Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping to finance the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: March 1, 2013

An article on Tuesday about a coming measles-rubella vaccination campaign in Rwanda misstated the source of the vaccine and some financing for the campaign. The vaccine and financing are being provided by the GAVI Alliance, not by the Measles and Rubella Initiative.

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Groupon Dismisses Its Chief, Andrew Mason

Andrew Mason, the irreverent programmer and musician who turned a failed social action site into the daily deals phenomenon Groupon, was dismissed Thursday as chief executive.

A day earlier, Groupon reported weak fourth- quarter earnings, which caused investors to shave off a quarter of the Chicago company’s value. The news about Mr. Mason, released after the market closed, sent shares up more than 4 percent in late trading.

In a note to Groupon employees that was typical of his sassy style, Mr. Mason wrote: “after four and a half intense and wonderful years as CEO of Groupon, I’ve decided that I’d like to spend more time with my family. Just kidding — I was fired today.”

He added, “If you’re wondering why ... you haven’t been paying attention.”

Groupon said in its earnings call that first-quarter revenue would be about 10 percent lower than analysts were expecting, among other disappointments.

Jordan Rohan, an analyst with Stifel, Nicolaus, said Mr. Mason’s exit “was long overdue.”

“I view Mason as a visionary idea generator,” Mr. Rohan said. “Few would argue with how impressive the Groupon organization was as it grew. However, at some point it became the overgrown toddler of the Internet — operationally clumsy, not quite ready to make adult decisions.”

Mr. Mason, who dodged a potential dismissal in November, will be temporarily replaced by Eric Lefkofsky, Groupon’s executive chairman, and Theodore J. Leonsis, its vice chairman, while they search for a replacement.

Now 32, Mr. Mason had a wild ride. Unlike many Silicon Valley entrepreneurs, he never seemed to dream about building a huge company or even becoming fantastically wealthy. Groupon was an outgrowth of a start-up, the Point, which was aimed at encouraging charitable actions by groups. In late 2008, Mr. Mason and a few colleagues reformulated it as a deals shop.

Over the years, Silicon Valley start-ups had tried many forms of deal sites, but Groupon was the first to really make it work, and did so instantly. The formula was simple and compelling. People were sent e-mails of offers for, say, a local restaurant. If they bought it, they got a bargain, Groupon got a commission and the restaurant won new patrons.

In two years, Mr. Mason was turning down a reported $6 billion offer from Google. As a reminder that fate is fickle, he put in the reception area of Groupon’s offices a gallery of framed magazine covers featuring Napster, Myspace and other tech wunderkinds that ultimately faded. To these losers, he then added a cover that featured Groupon.

“Our marketing guy thought we should put some press on the wall, but I didn’t want an atmosphere of popping the Champagne,” Mr. Mason told Chicago Time Out in 2010. “We still have a mountain to climb, and other iconic companies will be a footnote in history.”

Groupon’s public offering, in late 2011, valued the company at $16.5 billion. It was the most talked-about tech debut between Google and Facebook. The actors, stand-up comics and other creative types who made up much of Groupon’s early team watched in wonder. The company had a loose, informal style, with an editorial team as large as a midsize newspaper. Writers labored over the gags that introduced the deals. The one for a dentist started like this: “The Tooth Fairy is a burglarizing fetishist specializing in black-market ivory trade, and she must be stopped.”

But then the competition intensified, the criticism began and the stock struggled. Groupon’s market value is now $2.97 billion.

Groupon has 10,000 employees in 48 countries. Mr. Rohan, the analyst, said the new chief executive “will have to refocus the company on the most productive markets with the most productive sales people.” He added, “Groupon needs to give up on the grand vision of becoming an operating system for local commerce and instead be the best daily deals provider it can be.”

Even as the daily deals sites struggle financially — the No. 2 company, Amazon-backed LivingSocial, is in worse shape than Groupon — the number of digital coupon users in the United States continues to rise, according to eMarketer. An estimated 92.5 million Americans redeemed a digital coupon in 2012, up 4.9 percent from 88.2 million in 2011.

No surprise there, said Sucharita Mulpuru, an e-commerce analyst with Forrester Research. “Who doesn’t like 50 percent off something? The question was always how you create good consistent deal flow from merchants.”

She noted that in his letter, Mr. Mason talked about what was best for the customer. “They think their customer is Joe Smith who buys the Groupon,” Ms. Mulpuru said. “But the customer is the merchant. They have been focusing on the wrong person.”

Indeed, merchants got a lot of attention for complaining how successful deals came close to ruining them.

Mr. Mason’s letter was in the blunt tech tradition of a former Yahoo chief executive, Carol Bartz, who sent an e-mail to the search engine’s employees in September 2011 saying, “I’ve just been fired.”

In his letter, Mr. Mason wrote: “I’m o.k. with having failed at this part of the journey. If Groupon was Battletoads, it would be like I made it all the way to the Terra Tubes without dying on my first-ever play-through.” He added that he was looking for a good fat camp to lose the 40 pounds he had gained at Groupon.

Mr. Mason’s letter was very well received on Twitter, with people applauding his honesty as much as his sense of humor.

Mr. Mason himself retweeted a comment that said: “First the pope and now Andrew Mason!?! Our esteemed leaders are falling like flies.”

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Santa Cruz hit hard by officers' deaths

SANTA CRUZ — Flags throughout this sparkling beach town flew at half-staff Wednesday. The entire Police Department was meeting with grief counselors. Handmade signs cropped up, sympathy cards to a stunned city.

"Thank you for your service Santa Cruz Police Department. RIP Detective Baker. RIP Detective Butler." That's what Mary Gregg wrote in neat black letters on yellow construction paper, hanging her message in the window of the downtown check-cashing store where she works.

"Something," she felt, "had to be said today."

Best known for its surfing museum and a roller coaster that Bay Area newspaper columnist Herb Caen described as "one long shriek," Santa Cruz is not used to the kind of pain that rippled through town the day after a gunfight left two veteran officers — and the man they were investigating — dead.

The city's Police Department, which has less than 100 sworn officers, had operated for 150 years without losing a single one in the line of duty. Until Tuesday afternoon, when two veteran detectives in plainclothes walked up to Jeremy Goulet's house as part of a misdemeanor sexual assault investigation.

Sgt. Loran "Butch" Baker, 51, and Det. Elizabeth Butler, 38, were killed on Goulet's doorstep, Santa Cruz County Sheriff Phil Wowak said during a news conference near an impromptu memorial at police headquarters.

"We don't know all that happened when they came into contact with Goulet," said Wowak, whose department is leading the investigation so Santa Cruz police can mourn. "We do know what was left in the aftermath."

The 35-year-old Goulet, who had a long history of run-ins with the law, killed and disarmed the detectives before fleeing in Baker's car, Wowak said. Law enforcement officers from throughout the region began a sweep of the Santa Cruz neighborhood where Baker and Butler were slain. A short time later, Goulet ditched the car and tried to flee on foot.

In the ensuing gun battle, Wowak said, Goulet shot up a firetruck, sending firefighters, medical personnel and passersby scrambling. After killing the suspect, authorities discovered Goulet had been wearing body armor and had three guns.

"It is our belief that two of the three weapons belonged to the Santa Cruz Police Department, but we haven't confirmed it," said Wowak, adding that it was still unclear whether Goulet had taken the body armor from Baker's car or had it on before the shooting broke out.

"We know now that he was distraught," the sheriff said. "We know now that he had the intention of harming himself and possibly the police.… There's no doubt in anyone's mind that the officers who engaged Goulet stopped an imminent threat to the community."

Goulet had been arrested Friday on suspicion of disorderly conduct. Local news accounts said he had broken into the home of a co-worker and been fired from his job at The Kind Grind coffeehouse Saturday. A manager at the beachfront shop declined to comment Wednesday.

According to Goulet's father, the barista — who recently had moved from Berkeley to Santa Cruz — was a ticking time bomb who held police and the justice system in deep contempt. Ronald Goulet, 64, told the Associated Press that his son had had numerous run-ins with the law and had sworn he would never go back to jail.

But the elder Goulet said he never thought his troubled son would turn to such violence.

Goulet said his son undermined any success in the military (he reportedly was a member of the Marine Corps Reserves and later the Army) or college because of an insatiable desire to peep in the windows of women as they showered or dressed.

"He's got one problem, peeping in windows," his father said. "I asked him, 'Why don't you just go to a strip club?' He said he wants a good girl that doesn't know she's being spied on, and said he couldn't stop doing it."

In 2008, a Portland, Ore., jury convicted Jeremy Goulet on misdemeanor counts of unlawful possession of a firearm and invasion of personal privacy after he peeked into a woman's bathroom as she showered, said Don Rees, a chief deputy district attorney in Multnomah County.

Goulet faced additional charges, including attempted murder, after he allegedly fired a gun at the woman's boyfriend. The two had fought after Goulet was spotted outside the woman's condo, but a jury acquitted him of those charges, Rees said.

During the trial, Goulet admitted that he liked to use his cellphone to record unsuspecting women undressing, according to the Oregonian newspaper. Prosecutors alleged he had peeped at women "hundreds of times" without getting caught.

Goulet was given three years' probation, Rees said, but spent time in jail after his probation was revoked.

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Cellar victim Kampusch raped, starved in film of ordeal

VIENNA (Reuters) – A new film based on the story of Austrian kidnap victim Natascha Kampusch shows her being repeatedly raped by the captor who beat and starved her during the eight-and-a-half years that he kept her in a cellar beneath his house.

Kampusch was snatched on her way to school at the age of 10 by Wolfgang Priklopil and held in a windowless cell under his garage near Vienna until she escaped in 2006, causing a sensation in Austria and abroad. Priklopil committed suicide.

Kampusch had always refused to respond to claims that she had had sex with Priklopil, but in a German television interview on her 25th birthday last week said she had decided to reveal the truth because it had leaked out from police files.

The film, “3,096 Days” – based on Kampusch’s autobiography of the same name – soberly portrays her captivity in a windowless cellar less than 6 square metres (65 square feet) in area, often deprived of food for days at a time.

The emaciated Kampusch – who weighed just 38 kg (84 pounds) at one point in 2004 – keeps a diary written on toilet paper concealed in a box.

One entry reads: “At least 60 blows in the face. Ten to 15 nausea-inducing fist blows to the head. One strike with the fist with full weight to my right ear.”

The movie shows occasional moments that approach tenderness, such as when Priklopil presents her with a cake for her 18th birthday or buys her a dress as a gift – but then immediately goes on to chide her for not knowing how to waltz with him.

GREY AREAS

Antonia Campbell-Hughes, who plays the teenaged Kampusch, said she had tried to portray “the strength of someone’s soul, the ability of people to survive… but also the grey areas within a relationship that people don’t necessarily understand.”

The British actress said she had not met Kampusch during the making of the film or since. “It was a very isolated time, it was a bubble of time, and I wanted to keep that very focused,” she told journalists as she arrived for the Vienna premiere.

Kampusch herself attended the premiere, looking composed as she posed for pictures but declining to give interviews.

In an interview with Germany’s Bild Zeitung last week, she said: “Yes, I did recognize myself, although the reality was even worse. But one can’t really show that in the cinema, since it wasn’t supposed to be a horror film.”

The movie, made at the Constantin Film studios in Bavaria, Germany, also stars Amy Pidgeon as the 10-year-old Kampusch and Danish actor Thure Lindhardt as Priklopil.

“I focused mainly on playing the human being because… we have to remember it was a human being. Monsters do not exist, they’re only in cartoons,” Lindhart said.

“It became clear to me that it’s a story about survival, and it’s a story about surviving eight years of hell. If that story can be told then I can also play the bad guy.”

The director was German-American Sherry Hormann, who made her English-language debut with the 2009 move “Desert Flower”, an adaptation of the autobiography of Somali-born model and anti-female circumcision activist Waris Dirie.

“I’m a mother and I wonder at the strength of this child, and it was important for me to tell this story from a different perspective, to tell how this child using her own strength could survive this atrocious martyrdom,” Hormann said.

The Kampusch case was followed two years later by that of Josef Fritzl, an Austrian who held his daughter captive in a cellar for 24 years and fathered seven children with her.

The crimes prompted soul-searching about the Austrian psyche, and questions as to how the authorities and neighbors could have let such crimes go undetected for so long.

The film goes on general release on Thursday.

(Reporting by Georgina Prodhan, Editing by Paul Casciato)

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping to finance the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the vaccine and some financing for the campaign. The vaccine and financing is being provided by the GAVI Alliance, not the Measles and Rubella Initiative.

Read More..

Lockheed Criticized by F-35 Jet Program Chief

The general in charge of building the new F-35 fighter jet sharply criticized the main contractors on Wednesday, saying that Lockheed Martin and the engine maker, Pratt & Whitney, were trying to “squeeze every nickel” out of the program.

The comments, by Lt. Gen. Christopher Bogdan, echoed a pointed critique he made last September, when he suggested that a poor relationship between Lockheed and the government threatened the program.

General Bogdan also seemed frustrated by the grounding last week of all 64 of the high-tech planes after an inspection found a crack in the turbine blade of one of the engines made by Pratt & Whitney.

Loren B. Thompson, a consultant to Lockheed, said Wednesday that the problem might have been caused by a bad casting when that blade was made rather than a design flaw that might affect all the planes.

But Kyra Hawn, a spokeswoman for the F-35 office at the Pentagon, said the military would analyze data from an investigation by Pratt & Whitney before reaching any conclusions. She said the blade was in an engine that had been “driven to extreme tolerances” in ground and flight tests that went beyond its expected military use.

She said that also might have contributed to the cracking, and officials needed to determine whether the jets’ engines would require more frequent inspection than expected.

Pratt & Whitney, a unit of United Technologies, said it was close to completing its investigation of the blade cracking and would make recommendations to the Pentagon soon.

General Bogdan made his comments, first reported by Reuters, in Australia, where he was trying to persuade the Australian government to stick with plans to buy 100 of the jets.

“What I see Lockheed Martin and Pratt & Whitney doing today is behaving as if they are getting ready to sell me the very last F-35 and the very last engine and are trying to squeeze every nickel of that last F-35 and that last engine,” the general told reporters there.

“I want them both to start behaving like they want to be around for 40 years,” he said. “I want them to take on some of the risk of this program. I want them to invest in cost reductions. I want them to do the things that will build a better relationship. I’m not getting all that love yet.”

General Bogdan, who joined the program last summer as the top deputy and took charge in December, said he had seen some improvement from the companies. “Are they getting better at a rate that I want to see them getting better?” he asked. “No, not yet.”

Ms. Hawn, the government spokeswoman, said that with the Pentagon and foreign militaries facing budget cuts, the general was reflecting a wider view that military contractors have been “negotiating every contract as if it were their last.” His comments, she said, were “an attempt to reinforce that we have shared responsibility in driving down program costs.”

The F-35 is the Pentagon’s most expensive program. It could cost $396 billion if the Pentagon sticks to its plan to build 2,456 jets by the late 2030s.

Mr. Thompson, the Lockheed consultant, said an outside audit commissioned by Lockheed had found that the company earned a 7 percent profit since the program began in 2001.

Lockheed and Pratt & Whitney said they have taken a long-range view in reducing costs and sharing cost overruns and expect to achieve more savings.

Ms. Hawn said inspections of the other F-35s used in flight tests had not found any other cracked blades. She said inspections began Wednesday on jets used for training pilots.

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Tribune Co. hires advisors to explore sale of newspaper unit

Tribune Co. has hired investment bankers to advise the media company on the potential sale of its newspaper publishing unit.

The company announced that it has retained JPMorgan Chase & Co. and Evercore Partners to assess whether to sell the division that includes the Los Angeles Times, Chicago Tribune and six other daily newspapers.

The bankers will analyze bids from suitors, but their hiring does not necessarily mean that the assets would be sold.

"There is a lot of interest in our newspapers, which we haven't solicited," Gary Weitman, a Tribune spokesman, said in a statement. "Hiring outside financial advisors will help us determine whether that interest is credible, allow us to consider all of our options, and fulfill our fiduciary responsibility to our shareholders and employees."

Tribune hopes to sell the newspaper group intact instead of selling each paper individually, according to a person familiar with the matter.

The Chicago company has a healthy balance sheet and doesn't feel financial pressure to sell the properties, according to the person. It's unclear how long the process could take.

There has been widespread speculation that Tribune would attempt to unload the newspaper business to focus on its more promising television operations. Rupert Murdoch's News Corp. is among the possible bidders for the newspaper assets.

Tribune emerged from its four-year bankruptcy at the end of 2012 and appointed broadcasting veteran Peter Liguori as chief executive in January.

JPMorgan Chase holds an ownership stake in Tribune.

Evercore Partners, a boutique investment bank, also is working for the parent company of the New York Times on its planned divestiture of the Boston Globe.

walter.hamilton@latimes.com

andrew.tangel@latimes.com

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Cellar victim Kampusch raped, starved in film of ordeal

VIENNA (Reuters) – A new film based on the story of Austrian kidnap victim Natascha Kampusch shows her being repeatedly raped by the captor who beat and starved her during the eight-and-a-half years that he kept her in a cellar beneath his house.

Kampusch was snatched on her way to school at the age of 10 by Wolfgang Priklopil and held in a windowless cell under his garage near Vienna until she escaped in 2006, causing a sensation in Austria and abroad. Priklopil committed suicide.

Kampusch had always refused to respond to claims that she had had sex with Priklopil, but in a German television interview on her 25th birthday last week said she had decided to reveal the truth because it had leaked out from police files.

The film, “3,096 Days” – based on Kampusch’s autobiography of the same name – soberly portrays her captivity in a windowless cellar less than 6 square metres (65 square feet) in area, often deprived of food for days at a time.

The emaciated Kampusch – who weighed just 38 kg (84 pounds) at one point in 2004 – keeps a diary written on toilet paper concealed in a box.

One entry reads: “At least 60 blows in the face. Ten to 15 nausea-inducing fist blows to the head. One strike with the fist with full weight to my right ear.”

The movie shows occasional moments that approach tenderness, such as when Priklopil presents her with a cake for her 18th birthday or buys her a dress as a gift – but then immediately goes on to chide her for not knowing how to waltz with him.

GREY AREAS

Antonia Campbell-Hughes, who plays the teenaged Kampusch, said she had tried to portray “the strength of someone’s soul, the ability of people to survive… but also the grey areas within a relationship that people don’t necessarily understand.”

The British actress said she had not met Kampusch during the making of the film or since. “It was a very isolated time, it was a bubble of time, and I wanted to keep that very focused,” she told journalists as she arrived for the Vienna premiere.

Kampusch herself attended the premiere, looking composed as she posed for pictures but declining to give interviews.

In an interview with Germany’s Bild Zeitung last week, she said: “Yes, I did recognize myself, although the reality was even worse. But one can’t really show that in the cinema, since it wasn’t supposed to be a horror film.”

The movie, made at the Constantin Film studios in Bavaria, Germany, also stars Amy Pidgeon as the 10-year-old Kampusch and Danish actor Thure Lindhardt as Priklopil.

“I focused mainly on playing the human being because… we have to remember it was a human being. Monsters do not exist, they’re only in cartoons,” Lindhart said.

“It became clear to me that it’s a story about survival, and it’s a story about surviving eight years of hell. If that story can be told then I can also play the bad guy.”

The director was German-American Sherry Hormann, who made her English-language debut with the 2009 move “Desert Flower”, an adaptation of the autobiography of Somali-born model and anti-female circumcision activist Waris Dirie.

“I’m a mother and I wonder at the strength of this child, and it was important for me to tell this story from a different perspective, to tell how this child using her own strength could survive this atrocious martyrdom,” Hormann said.

The Kampusch case was followed two years later by that of Josef Fritzl, an Austrian who held his daughter captive in a cellar for 24 years and fathered seven children with her.

The crimes prompted soul-searching about the Austrian psyche, and questions as to how the authorities and neighbors could have let such crimes go undetected for so long.

The film goes on general release on Thursday.

(Reporting by Georgina Prodhan, Editing by Paul Casciato)

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Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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Deal Professor: In Wall St. Tax, a Simple Idea but Unintended Consequences

Some say that a financial transaction tax is a cost-free way to kill many a bird with one stone — raising revenue, preventing financial crashes and making markets safer. But advocates of this neat idea conveniently ignore the century of less-than-successful experience with this tax, including New York State’s own failed attempt.

The idea behind a financial transaction tax, which is a tax on individual market trades, has a smart pedigree. John Maynard Keynes suggested it, and James Tobin, a Nobel laureate in economics, was its most famous modern advocate. Tobin, who died in 2002, wanted to “throw some sand in the wheels” of the markets, and his idea, endorsed by Joseph Stiglitz and Lawrence H. Summers among others, is based on an increasingly held belief that markets are far from efficient. Imposing a transaction tax on each individual trade would eliminate wasteful trading and reduce market volatility, ending short-term speculation and mispricing of assets.

This net benefit is paired with a simple budget argument. The Robin Hood Tax campaign in Britain, for example, has used the slogan “Not complicated. Just brilliant” to support a 0.05 percent tax on transactions as an effective way to ease the budget without harming markets. Let’s face it, the banks are an easy target after the financial crisis.

It seems to be a win for everyone.

Unfortunately, the reality has been much different.

Let’s start with New York State, which has had such a tax since 1905. Over the next eight decades, the tax was revised up and down nine times, including a large increase in the middle of the Great Depression. In 1966, Mayor John V. Lindsay of New York City ended up raising the tax by 25 percent. It led to an immediate reaction as the New York Stock Exchange threatened to jump across the Hudson River to New Jersey.

In the 1970s, the tax began to be phased out. New York State still collects the tax — some $14.5 billion annually — but since 1981, the state has simply returned it to traders instead of keeping it. In other words, the tax is collected and immediately given back, something that can happen only in the strange world of taxes. (Other financial transaction taxes include a federal version, which was put in effect in 1914 to help pay for World War I and eliminated in 1966, and taxes in Massachusetts and Pennsylvania that were also done away with in the 1950s.)

A study of New York State’s tax over those eight decades by Anna Pomeranets and Daniel G. Weaver found that it increased the cost of capital for investors and reduced trading volume. Most important, they found the tax actually increased trading volatility by as much as 10 percent.

Increasing volatility is exactly what advocates of the tax don’t want. They want volatility reduced to prevent market disruptions, but the decline in traders in the markets mean fewer buyers and sellers and more price jumps. This finding of increased volatility is in general accord with nine other major papers to study this issue, including studies of the tax in 23 countries, among them Britain, Sweden and Japan. Only one of these papers found that a financial transaction tax reduced volatility.

The New York State tax experience raises a bigger issue — that of traders just going elsewhere. This problem was mirrored in Sweden.

In 1984, Sweden adopted a financial transaction tax. Some 30 percent to 50 percent of the country’s trading volume then shifted to Britain. The lower amount of trading meant that not only did the tax yield less money than predicted but that the country lost more in capital gains taxes than the financial transaction tax raised. The tax was abolished in 1991.

The Swedish and New York State examples show that not only will traders leave to trade elsewhere; the money that people think this tax will reap will not appear, as that trading migrates and volume declines. Japan decided to eliminate its financial transaction tax in 1999 for this reason.

And even if the trading does not shift to other places, financial people are adept at avoiding it. In Britain, for example, where the financial transaction tax has fluctuated from half a percent to 2 percent, the tax has raised significantly less revenue than one might expect, about £3 billion a year. The reason is that investors who trade regularly in Britain use options to avoid the tax, which applies only to trading in stock. The result may be that the tax pushes investors into more risky securities in their efforts to avoid it.

And the reduced volume does not just reduce the amount of revenue collected. It may impose the largest costs on people who cannot afford or avoid the tax. The money management firm BlackRock has calculated that if the financial transaction tax were set at 0.1 percent per trade, an investor putting $10,000 in its global equity fund would lose more than $2,300 in expected returns over a 10-year period. This amount would rise to $15,000 if the money were invested in a more actively managed European fund.

This means not only less in retirement funds, but fewer jobs. Although disputed, one study in 2004 by the Partnership for the City of New York found that if New York State started keeping a tax of 0.25 cents per share traded, it would lose 23,000 to 33,000 jobs for every 10 percent drop in volume and more than $3 billion in lost revenue and economic value, probably more than offsetting the amount it collected.

This is not to say that a financial transaction tax by itself is such a terrible idea. My point is that we already have lots of experience with this kind of tax, and it argues for caution. If you think a financial transaction tax will reduce volatility, then you have to account for the fact that taxes in the past have shown the opposite. And if the tax is not imposed globally, it will force migrations of trading to less regulated places and in more byzantine forms, possibly making the world markets less safe.

As for seeking revenue gains to solve budget problems, if the tax is too small, it will have no effect. But the larger it is — and the Robin Hood Foundation’s proposal is in the large sphere — the more markets will be affected. It is for these reasons that Canada has rejected such a tax.

Now, we are about to get a real-life case study. France has adopted a 0.2 percent financial transaction tax involving securities of a company with a market capitalization of more than 1 billion euros. The full effects of France’s tax are not yet known, but a preliminary study by Credit Suisse, according to The Economist, found that stocks not subject to a tax rose 19 percent by volume, but those affected by the tax declined 16 percent. And the net effect of the tax appears to have shifted trading to smaller stocks not subject to it, distorting the allocation of capital, which is another problem with the tax. And the European Union has proposed a tax for 11 of its member countries, giving us a possible second test.

Instead of rushing into the adoption of a financial transaction tax, it may behoove us to watch and see whether these new taxes in Europe work. And even if the United States plunges ahead, history tells us that any tax should be carefully structured and considered before being put into effect. For there are likely to be many unintended consequences. There’s a reason that economists say there is no free lunch.

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