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conulyG.O.P. Maps Out Waves of Attacks Over Health Law
http://nyti.ms/18pwauj
WASHINGTON — The memo distributed to House Republicans this week was concise and blunt, listing talking points and marching orders: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.” “Continue Collecting Constituent Stories.”
The document, the product of a series of closed-door strategy sessions that began in mid-October, is part of an increasingly organized Republican attack on the Affordable Care Act, President Obama’s signature legislative initiative. Republican strategists say that over the next several months, they intend to keep Democrats on their heels through a multilayered, sequenced assault.
The idea is to gather stories of people affected by the health care law — through social media, letters from constituents, or meetings during visits back home — and use them to open a line of attack, keep it going until it enters the public discourse and forces a response, then quickly pivot to the next topic.
For a House more used to disarray than methodical game plans, the success so far has been something of a surprise, even to the campaign’s organizers.
“Yeah, there is a method being followed here,” said Representative Michael C. Burgess, a Texas Republican involved in the effort, “but, really, these stories are creating themselves.”
First it was the malfunctioning website, HealthCare.gov, then millions of insurance policy cancellation notices sent to individuals with plans that did not meet the requirements of the health law. Earlier this week, the House aired allegations that personal data is insecure on the Internet-based insurance exchanges.
At a congressional field hearing set for Friday in Gastonia, N.C., the line of attack will shift to rate shocks expected to jolt the insurance markets in the next two years. Coming soon: a push to highlight people losing access to their longtime physicians and changes in Medicare Advantage programs for older people.
The effort has its roots in a strategy developed last spring, when House Republican leaders — plagued by party divisions that were thwarting legislative accomplishments — refocused the House’s committees on oversight rather than on the development of new policies.
Rob Borden, a general counsel to Representative Darrell Issa of California, the chairman of the House Committee on Oversight and Government Reform, moved to a newly created position that reported jointly to Speaker John A. Boehner and Representative Eric Cantor of Virginia, the majority leader. Mr. Borden’s task was to coordinate and monitor oversight activities across separate committees to make sure they are not overlapping or undercutting one another.
That aggressive campaign, which produced numerous hearings on the attacks in Benghazi, Libya, as well as on I.R.S. scrutiny of conservative groups, is now increasingly consumed by the health care fight. House Republican leaders empowered four committees — oversight, Ways and Means, Energy and Commerce, and Education and the Workforce — to take the lead, with support from other panels, such as the Science and Homeland Security Committees, which have examined computer security.
Mr. Cantor and Representative Cathy McMorris Rodgers of Washington, another member of the Republican leadership, have also leaned on all 231 House Republicans. A 17-page “House Republican Playbook” walks members through “messaging tools” like talking points, social media tactics and “digital fliers”; details lines of attack; offers up a sample opinion article for local newspapers; and provides an extensive timeline on the health care law and an exhaustive list of legislative responses that have gone nowhere.
A message of the week is presented to the Republican members at the beginning of each week, Ms. McMorris Rodgers said. A “Call to Action” email chain distributes relevant breaking news. A new website, gop.gov/yourstory, is collecting anecdotes from each member.
The goal, according to Ms. McMorris Rodgers, is to use all the “Republican voices we have in the House, the media markets in all the districts we represent, to take our message all over the country.”
“It penetrates,” she said. “It’s powerful.”
To Democrats, especially in the White House, the power of the effort stems from using anecdotes to paint a fundamentally misleading picture.
“There’s been so much noise and so much misinformation, and this incredible organized effort to block the notion that everybody should have affordable health care in this country,” President Obama told supporters of the health care law this month, “that I think it’s important for us to step back and take a look at what’s already been accomplished, because a lot of times it doesn’t make news. Controversies make news.”
Republicans have gone to the floor of the House and the Senate to tell constituent stories of soaring premiums or yawning new deductibles. But on Wednesday, the White House Council of Economic Advisers released a report showing that health care spending had grown by 1.3 percent since 2010, the year the health care law passed. That is the lowest rate on record for any three-year period and less than a third of the average since 1965, according to the White House.
Jason Furman, the council’s chairman, said much of that slowdown was attributable to structural changes in the health care economy ushered in by the health law, such as accountable care organizations, which band general practitioners, specialists and hospitals together to plan out a patient’s care, not play off one another to raise their billing. And insurance premiums on plans offered through the exchanges are lower than expected.
Congressional Democrats are trying to use such information and their own anecdotes to counter Republican attacks. Under the rubric of “This Is Obamacare” — with its own website of the same name, created by the Democratic National Committee — Democrats have been sharing “Affordable Care Act success stories” of ailing constituents getting health coverage for the first time, people being allowed to keep their adult children on their insurance, or consumers finding markedly cheaper insurance plans on the exchanges.
But Republicans are already looking ahead to next year, when they expect a raft of new issues as people start using their new health plans.
“We’re trying to stay as agile as we can,” said Brendan Buck, a spokesman for Mr. Boehner. “We know what issues are coming. We know what the consequences will be. We can’t say when they will pop exactly, but we’re prepared to talk about them.”
Four House Republicans will host Google hangouts on Thursday, employing social media to troll for stories from their constituents.
Representative John Shimkus, Republican of Illinois, who will host a hangout on Thursday with Representative Fred Upton of Michigan, the chairman of the Energy and Commerce Committee, said the hangout appeared on his calendar with no warning from the leadership. He ran into Mr. Upton on Wednesday morning and confessed his surprise.
“He said, ‘Hey, we’re going to do that thing tomorrow,’ and I said, ‘Yeah, I’ve never done one before,’ and he said, ‘Neither have I,’ ” Mr. Shimkus said, laughing. “I’m not that hip, but I guess I’m getting there.”
In Landmark Vote, Senate Limits Use of the Filibuster
http://nyti.ms/17Qt6DH
November 21, 2013
In Landmark Vote, Senate Limits Use of the Filibuster
By JEREMY W. PETERS
WASHINGTON — The Senate approved the most fundamental alteration of its rules in more than a generation on Thursday, ending the minority party’s ability to filibuster most presidential nominees in response to the partisan gridlock that has plagued Congress for much of the Obama administration.
Furious Republicans accused Democrats of a power grab, warning them that they would deeply regret their action if they lost control of the Senate next year and the White House in years to come. Invoking the Founding Fathers and the meaning of the Constitution, Republicans said Democrats were trampling the minority rights the framers intended to protect. But when the vote was called, Senator Harry Reid, the majority leader who was initially reluctant to force the issue, prevailed 52 to 48.
Under the change, the Senate will be able to cut off debate on executive and judicial branch nominees with a simple majority rather than rounding up a supermajority of 60 votes. The new precedent established by the Senate on Thursday does not apply to Supreme Court nominations or legislation itself.
It represented the culmination of years of frustration over what Democrats denounced as a Republican campaign to stall the machinery of Congress, stymie President Obama’s agenda and block his choices for cabinet posts and federal judgeships by insisting that virtually everything the Senate approves be done by a supermajority.
After repeatedly threatening to change the rules, Mr. Reid decided to follow through when Republicans refused this week to back down from their effort to keep Mr. Obama from filling any of three vacancies on the most powerful appeals court in the country.
This was the final straw for some Democratic holdouts against limiting the filibuster, providing Mr. Reid with the votes he needed to impose a new standard certain to reverberate through the Senate for years.
“There has been unbelievable, unprecedented obstruction,” Mr. Reid said as he set in motion the steps for the vote on Thursday. “The Senate is a living thing, and to survive it must change as it has over the history of this great country. To the average American, adapting the rules to make the Senate work again is just common sense.”
Republicans accused Democrats of irreparably damaging the character of an institution that in many ways still operates as it did in the 19th century, and of disregarding the constitutional prerogative of the Senate as a body of “advice and consent” on presidential nominations.
“You think this is in the best interest of the United States Senate and the American people?” asked the Republican leader, Senator Mitch McConnell, sounding incredulous.
“I say to my friends on the other side of the aisle, you’ll regret this. And you may regret it a lot sooner than you think,” he added.
Mr. Obama applauded the Senate’s move. “Today’s pattern of obstruction, it just isn’t normal,” he told reporters at the White House. “It’s not what our founders envisioned. A deliberate and determined effort to obstruct everything, no matter what the merits, just to refight the results of an election is not normal, and for the sake of future generations we can’t let it become normal.”
Only three Democrats voted against the measure.
The changes will apply to all 1,183 executive branch nominations that require Senate confirmation — not just cabinet positions but hundreds of high- and midlevel federal agency jobs and government board seats.
This fight was a climax to the bitter debate between the parties over electoral mandates and the consequences of presidential elections. Republicans, through their frequent use of the various roadblocks that congressional procedure affords them, have routinely thwarted Democrats. Democrats, in turn, have accused Republicans of effectively trying to nullify the results of a presidential election they lost, whether by trying to dismantle his health care law or keep Mr. Obama from filling his cabinet.
Republicans saw their battle as fighting an overzealous president who, left to his own devices, would stack a powerful and underworked court with judges sympathetic to his vision of big-government liberalism, pushing its conservative tilt sharply left. The court is of immense political importance to both parties because it often decides questions involving White House and federal agency policy.
Republicans proposed eliminating three of its 11 full-time seats. When Democrats balked, the Republicans refused to confirm any more judges, saying they were exercising their constitutional check against the executive.
Senator Pat Roberts, Republican of Kansas, said Democrats had undercut the minority party’s rights forever. “We have weakened this body permanently, undermined it for the sake of an incompetent administration,” he said. “What a tragedy.”
With the filibuster rules now rewritten — the most significant change since the Senate lowered its threshold to break a filibuster from two-thirds of the body to three-fifths, or 60 votes, in 1975 — the Senate can proceed with approving a backlog of presidential nominations.
There are now 59 nominees to executive branch positions and 17 nominees to the federal judiciary awaiting confirmation votes. The Senate acted immediately on Thursday when it voted with just 55 senators affirming to move forward on the nomination of Patricia A. Millett, a Washington lawyer nominated to the Washington appeals court. Two other nominees to that court, Cornelia T. L. Pillard and Robert L. Wilkins, are expected to be confirmed when the Senate returns from its Thanksgiving recess next month.
The filibuster or threats to use it have frustrated presidents and majority parties since the early days of the republic. Over the years, and almost always after the minority had made excessive use of it, the Senate has adjusted the rules. Until 1917, the year Woodrow Wilson derided the Senate as “a little group of willful men” that had rendered the government helpless through blocking everything in front of it, there was no rule to end debate. From 1917 to 1975, the bar for cutting off debate was set at two-thirds of the Senate.
Some would go even further than Thursday’s action. Senator Jeff Merkley, Democrat of Oregon, said that he would like to see the next fight on the filibuster to be to require senators to actually stand on the floor and talk if they wanted to stall legislation.
The gravity of the situation was reflected in an unusual scene on the Senate floor: Nearly all 100 senators were in their seats, rapt, as their two leaders debated.
As the two men went back and forth, Mr. McConnell appeared to realize there was no way to persuade Mr. Reid to change his mind. As many Democrats wore large grins, Republicans looked dour as they lost on a futile, last-ditch parliamentary attempt by Mr. McConnell to overrule the majority vote.
When Mr. McConnell left the chamber, he said, “I think it’s a time to be sad about what’s been done to the United States Senate.”
Typhoon Revives Debate on U.S. Food Aid Methods
http://nyti.ms/18TkwUZ
WASHINGTON — When Typhoon Haiyan slammed into the Philippines, the United States Agency for International Development swung into action: A ship filled with rice positioned in Sri Lanka was sent powering toward the devastated island nation as 55 tons of high-energy biscuits were airlifted from Miami. As much as $100 million more in food aid, the bulk of it from the United States, will still be needed in the coming months for the estimated 2.5 million people displaced by the storm.
But aid workers and antipoverty groups say that current laws governing American food aid could delay or hurt recovery efforts in the Philippines, where the disaster has reignited a long-running argument in the United States — the world’s largest food aid donor — over how America supplies food in its $1.4 billion international food aid program.
The Obama administration and some lawmakers say the disaster in the Philippines underscores the need to revise the program and give the aid agency the flexibility to buy less expensive food closer to the areas where disasters occur. Right now most American food aid is shipped from the United States, as required by law. The United States remains the only major donor country that continues to send food to humanitarian crisis spots, rather than buy food produced locally.
But the proposed program has met stiff resistance from the agriculture and shipping industries that say it will hurt American farmers and cost jobs. In Congress, both the Senate and House have rejected amendments to a new five-year farm bill that would have made significant changes to the food-aid program, although the Senate amendment does include modest increases in the amount of food that can be purchased locally.
Dr. Rajiv Shah, the administrator of the aid agency, said changes to the food aid program did not have to be an either/or situation.
“As you see from the initial response to the typhoon, we need both — American food and locally grown food,” he said in an interview. “It works in tandem. All we’re asking for is a little bit more flexibility to meet the humanitarian needs of a much more complex and changing world.”
The typhoon hit as lawmakers were meeting to finalize the farm bill, which will reauthorize agriculture and nutrition programs, including food aid. Lawmakers who have pushed for overhauling the program say they are stepping up their efforts to lobby fellow members of Congress to take another look at making changes to the program in light of the typhoon.
“This is just common sense,” said Representative Eliot L. Engel of New York, who is the ranking Democrat on the House Foreign Affairs Committee. “Buying food locally when it makes sense, like in this case, is cheaper and faster.”
Mr. Engel said the aid agency should be permitted to use more of its money to buy rice and other foods from Vietnam, Thailand or even areas of the Philippines not affected by the typhoon, rather than shipping it from the other side of the world. Danny Murphy, a Mississippi farmer who is president of the American Soybean Association, said the food aid program was fine the way it was and did not need changing.
“For the most part it has worked well for 60 years,” Mr. Murphy said. “It provides jobs in this country, and people get the food they need. Why change that?”
Many members of Congress, particularly those from farm states or states where the shipping industry is a major employer, are also opposed to changes in the program. The American Maritime Congress, an advocacy group for the United States merchant marine, said the United States might have to take out of service as many as 10 American ships used for food shipments and lose hundreds of jobs in the process.
The United States has contributed $10 million in food aid to the Philippines since the typhoon, and of that about $8 million is being used for local purchases. But antipoverty advocates say that a high percentage of local food is unlikely to continue. Under current law, the aid agency is limited to spending about $300 million each year — or about 20 percent of total American food aid — on local purchases, and right now much of that has already been committed to Syria and the Democratic Republic of Congo and as a reserve to other anticipated humanitarian crises around the world.
Under changes proposed by the Obama administration, the agency would be allowed to use up to 45 percent of its food-aid money to buy locally, but Congress has rejected that. As a result, international aid groups say that there might be long delays in getting food to the Philippines in time for people who need it, said Eric Munoz, a Washington policy analyst with Oxfam International, a humanitarian group.
The aid agency’s “own assessments show that it will take weeks for food to get to the Philippines from the U.S.,” Mr. Munoz said.
According to the agency, rice sent from the United States would take about 12 weeks to reach the Philippines, while rice bought in Thailand or Vietnam might take about eight weeks. Local rice is available immediately.
Mr. Munoz said another concern is the effect that rice shipped to the Philippines might have on the local economy. In the aftermath of the 2004 tsunami that hit Indonesia and the 2010 earthquake in Haiti, American food aid destabilized the local markets for rice and undercut farmers in those countries, further hampering the recovery.
In Manhattan Alleys, Dogs on Rat Hunts Find Bags of Fun
http://nyti.ms/18U6dj3
It was well after nightfall. The pack of dogs was split into two groups and was led to opposite ends of a desolate alley in downtown Manhattan.
A man collecting recyclable cans from the trash slipped out just before the owners unleashed the dogs.
The rat hunt was on.
The dogs raced toward a pile of trash bags in the middle of the alley, with the smaller dogs combing through the bags and chasing rats out toward the larger dogs.
Ernie, a 3-year-old hunt terrier, snapped up a fleeing rat in his jaws and gave him a hard shake. The rat quickly went limp. Ernie’s owner rejoiced over the kill — it was Ernie’s first, after just a few outings of hunting vermin.
This was another occasional outing for a group of dog owners who take their pets to downtown Manhattan to kill rats.
The hunts are conducted something like a country fox hunt, but in an urban setting. Members say it allows their dogs — mostly breeds known for chasing small game and vermin — to indulge in basic instinctual drives by killing a dozen or two dozen rats each time they are let loose.
“We don’t make a huge difference in the rat population, but the dogs have a lot of fun,” said Richard Reynolds, a main organizer of the group, which, in an effort to form the acronym RATS, he semiseriously calls the Ryders Alley Trencher-fed Society (Ryders Alley was once a rat-infested lane downtown, and trencher-fed refers to the keeping of hounds to hunt). The group, which includes some members who travel from the suburbs, has been meeting for 15 years, mostly in downtown Manhattan in areas where trash is abundant.
“We love garbage — if there’s food around, there are rats,” said Mr. Reynolds, a dog breeder from Tenafly, N.J.
Just before the recent alley hunt, the group had met in City Hall Park, with the energetic little dogs straining their leashes toward the bushes and assuming pointing positions. A local resident who was walking his 12-year-old Jack Russell terrier, Chloe, stopped to chat, and was incredulous when told what the group was doing: using their dogs to find, catch and kill rats in the streets.
“You guys can do that?” asked Chloe’s owner, Andrew Luan, 42. “I mean, you won’t get tickets, the city’s O.K. with that?”
In fact, it would appear that the rat hunters are not violating any laws or health codes, and the plight of rats, at least those living on and below New York’s streets, does not generate the same level of passion as the plight of, say, the city’s carriage horses.
“The city loves us,” claimed Mr. Reynolds, casting his group as a free extermination force. He was wearing a tweed cap and gripping a spike-tipped walking stick, for poking garbage bags and for protection from the rodents.
Soon the hunting group entered the alley — Theater Alley, a deserted narrow lane just off Park Row — and they invited Mr. Luan to come. He accepted.
“Looks like we got a new member,” said Jimmy Hoffman, 37, who held Mighty, his 3-year-old Patterdale terrier, on a leash.
“Hopefully you’ll get some food tonight, huh Mighty?” said Mr. Hoffman, of Bellerose, Queens.
In the alley, Ernie’s owner said she was a veterinarian from Manhattan on her third hunt who asked that her name not be published because “it wouldn’t go over well with some of my clients.”
“Once he got a taste for it, he has not stopped looking” for rats, she said, adding the hunt “provides mental stimulation” for the dogs.
“They are using their brain,” she said. “It’s in their nature, it’s what they want to do, but in the city, it’s hard for them to do it.”
Hunting rats does pose risks, since they are known to carry diseases, including leptospirosis, a bacterial disease that often affects animals, but the veterinarian said it was not the season for it.
Mr. Reynolds said there had been a few lacerations to the dogs from rat bites and other mishaps, but nothing serious. Still, he said, he carries “a traveling field hospital” in his truck, just in case, and a staple gun in his pocket, to mend wounds.
The group sometimes gets tips from homeless people or police officers, Mr. Reynolds said. In fact, he said, some officers have gone from initially being suspicious of what they were doing to suggesting rat locations and wishing them luck.
In Theater Alley, he said, he had a homeless tipster who repaired old computers discarded by the J&R electronics store nearby and used the store’s Wi-Fi to go online.
“I used to bring him a turkey sandwich and a six-pack and he’d email me reports on the rats here,” Mr. Reynolds said.
Still, not everyone supports the rat hunts. Brian Shapiro, the New York State director for the Humane Society of the United States, said there were numerous cases of dogs biting rats and ingesting poison consumed by the rat.
This type of activity exposes dogs to the “likelihood of eventual toxic exposure,” he said, adding, “The more times the owners send them out, they are repeatedly exposing them to that risk — it’s not good guardianship for a dog.”
“They don’t choose to go into the alley — they are sent in,” he said of the dogs, and added, “This is not an effective means of pest control because they are not getting any significant number of rats.”
As for the rats, he said, “You want to address them in a manner that causes the least amount of suffering.”
A spokeswoman for the New York City Police Department said there was no information available on the legality of using dogs to hunt rats in the city.
Mr. Reynolds said he hated animal cruelty, but he argued that no harm had ever come to any of the dogs, and added that rat poison causes a slow, painful death, compared with a quick death in a dog’s jaws.
Mr. Hoffman, a veterinary technician, said he was not insensitive to the plight of the rat; in fact, he treats pet rats in his work as a veterinary technician in Queens.
“I got no prejudices, but hunting is hunting,” he said.
Another stop during a recent hunt was an outdoor plaza at the Seward Park Extension on Allen Street. A resident standing outside, Dolly Laureano, greeted the group and said that her mother had posted a note about the plaza on the hunting group’s Facebook page.
Next to the plaza, the group put a small dog inside a Dumpster behind the Seventh Precinct station house, at Delancey and Ridge Streets, and the rats came shooting out a single hole at the bottom, with the dogs in hot pursuit.
One darted under a parked Lexus and was cornered by Paco, a feisty dog belonging to Bill Reyna, from Wayne, N.J. Finally, the rat streaked out, and Paco chomped down on it and left it at the base of a No Parking sign. Mr. Reyna photographed the encounter and showed it to Mr. Hoffman.
“Whoa, that’s mid-shake,” Mr. Hoffman exclaimed. “That’s got to get framed on the wall.”
Gynecologists Run Afoul of Panel When Patient Is Male
http://nyti.ms/1aER5Kp
About two months ago, Dr. Elizabeth Stier was shocked to learn that she would lose a vital credential, board certification as a gynecologist, unless she gave up an important part of her medical practice and her research: taking care of men at high risk for anal cancer.
The disease is rare, but it can be fatal and its incidence is increasing, especially among men and women infected with H.I.V. Like cervical cancer, anal cancer is usually caused by the human papillomavirus, or HPV, which is sexually transmitted.
Though most of her patients are women, Dr. Stier, who works at Boston Medical Center, also treated about 110 men last year, using techniques adapted from those developed to screen women for cervical cancer.
But in September, the American Board of Obstetrics and Gynecology insisted that its members treat only women, with few exceptions, and identified the procedure in which Dr. Stier has expertise as one that gynecologists are not allowed to perform on men. Doctors cannot ignore such directives from a specialty board, because most need certification to keep their jobs.
Now Dr. Stier’s studies are in limbo, her research colleagues are irate, and her male patients are distraught. Other gynecologists who had translated their skills to help male patients are in similar straits.
And researchers about to start a major clinical trial that is aimed at preventing anal cancer, with $5.6 million from the National Cancer Institute, say the board’s decision will keep some of the best qualified, most highly skilled doctors in the United States from treating male patients in the study. The director of the planned study and Dr. Stier have asked the gynecology board to reconsider its position.
But the board, based in Dallas, has not budged.
“We haven’t heard of any compelling reason to change anything,” said Dr. Kenneth L. Noller, the board’s director of evaluation. He said there were plenty of other doctors available to provide the HPV-related procedures that some gynecologists had been performing on men.
Dr. Larry C. Gilstrap, the group’s executive director, said the specialty of obstetrics and gynecology was specifically designed to treat problems of the female reproductive tract and was “restricted to taking care of women.” Of the 24 medical specialties recognized in the United States, he said, it is the only one that is gender-specific, and it has been that way since 1935.
Dr. Stier said that she, like many other doctors, had not understood the definition of their field to be quite so absolute.
The board had always regarded the treatment of women as its mission, Dr. Gilstrap said, but felt a particular need to emphasize it now because the specialty’s image was being tarnished by members who had strayed into moneymaking sidelines, like testosterone therapy for men, and liposuction and other cosmetic procedures for both women and men.
Dr. Mark H. Einstein, a gynecologic oncologist at Montefiore Medical Center in the Bronx, said, “The board’s approach is to be rather dogmatic and to draw a line in the sand.”
On Sept. 12, the board posted on its website a stringent and newly explicit definition of obstetrician-gynecologists, limiting the proportion of time they could spend on nongynecologic procedures and noting that, with few exceptions, members must not treat men. The notice specifically prohibited gynecologists from performing an examination called anoscopy on men.
Anoscopy involves using a tube and a light to examine the anal canal, which is about 1.5 inches long. The procedure is the same in men and women. A “high-resolution” version adds a magnifier to look for abnormal growths that may be cancers or precancers. Cancers usually require surgery, but doctors can burn off precancers in hopes of preventing cancer.
A similar approach led to a tremendous decline in cervical cancer in the United States, and doctors hope to accomplish the same for anal cancer. About 7,000 new cases of anal cancer, and 880 deaths, are expected in 2013 in the United States; the incidence has been increasing by 2.2 percent a year for the last 10 years.
Anoscopy and other techniques aimed at preventing anal cancer have not been rigorously tested, and the purpose of the planned clinical trial is to determine whether they work. Five thousand patients, men and women, are to be studied for eight years, ultimately costing tens of millions of dollars.
If the trial shows that cancers can be prevented, it could change the standard of care, Dr. Douglas R. Lowy, a deputy director of the Center for Cancer Research at the National Cancer Institute, said in an interview.
Doctors planning to participate in the trial have had extensive training in high-resolution anoscopy. People with various types of medical training can learn the procedure, but experts say that gynecologists are the quickest to master it because of their experience in screening women.
“We need as many trained people as possible,” said Dr. Joel Palefsky, an infectious disease specialist at the University of California, San Francisco, who will direct the study. “The assumption all along has been that many of the gynecologists we trained would participate in the study and would see both men and women.”
Dr. Stier had been treating men for more than 10 years, and expected to enroll about 100 in the study. Now, she will be able to enroll only women. She is the only person with the special training at her hospital, so now another hospital will have to sign up more men.
But what really worries her is what will become of the men she has been treating. Those who had precancers need to be examined once or twice a year, because the growths tend to recur. Dr. Stier said the procedures are embarrassing and uncomfortable for patients, and it takes time for a doctor to gain their trust. Many of her patients are poor, from minority groups and infected with H.I.V. Some live in shelters, some have histories of drug use. And anal disorders add more stigma. “My main issue here is that I don’t think my patients are going to get the follow-up that they need, and I think they’re going to be lost to care, and we take care of a very vulnerable patient population,” Dr. Stier said.
Dr. Einstein had also been treating some male patients and had planned to enroll men in the new trial. Like Dr. Stier, he was blindsided by the gynecology board’s notice.
He said only three doctors at his hospital had special training in high-resolution anoscopy, and that was nowhere near enough. Now two of those doctors, including himself, have to stop treating men.
“I think we’ll see significant setbacks,” Dr. Einstein said.
Urbanites Flee China’s Smog for Blue Skies
http://nyti.ms/19PC57Y
DALI, China — A typical morning for Lin Liya, a native of Shanghai transplanted to this ancient town in southwest China, goes like this: See her 3-year-old son off to school near the mountains; go for a half-hour run on the shores of Erhai Lake; and browse the local market for fresh vegetables and meat.
She finished her run one morning beneath cloudless blue skies and sat down with a visitor from Beijing in the lakeside boutique hotel started by her and her husband.
“I think luxury is sunshine, good air and good water,” she said. “But in the big city, you can’t get those things.”
More than two years ago, Ms. Lin, 34, and her husband gave up comfortable careers in the booming southern city of Guangzhou — she at a Norwegian risk management company, he at an advertising firm that he had founded — to join the growing number of urbanites who have decamped to rural China. One resident here calls them “environmental refugees” or “environmental immigrants.”
At a time when hundreds of millions of Chinese, many poor farmers, are leaving their country homesteads to find work and tap into the energy of China’s dynamic cities, a small number of urban dwellers have decided to make a reverse migration. Their change in lifestyle speaks volumes about anxieties over pollution, traffic, living costs, property values and the general stress found in China’s biggest coastal metropolises.
Take air quality: Levels of fine particulate matter in some Chinese cities reach 40 times the recommended exposure limit set by the World Health Organization. This month, an official Chinese news report said an 8-year-old girl near Shanghai was hospitalized with lung cancer, the youngest such victim in China. Her doctor blamed air pollution.
The urban refugees come from all walks of life — businesspeople and artists, teachers and chefs — though there is no reliable estimate of their numbers. They have staked out greener lives in small enclaves, from central Anhui Province to remote Tibet. Many are Chinese bobos, or bourgeois bohemians, and they say that besides escaping pollution and filth, they want to be unshackled from the material drives of the cities — what Ms. Lin derided as a focus on “what you’re wearing, where you’re eating, comparing yourself with others.”
The town of Dali in Yunnan Province, nestled between a wall of 13,000-foot mountains and one of China’s largest freshwater lakes, is a popular destination. Increasingly, the indigenous ethnic Bai people of the area are leasing their village homes to ethnic Han, the dominant group in China, who turn up with suitcases and backpacks. They come with one-way tickets from places like Beijing, Shanghai, Guangzhou and Shenzhen, all of which have roaring economies but also populations of 15 million people or more.
On Internet forums, the new arrivals to Dali discuss how to rent a house, where to shop, how to make a living and what schools are best for their children. Their presence is everywhere in the cobblestone streets of the old town. They run cafes, hotels and bookstores, and the younger ones sit on the streets selling trinkets from blankets.
Some become farmers here, and some spend their days home schooling their children. Their presence has transformed Dali and surrounding villages into a cross between Provence and Haight-Ashbury.
One magnet is the village of Shuanglang, which became a draw after the famous Yunnan natives Yang Liping, a dancer, and Zhao Qing, an artist, built homes there. As at other lakeside villages, the immigrants, some with immense wealth, live near fishermen and farmers.
“All kinds of people come here with different dreams,” said Ye Yongqing, 55, an ethnic Bai artist from the region who has lived mostly in cities, including London, but bought a home here five years ago. “Some people imagine this place as Greece or Italy or Bali.”
“Dali is one of the few places in China that still has a close tie to the earth,” he added, sitting in front of a table of squashes in his garden courtyard. “A lot of villages in China have become empty shells. Dali is a survivor of this phenomenon.”
Ms. Lin said she first fell in love with Dali when she came as a backpacker in 2006. She returned twice before moving here. In 2010, on the third visit, she and her husband, whom she had met trekking in Yunnan, looked for land to lease to build a hotel on Erhai Lake. It has not all been easy going, Ms. Lin said, citing negotiations and misunderstandings with local officials, villagers and employees.
“We just wanted to switch to a different life,” said Ms. Lin, who had lived in Shanghai as well as Guangzhou. “My friends in Shanghai are struggling there — not only in their work, but also just to live. The prices are too high, even higher than in Europe. They become crazy, go mad.”
Ms. Lin moved here less than two years after giving birth to a son. “It’s good for the baby because it’s like my mother’s childhood,” she said. “My mother’s childhood in Shanghai — the air was still clean, you could see blue skies, there was clean water.”
That is a common refrain among parents here. One afternoon, four mothers, all urban refugees, sat outside a bookstore cafe, Song’s Nest, practicing English with one another. “The one thing we all have in common is we moved here to raise our children in a good environment,” one woman said.
The bookshop’s owner, Song Yan, moved here this year and translates books by an Indian philosopher popular with Chinese spiritual seekers. One night, she and another translator and urban refugee, Zheng Yuantao, 33, talked over dinner about their moves.
“I’ve never felt so free in my life,” Mr. Zheng said. “I grew up as a city boy, and I never realized how much I like living close to nature.”
From the nearby lakeside village of Caicun, Huang Xiaoling, a photographer, flies back to Beijing to shoot portraits and events for clients. She had once lived in a courtyard home in the Chinese capital, but fled in September with her 3-year-old son and husband, an American who works remotely as a technology director for a New York publishing company.
“I’m still productive even though I don’t go into an office,” she said. “I don’t know if it’s the weather and the environment, or just me feeling that, ‘Oh, I got out of the cave that I wanted to escape.’ ”
http://nyti.ms/18pwauj
WASHINGTON — The memo distributed to House Republicans this week was concise and blunt, listing talking points and marching orders: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.” “Continue Collecting Constituent Stories.”
The document, the product of a series of closed-door strategy sessions that began in mid-October, is part of an increasingly organized Republican attack on the Affordable Care Act, President Obama’s signature legislative initiative. Republican strategists say that over the next several months, they intend to keep Democrats on their heels through a multilayered, sequenced assault.
The idea is to gather stories of people affected by the health care law — through social media, letters from constituents, or meetings during visits back home — and use them to open a line of attack, keep it going until it enters the public discourse and forces a response, then quickly pivot to the next topic.
For a House more used to disarray than methodical game plans, the success so far has been something of a surprise, even to the campaign’s organizers.
“Yeah, there is a method being followed here,” said Representative Michael C. Burgess, a Texas Republican involved in the effort, “but, really, these stories are creating themselves.”
First it was the malfunctioning website, HealthCare.gov, then millions of insurance policy cancellation notices sent to individuals with plans that did not meet the requirements of the health law. Earlier this week, the House aired allegations that personal data is insecure on the Internet-based insurance exchanges.
At a congressional field hearing set for Friday in Gastonia, N.C., the line of attack will shift to rate shocks expected to jolt the insurance markets in the next two years. Coming soon: a push to highlight people losing access to their longtime physicians and changes in Medicare Advantage programs for older people.
The effort has its roots in a strategy developed last spring, when House Republican leaders — plagued by party divisions that were thwarting legislative accomplishments — refocused the House’s committees on oversight rather than on the development of new policies.
Rob Borden, a general counsel to Representative Darrell Issa of California, the chairman of the House Committee on Oversight and Government Reform, moved to a newly created position that reported jointly to Speaker John A. Boehner and Representative Eric Cantor of Virginia, the majority leader. Mr. Borden’s task was to coordinate and monitor oversight activities across separate committees to make sure they are not overlapping or undercutting one another.
That aggressive campaign, which produced numerous hearings on the attacks in Benghazi, Libya, as well as on I.R.S. scrutiny of conservative groups, is now increasingly consumed by the health care fight. House Republican leaders empowered four committees — oversight, Ways and Means, Energy and Commerce, and Education and the Workforce — to take the lead, with support from other panels, such as the Science and Homeland Security Committees, which have examined computer security.
Mr. Cantor and Representative Cathy McMorris Rodgers of Washington, another member of the Republican leadership, have also leaned on all 231 House Republicans. A 17-page “House Republican Playbook” walks members through “messaging tools” like talking points, social media tactics and “digital fliers”; details lines of attack; offers up a sample opinion article for local newspapers; and provides an extensive timeline on the health care law and an exhaustive list of legislative responses that have gone nowhere.
A message of the week is presented to the Republican members at the beginning of each week, Ms. McMorris Rodgers said. A “Call to Action” email chain distributes relevant breaking news. A new website, gop.gov/yourstory, is collecting anecdotes from each member.
The goal, according to Ms. McMorris Rodgers, is to use all the “Republican voices we have in the House, the media markets in all the districts we represent, to take our message all over the country.”
“It penetrates,” she said. “It’s powerful.”
To Democrats, especially in the White House, the power of the effort stems from using anecdotes to paint a fundamentally misleading picture.
“There’s been so much noise and so much misinformation, and this incredible organized effort to block the notion that everybody should have affordable health care in this country,” President Obama told supporters of the health care law this month, “that I think it’s important for us to step back and take a look at what’s already been accomplished, because a lot of times it doesn’t make news. Controversies make news.”
Republicans have gone to the floor of the House and the Senate to tell constituent stories of soaring premiums or yawning new deductibles. But on Wednesday, the White House Council of Economic Advisers released a report showing that health care spending had grown by 1.3 percent since 2010, the year the health care law passed. That is the lowest rate on record for any three-year period and less than a third of the average since 1965, according to the White House.
Jason Furman, the council’s chairman, said much of that slowdown was attributable to structural changes in the health care economy ushered in by the health law, such as accountable care organizations, which band general practitioners, specialists and hospitals together to plan out a patient’s care, not play off one another to raise their billing. And insurance premiums on plans offered through the exchanges are lower than expected.
Congressional Democrats are trying to use such information and their own anecdotes to counter Republican attacks. Under the rubric of “This Is Obamacare” — with its own website of the same name, created by the Democratic National Committee — Democrats have been sharing “Affordable Care Act success stories” of ailing constituents getting health coverage for the first time, people being allowed to keep their adult children on their insurance, or consumers finding markedly cheaper insurance plans on the exchanges.
But Republicans are already looking ahead to next year, when they expect a raft of new issues as people start using their new health plans.
“We’re trying to stay as agile as we can,” said Brendan Buck, a spokesman for Mr. Boehner. “We know what issues are coming. We know what the consequences will be. We can’t say when they will pop exactly, but we’re prepared to talk about them.”
Four House Republicans will host Google hangouts on Thursday, employing social media to troll for stories from their constituents.
Representative John Shimkus, Republican of Illinois, who will host a hangout on Thursday with Representative Fred Upton of Michigan, the chairman of the Energy and Commerce Committee, said the hangout appeared on his calendar with no warning from the leadership. He ran into Mr. Upton on Wednesday morning and confessed his surprise.
“He said, ‘Hey, we’re going to do that thing tomorrow,’ and I said, ‘Yeah, I’ve never done one before,’ and he said, ‘Neither have I,’ ” Mr. Shimkus said, laughing. “I’m not that hip, but I guess I’m getting there.”
In Landmark Vote, Senate Limits Use of the Filibuster
http://nyti.ms/17Qt6DH
November 21, 2013
In Landmark Vote, Senate Limits Use of the Filibuster
By JEREMY W. PETERS
WASHINGTON — The Senate approved the most fundamental alteration of its rules in more than a generation on Thursday, ending the minority party’s ability to filibuster most presidential nominees in response to the partisan gridlock that has plagued Congress for much of the Obama administration.
Furious Republicans accused Democrats of a power grab, warning them that they would deeply regret their action if they lost control of the Senate next year and the White House in years to come. Invoking the Founding Fathers and the meaning of the Constitution, Republicans said Democrats were trampling the minority rights the framers intended to protect. But when the vote was called, Senator Harry Reid, the majority leader who was initially reluctant to force the issue, prevailed 52 to 48.
Under the change, the Senate will be able to cut off debate on executive and judicial branch nominees with a simple majority rather than rounding up a supermajority of 60 votes. The new precedent established by the Senate on Thursday does not apply to Supreme Court nominations or legislation itself.
It represented the culmination of years of frustration over what Democrats denounced as a Republican campaign to stall the machinery of Congress, stymie President Obama’s agenda and block his choices for cabinet posts and federal judgeships by insisting that virtually everything the Senate approves be done by a supermajority.
After repeatedly threatening to change the rules, Mr. Reid decided to follow through when Republicans refused this week to back down from their effort to keep Mr. Obama from filling any of three vacancies on the most powerful appeals court in the country.
This was the final straw for some Democratic holdouts against limiting the filibuster, providing Mr. Reid with the votes he needed to impose a new standard certain to reverberate through the Senate for years.
“There has been unbelievable, unprecedented obstruction,” Mr. Reid said as he set in motion the steps for the vote on Thursday. “The Senate is a living thing, and to survive it must change as it has over the history of this great country. To the average American, adapting the rules to make the Senate work again is just common sense.”
Republicans accused Democrats of irreparably damaging the character of an institution that in many ways still operates as it did in the 19th century, and of disregarding the constitutional prerogative of the Senate as a body of “advice and consent” on presidential nominations.
“You think this is in the best interest of the United States Senate and the American people?” asked the Republican leader, Senator Mitch McConnell, sounding incredulous.
“I say to my friends on the other side of the aisle, you’ll regret this. And you may regret it a lot sooner than you think,” he added.
Mr. Obama applauded the Senate’s move. “Today’s pattern of obstruction, it just isn’t normal,” he told reporters at the White House. “It’s not what our founders envisioned. A deliberate and determined effort to obstruct everything, no matter what the merits, just to refight the results of an election is not normal, and for the sake of future generations we can’t let it become normal.”
Only three Democrats voted against the measure.
The changes will apply to all 1,183 executive branch nominations that require Senate confirmation — not just cabinet positions but hundreds of high- and midlevel federal agency jobs and government board seats.
This fight was a climax to the bitter debate between the parties over electoral mandates and the consequences of presidential elections. Republicans, through their frequent use of the various roadblocks that congressional procedure affords them, have routinely thwarted Democrats. Democrats, in turn, have accused Republicans of effectively trying to nullify the results of a presidential election they lost, whether by trying to dismantle his health care law or keep Mr. Obama from filling his cabinet.
Republicans saw their battle as fighting an overzealous president who, left to his own devices, would stack a powerful and underworked court with judges sympathetic to his vision of big-government liberalism, pushing its conservative tilt sharply left. The court is of immense political importance to both parties because it often decides questions involving White House and federal agency policy.
Republicans proposed eliminating three of its 11 full-time seats. When Democrats balked, the Republicans refused to confirm any more judges, saying they were exercising their constitutional check against the executive.
Senator Pat Roberts, Republican of Kansas, said Democrats had undercut the minority party’s rights forever. “We have weakened this body permanently, undermined it for the sake of an incompetent administration,” he said. “What a tragedy.”
With the filibuster rules now rewritten — the most significant change since the Senate lowered its threshold to break a filibuster from two-thirds of the body to three-fifths, or 60 votes, in 1975 — the Senate can proceed with approving a backlog of presidential nominations.
There are now 59 nominees to executive branch positions and 17 nominees to the federal judiciary awaiting confirmation votes. The Senate acted immediately on Thursday when it voted with just 55 senators affirming to move forward on the nomination of Patricia A. Millett, a Washington lawyer nominated to the Washington appeals court. Two other nominees to that court, Cornelia T. L. Pillard and Robert L. Wilkins, are expected to be confirmed when the Senate returns from its Thanksgiving recess next month.
The filibuster or threats to use it have frustrated presidents and majority parties since the early days of the republic. Over the years, and almost always after the minority had made excessive use of it, the Senate has adjusted the rules. Until 1917, the year Woodrow Wilson derided the Senate as “a little group of willful men” that had rendered the government helpless through blocking everything in front of it, there was no rule to end debate. From 1917 to 1975, the bar for cutting off debate was set at two-thirds of the Senate.
Some would go even further than Thursday’s action. Senator Jeff Merkley, Democrat of Oregon, said that he would like to see the next fight on the filibuster to be to require senators to actually stand on the floor and talk if they wanted to stall legislation.
The gravity of the situation was reflected in an unusual scene on the Senate floor: Nearly all 100 senators were in their seats, rapt, as their two leaders debated.
As the two men went back and forth, Mr. McConnell appeared to realize there was no way to persuade Mr. Reid to change his mind. As many Democrats wore large grins, Republicans looked dour as they lost on a futile, last-ditch parliamentary attempt by Mr. McConnell to overrule the majority vote.
When Mr. McConnell left the chamber, he said, “I think it’s a time to be sad about what’s been done to the United States Senate.”
Typhoon Revives Debate on U.S. Food Aid Methods
http://nyti.ms/18TkwUZ
WASHINGTON — When Typhoon Haiyan slammed into the Philippines, the United States Agency for International Development swung into action: A ship filled with rice positioned in Sri Lanka was sent powering toward the devastated island nation as 55 tons of high-energy biscuits were airlifted from Miami. As much as $100 million more in food aid, the bulk of it from the United States, will still be needed in the coming months for the estimated 2.5 million people displaced by the storm.
But aid workers and antipoverty groups say that current laws governing American food aid could delay or hurt recovery efforts in the Philippines, where the disaster has reignited a long-running argument in the United States — the world’s largest food aid donor — over how America supplies food in its $1.4 billion international food aid program.
The Obama administration and some lawmakers say the disaster in the Philippines underscores the need to revise the program and give the aid agency the flexibility to buy less expensive food closer to the areas where disasters occur. Right now most American food aid is shipped from the United States, as required by law. The United States remains the only major donor country that continues to send food to humanitarian crisis spots, rather than buy food produced locally.
But the proposed program has met stiff resistance from the agriculture and shipping industries that say it will hurt American farmers and cost jobs. In Congress, both the Senate and House have rejected amendments to a new five-year farm bill that would have made significant changes to the food-aid program, although the Senate amendment does include modest increases in the amount of food that can be purchased locally.
Dr. Rajiv Shah, the administrator of the aid agency, said changes to the food aid program did not have to be an either/or situation.
“As you see from the initial response to the typhoon, we need both — American food and locally grown food,” he said in an interview. “It works in tandem. All we’re asking for is a little bit more flexibility to meet the humanitarian needs of a much more complex and changing world.”
The typhoon hit as lawmakers were meeting to finalize the farm bill, which will reauthorize agriculture and nutrition programs, including food aid. Lawmakers who have pushed for overhauling the program say they are stepping up their efforts to lobby fellow members of Congress to take another look at making changes to the program in light of the typhoon.
“This is just common sense,” said Representative Eliot L. Engel of New York, who is the ranking Democrat on the House Foreign Affairs Committee. “Buying food locally when it makes sense, like in this case, is cheaper and faster.”
Mr. Engel said the aid agency should be permitted to use more of its money to buy rice and other foods from Vietnam, Thailand or even areas of the Philippines not affected by the typhoon, rather than shipping it from the other side of the world. Danny Murphy, a Mississippi farmer who is president of the American Soybean Association, said the food aid program was fine the way it was and did not need changing.
“For the most part it has worked well for 60 years,” Mr. Murphy said. “It provides jobs in this country, and people get the food they need. Why change that?”
Many members of Congress, particularly those from farm states or states where the shipping industry is a major employer, are also opposed to changes in the program. The American Maritime Congress, an advocacy group for the United States merchant marine, said the United States might have to take out of service as many as 10 American ships used for food shipments and lose hundreds of jobs in the process.
The United States has contributed $10 million in food aid to the Philippines since the typhoon, and of that about $8 million is being used for local purchases. But antipoverty advocates say that a high percentage of local food is unlikely to continue. Under current law, the aid agency is limited to spending about $300 million each year — or about 20 percent of total American food aid — on local purchases, and right now much of that has already been committed to Syria and the Democratic Republic of Congo and as a reserve to other anticipated humanitarian crises around the world.
Under changes proposed by the Obama administration, the agency would be allowed to use up to 45 percent of its food-aid money to buy locally, but Congress has rejected that. As a result, international aid groups say that there might be long delays in getting food to the Philippines in time for people who need it, said Eric Munoz, a Washington policy analyst with Oxfam International, a humanitarian group.
The aid agency’s “own assessments show that it will take weeks for food to get to the Philippines from the U.S.,” Mr. Munoz said.
According to the agency, rice sent from the United States would take about 12 weeks to reach the Philippines, while rice bought in Thailand or Vietnam might take about eight weeks. Local rice is available immediately.
Mr. Munoz said another concern is the effect that rice shipped to the Philippines might have on the local economy. In the aftermath of the 2004 tsunami that hit Indonesia and the 2010 earthquake in Haiti, American food aid destabilized the local markets for rice and undercut farmers in those countries, further hampering the recovery.
In Manhattan Alleys, Dogs on Rat Hunts Find Bags of Fun
http://nyti.ms/18U6dj3
It was well after nightfall. The pack of dogs was split into two groups and was led to opposite ends of a desolate alley in downtown Manhattan.
A man collecting recyclable cans from the trash slipped out just before the owners unleashed the dogs.
The rat hunt was on.
The dogs raced toward a pile of trash bags in the middle of the alley, with the smaller dogs combing through the bags and chasing rats out toward the larger dogs.
Ernie, a 3-year-old hunt terrier, snapped up a fleeing rat in his jaws and gave him a hard shake. The rat quickly went limp. Ernie’s owner rejoiced over the kill — it was Ernie’s first, after just a few outings of hunting vermin.
This was another occasional outing for a group of dog owners who take their pets to downtown Manhattan to kill rats.
The hunts are conducted something like a country fox hunt, but in an urban setting. Members say it allows their dogs — mostly breeds known for chasing small game and vermin — to indulge in basic instinctual drives by killing a dozen or two dozen rats each time they are let loose.
“We don’t make a huge difference in the rat population, but the dogs have a lot of fun,” said Richard Reynolds, a main organizer of the group, which, in an effort to form the acronym RATS, he semiseriously calls the Ryders Alley Trencher-fed Society (Ryders Alley was once a rat-infested lane downtown, and trencher-fed refers to the keeping of hounds to hunt). The group, which includes some members who travel from the suburbs, has been meeting for 15 years, mostly in downtown Manhattan in areas where trash is abundant.
“We love garbage — if there’s food around, there are rats,” said Mr. Reynolds, a dog breeder from Tenafly, N.J.
Just before the recent alley hunt, the group had met in City Hall Park, with the energetic little dogs straining their leashes toward the bushes and assuming pointing positions. A local resident who was walking his 12-year-old Jack Russell terrier, Chloe, stopped to chat, and was incredulous when told what the group was doing: using their dogs to find, catch and kill rats in the streets.
“You guys can do that?” asked Chloe’s owner, Andrew Luan, 42. “I mean, you won’t get tickets, the city’s O.K. with that?”
In fact, it would appear that the rat hunters are not violating any laws or health codes, and the plight of rats, at least those living on and below New York’s streets, does not generate the same level of passion as the plight of, say, the city’s carriage horses.
“The city loves us,” claimed Mr. Reynolds, casting his group as a free extermination force. He was wearing a tweed cap and gripping a spike-tipped walking stick, for poking garbage bags and for protection from the rodents.
Soon the hunting group entered the alley — Theater Alley, a deserted narrow lane just off Park Row — and they invited Mr. Luan to come. He accepted.
“Looks like we got a new member,” said Jimmy Hoffman, 37, who held Mighty, his 3-year-old Patterdale terrier, on a leash.
“Hopefully you’ll get some food tonight, huh Mighty?” said Mr. Hoffman, of Bellerose, Queens.
In the alley, Ernie’s owner said she was a veterinarian from Manhattan on her third hunt who asked that her name not be published because “it wouldn’t go over well with some of my clients.”
“Once he got a taste for it, he has not stopped looking” for rats, she said, adding the hunt “provides mental stimulation” for the dogs.
“They are using their brain,” she said. “It’s in their nature, it’s what they want to do, but in the city, it’s hard for them to do it.”
Hunting rats does pose risks, since they are known to carry diseases, including leptospirosis, a bacterial disease that often affects animals, but the veterinarian said it was not the season for it.
Mr. Reynolds said there had been a few lacerations to the dogs from rat bites and other mishaps, but nothing serious. Still, he said, he carries “a traveling field hospital” in his truck, just in case, and a staple gun in his pocket, to mend wounds.
The group sometimes gets tips from homeless people or police officers, Mr. Reynolds said. In fact, he said, some officers have gone from initially being suspicious of what they were doing to suggesting rat locations and wishing them luck.
In Theater Alley, he said, he had a homeless tipster who repaired old computers discarded by the J&R electronics store nearby and used the store’s Wi-Fi to go online.
“I used to bring him a turkey sandwich and a six-pack and he’d email me reports on the rats here,” Mr. Reynolds said.
Still, not everyone supports the rat hunts. Brian Shapiro, the New York State director for the Humane Society of the United States, said there were numerous cases of dogs biting rats and ingesting poison consumed by the rat.
This type of activity exposes dogs to the “likelihood of eventual toxic exposure,” he said, adding, “The more times the owners send them out, they are repeatedly exposing them to that risk — it’s not good guardianship for a dog.”
“They don’t choose to go into the alley — they are sent in,” he said of the dogs, and added, “This is not an effective means of pest control because they are not getting any significant number of rats.”
As for the rats, he said, “You want to address them in a manner that causes the least amount of suffering.”
A spokeswoman for the New York City Police Department said there was no information available on the legality of using dogs to hunt rats in the city.
Mr. Reynolds said he hated animal cruelty, but he argued that no harm had ever come to any of the dogs, and added that rat poison causes a slow, painful death, compared with a quick death in a dog’s jaws.
Mr. Hoffman, a veterinary technician, said he was not insensitive to the plight of the rat; in fact, he treats pet rats in his work as a veterinary technician in Queens.
“I got no prejudices, but hunting is hunting,” he said.
Another stop during a recent hunt was an outdoor plaza at the Seward Park Extension on Allen Street. A resident standing outside, Dolly Laureano, greeted the group and said that her mother had posted a note about the plaza on the hunting group’s Facebook page.
Next to the plaza, the group put a small dog inside a Dumpster behind the Seventh Precinct station house, at Delancey and Ridge Streets, and the rats came shooting out a single hole at the bottom, with the dogs in hot pursuit.
One darted under a parked Lexus and was cornered by Paco, a feisty dog belonging to Bill Reyna, from Wayne, N.J. Finally, the rat streaked out, and Paco chomped down on it and left it at the base of a No Parking sign. Mr. Reyna photographed the encounter and showed it to Mr. Hoffman.
“Whoa, that’s mid-shake,” Mr. Hoffman exclaimed. “That’s got to get framed on the wall.”
Gynecologists Run Afoul of Panel When Patient Is Male
http://nyti.ms/1aER5Kp
About two months ago, Dr. Elizabeth Stier was shocked to learn that she would lose a vital credential, board certification as a gynecologist, unless she gave up an important part of her medical practice and her research: taking care of men at high risk for anal cancer.
The disease is rare, but it can be fatal and its incidence is increasing, especially among men and women infected with H.I.V. Like cervical cancer, anal cancer is usually caused by the human papillomavirus, or HPV, which is sexually transmitted.
Though most of her patients are women, Dr. Stier, who works at Boston Medical Center, also treated about 110 men last year, using techniques adapted from those developed to screen women for cervical cancer.
But in September, the American Board of Obstetrics and Gynecology insisted that its members treat only women, with few exceptions, and identified the procedure in which Dr. Stier has expertise as one that gynecologists are not allowed to perform on men. Doctors cannot ignore such directives from a specialty board, because most need certification to keep their jobs.
Now Dr. Stier’s studies are in limbo, her research colleagues are irate, and her male patients are distraught. Other gynecologists who had translated their skills to help male patients are in similar straits.
And researchers about to start a major clinical trial that is aimed at preventing anal cancer, with $5.6 million from the National Cancer Institute, say the board’s decision will keep some of the best qualified, most highly skilled doctors in the United States from treating male patients in the study. The director of the planned study and Dr. Stier have asked the gynecology board to reconsider its position.
But the board, based in Dallas, has not budged.
“We haven’t heard of any compelling reason to change anything,” said Dr. Kenneth L. Noller, the board’s director of evaluation. He said there were plenty of other doctors available to provide the HPV-related procedures that some gynecologists had been performing on men.
Dr. Larry C. Gilstrap, the group’s executive director, said the specialty of obstetrics and gynecology was specifically designed to treat problems of the female reproductive tract and was “restricted to taking care of women.” Of the 24 medical specialties recognized in the United States, he said, it is the only one that is gender-specific, and it has been that way since 1935.
Dr. Stier said that she, like many other doctors, had not understood the definition of their field to be quite so absolute.
The board had always regarded the treatment of women as its mission, Dr. Gilstrap said, but felt a particular need to emphasize it now because the specialty’s image was being tarnished by members who had strayed into moneymaking sidelines, like testosterone therapy for men, and liposuction and other cosmetic procedures for both women and men.
Dr. Mark H. Einstein, a gynecologic oncologist at Montefiore Medical Center in the Bronx, said, “The board’s approach is to be rather dogmatic and to draw a line in the sand.”
On Sept. 12, the board posted on its website a stringent and newly explicit definition of obstetrician-gynecologists, limiting the proportion of time they could spend on nongynecologic procedures and noting that, with few exceptions, members must not treat men. The notice specifically prohibited gynecologists from performing an examination called anoscopy on men.
Anoscopy involves using a tube and a light to examine the anal canal, which is about 1.5 inches long. The procedure is the same in men and women. A “high-resolution” version adds a magnifier to look for abnormal growths that may be cancers or precancers. Cancers usually require surgery, but doctors can burn off precancers in hopes of preventing cancer.
A similar approach led to a tremendous decline in cervical cancer in the United States, and doctors hope to accomplish the same for anal cancer. About 7,000 new cases of anal cancer, and 880 deaths, are expected in 2013 in the United States; the incidence has been increasing by 2.2 percent a year for the last 10 years.
Anoscopy and other techniques aimed at preventing anal cancer have not been rigorously tested, and the purpose of the planned clinical trial is to determine whether they work. Five thousand patients, men and women, are to be studied for eight years, ultimately costing tens of millions of dollars.
If the trial shows that cancers can be prevented, it could change the standard of care, Dr. Douglas R. Lowy, a deputy director of the Center for Cancer Research at the National Cancer Institute, said in an interview.
Doctors planning to participate in the trial have had extensive training in high-resolution anoscopy. People with various types of medical training can learn the procedure, but experts say that gynecologists are the quickest to master it because of their experience in screening women.
“We need as many trained people as possible,” said Dr. Joel Palefsky, an infectious disease specialist at the University of California, San Francisco, who will direct the study. “The assumption all along has been that many of the gynecologists we trained would participate in the study and would see both men and women.”
Dr. Stier had been treating men for more than 10 years, and expected to enroll about 100 in the study. Now, she will be able to enroll only women. She is the only person with the special training at her hospital, so now another hospital will have to sign up more men.
But what really worries her is what will become of the men she has been treating. Those who had precancers need to be examined once or twice a year, because the growths tend to recur. Dr. Stier said the procedures are embarrassing and uncomfortable for patients, and it takes time for a doctor to gain their trust. Many of her patients are poor, from minority groups and infected with H.I.V. Some live in shelters, some have histories of drug use. And anal disorders add more stigma. “My main issue here is that I don’t think my patients are going to get the follow-up that they need, and I think they’re going to be lost to care, and we take care of a very vulnerable patient population,” Dr. Stier said.
Dr. Einstein had also been treating some male patients and had planned to enroll men in the new trial. Like Dr. Stier, he was blindsided by the gynecology board’s notice.
He said only three doctors at his hospital had special training in high-resolution anoscopy, and that was nowhere near enough. Now two of those doctors, including himself, have to stop treating men.
“I think we’ll see significant setbacks,” Dr. Einstein said.
Urbanites Flee China’s Smog for Blue Skies
http://nyti.ms/19PC57Y
DALI, China — A typical morning for Lin Liya, a native of Shanghai transplanted to this ancient town in southwest China, goes like this: See her 3-year-old son off to school near the mountains; go for a half-hour run on the shores of Erhai Lake; and browse the local market for fresh vegetables and meat.
She finished her run one morning beneath cloudless blue skies and sat down with a visitor from Beijing in the lakeside boutique hotel started by her and her husband.
“I think luxury is sunshine, good air and good water,” she said. “But in the big city, you can’t get those things.”
More than two years ago, Ms. Lin, 34, and her husband gave up comfortable careers in the booming southern city of Guangzhou — she at a Norwegian risk management company, he at an advertising firm that he had founded — to join the growing number of urbanites who have decamped to rural China. One resident here calls them “environmental refugees” or “environmental immigrants.”
At a time when hundreds of millions of Chinese, many poor farmers, are leaving their country homesteads to find work and tap into the energy of China’s dynamic cities, a small number of urban dwellers have decided to make a reverse migration. Their change in lifestyle speaks volumes about anxieties over pollution, traffic, living costs, property values and the general stress found in China’s biggest coastal metropolises.
Take air quality: Levels of fine particulate matter in some Chinese cities reach 40 times the recommended exposure limit set by the World Health Organization. This month, an official Chinese news report said an 8-year-old girl near Shanghai was hospitalized with lung cancer, the youngest such victim in China. Her doctor blamed air pollution.
The urban refugees come from all walks of life — businesspeople and artists, teachers and chefs — though there is no reliable estimate of their numbers. They have staked out greener lives in small enclaves, from central Anhui Province to remote Tibet. Many are Chinese bobos, or bourgeois bohemians, and they say that besides escaping pollution and filth, they want to be unshackled from the material drives of the cities — what Ms. Lin derided as a focus on “what you’re wearing, where you’re eating, comparing yourself with others.”
The town of Dali in Yunnan Province, nestled between a wall of 13,000-foot mountains and one of China’s largest freshwater lakes, is a popular destination. Increasingly, the indigenous ethnic Bai people of the area are leasing their village homes to ethnic Han, the dominant group in China, who turn up with suitcases and backpacks. They come with one-way tickets from places like Beijing, Shanghai, Guangzhou and Shenzhen, all of which have roaring economies but also populations of 15 million people or more.
On Internet forums, the new arrivals to Dali discuss how to rent a house, where to shop, how to make a living and what schools are best for their children. Their presence is everywhere in the cobblestone streets of the old town. They run cafes, hotels and bookstores, and the younger ones sit on the streets selling trinkets from blankets.
Some become farmers here, and some spend their days home schooling their children. Their presence has transformed Dali and surrounding villages into a cross between Provence and Haight-Ashbury.
One magnet is the village of Shuanglang, which became a draw after the famous Yunnan natives Yang Liping, a dancer, and Zhao Qing, an artist, built homes there. As at other lakeside villages, the immigrants, some with immense wealth, live near fishermen and farmers.
“All kinds of people come here with different dreams,” said Ye Yongqing, 55, an ethnic Bai artist from the region who has lived mostly in cities, including London, but bought a home here five years ago. “Some people imagine this place as Greece or Italy or Bali.”
“Dali is one of the few places in China that still has a close tie to the earth,” he added, sitting in front of a table of squashes in his garden courtyard. “A lot of villages in China have become empty shells. Dali is a survivor of this phenomenon.”
Ms. Lin said she first fell in love with Dali when she came as a backpacker in 2006. She returned twice before moving here. In 2010, on the third visit, she and her husband, whom she had met trekking in Yunnan, looked for land to lease to build a hotel on Erhai Lake. It has not all been easy going, Ms. Lin said, citing negotiations and misunderstandings with local officials, villagers and employees.
“We just wanted to switch to a different life,” said Ms. Lin, who had lived in Shanghai as well as Guangzhou. “My friends in Shanghai are struggling there — not only in their work, but also just to live. The prices are too high, even higher than in Europe. They become crazy, go mad.”
Ms. Lin moved here less than two years after giving birth to a son. “It’s good for the baby because it’s like my mother’s childhood,” she said. “My mother’s childhood in Shanghai — the air was still clean, you could see blue skies, there was clean water.”
That is a common refrain among parents here. One afternoon, four mothers, all urban refugees, sat outside a bookstore cafe, Song’s Nest, practicing English with one another. “The one thing we all have in common is we moved here to raise our children in a good environment,” one woman said.
The bookshop’s owner, Song Yan, moved here this year and translates books by an Indian philosopher popular with Chinese spiritual seekers. One night, she and another translator and urban refugee, Zheng Yuantao, 33, talked over dinner about their moves.
“I’ve never felt so free in my life,” Mr. Zheng said. “I grew up as a city boy, and I never realized how much I like living close to nature.”
From the nearby lakeside village of Caicun, Huang Xiaoling, a photographer, flies back to Beijing to shoot portraits and events for clients. She had once lived in a courtyard home in the Chinese capital, but fled in September with her 3-year-old son and husband, an American who works remotely as a technology director for a New York publishing company.
“I’m still productive even though I don’t go into an office,” she said. “I don’t know if it’s the weather and the environment, or just me feeling that, ‘Oh, I got out of the cave that I wanted to escape.’ ”
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Date: 2013-11-28 07:35 am (UTC)