DealBook: Top Federal Prosecutor of Corporate Crime Resigns

1:42 p.m. | Updated with formal announcement

Lanny A. Breuer, the federal prosecutor who led the Justice Department’s response to corporate crime in the wake of the financial crisis, announced on Wednesday that he is stepping down after nearly four years in the post.

As head of the Justice Department’s criminal division, one of the most senior roles at the agency, Mr. Breuer tackled corporate bribery and public corruption. But it was his focus on Wall Street that received the most attention, from supporters and critics alike.

While he has come under fire for a dearth of prosecutions on Wall Street in response to the crisis, Mr. Breuer also oversaw an aggressive crackdown on money-laundering and interest-rate manipulation at some of the world’s biggest banks. In two weeks last month, he joined a nearly $2 billion case against HSBC for money-laundering and a $1.5 billion settlement with UBS for rate-rigging. Next week, he is expected to take a similar rate-rigging action against the Royal Bank of Scotland.

“I think the criminal division is a fundamentally different place than it was four years ago,” Mr. Breuer said in an interview on Tuesday. “It’s the highlight of my professional career.”

His departure, effective March 1, was widely expected. Mr. Breuer had told friends for weeks that he was ready to leave the public sector. While he has not announced his next step, it is expected that he will return to private practice. He was previously a partner at Covington & Burling, a white-shoe law firm.

By virtue of his perch at the Justice Department in Washington, Mr. Breuer became the face of Wall Street prosecutions in the aftermath of the financial crisis. But when few such cases materialized, critics like the Occupy Wall Street protesters turned on him, portraying him as an apologist for banks at the center of the mortgage mess.

In contrast, he drew praise for the sweeping crackdown on rate-rigging in the banking industry, which has largely involved international benchmark rates.

In a rate manipulation case last month, Mr. Breuer’s team secured a major payout from UBS and a guilty plea from the bank’s Japanese unit, making UBS the first big global bank in more than two decades to have a subsidiary plead guilty to fraud. Mr. Breuer, who announced the action after rejecting a last-minute plea from the bank’s chairman, also filed criminal charges against two former employees at the bank.

The deal sent a strong signal that the authorities wanted to hold banks responsible for their wrongdoing.

Following the UBS model, the Justice Department is now pursuing a guilty plea from a Royal Bank of Scotland subsidiary in Asia over its role in the interest rate manipulation scandal, people briefed on the matter said. That settlement, which could come as soon as next week, is likely to include more than $650 million in fines imposed by American and British authorities, two other people with direct knowledge of the matter said.

In an interview, Mr. Breuer said the rate-rigging case amounted to “egregious criminal conduct.” He struck a similar tone about two other major financial cases — the convictions of executives from Taylor, Bean & Whitaker, a now-defunct mortgage lender, and the 110-year prison term imposed on R. Allen Stanford for his Ponzi scheme.

Mr. Breuer has also focused on money-laundering, creating a task force in 2010 that has levied more than $3 billion in fines from banks, including the record fine against HSBC. He stopped short of indicting HSBC after some regulators warned that doing so could destabilize the global financial system.

Mr. Breuer argued that the charges he did not bring — for example, against Goldman Sachs and other banks suspected of fraud after selling toxic mortgage securities to investors — could not have been proved. It was not for a lack of trying, he said, noting that United States attorneys across the country, after reviewing the same evidence he did, also declined to act.

“It’s important for me to hold the financial institutions accountable,” he said. “There’s never been a time that a prosecutor said we should bring a securitization case and I said no.”

Under Mr. Breuer, the division has also increasingly used a 1977 law, the Foreign Corrupt Practices Act, to prosecute corporate bribery.

He also helped run the Justice Department’s investigation of the BP oil spill in the Gulf of Mexico, resulting in the company paying $4.5 billion in fines and other penalties and pleading guilty to 14 criminal charges related to the rig explosion in 2010.

In a statement, Attorney General Eric H. Holder Jr. praised Mr. Breuer. “Lanny has led one of the most successful and aggressive criminal divisions in the history of the Department of Justice,” he said.

Mr. Holder stood behind Mr. Breuer when questions arose about his involvement in the botched gun-trafficking case known as Operation Fast and Furious. The pair, who were both largely cleared after an inspector general investigation, worked together at Covington.

For years, Mr. Breuer moved in and out of government. The son of Holocaust survivors who fled Europe and settled in Queens, he landed at the Manhattan district attorney’s office after graduating from Columbia Law School. In between stints at Covington, he worked as a White House special counsel, defending President Bill Clinton amid federal investigations and impeachment proceedings.

In the interview on Tuesday, Mr. Breuer reflected on his unusual path to the Justice Department.

“The fact that I got to go from Elmhurst, Queens, to the criminal division is remarkable,” he said.

A version of this article appeared in print on 01/30/2013, on page B3 of the NewYork edition with the headline: Top Federal Prosecutor of Corporate Crime Will Resign.
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Senate overwhelmingly approves John Kerry for secretary of State









WASHINGTON — The Senate voted overwhelmingly Tuesday to confirm Sen. John F. Kerry (D-Mass.) as the next secretary of State, filling a crucial national security spot in President Obama’s second-term Cabinet.

The 94-3 vote clears the way for Kerry to replace Hillary Rodham Clinton after she steps down Friday.


Kerry, who will become America’s 68th top diplomat, failed to win only three Republican votes — those of Sens. John Cornyn and Rafael “Ted” Cruz, both of Texas, and Sen. James M. Inhofe of Oklahoma. 

A spokesman for Cornyn said Kerry supported liberal positions that most Texans oppose. Cruz has criticized Kerry, who fought in the Vietnam War, as anti-military.





Earlier Tuesday, Kerry received the unanimous endorsement of the Senate Foreign Relations Committee in a voice vote. He served on the committee for 28 years and chaired it for the last four.


Sen. Bob Corker (R-Tenn.), the ranking Republican on the committee, praised Kerry as a “realist” on foreign affairs issues, and said he was always “open to discussion” with colleagues of the opposite party.


Corker, noting that Kerry’s father was a foreign service officer, said he knew of no one “who’s lived a life that’s been ultimately more oriented toward being secretary of State.”

Leading Republican senators had promoted Kerry as an alternative to Susan Rice, the U.S. ambassador to the United Nations, for the job. Rice withdrew her name from consideration after Republicans criticized her for statements she made on TV talk shows after the deadly Sept. 11 attack on the U.S. mission in Benghazi, Libya.


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Liveblog: RIM Launches BlackBerry 10, Its Hail Mary Pass












This is it. The BlackBerry Experience event in New York will be RIM’s saving grace or its swan song. Everything is riding on the BlackBerry 10 operating system and the Z10 smartphone. And no matter how it goes, Wired will be there live beginning at 10 a.m. Eastern (7 a.m. Pacific).



Everything we’ve seen and heard suggests the OS is amazing and the phone is something people will actually want to buy, so it all comes down to the apps. They’ve gotta be awesome, and RIM knows it. That’s why they’ve been courting developers for month and have 70,000 apps available at launch.



After reorganizing the company and a few false starts, RIM will introduce the final version of its BlackBerry 10 operating system and at least one BlackBerry 10 smartphone, which is expected to become available in February. This is RIM’s Hail Mary pass. We’ll be there to see it thrown. Will consumers be there to catch it?



Roberto is a Wired Staff Writer for Gadget Lab covering augmented reality, home technology, and all the gadgets that fit in your backpack. Got a tip? Send him an email at: roberto_baldwin [at] wired.com.

Read more by Roberto Baldwin

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Singer Frank Ocean wants Chris Brown charged over brawl






LOS ANGELES (Reuters) – Rising R&B artist Frank Ocean wants fellow singer Chris Brown prosecuted following a brawl over a parking space at a Los Angeles-area recording studio, authorities said on Monday.


Brown is serving five years probation for assaulting his on-and-off girlfriend Rihanna in 2009 and risks having his probation revoked should charges be filed.






In the incident on Sunday, sheriff’s deputies responded to a call about a fight involving six men in West Hollywood. The deputies cited witnesses as saying that the Grammy-winning Brown, 23, punched Ocean during the brief altercation.


No charges have yet been filed, but Ocean “is desirous of prosecution in this incident,” said Los Angeles County Sheriff‘s spokesman Steve Whitmore.


Ocean, 25, who is nominated for best new artist and best record for “Thinkin Bout You” at the Grammys in February, said on Twitter on Sunday night that he “got jumped by Chris and a couple guys.” He said this resulted in a cut finger.


A representative for Brown has yet to comment.


The “Look at me Now” singer has attempted to rebuild his career and public image since 2009, but his entourage and that of Canadian rapper Drake were involved in a June 2012 brawl in a New York nightclub. No arrests or charges were brought in that case.


Brown and Ocean are both nominated in the best urban contemporary album category at the Grammys, which take place on February 10 in Los Angeles.


(Reporting by Eric Kelsey and Colleen Jenkins; Editing by David Brunnstrom)


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Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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Economic Scene: Energy Tax Is Underused Tool in Climate Change Fight


To understand the complicated politics of climate change in the United States, you may want to talk to Pamela Johnson, president of the National Corn Growers Association’s Corn Board.


She is concerned about the weather. The drought that parched the lower 48 states cut the harvest at her northern Iowa farm by about 40 bushels an acre. For the first time in memory, she says, she had to rely on the federally subsidized crop insurance program to stay afloat.


And yet Ms. Johnson’s main concern, and that of most other growers in the association, is not about how to deal with a changing climate — how to slow the pace of warming and how to adapt to a warmer world with more erratic weather.


Rather, growers worry that political support for crop insurance might flag after a year in which taxpayers paid billions in subsidies to farmers while virtually everybody else faced deep budget cuts.


“We are Americans before we are farmers,” Ms. Johnson said. “We know we have budget problems.” Still, she added: “For our farmers, crop insurance is the main concern. It helps keep us in business.”


The erratic weather across the country in the last couple of years seems to be softening Americans’ skepticism about global warming. Most New Yorkers say they believe big storms like Sandy and Irene were the result of a warming climate. Whether climate change is directly responsible or not, the odd weather patterns have underscored the risk that it poses to all of us.


What’s yet to be seen is whether this growing awareness of the risks will translate into sufficient political support to address climate change, especially after we figure out the costs we will have to bear to do so.


In his inaugural address, President Obama wove Hurricane Sandy and last year’s drought into a stirring plea to address climate change. “The failure to do so would betray our children and future generations,” the president said.


But even as he put global warming at the top of his agenda, he avoided dwelling on how much it would cost to address. And nowhere in his speech did he allude to the most powerful tool to address the problem: a tax on the use of energy.


Dealing with global warming will be expensive. The price tag last year for the drought was about $35 billion, according to the reinsurer Aon Benfield. Hurricane Sandy cost a further $65 billion. The National Oceanic and Atmospheric Administration said that last year ranked as the second-costliest in terms of natural disasters since 1980 — lagging only 2005 when Hurricane Katrina swamped New Orleans.


And yet this is nothing compared with what the future will bring.


“The impact to date has been pretty small,” said William Nordhaus of Yale, one of the leading economists studying the impact of climate change.


Nicholas Stern of the London School of Economics, another expert on the costs of climate change, said: “What we are seeing is on the back of warming of only 0.8 degrees centigrade” since the second half of the 19th century. “What we risk is 4, 5, 6 degrees even by the end of this century.”


For all the damage wrought by Sandy and Katrina, weather disasters in recent years have cost us probably less than a tenth of 1 percent of our economic product. Yet, according to Professor Nordhaus, “Damages will rise more sharply than the temperature curve.”


The president’s speech notwithstanding, the cost of dealing with these looming disasters is not to be found in the budgets discussed by the White House and Congressional Republicans, which would shrink much of the government to its smallest share of the economy since the early 1960s.


Neither is the cost of steering the economy away from the fossil fuels that are to blame for a warming atmosphere. A report from the World Economic Forum estimated that would cost $700 billion a year in public and private investment.


The reluctance is not because we have no idea of how to finance these efforts. We do. Top economists agree a tax on fuels and the carbon they spew into the atmosphere would be the cheapest way to combat climate change. Most advanced countries rely on some variant of this tax. The question is whether the prospect of more droughts and more powerful hurricanes push Americans to embrace it, too.


Among the 34 industrialized nations of the Organization for Economic Cooperation and Development, these taxes average about $68.4 per metric ton of carbon dioxide. The United States, by contrast, has a gas tax to pay for highway improvement, and that’s about it. Total federal taxes on energy amount to $6.30 per ton.


Some states add excise taxes — California has a gas tax equivalent to about $46.50 per ton of carbon dioxide and a $2.33-per-ton tax on jet kerosene. But, according to a review by the O.E.C.D., the federal government is unique in imposing no taxes on other energy use, from residential heating to power generation.


A tax on energy could single-handedly take on climate change. For starters, it would encourage people and businesses to burn less, reducing emissions at a stroke. One study found that a carbon tax of $15 per ton would reduce greenhouse emissions by 14 percent as people sought to save energy by driving less, insulating their homes and switching to renewable fuels, among other things.


What’s more, it would raise lots of money. Estimates reviewed in a report by the Tax Policy Center ranged from 0.6 percent of the nation’s gross domestic product — for a tax of $20 per ton of carbon dioxide — to 1.6 percent of G.D.P. for a tax of $41 per ton. Consider this: 1.6 percent of G.D.P. is $240 billion a year. And $41 per ton amounts to an extra 35 cents a gallon of gas.


By way of comparison, the Swiss economy does fairly well even while shouldering an effective carbon tax rate of more than $140 per ton.


Some of the money raised through more taxes on energy could be spent steeling communities to cope with more intense hurricanes and moving others out of harm’s way. It could even help ease the fiscal squeeze that so consumes our elected officials.


There are drawbacks. A carbon tax would fall more heavily on the poor — the Congressional Budget Office estimates that the poorest fifth of Americans spend 21.4 percent of their income on gas and utilities while the richest 20 percent spend only 6.8 percent. But economists at the budget office have pointed out that there are several ways to compensate lower-income Americans.


For all the merits of an energy tax, the United States seems a long way from embracing one. It was only three years ago that the corn growers and the rest of the farm lobby allied with energy producers and other corporations to derail President Obama’s first shot at climate change legislation, which would have set a limit on carbon emissions and required businesses to buy permits to emit.


As things stand, drought is unlikely to change their minds. Farmers are still covered by crop insurance, and they have powerful allies in Congress who will fight to keep subsidies in place. They may see little reason to support legislation that would make energy or fertilizer more expensive.


“Farmers would be deeply affected by an energy tax,” Ms. Johnson said.


As things stand for them, it is probably cheaper to deal with the occasional drought.


E-mail: eporter@nytimes.com;


Twitter: @portereduardo



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Bipartisan group sees change in politics on immigration reform

A bipartisan coalition of senators said Monday they have created a set of principles based upon which they hope lawmakers will pass immigration reform by summer.









WASHINGTON — Declaring that the politics of immigration  “have been turned upside down,” a bipartisan group of senators Monday outlined common principles for comprehensive immigration reform and expressed optimism that legislation granting legal status to most of the country's 11 million illegal immigrants could be realized by this summer.


One day before President Obama launches a campaign-style push for his vision of immigration reform, representatives of the so-called Group of Eight senators acknowledged previous false starts on the issue, and obstacles that probably lie ahead — particularly in determining how to increase the flow of legal immigration.


But, after an election in which the share of the nonwhite vote continued to grow and swung overwhelmingly toward Obama, the lawmakers said that the path forward was as clear as ever.








Arizona Sen. John McCain, the GOP’s 2008 presidential nominee and a past proponent of comprehensive reform, said the change in favor of taking action came down to one word: “Elections.”


PHOTOS: President Obama’s second inauguration


“The Republican Party is losing the support of our Hispanic citizens. And we realize that there are many issues in which we think we are in agreement with our Hispanic citizens, but this is a preeminent issue with those citizens,” he said at a Capitol Hill news conference. 


“For the first time ever, there's more political risk in opposing immigration reform than in supporting it,” added Sen. Charles E. Schumer (D-N.Y.).


The Senate blueprint, drafted during weeks of closed-door meetings by leading senators from each party, is more conservative than Obama's proposal, which the president plans to unveil Tuesday in a speech in Las Vegas. But its provisions for legalizing millions of undocumented immigrants go further than measures that failed to advance in Congress in previous years — a reminder of how swiftly the politics of immigration have shifted since the November election.


The Senate proposal would allow most of those in the country illegally to obtain probationary legal status immediately by paying a fine and back taxes and passing a background check. That would make them eligible to work and live in the U.S. They could earn a green card — permanent residency — after the government certifies that the U.S.-Mexican border has become secure, but might face a lengthy process before becoming citizens.


Obama is expected to push for a faster citizenship process that would not be conditional on border security standards being met first. The structure of the citizenship process will probably be among the most hotly debated parts of any immigration plan.


PHOTOS: A look ahead at 2013’s political battles


Less controversial provisions would tighten requirements on employers to check the immigration status of new workers; increase the number of visas for high-skill jobs; provide green cards automatically to people who earn master's degrees or PhDs in science, technology or math at U.S. universities; and create an agricultural guest-worker program.


Schumer said lawmakers are aiming for full legislative language to be put forward by March, which will then work its way through the committee process. A vote in the Senate could come by late spring or summer, he said.


“We still have a long way to go, but this bipartisan blueprint is a major breakthrough,” he said.


Though their effort was running parallel to the president’s, Democratic Sen. Richard J. Durbin of Illinois said he and Schumer spoke with Obama on Sunday and that the president “cheered us on.” McCain said Obama’s public campaign for it would be helpful to their cause.


Still, many conservatives on Capitol Hill remain skeptical about sweeping immigration legislation and could prove a major obstacle to any compromise.


“The last time we talked about this in 2007, it sounded very seductive. When we saw the details, it was clear it wouldn’t work,” Sen. Jeff Sessions (R-Ala.) said in an interview Monday. Sessions said he was particularly concerned that the Obama administration is not committed to securing the borders against future illegal immigration.


Similar criticism from Republican lawmakers doomed a 2007 immigration bill pushed by President George W. Bush and seniors Senate Democrats.


PHOTOS: President Obama’s past


Today, 22 GOP senators who opposed the 2007 plan remain in the Senate, including Minority Leader Mitch McConnell (R-Ky.). By contrast, just two of the 12 Republicans who backed the compromise six years ago are still in Congress — McCain and South Carolina's Lindsey Graham.


Republican resistance to an immigration overhaul promises to be even more intense in the House, where many conservative lawmakers are leery of any proposal that would provide a mechanism for immigrants here illegally to gain citizenship, a key demand on the left.


“When you legalize those who are in the country illegally, it costs taxpayers millions of dollars, costs American workers thousands of jobs and encourages more illegal immigration,” said Rep. Lamar Smith (R-Texas), the former chairman of the House Judiciary Committee. “By granting amnesty, the Senate proposal actually compounds the problem by encouraging more illegal immigration.”


Staff writers Brian Bennett and Lisa Mascaro contributed to this report.


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Researchers Set Record With Million-Core Calculation



Sure the popular open source platform Hadoop can crunch Big Data. But we’re talking Really Big Data. At Stanford University in Northern California, researchers just tapped into the world’s largest supercomputer and ran an application that crunched information across more than one million processor cores.


Joseph Nichols and his team are the first to run live code on the Lawrence Livermore National Laboratories’ Sequoia IBM Bluegene/Q supercomputer, a machine that spans over 1.5 million cores in total. The team used just over one million of those cores to simulate the amount of noise produced by an experimental jet engine, apparently setting a supercomputer record in the process.


Nichols and crew had never run the code on a machine with over 200,000 cores before, and they spent the past few weeks working closely with the Lawrence Livermore researchers to optimize the software for Sequoia. “I had no idea if it was going to work or not,” Nichols says.


The experiment shows that despite the rise of open source distributing computing tools such as Hadoop — which uses dirt-cheap, commodity hardware — old school supercomputers still provide much larger data crunching platforms. The largest Hadoop cluster likely spans around 8,800 cores.


Supercomputers work by breaking down very large problems into smaller problems and distributing them across many machines and many processor cores. Typically, adding more cores makes the calculations faster, but it also adds complexity. At a certain point, calculations can actually become slower due to bottlenecks introduced by the communications between processors.


But Sequoia’s processors are organized and networked in a new way — using a “5D Torus” interconnect. Each processor is directly connected to ten other processors, and can connect, with lower latency, to processors further away. But some of those processors also have an 11th connection, which taps into a central input/output channel for the entire system. These special processors collect signals from the processors and write the results to disk. This allowed most of the necessary communications to occur between the processors without a need to hit the disk.


The team hopes the results will help create quieter jet engines. Under the direction of Professors Parviz Moin and Sanjiva Lele, the Stanford team has been working with the NASA Glenn Research Center in Ohio and the NAVAIR branch of the U.S. Navy to predict how loud an experimental engine will be without having to actually construct a prototype. That’s harder than it sounds. Nichols explains that the acoustic energy of an engine is less than one percent of its total energy. Calculations have to be extremely precise in order to accurately model the noise an engine will generate.


But thanks to the Sequoia, Nichols thinks their research could go beyond just modeling into prescriptive design — in other words, figuring out what the optimum design would be.


There are many other possibilities. Nichols says that the code they’re working with — originally developed by former Stanford senior research associate Frank Ham — enables other researchers at Stanford to simulate the full flow of an entire aircraft wing and to model hypersonic scramjets, propulsion systems for flight at several times the speed of sound.


“It gave pause to a lot of people,” Nichols says. “We were like: ‘Whoa we can actually do that.’”


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Rock singer Morrissey postpones six more shows due to bleeding ulcer






LOS ANGELES (Reuters) – British rock singer Morrissey is postponing six performances on his U.S. tour due to a bleeding ulcer, his spokeswoman said on Sunday.


Morrissey is expected to make a full recovery and thanks everyone concerned for their support during this time,” his representative Lauren Papapietro said in a statement.






Morrissey, the former lead singer for 1980s alternative rock band The Smiths, checked into Beaumont Hospital on Friday in the Detroit suburb of Royal Oak, Papapietro said.


She declined to say if he remains hospitalized.


Due to his bleeding ulcer, Morrissey is postponing his upcoming shows in Asheville, North Carolina; Nashville, Tennessee; Atlanta, Georgia; Lawrence, Kansas; Clear Lake, Iowa; and Lincoln, Nebraska, Papapietro said.


He plans to resume his tour on February 9 in Las Vegas.


Due to an illness in his band, Morrissey, 53, canceled his show Thursday in Flint, Michigan, and postponed a Friday night performance in Minneapolis and another engagement set for Saturday night in Chicago, Papapietro said.


Morrissey, whose hits include “First of the Gang to Die” and “Irish Blood, English Heart,” toured North America last fall, played some shows in Australia and New Zealand in December and returned to the United States this month.


He kicked off his latest tour with a performance of his unreleased song “Action is My Middle Name” on “The Late Show with David Letterman” in New York.


(Reporting by Alex Dobuzinskis; Editing by Kevin Gray and Stacey Joyce)


Music News Headlines – Yahoo! News





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Personal Health: Keeping Blood Pressure in Check

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

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

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


Jane Brody speaks about hypertension.




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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

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