Weight-loss regimen a preferred choice for countering diabetes

After all those well-intentioned New Year's resolutions have yielded to the force of habit, many of the nation's 79 million obese adults will have a day of reckoning with their primary care physicians.

Lose weight and get active, the doctor will order, or risk developing diabetes. Then the MD will scribble a prescription.

For most patients, the prescribed treatment will not be a pill. It will be a 12-week program aimed at preventing Type 2 diabetes by getting obese adults to shed as little as 10 pounds and exercise for a little more than 20 minutes a day.

That regimen — the Diabetes Prevention Program — may soon become the blockbuster prescription medicine you've never heard of. In 2013, it is poised to become the envy of pharmaceutical companies, a new rival to programs such as Weight Watchers, and a target of opportunity for healthcare entrepreneurs.

Led by a trained coach, it is a testament to the power of a mentor and of setting modest goals in spurring healthful behavior. And it may be a crucial first test of the Affordable Care Act's focus on preventive health.

In nearly 30 clinical trials, scientists have established that the program is far more effective at helping people lose weight and prevent or delay the onset of diabetes than "usual care" — essentially, a doctor telling a patient to slim down and get active, and then sending him on his way. But the program hasn't been packaged in a form that healthcare providers can simply and cheaply offer to patients, said Dr. Jun Ma of the Palo Alto Medical Foundation Research Institute, who studies diabetes prevention.

The Diabetes Prevention Program is not rocket science. In 12 weekly sessions, a coach teaches obese subjects at high risk of developing diabetes to set goals for losing 5% to 7% of their body weight, limit the fat and calories they consume, track their food intake, get at least 150 minutes of exercise each week, and devise strategies to avoid gaining back lost pounds.

In trials, subjects who attended the tightly scripted sessions and followed the regimen were far more likely than those who were on their own to reach their weight-loss goals in three months — and to keep that weight off for more than a year. By doing so, they drove down their risk of developing Type 2 diabetes by 58%, according to a landmark report published in the New England Journal of Medicine in 2002.

The program, in short, is powerful medicine.

"If you could take it as a pill, it would definitely be commercialized," said Sean Duffy, a software designer and former Google employee who launched an online version of the program about a month ago.

In June, a panel of physicians and public health experts that advises the Department of Health and Human Services gave the program a mighty push into everyday medical practice. The U.S. Preventive Services Task Force recommended that doctors refer their obese patients to "intensive, multicomponent behavioral interventions" designed to promote weight loss and physical activity. It cited only one that met its strict standards: the Diabetes Prevention Program.

Under the Affordable Care Act, that carries significant weight. Starting in June, most health insurers will be required to make proven weight-loss and behavior-modification programs available without a copayment to obese customers with a doctor's referral.

No one knows whether expanded coverage of such programs can save money and head off a public health disaster. But without it, experts believe a tidal wave of Type 2 diabetes and heart disease — with a 20-year price tag estimated at $550 billion in the U.S. alone — is a virtual certainty.

For all its promise, the program has remained little more than a good idea — and a pretty expensive one at that — for years. The researchers who developed it at the University of Indiana pegged the cost of the trial's intensive 12-week phase and nine months of maintenance at about $1,300 per patient. To make it cheaper and more accessible, they trained a few YMCA chapters to deliver the program.

Today, about 75 chapters in 28 states and the District of Columbia offer it. The Centers for Disease Control and Prevention, which has been charged with broadening access to "lifestyle change" programs, disbursed $6.75 million in 2012 to encourage health insurers, public health advocates and employer groups to offer versions of the program.

But with more than 78 million people potentially in line to get it, demand far outstrips supply.

Researchers like Ma have been working on ways to use technology to make the program more widely available. In a study published last month in the Archives of Internal Medicine, she and her colleagues found that putting the 12-week curriculum on an inexpensive DVD and assigning a coach to answer questions and offer support helped 37% of obese participants lose 7% of their body weight — a rate more than twice as high as for those who got no help at all.

In a related study published in the same journal, researchers gave obese volunteers a personal digital device to monitor their weight, diet and physical activity and had them check in with a coach every other week. The volunteers lost more weight than trial subjects who were on their own.

The UnitedHealth Group's Diabetes Prevention and Control Alliance in Minnetonka, Minn., has worked to make the Diabetes Prevention Program available on demand to Comcast cable subscribers nationwide. UnitedHealth Group physicians and public health specialists worked with a TV production crew to create a reality-show version of the program. After the pilot aired last year in Philadelphia and Knoxville, Tenn., it took just three weeks to get 700 people to volunteer for a clinical trial of the TV-based program. The results of that will be published soon, said Dr. Deneen Vojta, chief clinical officer for the UnitedHealth program.

"These people lost a ton of weight," she said.

The growing scientific consensus around the diabetes program has not been lost on one of the nation's most ubiquitous and respected weight-loss programs, Weight Watchers. With 20,000 meetings a week across the United States, Weight Watchers International has the infrastructure that the Diabetes Prevention Program lacks. Like the diabetes program, its groups are run by coaches who give advice and encouragement and teach members to track their intake. The company has steadily added features — most recently a spate of food-tracking apps — as clinical trials showed their value.

Weight Watchers has been lobbying the government to recognize its programs as an effective tool for diabetes prevention. The stakes are huge: If insurers were required to cover the costs of patients' Weight Watchers memberships, the customer base could expand by leaps and bounds.

In Britain, the National Health Service will pay for the company's initial 12-week course, said David Kirchhoff, chief executive of Weight Watchers International in New York City. Given the program's widespread presence in the U.S. and evidence of its effectiveness in clinical trials, it makes sense for insurers here to pay too, he said.

Entrepreneurs are also getting in on the act. Duffy's San Francisco-based startup, Omada Health, launched an online version of the Diabetes Prevention Program called Prevent that may be the first of many digital spinoffs.

Designed to win the CDC's seal of approval, Prevent resembles a Facebook version of the Diabetes Prevention Program while preserving the privacy of customers who prefer it. Incoming members are matched to a group, and everyone works toward a goal of losing 5% to 7% of their body weight in 12 weeks under the supervision of a coach. Members' weights are transmitted to the coach by a digital scale upon enrollment and weekly thereafter.

Early testing has shown that as groups jell, members learn from — and lean on — one another, Duffy said. He plans to sell the program at about $120 per month for four months, primarily to insurers and companies for use by their customers and employees.

Payment will be due only after users show results, he said.

melissa.healy@latimes.com

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Kickstarter Campaigns Reap $319M in 2012

While Kickstarter’s hardware projects made headlines in 2012, film and gaming ideas (of both the video and board variety) were the real cash magnets for the crowdfunding site, raising a combined $176 million.

That’s just one of the many stats Kickstarter recently released on its crowdfunding activity in 2012, arguably the year the online service, and the notion of crowdfunding, went mainstream. In 2012 Kickstarter attracted more than 2 million backers who pledged a combined $319 million on everything from one-woman comedy shows to iPhone-enabled watches and electronic banana pianos. The money total blew away 2011 by 221 percent, and the number of backers grew a corresponding 238 percent.

But just because a campaign launched didn’t mean it was successful, in fact, it got harder as the year went on (especially for hardware projects), both by Kickstarter’s design and as the public wised up to beautiful-looking renderings of gadgets that would never get shipped. Of the 41,765 projects launched on Kickstarter, only 18,109 campaigns (about 43 percent) were successful.

Across project categories, gaming projects took in the most money, $83 million, thanks in large part to the Ouya gaming console, which raised $8.6 million in August. Film and video projects raised close to $58 million, the second-highest amount of cash, and Kickstarter notes that 10 percent of films at the January 2012 Sundance film festival were funded on the site. In third place were design projects (including furniture, iPhone cases, and bike accessories), which raised $50.1 million.

The single biggest Kickstarter star last year was the Pebble watch, which pulled in a record-shattering $10 million in May. However, in Kickstarter’s 50 slide “Best of 2012” presentation, there’s no mention of the e-paper watch nor hardly any other physical goods. The spotlight is clearly on art and performance campaigns; a not so subtle hint at Kickstarter’s growing fatigue with design and technology projects, which caused the crowdfunding site considerable pain in 2012.

Here was the problem: fully 84 percent of the top physical product-based projects were delayed. That in turn led to a wave of unhappy backers who mistakenly thought pledging amounted to online shopping. As a result, Kickstarter laid out stricter guidelines for campaigns in the design and technology categories, where you find nearly all of the non-food consumer products on the site.

Product inventors must now have photographs of their working prototypes instead of computer renderings, and clearly articulate to backers the risks of their project. Even if you follow these guidelines perfectly, the odds you’ll get your product accepted on Kickstarter have diminished. The startup’s widely-discussed “Kickstarter is Not A Store” blog post from September made it clear that Kickstarter doesn’t know how to handle million-dollar hardware projects and has no desire to figure it out.

In many ways, the decisions about what to include and exclude in its 2012 roundup are an indication of where Kickstarter wants to place its emphasis going forward. It’s projects like this video game proposal, the XOXO Festival (one of the first major festivals funded on the site), and a community hackerspace in Baghdad.

As cool as the Pebble watch may be, it’s not likely you’ll see the likes of it rise up again on Kickstarter, especially as other crowdfunding sites emerge and start to specialize in the categories and projects with which Kickstarter would rather not bother.

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“Lincoln” leads BAFTA film nominations with 10

LONDON (Reuters) – “Lincoln”, the story of U.S. President Abraham Lincoln’s battle to end slavery starring Daniel Day-Lewis in the title role, won 10 BAFTA nominations on Wednesday, putting it ahead of the pack at Britain’s top film honors.

The biopic was shortlisted in categories including best film, actor, supporting actor (Tommy Lee Jones) and supporting actress (Sally Field), but director Steven Spielberg was not nominated.

Added to its domination of the Golden Globe contenders going into Sunday night’s awards ceremony, British critics said the film appeared to be in pole position to sweep Oscar nominations which are announced on Thursday.

“Les Miserables”, the movie version of the global hit stage musical, and shipwreck saga “Life of Pi” followed with nine BAFTA nominations each, while the latest installment of James Bond, “Skyfall”, garnered eight.

Iranian hostage thriller “Argo” won seven nominations and “Anna Karenina”, an adaptation of the Russian novel, earned six.

Quentin Tarantino’s quirky slavery-era Western “Django Unchained” and “Zero Dark Thirty”, about the hunt for Osama bin Laden, were just behind with five nominations apiece.

“Amour”, Austrian director Michael Haneke’s moving portrayal of death, bagged four nominations, an unusually high number for a film in a foreign language.

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Eric Fellner of Working Title Films, the company behind Les Miserables and Anna Karenina, said he was pleased that two potentially risky projects had been recognized.

Les Miserables, by Oscar-winning director of “The King’s Speech” Tom Hooper, was sung live on set, while Joe Wright’s Anna Karenina, starring Keira Knightley and Jude Law, was set against the backdrop of elaborate stage sets.

“We knew that it was a much-loved musical and there was a large part of the world’s population who were also aware of the book,” Fellner said of Les Miserables after the BAFTA nominations were announced.

“But it didn’t stack up as a mainstream movie because over the past decades very few (musicals) have worked. It was a big risk,” he told Reuters, adding that awards recognition could provide a big lift for a picture just hitting theatres now.

Of Anna Karenina, he added: “The minute you do anything different it becomes harder to get it made. But we really believe in our film makers.”

Skyfall’s Judi Dench was nominated for best supporting actress as Bond’s spymaster M and Spanish actor Javier Bardem was nominated for best supporting actor as the villain Silva.

There is likely to be disappointment, however, that the movie which has become the most successful in British box office history, with critical acclaim to match, was not included on the most coveted shortlist – best film.

That award will be contested by Argo, Lincoln, Life of Pi, Les Miserables and Zero Dark Thirty.

Up for best actor alongside Day-Lewis is Ben Affleck (Argo), Bradley Cooper (Silver Linings Playbook), Hugh Jackman (Les Miserables) and Joaquin Phoenix in Scientology tale The Master.

The best actress award is between 85-year-old Emmanuelle Riva (Amour), Helen Mirren (Hitchcock), Jennifer Lawrence (Silver Linings Playbook), Jessica Chastain (Zero Dark Thirty) and Marion Cotillard (Rust and Bone).

As well as Haneke and Affleck, Ang Lee is in the running for best director (Life of Pi) as is Tarantino and Kathryn Bigelow (Zero Dark Thirty).

The BAFTAs have a patchy record in predicting which films go on to scoop the biggest movie honors, the Oscars, although last year the main winner in London, “The Artist”, also swept to success at the Academy Awards.

The awards ceremony for the BAFTAs, formally called the EE British Academy Film Awards, takes place in London on February 10.

(Reporting by Mike Collett-White, editing by Paul Casciato)

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Recipes for Health: Cauliflower and Tuna Salad — Recipes for Health

Andrew Scrivani for The New York Times

I have added tuna to a classic Italian antipasto of cauliflower and capers dressed with vinegar and olive oil. For the best results give the cauliflower lots of time to marinate.

1 large or 2 small or medium cauliflowers, broken into small florets

1 5-ounce can water-packed light (not albacore) tuna, drained

1 plump garlic clove, minced or pureéd

1/3 cup chopped flat-leaf parsley

3 tablespoons capers, drained and rinsed

1 tablespoon fresh lemon juice

3 tablespoons sherry vinegar or champagne vinegar

6 tablespoons extra virgin olive oil

Salt and freshly ground pepper

1. Place the cauliflower in a steaming basket over 1 inch of boiling water, cover and steam 1 minute. Lift the lid for 15 seconds, then cover again and steam for 5 to 8 minutes, until tender. Refresh with cold water, then drain on paper towels.

2. In a large bowl, break up the tuna fish and add the cauliflower.

3. In a small bowl or measuring cup, mix together the garlic, parsley, capers, lemon juice, vinegar, and olive oil. Season generously with salt and pepper. Add the cauliflower and toss together. Marinate, stirring from time to time, for 30 minutes if possible before serving. Serve warm, cold, or at room temperature.

Yield: Serves 6 as a starter or side dish

Advance preparation: You can make this up to a day ahead, but omit the parsley until shortly before serving so that it doesn’t fade. It keeps well in the refrigerator for up to 5 days.

Nutritional information per serving: 188 calories; 15 grams fat; 2 grams saturated fat; 2 grams polyunsaturated fat; 10 grams monounsaturated fat; 10 milligrams cholesterol; 8 grams carbohydrates; 3 grams dietary fiber; 261 milligrams sodium (does not include salt to taste); 9 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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DealBook: UBS Executives Questioned by Parliament in Wake of $1.5 Billion Fine

LONDON – Senior UBS executives faced tough questioning from British politicians on Wednesday over a recent rate-rigging scandal that led the Swiss banking giant to pay a combined $1.5 billion fine to global authorities.

During almost three hours of testimony, Andrea Orcel, head of UBS’s investment banking unit, and the firm’s chief risk and compliance officers were questioned over why the illegal activity, conducted over six years through 2010, was not discovered earlier.

“This scandal which took place at UBS was a shocker of enormous proportions,” said Andrew Tyrie, a politician who heads up the British Parliament’s commission on banking standards, which is investigating misconduct in the country’s financial services sector.

The multibillion-dollar fines were levied against the Swiss bank last month after American, British and Swiss regulators discovered that around 40 employees at the bank had actively manipulated key benchmark rates for financial gain.

During the recent financial crisis, senior managers at the Swiss bank also adjusted the firm’s interest rate submissions to portray the bank in a healthier financial position than it actually was, according to regulatory filings.

UBS’s Japanese subsidiary pleaded guilty to fraud related to the case, which included the manipulation of both the London interbank offered rate, or Libor, and Euro interbank offered rate, or Euribor. Combined, the rates underpin trillions of dollars of financial products worldwide, including sophisticated derivatives and home mortgages.

As part of the continuing case, the Justice Department has brought charges against two former UBS traders, Thomas Hayes and Roger Darin, for their roles in the illegal activity.

“These are industrywide problems,” said Mr. Orcel, a deal-making veteran who has advised on some of Europe’s biggest banking takeovers and who joined UBS last year from Bank of America. “We all got probably too arrogant, too self-convinced that things were correct the way they were. I think the industry needs to change.”

Mr. Orcel helped to broker the $97 billion acquisition of the Dutch bank ABN Amro in 2007 by a consortium of banks led by Royal Bank of Scotland. The mistimed deal played a role in R.B.S. being bailed out by the British government during the financial crisis.

The banker, who one British politician referred to as the “Ronaldo of investment banking” — a reference to the global Portuguese soccer start Cristiano Ronaldo – was asked whether he still would have supported the deal.

“Knowing what we know now,” Mr. Orcel said, “we would have advised them not to proceed.”

The British politicians peppered Mr. Orcel, UBS’s chief risk officer, Philip J. Lofts, and the firm’s global head of compliance, Andrew Williams, with questions about why the illegal activity was not discovered despite several internal audits of the bank’s trading activity.

The UBS officials acknowledged that only 18 of the 40 individuals linked to the rate-rigging scandal had been fired because of the illegal activity, though some of the implicated traders had subsequently moved to other banks before the misconduct was detected. Some employees connected to the illegal activity remained at the bank, the executives said.

The hearing also focused on the activities of Mr. Hayes, who worked at UBS from 2006 to 2009. The trader recorded around $260 million of profits during his time at the bank, though the UBS officials could not say how much of the earnings could be linked to ostensible manipulation of benchmark rates.

“His conduct was reprehensible,” Mr. Williams of UBS said on Wednesday. “We were all disgusted by it.”

When asked what steps the bank’s board had taken in the wake of the scandal, Mr. Williams said the Libor investigation had played a role in the firm’s decision to reduce its exposure to risky trading activity. Last year, the Swiss bank announced 10,000 job cuts, with a large percent of the layoffs expected in the firm’s investment bank.

“We are going to get out of much of the proprietary side of investment banking and go back to a client-focused model,” Mr. Williams told British politicians on Wednesday.

UBS is the latest global bank to be linked to the rate-manipulation scandal. Last year, the British firm Barclays agreed to pay a $450 million settlement with authorities after some of its traders were found to have altered Libor rate submissions for financial gain. Some of the bank’s senior executives, including the chief executive at the time, Robert E. Diamond Jr., resigned in the wake of the scandal.

More financial penalties are expected. The Royal Bank of Scotland has said it expects to announce an agreement with global authorities before it reports earnings in February, while Deutsche Bank of Germany has also said it had made financial provisions to cover potential fines.

Several American banks, including Citigroup and JPMorgan Chase, are also under investigation.

“This didn’t just involve traders at UBS,” Pat McFadden, a British politician said during the hearing on Wednesday. “This was a widespread practice in the banking industry. It was a serious corruption of the financial process.”

The $1.5 billion fine against UBS is the largest penalty levied so far in the five-year investigation into the manipulation of key benchmark rates, and was a new blow for the bank. Last year, UBS revealed a $2.3 billion loss related to illegal activity by a trader that led to the resignation of the firm’s former chief executive, Marcel Rohner. The bank agreed to pay a $47.5 million fine to British authorities for failing to detect the illegal trading.

UBS also agreed to pay American regulators $780 million in 2009 to settle allegations that it helped American clients evade taxes, while the bank also wrote down around $50 billion of sophisticated credit products during the financial crisis.

Mr. Rohner, several former chief executives of UBS’s investment banking unit, and senior officials from the Financial Services Authority, the British regulator, are to testify on Thursday in connection with the recent illegal activity at UBS.

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LAPD force exceeds 10,000 for the first time, officials say

For the first time in the city's history, Los Angeles' police force now exceeds 10,000 officers, city officials said Monday.

Appearing with LAPD Chief Charlie Beck to discuss the continued drop in crime last year, Mayor Antonio Villaraigosa said the department is budgeted for 10,023 officers, up from the 9,963 authorized over the last three years, during a deep budget crisis.

The staffing increase took effect Jan. 1, when 60 sworn officers moved into the LAPD from the General Services Department, which patrols parks, libraries and other municipal buildings, said Villaraigosa spokesman Peter Sanders. Those officers will continue to patrol city facilities, budget officials said.

Some questioned the significance of the staffing milestone, since the overall number of sworn officers employed by the city hasn't grown.

"It's an increase for show," said Kevin James, a candidate for mayor in the March 5 election who has questioned Villaraigosa's LAPD hiring goals. "The mayor really wanted to get to 10,000 one way or the other before he left office, and this was the way he could do it under the current budget constraints."

Los Angeles experienced a 10.5% decrease in gang crime and an 8.2% drop in violent crime last year, compared with 2011. The city had the lowest number of violent crimes per capita of any major city, including New York and Chicago, Villaraigosa said.

The mayor attributed those numbers — and a decade-long decline in crime — in large part to the expansion of the police force.

Villaraigosa originally promised to add 1,000 new officers to the department during the 2005 election campaign, criticizing then-Mayor James K. Hahn for failing to do so. Since then, he has succeeded in adding 800 officers, Sanders said. On Monday, Villaraigosa suggested that the addition of the final 200 will not be achieved until after June 30, when he leaves office.

"I would hope that the next mayor would, as we get out of this economic crisis, increase our Police Department to that 1,000," he said.

While Villaraigosa has been pushing for continued hiring at the LAPD, Beck has warned in recent weeks that the LAPD would lose 500 officers if voters fail to approve Proposition A, a half-cent sales tax measure on the March 5 ballot. That would represent more than half of the LAPD buildup accomplished by Villaraigosa.

Despite Beck's warnings, Villaraigosa said he is not ready to endorse Proposition A until the council makes a series of cost-cutting moves, such as turning over operation of the city zoo to a private entity.

Since Villaraigosa took office, homicides have decreased 38% and gang crime has dropped by a similar amount. The number of slayings has stayed largely the same over the last three years, with 297 homicides in 2010, 297 in 2011 and 298 last year. Overall crime dropped 1.4% last year. Property crimes, which are more numerous than violent crimes, increased for the first time in several years — driven in part by a 30% increase in cell phone thefts, officials said.

With little money to pay officers for overtime, the department has been compensating them with time off. The resulting staffing loss has been the equivalent of about 450 officers at any given time, according to department figures — a hit that has complicated crime-fighting strategies.

Preserving LAPD funding has become increasingly challenging for council members. For nine months they have debated whether to lay off dozens of civilian LAPD employees while continuing to hire enough police officers to maintain current staffing levels.

Councilman Paul Koretz, who opposed the layoffs, said the movement of the 60 building patrol officers to the LAPD was "a little smoke and mirrors." He questioned whether the LAPD buildup in the Villaraigosa era was financially sustainable.

"It just seems like we really never did the analysis to see if we could afford it," he said.

A defeat of the sales tax increase, which is projected to generate roughly $215 million in new revenue, would leave council members no choice but to roll back the size of the LAPD, Koretz said.

But Villaraigosa warned that would be dangerous, saying other California cities have seen upticks in crime after cutting back on officers.

"I know some people think that 10,000 cops is a magical illusion, a meaningless number, that more officers don't necessarily lead to a reduction in crime," said the mayor, adding: "Those critics talk a lot, but they're just plain wrong."

david.zahniser@latimes.com

richard.winton@latimes.com

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Video: Del Toro on 'Operatic' Grandeur of Mechs vs. Monsters in <em>Pacific Rim</em>

Guillermo del Toro is going big with Pacific Rim – very big. The latest film by the director of Pan’s Labyrinth and Hellboy is a big-budget sci-fi adventure that sees 25-story-high mega-mechs battling 25-story-high kaiju mega-monsters — think Godzilla vs. Gundam. It’s his largest film to date, not only in budget but in scope. “I went for a very operatic, very grand, very crazy type of imagery,” del Toro told Wired.

In our video interview, we talked with the director about the tradeoff between emotion and spectacle, using special effects versus sets and his “benign dictatorship” while filming the movie. Pacific Rim debuts July 11, 2013.

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Mariah Carey increased security in feud with fellow “Idol” judge

NEW YORK (Reuters) – Pop diva Mariah Carey said she hired increased security following what she described as threats reportedly made against her by fellow ‘American Idol‘ judge Nicki Minaj, according to an interview on ABC News.

Carey, 42, one of three new judges to join the “American Idol” panel for the hit talent show’s new season on January 16, told Barbara Walters in an interview airing on Monday, “it felt like an unsafe work environment.”

“Anytime anybody’s reeling threats at somebody, you know, it’s not appropriate,” Carey said.

“I’m a professional. I’m not used to that type of environment,” she said, adding that she hired extra security.

The diva was alluding to widely reported tension between her and Minaj, who were seen arguing with one another in a video from the show’s audition phase.

Walters has reported that, according to Carey, others on the “Idol” set heard Minaj go further and say, off-camera, “If I had a gun, I would shoot that bitch.”

Minaj, a Trinidadian-born singer and songwriter, previously denied making any remarks about firearms, but Carey told Walters that beefing up her security “was the appropriate thing to do.”

“Sitting there on the road with two babies, I’m not going to take any chances,” she said, referring to her 20-month old twins with husband Nick Cannon.

But in a sign of media savvy, she noted that “for all the drama, I hope it helps the show.”

Walters also asked Carey about reports she is being paid $ 18 million for each “Idol” season.

“I think we’re in the ballpark, (but) I can’t even talk about those things,” the singer replied.

(Reporting by Chris Michaud; Editing by Piya Sinha-Roy and Paul Simao)

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The New Old Age Blog: Who Should Receive Organ Transplants?

Joe Gammalo had been contending with pulmonary fibrosis, a scarring of the lungs, for more than a decade when he came to the Cleveland Clinic in 2008 seeking a lung transplant.

“It had gotten to the point where I was on oxygen all the time and in a wheelchair,” he told me in an interview. “I didn’t expect to live.”

Lung transplants are a dicey proposition, involving a huge surgical procedure, arduous follow-up, the lifelong use of potent immunosuppressive drugs and high rates of serious side effects. “It’s not like taking out an appendix,” said Dr. Marie Budev, the medical director of the clinic’s lung transplant program.

Only 50 to 57 percent of all recipients live for five years, she noted, and they will still die of their disease. But there’s no other treatment for pulmonary fibrosis.

Some medical centers would have turned Mr. Gammalo away. Because survival rates are even lower for older patients, guidelines from the International Society for Heart and Lung Transplantation caution against lung transplants for those over 65, though they set no age limit.

But “we are known as an aggressive, high-risk center,” said Dr. Budev. So Mr. Gammalo was 66 when he received a lung; his newly found buddy, Clyde Conn, who received the other lung from the same donor, was 69.

You can’t mistake the trend: A graying population and revised policies determining who gets priority for donated organs, have led to a rising proportion of older adults receiving transplants.

My colleague Judith Graham has reported on the increase in heart transplants, but the pattern extends to other organs, too.

The number of kidney transplants performed annually on adults over 65 tripled between 1998 and last year, according to data from the Scientific Registry of Transplant Recipients. In 2001, 7.4 percent of liver transplant recipients were over 65; last year, that rose to 13 percent.

The rise in elderly lung transplant candidates is particularly dramatic because, since 2005, a “lung allocation score” puts those at the highest mortality risk, rather than those who’ve waited longest, at the top of the list.

In 2001, about 3 percent of those on the wait list and of those transplanted were over 65; last year, older patients represented almost 18 percent of wait-listed candidates and more than a quarter of transplant recipients. (Medicare pays for the surgery, though patients face co-pays and considerable out-of-pocket costs, including for drugs and travel.)

The debate has grown, too: When the number of adults awaiting transplants keeps growing, but organ donations stay flat, is it desirable or even ethical that an increasing proportion of recipients are elderly?

Dr. Budev, who estimated that a third of her program’s patients are over 65, votes yes. As long as a program selects candidates carefully, “how can you deny them a therapy?” she asked. So the Cleveland Clinic has no age limit. “We feel that everyone should have a chance.”

At the University of Michigan, by contrast, the age limit remains 65, though Dr. Kevin Chan, the transplant program’s medical director, acknowledged that some fit older patients get transplanted.

“You can talk about this all day — it’s a tough one,” Dr. Chan said. Younger recipients have greater physiologic reserve to aid in the arduous recovery; older ones face higher risk of subsequent kidney failure, stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with.

Donated lungs, fragile and prone to injury, are a particularly scarce commodity. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants and 1,949 heart transplants. Only1,830 patients received lung transplants.

“What if there’s a 35-year-old on a ventilator who needs the lung just as much?” Dr. Chan said. “Why should a 72-year-old possibly take away a lung from a 35-year-old?” Yet, he acknowledged, “it’s easy to look at the statistics and say, ‘Give the lungs to younger patients.’ At the bedside, when you meet this patient and family, it’s a lot different.”

These questions about who deserves scarce resources — those most likely to die without them? or those most likely to live longer with them? — will persist as the population ages. They’re also likely to arise when the International Society for Heart and Lung Transplantation begins working towards revised guidelines this spring. (I’d also like to hear your take, below.)

Lots of 65- and 75-year-olds are very healthy. Yet transplants themselves can cause harm and there’s no backup, like dialysis. Without the transplant, they die. But when the transplant goes wrong, they also die.

More than four years post-transplant, the Cleveland Clinic’s “lung brothers” are success stories. Mr. Conn, who lives near Dayton, Ohio, can’t walk very far or lift more than 10 pounds, but he works part time as a real-estate appraiser and enjoys cruises with his wife.

Mr. Gammalo, a onetime musician, has developed diabetes, like nearly half of all lung recipients. But he went onstage a few weeks back to sing “Don’t Be Cruel” with his son’s rock band, “a highlight of both our lives,” he said.

Yet when I asked Mr. Conn, now 73, how he felt about having priority over a younger but healthier person, he paused. “It’s a good question,” he said, to which he had no answer.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Mobile Apps Drive Rapid Changes in Search Technology

SAN FRANCISCO — When the Federal Trade Commission decided last week to close its antitrust investigation of Google without charges, one important factor, though hardly mentioned, was just beneath the surface: the mobile revolution.

Google has repeatedly made the argument — and the commission agreed — that the speed of change in the technology industry made it impossible for regulators to impose restrictions without stalling future innovations.

Exhibit A is the mobile device. Nowhere has technology changed as rapidly and consumer behavior as broadly. As people abandon desktop computers for mobile ones, existing tech companies’ business models are being upended and new companies are blooming.

“Mobile is very much a moving target,” said Herbert Hovenkamp, a professor of antitrust law at the University of Iowa who has been a paid adviser to Google. “This is a market in which new competitors come in a week’s time.”

When the commission began its investigation 19 months ago, for instance, the iPhone did not have the Siri voice search, Apple did not have its own mapping service and Yelp’s mobile apps had no ads. By the time the inquiry concluded, all of that had changed. Google had new competitors on all sides trying to chip away at its hold on the mobile search and advertising market.

Still, Google is even more dominant on mobile phones than on desktop computers. It has 96 percent of the world’s mobile search market, according to StatCounter, which tracks Web use. It collects 57 percent of mobile ad revenue in the United States, while Facebook, its nearest competitor, gets just 9 percent, according to eMarketer.

But, analysts say, as people change their search habits on mobile devices — bypassing Google to go straight to apps like Yelp’s, for example — that dominance could wane, or a competitor could swoop in and knock Google off its perch.

“It’s important to recognize that many mobile apps are really vertical search engines,” said Rebecca Lieb, a digital media analyst at the Altimeter Group. “It is impossible to really say anyone dominates a section of mobile in a secure way right now.”

On cellphones or tablets, for instance, people increasingly skip Google altogether in favor of apps like Flixster for movie times or Kayak for flights.

Apple is taking on mobile search with Siri on the iPhone, which can answer questions about the weather or search for nearby restaurants. With its new mapping service, Apple has also entered local search.

On Friday, Blekko, a search start-up, introduced an app called Izik for Apple and Android devices. It tries to make searching more tablet-friendly by showing images instead of just links, and making it easier to swipe through many pages of results with a finger.

On mobile devices, said Rich Skrenta, chief executive of Blekko, “the user experience is so different that we think it opens things up. On your desktop, if it doesn’t look like Google, you think that’s not a search engine. On a tablet, it’s just vastly different.”

Jon Leibowitz, chairman of the F.T.C., said at a news conference Thursday that the speed of change in the tech industry meant that “you want to be careful before you apply sanctions.”

The commission also considered Google’s partnerships with cellphone makers like Samsung and HTC that license Google search on phones, so that a search box shows up on the home screen. In the end it decided not to take action against Google.

Some Google critics said that even though the competitive landscape is different on mobile devices, it should not have influenced the government’s analysis of Google’s behavior on the desktop Web.

“There’s no doubt that mobile applications, including Yelp’s, give consumers the ability to bypass the major search engines and go directly to the best provider of the service they’re looking for,” said Vince Sollitto, vice president for government relations at Yelp. Still, he added, “I don’t see how that impacts how someone is acting anticompetitively on the desktop.”

(One of Google’s concessions to the federal agency, that it would allow other Web companies to ask Google not to show their content in its own vertical search products — a chief complaint of Yelp’s — applies to mobile as well.)

But others said antitrust enforcement in the 21st century needs to be more agile.

Nick Wingfield contributed reporting from Seattle.

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