Jacob J. Lew, White House chief of staff, to get Treasury nod









WASHINGTON — President Obama on Thursday will nominate his chief of staff, Jacob J. Lew, a fiscal policy expert with deep Washington roots, as his new Treasury secretary to help lead the administration through budget battles ahead.

Lew, 57, would replace Timothy F. Geithner, who has been planning to leave the administration this month, according to a White House official. The official announcement is expected to come at 10:30 a.m. Pacific time.

“Throughout his career, Jack Lew has proven a successful and effective advocate for middle-class families who can build bipartisan consensus to implement proven economic policies,” the White House said.

Though he was a Citigroup Inc. executive for three years before joining the administration in 2009, Lew has far less experience dealing with Wall Street than Geithner had when he was nominated.


Quiz: How well do you remember 2012?


But Lew knows Washington. His skills honed in many years in the nation's capital are what Obama needs now for the coming budget fights, including a controversial increase in the debt ceiling, experts said.





"Over the past more than quarter of a century, Jack Lew has been an integral part of some of the most important budgetary, financial and fiscal agreements — bipartisan agreements — in Washington," said White House Press Secretary Jay Carney, who would not comment on a potential nomination.


Lew's experience dates to the 1970s when he began working as a House Democratic aide. Lew then spent eight years as a top advisor to former House Speaker Thomas P. "Tip" O'Neill Jr. (D-Mass.).


Lew is steeped in the mechanics of budget-making, having served as White House budget director under Presidents Clinton and Obama. The decision to tap him as Treasury secretary reflects the different economic landscape heading into a second Obama term.


In late 2008, the financial system was in turmoil. Obama turned to Geithner, who had been a key player in responding to the crisis as president of the Federal Reserve Bank of New York.


Now the financial system has healed. But the nation has huge budget deficits and, within weeks, must raise the $16.4 trillion debt limit or face a default.


So someone with a long history dealing with budget and spending issues is needed, said Chris Krueger, a senior policy analyst in Washington at financial services firm Guggenheim Partners.


"Jack Lew would not have been the right choice in 2009, but he's certainly a reflection of the times," Krueger said. "Lew is a creature of Washington. He's not a creature of Wall Street."


Lew lacks significant experience in financial regulatory issues and relationships in the industry, which would be crucial in another financial crisis, said Brian Gardner, an analyst at investment bank Keefe, Bruyette & Woods.


Lew has been chief of staff since early last year, and Obama has not yet decided on a replacement. As reports of his pending nomination circulated Wednesday, the Internet was abuzz with images of Lew's unusual signature, which would be stamped on all paper currency if he were to become Treasury secretary.


The signature — a childlike scrawl of small curlicues found on his Office of Management and Budget memos — is at odds with Lew's low-key personality.


An orthodox Jew, Lew observes the Sabbath, so from sundown Friday to sundown Saturday he doesn't drive, use electricity or work on his BlackBerry. But he has been available during that time if Obama has needed him and sometimes has walked to work at the White House.


University of Michigan law professor Michael Barr, who worked with Lew in the Clinton administration, described him as "very methodical, very careful."


Lew is a veteran of partisan battles on Capitol Hill, helping O'Neill craft compromises with former President Reagan in the 1980s on major changes to Social Security and the tax code and playing a key role for Clinton in budget negotiations with congressional Republicans in the late 1990s.


"He negotiated a series of balanced budgets with a heavily Republican Congress under President Clinton," Barr said. "He understands how tax and budget policy work. He understands the Congress."


Barr, who was an assistant Treasury secretary under Geithner in 2009-10, said Lew would be "exceptionally good at the job."


"It certainly makes a lot of sense to have someone come in now who is very steeped in the budget process and fiscal issues and is an effective negotiator with the Congress because so much attention is likely to be focused in that area," Barr said.


In the partisan gridlock following the Republican takeover of the House in 2010, Lew has had a more difficult task in navigating Congress. His hard-nosed negotiations over raising the debt limit in 2011 angered some Republicans. And although he's likely to be confirmed if nominated, it won't be without some Republican criticism, Krueger said.


"It's no secret that Lew and congressional Republicans don't have a fantastic relationship," Krueger said.


The confirmation process is "going to be a forum for the Senate to have a debate on the president's fiscal and economic and deficit positions," Krueger said.


Geithner was well-connected on Wall Street from years in the Treasury Department and at the New York Fed. But Lew has private-sector experience that many top Obama administration officials have lacked.


Lew was managing director and chief operating officer at Citi Alternative Investments in 2008-09. And he held the same position at Citi Global Wealth Management from 2006 to 2008.


That experience led to criticism when Lew was elevated in 2010 to White House budget director from his position as a top aide to Secretary of State Hillary Rodham Clinton.


Some liberals were concerned that Citi Alternative Investments, which manages private equity, hedge funds and real estate investments, reportedly profited from the collapse of the subprime housing market.


Lew earned $1.1 million in salary and other compensation from Citigroup in 2009, according to his government financial disclosure.


jim.puzzanghera@latimes.com


christi.parsons@latimes.com





Read More..

Charlie Sheen downplays Baja encounter with L.A. mayor









Los Angeles Mayor Antonio Villaraigosa found himself sucked deeper into the Charlie Sheen-TMZ-Hollywood gossip vortex Tuesday, with the actor speaking out again about the night they met up at a hotel in Mexico over the holidays.


Sheen made news last month after he tweeted a picture of himself with his arm around Villaraigosa the night of Sheen's bar opening in Baja California, Mexico. The former star of "Two and a Half Men" praised the mayor as a man who "knows how to party." But Villaraigosa downplayed the significance of the image, telling KNBC's Conan Nolan over the weekend that he had only "bumped into" Sheen and engaged in a three-minute conversation.


On Tuesday, Sheen challenged Villaraigosa's account, telling celebrity website TMZ that the mayor was drinking in Sheen's hotel suite in a room full of beautiful women, including at least one porn star. "I memorize 95 pages a week, so the last thing that I am is memory challenged," Sheen told the website. "We hung out for the better part of two hours."





Hours later, Sheen issued a more muted account, saying the mayor had spoken to many other people at the opening of the bar. "I am a giant fan of the mayor's and apologize if any of my words have been misconstrued," the statement said.


By then, however, Villaraigosa found himself fending off related questions at a news conference meant to be devoted to billionaire Eli Broad's new downtown art museum. "Can you just set the record straight for us?" asked one reporter. "What was it? Two hours or three minutes?" asked another. Then came the zinger: "Does what happens in Cabo stay in Cabo?"


Villaraigosa cackled at the Cabo crack but refused to take the bait. "I've said what I'm going to say on that, everybody," Villaraigosa declared. "You had fun. Let's talk about the important things, like a thousand jobs today" — a reference to construction work going on at Broad's museum.


Villaraigosa has frequently bristled at media questions about his personal life, going silent on some occasions and becoming visibly angry on others. Last week, he told KNBC's Nolan that Nolan had asked a "bozo question" about the Sheen photograph. He also noted that Nolan and other newsroom staffers have, like Sheen, asked the mayor to pose for pictures with them.


Sheen has been a TMZ staple, using the website as a platform to talk up his $100,000 gift to celebrity Lindsay Lohan and his porn star "goddesses." And Villaraigosa has glided easily between the world of politics and the entertainment industry since being elected in 2005.


"He's a celebrity mayor. And he's always wanted to be that," said Jaime Regalado, professor emeritus of political science at Cal State L.A. "If you're going to be a celebrity mayor, you have to take the good and the bad and everything in between" when it comes to news coverage.


david.zahniser@latimes.com


kate.linthicum@latimes.com





Read More..

NRA, video game makers to meet with Biden gun task force this week






WASHINGTON (Reuters) – The powerful gun lobby, the National Rifle Association, is slated to meet with Vice President Joe Biden as he considers recommendations on how to respond to a mass shooting last month in Newtown, Connecticut, the White House said on Tuesday.


After the Newtown school shooting, which President Barack Obama called the worst day of his presidency, he asked Biden to come up with a broad range of ideas to curb gun violence – ideas he will unveil in his annual State of the Union address, traditionally given in late January.






Obama has said he wants new gun control measures passed during the first year of his second term, but gun control is a divisive issue in the United States where the right to bear arms is enshrined in the Constitution.


Biden’s task force is examining legislation that would ban assault rifles, but is also looking at the role of violent movies and videogames in mass shootings and whether there is adequate access to mental health services.


Biden and his task force are slated to hold meeting this week with victims of gun violence, gun safety groups, hunting groups, and gun owners, White House spokesman Jay Carney told reporters.


“His group will also meet with representatives of the entertainment and video-game industries,” Carney said.


Health and Human Services Secretary Kathleen Sebelius will meet with mental health and disability advocates, and Education Secretary Arne Duncan is slated to meet with parent, teacher and education groups, Carney said.


The NRA has proposed armed guards in schools, an idea about which Obama has expressed skepticism.


The group’s top lobbyist, James J. Baker, will attend the task force meeting on Thursday, an NRA spokesman said.


“We are sending a representative to hear what they have to say,” NRA spokesman Andrew Arulanandam said in an e-mailed statement.


(Additional reporting by David Ingram; Editing by Sandra Maler and Jackie Frank)


Gaming News Headlines – Yahoo! News





Title Post: NRA, video game makers to meet with Biden gun task force this week
Url Post: http://www.news.fluser.com/nra-video-game-makers-to-meet-with-biden-gun-task-force-this-week/
Link To Post : NRA, video game makers to meet with Biden gun task force this week
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment




Read More..

'Lincoln' leads race for British Academy Awards


LONDON (AP) — Historical biopic "Lincoln" leads the race for the British Academy Film Awards, with 10 nominations including best picture and best actor — but nothing for director Steven Spielberg.


Epic musical "Les Miserables" and boy-meets-tiger saga "Life of Pi" received nine nominations each Wednesday for Britain's equivalent of the Oscars. James Bond adventure "Skyfall" got eight — rare awards recognition for an action movie — and Iran hostage thriller "Argo" took seven.


"Lincoln" focuses on the last months in the life of U.S. President Abraham Lincoln, as he struggled to end the Civil War and pass a constitutional amendment banning slavery.


Britain's Daniel Day-Lewis is nominated for leading actor for his uncanny embodiment of the iconic president, and there are supporting nominations for Sally Field as his wife Mary Todd Lincoln and Tommy Lee Jones as abolitionist firebrand Thaddeus Stevens.


The best picture nominees are "Lincoln," ''Les Miserables," ''Life of Pi," ''Argo" and Osama bin Laden thriller "Zero Dark Thirty."


"Les Miserables" is also a contender in the separate category of best British film, alongside "Anna Karenina," ''The Best Exotic Marigold Hotel," ''Seven Psychopaths" and "Skyfall."


"Les Mis" producer Tim Bevan said he was pleased with the movie's nine nominations, but surprised director Tom Hooper didn't make the shortlist.


"Steven Spielberg wasn't nominated for best director for 'Lincoln,' which tops the list, so it just goes to show how wide open it is this year," he said.


Ben Affleck is nominated both as director of "Argo" and as its leading actor. The other male acting contenders are Day-Lewis, Bradley Cooper for "Silver Linings Playbook," Hugh Jackman for "Les Miserables" and Joaquin Phoenix for "The Master."


"Skyfall" star Daniel Craig was snubbed, but the film received supporting acting nominations for Judi Dench's spy chief and Javier Bardem's scene-stealing baddie.


The best-actress shortlist includes 85-year-old "Amour" star Emmanuelle Riva — who was nominated for the same prize 52 years ago for "Hiroshima, Mon Amour" — Jennifer Lawrence for "Silver Linings Playbook," Jessica Chastain for "Zero Dark Thirty," Marion Cotillard for "Rust and Bone" and Helen Mirren for "Hitchcock."


Mirren said it had been wonderful to play Hitchcock's wife in Sacha Gervasi's film.


"Alma Reville was more than Hitchcock's wife, in many ways she was his muse, his assistant, his editor and more, and I am proud to have had the opportunity to portray her," Mirren said.


Besides Affleck, the heavyweight best-director list includes, Michael Haneke for Cannes Film Festival prize-winner "Amour," Quentin Tarantino for "Django Unchained," Ang Lee for "Life of Pi" and Kathryn Bigelow for "Zero Dark Thirty."


Poignant old-age portrait "Amour" is up for best foreign-language film, along with Norway's "Headhunters," Denmark's "The Hunt" and French films "Rust and Bone" and "Untouchable."


In recent years, the British awards, known as BAFTAs, have helped underdog films including "Slumdog Millionaire," ''The King's Speech" and "The Artist" gain momentum for Oscars success.


The winners will be announced at a ceremony in London on Feb. 10, two weeks before the Hollywood awards.


___


Jill Lawless can be reached at http://Twitter.com/JillLawless


Read More..

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.”


Read More..

Disneyland fights multiday pass abuse by photographing holders









Workers at Disneyland and Disney California Adventure Park took photos of visitors entering the parks Tuesday as part of a new crackdown on abuse of multiday passes.


The photographing of guests — including children — delayed visitors' getting into the park by about 45 minutes, parkgoers said.


"They delayed literally thousands of people in line to do this process," said Bob Shoberg, a San Jose resident who visited Disneyland with his wife, daughters, in-laws and grandchildren.





Disneyland officials denied that guests suffered significant delays and said only multiday pass holders were photographed.


Disney has been struggling to stop several ticket brokers in Anaheim from buying multiday park passes and then "leasing" or "renting" them to visitors for individual days.


The scenario works like this: A ticket broker buys a three-day "park hopper" pass for $205 and rents the ticket to three guests for $99 a day. The broker makes a profit of $92, and the guests, who would otherwise pay $125 for a one-day "park hopper" ticket, save $26 each.


Disneyland prohibits visitors from sharing multiday passes, but the practice does not violate local laws.


To help stop the practice, Disneyland workers a few months ago began adding the names of parkgoers to the passes and requiring that they show identification at the front gate.


On Tuesday, Disneyland took the latest step of photographing visitors who are using a multiday pass for the first time, park spokeswoman Suzi Brown said.


When the pass is used a second time, Disneyland workers at the park turnstiles will see a photo of the guest pop up on a computer screen, she said. If the person at the turnstile is not the person shown on the screen, Brown said the guest won't be allowed to use the ticket.


Disneyland officials declined to say what percentage of visitors use multiday passes, but Brown said only a "very small percentage of guests" were photographed, and that did not cause a significant delay.


"So that our guests are not taken advantage of, we strongly advise that they only purchase tickets at Disneyland Resort, at our hotels or through an authorized seller to ensure that tickets are valid," Brown added.


Brown said the parks realized the problem was growing when park workers noticed ticket brokers waving signs hawking discounted passes on the streets around the park.


One business, Bestticketshere.com, says on its website that it rents multiday passes for Disneyland and Universal Studios. The website said the business guarantees its tickets will be accepted or customers will get a full refund.


In response to an email request for comment on Disneyland's new crackdown, the company wrote: "Is the ultimate goal to shut these companies down so everyone has to pay full price?"


Most theme parks take photographs of people who buy annual passes and affix them to the pass.


Universal Studios Hollywood uses fingerprints and cross-checks the names printed on the annual passes to ensure that the tickets are not shared, park officials said. At Raging Waters in San Dimas, annual pass buyers are photographed and their photo is affixed to the pass.


hugo.martin@latimes.com





Read More..

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





Read More..

2nd Winehouse inquest confirms alcohol death


LONDON (AP) — Amy Winehouse died from accidental alcohol poisoning when she resumed drinking after a period of abstinence, a second coroner's inquest confirmed Tuesday.


Coroner Shirley Radcliffe ruled that the 27-year-old soul singer "died as a result of alcohol toxicity" and recorded a verdict of death by misadventure. She said there were no suspicious circumstances.


She said that Winehouse "voluntarily consumed alcohol — a deliberate act that took an unexpected turn and led to her death."


The Grammy-winning singer, who fought a very public battle with drug and alcohol abuse for years, was found dead at her London home on July 23, 2011, with empty vodka bottles scattered around her.


Radcliffe said a postmortem had found that Winehouse had a blood alcohol level five times the legal driving limit, and above a level that can prove fatal.


She said that that much alcohol could affect the central nervous system so much that a patient could "fall asleep and not wake up."


Pathologist Michael Sheaff told the inquest that Winehouse had likely suffered a respiratory arrest after consuming so much alcohol. The level in her blood was 416 milligrams per 100 milliliters, a blood alcohol level of 0.4 percent. The British legal driving limit is 0.08 percent.


Winehouse's family did not attend the 45-minute inquest, which was held after the original coroner was found to lack the proper qualifications for the job.


That coroner later resigned after her qualifications were questioned. She had been hired by her husband, the senior coroner for inner north London. But she had not been a registered lawyer in Britain for five years as required.


In Britain, inquests are held to determine the facts whenever someone dies unexpectedly, violently or in disputed circumstances.


Tuesday's verdict was the same as that produced by the first inquest in 2011.


The beehive-haired Winehouse shot to global fame with her 2006 album "Back to Black," which won five Grammys. But her erratic public behavior, turbulent private life and frequent health problems — which included seizures, emphysema and bulimia — often overshadowed her talent.


Tuesday's second inquest re-heard testimony from witnesses and experts including the bodyguard who found Winehouse dead, the police officer who investigated and a doctor who treated the singer as she tried to quit drugs and alcohol.


The doctor, Christina Romete, said Winehouse was "a highly intelligent individual, very determined and willful," who did not easily follow doctors' orders and resisted suggestions she seek psychological help.


She said the singer had successfully given up drugs after a period taking heroin, crack cocaine and marijuana, but had struggled to stop drinking, going through periods of abstinence followed by booze binges.


She started drinking a few days before her death, after being dry for almost two weeks.


"She said she started drinking again because she felt bored," said Romete, who saw Winehouse the day before she died.


"I asked Amy if she was going to stop drinking that evening, and she said she did not know," the doctor said.


Read More..

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.


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

Read More..

Noise requirements proposed for hybrid and electric vehicles


Used Cars


Dealer and private-party ads










Make:

Model:

Price Range:

to


Search within:

miles of ZIP




Read More..