Rescuer Appears for New York Downtown Hospital

Manhattan’s only remaining hospital south of 14th Street, New York Downtown, has found a white knight willing to take over its debt and return it to good health, hospital officials said Monday.

NewYork-Presbyterian Hospital, one of New York City’s largest academic medical centers, has proposed to take over New York Downtown in a “certificate of need” filed with the State Health Department. The three-page proposal argues that though New York Downtown is projected to have a significant operating loss in 2013, it is vital to Lower Manhattan, including Wall Street, Chinatown and the Lower East Side, especially since the closing of St. Vincent’s Hospital after it declared bankruptcy in 2010.

The rescue proposal, which would need the Health Department’s approval, comes at a precarious time for hospitals in the city. Long Island College Hospital, just across the river in Cobble Hill, Brooklyn, has been threatened with closing after a failed merger with SUNY Downstate Medical Center, and several other Brooklyn hospitals are considering mergers to stem losses.

New York Downtown has been affiliated with the NewYork-Presbyterian health care system while maintaining separate operations.

“We are looking forward to having them become a sixth campus so the people in that community can continue to have a community hospital that continues to serve them,” Myrna Manners, a spokeswoman for NewYork-Presbyterian, said.

Fred Winters, a spokesman for New York Downtown, declined to comment.

Presbyterian’s proposal emphasized that it would acquire New York Downtown’s debt at no cost to the state, a critical point at a time when the state has shown little interest in bailing out failing hospitals.

The proposal said that if New York Downtown were to close, it would leave more than 300,000 residents of Lower Manhattan, including the financial district, Greenwich Village, SoHo, the Lower East Side and Chinatown, without a community hospital. In addition, it said, 750,000 people work and visit in the area every day, a number that is expected to grow with the construction of 1 World Trade Center and related buildings.

The proposal argues that New York Downtown is essential partly because of its long history of responding to disasters in the city. One of its predecessors was founded as a direct result of the 1920 terrorist bombing outside the J. P. Morgan Building, and the hospital has responded to the 1975 bombing of Fraunces Tavern, the 1993 and 2001 attacks on the World Trade Center, and, this month, the crash of a commuter ferry from New Jersey.

Like other fragile hospitals in the city, New York Downtown has shrunk, going to 180 beds, down from the 254 beds it was certified for in 2006, partly because the more affluent residents of Lower Manhattan often go to bigger hospitals for elective care.

The proposal says that half of the emergency department patients at New York Downtown either are on Medicaid, the program for the poor, or are uninsured.

NewYork-Presbyterian would absorb the cost of the hospital’s maternity and neonatal intensive care units, which have been expanding because of demand, but have been operating at a deficit of more than $1 million a year, the proposal said.

Read More..

Rescuer Appears for New York Downtown Hospital

Manhattan’s only remaining hospital south of 14th Street, New York Downtown, has found a white knight willing to take over its debt and return it to good health, hospital officials said Monday.

NewYork-Presbyterian Hospital, one of New York City’s largest academic medical centers, has proposed to take over New York Downtown in a “certificate of need” filed with the State Health Department. The three-page proposal argues that though New York Downtown is projected to have a significant operating loss in 2013, it is vital to Lower Manhattan, including Wall Street, Chinatown and the Lower East Side, especially since the closing of St. Vincent’s Hospital after it declared bankruptcy in 2010.

The rescue proposal, which would need the Health Department’s approval, comes at a precarious time for hospitals in the city. Long Island College Hospital, just across the river in Cobble Hill, Brooklyn, has been threatened with closing after a failed merger with SUNY Downstate Medical Center, and several other Brooklyn hospitals are considering mergers to stem losses.

New York Downtown has been affiliated with the NewYork-Presbyterian health care system while maintaining separate operations.

“We are looking forward to having them become a sixth campus so the people in that community can continue to have a community hospital that continues to serve them,” Myrna Manners, a spokeswoman for NewYork-Presbyterian, said.

Fred Winters, a spokesman for New York Downtown, declined to comment.

Presbyterian’s proposal emphasized that it would acquire New York Downtown’s debt at no cost to the state, a critical point at a time when the state has shown little interest in bailing out failing hospitals.

The proposal said that if New York Downtown were to close, it would leave more than 300,000 residents of Lower Manhattan, including the financial district, Greenwich Village, SoHo, the Lower East Side and Chinatown, without a community hospital. In addition, it said, 750,000 people work and visit in the area every day, a number that is expected to grow with the construction of 1 World Trade Center and related buildings.

The proposal argues that New York Downtown is essential partly because of its long history of responding to disasters in the city. One of its predecessors was founded as a direct result of the 1920 terrorist bombing outside the J. P. Morgan Building, and the hospital has responded to the 1975 bombing of Fraunces Tavern, the 1993 and 2001 attacks on the World Trade Center, and, this month, the crash of a commuter ferry from New Jersey.

Like other fragile hospitals in the city, New York Downtown has shrunk, going to 180 beds, down from the 254 beds it was certified for in 2006, partly because the more affluent residents of Lower Manhattan often go to bigger hospitals for elective care.

The proposal says that half of the emergency department patients at New York Downtown either are on Medicaid, the program for the poor, or are uninsured.

NewYork-Presbyterian would absorb the cost of the hospital’s maternity and neonatal intensive care units, which have been expanding because of demand, but have been operating at a deficit of more than $1 million a year, the proposal said.

Read More..

DealBook Column: Mary Jo White, Nominee for S.E.C.'s 'New Sherrif,' Has Worn Banks' Hat

“You don’t want to mess with Mary Jo.”

That’s what President Obama said about his pick to run the Securities and Exchange Commission, Mary Jo White. The nomination of Ms. White, a former prosecutor who took on the terrorists behind the bombing of the World Trade Center in 1993 and the Mafia boss John Gotti, was meant to signal that the S.E.C. would be getting tough on Wall Street. CBS called her “Wall Street’s new sheriff.” The Wall Street Journal said she would be “putting a tougher face on an agency still tainted by embarrassing enforcement missteps in the run-up to the financial crisis.” The New York Times said her appointment represented a “renewed resolve to hold Wall Street accountable.”

Hold on.

While Ms. White is a decorated prosecutor, she has spent the last decade vigorously defending — and billing by the hour — Wall Street’s biggest banks, as a rainmaking partner at the white-shoe law firm Debevoise & Plimpton. The average partner at the firm was paid $2.1 million a year, according to American Lawyer; but she was no average partner, very likely being paid at least double that. Her husband, John W. White, is a corporate partner at Cravath, Swaine & Moore. He counts JPMorgan Chase, Credit Suisse and UBS as clients. The average partner at Cravath makes $3.1 million. He, too, was a former official at the S.E.C. — he left Cravath to run the corporate division of the S.E.C. starting in 2006 just in time for the run-up to the financial crisis. He left in November 2008, a month after the bank bailouts, to return to Cravath.

It seems Mr. and Ms. White have made a fine art of the revolving door between government and private practice.

So how conflicted is Ms. White? Let’s count the ways.

They are well documented: she was JPMorgan Chase’s go-to lawyer for many of the cases brought against it relating to the financial crisis. She was arm-in-arm with Kenneth D. Lewis, Bank of America’s former chief executive, keeping him out of trouble when the New York attorney general accused Mr. Lewis of defrauding investors by not disclosing the losses at Merrill Lynch before completing Bank of America’s acquisition of the firm. (And empirically, Mr. Lewis did keep crucial information about the deal from investors.)

This is what she had to say about Mr. Lewis, in a court filing submitted on his behalf: “Some have looked to assign blame for every aspect of the financial crisis, even where there is no evidence of misconduct. This case is a product of that dynamic and does not withstand either legal or factual scrutiny.” It was a refrain she often made about her clients related to the financial crisis.

And then there was Senator Bill Frist, the Republican from Tennessee, whom she successfully represented when the S.E.C. and the Justice Department started an investigation into whether he was involved in insider trading in shares of HCA, the hospital chain. She persuaded them to shut down the investigation.

She also worked with Siemens, the German industrial giant, when it pleaded guilty to charges of bribery, paying a record $1.6 billion penalty.

And then, of course, there was John Mack. She worked for the board of Morgan Stanley during a now well-publicized 2005 investigation into insider trading that ended soon after she made a phone call to the S.E.C. Using her connections at the top of the agency, she dialed up Linda Thomsen, then the commission’s head of enforcement, to find out whether Mr. Mack, who was being considered for Morgan Stanley’s chief executive position, was being implicated. He ultimately wasn’t. As the Huffington Post pointed out in a recent article about Ms. White, Robert Hanson, an S.E.C. supervisor, later testified, “It is a little out of the ordinary for Mary Jo White to contact Linda Thomsen directly, but that White is very prestigious and it isn’t uncommon for someone prominent to have someone intervene on their behalf.”

All of Ms. White’s previous engagements create not only an “optics” problem, but a practical, on-the-job problem. She will most likely need to recuse herself from just about anything related to her previous work.

“I will not for a period of two years from the date of my appointment participate in any particular matter involving specific parties that is directly and substantially related to my former employer or former clients, including regulations and contracts,” is the language in an ethics pledge that she will have to agree to follow.

Some appointees, including Mary L. Schapiro, the former chairwoman of the S.E.C., recused themselves from any involvement in work that was related to a previous employer even after the two-year moratorium. Gary Gensler, the chairman of the Commodity Futures Trading Commission, recused himself from the investigation into MF Global because of his previous employment at Goldman Sachs, where Jon Corzine was the firm’s head, even though it had been years since the two had worked together.

And then there is the issue of Mr. White’s husband, who will have a continuing role at Cravath, one of the most pre-eminent firms in the country, whose clients include some of the nation’s largest corporations.

“This president has adopted the toughest ethics rules of any administration in history,” said Amy Brundage, a White House spokeswoman, “and this nominee is no exception. As S.E.C. chair, Mary Jo White will be in complete compliance with all ethics rules.”

None of these conflicts gets at another potential problem for Ms. White. The job of chairwoman of S.E.C. isn’t simply about enforcement; she has a deputy for that. The biggest challenge anyone who takes the job will have to confront over the next several years will be executing and enforcing provisions of Dodd-Frank and working to regulate electronic trading — something that even the most sophisticated financial professionals, let alone a lawyer, often have a tough time understanding. She has zero experience in this area.

Of course, there can always be a value to inviting a onetime rival onto the team.

“I believe she is one of those people who will understand that her public role will be very, very different than her role as a defense lawyer,” Dennis M. Kelleher of Better Markets, a watchdog group, told me. “I don’t think she’s going to be like so many others who don’t get that they have a very different role when they hold high public office.

“No question, she’s said some things that are controversial and questionable,” Mr. Kelleher said. “Moreover, I hope and expect that she will be asked publicly about them in the confirmation process and that she will have convincing answers.”

Of course, if she is confirmed, we must all hope that she can put her previous client relationships behind her and work for her new client — us.

Read More..

Stanley Karnow, Historian and Journalist, Is Dead at 87

Stanley Karnow, a Pulitzer Prize-winning historian and journalist who produced acclaimed books and television documentaries about Vietnam and the Philippines in the throes of war and upheaval, died on Sunday at his home in Potomac, Md. He was 87.

The cause was congestive heart failure, said Mr. Karnow’s son, Michael.

For more than three decades Mr. Karnow was a correspondent in Southeast Asia, working for Time, Life, The Saturday Evening Post, The Washington Post, NBC News, The New Republic, King Features Syndicate and the Public Broadcasting Service. But he was best known for his books and documentaries.

He was in Vietnam in 1959, when the first American advisers were killed, and lingered long after the guns fell silent, talking to fighters, villagers, refugees, North and South Vietnamese political and military leaders, the French and the Americans, researching a people and a war that had been little understood.

The result was the 750-page book “Vietnam: A History,” published in 1983, and its companion, a 13-hour PBS documentary, “Vietnam: A Television History.” Unlike many books and films on Vietnam in the 1960s and ’70s and the nightly newscasts that focused primarily on America’s role and its consequences at home and abroad, Mr. Karnow addressed all sides of the conflict and traced Vietnam’s culture and history.

“Vietnam: A History” was widely praised and a best seller. The documentary, with Mr. Karnow as chief correspondent, was at the time the most successful ever produced by public television, viewed by an average of nearly 10 million people a night through 13 episodes. It won six Emmy Awards, as well as Peabody, Polk and duPont-Columbia awards.

Six years later, Mr. Karnow delivered his second comprehensive book and television examination of a Southeast Asian nation. The book, “In Our Image: America’s Empire in the Philippines” (1989), was a panorama of centuries of Filipino life under Spanish and American colonial rule, followed by independence under sometimes corrupt American-backed leaders. It won the 1990 Pulitzer Prize for history.

Narrated by Mr. Karnow, the three-part PBS documentary “The U.S. and the Philippines: In Our Image” traced America’s paternalistic colonial rule in the Philippines, the shared suffering of Filipinos and Americans under a cruel Japanese occupation in World War II, and Manila’s postwar independence under regimes nominally democratic but repressive, corrupt or indifferent to the miseries of its people.

Mr. Karnow also wrote “Mao and China: From Revolution to Revolution” (1972) and was a co-author of or contributor to books based on his years in Asia, including “Asian-Americans in Transition” (1992), “Passage to Vietnam” (1994), “Mekong” (1995) and “Historical Atlas of the Vietnam War” (1995).

Early in his career he lived in Paris for a decade, and in 1997 he published a memoir, “Paris in the Fifties.” A nostalgic reporter’s notebook of life among the cafe philosophers, berated musicians and pseudo-revolutionary artistes, it danced with digressions about taxes, restaurants, the guillotine, Hemingway, Charles de Gaulle and the Devil’s Island penal colony.

In its range, learning and appetite for fun, Bernard Kalb, the former CBS reporter and Mr. Karnow’s friend since Vietnam, told The Associated Press in 2009, the memoir was vintage Karnow. “Stanley has a great line about how being a journalist is like being an adolescent all your life,” he said.

Stanley Karnow was born in Brooklyn on Feb. 4, 1925, the son of Harry and Henriette Koeppel Karnow. He grew up in a city with more than a dozen daily newspapers and decided early that he wanted to become a reporter. He served in the Army Air Forces in World War II. After graduating from Harvard with a bachelor’s degree in 1947, he sailed for France, intending to spend the summer. He stayed for a decade.

This article has been revised to reflect the following correction:

Correction: January 28, 2013

An earlier version of this article misstated the year in which Stanley Karnow was a Nieman Fellow at Harvard University. It was 1958, not 2002. The article also misspelled the name of the Nieman Fellowship.

Read More..

Pentagon to Beef Up Cybersecurity Force to Counter Attacks

WASHINGTON — The Pentagon is moving toward a major expansion of its cybersecurity force to counter increasing attacks on the nation’s computer networks, as well as to expand offensive computer operations on foreign adversaries, defense officials said Sunday.

The expansion would increase the Defense Department’s Cyber Command by more than 4,000 people, up from the current 900, an American official said. Defense officials acknowledged that a formidable challenge in the growth of the command would be finding, training and holding onto such a large number of qualified people.

The Pentagon “is constantly looking to recruit, train and retain world class cyberpersonnel,” a defense official said Sunday.

“The threat is real and we need to react to it,” said William J. Lynn III, a former deputy defense secretary who worked on the Pentagon’s cybersecurity strategy.

As part of the expansion, officials said the Pentagon was planning three different forces under Cyber Command: “national mission forces” to protect computer systems that support the nation’s power grid and critical infrastructure; “combat mission forces” to plan and execute attacks on adversaries; and “cyber protection forces” to secure the Pentagon’s computer systems.

The move, part of a push by Defense Secretary Leon E. Panetta to bolster the Pentagon’s cyberoperations, was first reported on The Washington Post’s Web site.

In October, Mr. Panetta warned in dire terms that the United States was facing the possibility of a “cyber-Pearl Harbor” and was increasingly vulnerable to foreign computer hackers who could dismantle the nation’s power grid, transportation system, financial network and government. He said that “an aggressor nation” or extremist group could cause a national catastrophe, and that he was reacting to increasing assertiveness and technological advances by the nation’s adversaries, which officials identified as China, Russia, Iran and militant groups.

Defense officials said that Mr. Panetta was particularly concerned about a computer attack last August on the state oil company Saudi Aramco, which infected and made useless more than 30,000 computers. In October, American intelligence officials said they were increasingly convinced that the Saudi attacks originated in Iran. They described an emerging shadow war of attacks and counterattacks already under way between the United States and Iran in cyberspace.

Among American officials, suspicion has focused on the “cybercorps” created in 2011 by Iran’s military, partly in response to American and Israeli cyberattacks on the Iranian nuclear enrichment plan at Natanz. There is no hard evidence, however, that the attacks were sanctioned by the Iranian government.

The attacks emanating from Iran have inflicted only modest damage. Iran’s cyberwarfare capabilities are weaker than those of China and Russia, which intelligence officials believe are the sources of a significant number of attacks on American companies and government agencies.

The expansion of Cyber Command comes as the Pentagon is making cuts elsewhere, including in the size of its conventional armed forces.

Read More..

Well: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

Read More..

Well: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

Read More..

Stanley Karnow, Historian and Journalist, Is Dead at 87

Stanley Karnow, a Pulitzer Prize-winning historian and journalist who produced acclaimed books and television documentaries about Vietnam and the Philippines in the throes of war and upheaval, died on Sunday at his home in Potomac, Md. He was 87.

The cause was congestive heart failure, said Mr. Karnow’s son, Michael.

For more than three decades Mr. Karnow was a correspondent in Southeast Asia, working for Time, Life, The Saturday Evening Post, The Washington Post, NBC News, The New Republic, King Features Syndicate and the Public Broadcasting Service. But he was best known for his books and documentaries.

He was in Vietnam in 1959, when the first American advisers were killed, and lingered long after the guns fell silent, talking to fighters, villagers, refugees, North and South Vietnamese political and military leaders, the French and the Americans, researching a people and a war that had been little understood.

The result was the 750-page book “Vietnam: A History,” published in 1983, and its companion, a 13-hour PBS documentary, “Vietnam: A Television History.” Unlike many books and films on Vietnam in the 1960s and ’70s and the nightly newscasts that focused primarily on America’s role and its consequences at home and abroad, Mr. Karnow addressed all sides of the conflict and traced Vietnam’s culture and history.

“Vietnam: A History” was widely praised and a best seller. The documentary, with Mr. Karnow as chief correspondent, was at the time the most successful ever produced by public television, viewed by an average of nearly 10 million people a night through 13 episodes. It won six Emmy Awards, as well as Peabody, Polk and duPont-Columbia awards.

Six years later, Mr. Karnow delivered his second comprehensive book and television examination of a Southeast Asian nation. The book, “In Our Image: America’s Empire in the Philippines” (1989), was a panorama of centuries of Filipino life under Spanish and American colonial rule, followed by independence under sometimes corrupt American-backed leaders. It won the 1990 Pulitzer Prize for history.

Narrated by Mr. Karnow, the three-part PBS documentary “The U.S. and the Philippines: In Our Image” traced America’s paternalistic colonial rule in the Philippines, the shared suffering of Filipinos and Americans under a cruel Japanese occupation in World War II, and Manila’s postwar independence under regimes nominally democratic but repressive, corrupt or indifferent to the miseries of its people.

Mr. Karnow also wrote “Mao and China: From Revolution to Revolution” (1972) and was a co-author of or contributor to books based on his years in Asia, including “Asian-Americans in Transition” (1992), “Passage to Vietnam” (1994), “Mekong” (1995) and “Historical Atlas of the Vietnam War” (1995).

Early in his career he lived in Paris for a decade, and in 1997 he published a memoir, “Paris in the Fifties.” A nostalgic reporter’s notebook of life among the cafe philosophers, berated musicians and pseudo-revolutionary artistes, it danced with digressions about taxes, restaurants, the guillotine, Hemingway, Charles de Gaulle and the Devil’s Island penal colony.

In its range, learning and appetite for fun, Bernard Kalb, the former CBS reporter and Mr. Karnow’s friend since Vietnam, told The Associated Press in 2009, the memoir was vintage Karnow. “Stanley has a great line about how being a journalist is like being an adolescent all your life,” he said.

Stanley Karnow was born in Brooklyn on Feb. 4, 1925, the son of Harry and Henriette Koeppel Karnow. He grew up in a city with more than a dozen daily newspapers and decided early that he wanted to become a reporter. He served in the Army Air Forces in World War II. After graduating from Harvard with a bachelor’s degree in 1947, he sailed for France, intending to spend the summer. He stayed for a decade.

This article has been revised to reflect the following correction:

Correction: January 28, 2013

An earlier version of this article misstated the year in which Stanley Karnow was a Nieman Fellow at Harvard University. It was 1958, not 2002. The article also misspelled the name of the Nieman Fellowship.

Read More..

India Ink: Scattered Protests in Delhi on Republic Day

Several groups of protesters marched and demonstrated in New Delhi on Saturday as India celebrated its 64^th Republic Day, demanding better safety for women, a movement that started after the Dec. 16 gang rape of a young woman here.

A march of several hundred students, organized by the All India Students’ Association, sat on the street at Jantar Mantar, a designated protest area in central Delhi. The protesters carried the placards bearing slogans including, “No Violence Against Women,”l “Unknown Citizen,” and “Freedom Without Fear.” They shouted slogans including, “We Want Justice” and “Rajpath is yours. Janpath is ours.” (Rajpath is the street where the official Republic Day parade passes and Janpath is where the protesters began their march.)

“We want to counter the notion that women are safe inside. We want women to be safe outside,” said Oshin Siao Bhatt, a student at Miranda House College of Delhi University who attended.

“In 2012 only one rapist was convicted in Delhi while about 600 rapes took place,” Shafaq Khan, a philosophy student at Jawaharlal Nehru University said. “We want to reclaim our republic.”

At another rally organized by the Progressive Democratic Student Union, protesters’ placards proclaimed: “Respect The Sex Which Gave You Birth” and  “Punish The Police, Sensitize Judiciary, Eradicate Rape.”

At a third, placards read, “We Want Safety, Not Compensation,” referring to the money given by government to the family of the rape victim, and “We Want Justice Not Dates,” referring to the judicial delays.

At a fourth protest rally, an activist, Arvind Kejriwal, who has formed the Aam Admi, or Common Men, party to run for election, told a crowd that if the right people enter into politics, violence against women will decline. One small group of protesters had created a funeral pyre that they said represented the Delhi rape victim, and said they would not move themselves until the rapists were hanged.

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Digital Domain: Republic Wireless’s Plan Melds Wi-Fi and Network Calling

AN Android smartphone with unlimited calls, unlimited texting, unlimited data and no contract, all for $19 a month? Really?

When I first saw this offer from Republic Wireless, I rubbed my eyes and looked for an asterisk leading to fine print that detailed a huge catch. But Republic, a division of a telecom company called Bandwidth.com, delivers exactly what it advertises. It can do so because the handset technology is a curious hybrid: it uses Wi-Fi when the customer is in a Wi-Fi area and Sprint Nextel’s 3G network when it is not.

The concept brings together the best of two worlds: the low cost of voice calls carried over the Internet and the convenience of making calls to any phone number using a major carrier’s cellular network when Wi-Fi isn’t available.

In my own case, on a typical day, I use my mobile phone mostly when I’m not actually mobile: I’m either at home or at work, perfectly positioned to use Wi-Fi at both locations. And I don’t even use the phone as a phone all that much. I use it mainly for e-mail and texts, neither of which requires enough bandwidth to benefit from the power of the fastest data networks.

If you walk into a Verizon Wireless store and buy an iPhone 5, you’ll pay $60 or more a month for an unlimited talk and texting plan, depending on the data allocation for Internet use that you select to go with it. Some of that monthly charge goes toward repaying the carrier for the discounted price that makes a $649 iPhone seem as if it costs only $200. But most of the charge is for gaining access to the carrier’s wireless network.

“We were looking at a mobile industry that had begun to charge extraordinary amounts of money, and we saw an industry opportunity that everybody else was missing: Wi-Fi is the new mobile,” says David Morken, co-founder and chief executive of Bandwidth, based in Raleigh, N.C.

Smartphone apps that offer voice calls using data plans, not minutes allocated for calls, are plentiful. Just last month, Facebook quietly added an option that lets users of the iPhone version of Facebook Messenger place free voice calls to other Messenger users. But using those apps to make a call means the recipient has to run the same app, an irksome requirement that never comes up when using phones alone.

Republic buys access to Sprint’s network on a wholesale basis for calls made outside of Wi-Fi areas. Its business model assumes, however, that Wi-Fi carries the load a majority of the time its phones are used. The company says that its service, even at $19 a month, is a profitable operation on a per-customer basis.

“We don’t have to force people, or even ask people, how to behave,” Mr. Morken says. “Over 60 percent of the time that the phone is being used, on average, our users are using Wi-Fi and that number is only going up.”

Last month, I tested a Republic handset, a Motorola Defy XT. It’s a light smartphone with a small screen, acceptable sound quality and great battery life.

Republic’s Web site gently warns against acting like a “data hog” and encourages its customers to “play nice and try to use Wi-Fi as much as you can.” But scolding isn’t needed: Wi-Fi is faster than 3G, so users have an incentive to opt for Wi-Fi wherever it is available.

The Motorola handset is the only one now offered by Republic, and it costs $259. The phone runs an older version of Android, and it has some first-generation glitches, like losing a connection when a caller starts out on a Wi-Fi network and then leaves the coverage area. (With a click, the call is resumed using Sprint’s cellular network.)

Today most Wi-Fi access requires a logon. But that shouldn’t prove a great inconvenience: you can simply set up the phone once with Wi-Fi at home, then once more at the office. At other locations, users can ignore Wi-Fi availability and use 3G instead.

Mr. Morken says a solution to the Wi-Fi-to-cellular handoff problem has been worked out in the company’s lab, and should be available midyear. Later this year, he also expects to offer more handset models, including one at the high end; he says they will run the latest version of Android.

Matt Carter, president of the Global Wholesale and Emerging Solutions division at Sprint, asserted that the company was happy to serve as Republic’s supplier. When I asked whether Republic’s Wi-Fi-centric model, with its drastically lower price to the consumer, would pose a serious threat to the incumbent carriers, including Sprint, he said, “If the world operated based on just economic decisions, people wouldn’t go buy the most expensive cars on the planet, right?”

Mr. Carter listed reasons that most consumers would prefer the wireless service obtained directly from a major carrier: a wider range of devices and the convenience of placing a call without having to tinker with Wi-Fi setup.

Republic “will resonate with a sliver of the marketplace,” Mr. Carter said. He compared wireless carriers to the major airline carriers, which still control a majority of the market despite low-priced upstarts like JetBlue or Southwest, which he described as appealing only to “a certain segment of the population.”

Philip Cusick, a J.P. Morgan analyst who covers telecommunications, says he doesn’t expect a major shift of customers to Republic Wireless. The price difference isn’t as great as it first appears, he says, when one considers that 80 percent of customers of AT&T and Verizon are on family or employer-related discount plans.

MR. MORKEN of Bandwidth.com says he knows that his company must lower the price of its handset — the industry rule-of-thumb for no-contract wireless services is that a simple handset cannot cost more than $99 and a smartphone, $149. But if Republic can offer me an Android phone with a generously sized screen for a reasonable price, I don’t see why, with Wi-Fi available at work and home, I should continue to pay an expensive-sports-car price for my wireless service.

“There’s a reason why the carriers around the world don’t want you using Wi-Fi for voice and text,” Mr. Morken says. “You will soon realize you shouldn’t have to pay what you’re paying today.”

Randall Stross is an author based in Silicon Valley and a professor of business at San Jose State University. E-mail: stross@nytimes.com.

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