FTC study taking aim at online marketing of booze

LOS ANGELES (Reuters) – The Federal Trade Commission (FTC) plans this summer to recommend ways that the alcoholic beverage industry can better protect underage viewers from seeing its advertisements online.

Distillers, brewers and wineries pour millions of dollars into brand promotion on Twitter, Facebook and other social media, and industry critics contend they are not doing enough to prevent young consumers from receiving these messages.

“We’re doing a deep dive on how they’re using the Internet and social media,” said Janet Evans, a lawyer with the FTC, which is conducting a year-long study due to be released by early summer. “We’re focusing on underage exposure.”

She would not elaborate on any potential recommendations that might come out of the study, which began in April 2012.

The FTC is reviewing data from 14 big producers, Evans said, including Beam Inc, the maker of Jim Beam, Diageo Plc, home to Johnnie Walker, and Constellation Brands Inc, which makes Robert Mondavi and Ravenswood wines.

The FTC report “is something we take seriously and place at high priority,” said Karena Breslin, director for digital marketing at Constellation.

The FTC has made two requests for information since the study began, she said.

The regulatory agency has not said it intends to impose restrictions on liquor company social media advertising but it can make recommendations to the industry.

The FTC is empowered to file suit to ensure consumers are protected from deceptive marketing practices, Evans said, but she stressed that studies of this nature are meant to promote better self-regulation, not provide a basis for a case.

Industry executives say alcohol makers and distributors voluntarily adhere to the same industry-set standard for marketing to underage viewers on social media sites that the industry set for its ads on TV and other media. That requires that at least 71.6 percent of an audience consists of adults 21 and older.

“No one in their right mind would want to advertise to people who can’t legally buy their product,” said Frank Coleman, senior vice president for Distilled Spirits Council of the United States (DISCUS), the trade group that sets the industry’s advertising codes.

Coleman also cited recent data showing the audiences for Facebook and Twitter are skewed heavily towards viewers who are above the legal drinking age.

“According to Nielsen’s latest data, the demographic audience for Facebook is 83.5 percent 21 years and older, and for Twitter it is 85 percent,” Coleman said.

In June 2011, DISCUS revised its code upwards to 71.6 percent from 70 percent, after the FTC recommended it review the standard to better reflect U.S. Census population data.

Industry critics, including David Jernigen, director of the Center on Alcohol Marketing and Youth at Johns Hopkins University, and Sarah Mart, research director of the advocacy group Alcohol Justice, contend the industry didn’t go far enough and should raise the standard further.

Jernigen said it needs to be at least 85 percent to effectively protect youth, so there would be no more than 15 percent exposure to the underage drinking population.

“The industry says its self-regulating but it’s ineffective and social media opens up a whole new set of problems because their ads are everywhere,” said Mart.

Coleman said the group now requires members to install age-checking tools via instant messaging as a gateway to Twitter feeds and other branded Web platforms that ask the user for a birth date before admitting them.

In the first nine months of 2012, beer, wine and spirits manufacturers spent an estimated $ 35 million for paid Web display advertising, but industry executives estimate many millions more were spent on website creation, video production for platforms like Google’s YouTube and social media marketing efforts.

“We’ve significantly adjusted more money to digital for online video, websites, Facebook and Twitter content,” said Kevin George, global chief marketing officer for Jim Beam, which spends 30 percent of its media spend for online outlets, up from 10 percent in 2008, he said.

Many companies are expanding their digital staff. Wine maker Constellation hired Breslin three years ago to initiate digital marketing and now has a team of five reporting to her.

Many alcoholic beverage companies flocked to Facebook because it requires users to post their birth dates when signing up.

Last year Twitter partnered with Buddy Media to offer a screening tool that sends a direct message to fans who click on an alcoholic brand. The message sends the fan a link to a site that asks for date of birth.

Salesforce.com bought Buddy Media last June, which is now folding the platform into its marketing cloud portfolio.

Health advocates and industry critics are crying foul. “Facebook and other interactive platforms are poorly monitored and not well age-protected,” said Jernigen of Johns Hopkins University. “Anyone can say they’re 21 and click yes.”

(Reporting by Susan Zeidler; Editing by Ron Grover, Alden Bentley and Phil Berlowitz)

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Serena Williams out of Australian Open

MELBOURNE, Australia (AP) — Serena Williams is out of the Australian Open after losing her quarterfinal match 3-6, 7-5, 6-4 to 19-year-old American Sloane Stephens.

Williams appeared to hurt her lower back while attempting to pull up short of the net during the eighth game of the second set. She called for a trainer after the ninth game with the score 5-4 and on serve.

Stephens won the second set when Williams, serving slower than usual, was broken. Williams also had her service broken in the final game of the match.

At 2-1 and on the way to a changeover in the third set, Williams smashed her racket angrily on the court then threw it toward her chair.

Stephens will play defending champion Victoria Azarenka in the semifinals.

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DealBook: Allergan to Buy MAP Pharmaceuticals for $958 Million

Allergan has agreed to pay nearly $1 billion to acquire MAP Pharmaceuticals and gain full control of its experimental treatment for migraine headaches, the two companies announced Tuesday night.

The purchase price of $25 a share in cash is a 60 percent premium over MAP’s closing price on Tuesday of $15.58 a share. The deal, valued at $958 million in total, suggests that Allergan has considerable faith that MAP’s new migraine treatment will win regulatory approval from the Food and Drug Administration by the agency’s deadline of April 15.

The two companies said the deal had been unanimously approved by the boards of both companies and was expected to close in the second quarter.

Allergan already had the rights to help market the migraine drug, known as Levadex, in the United States and Canada, but after an acquisition it would have control of all the profits and costs globally.

Allergan is most known for Botox, a form of the botulinum toxin, which is used for cosmetic purposes as well as medical ones, including the treatment of chronic migraines with the goal of reducing the frequency of headaches. By contrast, Levadex is meant to treat migraines after they occur, making it complementary to Botox, Allergan said.

Levadex is actually a new form of an old drug, known as dihydroergotamine, or DHE, which has been used to treat severe migraine attacks for decades. DHE is typically given by intravenous infusion, requiring patients to get to a hospital at a time when many would rather remain in a dark quiet room.

Levadex, by contrast, is breathed into the lungs using an inhaler similar to one used for asthma, allowing people to use it at home.

The F.D.A. declined to approve Levadex last March, though MAP said the rejection was related to manufacturing and questions about use of the inhaler, not the safety and efficacy of the drug. It resubmitted its application, with additional data and answers to questions from the F.D.A., in October.

Levadex would be the first approved product for MAP, which is based in Mountain View, Calif.

Allergan said that if Levadex is approved by April, the transaction would dilute earnings by about 7 cents a share in 2013 and add to earnings in the second half of 2014.

Allergan was advised by Goldman Sachs and the law firm Gibson, Dunn & Crutcher. MAP was advised by Centerview Partners and the law firm Latham & Watkins.

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The Week: A Roundup of This Week’s Science News

“Science,” a colleague once said at a meeting, “is a mighty enterprise, which is really rather quite topical.” He was so right: as we continue to enhance our coverage of the scientific world, we always aim to keep the latest news front and center.

His observation seemed like a nice way to introduce this column, which will highlight the week’s developments in health and science news and glance at what’s ahead. This past week, for instance, the mighty enterprise of science addressed itself to such newsy topics as the flu (there’s still time to get vaccinated!), and mental illness and gun control.

In addition to the big-headline stories that invite wisdom from scientists, each week there is a drumbeat of purely scientific and medical news that emerges from academic journals, fieldwork and elsewhere. These developments, from the quirky to the abstruse, often make their way into the daily news cycle, depending on the strength of the research behind them. (Well, that’s how we judge them, anyway.)

Many discoveries are hard to unravel. “In a way, science is antithetical to everything that has to do with a newspaper,” the same colleague observed. “You couldn’t imagine anything less consumer-friendly.”

Let’s aim to fix that. Below, a selection of the week’s stories.

DEVELOPMENTS

Health

Strange, but Effective

People with a bacterial infection called Clostridium difficile — which kills 14,000 Americans a year — have a startling cure: a transplant of someone else’s feces into their digestive system, which introduces good bacteria that the gut needs to fight off the bad. For some people, antibiotics don’t fix this problem, but an infusion of diluted stool from a healthy person seems to do the trick.

Genetics

Dig We Must

Hillery Metz and Hopi Hoekstra/Harvard University

Evolutionary biologists at Harvard took a tiny species of deer mice, known for building elaborate burrows with long tunnels, and bred it with another species of deer mice, which builds short-tunneled burrows. Comparing the DNA of the original mice with their offspring, the biologists pinpointed four regions of genetic code that help tell the mice what kind of burrow to construct.

Aerospace

Launch, Then Inflate

Uncredited/Bigelow Aerospace, via Associated Press

NASA signed a contract for an inflatable space habitat — roughly pineapple-shaped, with walls of floppy cloth — that will ideally be appended to the International Space Station in 2015. NASA aims to use the pod to test inflatable technology in space, but the company that builds these things, Bigelow Aerospace, has bigger ambitions: think of a 12-person apartment and laboratory in the sky, with two months’ rent at north of $26 million.

Biology

What’s Green and Flies?

Jodi Rowley/Australian Museum

National Geographic reported on an Australian researcher working in Vietnam who discovered a great-looking new species of flying frog. Described as having flappy forearms (the better for gliding), the three-and-a-half-inch-long frog likes to “parachute” from tree to tree, Jodi Rowley, an amphibian biologist at the Australian Museum in Sydney, told the magazine. She named it Helen’s Flying Frog, for her mother.

Privacy

That’s Joe’s DNA!

People who volunteer their genetic information for the betterment of science — and are assured anonymity — may find that their privacy is not a slam dunk. A researcher who set out to crack the identities of a few men whose genomes appeared in a public database was able to do so using genealogical Web sites (where people upload parts of their genomes to try to find relatives) as well as some simple search tools. He was trying to test the database’s security, but even he did not expect it to be so easy.

Genetics

An On/Off Switch for Disease

Geneticists have long puzzled over what it is that activates a disease in one person but not in another — even in identical twins. Now researchers from Johns Hopkins and the Karolinska Institute in Sweden who studied people with rheumatoid arthritis have identified a pattern of chemical tags that tell genes whether to turn on or not. In rheumatoid arthritis, the immune system attacks the body, and it is thought the tags enable the attack.

Planetary Science

That Red Planet

Everybody loves Mars, and we’re all secretly hoping that NASA’s plucky little rover finds evidence of life there. Meanwhile, a separate NASA craft — the Mars Reconnaissance Orbiter, which has been looping the planet since 2006 — took some pictures of a huge crater that looks as if it once held a lake fed by groundwater. It is too soon to say if the lake held living things, but NASA’s news release did include the happy phrase “clues to subsurface habitability.”

COMING UP

Animal Testing

Retiring Chimps

Emily Wabitsch/European Pressphoto Agency

A lot of people have strong feelings about the use of chimpanzees in biomedical and behavioral experiments, and the National Institutes of Health has been listening. On Tuesday, the agency is to release its recommendations for curtailing chimp research in a big way. This will be but a single step in a long process and it will apply only to the chimps the agency owns, but it may well stir big reactions from many constituencies.

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As Jordan Elections Near, Protesters Focus on King

Bryan Denton for The New York Times

Local tribal leaders in southern Jordan waited for a campaign event to begin on Saturday. Parliamentary elections are being held on Wednesday.

AMMAN, Jordan — For two years, protests demanding reform here have seethed, fueled by complaints about corruption, incompetent governing and the slow pace of change. In November, deadly demonstrations against a cut in fuel subsidies spread throughout the country.

Bryan Denton for The New York Times

Young supporters of the Islamic Action Front who are boycotting elections follow their party’s demonstration online.

The widening anger has brought together longtime political opposition figures with those who were once a part of the monarchy’s loyal base. The focus of the protests has also started to broaden, from anger at corrupt officials to bolder expressions of dissatisfaction with King Abdullah II.

To quiet his critics, the king is relying on a new round of parliamentary elections scheduled for Wednesday, a contest that he has promised “will breathe life into our democracy.”

The vote comes as Jordan copes with a number of domestic challenges, including a crushing deficit and a flood of more than 200,000 Syrian refugees — the kinds of crises that have often derailed movements for reform.

However, while the opposition has often seemed more conservative in Jordan than elsewhere in the region — calling for reform rather than the overthrow of the government — it is has shown no sign of easing pressure on the king.

The disillusionment that has fueled the protests is concentrated in the southern city of Ma’an, known for uprisings and phosphate mines.

In the center of town this week, a group of men who had occupied a traffic circle to protest the region’s lack of jobs ate lunch in a tent. Some said they had worked as smugglers, but even that trade had dried up.

“We want to live,” proclaimed graffiti on a sculpture. Beyond it the charred remains of the governor’s residence was visible, set on fire during a recent protest.

The parliamentary campaign in Ma’an has focused on local issues — like winning the region its share of the spoils from the mines — and on the corruption that has become a rallying cry for dissent across the country.

“They don’t see anything from the precious mines,” said Abdul-Karim al-Bahri al-Muhameed, a former civil servant who is running with the support of his tribe. “The king is not serious about getting the money stolen by corruption,” he said.

He sat in the salon of a tribal leader, Sheik Adel al-Muhameed, a supporter of his candidacy who was boycotting the vote. “I don’t trust the Parliament,” he said.

During the last two years, the government had approached tribal leaders like him to try and stop the street protests, Mr. Muhameed said. “The government cannot handle it,” he said. The election, he added, “is a play.”

Citing a history of rigged elections in Jordan that have produced toothless legislatures, many government critics have dismissed Wednesday’s polling as a cosmetic and desperate effort by an absolute monarch to avoid handing over power. A few opposition groups, including the largest, the Jordanian Muslim Brotherhood, and the protest network known as Hirak are boycotting the vote.

“He doesn’t carry out of any of his promises,” said Nimer al-Assaf, the deputy general secretary of the Islamic Action Front, the Brotherhood’s political party. Mr. Assaf predicted that no more than 25 percent of registered voters would turn up at the polls. “People are rejecting the whole idea,” he said.

But other opposition groups are participating in the election, stirring new divides.

Other candidates, to be sure, have put aside their misgivings in the hope that freedom will gradually emerge.

“Democracy happens in degrees,” said Mohamed al-Hajouj, a Palestinian refugee who is running for Parliament, undeterred by gerrymandered districts that continue to underrepresent the country’s citizens of Palestinian origin, a majority.

Something had to be done, Mr. Hajouj reckoned, likening Jordan to a grenade ready to explode. The elections, he said, would keep it from blowing up.

Jordanian officials say they have added a number of election safeguards to prevent what was seen as a process manipulated by the country’s powerful intelligence services and marred by vote-buying and other fraud.

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At Obama’s church service, hymns, prayers – and a tweet?

WASHINGTON (Reuters) – There was preaching, praying and singing at President Barack Obama’s church service on Inauguration Day on Monday. But was there tweeting, too?

As Atlanta pastor Andy Stanley wrapped up his sermon at St. John’s Episcopal Church across from the White House by urging Obama to leverage his power for the greater good, a tweet went out from the president’s own Twitter feed.

“I’m honored and grateful that we have a chance to finish what we started. Our work begins today. Let’s go. -bo,” said the tweet, which went to more than 26 million Obama followers.

Obama typically designates tweets that he writes himself by signing his initials in lowercase: “-bo.” That led to questions over whether the president had tweeted from church – and perhaps provided a new chapter in the debate over the appropriate use of social media.

But a White House spokesman said Obama did not send the tweet in the middle of the church service.

That means it could have been done by Obama in advance and timed for release while he was in church, or that it was posted by Organizing for Action, the non-profit group that now operates the president’s Twitter account.

The new group, which is led by Obama’s former campaign team, plans to try to build public support for the president’s policies.

The group did not immediately comment on the authorship or timing of the tweet.

Even if Obama had sent out the tweet from church, such messages from the pew are no longer taboo, said Scott Williams, a pastor and consultant from Edmond, Oklahoma, who works with ministries to use social media to spread the word and engage members.

“It’s definitely OK – it’s relevant,” he said. He cited a verse from the prophet Isaiah: “Like a crane or a swallow, so did I twitter.”

“‘Thou shalt twitter in church’ is a way that I present it,” Williams said in an interview, noting that many people now used Bible apps on their mobile devices in the pews.

Stanley’s North Point Community Church in Atlanta produced a Christmas music video for iPhones and iPads that has been viewed 3.7 million times on YouTube, said Williams, who is familiar with the 33,000-member ministry.

Stanley delivered his sermon in a very “old-school” setting. St. John’s, a yellow church with white trim, was built in 1816 and often is called the “Church of the Presidents” because every president since James Madison has attended it at least occasionally.

The service included a mix of traditional hymns such as “Oh God, Our Help in Ages Past,” a gospel solo by singer Ledisi, and an African-American spiritual, “Great Day.” It also included readings and prayers from Jewish, Christian and Catholic clergy.

Stanley talked about a passage in the Bible where Jesus washes his disciples’ feet, setting an example of equality.

“What do you do when it dawns on you that you’re the most powerful person in the room? You leverage that power for the benefit of other people in the room,” Stanley said.

“Mister President, you have an awfully big room,” the pastor said. “It’s as big as our nation. At times, as you know, it’s as big as this world.”

(Editing by David Lindsey and Peter Cooney)

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Jim, John Harbaugh ready for rematch at Super Bowl

SANTA CLARA, Calif. (AP) — Jim and John Harbaugh have exchanged a handful of text messages, and plan to leave it at that. No phone conversations necessary while the season's still going. No time for pleasantries, even for the friendly siblings.

There is work to be done to prepare for the Super Bowl, prepare for each other, prepare for a history-making day already being widely hyped as "Harbowl" or "Superbaugh" depending which nickname you prefer.

"It doesn't matter who the coach is, what relationship you have with the person on the other side," 49ers coach Jim Harbaugh said so matter-of-factly Monday afternoon.

Their parents sure aren't picking sides for the Feb. 3 matchup in New Orleans.

These days, the Harbaughs' longtime coaching father, Jack, stays away from game-planning chatter or strategy sessions with his Super Bowl-bound coaching sons. Baltimore's John Harbaugh and little brother Jim have been doing this long enough now to no longer need dad's input.

Yet, they still regularly seek it. And, their father does offer one basic mantra: "Get ahead, stay ahead."

"Probably the greatest advice that I've ever been given and the only advice that I've ever found to be true in all of coaching, I think we mentioned it to both John and Jim ... the coaching advice is, 'Get ahead, stay ahead,'" Jack Harbaugh said.

"If I'm called upon, I'll repeat that same message."

His boys still call home regularly to check in with the man who turned both on to the coaching profession years ago, and the mother who has handled everything behind the scenes for decades in a highly competitive, sports-crazed family — with all the routine sports clichés to show for it.

The Harbaugh brothers will become the first siblings to square off from opposite sidelines when their teams play for the NFL championship at the Superdome.

Not that they're too keen on playing up the storyline that has no chance of going away as hard as they try.

"Well, I think it's a blessing and a curse," Jim Harbaugh said Monday. "A blessing because that is my brother's team. And, also, personally I played for the Ravens. Great respect for their organization. ... The curse part would be the talk of two brothers playing in the Super Bowl and what that takes away from the players that are in the game. Every moment that you're talking about myself or John, that's less time that the players are going to be talked about."

Both men love history, just not the kind with them making it.

"I like reading a lot of history ... I guess it's pretty neat," John Harbaugh offered Monday. "But is it really going to be written about? It's not exactly like Churchill and Roosevelt or anything. It's pretty cool, but that's as far as it goes."

Nice try, guys.

John watched the end of Jim's game from the field in Foxborough, Mass., as Baltimore warmed up for the AFC championship game. Jim called his sister's family from the team plane before takeoff after a win at Atlanta and asked how his big brother's team was doing against New England.

The improbable Super Bowl features a set of brothers known around the NFL as fierce competitors unafraid to make a bold move during the season. Unafraid to upset anyone who stands in their way.

In fact, each one made a major change midseason to get this far — John fired his offensive coordinator, while Jim boosted his offense with a quarterback switch from Alex Smith to Colin Kaepernick.

Leading up to Sunday's games, parents Jack and Jackie said they would wait to decide whether to travel to New Orleans if both teams advanced or stick to what has been working so well — watching from the comfort of their couch in Mequon, Wis.

"We enjoy it very much. We get down in our basement, turn on the television and just have a fantastic day watching outstanding football," Jack said last week. "We share our misery with no one but ourselves. Not only the misery, but the ups and downs, the ins and outs of an outstanding professional game."

And, no, the Harbaughs weren't looking ahead to a potential big trip to the Big Easy.

Jack insists his wife is quick to pull out that old sports cliche: "It's one game at a time. I think it's very appropriate," he said.

Jim figures they won't possibly miss this history-making game.

"I think they'll be there," he said with a smile.

The brothers, separated in age by 15 months, have taken different paths to football's biggest stage — years after their intense games of knee football at the family home. They tried to beat each other at cards, or whatever other game it was at the time. Sometimes, they tried to beat each other up. Sister, Joani Crean, often got in on the fun, too.

The 49-year-old Jim never reached a Super Bowl, falling a last-gasp pass short during a 15-year NFL career as a quarterback. The 50-year-old John never played in the NFL.

Still, both will tell you, "Who's got it better than us? No-body!" — one catchphrase they got from their dad.

"We can't put into words what it means to see John and Jim achieve this incredible milestone," their brother-in-law, Indiana basketball coach Tom Crean, said on Twitter. "We talked to Jim (before) his team plane left. All he wanted to know was how was John doing? How were they playing? One incredible family who puts the care, well-being and love for each other at the forefront like most families do. Again, we are very proud of them. Going to be exciting to watch it unfold."

John worked his way up from the bottom of the coaching ranks, while Jim was the star college quarterback at Michigan, a first-round draft pick and eventual Pro Bowler who made coaching his career once he retired.

John already has the one-up, while Jim's team is the early favorite. John's Ravens beat the 49ers 16-6 on Thanksgiving night 2011, in Jim's rookie season as an NFL coach — though both know that means nothing now.

"I just want everybody to know, that was a four-day deal and every story has been told," John said. "We're not that interesting. There's nothing more to learn. The tape across the middle of the room story, OK, you got it? It's OK. It was just like any other family, really. I really hope the focus is not so much on that. We get it, it's really cool and it's exciting and all that."

Said Jim, "Completely new business."

In spite of his efforts to avoid the topic, Jim did take the opportunity to express how proud he is of John.

"He's a great football coach, a real grasp of all phases — offense, defense, special teams. I think he could coordinate at least two of those phases and do it as well as anyone in the league," Jim said. "I've got half the amount of coaching experience he does. Again, it's not about us. I keep coming back to that. I'm really proud of my brother. I love him. That's the blessing part, that this is happening to him."

And, fittingly for the big brother, John feels the exact same way.

___

AP Sports Writer Dave Ginsburg in Baltimore contributed to this story.

___

Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Bank of Japan Expands Efforts to Prop Up Nation’s Economy

TOKYO (AP) — Bowing to government pressure, Japan’s central bank on Tuesday pledged more aggressive action to lift the economy, including setting a 2 percent inflation target.

The Bank of Japan said it would conduct “open-ended” asset purchases to help achieve the goal of breaking out of a long spell of deflation.

Prime Minister Shinzo Abe had urged the central bank to ease monetary policy further to prop up the economy.

Whether the effort will succeed remains to be seen: the central bank has not achieved even its 1 percent inflation target, with price increases hovering below 0.5 percent for the past two years despite surges in energy costs.

The central bank described its inflation goal as a “price stability target.” It said: “Under the price stability target, the bank will pursue monetary easing and aim to achieve this target at the earliest possible time.”

But it said it would also “ascertain whether there is any significant risk to the sustainability of economic growth, including from the accumulation of financial imbalances.”

Among the risks are a ballooning public debt, already well over twice the size of Japan’s gross domestic product.

Mr. Abe’s government is seeking to spur growth both through heavy spending on public works and other projects and through monetary easing. The central bank’s announcement on Tuesday was in line with expectations.

The government was determined that the central bank set a 2 percent inflation target, the trade minister, Toshimitsu Motegi, told reporters on Monday. “We want a clear inflation target to aim for,” Mr. Motegi said. “Other countries have inflation targets, and it’s not just 1 percent. They are all at least 2 percent,” he said.

He said the monetary easing, which has involved tens of trillions of yen (hundreds of billions of dollars) in asset purchases and years of near-zero interest rates, so far had been “inadequate.”

The Abe government is expected to nominate as Bank of Japan governor an expert known to favor its policies when the term of the current governor, Masaaki Shirakawa, ends this spring.

However, Mr. Motegi rejected accusations that the government’s demands were meant to erode the central bank’s independent status.

“We are not doing this to gang up and pick on Mr. Shirakawa,” he said. But he added that “the policy of aiming to escape deflation will not change, not today, not tomorrow or the day after tomorrow.”

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Well: A Check on Physicals

“Go Beyond Your Father’s Annual Physical. Live Longer, Feel Better”

This sales pitch for the Princeton Longevity Center’s “comprehensive exam” promises, for $5,300, to take “your health beyond the annual physical.” But it is far from certain whether this all-day checkup, and others less inclusive, make a meaningful difference to health or merely provide reassurance to the worried well.

Among physicians, researchers and insurers, there is an ongoing debate as to whether regular checkups really reduce the chances of becoming seriously ill or dying of an illness that would have been treatable had it been detected sooner.

No one questions the importance of regular exams for well babies, children and pregnant women, and the protective value of specific exams, like a Pap smear for sexually active women and a colonoscopy for people over 50. But arguments against the annual physical for all adults have been fueled by a growing number of studies that failed to find a medical benefit.

Some experts note that when something seemingly abnormal is picked up during a routine exam, the result is psychological distress for the patient, further testing that may do more harm than good, and increased medical expenses.

“Part of the problem of looking for abnormalities in perfectly well people is that rather a lot of us have them,” Dr. Margaret McCartney, a Scottish physician, wrote in The Daily Mail, a British newspaper. “Most of them won’t do us any harm.”

She cited the medical saga of Brian Mulroney, former prime minister of Canada. A CT scan performed as part of a checkup in 2005 revealed two small lumps in Mr. Mulroney’s lungs. Following surgery, he developed an inflamed pancreas, which landed him in intensive care. He spent six weeks in the hospital, then was readmitted a month later for removal of a cyst on his pancreas caused by the inflammation.

The lumps on his lungs, by the way, were benign. But what if, you may ask, Mr. Mulroney’s lumps had been cancer? Might not the discovery during a routine exam have saved his life?

Logic notwithstanding, the question of benefits versus risks from routine exams can be answered only by well-designed scientific research.

Defining the value of a routine checkup — determining who should get one and how often — is especially important now, because next year the Affordable Care Act will add some 30 million people to the roster of the medically insured, many of whom will be eligible for government-mandated preventive care through an annual exam.

Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine, who directed a study of annual physicals in 2007, reported that an estimated 44.4 million adults in the United States undergo preventive exams each year. He concluded that if every adult were to receive such an exam, the health care system would be saddled with 145 million more visits every year, consuming 41 percent of all the time primary care doctors spend with patients.

There is already a shortage of such doctors and not nearly enough other health professionals — physician assistants and nurse practitioners — to meet future needs. If you think the wait to see your doctor is too long now, you may want to stock up on some epic novels to keep you occupied in the waiting room in the future.

Few would challenge the axiom that an ounce of prevention is worth a pound of cure. Lacking incontrovertible evidence for the annual physical, this logic has long been used to justify it:

¶ If a thorough exam and conversation about your well-being alerts your doctor to a health problem that is best addressed sooner rather than later, isn’t that better than waiting until the problem becomes too troublesome to ignore?

¶ What if you have a potentially fatal ailment, like heart disease or cancer, that may otherwise be undetected until it is well advanced or incurable?

¶ And wouldn’t it help to uncover risk factors like elevated blood sugar or high cholesterol that could prevent an incipient ailment if they are reversed before causing irreparable damage?

Even if there is no direct medical benefit, many doctors say that having their patients visit once a year helps to maintain a meaningful relationship and alert doctors to changes in patients’ lives that could affect health. It is also an opportunity to give patients needed immunizations and to remind them to get their eyes, teeth and skin checked.

But the long-sacrosanct recommendation that everyone should have an annual physical was challenged yet again recently by researchers at the Nordic Cochrane Center in Copenhagen.

The research team, led by Dr. Lasse T. Krogsboll, analyzed the findings of 14 scientifically designed clinical trials of routine checkups that followed participants for up to 22 years. The team found no benefit to the risk of death or serious illness among seemingly healthy people who had general checkups, compared with people who did not. Their findings were published in November in BMJ (formerly The British Medical Journal).

In introducing their analysis, the Danish team noted that routine exams consist of “combinations of screening tests, few of which have been adequately studied in randomized trials.” Among possible harms from health checks, they listed “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, adverse psychosocial effects due to labeling, and difficulties with getting insurance.”

Furthermore, they wrote, “general health checks are likely to be expensive and may result in lost opportunities to improve other areas of health care.”

In summarizing their results, the team said, “We did not find an effect on total or cause-specific mortality from general health checks in adult populations unselected for risk factors or disease. For the causes of death most likely to be influenced by health checks, cardiovascular mortality and cancer mortality, there were no reductions either.”

What, then, should people do to monitor their health?

Whenever you see your doctor, for any reason, make sure your blood pressure is checked. If a year or more has elapsed since your last blood test, get a new one.

Keep immunizations up to date, and get the screening tests specifically recommended based on your age, gender and known risk factors, including your family and personal medical history.

And if you develop a symptom, like unexplained pain, shortness of breath, digestive problems, a lump, a skin lesion that doesn’t heal, or unusual fatigue or depression, consult your doctor without delay. Seek further help if the initial diagnosis and treatment fails to bring relief.

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Iran Publicly Hangs 2 Men Convicted in Stabbing

Ebrahim Noroozi/Fars, via Associated Press

Iranians reacted in Tehran on Sunday at the execution of two men, whose stabbing of a man, caught on a video camera and posted online, caused an uproar.

TEHRAN — An eerie silence filled the air as a crowd of around 300 gathered Sunday just before sunrise in a Tehran park. They awaited the arrival of two young men who were about to die.

Amir Pourmand/Iranian Students News Agency, via Associated Press

Just before nooses were put on their necks, Alireza Mafiha, 23, laid his head on an executioner’s shoulder. Mohammad Ali Sarvari, 20, is at center.

The condemned stood shoulder to shoulder, motionless, in front of two police trucks with two nooses hanging from extendable cranes, about 15 feet high. Black-clad executioners were inspecting the remote controls they would use to hang the men, both in their early 20s, who were convicted of stabbing a man in November and stealing his bag and the equivalent of $20.

From behind a makeshift barrier of scaffolding, the crowd jostled for position. “Let’s move to the other side,” one spectator whispered to his wife, pointing to the spot where Iranian state television cameras had been set up. “I think we will have a better view from there.”

Although every year hundreds of convicts are hanged in Iran, a public hanging in a central park in Tehran is a rare event. Most hangings take place inside prisons, according to Iranian judicial officials and international human rights organizations.

Sunday’s execution in Park-e Honarmandan (Artists Park), near the crime scene, was part of a heavy-handed offensive by Iranian authorities, who say they are trying to prevent rising crime rates from getting out of hand by setting harsh examples. In recent weeks, public executions have been stepped up, and in several large cities the police have been rounding up what they call thugs and hooligans.

Police commanders and other officials blame government mismanagement of the economy — which they say has caused a rise in unemployment and inflation — for the increase in crime. International economic sanctions have aggravated problems, many here say, leading to a record gap between rich and poor in Iran.

While no official statistics are publicly available, officials report a rise in violent crimes, mostly perpetrated by young men attacking their victims with knives to get money and other valuables. Local news media report only a fraction of the episodes, but at social gatherings of middle-class Iranians — the usual targets — horrific stories of theft, kidnapping, rape and home burglaries abound.

“Two young men entered my house two weeks ago and beat me senseless,” said Manijeh, 54, a homemaker from north Tehran, a more affluent section of the city. The intruders bound her arms and legs and beat her, asking for the location of the safe, she said. “But we don’t have a safe,” said Manijeh, who declined to reveal her surname out of fear that the burglars would return. They stole her car, ransacked her home and took nearly everything inside, she said.

“Our city has become completely unsafe,” said Manijeh, speaking after her recent release from a hospital. “These things would never happen until some years ago. We need the harshest measures to stop these criminals.”

Armin, 30, an engineer, said his father was recently robbed and beaten by a gang of thieves on motorcycles. “They hit him hard, but afterwards he received an anonymous call telling him where to find his bag,” he said. “They took all his money but returned his documents.”

On Sunday, the two condemned men, Alireza Mafiha, 23, and Mohammad Ali Sarvari, 20, stood before the onlookers, many of whom said they were family members and friends.

“They have shaved his hair,” said one young man pointing at Mr. Mafiha who said he knew both men. Mr. Sarvari, baby-faced, stared wide-eyed into the crowd.

The two men, both unemployed and from poor families, had been caught two months ago on a security camera robbing a man and stabbing him, helped by two accomplices. Video from the crime spread on the Internet and caused a widespread uproar, prompting politicians and clerics to call for harsh measures.

Two weeks later, all four men were arrested. The head of Iran’s judiciary, Ayatollah Sadegh Larijani, made it clear in comments on the crime that even though their victim had not died, a death sentence for the two main defendants, Mr. Mafiha and Mr. Sarvari, was likely. “We need to act assertively and increase the costs for those committing street crimes,” he said, according to the semiofficial Fars news agency.

Ramtin Rastin contributed reporting.

This article has been revised to reflect the following correction:

Correction: January 20, 2013

An earlier version of this story and a picture caption misstated the ages of the two men who were executed. Alireza Mafiha was 23 and Mohammad Ali Savari was 20.

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