Republicans Eye a Debt Fight Obama Wants to Sidestep

WASHINGTON — President Obama’s eyes narrowed late Tuesday as he looked into the cameras and warned Republicans that he had no intention of ever getting pulled into another negotiation over raising the nation’s borrowing limit.

“I will not have another debate with this Congress over whether or not they should pay the bills that they’ve already racked up through the laws that they passed,” the president said, pausing to repeat himself. “We can’t not pay bills that we’ve already incurred.”

But it is not clear exactly how Mr. Obama can avoid engaging in just such a tug of war.

In the wake of the president’s victory on taxes over the New Year’s holiday, Republicans in Congress are betting that by refusing to unconditionally raise the $16.4 trillion debt ceiling, they can force Mr. Obama to the bargaining table on spending cuts and issues like reform of Medicare and Social Security.

That would inevitably reprise the bitter clash over the debt ceiling in the summer of 2011, when the government came close to shutting down before lawmakers and the president agreed to a $1.2 trillion package of spending cuts in exchange for Republican agreement to raise the debt ceiling by about the same amount.

And that is exactly what Republicans want.

The party’s caucus in the House will discuss its debt ceiling strategy at its retreat in Williamsburg, Va., in a couple of weeks, according to a top Republican aide, who said it was determined to insist again on spending cuts that equal the increase in the amount the country can borrow.

“The speaker told the president to his face that everything you want in life comes with a price. That doesn’t change here,” the Republican aide said. “I don’t think he has any choice.”

That strategy could risk a new round of criticism aimed at Republicans from a public weary of brinkmanship. The 2011 fight ended with a last-minute deal but led to a downgrade in the rating of the nation’s debt and a slump in the economic recovery.

But Brendan Buck, a spokesman for Speaker John A. Boehner, said Republicans had made it clear what they wanted in exchange for a willingness to allow borrowing to increase.

“If they want to get the debt limit raised, they are going to have to engage and accept that reality,” Mr. Buck said. “The president knows that.”

In fact, the White House has been on notice for months that Republicans view the debt ceiling as leverage in the next budget fight. Now, the question is what Mr. Obama and his advisers can do to sidestep that fight.

One possibility is to turn to business executives for support. Many top chief executives view the possibility of a debt ceiling crisis as a significant impediment to the nation’s economy just as it is beginning to grow again. Those executives might try to pressure Republican lawmakers not to use the country’s credit as a negotiating tool.

Mr. Obama might also take to the road again, using the power of his office to try to convince the public that another fight over the debt ceiling risks another economic crisis. Public polls after the last debt ceiling fight suggested that more people blamed Republicans for the threat of a default.

The president and his aides have signaled that they will try to educate the public by explaining that the increase in the borrowing limit is necessary to cover debts that the government has already incurred. In his statement on Tuesday night, Mr. Obama warned about what would happen if the country did not meet its obligations.

“If Congress refuses to give the United States government the ability to pay these bills on time, the consequences for the entire global economy would be catastrophic — far worse than the impact of a fiscal cliff,” Mr. Obama said.

In the coming days and weeks, Mr. Obama is likely to try to focus negotiations on the other looming issue: how to avoid deep across-the-board cuts to the nation’s military and domestic programs. The deal passed on Tuesday postpones those cuts for two months, but Mr. Obama and lawmakers in both parties are eager to avoid them.

Instead, the president wants a debate over spending cuts and tax changes that would remove loopholes and deductions for wealthy Americans.

That fight is coming. The question is whether the president can avoid conducting it in the middle of a nasty, drawn-out debate over the debt limit.

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Ruling over bumper-car injury supports amusement park

SAN FRANCISCO — The California Supreme Court, protecting providers of risky recreational activities from lawsuits, decided Monday that bumper car riders may not sue amusement parks over injuries stemming from the inherent nature of the attraction.

The 6-1 decision may be cited to curb liability for a wide variety of activities — such as jet skiing, ice skating and even participating in a fitness class, lawyers in the case said.

"This is a victory for anyone who likes fun and risk activities," said Jeffrey M. Lenkov, an attorney for Great America, which won the case.

But Mark D. Rosenberg, who represented a woman injured in a bumper car at the Bay Area amusement park, said the decision was bad for consumers.

"Patrons are less safe today than they were yesterday," Rosenberg said.

The ruling came in a lawsuit by Smriti Nalwa, who fractured her wrist in 2005 while riding in a bumper car with her 9-year-old son and being involved in a head-on collision. Rosenberg said Great America had told ride operators not to allow head-on collisions, but failed to ask patrons to avoid them.

The court said Nalwa's injury was caused by a collision with another bumper car, a normal part of the ride. To reduce all risk of injury, the ride would have to be scrapped or completely reconfigured, the court said.

"A small degree of risk inevitably accompanies the thrill of speeding through curves and loops, defying gravity or, in bumper cars, engaging in the mock violence of low-speed collisions," Justice Kathryn Mickle Werdegar wrote for the majority. "Those who voluntarily join in these activities also voluntarily take on their minor inherent risks."

Monday's decision extended a legal doctrine that has limited liability for risky sports, such as football, to now include recreational activities.

"Where the doctrine applies to a recreational activity," Werdegar wrote, "operators, instructors and participants …owe other participants only the duty not to act so as to increase the risk of injury over that inherent in the activity."

Amusement parks will continue to be required to use the utmost care on thrill rides such as roller coasters, where riders surrender control to the operator. But on attractions where riders have some control, the parks can be held liable only if their conduct unreasonably raised the dangers.

"Low-speed collisions between the padded, independently operated cars are inherent in — are the whole point of — a bumper car ride," Werdegar wrote.

Parks that fail to provide routine safety measures such as seat belts, adequate bumpers and speed controls might be held liable for an injury, but operators should not be expected to restrict where a bumper car is bumped, the court said.

The justices noted that the state inspected the Great America rides annually, and the maintenance and safety staff checked on the bumper cars the day Nalwa broke her wrist. The ride was functioning normally.

Reports showed that bumper car riders at the park suffered 55 injuries — including bruises, cuts, scrapes and strains — in 2004 and 2005, but Nalwa's injury was the only fracture. Nalwa said her wrist snapped when she tried to brace herself by putting her hand on the dashboard.

Rosenberg said the injury stemmed from the head-on collision. He said the company had configured bumper rides in other parks to avoid such collisions and made the Santa Clara ride uni-directional after the lawsuit was filed.

Justice Joyce L. Kennard dissented, complaining that the decision would saddle trial judges "with the unenviable task of determining the risks of harm that are inherent in a particular recreational activity."

"Whether the plaintiff knowingly assumed the risk of injury no longer matters," Kennard said.

maura.dolan@latimes.com

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The Future Is Now: What We Imagined for 2013 — 10 Years Ago

Predicting the future is hard, but that doesn’t stop us from trying. We’re Wired, after all.

Ten years ago, we boldly declared that we’d be living with phones on our wrists, data-driven goggles on our eyes and gadgets that would safety-test our food for us. Turns out, a lot of the things Sonia Zjawinski conceptualized in our “Living in 2013” feature way back in 2003 were remarkably close to what we’ve seen. We even got the iPhone right (sort of).

And so, as we look back on life in 2013 circa 2003, we’re going to spin it forward once again to tell you what life will be like in 2023.

Predicted for 2003 (above):

Apple redefined the desktop, laptop, and MP3 player. The next insanely great thing: an LCD arm cuff that includes a PDA, wireless Internet, a mini iPod, and, of course, a phone. The iPhone bracelet's motion sensor allows you to scroll through apps and files with the flick of a wrist, its clasp holds a digicam for use during video calls, and its wireless ear clip lets you listen and speak to callers. And everything can be done via voice recognition or touchscreen. Talk about the right call. Illustration: Kenn Brown.

Delivered in 2013:

Hey, it turns out, Apple gave us an iPhone after all! We got the name right, and even seemed to know about FaceTime. But the form factor details? Not so much. While you can wear an iPod nano as a watch, or make a call with your iPhone, if you want the watch-plus-phone combination that we teased you with 10 years ago, for now you'll need to pick up a secondary gadget that can transmit to your phone, like this Pebble. Photo: Ariel Zambelich/Wired.

Looking ahead to 2023:

Here's the thing, the screen on a watch is simply too small to display lots of data. And as an input device? Forget it. Yet keeping your phone out of sight means you often can't interact with your data on the go. The obvious answer is a variable size display. Samsung has already demonstrated a pretty convincing foldable OLED display prototype. Given 10 more years, we can easily see one screen serving multiple purposes by taking on multiple form factors, depending on whether you wanted to simply glance at it to read a message, or unfold it to write your reply. Illustration: Simon Lutrin/Wired

Mat Honan is a senior writer for Wired's Gadget Lab and the co-founder of the Knight-Batten award-winning Longshot magazine.

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Follow @mat on Twitter.

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Playboy Hugh Hefner marries his ‘runaway bride’

LOS ANGELES (AP) — Hugh Hefner is celebrating the new year as a married man once again.

The 86-year-old Playboy magazine founder exchanged vows with his “runaway bride,” Crystal Harris, at a private Playboy Mansion ceremony on New Year’s Eve. Harris, a 26-year-old “Playmate of the Month” in 2009, broke off a previous engagement to Hefner just before they were to be married in 2011.

Playboy said on Tuesday that the couple celebrated at a New Year’s Eve party at the mansion with guests that included comic Jon Lovitz, Gene Simmons of KISS and baseball star Evan Longoria.

The bride wore a strapless gown in soft pink, Hefner a black tux. Hefner’s been married twice before but lived the single life between 1959 and 1989.

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Study Suggests Lower Mortality Risk for Overweight People

A century ago, Elsie Scheel was the perfect woman. So said a 1912 article in The New York Times about how Miss Scheel, 24, was chosen by the “medical examiner of the 400 ‘co-eds’ ” at Cornell University as a woman “whose very presence bespeaks perfect health.”

Miss Scheel, however, was hardly model-thin. At 5-foot-7 and 171 pounds, she would, by today’s medical standards, be clearly overweight. (Her body mass index was 27; 25 to 29.9 is overweight.)

But a new report suggests that Miss Scheel may have been onto something. The report on nearly three million people found that those whose B.M.I. ranked them as overweight had less risk of dying than people of normal weight. And while obese people had a greater mortality risk over all, those at the lowest obesity level (B.M.I. of 30 to 34.9) were not more likely to die than normal-weight people.

The report, although not the first to suggest this relationship between B.M.I. and mortality, is by far the largest and most carefully done, analyzing nearly 100 studies, experts said.

But don’t scrap those New Year’s weight-loss resolutions and start gorging on fried Belgian waffles or triple cheeseburgers.

Experts not involved in the research said it suggested that overweight people need not panic unless they have other indicators of poor health and that depending on where fat is in the body, it might be protective or even nutritional for older or sicker people. But over all, piling on pounds and becoming more than slightly obese remains dangerous.

“We wouldn’t want people to think, ‘Well, I can take a pass and gain more weight,’ ” said Dr. George Blackburn, associate director of Harvard Medical School’s nutrition division.

Rather, he and others said, the report, in The Journal of the American Medical Association, suggests that B.M.I., a ratio of height to weight, should not be the only indicator of healthy weight.

“Body mass index is an imperfect measure of the risk of mortality,” and factors like blood pressure, cholesterol and blood sugar must be considered, said Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis.

Dr. Steven Heymsfield, executive director of the Pennington Biomedical Research Center in Louisiana, who wrote an editorial accompanying the study, said that for overweight people, if indicators like cholesterol “are in the abnormal range, then that weight is affecting you,” but that if indicators are normal, there’s no reason to “go on a crash diet.”

Experts also said the data suggested that the definition of “normal” B.M.I., 18.5 to 24.9, should be revised, excluding its lowest weights, which might be too thin.

The study did show that the two highest obesity categories (B.M.I. of 35 and up) are at high risk. “Once you have higher obesity, the fat’s in the fire,” Dr. Blackburn said.

But experts also suggested that concepts of fat be refined.

“Fat per se is not as bad as we thought,” said Dr. Kamyar Kalantar-Zadeh, professor of medicine and public health at the University of California, Irvine.

“What is bad is a type of fat that is inside your belly,” he said. “Non-belly fat, underneath your skin in your thigh and your butt area — these are not necessarily bad.”

He added that, to a point, extra fat is accompanied by extra muscle, which can be healthy.

Still, it is possible that overweight or somewhat obese people are less likely to die because they, or their doctors, have identified other conditions associated with weight gain, like high cholesterol or diabetes.

“You’re more likely to be in your doctor’s office and more likely to be treated,” said Dr. Robert Eckel, a past president of the American Heart Association and a professor at University of Colorado.

Some experts said fat could be protective in some cases, although that is unproven and debated. The study did find that people 65 and over had no greater mortality risk even at high obesity.

“There’s something about extra body fat when you’re older that is providing some reserve,” Dr. Eckel said.

And studies on specific illnesses, like heart and kidney disease, have found an “obesity paradox,” that heavier patients are less likely to die.

Still, death is not everything. Even if “being overweight doesn’t increase your risk of dying,” Dr. Klein said, it “does increase your risk of having diabetes” or other conditions.

Ultimately, said the study’s lead author, Katherine Flegal, a senior scientist at the Centers for Disease Control and Prevention, “the best weight might depend on the situation you’re in.”

Take the perfect woman, Elsie Scheel, in whose “physical makeup there is not a single defect,” the Times article said.

This woman who “has never been ill and doesn’t know what fear is” loved sports and didn’t consume candy, coffee or tea. But she also ate only three meals every two days, and loved beefsteak.

Maybe such seeming contradictions made sense against the societal inconsistencies of that time. After all, her post-college plans involved tilling her father’s farm, but “if she were a man, she would study mechanical engineering.”

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Shell Oil Rig Runs Aground in Alaska

An enormous Shell Oil offshore drilling rig ran aground on an island in the Gulf of Alaska on Monday night after it broke free from tow ships in rough seas, officials said.

The rig, the Kulluk, which was used for test drilling in the Arctic last summer, is carrying about 139,000 gallons of diesel fuel and 12,000 gallons of lubricating oil and hydraulic fluid, the officials said.

A Coast Guard helicopter flew over the rig after the grounding at 8:48 p.m. and “detected no visible sheen,” said Darci Sinclair, a spokeswoman for a unified command of officials from Shell, Alaskan state agencies and other groups that has been directing the response since the troubles with the rig began last Thursday.

Ms. Sinclair said that more overflights were planned after daybreak on Tuesday, and that the unified command would be monitoring the fuel situation as it planned further actions. “The focus will be around salvage,” she said.

The 266-foot diameter rig ran aground on the east coast of Sitkalidak Island, an uninhabited island that is separated by the Sitkalidak Strait from the far larger Kodiak Island to the west. The nearest town, Old Harbor, is across the strait on Kodiak Island; it has a population of about 200 people.

Ms. Sinclair said the coast where the Kulluk ran aground has a combination of rocky and sandy terrain.

Earlier Monday, a Shell spokesman had said that the rig had been brought under control after towlines were reconnected to two ships during a break in what had been several days of extremely rough seas and high winds.

But late Monday afternoon the line from one of the ships, the Aiviq, became separated. Then several hours later, the other ship, the Alert, was ordered to disconnect its towline, out of concern for the safety of the ship’s nine-person crew. At the time, Ms. Sinclair said, swells were as high as 35 feet and winds were gusting up to 65 miles an hour.

The Kulluk, one of two rigs that Shell used to drill test wells off the North Slope of Alaska as part of the company’s ambitious and expensive effort to open Arctic waters to oil production, was being towed by the Aiviq to a Seattle shipyard for off-season maintenance when the towline initially separated during a storm on Thursday.

The Aiviq then lost power, and other support ships and a Coast Guard cutter were brought in to help with engine repairs and to reconnect towlines to the Kulluk, which does not have its own propulsion system. The 18 workers aboard the rig were evacuated by Coast Guard helicopters on Saturday.

Over the weekend, support crews struggled in 25-foot swells to reconnect towlines, succeeding several times. But each time the lines separated again, leaving the rig in danger of drifting toward land.

The Kulluk, which was built in Japan in 1983 and upgraded over the past six years at a cost of $292 million, is designed for icy conditions in the Arctic. It can drill in up to 400 feet of water and up to 20,000 feet deep. During drilling season it carries a crew of about 140 people, Mr. Smith said.

Shell has spent six years and more than $4 billion in its effort to drill in Arctic waters, one of the last untapped oil-producing regions in the United States. But the effort has faced regulatory hurdles and opposition from American Indian and environmental groups.

Last summer, the Kulluk drilled a shallow test well in the Beaufort Sea while another rig drilled a similar hole in the Chukchi Sea to the west.

But Shell announced in September that it would be forced to delay further drilling until this year after a specialized piece of equipment designed to contain oil from a spill was damaged in a testing accident.

The episode was one of a number of setbacks for the Arctic drilling program last year.

Shell now says it hopes to drill five exploratory wells in the region during the 2013 drilling season, which begins in mid-July.

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Hillary Clinton expected to make full recovery from blood clot

WASHINGTON – The blood clot that led to Secretary of State Hillary Rodham Clinton’s hospitalization on Sunday is lodged in a vein behind her right ear, her doctors disclosed in a statement late Monday.

The doctors said the clot, called a right transverse sinus venous thrombosis, was discovered on Sunday when Clinton underwent an MRI as a “routine follow-up” to the treatment she has been receiving for a concussion. The vein runs between the brain and skull.

Drs. Lisa Bardack with the Mt. Kisco Medical Group and Gigi El-Bayoumi at The George Washington University Hospital said in their statement that the clot is being treated with blood thinners. They didn’t predict when she would be able to leave New York-Presbyterian Hospital, saying that she would be released “once the medication dose has been established.”

They said the clot didn’t result in a stroke or any neurological damage.

The doctors said that “in all other aspects of her recovery, the secretary is making excellent progress, and we are confident she will make a full recovery.” They described Clinton as being “in good spirits, engaging with her doctors, her family and her staff.”

Clinton suffered a concussion 2 1/2 weeks ago after she fell while she was battling a flu virus. She has made no public appearances since then and was forced to miss congressional hearings exploring the terrorist attack in September in Libya that killed four Americans.

With Clinton releasing only bare-bones information about her condition, most medical speculation has focused on the possibility that the clot formed in her leg while she was resting in bed trying to recover.

Clots in the leg are not uncommon and pose risks largely because they can travel into the lungs, potentially causing severe distress or even death. Clots in the head are rarer.

Clinton is in the final few weeks of her service as secretary of state. President Obama has chosen Sen. John Kerry (D-Mass.) to succeed her.

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paul.richter@latimes.com

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The Best of Exploration: Top 8 Stories of Space Exploration in 2012

Our recap of the year’s best exploratory exploits continues today with a look at the biggest developments in space exploration. 2012 saw the stunning debut of new spacecraft (Curiosity), the continued contributions of geriatric ones (Voyager), and the first full year since the end of the Space Shuttle program. Casey Dreier of The Planetary Society nominated 8 particularly meaningful developments from the last twelve months.

Image: Dreier’s pick for image of the year, a Cassini photograph of Saturn’s north pole through an infrared filter. (Credit: NASA / JPL / SSI / Emily Lakdawalla)

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Kardashian, West feel ‘blessed’ over baby news

ATLANTIC CITY, N.J. (AP) — Kim Kardashian and Kanye West are feeling lucky about their first child together.

“It’s true,” the 32-year-old reality TV star said in a statement on her site Monday. “Kanye and I are expecting a baby. We feel so blessed and lucky and wish that in addition to both of our families, his mom and my dad could be here to celebrate this special time with us.”

Kardashian’s father, Robert Kardashian, died in 2003. West’s mother, Donda West, died in 2007.

Kardashian added in the blog post that she was “looking forward to great new beginnings in 2013 and to starting a family.”

The 35-year-old rapper revealed to a crowd of more than 5,000 in song form at a concert Sunday that his girlfriend is pregnant. Kardashian was in the crowd at Revel Resort’s Ovation Hall with her mother, Kris Jenner, and West’s mentor and best friend, Jay-Z.

The news instantly went viral online, with thousands posting and commenting on the expecting couple.

Most of the Kardashian clan tweeted about the news, including Kim’s sisters. Kourtney Kardashian wrote: “Another angel to welcome to our family. Overwhelmed with excitement!”

West told concertgoers to congratulate his “baby mom” and that this was the “most amazing thing.”

Representatives for West and Kardashian didn’t immediately respond to emails about the pregnancy.

The rapper and reality TV star went public with their relationship in March.

Kardashian married NBA player Kris Humphries in August 2011 and their divorce is not finalized.

West’s Sunday-night show was his third consecutive performance at Revel. He took the stage for nearly two hours, performing hits like “Good Life,” ”Jesus Walks” and “Clique” in an all-white ensemble with two bandmates.

Kardashian is expected to spend New Year’s Eve at public appearance at a Las Vegas nightclub.

___

AP Writer Bianca Roach contributed to this report.

___

Follow Mesfin Fekadu on Twitter at http://twitter.com/MusicMesfin . Follow Bianca Roach at http://twitter.com/B__Roach

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F.D.A. Approves Sirturo, a New Tuberculosis Drug

The Food and Drug Administration announced on Monday that it had approved a new treatment for multidrug-resistant tuberculosis that can be used as an alternative when other drugs fail.

The drug, to be called Sirturo, was discovered by scientists at Janssen, the pharmaceuticals unit of Johnson & Johnson, and is the first in a new class of drugs that aims to treat the drug-resistant strain of the disease.

Tuberculosis is a highly infectious disease that is transmitted through the air and usually affects the lungs but can also affect other parts of the body, including the brain and kidneys. It is considered one of the world’s most serious public health threats. Although rare in the United States, multidrug-resistant tuberculosis is a growing problem elsewhere in the world, especially in poorer countries. About 12 million people worldwide had tuberculosis in 2011, according to Johnson & Johnson, and about 630,000 had multidrug-resistant TB.

A study in September in The Lancet found that almost 44 percent of patients with tuberculosis in countries like Russia, Peru and Thailand showed resistance to at least one second-line drug, or a medicine used after another drug had already failed.

Treating drug-resistant tuberculosis can take years and can cost 200 times as much as treating the ordinary form of the disease

“This is quite a milestone in the story of therapy for TB,” Dr. Paul Stoffels, the chief scientific officer at Johnson & Johnson, said in an interview. He said the approval was the first time in 40 years that the agency had approved a drug that attacked tuberculosis in a different way from the current treatments on the market. Sirturo works by inhibiting an enzyme needed by the tuberculosis bacteria to replicate and spread throughout the body.

Sirturo, also known as bedaquiline, would be used on top of the standard treatment, which is a combination of several drugs. Patients with drug-resistant tuberculosis often must be treated for 18 to 24 months.

Even as it announced the approval, however, the F.D.A. also issued some words of caution.

“Multidrug-resistant tuberculosis poses a serious health threat throughout the world, and Sirturo provides much-needed treatment for patients who have don’t have other therapeutic options available,” Edward Cox, director of the office of antimicrobial products in the F.D.A.’s center for drug evaluation and research, said in a statement. “However, because the drug also carries some significant risks, doctors should make sure they use it appropriately and only in patients who don’t have other treatment options.”

The consumer advocacy group Public Citizen opposed approval in a letter to the F.D.A. in mid-December, saying that the results of a limited clinical trial showed that patients using bedaquiline were five times as likely to die than those on the standard drug regimen to treat the disease.

“Given that bedaquiline belongs to an entirely new class of drugs, it is entirely feasible that death in some cases was due to some unmeasured toxicity of the drug,” the letter said.

Sirturo carries a so-called black box warning for patients and health care professionals that the drug can affect the heart’s electrical activity, which could lead to an abnormal and potentially fatal heart rhythm. The warning also notes deaths in patients treated with Sirturo. Nine patients who received Sirturo died compared with two patients who received a placebo. Five of the deaths in the Sirturo group and all of the deaths in the placebo arm seemed to be related to tuberculosis, but no consistent reason for the deaths in the remaining Sirturo-treated patients could be identified.

Doctors Without Borders and the Bill and Melinda Gates Foundation, both active in the fight against tuberculosis and other global diseases, applauded the F.D.A.’s decision.

Jan Gheuens, interim director of the TB Program for the Gates Foundation, called it a “long-awaited event” and said the fight against TB had not benefited from new drugs in the way H.I.V. had. Beyond the benefits of the drug itself, he said the quick approval process could be a model for other drugs sorely needed in the developing world.

He also suggested, however, that more trials should be conducted to get a better understanding of the side effects that led to the black box warning.

The F.D.A. approved bedaquiline under an accelerated program that allows the agency to conditionally approve drugs that are viewed as filling unmet medical needs with less than the usual evidence that they work. The drug’s approval was based on studies that showed it killed bacteria more quickly than a control group taking the standard regimen, but it did not measure whether in the end patients actually fared better on bedaquiline. Johnson & Johnson will conduct larger clinical trials to investigate whether the drug performs as predicted.

In a statement responding to Public Citizen’s letter, a spokeswoman for Johnson & Johnson said the company was committed to supporting appropriate use of Sirturo and would “work to ensure Sirturo is used only where treatment alternatives are not available.”

Dr. Stoffels said the hope was that other new tuberculosis drugs would also be approved that, when used in combination with bedaquiline, could shorten and simplify the current standard of treatment. “That is still a long time away,” he acknowledged, but “this is a first step in a new regimen for TB.”

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