City Room: How Are You Warding Off the Flu?

Sure, you could go out and get a flu shot like everyone keeps telling you to do. It’s relatively cheap, and available just about everywhere.

But the shot is not 100 percent effective. And it takes two weeks to kick in. Although influenza can be deadly, some have been making light of the virus’s symptoms.

If you’re holding out, or procrastinating, or have decided against getting vaccinated altogether, what alternative means are you using to keep those bad bugs away? Comment in the box below.

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Sharp Words From European Minister for Countries in North


BRUSSELS — Jean-Claude Juncker, the departing leader of the group of ministers who oversee the euro currency, sharply criticized northern Europeans on Thursday for demanding austerity budgets from their southern neighbors.


But in the same speech he seemed to endorse as his successor an official from the Netherlands, one of countries that has made the toughest demands for fiscal rigor in the euro zone.


Mr. Juncker, himself a northern European and prime minister of Luxembourg, told members of the European Parliament’s influential Economic and Monetary Affairs Committee that northerners had falsely painted themselves as more economically virtuous than southerners. “I’m totally against this distinction,” he said.


Mr. Juncker warned that some members of his own country’s Parliament had become fed up with “the German diktat,” and he said countries making painful economic adjustments should be rewarded for their efforts.


“We have been arrogant” toward countries like Greece, he said.


Still, Mr. Juncker said his successor as head of the Eurogroup of ministers would speak one of the languages of the Benelux, a grouping that includes Belgium, the Netherlands and Luxembourg. Mr. Juncker’s comments were characteristically cryptic, but appeared to lend weight to the chances of the front-runner for the job, Jeroen Dijsselbloem, the Dutch finance minister.


The president of the Eurogroup plays a coordinating role among finance ministers when they make critical decisions like giving political approval for bailouts or pressuring governments to shore up their finances to preserve the stability of the euro. Mr. Juncker has held the post since 2005; although his term expired last summer, he indicated he would stay on for a limited time until a successor was named.


At a news conference Thursday, Mr. Juncker said a decision on his successor should be made on, or shortly after, Jan. 21, because that would be the last meeting of the Eurogroup at which he would serve as president.


Although the president of the Eurogroup is supposed to be elected by ministers, as a practical matter is decided by consensus among governments, opening the way for political horse-trading.


Mr. Dijsselbloem’s candidacy gained strength in recent weeks partly because he comes from a country that still holds a triple-A debt rating, making him a natural ally of Germany. But his candidacy is more problematic for the French, the other major power in the euro area.


The government led by President François Hollande has emphasized giving the most vulnerable members of the euro area the leeway to make painful economic adjustments. By contrast, the Netherlands, along with Germany and Finland, has pressed indebted nations like Greece and Portugal to tighten their belts, despite the recessionary effect on their economies.


One factor that could help the French swing in support of Mr. Dijsselbloem, a member of the Dutch Labor Party, is that he, like Mr. Hollande, is a socialist.


Meanwhile, for the soon-to-be created single banking supervisory agency for the euro zone, Mr. Juncker suggested Thursday that a Frenchwoman could be offered a senior role. And although Mr. Juncker again did not offer names, there are reports in the French news media that Danièle Nouy, an official at the Banque de France, could be offered such a role, partly to assuage French concerns.


Mr. Dijsselbloem, 46, won the finance portfolio, his first Netherlands cabinet post, late last year, and he has little experience at the top levels of government or in European affairs. But he did take office in time to participate in a round of marathon meetings by finance ministers to strike agreements on resuming aid to Greece and the creation of the single banking supervisor.


“I suppose he is suitable as he wouldn’t be finance minister,” said Sophie in ‘t Veld, a Dutch member of the European Parliament for the Democrats 66, a liberal and pro-European political party.


“But how is he going to navigate between the deeply euro-skeptic electorate and a deeply euro-skeptic Parliament that will expect him to be a troublemaker in Europe and, on the other hand, show compromise and consensus as the head of the Eurogroup?” she asked.


Mr. Dijsselbloem told the Dutch daily newspaper De Volkskrant at the end of December that he regarded “strengthening European cooperation inevitable and good for the Netherlands.” But he also cautioned that, “when it comes to Greece, for example, everyone looks to the Netherlands and we have to take the floor” and that, “from us, from Germany and Finland, it’s expected that we exhibit some strictness.”


That, though, is an approach that Mr. Juncker on Thursday cautioned his successor against taking. For countries like Greece and Portugal facing brutal austerity, he said, there should be rewards for meeting targets and “not only a big stick.”


Mr. Juncker also called for euro area countries to adopt a legal minimum wage so as not “to lose the support of the working classes.”


And in a marked contrast to the stance of some Dutch politicians, Mr. Juncker suggested that countries like Spain and Ireland should have some scope for using European bailout funds to bail out their banks directly. Otherwise, said Mr. Juncker, the purpose of the bailout fund “would lose a large part of its sense.”


For his part, Mr. Juncker said at the news conference that he would concentrate on winning another term as the prime minister of Luxembourg and use that perch to continue to play a role in European affairs.


“You will hear from me,” he said.


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Global Update: China Moves to Prevent Spread of Yellow Fever From Africa





In a move that underlines how many Chinese citizens now work in Africa, China’s quarantine officials recently urged greater efforts to make sure that a yellow fever epidemic now raging in Sudan does not come back to China.




Local health authorities were asked to scan all travelers arriving from Sudan for fevers. Chinese citizens planning travel to Sudan were advised to get yellow fever shots. Customs officers were told that containers arriving from Sudan might have stray infected mosquitoes inside.


Sudan’s epidemic is considered the world’s worst in 20 years. Sweden, Britain and other donors have paid for vaccinations. The United States Navy’s laboratory in Egypt has helped with diagnoses.


Estimates of the number of Chinese working in Africa, many in the oil and mining industries or on major construction projects, range from 500,000 to 1 million. Experts on AIDS have previously warned that the workers could become a new means of bringing that disease to China, which has a low H.I.V.-infection rate.


ProMED-mail, a Web site that follows emerging diseases, has tracked reports about the Sudan outbreak, with its moderators adding valuable context. China’s mosquito-killing winters make a large yellow fever outbreak there unlikely, moderators said. But Sudan’s containment efforts are troubled. For example, vaccinated people cannot get cards proving they have had shots, but the cards are reported to be for sale at police checkpoints.


Australia’s now-endemic dengue fever, according to ProMED moderators, may have come from mosquitoes arriving in containers from East Timor.


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Baseball Dumping Dugout-to-Bullpen Landlines





The reserve clause is dead. And so are wool uniforms. There are no longer eight teams in each league. And the Houston Astros have departed the National League.




 Major League Baseball is now about to disconnect the landlines that link dugouts to bullpens. Long after the rest of society embraced cellphones, managers and coaches will soon be able to discuss pitching changes on Samsung Galaxy S III phones.


The 21st-century 4G dugout-to-bullpen connection that is being created by T-Mobile USA as part of its wireless sponsorship with Major League Baseball was announced Tuesday at the International Consumer Electronics Show in Las Vegas.


 “This is baseball’s continued push into the digital age,” said Tim Brosnan, Major League Baseball’s executive vice president for business. “It’s also about a very aggressive wireless provider that sought us out to create this unique communications platform.”


Baseball had not thought of a dugout-to-bullpen phone system in its talks with various wireless providers about a national sponsorship over the past decade, Brosnan said.


The wireless system will be tested at the World Baseball Classic in Arizona in March. After assessing how it works and fixing any problems, baseball will roll it out in the major leagues. Whether each stadium will have it in 2013 has not been determined.


T-Mobile’s sponsorship plans also include enhancing network connectivity for fans at all ballparks and helping MLB Advanced Media create content for smartphones and tablets.


To create the dugout-to-bullpen communications system, each ballpark will get the equivalent of a small cellular system with a miniature cell tower.


But while wireless companies like T-Mobile are continuously trying to broaden their national coverage territory, the dugout-to-bullpen system will have limits enforced by a technology called geo-fencing. So, managers and pitching coaches will not be able to chat with the bullpen coach from the pitcher’s mound. And bullpen coaches cannot ask, “Can you hear me now?” once they leave the bullpen’s environs.


“The guidance we’ve been given is that we shouldn’t fundamentally change what makes baseball baseball,” said Mark McDiarmid, T-Mobile’s vice president for engineering. “There is reason to be cautious about how far the coach could move away from the dugout before the umpires might think it’s inappropriate.”


Baseball is not shifting to cellphones because of an incident during the eighth inning of Game 5 of the 2011 World Series when the noise at Rangers Ballpark in Arlington caused Derek Lilliquist, the Cardinals’ bullpen coach, to misunderstand Manager Tony La Russa’s instructions about which relievers should start warming up.


Twice, La Russa asked that Jason Motte get up. Lilliquist apparently did not hear the first request. When La Russa called again to get Motte ready, Lilliquist thought he was asking for Lance Lynn. The miscommunication led to La Russa’s surprise when he summoned a right-hander and Lynn arrived at the mound, not Motte. Lynn stayed in long enough to issue an intentional walk; Motte quickly got ready and replaced him.


Lilliquist might well have heard La Russa’s instructions if they had used the cellphone system, with multiple microphones, noise mitigation and the ability to raise audio levels.


 Given T-Mobile’s investment over the next three years, it is not surprising that each dugout’s branded cellphone docking station — about the size of a personal computer tower — will be about as visible to TV cameras as the Gatorade vessel is.


But, Brosnan said, baseball has not ordained the obvious commercial tie-in: that each call to the bullpen on Fox, ESPN and TBS’s national telecasts be sponsored by T-Mobile.


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Pap Test May Prove Useful at Detecting More Types of Cancer, Study Suggests





The Pap test, which has prevented countless deaths from cervical cancer, may eventually help to detect cancers of the uterus and ovaries as well, a new study suggests.




For the first time, researchers have found genetic material from uterine or ovarian cancers in Pap smears, meaning that it may become possible to detect three diseases with just one routine test.


But the research is early, years away from being used in medical practice, and there are caveats. The women studied were already known to have cancer, and while the Pap test found 100 percent of the uterine cancers, it detected only 41 percent of the ovarian cancers. And the approach has not yet been tried in women who appear healthy, to determine whether it can find early signs of uterine or ovarian cancer.


On the other hand, even a 41 percent detection rate would be better than the status quo in ovarian cancer, particularly if the detection extends to early stages. The disease is usually advanced by the time it is found, and survival is poor. About 22,280 new cases were expected in the United States in 2012, and 15,500 deaths. Improved tests are urgently needed.


Uterine cancer has a better prognosis, but still kills around 8,000 women a year in the United States.


These innovative applications of the Pap test are part of a new era in which advances in genetics are being applied to the detection of a wide variety of cancers or precancerous conditions. Scientists are learning to find minute bits of mutant DNA in tissue samples or bodily fluids that may signal the presence of hidden or incipient cancers. Ideally, the new techniques would find the abnormalities early enough to cure the disease or even prevent it entirely. But it is too soon to tell.


“Is this the harbinger of things to come? I would answer yes,” said Dr. Bert Vogelstein, director of the Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins University, and a senior author of a report on the Pap test study published on Wednesday in the journal Science Translational Medicine. He said the genomes of more than 50 types of tumors had been sequenced, and researchers were trying to take advantage of the information.


Similar studies are under way or are being considered to look for mutant DNA in blood, stool, urine and sputum, both to detect cancer and also to monitor the response to treatment in people who already have the disease.


But researchers warn that such tests, used for screening, can be a double-edged sword if they give false positive results that send patients down a rabbit hole of invasive tests and needless treatments. Even a test that finds only real cancers may be unable to tell aggressive, dangerous ones apart from indolent ones that might never do any harm, leaving patients to decide whether to watch and wait or to go through surgery, chemotherapy and radiation with all the associated risks and side effects.


“Will they start recovering mutations that are not cancer-related?” asked Dr. Christopher P. Crum, a professor at Harvard Medical School who was not involved in the research.


But he also called the study a “great proof of principle,” and said, “Any whisper of hope to women who suffer from endometrial or ovarian cancer would be most welcome.”


DNA testing is already performed on samples from Pap tests, to look for the human papillomavirus, or HPV, which causes cervical cancer. Dr. Vogelstein and his team decided to try DNA testing for cancer. They theorized that cells or DNA shed from cancers of the ovaries and the uterine lining, or endometrium, might reach the cervix and turn up in Pap smears.


The team picked common mutations found in these cancers, and looked for them in tumor samples from 24 women with endometrial cancer and 22 with ovarian cancer. All the cancers had one or more of the common mutations.


Then, the researchers performed Pap tests on the same women, and looked for the same DNA mutations in the Pap specimens. They found the mutations in 100 percent of the women with endometrial cancer, but in only 9 of the 22 with ovarian cancer. The test identified two of the four ovarian cancers that had been diagnosed at an early stage.


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Pap Test May Prove Useful at Detecting More Types of Cancer, Study Suggests





The Pap test, which has prevented countless deaths from cervical cancer, may eventually help to detect cancers of the uterus and ovaries as well, a new study suggests.




For the first time, researchers have found genetic material from uterine or ovarian cancers in Pap smears, meaning that it may become possible to detect three diseases with just one routine test.


But the research is early, years away from being used in medical practice, and there are caveats. The women studied were already known to have cancer, and while the Pap test found 100 percent of the uterine cancers, it detected only 41 percent of the ovarian cancers. And the approach has not yet been tried in women who appear healthy, to determine whether it can find early signs of uterine or ovarian cancer.


On the other hand, even a 41 percent detection rate would be better than the status quo in ovarian cancer, particularly if the detection extends to early stages. The disease is usually advanced by the time it is found, and survival is poor. About 22,280 new cases were expected in the United States in 2012, and 15,500 deaths. Improved tests are urgently needed.


Uterine cancer has a better prognosis, but still kills around 8,000 women a year in the United States.


These innovative applications of the Pap test are part of a new era in which advances in genetics are being applied to the detection of a wide variety of cancers or precancerous conditions. Scientists are learning to find minute bits of mutant DNA in tissue samples or bodily fluids that may signal the presence of hidden or incipient cancers. Ideally, the new techniques would find the abnormalities early enough to cure the disease or even prevent it entirely. But it is too soon to tell.


“Is this the harbinger of things to come? I would answer yes,” said Dr. Bert Vogelstein, director of the Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins University, and a senior author of a report on the Pap test study published on Wednesday in the journal Science Translational Medicine. He said the genomes of more than 50 types of tumors had been sequenced, and researchers were trying to take advantage of the information.


Similar studies are under way or are being considered to look for mutant DNA in blood, stool, urine and sputum, both to detect cancer and also to monitor the response to treatment in people who already have the disease.


But researchers warn that such tests, used for screening, can be a double-edged sword if they give false positive results that send patients down a rabbit hole of invasive tests and needless treatments. Even a test that finds only real cancers may be unable to tell aggressive, dangerous ones apart from indolent ones that might never do any harm, leaving patients to decide whether to watch and wait or to go through surgery, chemotherapy and radiation with all the associated risks and side effects.


“Will they start recovering mutations that are not cancer-related?” asked Dr. Christopher P. Crum, a professor at Harvard Medical School who was not involved in the research.


But he also called the study a “great proof of principle,” and said, “Any whisper of hope to women who suffer from endometrial or ovarian cancer would be most welcome.”


DNA testing is already performed on samples from Pap tests, to look for the human papillomavirus, or HPV, which causes cervical cancer. Dr. Vogelstein and his team decided to try DNA testing for cancer. They theorized that cells or DNA shed from cancers of the ovaries and the uterine lining, or endometrium, might reach the cervix and turn up in Pap smears.


The team picked common mutations found in these cancers, and looked for them in tumor samples from 24 women with endometrial cancer and 22 with ovarian cancer. All the cancers had one or more of the common mutations.


Then, the researchers performed Pap tests on the same women, and looked for the same DNA mutations in the Pap specimens. They found the mutations in 100 percent of the women with endometrial cancer, but in only 9 of the 22 with ovarian cancer. The test identified two of the four ovarian cancers that had been diagnosed at an early stage.


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Wall Street Modestly Higher





Wall Street stocks traded higher on Wednesday after Alcoa got the earnings season under way with better-than-expected revenue and an encouraging outlook for the year.


The Standard & Poor’s 500-stock index rose 0.2 percent in late trading, the Dow Jones industrial average added 0.4 percent and the Nasdaq composite index was up 0.4 percent. European shares closed moderately higher.


Alcoa said it expected global demand for aluminum would continue to grow in 2013, though the company kept a cautious tone as worries lingered over a looming budget confrontation in Washington. Shares of Alcoa, the largest aluminum producer in the United States, were almost unchanged.


Still, investors were wary about the outcome of the fourth-quarter earnings season. Profits were expected to beat the previous quarter’s lackluster results, but analysts’ estimates were down sharply from where they were in October. Earnings were expected to grow by 2.7 percent, according to Thomson Reuters data.


Equities have pulled back over the last two sessions from last week’s rally, which was spurred by a deal in Washington that averted automatic spending cuts and across-the-board tax increases.


“With the euphoria of the fiscal cliff deal wearing off, the market is looking for the next positive theme and the hope is that earnings season can fill that need,” said Andre Bakhos, director of market analytics at Lek Securities in New York. “With expectations muted, any semblance of decent numbers could provide a robust upside potential.”


Constellation Brands, whose labels include Robert Mondavi and Ravenswood wines, fell 0.4 percent after it reported higher profit.


Apollo Group slid more than 7 percent after it reported lower student sign-ups for the third straight quarter and cut its operating profit forecast for 2013.


Dish Network late Tuesday announced a bid for Clearwire that trumped Sprint Nextel’s $2.2 billion offer, setting the stage for a battle over the wireless service provider. Clearwire was up 7.8 percent, while Sprint lost 1.8 percent.


Seagate Technology, the maker of computer hard drives, rose 5.9 percent after it raised its second-quarter revenue forecast.


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China Says It Will Overhaul Re-education System





BEIJING — China will start overhauling its draconian system of re-education through labor in the coming year, according to the state news media, signaling the incoming leadership’s determination to alter one of the government’s more widely despised cudgels for punishing petty criminals, religious dissidents, petitioners and other perceived social irritants.




The brief announcement on Monday, by the official Xinhua news agency, lacked details, but legal advocates said they were hopeful that the five-decade-old system for locking up offenders without trial would be significantly modified, if not abolished altogether.


“If true, this would be an important advance,” said Zhang Qianfan, a law professor at Peking University who has long pushed for the system’s demise. “It’s a tool that is widely abused.”


Established by Mao Zedong in the 1950s to swiftly neutralize political opponents, re-education through labor has evolved into a sprawling extralegal system of 350 camps where more than 100,000 people toil in prison factories and on farms for up to four years. Sentences are meted out by local public security officials, and defendants have no access to lawyers and little chance for appeal.


Since the 1980s, legal scholars and human rights advocates have been urging an end to the system and urging that the prosecution of minor offenses be shifted to criminal courts. The campaign has been re-energized in recent months by several cases, widely promoted in the news media, in which people were consigned to the camps for criticizing or simply annoying local party officials.


Among the more notable cases was that of Ren Jianyu, a college graduate turned village official in southwestern China who was sent to a work camp for “subversion” after investigators found in his closet a T-shirt that declared “Freedom or death.” In November, local officials, apparently cowed by a welter of condemnation in newspapers and on the Internet, cut short his two-year sentence.


A similar backlash also persuaded officials in Hunan Province last summer to free a woman, Tang Hui, who was given an 18-month sentence after she repeatedly protested that the seven men who had raped and forced her 11-year-old daughter into prostitution had been treated too leniently.


But any jubilation that the system might be on its way out was tempered by the manner in which the news emerged. Details of a conference held by top judicial and legal officials were reported online on Monday by a number of news media outlets — including word that the party would “stop using the system” within a year. Those accounts, however, were later deleted, leaving only the brief Xinhua account.


Chen Dongsheng, a bureau chief for the official Legal Daily who listened to a closed-circuit telecast of the meeting, told The Associated Press that Meng Jianzhu, chief of the Communist Party’s politics and law committee, had pledged to end the system, saying it had “played a useful role in the past, but conditions had now changed.”


But Mr. Chen’s microblog postings on the subject promptly disappeared, and he could not be reached for comment.


In its own report, Xinhua used the word “reform,” suggesting the changes to the system labor might be less than sweeping. Such changes could involve giving the system the legislative authority it currently lacks and subjecting decisions to some level of judicial review, although China’s party-controlled courts rarely rule in favor of defendants.


In a separate account of the same meeting, Xinhua included comments by Mr. Meng and Xi Jinping, the incoming president, but left out any mention of re-education through labor. Mr. Xi, who has promised to strengthen the nation’s legal system since his elevation to party secretary in November, reiterated his support for greater rule of law, saying the government should “improve empathy and public credibility of legal affairs work, striving to ensure that the public feels that justice is served in every law case.”


Rights advocates are pleased that the issue is on the leadership’s agenda but said that the devil would be in the details. Previous proposals for change, they noted, have included an 18-month cap on sentences, weekend furloughs for prisoners and access to lawyers for defendants. But such modifications alone, they said, would leave intact the bones of a system that violates international legal conventions as well as Chinese law.


“The risk is we’ll get re-education lite — a system that perpetuates the ability of police to deprive people of liberty for significant periods of time without trial or judicial oversight,” said Nicholas Bequelin, a senior researcher at Human Rights Watch. “My fear is that such a system would end up being harder to do away with.”


Patrick Zuo contributed research.



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Providing a Template to Challenge Apple


TAIPEI — In the China smartphone market, Apple has seen better days.


Despite having reported record sales of the iPhone 5, the U.S. technology giant’s presence on the mainland flagged in 2012; it was pushed out of the top five smartphone makers in that market during the third quarter, with just 8 percent of the market, according to the research firm Canalys.


As Coolpad, Huawei, Lenovo, Samsung and ZTE surged ahead of Apple, a major force behind their success was MediaTek, a Taiwanese chip maker whose products have drastically reduced the cost for manufacturers of getting new phones to market.


The company entered the smartphone business late, introducing its first chipset in 2011 inside a Lenovo phone. But within a year and a half, analysts say, MediaTek has taken 50 percent of China’s market for smartphone chips.


That success has come with the adoption of what MediaTek calls a “turnkey solution.” Rather than simply provide a chip, the company also offers instructions on how to build a phone, the software architecture to run it and dedicated consultants to advise phone makers through the production process. MediaTek’s chief financial officer, David Ku, describes this as a franchise model in which all the clients have to do is “turn on the burner.”


Peter Liao, an analyst at Nomura Securities who covers the industry, said MediaTek saved phone makers the often prohibitive cost of research and development.


“It typically takes a lot of money and time to develop a new handset model, but MediaTek comes in and provides a total solution,” Mr. Liao said.


The company has proved wildly popular among Chinese phone makers. Besides supplying Huawei, Lenovo and ZTE, MediaTek also supports lesser-known manufacturers, including those that make so-called bandit phones that imitate premium models from Apple, Samsung and HTC.


TCL Communication Technology Holdings, a Chinese phone maker that sells phones primarily in Europe and Latin America, uses MediaTek’s chips. Its chief operating officer, Wang Jiyang, said that when his company works with MediaTek, its only major design tasks are to make the software more user-friendly and to tailor the look and feel of the phone.


“In general, with MediaTek’s help, we’re able to achieve almost twice as fast time to market, compared to other solutions,” Mr. Wang said.


MediaTek was founded in 1997. It started out making chips for home entertainment electronics like DVD players and televisions before moving into components for CD and DVD-ROM devices. In 2004, it began making chips for small mobile phones.


MediaTek estimates that it will lead the Chinese market by selling 110 million smartphone chips in 2012, up from 10 million chips a year ago.


By comparison, Qualcomm, the global leader in smartphone chips, is expected to finish 2012 in second place in China with 82 million chips shipped, according to the research firm DigiTimes.


MediaTek has been powered by consumers like Zhang Ying, 31, who want to try the latest technology but not pay a premium for it. Mr. Zhang, a Shanghai resident, bought a knockoff HTC phone last year. “Every person has a price point,” he said. “At a time when some of my friends were buying Samsung or iPhone, I wanted to show that I can keep up with them. A lot of domestic phones are cheap and of fairly good quality.”


People who think like Mr. Zhang are dominating sales, especially among first-time smartphone buyers. In a September report, McKinsey, the global consulting firm, estimated that 69 percent of all smartphones sold in China would cost less than 1,500 renminbi, or about $240, by the second half of 2013.


And MediaTek is taking its business model to other emerging markets. The company’s products support features that are popular in developing countries, like noise-reducing speakers and slots for two SIM cards.


In India, local brands like Spice and Micromax are rolling out lower-priced smartphone models using MediaTek parts. In Brazil, phones by Motorola Mobility, as well as local brands like Gradiente and Multilaser, will also have MediaTek chips.


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Health Spending Growth Stays Low for 3rd Straight Year





WASHINGTON — National health spending climbed to $2.7 trillion in 2011, or an average of $8,700 for every person in the country, but as a share of the economy, it remained stable for the third consecutive year, the Obama administration said Monday.




The rate of increase in health spending, 3.9 percent in 2011, was the same as in 2009 and 2010 — the lowest annual rates recorded in the 52 years the government has been collecting such data.


Federal officials could not say for sure whether the low growth in health spending represented the start of a trend or reflected the continuing effects of the recession, which crimped the economy from December 2007 to June 2009.


Kathleen Sebelius, the secretary of health and human services, said that “the statistics show how the Affordable Care Act is already making a difference,” saving money for consumers. But a report issued by the Centers for Medicare and Medicaid Services, in her department, said that the law had so far had “no discernible impact” on overall health spending.


Although some provisions of the law have taken effect, the report said, “their influence on overall health spending through 2011 was minimal.”


The recession increased unemployment, reduced the number of people with private health insurance, lowered household income and assets and therefore tended to slow health spending, said Micah B. Hartman, a statistician at the Centers for Medicare and Medicaid Services.


In the report, federal officials said that total national spending on prescription drugs and doctors’ services grew faster in 2011 than in the year before, but that spending on hospital care grew more slowly.


Medicaid spending likewise grew less quickly in 2011 than in the prior year, as states struggled with budget problems. But Medicare spending grew more rapidly, because of an increase in “the volume and intensity” of doctors’ services and a one-time increase in Medicare payments to skilled nursing homes, said the report, published in the journal Health Affairs.


National health spending grew at roughly the same pace as the overall economy, without adjusting for inflation, so its share of the economy stayed the same, at 17.9 percent in 2011, where it has been since 2009. By contrast, health spending accounted for just 13.8 percent of the economy in 2000.


Health spending grew more than 5 percent each year from 1961 to 2007. It rose at double-digit rates in some years, including every year from 1966 to 1984 and from 1988 to 1990.


The report did not forecast the effects of the new health care law on future spending. Some provisions of the law, including subsidized insurance for millions of Americans, could increase spending, officials said. But the law also trims Medicare payments to many health care providers and authorizes experiments to slow the growth of health spending.


“The jury is still out whether all the innovations we’re testing will have much impact,” said Richard S. Foster, who supervised the preparation of the report as chief actuary of the Medicare agency. “I am optimistic. There’s a lot of potential. More and more health care providers understand that the future cannot be like the past, in which health spending almost always grew faster than the gross domestic product.”


Evidence of the new emphasis can be seen in a series of articles published in The Archives of Internal Medicine, now known as JAMA Internal Medicine, under the title “Less Is More.” The series highlights cases in which “the overuse of medical care may result in harm and in which less care is likely to result in better health.”


Total spending for doctors’ services rose 3.6 percent in 2011, to $436 billion, while spending for hospital care increased 4.3 percent, to $850.6 billion.


Spending on prescription drugs at retail stores reached $263 billion in 2011, up 2.9 percent from 2010, when growth was just four-tenths of 1 percent. The latest increase was still well below the average increase of 7.8 percent a year from 2000 to 2010.


Federal officials said the increase in 2011 resulted partly from rapid growth in prices for brand-name drugs.


Prices for specialty drugs, typically prescribed by medical specialists for chronic conditions, have increased at double-digit rates in recent years, the government said. In addition, spending on new brand-name drugs — those brought to market in the previous two years — more than doubled from 2010 to 2011, driven by an increase in the number of new medicines.


“In 2011,” the report said, “spending for private health insurance premiums increased 3.8 percent, as did spending for benefits. Out-of-pocket spending by consumers increased 2.8 percent in 2011, accelerating from 2.1 percent in 2010 but still slower than the average annual growth rate of 4.7 percent” from 2002 to 2008.


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