Well: No Consensus on Plantar Fasciitis

Phys Ed

Gretchen Reynolds on the science of fitness.

There are more charismatic-sounding sports injuries than plantar fasciitis, like tennis elbow, runner’s knee and turf toe. But there aren’t many that are more common. The condition, characterized by stabbing pain in the heel or arch, sidelines up to 10 percent of all runners, as well as countless soccer, baseball, football and basketball players, golfers, walkers and others from both the recreational and professional ranks. The Lakers star Kobe Bryant, the quarterback Eli Manning, the Olympic marathon runner Ryan Hall and the presidential candidate Mitt Romney all have been stricken.

But while plantar fasciitis is democratic in its epidemiology, its underlying cause remains surprisingly enigmatic. In fact, the mysteries of plantar fasciitis underscore how little is understood, medically, about overuse sports injuries in general and why, as a result, they remain so insidiously difficult to treat.

Experts do agree that plantar fasciitis is, essentially, an irritation of the plantar fascia, a long, skinny rope of tissue that runs along the bottom of the foot, attaching the heel bone to the toes and forming your foot’s arch. When that tissue becomes irritated, you develop pain deep within the heel. The pain is usually most pronounced first thing in the morning, since the fascia tightens while you sleep.

But scientific agreement about the condition and its causes ends about there.

For many years, “most of us who treat plantar fasciitis believed that it involved chronic inflammation” of the fascia, said Dr. Terrence M. Philbin, a board-certified orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, who specializes in plantar fasciitis.

It was thought that by running or otherwise repetitively pounding their heels against the ground, people strained the plantar fascia, and the body responded with a complex cascade of inflammatory biochemical processes that resulted in extra blood and fluids flowing to the injury site, as well as enhanced pain sensitivity.

But instead of lasting only a few days and then fading, as acute inflammation usually does, the process can become chronic and create its own problems, causing tissue damage and continuing pain.

This progression is also what experts believed was happening when people developed chronic Achilles tendon pain, tennis elbow or other lingering, overuse injuries.

But when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, “they did not find much if any inflammation,” Dr. Philbin said. There were virtually none of the cellular markers that characterize that condition.

“Plantar fasciitis does not involve inflammatory cells,” said Dr. Karim Khan, a professor of family practice medicine at the University of British Columbia and editor of The British Journal of Sports Medicine, who has written extensively about overuse sports injuries.

Instead, plantar fasciitis more likely is caused by degeneration or weakening of the tissue. This process probably begins with small tears that occur during activity and that, in normal circumstances, the body simply repairs, strengthening the tissue as it does. That is the point of exercise training.

But sometimes, for unknown reasons, this ongoing tissue damage overwhelms the body’s capacity to respond. The small tears don’t heal. They accumulate. The tissue begins subtly to degenerate, even to shred. It hurts.

By and large, most sports medicine experts now believe that this is how we develop other overuse injuries, like tennis elbow or Achilles tendinopathy, which used to be called tendinitis. The suffix “itis” means inflammation. But since the injury isn’t thought to involve chronic inflammation, its name has changed.

This has not yet happened with plantar fasciitis, and may not, given what a mouthful fasciopathy would be.

The evolving medical opinions about plantar fasciitis matter, beyond nomenclature, though, because treatments depend on causes. At the moment, many physicians rely on injections of cortisone, a steroid that is both a pain reliever and anti-inflammatory, to treat plantar fasciitis. And cortisone shots do reduce the soreness. In a study published last year in BMJ, patients who received cortisone injections reported less heel pain after four months than those whose shots had contained a placebo saline solution.

But whether those benefits will last is unknown, especially if plantar fasciitis is, indeed, degenerative. In studies with people suffering from tennis elbow, another injury that is now considered degenerative, cortisone shots actually slowed tissue healing.

We need similar studies in people with plantar fasciitis, Dr. Khan said. “They have not been done.”

Thankfully, most people who develop plantar fasciitis will recover within a few months without injections or other invasive treatments, Dr. Philbin said, if they simply back off their running mileage somewhat or otherwise rest the foot and stretch the affected tissues. Stretching the plantar fascia, as well as the Achilles tendon, which also attaches to the heel bone, and the hamstring muscles seems to result in less strain on the fascia during activity, meaning less ongoing trauma and, eventually, time for the body to catch up with repairs.

To ensure that you are stretching correctly, Dr. Philbin suggests consulting a physical therapist, after, of course, visiting a sports medicine doctor for a diagnosis. Not all heel or arch pain is plantar fasciitis. And comfort yourself if you do have the condition with the knowledge that Kobe Bryant, Eli Manning and Ryan Hall have all returned to competition and Mr. Romney still runs.

Read More..

Boeing Engineers Approve Pact, but Tech Workers Say No

SEATTLE (AP) — The union representing Boeing Co.'s engineers and technical workers delivered a split decision on a new contract Tuesday, with the engineers accepting their offer and the technical workers rejecting theirs and authorizing a future strike.

The union had recommended that both units reject the contract offer because it would not provide pensions to new employees. They would have a 401k retirement plan instead.

The union called that unacceptable, but the Chicago-based airplane-maker said the change was important to the company's future.

The vote came as the company is trying to solve battery problems that have grounded its new 787s. The engineers and technical workers in the union work on plans for new planes and solve problems that arise on the factory floor.

While a strike by the technical workers is not imminent, the vote means the negotiating team can call one at any time, said Bill Dugovich, spokesman for the Society of Professional Engineering Employees in Aerospace.

The engineers' vote means those 15,500 employees have a new four-year contract in place, Dugovich said. Union negotiators hope to resume contract talks soon on behalf of the 7,400 technical workers, he said.

Boeing Commercial Airplanes President and CEO Ray Conner said in a statement that the company was pleased with the engineers' vote but "deeply disappointed" in the technical workers' rejection of what he called the company's "best and final" offer.

"The realities of the market require us to make changes so we can invest in new products and keep winning in this competitive environment ..." Conner said in his statement. "That's why our proposal to move future hires to an enhanced 401(k)-style retirement plan is so important, as we have repeatedly emphasized over the course of these negotiations."

Union members rejected one previous contract offer in October. SPEEA last went on strike for 40 days in 2000.

"With this second rejection by technical workers of Boeing takeaways, it's time for the company to stop wasting resources and improve its offer to reflect the value and contributions technical workers bring to Boeing," SPEEA Executive Director Ray Goforth said in a statement. "That way, we can avoid a strike and focus on fixing the problems of the 787 and restoring customer confidence in Boeing."

The latest labor unrest is happening as U.S. regulators launch an open-ended review of the 787's design and construction. Last month, a battery on a parked 787 caught fire in Boston. On Jan. 16, another 787 made an emergency landing in Japan after another battery problem.

All 50 787s that Boeing had delivered so far are grounded until the issue is resolved.

The union's nearly 23,000 employees are mostly in the Puget Sound region. Union leaders believe a strike would shut down Boeing production lines in Everett, Wash., where its big planes are made, as well as in Renton, Wash., where it cranks out the widely used 737.

The factory-floor assembly work is done by the members of the International Association of Machinists. The Machinists approved a new, four-year contract in December 2011, after a walkout in 2008 that contributed to a 3½-year delay in delivering the first 787.

It was also a factor in Boeing opening a plant in South Carolina, where laws make it more difficult to unionize.

Read More..

President Sargsyan Wins Easy Victory in Armenia Election

President Serzh Sargsyan of Armenia easily won re-election to a second five-year term, according to preliminary returns released on Tuesday by the Central Election Commission.

The preliminary results showed Mr. Sargsyan with about 59 percent of the vote, enough to win the presidency outright and avoid a runoff. The former foreign minister, Raffi Hovanessian, was a distant second with about 37 percent, the returns showed.

Armenians went to the polls on Monday with Mr. Sargsyan heavily favored to win and maintain stability in a country that has become an increasingly important, if uneasy, United States ally in monitoring Iran’s nuclear ambitions.

A veteran politician, Mr. Sargsyan, 58, is generally viewed as having presided over modest economic improvements in recent years, even as the country has struggled because of closed borders with Turkey and Azerbaijan, its enemy in a continuing war over the disputed territory of Nagorno-Karabakh.

But while Mr. Sargsyan’s victory has been predicted for months, there have been some unexpected developments in the campaign. One challenger, Andreas Ghukasian, a political commentator who manages a radio station in the capital, Yerevan, has been on a hunger strike, demanding that the incumbent be removed from the ballot.

Another challenger, Paruir A. Airikyan, was shot in the shoulder in late January in what the authorities described as an assassination attempt, although there was no known motive. He is a former Soviet dissident who promoted Armenian independence and has run unsuccessfully for president several times.

Mr. Airikyan briefly considered invoking a constitutional provision to delay the election for two weeks as a result of his injury, but he ultimately decided to allow the balloting to proceed.

Mr. Sargsyan’s second term will be watched closely for any sign of progress in resolving the war with Azerbaijan and for any indication that Armenia would reduce support for economic sanctions against Iran, as they make life more difficult in both countries.

The conflict over Nagorno-Karabakh continues at a low simmer with periodic violence along the line of contact, including frequent exchanges of gunfire and occasional casualties. Peace talks led by the so-called Minsk Group, which is led by the United States, Russia and France, have mostly stalled.

Armenia has traditionally relied heavily on Iran as an economic partner, but those ties are now constrained by the sanctions over Iran’s nuclear program. Iran insists its purposes are peaceful, but Western powers accuse Tehran of seeking the technology to build nuclear weapons and have imposed a broadening array of United States, United Nations and European Union sanctions.

Armenia has supported the measures, while continuing to engage in some trade that circumvents them, like swapping its electricity for natural gas from Iran with no money changing hands.

“Having Iran as your economic lifeline is not a good position to be in,” said one senior Western diplomat, who asked not to be identified to avoid creating any tension with players in the region.

“They have been very, very careful, very, very good, at some cost to Armenia, to honor international U.N., U.S. and E.U. sanctions against Iran,” the diplomat said. “But it’s increasingly difficult for them to do that.”

International election observers have fanned out across Armenia in recent days. Initial reports suggested that Mr. Sargsyan’s party had made some inappropriate use of government resources to promote his candidacy, a common criticism of incumbent candidates in former Soviet republics. But observers say the overall political climate has improved, with opposition candidates, for instance, enjoying better access to coverage by the news media.

Still, Armenia faces a peculiar problem when it comes to potential election fraud because of the hundreds of thousands of Armenian citizens who live abroad, including in the United States — one of the largest percentage diasporas in the world given Armenia’s population of 3.1 million, according to the World Bank.

With few exceptions, absentee balloting is not permitted. That means the Armenian election rolls are filled with the names of people who will not appear in person to vote, creating the potential for fraudulent use of those names.

Mr. Sargsyan faced relatively weak competition after his two strongest potential challengers and their parties announced last year that they would not compete — former President Levon Ter-Petrossian of the Armenian National Congress and Gagik Tsarukyan of the Prosperous Armenia Party. Mr. Tsarukyan is a wealthy businessman, lawmaker and the head of Armenia’s national Olympic committee.

Mr. Sargsyan and his wife, Rita, paused Monday to speak with reporters after voting in Yerevan. “I have voted for the security of our citizens and our families,” he said, according to aysor.am, an Armenian news site.

Read More..

China’s Army Is Seen as Tied to Hacking Against U.S.

This 12-story building on the outskirts of Shanghai is the headquarters of Unit 61398 of the People’s Liberation Army. China’s defense ministry has denied that it is responsible for initiating digital attacks.

On the outskirts of Shanghai, in a run-down neighborhood dominated by a 12-story white office tower, sits a People’s Liberation Army base for China’s growing corps of cyberwarriors.

The building off Datong Road, surrounded by restaurants, massage parlors and a wine importer, is the headquarters of P.L.A. Unit 61398. A growing body of digital forensic evidence — confirmed by American intelligence officials who say they have tapped into the activity of the army unit for years — leaves little doubt that an overwhelming percentage of the attacks on American corporations, organizations and government agencies originate in and around the white tower.

An unusually detailed 60-page study, to be released Tuesday by Mandiant, an American computer security firm, tracks for the first time individual members of the most sophisticated of the Chinese hacking groups — known to many of its victims in the United States as “Comment Crew” or “Shanghai Group” — to the doorstep of the military unit’s headquarters. The firm was not able to place the hackers inside the 12-story building, but makes a case there is no other plausible explanation for why so many attacks come out of one comparatively small area.

“Either they are coming from inside Unit 61398,” said Kevin Mandia, the founder and chief executive of Mandiant, in an interview last week, “or the people who run the most-controlled, most-monitored Internet networks in the world are clueless about thousands of people generating attacks from this one neighborhood.”

Other security firms that have tracked “Comment Crew” say they also believe the group is state-sponsored, and a recent classified National Intelligence Estimate, issued as a consensus document for all 16 of the United States intelligence agencies, makes a strong case that many of these hacking groups are either run by army officers or are contractors working for commands like Unit 61398, according to officials with knowledge of its classified content.

Mandiant provided an advance copy of its report to The New York Times, saying it hoped to “bring visibility to the issues addressed in the report.” Times reporters then tested the conclusions with other experts, both inside and outside government, who have examined links between the hacking groups and the army (Mandiant was hired by The New York Times Company to investigate a sophisticated Chinese-origin attack on its news operations, but concluded it was not the work of Comment Crew, but another Chinese group. The firm is not currently working for the Times Company but it is in discussions about a business relationship.)

While Comment Crew has drained terabytes of data from companies like Coca-Cola, increasingly its focus is on companies involved in the critical infrastructure of the United States — its electrical power grid, gas lines and waterworks. According to the security researchers, one target was a company with remote access to more than 60 percent of oil and gas pipelines in North America. The unit was also among those that attacked the computer security firm RSA, whose computer codes protect confidential corporate and government databases.

Contacted Monday, officials at the Chinese embassy in Washington again insisted that their government does not engage in computer hacking, and that such activity is illegal. They describe China itself as a victim of computer hacking, and point out, accurately, that there are many hacking groups inside the United States. But in recent years the Chinese attacks have grown significantly, security researchers say. Mandiant has detected more than 140 Comment Crew intrusions since 2006. American intelligence agencies and private security firms that track many of the 20 or so other Chinese groups every day say those groups appear to be contractors with links to the unit.

While the unit’s existence and operations are considered a Chinese state secret, Representative Mike Rogers of Michigan, the Republican chairman of the House Intelligence Committee, said in an interview that the Mandiant report was “completely consistent with the type of activity the Intelligence Committee has been seeing for some time.”

Read More..

National Briefing | South: Abortion Curbs Clear Senate in Arkansas

The State Senate voted 25 to 7 on Monday to ban most abortions 20 weeks into a pregnancy. The measure goes back to the House to consider an amendment that added exceptions for rape and incest. The legislation is based on the belief that fetuses can feel pain 20 weeks into a pregnancy, and is similar to bans in several other states. Opponents say it would require mothers to deliver babies with fatal conditions. Gov. Mike Beebe has said he has constitutional concerns about the proposal but has not said whether he will veto it.

Read More..

National Briefing | South: Abortion Curbs Clear Senate in Arkansas

The State Senate voted 25 to 7 on Monday to ban most abortions 20 weeks into a pregnancy. The measure goes back to the House to consider an amendment that added exceptions for rape and incest. The legislation is based on the belief that fetuses can feel pain 20 weeks into a pregnancy, and is similar to bans in several other states. Opponents say it would require mothers to deliver babies with fatal conditions. Gov. Mike Beebe has said he has constitutional concerns about the proposal but has not said whether he will veto it.

Read More..

Japan Finds Swelling in Second Boeing 787 Battery

TOKYO (Reuters) - Cells in a second lithium-ion battery on a Boeing Co 787 Dreamliner forced to make an emergency landing in Japan last month showed slight swelling, a Japan Transport Safety Board (JTSB) official said on Tuesday.

The jet, flown by All Nippon Airways Co, was forced to make the landing after its main battery failed.

"I do not know the exact discussion taken by the research group on the ground, but I heard that it is a slight swelling (in the auxiliary power unit battery cells). I have so far not heard that there was internal damage," Masahiro Kudo, a senior accident investigator at the JTSB said in a briefing in Tokyo.

Kudo said that two out of eight cells in the second battery unit showed some bumps and the JTSB would continue to investigate to determine whether this was irregular or not.

The plane's auxiliary power unit (APU) powers the aircraft's systems when it is on the ground. National Transportation Safety Board investigators in the United States are probing the APU from a Japan Airlines plane that caught fire at Boston's Logan airport when the plane was parked.

The U.S. Federal Aviation Authority grounded all 50 Boeing Dreamliners in commercial service on January 16 after the incidents with the two Japanese owned 787 jets.

The groundings have cost airlines tens of millions of dollars, with no solution yet in sight.

Boeing rival Airbus said last week it had abandoned plans to use lithium-ion batteries in its next passenger jet, the A350, in favor of traditional nickel-cadmium batteries.

Lighter and more powerful than conventional batteries, lithium-ion power packs have been in consumer products such as phones and laptops for years but are relatively new in industrial applications, including back-up batteries for electrical systems in jets.

(Reporting by Mari Saito; Editing by Richard Pullin)

Read More..

IHT Rendezvous: In Singapore's Immigration Debate, Sign of Asia's Slipping Middle Class?

BEIJING — Immigration is a hot-button issue nearly everywhere in the world, though the contours of the debate vary from place to place. In the United States, sweeping changes to the law may offer legal residency for millions of people who have entered the country illegally, my colleague Ashley Parker reports.

In Singapore, the debate looks somewhat different: The government plans to increase the population from just over five million to a possible high of nearly seven million by 2030, via regulated, legal immigration, and this is provoking opposition.

So much so that on Saturday, about 3,000 people turned out for what some commentators said was one of the biggest demonstrations in the nation’s history. (If the number seems small, it reflects the tight political control exerted over Singapore life by the People’s Action Party, which has run the country for about half a century and discourages public protest.)

What are the contours of the debate in Singapore?

Concern over booming immigration, often focused on new arrivals from increasingly rich China, has been simmering in the nation, with many feeling that the immigrants do not play by the same rules, that their manners are poor and that they are pushing up prices. That feeling crystallized last year when a wealthy Chinese man driving a Ferrari at high speed killed three people (including himself) in a nighttime accident.

(Similar sentiments are found in Hong Kong, as my colleagues Bettina Wassener and Gerry Mullany wrote.)

Vividly illustrating the resentment, Singaporeans sometimes call the wealthy immigrants “rich Chinese locusts,” according to an article in the Economic Observer’s Worldcrunch.

So the Singapore government’s Population White Paper that passed in Parliament earlier this month, just before Chinese New Year, was bound to stir things up.

The government is presenting the rise in immigration as a target that is needed if Singapore, where immigrants already make up about 40 percent of the population, and which has the highest concentration of millionaires in the world, is to continue to flourish, reports said. Singaporeans just are not having enough children, said the prime minister, Lee Hsien Loong.

“In my view, in 2030, I think six million will not be enough to meet Singaporeans’ needs as our population ages because of this problem of the baby boomers and bulge of aging people,” Mr. Lee said in Parliament, adding that 6.9 million was not a target but a number to be used to help plan for infrastructure.

“Do we really need to increase our population by that much?” wrote a person called Chang Wei Meng in a letter to The Straits Times, according to Reuters. “What happened to achieving the Swiss standard of living?”

Gilbert Goh, a main organizer of the rally Saturday at Singapore’s Speaker’s Corner in a public park, said the protesters had a message: “They want to tell the government, please reconsider this policy. The turnout is a testimony that this policy is flawed and unpopular on the ground,” The Associated Press quoted Mr. Goh as saying.

Yet amid the familiar rhetoric about immigrants, heard around the world – they don’t fit in, they’re rude, they’re different – might something more important be going on here?

In a blog post on Singapore News Alternative, Nicole Seah, a politician who has run for Parliament and comments on social issues, wrote: “Along with many other Singaporeans, I oppose the White Paper.”

Why? She is looking for “a society that lives in harmony, rather than tense and overcrowded conditions,” she writes.

“Not the Singapore Inc. that has been aggressively forced down our throats the past few years – a Singapore which is in danger of becoming a transient state where people from all over, come, make their fortunes, and leave.”

Not “a Singapore that has become a playground for the rich and the people who can afford it. A Singapore where the middle class is increasingly drowned out because they do not have the social clout or sufficient representatives in Parliament to voice their concerns.”

Ms. Seah’s statements raise an interesting question: Is this part of a phenomenon that the columnist Chrystia Freeland has written about so ably for this newspaper, the ascendancy of a wealthy, “plutocrat” class and the slipping status of the middle class?

As Ms. Freeland wrote last week: “The most important fact about the United States in this century is that middle-class incomes are stagnating. The financial crisis has revealed an equally stark structural problem in much of Europe.” Is it hitting Asia, too, and does Singapore’s protest speak, at least in part, to this? Hong Kong’s dissatisfaction too?

Read More..

Tech Industry Sets Its Sights on Gambling

Jim Wilson/The New York Times

Cesar Miranda, left, and his brother, Edgar, working on their claw crane game in San Jose, Calif.

SAN FRANCISCO — Look out Las Vegas, here comes FarmVille.

Silicon Valley is betting that online gambling is its next billion-dollar business, with developers across the industry turning casual games into occasions for adults to wager.

At the moment these games are aimed overseas, where attitudes toward gambling are more relaxed and online betting is generally legal, and extremely lucrative. But game companies, from small teams to Facebook and Zynga, have their eye on the ultimate prize: the rich American market, where most types of real-money online wagers have been cleared by the Justice Department.

Two states, Nevada and Delaware, are already laying the groundwork for virtual gambling. Within months they will most likely be joined by New Jersey.

Bills have also been introduced in Mississippi, Iowa, California and other states, driven by the realization that online gambling could bring in streams of tax revenue. In Iowa alone, online gambling proponents estimated that 150,000 residents were playing poker illegally.

Legislative progress, though, is slow. Opponents include an influential casino industry wary of competition and the traditional antigambling factions, who oppose it on moral grounds.

Silicon Valley is hardly discouraged. Companies here believe that online gambling will soon become as simple as buying an e-book or streaming a movie, and that the convenience of being able to bet from your couch, surrounded by virtual friends, will offset the lack of glittering ambience found in a real-world casino. Think you can get a field of corn in FarmVille, the popular Facebook game, to grow faster than your brother-in-law’s? Five bucks says you cannot.

“Gambling in the U.S. is controlled by a few land-based casinos and some powerful Indian casinos,” said Chris Griffin, chief executive of Betable, a London gambling start-up that handles the gaming licenses and betting mechanics of the business for developers. “What potentially becomes an interesting counterweight is all of a sudden thousands of developers in Silicon Valley making money overseas and wanting to turn their efforts inward and make money in the U.S.”

Betable has set up shop in San Francisco, where 15 studios are now using its back-end platform. “This is the next evolution in games, and kind of ground zero for the developer community,” Mr. Griffin said.

Overseas, online betting is generating an estimated $32 billion in annual revenue — nearly the size of the United States casino market. Juniper Research estimates that betting on mobile devices alone will be a $100 billion worldwide industry by 2017.

“Everyone is really anticipating this becoming a huge business,” said Chris DeWolfe, a co-founder of the pioneering social site Myspace, who is throwing his energies into a gaming studio with a gambling component backed by, among others, the personal investment funds of Jeff Bezos, Amazon’s founder, and Eric E. Schmidt, Google’s executive chairman.

As companies eagerly wait for the American market to open up, they are introducing betting games in Britain, where Apple has tweaked the iPhone software to accommodate them. Facebook began allowing online gambling for British users last summer with Jackpotjoy, a bingo site; deals with other developers followed in December and this month.

Zynga, the company that developed FarmVille, Mafia Wars, Words With Friends and many other popular casual games, is advertising the imminent release of its first betting games in Britain. “All your favorite Zynga game characters will be there, except this time they’ll have real money prizes to offer you,” an ad says. “Play online casino games for pennies and live the dream!”

Mr. DeWolfe’s studio, SGN, is also on the verge of starting its first real-money games in Britain. “Those companies that have a critical mass of users that are interested in playing real-money games are going to be incredibly valuable,” he said.

Mark Pincus, the chief executive of Zynga, said the company was just following the market. “There is no question there is great interest from all kinds of people in games of chance, whether it is for real money or virtual rewards,” he said. Zynga, which has missed revenue expectations in the last year, is making gambling a centerpiece of its new strategy. It has just applied to Nevada for a gambling license.

Casual gaming first blossomed on Facebook’s Web site, where players could readily corral friends into their games. It is now being rethought for mobile devices, so people can play in brief snippets as they wait for a bus or a sandwich.

Some games mimic the slots and poker found in casinos; others emphasize considerably more creativity. The vast majority of casual game players play at no charge. A small number buy virtual objects in the game to speed their play or increase their status.

Tech executives expect an equally small number to play for real money but believe they will bet heavily, making them much more valuable to the gaming companies. By Betable’s estimate, the lifetime value of a casual player is $2 versus $1,800 for a real-money player.

Read More..

Well: Health Effects of Smoking for Women

The title of a recent report on smoking and health might well have paraphrased the popular ad campaign for Virginia Slims, introduced in 1968 by Philip Morris and aimed at young professional women: “You’ve come a long way, baby.”

Today that slogan should include: “…toward a shorter life.” Ten years shorter, in fact.

The new report is one of two rather shocking analyses of the hazards of smoking and the benefits of quitting published last month in The New England Journal of Medicine. The data show that “women who smoke like men die like men who smoke,” Dr. Steven A. Schroeder, a professor of health and health care at the University of California, San Francisco, wrote in an accompanying editorial.

That was not always the case. Half a century ago, the risk of death from lung cancer among men who smoked was five times higher than that among women smokers. But by the first decade of this century, that risk had equalized: for both men and women who smoked, the risk of death from lung cancer was 25 times greater than for nonsmokers, Dr. Michael J. Thun of the American Cancer Society and his colleagues reported.

Today, women who smoke are even more likely than men who smoke to die of lung cancer. According to a second study in the same journal, women smokers face a 17.8 times greater risk of dying of lung cancer than women who do not smoke; men who smoke are at 14.6 times greater risk to die of lung cancer than men who don’t. Women who smoke now face a risk of death from lung cancer that is 50 percent higher than the estimates reported in the 1980s, according to Dr. Prabhat Jha of the Center for Global Health Research in Toronto and his colleagues.

After controlling for age, body weight, education level and alcohol use, the new analysis found something else: men and women who continue to smoke die on average 10 years sooner than those who never smoked.

Dramatic progress has been made in reducing the prevalence of smoking, which has fallen from 42 percent of adults in 1965 (the year after the first surgeon general’s report on smoking and health) to 19 percent in 2010. Yet smoking still results in nearly 200,000 deaths a year among people 35 to 69 years old in the United States. A quarter of all deaths in this age group would not occur if smokers had the same risk of death as nonsmokers.

The risks are even greater among men 55 to 74 and women 60 to 74. More than two-thirds of all deaths among current smokers in these age groups are related to smoking. Over all, the death rate from all causes combined in these age groups “is now at least three times as high among current smokers as among those who have never smoked,” Dr. Thun’s team found.

While lung cancer is the most infamous hazard linked to smoking, the habit also raises the risk of death from heart disease, stroke, pulmonary disease and other cancers, including breast cancer.

Furthermore, changes in how cigarettes are manufactured may have increased the dangers of smoking. The use of perforated filters, tobacco blends that are less irritating, and paper that is more porous made it easier to inhale smoke and encouraged deeper inhalation to achieve satisfying blood levels of nicotine.

The result of deeper inhalation, Dr. Thun’s report suggests, has been an increased risk of chronic obstructive pulmonary disease, or C.O.P.D., and a shift in the kind of lung cancer linked to smoking. Among nonsmokers, the risk of death from C.O.P.D. has declined by 45 percent in men and has remained stable in women, but the death rate has more than doubled among smokers.

But there is good news, too: it’s never too late to reap the benefits of quitting. The younger you are when you stop smoking, the greater your chances of living a long and healthy life, according to the findings of Dr. Jha’s international team.

The team analyzed smoking and smoking-cessation histories of 113,752 women and 88,496 men 25 and older and linked them to causes of deaths in these groups through 2006.

Those who quit smoking by age 34 lived 10 years longer on average than those who continued to smoke, giving them a life expectancy comparable to people who never smoked. Smokers who quit between ages 35 and 44 lived nine years longer, and those who quit between 45 and 54 lived six years longer. Even quitting smoking between ages 55 and 64 resulted in a four-year gain in life expectancy.

The researchers emphasized, however, that the numbers do not mean it is safe to smoke until age 40 and then stop. Former smokers who quit by 40 still experienced a 20 percent greater risk of death than nonsmokers. About one in six former smokers who died before the age of 80 would not have died if he or she had never smoked, they reported.

Dr. Schroeder believes we can do a lot better to reduce the prevalence of smoking with the tools currently in hand if government agencies, medical insurers and the public cooperate.

Unlike the races, ribbons and fund-raisers for breast cancer, “there’s no public face for lung cancer, even though it kills more women than breast cancer does,” Dr. Schroeder said in an interview. Lung cancer is stigmatized as a disease people bring on themselves, even though many older victims were hooked on nicotine in the 1940s and 1950s, when little was known about the hazards of smoking and doctors appeared in ads assuring the public it was safe to smoke.

Raising taxes on cigarettes can help. The states with the highest prevalence of smoking have the lowest tax rates on cigarettes, Dr. Schroeder said. Also helpful would be prohibiting smoking in more public places like parks and beaches. Some states have criminalized smoking in cars when children are present.

More “countermarketing” of cigarettes is needed, he said, including antismoking public service ads on television and dramatic health warnings on cigarette packs, as is now done in Australia. But two American courts have ruled that the proposed label warnings infringed on the tobacco industry’s right to free speech.

Health insurers, both private and government, could broaden their coverage of stop-smoking aids and better publicize telephone quit lines, and doctors “should do more to stimulate quit attempts,” Dr. Schroeder said.

As Nicola Roxon, a former Australian health minister, put it, “We are killing people by not acting.”

Read More..