Germany rejects Swiss tax deal













Germany’s upper house of parliament has rejected a deal with Switzerland to tax German assets held in Swiss bank accounts.












The deal would have allowed Germans with undeclared assets in Switzerland to avoid punishment by making a one-off payment of between 21% and 41% of the value of their assets.


The deal had been negotiated in April and was due to take effect in January.


But it needed to be ratified by both parliaments.


The rejection by the German upper house, the Bundesrat, prolongs the dispute between the two countries over how to deal with the estimated 180-200bn euros (£145-160bn) of German assets hidden in Switzerland.


German Finance Minister Wolfgang Schaeuble had called for support for the deal, saying: “The agreement tries to find a better solution for a situation which is unsatisfactory.”


But Norbert Walter-Borjans, of the main opposition Social Democrats, told the Bundesrat it was a deal which made “honest taxpayers feel like fools”.


Swiss Finance Minister Eveline Widmer-Schlumpf said her government remained “committed to a successful ratification”.


And the Swiss Bankers Association said in a statement: “The German upper house has missed a major opportunity to reach a fair, optimum and sustainable solution for all parties to definitively settle the bilateral tax issues.”


BBC News – Business


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Egypt reformist warns of turmoil from Morsi decree












CAIRO (AP) — Prominent Egyptian democracy advocate Mohammed ElBaradei warned Saturday of increasing turmoil that could potentially lead to the military stepping in unless the Islamist president rescinds his new, near absolute powers, as the country’s long fragmented opposition sought to unite and rally new protests.


Egypt‘s liberal and secular forces — long divided, weakened and uncertain amid the rise of Islamist parties to power — are seeking to rally themselves in response to the decrees issued this week by President Mohammed Morsi. The president granted himself sweeping powers to “protect the revolution” and made himself immune to judicial oversight.












The judiciary, which was the main target of Morsi’s edicts, pushed back Saturday. The country’s highest body of judges, the Supreme Judical Council, called his decrees an “unprecedented assault.” Courts in the Mediterranean city of Alexandria announced a work suspension until the decrees are lifted.


Outside the high court building in Cairo, several hundred demonstrators rallied against Morsi, chanting, “Leave! Leave!” echoing the slogan used against former leader Hosni Mubarak in last year’s uprising that ousted him. Police fired tear gas to disperse a crowd of young men who were shooting flares outside the court.


The edicts issued Wednesday have galvanized anger brewing against Morsi and the Muslim Brotherhood, from which he hails, ever since he took office in June as Egypt’s first freely elected president. Critics accuse the Brotherhood — which has dominated elections the past year — and other Islamists of monopolizing power and doing little to bring real reform or address Egypt’s mounting economic and security woes.


Oppositon groups have called for new nationwide rallies Tuesday — and the Muslim Brotherhood has called for rallies supporting Morsi the same day, setting the stage for new violence.


Morsi supporters counter that the edicts were necessary to prevent the courts, which already dissolved the elected lower house of parliament, from further holding up moves to stability by disbanding the assembly writing the new constitution, as judges were considering doing. Like parliament was, the assembly is dominated by Islamists. Morsi accuses Mubarak loyalists in the judiciary of seeking to thwart the revolution’s goals and barred the judiciary from disbanding the constitutional assembly or parliament’s upper house.


In an interview with a handful of journalists, including The Associated Press, Nobel Peace laureate ElBaradei raised alarm over the impact of Morsi’s rulings, saying he had become “a new pharaoh.”


“There is a good deal of anger, chaos, confusion. Violence is spreading to many places and state authority is starting to erode slowly,” he said. “We hope that we can manage to do a smooth transition without plunging the country into a cycle of violence. But I don’t see this happening without Mr. Morsi rescinding all of this.”


Speaking of Egypt’s powerful military, ElBaradei said, “I am sure they are as worried as everyone else. You cannot exclude that the army will intervene to restore law and order” if the situation gets out of hand.


But anti-Morsi factions are chronically divided, with revolutionary youth activists, new liberal political parties that have struggled to build a public base and figures from the Mubarak era, all of whom distrust each other. The judiciary is also an uncomfortable cause for some to back, since it includes many Mubarak appointees who even Morsi opponents criticize as too tied to the old regime.


Opponents say the edicts gave Morsi near dictatorial powers, neutering the judiciary when he already holds both executive and legislative powers. One of his most controversial edicts gave him the right to take any steps to stop “threats to the revolution,” vague wording that activists say harkens back to Mubarak-era emergency laws.


Tens of thousands of people took to the streets in nationwide protests on Friday, sparking clashes between anti-and pro-Morsi crowds in several cities that left more than 200 people wounded.


On Saturday, new clashed broke out in the southern city of Assiut. Morsi opponents and members of the Muslim Brotherhood swung sticks and threw stones at each other outside the offices of the Brotherhood‘s political party, leaving at least seven injured.


ElBaradei and a six other prominent liberal leaders have announced the formation of a National Salvation Front aimed at rallying all non-Islamist groups together to force Morsi to rescind his edicts.


The National Salvation Front leadership includes several who ran against Morsi in this year’s presidential race — Hamdeen Sabahi, who finished a close third, former foreign minister Amr Moussa and moderate Islamist Abdel-Moneim Aboul-Fotouh. ElBaradei says the group is also pushing for the creation of a new constitutional assembly and a unity government.


ElBaradei said it would be a long process to persuade Morsi that he “cannot get away with murder.”


“There is no middle ground, no dialogue before he rescinds this declaration. There is no room for dialogue until then.”


The grouping seems to represent a newly assertive political foray by ElBaradei, the former chief of the U.N. nuclear watchdog agency. ElBaradei returned to Egypt in the year before Mubarak’s fall, speaking out against his rule, and was influential with many of the youth groups that launched the anti-Mubarak revolution.


But since Mubarak’s fall, he has been criticized by some as too Westernized, elite and Hamlet-ish, reluctant to fully assert himself as an opposition leader.


The Brotherhood‘s Freedom and Justice political party, once headed by Morsi, said Saturday in a statement that the president’s decision protects the revolution against former regime figures who have tried to erode elected institutions and were threatening to dissolve the constitutional assembly.


The Brotherhood warned in another statement that there were forces trying to overthrow the elected president in order to return to power. It said Morsi has a mandate to lead, having defeated one of Mubarak’s former prime ministers this summer in a closely contested election.


Morsi’s edicts also removed Abdel-Meguid Mahmoud, the prosecutor general first appointed by Mubarak, who many Egyptians accused of not prosecuting former regime figures strongly enough.


Speaking to a gathering of judges cheering support for him at the high court building in Cairo, Mahmoud warned of a “vicious campaign” against state institutions. He also said judicial authorities are looking into the legality of the decision to remove him — setting up a Catch-22 of legitimacy, since under Morsi’s decree, the courts cannot overturn any of his decisions.


“I thank you for your support of judicial independence,” he told the judges.


“Morsi will have to reverse his decision to avoid the anger of the people,” said Ahmed Badrawy, a labor ministry employee protesting at the courthouse. “We do not want to have an Iranian system here,” he added, referring to fears that hardcore Islamists may try to turn Egypt into a theocracy.


Several hundred protesters remained in Cairo’s Tahrir Square Saturday, where a number of tents have been erected in a sit-in following nearly a week of clashes with riot police.


____


Brian Rohan contributed to this report from Cairo.


Middle East News Headlines – Yahoo! News


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HP says products may have been sold to Syria by others












(Reuters) – Hewlett Packard Co said in a letter made public on Friday that its products could have been delivered to Syria through resellers or distributors, but the world’s largest PC maker affirmed it did not sell directly to the country.


The letter was a response to a request from the U.S. Securities and Exchange Commission‘s Office of Global Security Risk that asked whether HP’s products were sold in countries where they would be subject to U.S. sanctions.












“We are aware of November 2011 news reports that your equipment was installed by the Italian company, Area SpA, in Syria as part of a nationwide surveillance and tracking system designed to monitor people in that country,” the SEC wrote in its request.


“Please describe to us the nature, duration, and extent of your past, current, and anticipated contacts with Syria and Iran, whether through subsidiaries, distributors, resellers, vendors, retailers, or other direct or indirect arrangements.”


In a letter dated October 9, HP said it had not authorized the sale of products to Syria.


Instead, HP said the Italian surveillance company had likely obtained its products from an HP partner that was unaware of their ultimate destination.


In another October 9 letter to the agency, HP said it ended its contract with Area SpA in April.


Calls to HP seeking further comment were unanswered as were calls to Area SpA.


HP’s overseas subsidiaries ended sales of printers and related supplies to third-party distributors and resellers with customers in Iran in early 2009, the company wrote.


But because its products are often sold by others through indirect channels without its knowledge or consent “it is always possible that products may be diverted to Iran or Syria after being sold to channel partners, such as distributors and resellers,” HP said.


Reuters has documented how banned computer equipment from U.S. companies has made its way to Iran’s largest telecommunications company through China-based ZTE.


Networking equipment maker Cisco Systems Inc has since cut its ties to ZTE.


HP said in both letters that it would continue to work with ZTE, but it had conducted an internal investigation relating to an alleged sale of its products to MTN Irancell, Iran’s second largest mobile carrier.


The company was also asked about EDS – an IT outsourcing company that HP bought in 2008 – and any activity in Iran, Syria and Sudan.


HP said it had the same policy regarding Sudan as it did on sales to Iran or Syria.


HP is eager to avoid more negative publicity after surprising the market on Tuesday with an $ 8.8 billion write-down on its $ 11.1 billion acquisition of software group Autonomy, accusing the British company of improper accounting to inflate sales.


Autonomy has denied any wrongdoing.


(Reporting by Nicola Leske in New York. Editing by Leslie Gevirtz and Andre Grenon)


Tech News Headlines – Yahoo! News


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Vampires, 007 may set record Thanksgiving sales












LOS ANGELES (Reuters) – The teen vampire movie “Twilight Saga: Breaking Dawn – Part 2″ continued to lure huge audiences, siphoning off $ 12.8 million in Wednesday night showings in what could fuel a record box office haul for the five-day Thanksgiving Day holiday.


The final film in the “Twilight” series, collected $ 141.3 million last weekend for the industry’s eighth largest opening weekend. On Wednesday it combined with the Daniel CraigJames Bond” film “Skyfall” to lead a slate of films that generated $ 44.3 million in total U.S. and Canadian ticket sales for the day, according to unofficial data from Hollywood.com’s box office division.












That’s 20 percent ahead of last year’s take for the Wednesday before Thanksgiving and, if the pace holds, would put Hollywood on a path to a $ 278 million holiday weekend, according to Hollywood.com estimates. The 2009 holiday weekend record of $ 273 million included “The Twilight Saga: New Moon” and the football flick, “The Blind Side.”


Hollywood traditionally opens its largest Thanksgiving weekend films on Wednesday, when schools are closed before the Thursday holiday.


“Skyfall,” the 23rd film in the “James Bond” series about the exploits of a British spy, collected $ 7.4 million in Wednesday showings.


Dreamworks Animation’s “Rise of the Guardians,” featuring the voices of Chris Pine and Alec Baldwin in a story about the Tooth Fairy, Easter Bunny and other childhood characters that save the world, opened with $ 4.85 million in Wednesday sales.


“Twilight” and “Skyfall” each easily appear headed to more than $ 200 million in box office sales. “Skyfall,” released by Sony Pictures in association with MGM, has generated more than $ 178 million so far in domestic ticket sales through Wednesday, already making it the 10th biggest selling film of 2012.


“Twilight,” starring Kristen Stewart, Robert Pattinson and Taylor Lautner, has totaled $ 175.5 million through Wednesday in the U.S. and Canada, according to the Hollywood.com unofficial tally. It was released by Lionsgate Entertainment.


(Reporting By Ronald Grover; Editing by Sandra Maler)


Movies News Headlines – Yahoo! News


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First Person: Unemployed, Disabled and Hungry for Work












Five million Americans are among the long-term unemployed–those without a job for 27 weeks or longer–according to the Bureau of Labor Statistics. Another 7.3 million are looking for work, while the unemployment rate sits at 7.9 percent. Numbers aside, individual stories illustrate how America is affected. To see how joblessness hits home, Yahoo News asked unemployed workers to share their job-hunting stories. Here’s one.


FIRST PERSON | I am 40 and live in Racine, Wis. I have been unemployed since I was 33. I try to find work, but I’ve been disabled since 27, and I do not collect Social Security or other income. On job applications, when I am asked if I have any disabilities, I answer yes.












I have even tried to travel to different states for employment. I am seeking employment where I can. I have tried Lowe’s, Home Depot and other similar stores. All I get are letters saying I do not qualify for employment.


By trade, I am a tattoo artist, a job I have been very good at until I became disabled. I have shoulder impingement syndrome, which consists of some of the following: torn ligaments, torn tendons, bone spurs, bursitis and arthritis.


And constant pain. I feel the weather. I hardly sleep. I wish I could be somewhere else, as it is hard on my mind to deal with on a daily basis.


Still, I try to find work where I can in this tough economy, and I am on several lists to be called and never have been called to date.


I am too proud to try to get Social Security. I cannot even afford insurance to get my condition fixed. I even have applied for local state insurance to get the problem resolved so I can work again, always with no luck. So I have remained unemployed now for over 10 years and going.


I injured myself, and I am not able to lift more than 10 pounds at a time or stand or sit for long periods of time.


I just want a job so I can try to cover the medical expenses myself since I cannot get help. Surgery costs are around $ 18,000, which sounds pretty reasonable to me.


I am no stranger to hard work. Since 12, I cut grass, shoveled snow, painted houses and fences, swept chimneys, worked in heat treatment plants with dirt and oil, worked in the casting of hot metals, laid brick, made bathroom sinks, swept floors in factories, did drill-press work, sanding work, and worked at fast food places.


I do not lie to get jobs or hid my injury. I do want to work, but I worry now that my disability will mean I won’t be hired by companies because they’re afraid it will come back on them and their company.


I cannot afford private insurance as I do not have steady income. Now I find whatever I can do to reach my goal of paying for my own surgery.


It is a sad world when you live in pain, day in and day out, and you want and need to find work.


Health News Headlines – Yahoo! News


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Wall St Week Ahead: Political wrangling to pinch market’s nerves












NEW YORK (Reuters) – Volatility is the name of this game.


With the S&P 500 above 1,400 following five days of gains, traders will be hard pressed not to cash in on the advance at the first sign of trouble during negotiations over tax hikes and spending cuts that resume next week in Washington.












President Barack Obama and U.S. congressional leaders are expected to discuss ways to reduce the budget deficit and avoid the “fiscal cliff” of automatic tax increases and spending cuts in 2013 that could tip the economy into recession.


As politicians make their case, markets could react with wild swings.


The CBOE Volatility Index <.VIX>, known as the VIX, Wall Street‘s favorite barometer of market anxiety that usually moves in an inverse relationship with the S&P 500, is in a long-term decline with its 200-day moving average at its lowest in five years. The VIX could spike if dealings in Washington begin to stall.


“If the fiscal cliff happens, a lot of major assets will be down on a short-term basis because of the fear factor and the chaos factor,” said Yu-Dee Chang, chief trader and sole principal of ACE Investments in Virginia.


“So whatever you are in, you’re going to lose some money unless you go long the VIX and short the market. The ‘upside risk’ there is some kind of grand bargain, and then the market goes crazy.”


He set the chances of the economy going over the cliff at only about 5 percent.


Many in the market agree there will be some sort of agreement that will fuel a rally, but the road there will be full of political landmines as Democrats and Republicans dig in on positions defended during the recent election.


Liberals want tax increases on the wealthiest Americans while protecting progressive advances in healthcare, while conservatives make a case for deep cuts in programs for the poor and a widening of the tax base to raise revenues without lifting tax rates.


“Both parties will raise the stakes and the pressure on the opposing side, so the market is going to feel much more concerned,” said Tim Leach, chief investment officer of U.S. Bank Wealth Management in San Francisco.


“The administration feels really confident at this point, or a little more than the Republican side of Congress may feel,” he said. “But it’s still a balanced-power Congress so neither side can feel that they can act with impunity.”


THE MIDDLE EAST AND EUROPE


Tension in the Middle East and unresolved talks in Europe over aid for Greece could add to the uncertainty and volatility on Wall Street could surge, analysts say.


An Egypt-brokered ceasefire between Israel and Hamas came into force late on Wednesday after a week of conflict, but it was broken with the shooting of a Palestinian man by Israeli soldiers, according to Palestine’s foreign minister.


Buoyed by accolades from around the world for mediating the truce, Egyptian President Mohamed Mursi assumed sweeping powers, angering his opponents and prompting violent clashes in central Cairo and other cities on Friday.


“Those kinds of potential large-scale conflicts can certainly overwhelm some of the fundamental data here at home,” said U.S. Bank’s Leach.


“We are trying to keep in mind the idea that there are a lot of factors that are probably going to contribute to higher volatility.”


On a brighter note for markets, Greece’s finance minister said the International Monetary Fund has relaxed its debt-cutting target for Greece and a gap of only $ 13 billion remains to be filled for a vital aid installment to be paid.


Still, a deal has not been struck, and Greece is increasingly frustrated at its lenders, still squabbling over a deal to unlock fresh aid even though Athens has pushed through unpopular austerity cuts.


HOUSING DATA COULD CONFIRM RECOVERY


Next week is heavy on economic data, especially on the housing front. Some of the numbers have been affected by Superstorm Sandy, which hit the U.S. East Coast more than three weeks ago, killing more than 100 people in the United States alone and leaving billions of dollars in damages.


The housing data, though, could continue to confirm a rebound in the sector that is seen as a necessary step to unlock spending and lower the stubbornly high unemployment rate.


Tuesday’s S&P/Case-Shiller home price index for September is expected to show the eighth straight month of increases, extending the longest continuous string of gains since prices were boosted by a homebuyer tax credit in 2009 and 2010.


New home sales for October, due on Wednesday, and October pending home sales data, due on Thursday, are also expected to show a stronger housing market.


Other data highlights next week include durable goods orders for October and consumer confidence for November on Tuesday and the Chicago Purchasing Managers Index on Friday.


At Friday’s close, the S&P 500 wrapped up its second-best week of the year with a 3.6 percent gain. Encouraging economic data next week could confirm that regardless of the ups and downs that the fiscal cliff could bring, the market’s fundamentals are solid.


Jeff Morris, head of U.S. equities at Standard Life Investments in Boston, said that “it’s kind of noise here” in terms of whether the market has spent “a few days up or down. It has made some solid gains over the course of the year as the housing recovery has come into view, and that’s what’s underpinning the market at these levels.


“I would caution against reading too much into the next few days.”


(Wall St Week Ahead runs every Friday. Questions or comments on this column can be emailed to: rodrigo.campos(at)thomsonreuters.com)


(Reporting by Rodrigo Campos; Editing by Tim Dobbyn and Jan Paschal)


Economy News Headlines – Yahoo! News


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Beijing’s S. China Sea rivals protest passport map












TAIPEI, Taiwan (AP) — China has enraged several neighbors with a few dashes on a map, printed in its newly revised passports that show it staking its claim on the entire South China Sea and even Taiwan.


Inside the passports, an outline of China printed in the upper left corner includes Taiwan and the sea, hemmed in by the dashes. The change highlights China’s longstanding claim on the South China Sea in its entirety, though parts of the waters also are claimed by the Philippines, Vietnam, Taiwan, Brunei and Malaysia.












China’s official maps have long included Taiwan and the South China Sea as Chinese territory, but the act of including them in its passports could be seen as a provocation since it would require other nations to tacitly endorse those claims by affixing their official seals to the documents.


Ruling party and opposition lawmakers alike condemned the map in Taiwan, a self-governed island that split from China after a civil war in 1949. They said it could harm the warming ties the historic rivals have enjoyed since Ma Ying-jeou became president 4 1/2 years ago.


“This is total ignorance of reality and only provokes disputes,” said Taiwan’s Mainland Affairs Council, the Cabinet-level body responsible for ties with Beijing. The council said the government cannot accept the map.


Philippine Foreign Secretary Albert del Rosario told reporters in Manila that he sent a note to the Chinese Embassy that his country “strongly protests” the image. He said China’s claims include an area that is “clearly part of the Philippines’ territory and maritime domain.”


The Vietnamese government said it had also sent a diplomatic note to the Chinese Embassy in Hanoi, demanding that Beijing remove the “erroneous content” printed in the passport.


In Beijing, the Foreign Ministry said the new passport was issued based on international standards. China began issuing new versions of its passports to include electronic chips on May 15, though criticism cropped up only this week.


“The design of this type of passports is not directed against any particular country,” Chinese Foreign Ministry spokeswoman Hua Chunying said at a daily media briefing Friday. “We hope the relevant countries can calmly treat it with rationality and restraint so that the normal visits by the Chinese and foreigners will not be unnecessarily interfered with.”


It’s unclear whether China’s South China Sea neighbors will respond in any way beyond protesting to Beijing. China, in a territorial dispute with India, once stapled visas into passports to avoid stamping them.


“Vietnam reserves the right to carry out necessary measures suitable to Vietnamese law, international law and practices toward such passports,” Vietnamese foreign ministry spokesman Luong Thanh Nghi said.


Taiwan does not recognize China’s passports in any case; Chinese visitors to the island have special travel documents.


China maintains it has ancient claims to all of the South China Sea, despite much of it being within the exclusive economic zones of Southeast Asian neighbors. The islands and waters are potentially rich in oil and gas.


There are concerns that the disputes could escalate into violence. China and the Philippines had a tense maritime standoff at a shoal west of the main Philippine island of Luzon early this year.


The United States, which has said it takes no sides in the territorial spats but that it considers ensuring safe maritime traffic in the waters to be in its national interest, has backed a call for a “code of conduct” to prevent clashes in the disputed territories. But it remains unclear if and when China will sit down with rival claimants to draft such a legally binding nonaggression pact.


The Philippines, Brunei, Malaysia and Vietnam are scheduled to meet Dec. 12 to discuss claims in the South China Sea and the role of China.


___


Associated Press writers Oliver Teves in Manila, Philippines, Chris Brummitt in Hanoi, Vietnam, and researcher Zhao Liang in Beijing contributed to this report.


Asia News Headlines – Yahoo! News


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Nicole ‘Snooki’ Polizzi, Miley Cyrus Share Birthday Joy On Twitter












Jersey Shore” star Nicole “Snooki” Polizzi was celebrating her 25th birthday on Black Friday, but it wasn’t the shops that provided her with her favorite present.


The reality star and new mom Tweeted that her baby boy — Lorenzo, who was born in August — was the most rewarding gift of all.












PLAY IT NOW: The Jersey Shore Cast Makes A Plea To Help ‘Restore The Shore’


“My favorite birthday gift,” she Tweeted, linking to a photo of the MTV star holding her little one. (Click HERE to see the full pic.)


But, Snooki didn’t leave out her love for her fiance, Lorenzo’s daddy — Jionni LaValle, thanking him for celebrating her big day with her.


VIEW THE PHOTOS: We Did It All For The ‘Snooki’! Hot Shots Of The ‘Jersey Shore’ Star!


“Best Birthday ever with my fiance @JLaValle and Lorenzo,” she wrote.


In typical Snooki fashion, though, she wasn’t the perfect birthday girl. She made sure to emphasize it was her big day.


“Lol I’m being that annoying birthday girl to @JLaValle saying ‘but it’s my birthday today you have to,’” she Tweeted.


VIEW THE PHOTOS: She’s Just Bein’ Miley!


Snooki wasn’t the only celeb celebrating their birthday on Black Friday. Miley Cyrus turned 20, and hit Twitter to thank her fans for their well wishes.


“So much BIRFFFDAY love!” she wrote. “i wish everyday was like this.”


VIEW THE PHOTOS: Miley Cyrus & Liam Hemsworth: Young Hollywood’s Hot Power Couple


Copyright 2012 by NBC Universal, Inc. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


Social Media News Headlines – Yahoo! News


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Marc Anthony comes to aid of Dominican orphanage












SANTO DOMINGO, Dominican Republic (AP) — Singer Marc Anthony is coming to the aid of an orphanage in the Dominican Republic.


A foundation run by Anthony with music and sports producer Henry Cardenas plans to build a new residence hall, classrooms and a baseball field for the Children of Christ orphanage in the eastern city of La Romana. Anthony attended the groundbreaking ceremony Friday with his model girlfriend Shannon de Lima.












Children of Christ Foundation Director Sonia Hane said Anthony visited the orphanage previously and decided to help. His Maestro Cares Foundation raised $ 200,000 for the expansion on land donated by a sugar company. The orphanage was founded in 1996 for children who were abused or abandoned or whose parents were unable to care for them.


Entertainment News Headlines – Yahoo! News


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Laws don’t curb pricey prostate cancer treatments












NEW YORK (Reuters Health) – Laws meant to prevent the overuse of expensive healthcare services don’t stop doctors from using pricey prostate cancer treatments, according to two new studies.


Researchers found doctors used robots and special radiation to treat prostate cancer regardless of whether their area had laws requiring government approval before money is spent on healthcare facilities and new equipment.












“Certificate of need laws were designed to align public need with use of different services,” said Dr. Bruce Jacobs, a lead author of one of the studies from the University of Michigan in Ann Arbor.


The U.S. government required states to implement the laws in the 1970s and early 1980s, but stopped a few decades ago. Still, some states continue to use the laws in an effort to control costs.


In each study, the researchers looked at treatments for prostate cancer, which is the most common cancer in American men.


The American Cancer Society estimates that one in every six men will be diagnosed with prostate cancer in their lifetime, but most will not die from it. Past research found that many men’s prostate cancer is slow-growing, and most are candidates for active surveillance or “watchful waiting.”


In Jacobs’s study, the researchers looked at whether states with strict laws – those that require approval for even low-cost equipment – used robotic surgery to remove fewer prostates than states with less strict or no laws.


Jacobs and his colleagues write in The Journal of Urology that the price of such robots, and the questions surrounding whether or not robotic surgery to remove a prostate is better than the old-fashioned way should make it an “ideal target” for review under the laws.


In September, for example, one of the studies that have questioned the usefulness of robotic surgery found that men who had robotic surgery ended up having fewer short-term complications, but questioned its long-term benefits and whether the hefty price tag of $ 1.5 million in startup costs is worth it. (see Reuters Health article of Sep. 12, 2012:)


But another recent study found robotic surgery led to fewer complications, fewer readmissions to the hospital, and fewer deaths due to surgery than traditional methods, according to Intuitive Surgical, the maker of the da Vinci Surgical System.


“That is significant for the patient and for reducing overall costs to the system,” wrote Angela Wonson, a spokesperson for Intuitive Surgical, in an email to Reuters Health.


Overall, in the new study, the use of robotic surgery to remove prostates in Medicare patients increased regardless of whether there were strict, less strict or no laws in place. Also, the chance a surgeon used robots had nothing to do with the laws.


RADIATION AND COSTS


A second study by another group of researchers looked at whether the laws limited the use of intensity modulated radiation therapy (IMRT) or slowed the growth of healthcare costs related to prostate cancer.


IMRT allows doctors to focus radiation beams onto the cancer without harming healthy tissue.


However, the researchers write that IMRT is costly and – to their knowledge – has not been compared to other prostate cancer treatments in a randomized controlled trial, which is considered the “gold standard” of medical research.


In a group of Medicare patients, Dr. Ganesh Palapattu, the chief of urologic oncology at the University of Michigan and the study’s senior researcher, found that areas with the laws actually saw greater growth in IMRT use.


Palapattu and his colleagues found that IMRT use increased from about 2 percent of all prostate cancer treatments in 2002 to almost half in 2009 in areas with the laws.


In areas without the laws, IMRT use increased from about 11 percent of all prostate cancer treatments to about 42 percent over the same time span.


The laws also didn’t seem to help control prostate cancer treatment costs when the researchers compared the price to treat one person with prostate cancer in states with laws, compared to states without laws.


Palapattu told Reuters Health that it may be time to reevaluate the regulations.


“If the goal is to limit the overutilization of more expensive therapies and to improve efficacy or health, then we have to reexamine how we’re doing this,” he said.


Jacobs told Reuters Health that there is more research to be done, because his group’s study did not look at how many applications for equipment may have been turned down by the states’ approval board.


“I think if we really want to get to the bottom of how effective these (laws) are, the next step is to really look closely at each state’s process of review,” he said.


Palapattu said he’d also like to see if the findings are the same for non-Medicare patients. But, for now, he said men with prostate cancer should talk to their doctors about which treatment is right for them.


“Newer isn’t always better, and it’s important to have a meaningful conversation with your physician on treatment options and which one might be best for you and why,” he said.


SOURCE: http://bit.ly/QzKXvE and http://bit.ly/R5AUhH The Journal of Urology, online November 19, 2012.


Seniors/Aging News Headlines – Yahoo! News


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