Will Obama's order lead to surge in gun research?

MILWAUKEE (AP) — Nearly as many Americans die from guns as from car crashes each year. We know plenty about the second problem and far less about the first. A scarcity of research on how to prevent gun violence has left policymakers shooting in the dark as they craft gun control measures without much evidence of what works.

That could change with President Barack Obama's order Wednesday to ease research restrictions pushed through long ago by the gun lobby. The White House declared that a 1996 law banning use of money to "advocate or promote gun control" should not keep the Centers for Disease Control and Prevention and other federal agencies from doing any work on the topic.

Obama can only do so much, though. Several experts say Congress will have to be on board before anything much changes, especially when it comes to spending money.

How severely have the restrictions affected the CDC?

Its website's A-to-Z list of health topics, which includes such obscure ones as Rift Valley fever, does not include guns or firearms. Searching the site for "guns" brings up dozens of reports on nail gun and BB gun injuries.

The restrictions have done damage "without a doubt" and the CDC has been "overly cautious" about interpreting them, said Daniel Webster, director of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health.

"The law is so vague it puts a virtual freeze on gun violence research," said a statement from Michael Halpern of the Union of Concerned Scientists. "It's like censorship: When people don't know what's prohibited, they assume everything is prohibited."

Many have called for a public health approach to gun violence like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago even as the number of vehicles on the road rose.

"The answer wasn't taking away cars," said Dr. Georges Benjamin, executive director of the American Public Health Association.

However, while much is known about vehicles and victims in crashes, similar details are lacking about gun violence.

Some unknowns:

—How many people own firearms in various cities and what types.

—What states have the highest proportion of gun ownership.

—Whether gun ownership correlates with homicide rates in a city.

—How many guns used in homicides were bought legally.

—Where juveniles involved in gun fatalities got their weapons.

—What factors contribute to mass shootings like the Newtown, Conn., one that killed 26 people at a school.

"If an airplane crashed today with 20 children and 6 adults there would be a full-scale investigation of the causes and it would be linked to previous research," said Dr. Stephen Hargarten, director of the Injury Research Center at the Medical College of Wisconsin.

"There's no such system that's comparable to that" for gun violence, he said.

One reason is changes pushed by the National Rifle Association and its allies in 1996, a few years after a major study showed that people who lived in homes with firearms were more likely to be homicide or suicide victims. A rule tacked onto appropriations for the Department of Health and Human Services barred use of funds for "the advocacy or promotion of gun control."

Also, at the gun group's urging, U.S. Rep. Jay Dickey, a Republican from Arkansas, led an effort to remove $2.6 million from the CDC's injury prevention center, which had led most of the research on guns. The money was later restored but earmarked for brain injury research.

"What the NRA did was basically terrorize the research community and terrorize the CDC," said Dr. Mark Rosenberg, who headed the CDC's injury center at the time. "They went after the researchers, they went after institutions, they went after CDC in a very big way, and they went after me," he said. "They didn't want the data to be collected because they were threatened by what the data were showing."

Dickey, who is now retired, said Wednesday that his real concern was the researcher who led that gun ownership study, who Dickey described as being "in his own kingdom or fiefdom" and believing guns are bad.

He and Rosenberg said they have modified their views over time and now both agree that research is needed. They put out a joint statement Wednesday urging research that prevents firearm injuries while also protecting the rights "of legitimate gun owners."

"We ought to research the whole environment, both sides — what the benefits of having guns are and what are the benefits of not having guns," Dickey said. "We should study any part of this problem," including whether armed guards at schools would help, as the National Rifle Association has suggested.

Association officials did not respond to requests for comment. A statement Wednesday said the group "has led efforts to promote safety and responsible gun ownership" and that "attacking firearms" is not the answer. It said nothing about research.

The 1996 law "had a chilling effect. It basically brought the field of firearm-related research to a screeching halt," said Benjamin of the Public Health Association.

Webster said researchers like him had to "partition" themselves so whatever small money they received from the CDC was not used for anything that could be construed as gun policy. One example was a grant he received to evaluate a community-based program to reduce street gun violence in Baltimore, modeled after a successful program in Chicago called CeaseFire. He had to make sure the work included nothing that could be interpreted as gun control research, even though other privately funded research might.

Private funds from foundations have come nowhere near to filling the gap from lack of federal funding, Hargarten said. He and more than 100 other doctors and scientists recently sent Vice President Joe Biden a letter urging more research, saying the lack of it was compounding "the tragedy of gun violence."

Since 1973, the government has awarded 89 grants to study rabies, of which there were 65 cases; 212 grants for cholera, with 400 cases, yet only three grants for firearm injuries that topped 3 million, they wrote. The CDC spends just about $100,000 a year out of its multibillion-dollar budget on firearm-related research, New York Mayor Michael Bloomberg has said.

"It's so out of proportion to the burden, however you measure it," said Dr. Matthew Miller, associate professor of health policy at the Harvard School of Public Health. As a result, "we don't know really simple things," such as whether tighter gun rules in New York will curb gun trafficking "or is some other pipeline going to open up" in another state, he said.

What now?

CDC officials refused to discuss the topic on the record — a possible sign of how gun shy of the issue the agency has been even after the president's order.

Health and Human Services Secretary Kathleen Sebelius said in a statement that her agency is "committed to re-engaging gun violence research."

Others are more cautious. The Union of Concerned Scientists said the White House's view that the law does not ban gun research is helpful, but not enough to clarify the situation for scientists, and that congressional action is needed.

Dickey, the former congressman, agreed.

"Congress is supposed to do that. He's not supposed to do that," Dickey said of Obama's order. "The restrictions were placed there by Congress.

"What I was hoping for ... is 'let's do this together,'" Dickey said.

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Follow Marilynn Marchione's coverage at http://twitter.com/MMarchioneAP

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Housing, job data push S&P to five-year high; Intel down late

NEW YORK (Reuters) - Stronger-than-expected data on housing starts and jobless claims lit a fire under stocks on Thursday, pushing the S&P 500 to a five-year high and its third day of gains.

A pair of economic reports lifted investors' sentiment. The number of Americans filing new claims for unemployment benefits fell to a five-year low last week and housing starts jumped last month to the highest since June 2008.

Strength in the housing and labor markets is key to sustained growth and higher corporate profits, helping to bring out buyers even on a day when earnings reports were mixed.

Gains were tempered by weakness in the financial sector, with Bank of America down 4.2 percent to $11.28 and Citigroup off 2.9 percent to $41.24 after their results.

In other negative earnings news, shares of chipmaker Intel fell 5.2 percent to $21.49 in extended-hours trading after the company forecast quarterly revenue that fell short of analysts' expectations. Intel had ended the regular session up 2.6 percent at $22.68.

The S&P 500 ended at its highest since December 2007 and now sits just 5.6 percent from its all-time closing high of 1,565.15.

"Having consolidated really for the last two weeks, the fact that we broke out, I think that that is sucking in quite a bit of money," said James Dailey, portfolio manager of TEAM Asset Strategy Fund in Harrisburg, Pennsylvania.

The Dow Jones industrial average <.dji> was up 84.79 points, or 0.63 percent, at 13,596.02. The Standard & Poor's 500 Index <.spx> was up 8.31 points, or 0.56 percent, at 1,480.94. The Nasdaq Composite Index <.ixic> was up 18.46 points, or 0.59 percent, at 3,136.00.

Better-than-expected earnings and revenue reported by online marketplace eBay late Wednesday helped the stock gain 2.7 percent to $54.33.

In the housing sector, PulteGroup Inc shares gained 4.9 percent to $20.29 and Toll Brothers Inc advanced 3.1 percent to $35.99. The PHLX housing sector index <.hgx> climbed 2.4 percent, reaching its highest close since August 2007.

Semiconductor shares <.sox> rose 2 percent to the highest close in eight months.

Financials were the only S&P 500 sector to register a slight decline for the day.

Bank of America's fourth-quarter profit fell as it took more charges to clean up mortgage-related problems. Citigroup posted $2.32 billion of charges for layoffs and lawsuits.

Energy shares led gains on the Dow as U.S. crude oil prices jumped more than 1 percent. Shares of Exxon Mobil were up 0.8 percent at $90.20 while shares of Chevron were up 0.7 percent at $114.75.

S&P 500 earnings are expected to have risen 2.3 percent in the fourth quarter, Thomson Reuters data showed. Expectations for the quarter have fallen considerably since October when a 9.9 percent gain was estimated.

Volume was roughly 6.5 billion shares traded on the New York Stock Exchange, the Nasdaq and the NYSE MKT, compared with the 2012 average daily closing volume of about 6.45 billion.

Advancers outpaced decliners on the NYSE by about 22 to 7 and on the Nasdaq by about 2 to 1.

(Additional reporting by Chuck Mikolajczak; Editing by Kenneth Barry and Nick Zieminski)

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In Regional Elections, a Microcosm of Trouble Ahead for Merkel

BERLIN — With the national parliamentary election scheduled for September, many in Germany are looking to Lower Saxony, which holds regional elections on Sunday, for clues of what could happen in Berlin this autumn.

Political experts insist that regional elections in Germany have traditionally had little direct influence on the outcome of national elections. But several similarities between Lower Saxony and the German government make it appear a microcosm of the larger political scene.

Like Chancellor Angela Merkel’s government, Lower Saxony’s is led by a center-right coalition of her Christian Democrats and the Free Democrats. The Christian Democratic candidate in the state, David McAllister, is personally popular with voters, as is the chancellor, helping him to close in on his Social Democratic rival, Stephan Weil, making for a tight race.

But also like the chancellor, Mr. McAllister will rely heavily on the Free Democrats’ winning enough votes to earn seats in the regional legislature to continue his current government. In recent surveys, the party has hovered around 5 percent, the threshold needed to secure representation at the regional and national levels.

That polling has focused attention on the vote in Lower Saxony as a make-or-break moment for the party and perhaps even for Ms. Merkel’s coalition in Berlin.

The Free Democratic Party ended a string of losses at the regional level by winning slightly more than 8 percent of the vote in two states last year, North Rhine-Westphalia and Schleswig-Holstein. But for now that performance has not translated into a stronger position at the national level.

Many blame a lack of leadership. The party chairman, Philipp Rösler, who also serves as economy minister, consistently ranks as among the country’s least-popular politicians. But Karl-Rudolf Korte, a professor of politics at the University of Duisburg-Essen, says the party’s problems reach deeper than who is at its helm.

“It is not a problem of personality — it is a problem of issues,” Mr. Korte said.

Regardless of the outcome Sunday, he predicts that the party would be well advised to go for a two-pronged approach, keeping Mr. Rösler as its leader, but choosing the party’s parliamentary leader, Rainer Brüderle, as its main candidate because of his popularity.

Traditionally the Free Democrats have provided a clear voice for individual citizens’ rights against an overly powerful nanny state. They have served in more governments in postwar Germany than any other political party, although as the junior coalition partner. Two respected presidents, Theodor Heuss and Walter Scheel, hailed from the Free Democrats, as did an influential former foreign minister, Hans-Dietrich Genscher.

Four years ago, the Free Democratic Party, or F.D.P., emerged with its strongest showing ever, earning 14.6 percent of the vote after campaigning on a promise to cut taxes. But with the euro crisis, that promise has been watered down and the party has failed to find other issues that resonate with voters.

At a party congress this month, Mr. Brüderle sought to drum up support by singling out legislation passed by the current coalition that clearly reflected the Free Democrats’ influence.

“The F.D.P. made the union better,” he said of the coalition, citing the scrapping of required military service, a €10 payment at doctors’ offices, policies affecting growth and consumer protection laws. “We need to believe in ourselves then many others will believe in us.”

A poll by the Forsa Institute, published by the weekly Stern on Wednesday showed the Free Democratic Party getting only 3 percent support, which would translate to their ejection from lower house of Parliament, the Bundestag.

Such an outcome would force Ms. Merkel, whose center-right Christian Democrats appear to be stronger than ever, earning 43 percent support in the Forsa survey, to find a new partner in government.

The center-left Social Democrats, however, polled their lowest since 2011, earning only 23 percent, largely because of a plunge in popularity for their candidate in the national election, Peer Steinbrück.

Manfred Güllner, who heads the Forsa Institute, said that even if the Social Democratic candidate in Lower Saxony, Mr. Weil, could pull off a victory, it would be unlikely to translate into increased support for Mr. Steinbrück.

“The latest survey shows that peoples’ image of Mr. Steinbrück has become increasingly negative,” Mr. Güllner said. “People view him as greedy, arrogant and awkward. Very few people associate him with political competence.”

Mr. Steinbrück’s image as a former finance minister who shepherded Germany through the first days of the financial crisis has been battered by a drawn-out debate over his private earnings from a book and, more recently, a comment that Ms. Merkel benefited from a “women’s bonus.”

Even an attempt by Mr. Steinbrück to change that image by inviting undecided voters to his home for a personal talk backfired earlier this week when the media began reporting that the family of a person in Lower Saxony that was selected from 150 candidates included an active member of the party’s local branch.

A victory by the Social Democrats in Lower Saxony, however, could have a greater impact on national politics through the upper house of Parliament, the Bundesrat, which is made up of representatives of the country’s 16 states. Together with their main political allies, the Greens, they could form a majority.

“If a party is clever, such a majority can be used to block, drag out or otherwise delay any legislative procedure,” Mr. Korte said.

That power would effectively hamper the government’s ability to pass legislation, regardless of their popularity.

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American Idol's New Judges Make Their Debut

TV Watch

American Idol

01/16/2013 at 11:00 PM EST

From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj and Keith Urban

Michael Becker/FOX.

American Idol is back!

Season 12 premiered Wednesday night with the first auditions in New York City. And fans hoping to get a taste of drama from new judges Mariah Carey and Nicki Minaj were not disappointed.

"Right away we knew it was going to be an interesting couple of days," host Ryan Seacrest said at the start of the two-hour episode.

And he was right. (Spoilers ahead!) While fellow newbie Keith Urban and veteran judge Randy Jackson were all about the business of finding talented singers, there was immediate tension between Carey and Minaj, who wore a drum major's hat to her first day on the job.

"We can have accessories?" Carey said disapprovingly after taking her seat at the panel. "I didn't know that was allowed."

"Why did you have to reference my hat?" Minaj responded.

Later, when Carey boasted about her holiday hit, "All I Want for Christmas," Minaj clenched her fists, gritted her teeth and used the b-word. Carey's response? "I rebuke it," she said.

The two women talked over each other at times, rolled eyes and seemed to annoy one another. More than once Carey said "Nicki" like an frustrated mother calls her child out for misbehaving. And Minaj pushed Carey's buttons by talking in a British accent.

But as the two formerly feuding judges have said in recent interviews, the show should be about the hopeful contestants – and there were a handful of talented singers who earned golden tickets to Hollywood:

• Tenna Torres, who attended Camp Mariah and had previously sung for the singer, impressed the panel with her version of "You've Got a Friend," and made her idol very proud.

• Christina "Isabelle," who told a story of losing weight and finding confidence, had Minaj saying, "OMG! OMG!" with her version of "Summertime."

• Frankie Ford, who sings for change on the New York City subway system, stumbled at first but delivered a soulful version of the Eurythmics' "Sweet Dreams." "I like your big voice," Urban said. "There's a lot of musicality in the tone."

Added Carey: "You have an inner glow, which is always beautiful to see."

• Despite hearing loss in both ears, Angela Miller, who sang "Mama Knows Best" by Jessie J, was "definitely one of the best," according to Jackson.

• And Ashlee Feliciano thrilled the female judges with her version of Corinne Bailey Rae's "Put Your Records On." "So pretty," Minaj said. "I want to come to your show ... I'm so inspired by you."

"The potential is great. It was beautiful," Carey said. "You should be really proud of yourself."

At the end of the first two days of auditions, the re-invented Idol panel had done its job: the judges praised the talented singers and handed out 41 tickets to Hollywood; they sent home the kooky contestants (often sweetly) and offered constructive criticism and an invitation to come back next year to the ones still on their way to greatness.

"We gel well in a weird crazy way," Minaj said at the end of the show. Carey said, "I agree."

We'll see how long that lasts! Auditions continue Thursday (8 p.m. ET) on Fox.

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Large study confirms flu vaccine safe in pregnancy

NEW YORK (AP) — A large study offers reassuring news for pregnant women: It's safe to get a flu shot.

The research found no evidence that the vaccine increases the risk of losing a fetus, and may prevent some deaths. Getting the flu while pregnant makes fetal death more likely, the Norwegian research showed.

The flu vaccine has long been considered safe for pregnant women and their fetus. U.S. health officials began recommending flu shots for them more than five decades ago, following a higher death rate in pregnant women during a flu pandemic in the late 1950s.

But the study is perhaps the largest look at the safety and value of flu vaccination during pregnancy, experts say.

"This is the kind of information we need to provide our patients when discussing that flu vaccine is important for everyone, particularly for pregnant women," said Dr. Geeta Swamy, a researcher who studies vaccines and pregnant women at Duke University Medical Center.

The study was released by the New England Journal of Medicine on Wednesday as the United States and Europe suffer through an early and intense flu season. A U.S. obstetricians group this week reminded members that it's not too late for their pregnant patients to get vaccinated.

The new study was led by the Norwegian Institute of Public Health. It tracked pregnancies in Norway in 2009 and 2010 during an international epidemic of a new swine flu strain.

Before 2009, pregnant women in Norway were not routinely advised to get flu shots. But during the pandemic, vaccinations against the new strain were recommended for those in their second or third trimester.

The study focused on more than 113,000 pregnancies. Of those, 492 ended in the death of the fetus. The researchers calculated that the risk of fetal death was nearly twice as high for women who weren't vaccinated as it was in vaccinated mothers.

U.S. flu vaccination rates for pregnant women grew in the wake of the 2009 swine flu pandemic, from less than 15 percent to about 50 percent. But health officials say those rates need to be higher to protect newborns as well. Infants can't be vaccinated until 6 months, but studies have shown they pick up some protection if their mothers got the annual shot, experts say.

Because some drugs and vaccines can be harmful to a fetus, there is a long-standing concern about giving any medicine to a pregnant woman, experts acknowledged. But this study should ease any worries about the flu shot, said Dr. Denise Jamieson of the Centers for Disease Control and Prevention.

"The vaccine is safe," she said.

___

Online:

Medical journal: http://www.nejm.org

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Asian shares consolidate, caution ahead of Chinese data

TOKYO (Reuters) - Asian shares eked out modest gains Thursday, consolidating amid better-than-expected U.S. earnings but demand was capped by caution ahead of Chinese data on Friday.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> added 0.1 percent, after falling in the past two sessions, pulled higher by a surge in Australian shares <.axjo>, which rose 1 percent to a 20-month high.

Australian employment surprisingly contracted by 5,500 in December, bolstering the odds for another interest rate cut. The prospect of further policy easing boosted local shares but sent the Australian dollar down to session lows of $1.0534 from $1.0560 before the data.

Analysts said the data came against a fairly positive global backdrop.

"There's a growing sentiment among investors that international risks have been significantly reduced, particularly after the U.S. made a start on its fiscal negotiations," said Ric Spooner, market strategist at CMC Markets in Sydney.

World stock markets ended flat on Wednesday with the banking sector rising as earnings from Goldman Sachs nearly tripled and JPMorgan Chase's fourth-quarter net income jumped 53 percent and earnings for 2012 set a record.

Investors will now turn to economic reports from China on Friday, including fourth-quarter GDP, December industrial output, retail sales and house price, which will offer clues on the health of Asia's biggest economy.

Data showing demand for new cars in recession-bound Europe fell to a 17-year low in 2012 reminded investors of the challenges facing the global economy, after the World Bank sharply cut its outlook for world growth this year to 2.4 percent from 3 percent, citing a slow recovery in developed nations.

YEN RESUMES WEAKNESS

The dollar and the euro regained ground against the yen, snapping two days of selling when investors took profits from these currencies' sharp and rapid rises against the Japanese currency since November.

Traders expect the yen to remain on a weakening trend amid expectations for bolder monetary easing measures from the Bank of Japan as part of the new government's push to drive Japan out of years of deflation and economic slump.

Japan's benchmark Nikkei average <.n225> inched up 0.2 percent, after tumbling 2.6 percent for its largest daily decline in eight months on Wednesday. The Nikkei hit a 32-month high on Tuesday as the yen's slump to multi-year lows against the dollar and the euro bolstered exporters on improving earnings outlook. <.t/>

The dollar was up 0.1 percent to 88.50 yen, off its peak since June 2010 of 89.67 touched on Monday, while the euro climbed 0.3 percent to 117.75 yen, after surging to its highest since May 2011 of 120.13 yen on Monday.

Anxiety about a possible protracted fight in Washington over raising the federal borrowing limit pushed the five-year cost to insure against a U.S. default up to 44 basis points on Wednesday, the highest since August 2011 during the first debt ceiling battle between U.S. President Barack Obama and Republican lawmakers.

The euro was up 0.1 percent to $1.3306 against the dollar, after reaching an 11-month high of $1.3404 on Monday.

COMMODITIES SEEN RISING

Reduced concerns over the euro zone debt problems, relatively more solid global economic fundamentals than last year and China's moderate recovery suggest there are buying opportunities for shares in cyclically dependant sectors and economies including Japan, Philip Poole, Head of Strategy at HSBC Global Asset Management, told a seminar in Tokyo this week.

"Recovery will feed through into 2013, but China won't go back to pre-crisis (of 2008) levels of growth of 10 percent," Poole said, adding that growth was likely to be 7-8 percent in 2013, a level investors now need to get used to.

"Cyclically sensitive sectors look relatively cheap in emerging countries and developed countries," while defensives were less attractive given their relative outperformance in 2012 under the more stressed financial environment, Poole said.

Another sector likely seen getting a boost from the reduced risk environment is commodities.

"Investment focus for 2013 is shifting to economically sensitive areas as global recovery takes place, boosting commodities prices," said Naohiro Niimura, a partner at research and consulting firm Market Risk Advisory.

The rally in platinum prices to 3-month highs this week, regaining its premium over gold for the first time since March 2012, is an indication of investors turning more proactive about taking risks, he said.

U.S. crude was down 0.2 percent at $94.05 a barrel while Brent was steady around $109.64.

(Additional reporting by Thuy Ong in Sydney; Editing by Shri Navaratnam)

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India Ink: A Hospital Network With a Vision

Fixes looks at solutions to social problems and why they work.

As the United States struggles to find new business models for health care, some innovators are looking to other industries, ones that provide high-quality services for low prices. In a recent article in The New Yorker, for example, Atul Gawande suggests that the Cheesecake Factory restaurant chain — with its size, central control and accountability for the customer experience — could be a model of sorts for health care. That’s not as outlandish as it seems. The world’s largest provider of eye care has found success by directly adapting the management practices of another big-box food brand, one that is not often associated with good health: McDonald’s.

Aravind can practice compassion successfully because it is run like a McDonald’s.

In 1976, Dr. Govindappa Venkataswamy — known as Dr. V — retired from performing eye surgery at the Government Medical College in Madurai, Tamil Nadu, a state in India’s south. He decided to devote his remaining years to eliminating needless blindness among India’s poor. Twelve million people are blind in India, the vast majority of them from cataracts, which tend to strike people in India before 60 — earlier than in the West. Blindness robs a poor person of his livelihood and with it, his sense of self-worth; it is often a fatal disease. A blind person, the Indian saying goes, is “a mouth with no hands.”

Dr. V started by establishing an 11-bed hospital with six beds reserved for patients who could not pay and five for those who would pay modest rates. He persuaded his siblings to join him in mortgaging their houses, pooling their savings and pawning their jewels to build it. Today, the Aravind Eye Care System is a network of hospitals, clinics, community outreach efforts, factories, and research and training institutes in south India that has treated more than 32 million patients and has performed 4 million surgeries. And it is still largely run by Dr V’s siblings and their spouses and children — he has at least 21 relatives who are eye surgeons. (Aravind’s story is well-told in depth in a new book, “Infinite Vision.”)

Aravind is not just a health success, it is a financial success. Many health nonprofits in developing countries rely on government help or donations, but Aravind’s core services are sustainable: patient care and the construction of new hospitals are funded by fees from paying patients. And at Aravind, patients pay only if they want to. The majority of Aravind’s patients pay only a symbolic amount, or nothing at all.

Dr V was guided by the teachings of the radical Indian nationalist and mystic Sri Aurobindo (Aravind is a southern Indian variation of Aurobindo), who located man’s search for his divine nature not in turning away from the world, but by engaging with it.

This philosophy, however, has produced a sustainable business model because of the other major influence on Dr. V: McDonald’s. Sri Aurobindo and McDonald’s are an unlikely pair. But Aravind can practice compassion successfully because it is run like a McDonald’s, with assembly-line efficiency, strict quality norms, brand recognition, standardization, consistency, ruthless cost control and above all, volume.

Aravind’s efficiency allows its paying patients to subsidize the free ones, while still paying far less than they would at other Indian hospitals. Each year, Aravind does 60 percent as many eye surgeries as the United Kingdom’s National Health System, at one one-thousandth of the cost.

Aravind’s ideas reach around the world. It runs hospitals in other parts of India with partners. It is also host to a parade of people who come to learn how it works, and it sends staff to work with other organizations. So far about 300 hospitals in India and in other countries are using the Aravind model. All are eye hospitals. But Aravind has also trained staff from maternity hospitals, cancer centers, and male circumcision clinics, among other places. Some share Aravind’s social mission. Others simply want to operate more efficiently.

The vast majority of people blind from cataracts in rural India have no idea why they are blind, nor that a surgery exists that can restore their sight in a few minutes. Aravind attracts these patients in two ways. First, it holds eye camps — 40 a week around the states of Tamil Nadu and Kerala. The camps visit villages every few months, offering eye exams, basic treatments, and fast, cheap glasses. Patients requiring surgery are invited with a family member to come to the nearest of Aravind’s nine hospitals; all transport and lodging, like the surgery, is free.

When Aravind surveyed the impact of its camps, it found to its dismay that they only attracted 7 percent of people in a village who needed care, mainly because they were infrequent. To provide a permanent presence in rural areas, Aravind established 36 storefront vision centers. They are staffed by rural women recruited and given two years’ training by Aravind. They have cameras, so doctors at Aravind’s hospitals can do examinations remotely. These centers increase Aravind’s market penetration to about 30 percent within one year of operation.

At Aravind’s hospitals, free patients lodge on a mat on the floor in a 30-person dormitory. Paying patients can choose various levels of luxury, including private, air-conditioned rooms. All patients get best-practice cataract surgeries, but paying patients can choose more sophisticated surgeries with faster recoveries (but not higher success rates). The doctors are identical, rotating between the free and paid wings.

Also standard for all patients is the Aravind assembly line. Dr. V spent a few days at McDonalds’ Hamburger University in Oak Brook,, Ill., but that visit was a product of his longstanding obsession with efficiency. “This man would go into an airport and walk around with the janitor and see how he cleans the toilet,” said Dr. S. Aravind, an eye surgeon with a masters degree in business who is Aravind’s director of projects. (He is Dr. V’s nephew, also named for Sri Aurobindo.) “He would go to a five star hotel and follow the catering people.”

Doctors are hard to find and expensive, so the surgical system is set up to get the most out of them. Patients are prepared before surgery and bandaged afterwards by Aravind-trained nurses. The operating room has two tables. The doctor performs a surgery — perhaps 5 minutes — on Table 1, sterilizes her hands and turns to Table 2. Meanwhile, a new patient is prepped on Table 1. Aravind doctors do more than 2,000 surgeries a year; the average at other Indian hospitals is around 300. As for quality, Aravind’s rate of surgical complications is half that of eye hospitals in Britain.

This volume is key to Aravind’s ability to offer free care. The building and staff costs are the same no matter how many surgeries each doctor performs. High volume means that these fixed costs are spread among vastly more people.

In the 1980s, Aravind faced a dilemma. A new surgery, which implanted a lens in the patient’s eye, had become the gold standard for treating cataracts. But these lenses were not made in India, and Aravind could persuade manufacturers to reduce their cost only from $100 to $70 per lens. Should Aravind begin providing first-class treatment for paying patients and second-class treatment for free ones? Or should it try to get enough money from paid patients to cover intraocular lenses for all? Neither was acceptable.

The solution was to get into manufacturing. In 1992, Aravind set up Aurolab, which now makes lenses (for $2 apiece), sutures and medicines. Aurolab is now a major global supplier of intraocular lenses and has driven down the price of lenses made by other manufacturers as well.

Aravind could not do its work without paying patients, of course — they subsidize free patients. They also improve service, by demanding high quality for their money. But it also works the other way around: the free patients improve service and price for patients who pay. “One of our big advantages is the scale of the work we do,” said Dr. Aravind. “You become a good resource center for training doctors, nurses, everybody. Because of high volume, doctors get better at what they do. They can develop subtle specialties.” And free patients make cost control a priority. “If 60 percent of your patients are paying very little or nothing, your cost structure is attuned towards that,” Dr. Aravind said.

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Whenever there is an innovator like Aravind, the question arises: how replicable is this? Do you need a Dr. V? Or is there a system that ordinary mortals can adapt?

The answer is a little of both. Other hospitals can and do successfully use the model. Lions Clubs International, which has worked to prevent blindness for more than a century, finances and supports a training institute. Aravind also works with the Berkeley-based Seva Foundation to grow eye hospitals in other countries. “There are a lot of eye hospitals in the developing world. Almost every single one is considerably underproducing,” said Suzanne Gilbert, the director of Seva’s Center for Innovation in Eye Care. “Surgical programs so often focus on the technique being used. Often the same level of scrutiny not applied to management, human resources and other systems that make the surgery work.”

Seva has worked with Aravind to establish hospitals in other countries (the Lumbini Eye Institute in Nepal has been particularly successful).  But its campaign to turn those hospitals into training centers has gone slowly. It’s hard to build those hospitals to be able to reach out while keeping good quality,” said Gilbert.   Seva was aiming to have 100 hospitals in the network by 2015, but has scaled back that goal.

“Of the 300 hospitals (that use Aravind’s model), I’d say 20 percent get the whole thing,” said Dr. Aravind. “Another 50 percent pick up pieces — how to make your operating tables more efficient, for example.  And the rest struggle.”

Combining paid and free care in a self-sufficient hospital is not possible for most health specialties. “The essential ingredient is volume that straddles the socioeconomic spectrum,” said Jaspal Sandhu, a Berkeley engineer who has studied Aurolab, and who is co-founder of the Gobee Group, a design firm that works with organizations to increase their social impact. “If you’re focusing on rich diseases or poor diseases, this model in existing form can’t really play out. The nice thing about cataracts is that it doesn’t greatly discriminate. And a cataract is a one-time hit. There’s a cure for it. You can treat it in a couple of days and it won’t come back.”

Male circumcision — an AIDS prevention measure — fits this description, and the World Health Organization’s guidelines for scaling up male circumcision uses Aravind’s principles. “When I was a doctor in a government hospital we did between 8 and maybe 12 circumcisions in a day per doctor,” said Dino Rech, a South African physician who has overseen the expansion of circumcision in several countries.  “With this model, the slowest doctors are doing 40 in a day — up to 60 for the faster ones.”

The McDonald’s part is the easiest piece of the Aravind model to export. More difficult to replicate is Aravind’s commitment to serving the largest number of free patients possible — indeed, to aim to eventually serve all of them. What’s needed, said Dr. Aravind, “is not leadership in the sense of organizing and making it work. It’s leadership that comes from empathizing with the community.”

Aravind spends a lot of resources recruiting free patients. “Never restrict demand. Build your capacity to meet the demand,” Dr. Aravind said. This community outreach work is the easiest part to sacrifice, he said. “This is where mission and leadership come in. People try to justify it with many things — we’ll build a bigger organization, then we’ll go back to community. If you have a choice between your paying and your free patients — well, the team is watching how you prioritize. Here’s its been internalized that this is the way we deal with any issue.  If someone can embody that, they can be like our founder.”

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Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and the author of, most recently, “Join the Club: How Peer Pressure Can Transform the World” and the World War II spy story e-book “D for Deception.”

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Commentary: Background Checks? Yes, but Leave Video Games Alone

COMMENTARY | I have mixed feelings toward the White House‘s gun violence response. I agree that background checks should be required before people are allowed to buy a firearm and that an assault weapon ban should be reinstated into law. While limiting the number of bullets in a weapon’s magazine will decrease the number of deaths in a mass shooting, the public does not need high-capacity magazines. Therefore any weapon using high-capacity magazines should be banned from public use, not just capping the magazines to 10 bullets.

But violent video games and other media images and scenes real-life violence? These media do not kill people. The shooters kill the people. Those who are mentally unstable may not understand that violent video games are not real life and should not be duplicated in real life. As long as gamers understand the difference between video games and real life, that shouldn’t be touched.

– Edmond, Okla.

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It's a Boy for Elton John

Mom & Babies
Celebrity Baby Blog

01/15/2013 at 10:00 PM ET

George Pimentel/WireImage

Elton John is a father again!

The musician and David Furnish welcomed their second child, son Elijah Joseph Daniel Furnish-John, via surrogate on Friday, Jan. 11 in Los Angeles, the couple confirm to HELLO.

Born at 6:40 p.m., Elijah weighed in at 8 lbs., 4 oz.

John and Furnish, who married in 2005, are already parents to son Zachary Jackson Levon, 2.

“Both of us have longed to have children, but the reality that we now have two sons is almost unbelievable. The birth of our second son completes our family in a most precious and perfect way,” the couple say in a statement.

“It is difficult to fully express how we are feeling at this time; we are just overwhelmed with happiness and excitement.”

John, 65, has been open about his desire to expand their family.

“I know when he goes to school there’s going to be an awful lot of pressure, and I know he’s going to have people saying, ‘You don’t have a mummy,’” says the singer-songwriter of his decision to have another baby.

“It’s going to happen. We talked about it before we had him. I want someone to be at his side and back him up. We shall see.”

– Sarah Michaud

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Risk to all ages: 100 kids die of flu each year

NEW YORK (AP) — How bad is this flu season, exactly? Look to the children.

Twenty flu-related deaths have been reported in kids so far this winter, one of the worst tolls this early in the year since the government started keeping track in 2004.

But while such a tally is tragic, that does not mean this year will turn out to be unusually bad. Roughly 100 children die in an average flu season, and it's not yet clear the nation will reach that total.

The deaths this year have included a 6-year-old girl in Maine, a 15-year Michigan student who loved robotics, and 6-foot-4 Texas high school senior Max Schwolert, who grew sick in Wisconsin while visiting his grandparents for the holidays.

"He was kind of a gentle giant" whose death has had a huge impact on his hometown of Flower Mound, said Phil Schwolert, the Texas boy's uncle.

Health officials only started tracking pediatric flu deaths nine years ago, after media reports called attention to children's deaths. That was in 2003-04 when the primary flu germ was the same dangerous flu bug as the one dominating this year. It also was an earlier than normal flu season.

The government ultimately received reports of 153 flu-related deaths in children, from 40 states, and most of them had occurred by the beginning of January. But the reporting was scattershot. So in October 2004, the government started requiring all states to report flu-related deaths in kids.

Other things changed, most notably a broad expansion of who should get flu shots. During the terrible 2003-04 season, flu shots were only advised for children ages 6 months to 2 years.

That didn't help 4-year-old Amanda Kanowitz, who one day in late February 2004 came home from preschool with a cough and died less than three days later. Amanda was found dead in her bed that terrible Monday morning, by her mother.

"The worst day of our lives," said her father, Richard Kanowitz, a Manhattan attorney who went on to found a vaccine-promoting group called Families Fighting Flu.

The Centers for Disease Control and Prevention gradually expanded its flu shot guidance, and by 2008 all kids 6 months and older were urged to get the vaccine. As a result, the vaccination rate for kids grew from under 10 percent back then to around 40 percent today.

Flu vaccine is also much more plentiful. Roughly 130 million doses have been distributed this season, compared to 83 million back then. Public education seems to be better, too, Kanowitz observed.

The last unusually bad flu season for children, was 2009-10 — the year of the new swine flu, which hit young people especially hard. As of early January 2010, 236 flu-related deaths of kids had been reported since the previous August.

It's been difficult to compare the current flu season to those of other winters because this one started about a month earlier than usual.

Look at it this way: The nation is currently about five weeks into flu season, as measured by the first time flu case reports cross above a certain threshold. Two years ago, the nation wasn't five weeks into its flu season until early February, and at that point there were 30 pediatric flu deaths — or 10 more than have been reported at about the same point this year. That suggests that when the dust settles, this season may not be as bad as the one only two years ago.

But for some families, it will be remembered as the worst ever.

In Maine, 6-year-old Avery Lane — a first-grader in Benton who had recently received student-of-the-week honors — died in December following a case of the flu, according to press reports. She was Maine's first pediatric flu death in about two years, a Maine health official said.

In Michigan, 15-year-old Joshua Polehna died two weeks ago after suffering flu-like symptoms. The Lake Fenton High School student was the state's fourth pediatric flu death this year, according to published reports.

And in Texas, the town of Flower Mound mourned Schwolert, a healthy, lanky 17-year-old who loved to golf and taught Sunday school at the church where his father was a youth pastor.

Late last month, he and his family drove 16 hours to spend the holidays with his grandparents in Amery, Wis., a small town near the Minnesota state line. Max felt fluish on Christmas Eve, seemed better the next morning but grew worse that night. The family decided to postpone the drive home and took him to a local hospital. He was transferred to a medical center in St. Paul, Minn., where he died on Dec. 29.

He'd been accepted to Oklahoma State University before the Christmas trip. And an acceptance letter from the University of Minnesota arrived in Texas while Max was sick in Minnesota, his uncle said.

Nearly 1,400 people attended a memorial service for Max two weeks ago in Texas.

"He exuded care and love for other people," Phil Schwolert said.

"The bottom line is take care of your kids, be close to your kids," he said.

On average, an estimated 24,000 Americans die each flu season, according to the Centers for Disease Control and Prevention. People who are elderly and with certain chronic health conditions are generally at greatest risk from flu and its complications.

The current vaccine is about 60 percent effective, and is considered the best protection available. Max Schwolert had not been vaccinated, nor had the majority of the other pediatric deaths.

Even if kids are vaccinated, parents should be watchful for unusually severe symptoms, said Lyn Finelli of the CDC.

"If they have influenza-like illness and are lethargic, or not eating, or look punky — or if a parent's intuition is the kid doesn't look right and they're alarmed — they need to call the doctor and take them to the doctor," she advised.

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CDC advice on kids: http://www.cdc.gov/flu/protect/children.htm

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