell Wednesday evening.


Reid, a Nevada Democrat, repeatedly pressed Boehner to have the House take up a Senate-passed bill extending income tax cuts on income under $250,000, calling that measure the only “viable escape route.” House Republicans have thus far balked at raising taxes at all.


“The Speaker just has a few days left to change his mind,” Reid said. “But I have to be very honest…I don’t know, time-wise, how it can happen now.”


"Speaker Boehner should call members of the House back today," Reid said, adding that the Ohio Republican "seems to care more about keeping his speakership" than pushing his party to accept a deal that would avert a tax increase for all but the highest income taxpayers. Democrats have repeatedly leveled that charge at Boehner, whose reelection on January 3 is not seriously in doubt despite ever-louder conservative grumbling.


Reid also accused Boehner of operating a "dictatorship" that had shut out House Democrats and all but the most conservative voices in the GOP, saying that the Senate-passed bill would pass with mostly Democratic votes but some Republican support as well.


“Nothing can move forward in regards to our budget crisis unless Speaker Boehner and Leader McConnell are willing to participate in coming up with a bipartisan plan,” Reid warned. “Speaker Boehner is unwilling to negotiate, we’ve not heard a word from Leader McConnell, nothing is happening. Democrats can’t put together a plan on their own,” he said.



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