IHT Rendezvous: Regulating the British Press

LONDON — News doesn’t just travel fast here. It happens fast, too. And once it has happened, new news overtakes the old: the dogs bark, as the old Middle Eastern adage has it, but the caravan moves on.

So it has seemed in the almost two months since the publication of the bulky Leveson Report into the culture and behavior of the British press. The land has been swamped by a procession of other front-page stories — British hostages in Algeria! Referendum on Europe! — and the urgency of Lord Justice Sir Brian Leveson’s call for statutory oversight of the rambunctious press here seems to have dissipated.

But a couple of developments in recent days have recalled some of the issues — quite apart from a steady trickle of arrests linked to the phone hacking and allied scandals that prompted the Leveson inquiry in the first place.

Page Two

Posts written by the IHT’s Page Two columnists.

One was the return from duty in Afghanistan of Prince Harry, the third in line to the British throne, who, as I describe in my latest column on Page Two of The International Herald Tribune, stirred a media frenzy by acknowledging that — no real surprise here — as the gunner co-pilot of an Apache attack helicopter, he was expected to fire on Taliban insurgents.

But there was a sub-plot.

Prince Harry’s aversion to the British media — equally unsurprising in light of the tangled relationship between his mother, Princess Diana, and the world’s newspapers, photographers and broadcasters — appears to be growing to the extent that he accused the British press of always writing “rubbish” about him.

A video report from Britain’s Channel 4 News shot during Prince Harry’s recent deployment to Afghanistan.

And yet, for the 20 weeks of Prince Harry’s deployment in Afghanistan, most news outlets in Britain had largely agreed with Buckingham Palace and the Ministry of Defense not to cover closely his role in the war, in return for guaranteed access at the end of his tour — a gesture of what the authorities would doubtless call responsibility on the part of that same press the prince dismissed.

The prince’s comments drew a tart response from Peter Barron, the editor of the regional Northern Echo. “It would have been nice if Prince Harry had resisted getting out his huge tar brush to blacken the entire British press and acknowledged that there are good and bad in every profession — including the armed forces,” he said.

The broader issue of how Britain regulates its media is still the object of closed-door talks among editors and executives and between politicians. But it could well resurface publicly next month.

“This is not about politicians determining what journalists do or do not write. The freedom of the press is essential,” Harriet Harman, the spokeswoman on media affairs for the opposition Labour Party, told a gathering in Oxford, England, last week. “But so is that other freedom: the freedom of a private citizen to go about their business without harassment, intrusion or the gross invasion of their grief and trauma. Those two freedoms are not incompatible.”

She challenged the government directly to set out its own proposals for the future regulation of the press.

“It is now time for the government to have the courage of its convictions,” she said, adding: “The public must be able to scrutinize the proposals. And Parliament — to whom Lord Justice Leveson trusted a key role in setting up the new system — must be able to decide.”

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Dispute With Antigua and Barbuda Threatens U.S. Copyrights

WASHINGTON — A long-simmering trade conflict between the United States and Antigua and Barbuda appears to be boiling over.

Antigua and Barbuda, which has a $1 billion economy, is planning on getting legal retribution from the United States’ $15 trillion economy over its refusal to let Americans gamble at online sites based in the Caribbean nation — perhaps by offering downloads of American intellectual property, like Hollywood films, network television shows or hit pop songs. On Monday, the World Trade Organization gave its go-ahead for Antigua and Barbuda’s tentative plan.

“The economy of Antigua and Barbuda has been devastated by the United States government’s long campaign to prevent American consumers from gambling,” Harold Lovell, Antigua’s finance minister, said in a statement. “These aggressive efforts to shut down the remote gaming industry in Antigua have resulted in the loss of thousands of good-paying jobs and seizure by the Americans of billions of dollars belonging to gaming operators and their customers.”

The conflict’s roots are a decade old. The World Trade Organization said that the United States had violated its trade agreements by preventing Americans from betting at sites based in Antigua and Barbuda. Because Washington is unwilling to make the betting legal, the countries have been locked in a dispute over what constitutes fair trade practices and fair compensation.

The online gambling industry was at one point the second-largest employer in the Caribbean country, its government has said, and economists estimated its worth at $3.4 billion. Gambling employment has dropped to fewer than 500 people from more than 4,000 as a result of the United States’ trade policy, it said.

On Monday, a dispute settlement body in Geneva gave Antigua and Barbuda the nod to, in essence, violate American intellectual property rights to make up its losses, calculated at $21 million a year.

It remains murky just how the Antigua and Barbuda government might go about it. But trade watchers suggested it might set up a site where viewers could pay a pittance to watch a film or television show with an American copyright. The United States might not be able to shut the site down under international law.

“We are disappointed with Antigua and Barbuda’s decision to abandon constructive settlement discussions,” Nkenge Harmon, a spokeswoman for the United States trade representative, said in an e-mail. “As recently as Friday, our two countries held high-level discussions on possible settlement options that would have brought real benefits to Antigua’s businesses and people.”

The Obama administration said that the proposed plan might further hurt trade relations between the two countries.

“If Antigua does proceed with the unprecedented plan for its government to authorize the theft of intellectual property, it would only serve to hurt Antigua’s own interests,” Ms. Harmon said. “Government-authorized piracy would undermine chances for a settlement. It also would serve as a major impediment to foreign investment in the Antiguan economy, particularly in high-tech industries.”

Trade experts said that Antigua and Barbuda’s plan for retribution seemed designed to provoke American filmmakers and recording artists into pushing for Congress to allow foreign Internet gambling sites to serve American customers.

They also noted that it was the United States that had pushed for the unusual “cross-retaliation” mechanism at the W.T.O., where trade violations that hurt one industry could be countered with trade actions against a completely different industry.

“The irony is rich, rich, rich,” said Lori Wallach, the director of Global Trade Watch at Public Citizen, a Washington-based consumer advocacy group.

“The practical question is, Is there a majority in the House and Senate to vote to revoke the ban, and would Congress do it because the W.T.O. told them?” she said, saying it was unclear how the two countries would proceed.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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