Well: Can Foods Affect Colon Cancer Survival?

A new study suggests that what you eat may affect your chances of surviving colon cancer.

The research is among the first to look at the impact that specific nutrients have on the likelihood of disease recurrence in people with colon cancer, one of the leading causes of cancer death in the United States. It found that people treated for Stage 3 disease, in which tumor cells have spread to lymph nodes, had greatly increased chances of dying of it or experiencing a recurrence if their diets were heavy in carbohydrate-rich foods that cause spikes in blood sugar and insulin.

The patients who consumed the most carbohydrates and foods with high glycemic loads — a measure of the extent to which a serving of food will raise blood sugar — had an 80 percent greater chance of dying or having a recurrence during the roughly seven-year study period than those who had the lowest levels. Stage 3 colon cancer patients typically have a five-year survival rate of about 50 to 65 percent.

The study, however, was observational, meaning it could only highlight an association between carbohydrates and cancer outcomes without proving direct cause and effect. The researchers also obtained some of their data from food questionnaires that required patients to recall details about their diets, a method that can be unreliable.

Still, the researchers, who published their findings in The Journal of the National Cancer Institute, believe insulin may play a critical role in colon cancer recurrence. Chronically high insulin levels have been linked to cancer recurrence and mortality in previous research, and people with a history of Type 2 diabetes or elevated plasma C-peptide, a marker of long-term insulin production, have also been found to have an increased risk of colon cancer. One hypothesis is that insulin may fuel the growth of cancer cells and prevent cell death, or apoptosis, in cancer cells that have spread.

“It’s not simply that all carbs are bad or that you should avoid all sugar,” said Dr. Jeffrey A. Meyerhardt, the lead author of the study and an associate professor of medicine at the Dana-Farber Cancer Institute in Boston. It’s not as simple as ‘sugar causes cancer to grow.’”

He added: “Different carbs and sugar lead to different responses in your body. I think people should focus on a well-balanced diet” and substitute foods associated with lower glycemic loads or carbs for foods that have higher levels.

Earlier research published by Dr. Meyerhardt’s group showed that Stage 3 colon cancer patients who most closely followed a Western-style diet — with high intakes of meat, fat, refined grains and sugary desserts — had a threefold increase in recurrence and death from the disease compared with those who most strongly deviated from Western patterns of eating.

For this study, Dr. Meyerhardt and his team wanted to see to what extent carbohydrate intake could influence the progression of the disease, so they followed about 1,000 Stage 3 colon cancer patients taking part in a clinical trial sponsored by the National Cancer Institute. The patients, who had all had surgery and chemotherapy as part of their treatments, provided information on their diets and lifestyle habits. But the researchers went beyond just carbohydrate and sugar intake, taking into account glycemic measures.

The glycemic index, an increasingly popular nutritional measure, looks at the rate at which carbohydrate-containing foods raise a person’s fasting level of blood sugar and subsequent need for insulin. Sugary drinks, white bread and other highly processed carbohydrates rank higher on the index, while those that are digested more slowly, like brown rice, many vegetables, unrefined grains and legumes, have a lower index value.

Another barometer, however, is the glycemic load, which refers to the blood sugar effect of a standard serving of a food. A glycemic load of 10 or less for a food is generally considered low, while 20 or more is high. The latest study showed that glycemic load and total carbohydrate intake were the best predictors of cancer recurrence and mortality, and the link was strongest in people who were overweight or obese.

Dr. Meyerhardt said the findings suggest that colon cancer patients would be wise to keep glycemic load in mind while making food decisions, looking for ways to work into their diets foods that rank lower on the scale.

“So if you think about beverages, most juices and certainly sodas have a higher glycemic load than flavored waters and tomato juice and things like that,” he said. “Fruits like a date or raisins have very high glycemic loads, whereas fresh fruits like an apple, orange or cantaloupe all have sugar but have a very low glycemic load. Substitute brown rice for white, whole grains instead of white bread, and instead of having a starchy potato as your side dish, substitute beans and vegetables.”

One expert who was not involved in the research, Somdat Mahabir, a nutritional epidemiologist with the National Cancer Institute’s division of cancer control and population sciences, said the findings from the latest study must be borne out in further research. But in the meantime, making dietary changes that reduce glycemic load is a reasonable recommendation for colon cancer patients, he said, since it can only be helpful, not harmful.

“The results of the current study need to be confirmed, but the current indications are that diet is important to colon cancer survival,” Dr. Mahabir said.

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Your Money: After the Storm: Managing Your Homeowner’s Claim

Tom Mihalek/Reuters

Mark Baronowski shoveled sand from the living room of a beach front property in Bay Head, N.J., last week. Many victims of Hurricane Sandy are novices when it comes to catastrophic insurance claims.

There is a sort of honeymoon period that occurs after a big storm like Hurricane Sandy, when insurance executives appear on the local news offering reassuring words. Their brightly painted vans pull into residential neighborhoods amid the standing water and debris. Everyone is hopeful. Handshakes and back-patting all around.

That period is about to end. Prices for roofers and construction materials will rise, disadvantageous parsing of policy language will commence and gangs of class-action lawyers will round up aggrieved clients who still have months of homelessness ahead of them. Many claims will take years to settle.

It happens every time, and so it will with this storm. That’s not to say that a majority of people with insurance claims won’t be satisfied with the check they receive or won’t get one quickly.

But when this many people have extensive damage to their most significant asset, billions of dollars are at stake for the companies that have the power to make them whole. So there is no reason for policyholders to be anything but wary until their own big check clears.

Many victims of Hurricane Sandy are novices when it comes to catastrophic insurance claims. So to see what sort of resistance they should expect shortly, I turned to the lawyers and adjusters-for-hire who do nothing but negotiate with insurance companies all day long. Some of them used to work for the companies, in fact.

Here are the things they warn people to watch out for:

THAT INDEPENDENT ADJUSTER Many people with damaged homes have started to meet with representatives who assessed their damaged homes to estimate repair costs. They may have introduced themselves as “independent adjusters,” but this is a misnomer. They represent the insurance company and are not neutral.

In storms like this, large numbers of these freelance claims adjusters parachute in from out of town. In the industry, they are known as storm troopers. They work 18-hour days for a while since no insurance company has enough of its own full-time staff to deploy after a storm like this one. Often, they make enough money not to work for months afterward.

“These guys have a lot of work to do, and it’s a thankless job,” said Matthew Tennenbaum, who used to be an independent adjuster but switched sides and now works for policyholders as a “public” adjuster in Cherry Hill, N.J.

Mr. Tennenbaum worries about the storm troopers’ thoroughness. “They’re going to see 10 properties a day and they’re quickly writing estimates,” he said. “If they spend an extra three or four hours properly writing one estimate, they could have written three more and made more money.”

Though many of them are former builders or contractors, they may not, if time is of the essence, always pull up every floor, explore every inch of the attic or look behind every wall. And they may not know much about your insurance company’s policy.

“The insurance companies hand them a manual, and they may not really understand the manual,” said J. Robert Hunter, the director of insurance for the Consumer Federation of America, who has worked for insurance companies and once ran the federal flood insurance program.  “It’s a crash course at that point.”

  The good news here is that these are not the people who make the final call on your claim. But many policyholders assume that their word is the final word.

WIND VERSUS FLOOD Back at headquarters, other adjusters have their eye on an exclusion that will be crucial for this storm, with its horrific storm surges but relatively mild winds: homeowner’s insurance generally does not cover floods.

Unfortunately, many people do not know this and many more have not purchased or renewed policies with the federal flood insurance program that covers up to $250,000 of flood damage. Researchers from the Wharton Risk Management and Decision Processes Center, working with colleagues at Florida State, the University of Miami and Columbia University, surveyed people in the storm’s path by telephone three days before it hit.

Among people within a block of a body of water, 46 percent had no flood insurance. In areas that had been evacuated in past storms or where the authorities advised people to leave, 58 percent did not have it. Moreover, 39 percent of all the people who thought they did have flood coverage mistakenly believed that their homeowner’s insurance covered it.

People without coverage but lots of damage from the storm surge might do one of a couple of things. A few stubborn ones will sue, arguing that if the wind drove the surge then it’s not really a flood. Judges haven’t taken kindly to this line of reasoning over the years, but that probably won’t keep people from trying again. The Federal Emergency Management Agency may also offer some assistance.

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Preparing to Step Aside in China, Hu Jintao Warns of Challenges

Changing of the Guard in China:
The New York Times’s Beijing correspondents discuss the challenges ahead for China as the country begins its once-in-a-decade leadership transition.

BEIJING — Capping 10 careful years at the helm of the Communist Party, China’s top leader, Hu Jintao, on Thursday boasted of successes during his tenure while issuing a blunt warning against unrest and political reform.

Mr. Hu, 69, is to step down as the party’s general secretary next week, handing over power to his designated successor, Xi Jinping. His speech at the opening here in Beijing of the Communist Party’s 18th Congress was likely to be his last major address — a chance to write his own eulogy while also setting the course for Mr. Xi.

“He’s worried about how history will view him,” said Qian Gang, who works with the China Media Project of Hong Kong University. “On the whole, he is against reform.”

Formally, Mr. Hu nodded to almost every manner of reform: economic, social, political and environmental. But, in the fashion of his predecessors, this was balanced with warnings of the need to guard against a rise in unrest. It was an unusual admission for a man whose signature slogan is creating for China a “harmonious society.”

“Social contradictions have clearly increased,” said the formal 64-page document issued at the congress. (Mr. Hu’s speech, even at 100 minutes, was only a summary.)

“There are many problems concerning the public’s immediate interests in education, employment, social security, health care, housing, the environment, food and drug safety, workplace safety, public security and law enforcement.”

The solution, Mr. Hu said, was “reform and opening up,” a policy initiated by the man who chose him for the job nearly two decades ago, the paramount leader Deng Xiaoping.

Mr. Hu also lauded his own contribution to Communist Party ideology: “Scientific Development.” Most of his predecessors have had their own ideologies enshrined as guiding state doctrines. His repetition of the phrase — which means that the party should be pragmatic and follow policies that are demonstrably effective — implied that he, too, would be so honored.

But his caveats to reform were many.

According to Mr. Qian, a leading expert on textual analysis of Chinese leaders’ speeches, Mr. Hu’s speech hit on almost every anti-reform phrase used by Chinese Communist leaders.

He referred to Communist China’s founder three times with the phrase “Mao Zedong Thought,” and said the party must “resolutely not follow Western political systems,” something not mentioned at the last party congress five years ago.

“They don’t say these terms lightly,” Mr. Qian said. “When they mention it, it matters.”

Mr. Hu also coined a new term, pledging that the party will not to follow the “wicked way” of changing the party’s course.

Mr. Hu’s speech is thought to have been drawn up in cooperation with his successor, Mr. Xi. While Mr. Xi is widely thought to be consulting with liberal members of China’s intelligentsia, he either did not oppose Mr. Hu’s direction or was not able to change it.

That is important, observers say, because Mr. Xi will not exercise unrestrained power when he takes over. Besides the other half-dozen members on the Standing Committee of the party’s Politburo, he will also have to listen to the advice of Mr. Hu, Mr. Hu’s own predecessor, Jiang Zemin, and an estimated 20 other “senior leaders.” As if to emphasize their role, these men were seated on the dais next to Mr. Hu. Many of them are in their 70s and 80s and have exercised power for decades.

“Xi Jinping certainly won’t be a Gorbachev,” said Yao Jianfu, a former official and researcher who closely follows Chinese politics and advocates democratic change. “Every aspect of reform has an important precondition — that the Communist Party remains in charge.”

Even though Mr. Hu’s speech was broadcast live on national television and on screens in Beijing subway cars, gauging popular opinion was difficult.

Microbloggers, who are mostly urban and fairly well educated, at times cast scorn on the rhetoric. One blogger listed the Marxist terminology that Mr. Hu used and wrote simply “madness.” Others used laughing emoticons, while some delved closely into the speech for clues to new policies — some noted his fleeting mention of China’s unpopular single-child policy.

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After Many Slip-Ups, Mideast E-Commerce Gains Its Footing

DUBAI — Back in 2005, Souq.com was a new Web site modeled after eBay in the United States, catering to the nascent online retailing market in the Middle East. In the last week of October 2012, the fast-growing site received $45 million in funding from international investors, creating a new benchmark for the region’s evolving e-commerce scene.

“When we launched at the end of 2005, e-commerce was still in its infancy, and getting started that early gave us time to find a business model that works today,” said Ronaldo Meshawar, chief executive of Souq, which is based in Dubai. “It also helped us be an enabler in the region for businesses to sell their products online.”

The $45 million deal bolsters an industry that is still relatively young and fragmented, extremely capital intensive, and facing logistical hurdles that have led many sites to shut down.

The large size of the funding shows that money, particularly from foreign investors, is available for the right kind of business. That means one that appeals to consumers and has the potential to grow.

There have been a lot of mixed messages for the regional e-commerce community over the last year. The sudden exit of LivingSocial, the global daily deals site, from the Middle East in August seemed put a nail in the coffin of the regional online retailing market.

The demise of other promising, local sites, including Joob, Nahel and Mizado, in the months preceding the abrupt closure of LivingSocial’s regional operations suggested that e-commerce business models in the Gulf were not working.

But success stories are now starting to emerge from a handful of e-commerce sites that are figuring out how to run an online business in the area.

Namshi.com, a copycat of Zappos.com, which sells shoes online, has shown strong growth in its first year of operation. The site grew from three to 100 employees since it began in October 2011, and now manages 600 orders a day, according to Namshi’s founders.

Backed by e-commerce veterans, including Rocket Internet in Germany, Namshi also received $20 million in funding from J.P. Morgan and Blakeney Management in September to further grow the business.

“There are challenges around delivery of product, setting up efficient distribution centers and making the right decisions about styles to keep in our inventory base,” said Muhammed Mekki, one of Namshi’s three co-founders.

“The initial funding was there to test and see if fashion e-commerce can work in the Mideast,” he said. “Now that we’ve proven the model works, we’ll focus on expanding.”

MarkaVIP, a Jordanian site that provides discounts on luxury items, has also caught the eye of international investors, attracting $10 million in capital from European and American investment firms in April.

Souq is the latest and biggest in a string of new sites. The firm received funding from the South African group Naspers and Tiger Global, a New York hedge fund.

The firm’s parent company, Jabbar Internet Group, still holds a majority stake. Jabbar Internet manages the spin-off brands that were not purchased by Yahoo when Maktoob, a news site, was sold to Yahoo in 2009 for $175 million.

When Souq started up in 2005, the team brought eBay’s auction model to the region, in Arabic. They soon faced a slew of problems that smaller sites had been unable to resolve in the early years.

For one thing, transporting goods ordered on the Web across the Gulf countries was not easy because currencies and legal structures varied from place to place. Often, there was the added necessity of opening new bank accounts or finding a local partner to share the business. This also made it more difficult to manage inventory.

Online payment was also a hurdle. Many customers preferred to pay with cash on delivery rather than entering credit card details online. Cash on delivery put a strain on the company’s resources as it had to ship goods first and collect, or not, the money later.

Online payments are now becoming more widely accepted and some of the shipping issues have been resolved. As part of those efforts, Namshi joined with Aramex, a global shipping firm based in Amman. The arrangement lets Namshi use Aramex’s network of warehouses to store its inventory and ship orders in 24 hours.

To simplify things, Souq scrapped the eBay-style auction model in 2010 and instead adopted fixed prices. “You can’t take a model and just apply it to the region,” Mr. Meshawar said. “The copycat model doesn’t work, we had to execute on the ground and adapt.”

Now, Souq has 8 million to 9.5 million unique visits each month and a client base of 3.5 million customers across the Gulf, according to Mr. Meshawar. The site ships thousands of items a day.

The new funding will go toward setting up new distribution centers, expanding geographically and streamlining operations. Plans are in place to open logistics centers in the United Arab Emirates, Saudi Arabia and Egypt, where the site already has a strong following.

The money will also help Souq expand into new categories, including fashion and lifestyle, following the site’s recent acquisition of the fashion site Sukar.com and the sports site run2sport.com.

This is the third round of financing for Souq, which has 200 employees and 50,000 sellers in its online marketplace.

“The failure of some sites just shows that the get-rich-quick, poorly managed sites won’t make it, and it’s a learning curve for entrepreneurs trying to enter the region’s market,” said Alexandra Toomey, an independent e-commerce analyst in Dubai. “Established e-commerce companies with a proven product can succeed if they adapt to the market correctly and have the right backing.”

This article has been revised to reflect the following correction:

Correction: November 8, 2012

A previous version of this article wrongly included the online bookseller Jamalon in a list of Web sites that have closed this year. Jamalon is still operating.

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Global Update: Polio Eradication Efforts in Pakistan Focus on Pashtuns

Michael Kamber for The New York Times

Polio will never be eradicated in Pakistan until a way is found to persuade poor Pashtuns to embrace the vaccine, according to a study released by the World Health Organization.

A survey of 1,017 parents of young children found that 41 percent had never heard of polio and 11 percent refused to vaccinate their children against it. The survey was done in Karachi, Pakistan’s largest city and the only big city in the world where polio persists; it was published in the agency’s November bulletin.

Parents from poor families “cited lack of permission from family elders,” said Dr. Anita Zaidi, who teaches pediatrics at the Aga Khan University in Karachi. Some rich parents also disdained the vaccine, saying it was “harmful or unnecessary,” she added.

Pashtuns account for 75 percent of Pakistan’s polio cases even though they are only 15 percent of the population. Wealthy children are safer because the virus travels in sewage, and their neighborhoods may have covered sewers and be less flood-prone.

Pashtuns are the largest ethnic group in next-door Afghanistan, where polio has also never been wiped out. Most Taliban fighters are Pashtun, and some Taliban threatened to kill vaccinators earlier this year. Two W.H.O. vaccinators were shot in Karachi in July.

Rumors persist that the vaccine is a plot to sterilize Muslims. But the eradication drive is recruiting Pashtuns as vaccinators and asking prominent religious leaders from various sects to make videos endorsing the vaccine.

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Global Update: Polio Eradication Efforts in Pakistan Focus on Pashtuns

Michael Kamber for The New York Times

Polio will never be eradicated in Pakistan until a way is found to persuade poor Pashtuns to embrace the vaccine, according to a study released by the World Health Organization.

A survey of 1,017 parents of young children found that 41 percent had never heard of polio and 11 percent refused to vaccinate their children against it. The survey was done in Karachi, Pakistan’s largest city and the only big city in the world where polio persists; it was published in the agency’s November bulletin.

Parents from poor families “cited lack of permission from family elders,” said Dr. Anita Zaidi, who teaches pediatrics at the Aga Khan University in Karachi. Some rich parents also disdained the vaccine, saying it was “harmful or unnecessary,” she added.

Pashtuns account for 75 percent of Pakistan’s polio cases even though they are only 15 percent of the population. Wealthy children are safer because the virus travels in sewage, and their neighborhoods may have covered sewers and be less flood-prone.

Pashtuns are the largest ethnic group in next-door Afghanistan, where polio has also never been wiped out. Most Taliban fighters are Pashtun, and some Taliban threatened to kill vaccinators earlier this year. Two W.H.O. vaccinators were shot in Karachi in July.

Rumors persist that the vaccine is a plot to sterilize Muslims. But the eradication drive is recruiting Pashtuns as vaccinators and asking prominent religious leaders from various sects to make videos endorsing the vaccine.

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News Analysis: For Obama, Housing Policy Presents Second-Term Headaches

A second-term president may be just the person to tackle America’s housing problems.

When President Obama first came into office, home prices were crashing, foreclosures were soaring and the previous Bush administration had just initiated the bailout of Fannie Mae and Freddie Mac, the government-backed entities that agree to repay mortgages if the original borrower defaults.

With the market in shambles in 2008, the Obama administration pursued a tentative housing policy, for the most part avoiding big moves that might have further weakened the housing market or banks. Eventually, there were some bolder initiatives, like the national mortgage settlement with big banks as well as the Treasury Department’s later aid programs for homeowners.

But as President Obama’s first administration comes to an end, the government is still deeply embedded in the mortgage market. In the third quarter, various government entities backstopped 92 percent of all new residential mortgages, according to Inside Mortgage Finance, a publication that focuses on the home loan industry.

Mr. Obama’s economic team has consistently said it wants the housing market to work without significant government support. But it has taken few actual steps to advance that idea.

“I think Obama is absolutely committed to reducing the government’s role,” said Thomas Lawler, a former chief economist at Fannie Mae and founder of Lawler Economic and Housing Consulting, an industry analysis firm. “But no one’s yet found a format to do that.”

Housing policy is hard to tackle because so many people have benefited from the status quo. The entire real estate system — the banks, the agents, the home buyers — all depend on a market that provides fixed-rate, 30-year mortgages that can be easily refinanced when interest rates drop. That sort of loan is rare outside of the United States. And any effort to overhaul housing and the mortgage market could eventually reduce the amount of such mortgages in the country, angering many and creating a political firestorm.

In other words, the best person to fundamentally change how housing works may be a president who won’t be running for office again.

Most immediately, the housing market has to be strong enough to deal with a government pullback. Some analysts think it’s ready. “I think the housing recovery is far enough along that they can start winding down Fannie and Freddie,” said Phillip L. Swagel at the University of Maryland’s School of Public Policy, who served as assistant secretary for economic policy under Treasury Secretary Henry M. Paulson Jr.

The administration can take smaller steps first. Mr. Lawler, the housing economist, thinks the government could start to reduce the maximum amount that it will guarantee for Fannie and Freddie loans. In some areas, like parts of the Northeast and California, it is as high as $625,000. Before the financial crisis, it was essentially capped at $417,000.

The big question is whether the private sector — banks and investors that buy bonds backed with mortgages — will pick up the slack when the government eases out of the market. If they don’t, the supply of mortgages could fall and house prices could weaken.

Banks say their appetite depends on how new rules for mortgages turn out. In setting such regulations, some tough choices have to be made.

The new rules will effectively map the riskiness of various types of mortgages. In determining that, regulators will look at the features of the loans and the borrowers income. Banks say they are unlikely to hold loans deemed risky, and their lobbyists are pressing for legal protection on the safer ones, called qualified mortgages.

The temptation will be to make the definition of what constitutes a qualified mortgage as broad as possible, to ensure that the banks lend to a wide range of borrowers. But regulators concerned with the health of the banks won’t want a system that incentivizes institutions to make potentially risky loans.

One set of qualified mortgage regulations, being written by Consumer Financial Protection Bureau, could be finalized as early as January. Other regulators like the Federal Reserve are expected to take longer in finalizing their mortgage rules. Resolving the conflict between mortgage availability and bank strength may ultimately depend the person who replaces Timothy F. Geithner as Treasury secretary. Mr. Geithner is stepping down at the end of Mr. Obama’s first term.

The Obama administration faces other daunting decisions.

One is how to deal with the considerable number of troubled mortgages still in the financial system. Banks might be reluctant to make new loans until they have a better idea of the ultimate amount of losses on the old loans. “If you don’t ever deal with these problems, you may never get to where you want to go,” said Mr. Lawler, the housing economist.

To help tackle that issue, the new administration might decide to make its mortgage relief programs more aggressive. It might even aim for more loan modifications, writing down the value of the mortgages to make them easier to pay. The Federal Housing Finance Agency, the regulator that oversees Fannie Mae and Freddie Mac, has effectively blocked such write-downs on the vast amount of loans those entities have guaranteed.

A new Obama administration may move to change the agency’s stance on write-downs, perhaps by replacing its acting director, Edward DeMarco. If that happened, it would be a sign that the White House has a taste for more radical housing actions. The agency declined to comment.

Then there’s what to do with the Federal Housing Administration, another government entity that has backstopped a huge amount of mortgages since the financial crisis. The housing administration was set up to focus on lower-income borrowers, and it backs loans that have very low down payments. Its share of the market has grown from where it was before the crisis. The F.H.A. accounted for 13 percent of the market in the third quarter, according to Inside Mortgage Finance.

The new administration has to decide whether it wants the F.H.A. to continue doing as much business. The risk is that a big pull back by the F.H.A. could reduce the availability of mortgages to lower-income borrowers. Banks almost certainly won’t want to write loans with minuscule down payments because they’re considered riskier.

Ultimately, housing policy comes down to one question: Which borrowers should get the most subsidies?

Right now, the government largesse encompasses a wide swath of borrowers. But most analysts believe government support should be focused on lower-income borrowers.

“We will know that the Obama administration is serious about housing finance reform when it comes up with a proposal for affordable housing,” said Mr. Swagel, the University of Maryland professor.

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Obama’s Other ‘Cliff’ Is in Foreign Policy

For all the talk of a “fiscal cliff” threatening the nation’s finances, President Obama also faces a foreign policy cliff of sorts, with a welter of national security issues that he put on the back burner during the campaign now clamoring for his attention.

Atop that list, administration officials and foreign policy experts say, is the bloody civil war in Syria and the standoff with Iran over its nuclear program. The United States is likely to engage the Iranian government in direct negotiations over the next few months, in perhaps a last-ditch diplomatic effort to head off a military strike on its nuclear facilities.

Administration officials said that they had not set a date for talks and that they did not know if Iran’s supreme leader, Ayatollah Ali Khamenei, would give his blessing. But with Iran’s uranium centrifuges spinning and Israel threatening its own military action, the need to avoid a war may make this high-risk diplomatic effort Mr. Obama’s No. 1 priority.

Syria, too, will demand a pressing response, given the high human toll of the violence and the danger of a spreading regional conflict. Mr. Obama, however, remains leery of being dragged into the conflict, rejecting calls to supply weapons to rebel groups. His reluctance has been partly political, experts say, but he also has strategic qualms.

“At a time when he was running on a platform of ending wars in the Middle East, he did not want to be seen as starting one,” said Martin S. Indyk, a former American ambassador to Israel.

“But if he doesn’t try to intervene in a way that gives him a way to shape a post-Assad regime on the ground,” Mr. Indyk continued, referring to the Syrian president, Bashar al-Assad, “there’s a high risk of descent into chaos in Syria, and a sectarian war that spreads to Lebanon, Bahrain and eventually Saudi Arabia.”

Beyond those flash points, the president will have to grapple with Pakistan, an unstable nuclear state whose relationship with Washington has eroded during his presidency. And he will have to oversee an orderly exit from Afghanistan, where the waning American role threatens to throw the country back into chaos and Islamic militancy.

As he does so, some question whether he will rethink his administration’s heavy reliance on drone strikes to kill people suspected of being extremists, a policy that has proved lethally efficient but has sown deep resentment in Pakistan and Afghanistan.

More broadly, Mr. Obama will face Russia under the aggressive leadership of President Vladimir V. Putin and China with the opposite problem — negotiating a tumultuous change in power after a scandal that tainted the top ranks of its Communist leadership.

None of these problems are new, but many were effectively shelved over the past year as the president waged a bitter re-election battle dominated by his stewardship of the economy. Foreign policy played such a bit part in the election that even in the debate ostensibly devoted to it, Mr. Obama and Mitt Romney detoured into a discussion of high school test scores in Massachusetts.

For reasons of history and political reality, a re-elected Mr. Obama is likely to devote more time to foreign affairs. From Richard M. Nixon to Bill Clinton, presidents have tended to make their bid for statesman status in their second terms. The prospect of continuing gridlock — with the Republicans still controlling the House — gives Mr. Obama all the more reason to favor diplomacy over domestic legislation.

There is also some unfinished business from the past four years, not least Mr. Obama’s frustrated efforts to broker a peace agreement between Israel and the Palestinians. But several experts cast doubt on whether the president would throw himself into the role of Middle East peacemaker, as Mr. Clinton did in his second term.

The Israeli prime minister, Benjamin Netanyahu, who has had a fraught relationship with Mr. Obama, faces his own voters early next year, but he seems likely to stay in power with a right-wing government. Such an arrangement could make peacemaking difficult.

“Because he got his fingers burned and was outmaneuvered by Netanyahu, he will wait to see the outcome in the Israeli election,” said Mr. Indyk, who wrote a book about Mr. Obama’s foreign policy, “Bending History.” He added that the president is “going to think long and hard about trying again.”

The added wrinkle for the United States: the Palestinian Authority is likely to petition for nonstate membership in the United Nations next month, a step it had put off until after the election. If the United Nations were to grant it, that would trigger Congress to cut off aid not only to the Palestinian Authority but also to the United Nations itself.

The mere fact of Mr. Obama’s victory does not ease these problems. But as the president himself famously said to Russia’s former president, Dmitri A. Medvedev, at a nuclear conference in South Korea, he may have more room to maneuver in dealing with them.

Ask foreign policy experts for wild cards in a second Obama term and two countries come up: India and Cuba. Little progress was made in opening the door to Havana during the past four years, but hope springs eternal for those who advocate an end to the half-century-old trade embargo. Mr. Obama also is likely to build on his ties to India.

India figures into the biggest geopolitical bet of Mr. Obama’s presidency: the American pivot from the Middle East to China and Asia. With four more years, experts said, Mr. Obama can put meat on the bones of an ambitious, but incomplete, policy.

Here, however, is where the fiscal cliff meets foreign policy. To be credible in reasserting an American presence in Asia, experts said, will require a robust military presence from the Yellow Sea to the South China Sea. But unless the White House and Congress can strike some kind of fiscal deal, the Pentagon will face deep automatic cuts in its budget, depriving it of the ability to project power as it once did.

For Mr. Obama to realize his grandest visions abroad, then, he will still have to work with the same House Republicans who thwarted him on the home front in his first term.

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A Capitalist’s Dilemma, Whoever Wins the Election

WHATEVER happens on Election Day, Americans will keep asking the same question: When will this economy get better?

Victo Ngai

Clayton Christensen, author of “The Innovator’s Dilemma,” says the winner of the presidential election must face “the capitalist’s dilemma."

In many ways, the answer won’t depend on who wins on Tuesday. Anyone who says otherwise is overstating the power of the American president. But if the president doesn’t have the power to fix things, who does?

It’s not the Federal Reserve. The Fed has been injecting more and more capital into the economy because — at least in theory — capital fuels capitalism. And yet cash hoards in the billions are sitting unused on the pristine balance sheets of Fortune 500 corporations. Billions in capital is also sitting inert and uninvested at private equity funds.

Capitalists seem almost uninterested in capitalism, even as entrepreneurs eager to start companies find that they can’t get financing. Businesses and investors sound like the Ancient Mariner, who complained of “Water, water everywhere — nor any drop to drink.”

It’s a paradox, and at its nexus is what I’ll call the Doctrine of New Finance, which is taught with increasingly religious zeal by economists, and at times even by business professors like me who have failed to challenge it. This doctrine embraces measures of profitability that guide capitalists away from investments that can create real economic growth.

Executives and investors might finance three types of innovations with their capital. I’ll call the first type “empowering” innovations. These transform complicated and costly products available to a few into simpler, cheaper products available to the many.

The Ford Model T was an empowering innovation, as was the Sony transistor radio. So were the personal computers of I.B.M. and Compaq and online trading at Schwab. A more recent example is cloud computing. It transformed information technology that was previously accessible only to big companies into something that even small companies could afford.

Empowering innovations create jobs, because they require more and more people who can build, distribute, sell and service these products. Empowering investments also use capital — to expand capacity and to finance receivables and inventory.

The second type are “sustaining” innovations. These replace old products with new models. For example, the Toyota Prius hybrid is a marvelous product. But it’s not as if every time Toyota sells a Prius, the same customer also buys a Camry. There is a zero-sum aspect to sustaining innovations: They replace yesterday’s products with today’s products and create few jobs. They keep our economy vibrant — and, in dollars, they account for the most innovation. But they have a neutral effect on economic activity and on capital.

The third type are “efficiency” innovations. These reduce the cost of making and distributing existing products and services. Examples are minimills in steel and Geico in online insurance underwriting. Taken together in an industry, such innovations almost always reduce the net number of jobs, because they streamline processes. But they also preserve many of the remaining jobs — because without them entire companies and industries would disappear in competition against companies abroad that have innovated more efficiently.

Efficiency innovations also emancipate capital. Without them, much of an economy’s capital is held captive on balance sheets, with no way to redeploy it as fuel for new, empowering innovations. For example, Toyota’s just-in-time production system is an efficiency innovation, letting manufacturers operate with much less capital invested in inventory.

INDUSTRIES typically transition through these three types of innovations. By illustration, the early mainframe computers were so expensive and complicated that only big companies could own and use them. But personal computers were simple and affordable, empowering many more people.

Companies like I.B.M. and Hewlett-Packard had to hire hundreds of thousands of people to make and sell PC’s. These companies then designed and made better computers — sustaining innovations — that inspired us to keep buying newer and better products. Finally, companies like Dell made the industry much more efficient. This reduced net employment within the industry, but freed capital that had been used in the supply chain.

Clayton M. Christensen is a business professor at Harvard and a co-author of “How Will You Measure Your Life?”

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A Collective Effort to Save Decades of Research at N.Y.U.

The calls started coming in late on Tuesday and early Wednesday: offers of dry ice, freezer space, coolers. By the end of Thursday there were dozens more: A researcher at Weill Cornell Medical College would clear 1,000 tanks to save threatened zebra fish; another, at Cold Spring Harbor Laboratory, promised to replace some genetically altered mice that were lost; and a doctor at the Children’s Hospital of Philadelphia even offered take over entire experiments, to keep them going.

As hurricane-driven waters surged into New York University research buildings in Kips Bay, on the East Side of Manhattan, investigators in New York and around the world jumped on the phone to offer assistance — executing a reverse Noah’s ark operation, to rescue lab animals and other assets from a flooding vessel.

“I’ve had 43 people who have offered to help so far, and some of them are direct competitors,” said Gordon Fishell, associate director of the N.Y.U. Neuroscience Institute, who lost more than 5,000 genetically altered mice when storm waters surged the night of Oct. 30, cutting off power. “It’s just been unbelievable,” he said. “It really buoys my spirits and my lab’s.”

Staff members at N.Y.U. worked around the clock to preserve research materials, running in and out of darkened buildings without elevator service, hauling dry ice and other supplies up anywhere from 2 to more than 15 floors.

The university’s medical center also got instant help, from almost every major research institution in the area.

The response reflects large shifts in the way that science is conducted over the past generation or so. Individual labs always compete to be first, but researchers increasingly share materials that are enormously expensive and time-consuming to reproduce. The loss of a single cell line or genetically altered animal can slow progress for years in some areas of biomedical research.

“We are totally dependent on each other in the life sciences now, for a very large number of cell lines and extracts, research animals and unique chemical tools and antibodies that might not have backup copies anywhere in the world, or in very few places,” said Dr. Steven Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute of M.I.T. and Harvard. “Losing any of these tools tears a significant hole in the entire field.”

Danny Reinberg, a professor of biochemistry at N.Y.U.’s medical school, has studied genetics for 30 years, accumulating valuable mice strains and stocks of extracts from cell nuclei that would be extremely difficult to replace. The extracts must be stored at minus 112 degrees Fahrenheit.

Dr. Reinberg said he lost all of his mice: nine strains, including more than 1,000 animals that died in the storm surge. But he managed to save all of the cell extracts by moving some containers into freezers at N.Y.U. labs that weren’t affected and others to the Rockefeller, Columbia and Cornell medical centers, each of which cleared space, he said.

“We were able to save many things; it was just phenomenal to get that kind of help,” said Dr. Reinberg, whose house in New Jersey has had no power.

“Later in the week, at a Starbucks, I could finally download all my e-mail, and there were messages from people at the University of Pennsylvania and the Howard Hughes Medical Institute, asking how they could help us re-establish the mouse lines we lost,” he said.

Some scientists have become interdependent because their students, who develop a specialty in specific tissues or animals, often move among labs. Research projects sometimes draw on experiments or analyses the students worked on at more than one place.

One researcher working in Dr. Fishell’s lab was formerly a student of Dr. Stewart Anderson of the Children’s Hospital of Philadelphia, who sent Dr. Fishell a text message on Wednesday to offer help. “I told him that even if it costs money, we’re happy to keep experiments rolling, if we’re able to,” Dr. Anderson said.

By late Thursday, freezer space in minus-112-degree units was extremely tight in the city. So was dry ice.

Susan Zolla-Pazner, director of AIDS research at the Manhattan Veterans Affairs Medical Center, had lost power in her 18th-floor lab in the department’s building at 23rd Street and First Avenue. She finally hired a company to haul her 20 freezers-full of specimens, for safekeeping.

“We spent all of Tuesday and Wednesday hauling 1,300 pounds of dry ice up to the 18th floor, using the stairs, to stabilize the freezers first,” said Dr. Zolla-Pazner, who is also a professor of pathology at N.Y.U. School of Medicine. “And the dry ice people would only take cash. I have about 25 to 30 people working for me, and everyone was out there on 23rd Street, reaching into their pockets to get what we needed. It was a herculean and heroic effort on the part of everyone here, and that is the story that needs to be told.”

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