Michelle Obama wears Wu to the balls again

WASHINGTON (AP) — Michelle Obama made it a fashion tradition Monday night, wearing a custom-made Jason Wu gown to the inauguration balls. The ruby-colored dress was a follow-up to the white gown Wu made for her four years ago when she was new to Washington, the pomp and circumstance, and the fashion press.

She now emerged in velvet and chiffon as a bona fide trendsetter.

“I can’t believe it. It’s crazy,” said Wu, reached at his Manhattan studio. “To have done it once was already the experience of my life. To have a second time is tremendous.”

President Barack Obama also struck a similar style chord to his first-term inaugural balls: He wore a white tie with his tuxedo.

The red halter dress was the only one Wu, who went from fashion insider to household name on this night in 2009, submitted for Mrs. Obama’s consideration. He collaborated with jeweler Kimberly McDonald on the jeweled neckline. “For this occasion, it had to be real diamonds,” Wu said.

He said he felt the dress showed how he has grown up as a designer — and how Mrs. Obama’s style has evolved to be even more confident.

The first family headed out to inaugural festivities earlier on Monday with Mrs. Obama leading a very coordinated fashion parade in a navy-silk, checkered-patterned coat and dress by Thom Browne that were inspired by a menswear necktie.

The outfit was specifically designed for Mrs. Obama, but Browne said he wasn’t 100 percent sure she was going to wear it until she came out with it on at Inauguration. “I am proud and humbled,” he said.

The rest of Mrs. Obama’s Inauguration Day outfit included a belt from J. Crew, necklace by Cathy Waterman and a cardigan by Reed Krakoff, whose ensemble she also wore to yesterday’s intimate, indoor swearing-in ceremony.

Obama wore a blue tie with his white shirt, dark suit and overcoat. Malia Obama had on a plum-colored J. Crew coat with the hemline of an electric-blue dress peeking out and a burgundy-colored scarf, and her younger sister Sasha had on a Kate Spade coat and dress in a similar purple shade.

“It is an honor that Sasha Obama chose to wear Kate Spade New York,” said the company’s creative director, Deborah Lloyd, in an email to the Associated Press. “She epitomizes the youthful optimism and colorful spirit of the brand. We are so proud to have been a part of this historic moment.”

Jenna Lyons, creative director of J. Crew, said it was “a huge point of pride for all of us” to be a part of the day — as the brand was back in 2009 when the girls wore outfits by CrewCuts, its children’s label.

“It’s amazing to see the evolution of the family. I love the way Michelle looks. She looks beautiful in something so clean and tailored. It’s such an elegant choice,” Lyons said, “and they all look so sophisticated! You can see how the girls have grown up in the four years, and they’re still so alive and vibrant, but more sophisticated.”

The vice president’s wife, Jill Biden, wore a gray coat and dress by American designer Lela Rose.

Mrs. Obama has worn Browne’s designs for other occasions, including a gray dress with black lace overlay to one of the presidential debates last fall, and she honored him last summer at the Smithsonian’s Cooper-Hewitt National Design Awards for his contribution to fashion.

Browne made his name in modern — very modern — menswear, but he launched womenswear in 2011. He was in Paris on Monday, just finishing previews for his next menswear collection. The idea to use the tie fabric came to him because he was indeed designing these men’s clothes at the same time, he explained.

“I wanted ‘tailored’ for her. For me, she stands for strength and confidence, and that’s what I wanted to design for her,” he said.

Simon Collins, dean of the school of fashion at Parsons The New School for Design in New York, said the Obamas dressed in their typical fashion: one that shows pride in their appearance.

“They are a stylish couple and their children look fabulous. Too many people get dressed in the dark,” he said. “They show it’s good to dress up, take pride in how you look. … It’s a wonderful example for America and the rest of the world.”

He also noted that the Obamas seem to understand that the fashion industry is a driving force in the U.S. economy and that its lobby is a powerful one. They don’t treat fashion frivolously, he observed.

The first lady “is so supportive of so many American designers,” Browne noted.

But Collins said he was a bit surprised the public doesn’t pay much attention to the president’s wardrobe. He joked that Obama should perhaps try one of Browne’s signature shrunken suits — the ones that show a man’s ankles.

At the end of the Inaugural festivities, Mrs. Obama’s outfit and accompanying accessories will go to the National Archives.

___

Samantha Critchell tweets fashion at (at)AP_Fashion, and can be reached on Twitter at (at)Sam_Critchell.

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The New Old Age Blog: The Brutal Truth of 'Amour'

It has been a few days since I left the movie theater in a bit of a daze, and I’m still thinking about “Amour.”

So much of this already much-honored film rings utterly true: the way a long-married Parisian couple’s daily routines, their elegant life of books and music and art, can be upended in a moment. The tender care that Georges (Jean-Louis Trintignant) provides for Anne (Emmanuelle Riva) as multiple strokes claim her body and her mind, and the inexorable way that care wears them both down. Their withdrawal into a proud dyad that seeks and accepts little help from outsiders, even family. “We’ve always coped, your mother and I,” Georges tells their daughter.

The writer and director Michael Haneke’s previous movies, which I haven’t seen, tend to be described as shocking, violent, even punitive. “Amour,” which Times critic Manohla Dargis called a masterpiece, includes one brief spasm of violence, but the movie remains restrained, not graphic. It’s brutal only because life, and death, can be brutal.

Is popular culture paying more attention to aging and caregiving? In the last couple of years, I have written about these subjects surfacing in a YouTube series (“Ruth & Erica”), in movies like “The Iron Lady,” in novels like Walter Mosley’s “The Last Days of Ptolemy Grey.”

A couple of weeks back, watching a play called “The Other Place,” starring the remarkable Laurie Metcalfe, I suddenly realized that the dynamic physician and businesswoman onstage had some sort of early-onset dementia. Dementia seems a particularly popular subject, in fact. Intrinsically dramatic, it suffuses the Mosley novel and Alice LaPlante’s “Turn of Mind,” and some of my favorite movies about aging, “Away From Her,” “Iris” and “The Savages.”

“Kings Point,” Sari Gilman’s compelling documentary about a retirement community in Florida where nobody seemed to expect to grow old, just won an Oscar nomination for best short-subject documentary and will be shown on HBO in March. And “Amour,” which won the Palme d’Or at Cannes, is up for five Academy Awards, including best picture, best director and a best actress nomination for the 85-year-old Ms. Riva. (Academy voters: Just give it to her.)

A number of these artists, Mr. Haneke included, have spoken about their own experiences with aged relatives. Perhaps, as the population ages and more people confront the consequences, the stories our culture tells itself have evolved to include more old people, more caregivers. Or maybe I just want that to be true.

“Do not go see this,” my movie-going buddy had been warned, probably because her mother has dementia and friends who had seen the film wanted to spare her. I know some people found “Amour” too slow-paced or claustrophobic — like many elderly couples’ lives, it basically takes place in four rooms — or too grim. (If you’ve seen it, tell us what you thought.)

If you’re a full-time caregiver or you’re coping with a relative with dementia, perhaps you would prefer to spend your 2 hours 7 minutes of precious time off watching something funny. Escapism has its virtues.

But I found “Amour” unflinching and provocative and beautiful.

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

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DealBook: At Davos, Crisis Is the New Normal

DAVOS, Switzerland — In certain ways, the very setting of the World Economic Forum reflects the restless, challenged state of human affairs. Our footing is uncertain, as on this ski resort’s slithery streets, and we have steep slopes to climb, as the Magic Mountain will remind the global elite this week.

Barely into 2013, Mali and Algeria are new sites of hot war and chilling fear. Where the tumult that began in the Arab Spring will end is still as unclear as when it erupted — far from Davos — two years ago.

The challenge posed by the free flow of information in China went to the New Year streets in Guangzhou. Washington’s feuding politicians walked up to the brink before resolving not to jump off the so-called fiscal cliff. Europe seems to have averted a collapse of the euro, but even in Germany, growth is anemic.

Crisis, in short, is the new normal.

And while the business community determinedly seeks opportunity in troubled times, even many an entrepreneur views the years since the financial crisis of 2008 as what Rich Lesser, the new chief executive of the Boston Consulting Group, called “a higher period of turbulence and uncertainty in the global economy than we have experienced in a very long time.”

The days in which “quants” and algorithms reigned supreme are gone, their increasingly untrackable results having helped the financial system spin out of control in 2008 and 2009. The heady triumph of capitalism after 1989 is also a distant memory, although its chief effect — that capital went global — remains a driving force of our age.

But global capital does not solve big world issues: debt and financial crisis, political paralysis or gridlock, the transformative effects of the digital revolution, climate change, resource shortages, shifting demographics.

For those tasks, we must rely either on the nation state — an aging collective unit that does not readily serve transnational action — or on international institutions whose effectiveness is regularly questioned by the Davos crowd.

“The global economy has integrated, but global society is as fragmented as ever,” said Dennis J. Snower, president of the Kiel Institute for the World Economy.

In that fragmentation, there is an increasing lack of consensus about the global way forward. A few years ago, the inexorable rise of China led to talk of a new Beijing consensus, replacing the Washington consensus that epitomized the confident domination of the United States.

But China, while still growing, is growing less fast. It remains a one-party state, and its advance has arguably resulted more from enormous investment than creative increases in productivity. The challenges to its new leadership are clear: the need for financial reform; the perils of shadow banking and corruption; thick urban pollution; and, above all, the free flow of information, as seen in the standoff this month between a state censor in Guangzhou and journalists at the Southern Weekend and their supporters.

Ian Bremmer, head of the Eurasia Group political consulting firm, who in general sees a big return of politics in business calculations as the world becomes permanently restless, likened China to a large car that is racing toward a brick wall, “and we don’t know if they have steering” to skirt the obstacle, or whether they will hit it.

“As China grows wealthier,” he said in an interview, “entrenched Chinese will see the benefit of the rule of law” — a key element of the Washington consensus. But “the new leadership is not anywhere near there.”

For Yasheng Huang, a professor at the Sloan School of Management at the Massachusetts Institute of Technology, the saving grace of the incoming president, Xi Jinping, and his colleagues is that they are pragmatists. Pragmatism, he argued in an interview by phone, “means that you weigh the costs and benefits of certain actions.” It “checks the ideology.”

Yet even as China helps to sustain international growth — where would Europe’s purveyors of luxury be without the eager Chinese consumer? — it remains, like other emerging countries, self-absorbed.

“Look at the big debates of the last five years,” said Minxin Pei, like Mr. Huang a Chinese-born academic, who teaches at Claremont McKenna College in California. “It’s very hard to find one that originated in Beijing. People talk about China outside China, but still the country is very inward-looking.” This also feeds rising nationalism seen most markedly in the escalating dispute between China and Japan in the East China Sea.

As with China, so with Russia, India and Brazil, or indeed South Africa, Nigeria, Indonesia and other favorites of those who seek bright spots on a gloomy globe. In Brazil, “everything is focused on being Brazilian, how great it is,” noted Misha Glenny, a British analyst who has written on global mafias, cybercrime and is now working on a book about Brazil.

In these countries, absorbed in their own material advances and increasingly wary of a Washington-made prescription for their future, the “fiscal cliff” and debate about the limit on the United States deficit serve as proof that they are on the right path, though critics might dispute it.

“On the whole, we made a recovery from the crisis even faster than other countries,” President Vladimir V. Putin of Russia told a news conference last month. “Just look at the recession in Europe, while Russia has posted growth, albeit a modest one, but we still have a much better situation than in the once-prosperous euro zone, or even in the United States.”

In the United States, recent books have argued that the country’s status as a debtor nation is curbing its global reach. After the last-minute fiscal deal this month, a commentary of the kind believed to reflect high government thinking on the state-run Chinese news agency Xinhua noted tartly: “The American people were once better known for their ability to make tough choices on difficult issues.” It went on, “The Americans may be proud of their mature democracy, but the political gridlock in Washington really looks ugly from an outsider’s view.”

One example of how nations in transition are going their own way is Egypt, where President Mohamed Morsi seems to seek a geopolitical mix: a dose of Turkey, an Islamist-leaning democracy, with much-needed financial aid from China, and relations with Washington warm enough to garner more aid and collaborate on diplomacy like mediating the Israeli-Palestinian fighting over the Gaza Strip last November.

The fluid nature of this world is enhanced by digital communication. With the collapse in newspaper readership and the spread of social media, “everyone gets little snippets of information, and never fully understands the implications,” Mr. Glenny noted. “Very few people do deeper reading and thinking.”

This, he argued, increases people’s sense that “everything has just become too big to grasp and understand.”

A crucial topic for the dozen or so analysts interviewed for this article, and central also to discussions of increasingly important trends like the global rise of women, is education. Instead of machines being in charge, a nimble human mind, connecting individuals with collective wisdom, is seen as the antidote to cacophony, poverty and chaos.

In this view, more and better schooling will help lift hundreds of millions out of poverty, make it easier for populations to cope with change and stimulate the kind of innovation that Mr. Lesser sees already in technology, medicine and health care.

What kind of education is a topic that will be much debated at Davos, to judge from several scheduled sessions on disruptive universities and the like.

“We need government to recognize the need to build the next-gen work force,” Mr. Lesser said. This is “fundamental to staying competitive in the future,” he said. “The challenge goes beyond education. It’s also about good immigration policies.” In this way, he argued, a country facing demographic challenges — Germans, according to a government survey released last week, are the most childless adults in Europe — may preserve wealth and adapt to the future.

Whether by increasing online courses, interacting with students or raising the relatively dismal level of numeracy and literacy among American high school graduates, improving education “is one of the few things I can be unguardedly optimistic about,” said Niall Ferguson, the Harvard University historian. “The solutions are relatively cheap, simple and to hand.”

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With Obama fundraising, Latinos demonstrate growing clout

WASHINGTON — Cecilia Soto-Loftus, co-founder of a Malibu party services company, was new to presidential politics when she started raising money for President Obama's reelection bid last year.

After pulling in more than $400,000, she is getting the red carpet treatment at this weekend's inaugural festivities, with invitations to a strategy briefing for top fundraisers, a VIP candlelight reception and the official inaugural ball.

The special access reflects the unusual role Soto-Loftus and other Latino fundraisers played in Obama's 2012 campaign, the first to focus on tapping Latino celebrities, lawyers, business owners and community leaders for cash. The effort, called the Futuro Fund, aimed to raise $6 million — and brought in more than $30 million.

"It really sent a strong message that we shouldn't be overlooked," said Soto-Loftus, a Boyle Heights native who hopes to be considered for an ambassadorship, perhaps to Costa Rica or the Bahamas. "And I think we have only hit the tip of the iceberg."

Though $30 million was a small slice of Obama's record $1.1-billion haul, the Futuro Fund inducted a new cohort of donors into national politics, and created a Latino fundraising network that other politicians are clamoring to access. Most importantly, the group's work demonstrated the growing clout of Latinos beyond the ballot box.

"This is practically the final frontier in terms of what we need to be doing as political players in this country," said Arturo Vargas, executive director of the National Assn. of Latino Elected and Appointed Officials. "We've had the elected officials. We've had the activists. We've had the voters. And now we have the donors."

Democrats are using the inauguration to cement ties with the new class of donors.

Obama named actress Eva Longoria, a co-founder of the Futuro Fund, as co-chairwoman of his inaugural committee. And on Sunday night, Vice President Joe Biden made a surprise appearance at a gala performance of legendary Latino artists including Jose Feliciano, Rita Moreno and Chita Rivera that Longoria hosted at the Kennedy Center. The event was the culmination of Latino Inaugural 2013, a three-day celebration organized by the Futuro Fund.

"In this election, you spoke in a way that the world — and I mean the world, as well as the United States — could not fail to hear," Biden said as he thanked the black-tie crowd.

The proximity to power has given Latino fundraisers a new avenue to push their policy agenda. During the campaign, Longoria and others pressed Obama to overhaul immigration laws. Now they aim to continue advocating for immigration reform, for more Latinos in the administration, and for a host of other issues.

"We're going to be able to have influence on what affects our communities, whether it's the economy or jobs or education or healthcare," Longoria said before taking the stage Sunday night.

"The work begins now," noted Henry R. Muñoz III, owner of a San Antonio architecture firm. "It's all about how we harness and leverage what we have been able to achieve."

He and Longoria started the fund with San Juan lawyer Andres Lopez, an early backer of Obama who was frustrated when few other Latino fundraisers participated in the 2008 campaign. "We hadn't shown our financial muscle and hadn't earned the respect at that very important table we thought we could earn," Lopez said.

In mid-2011, the trio made their pitch to Obama campaign manager Jim Messina and finance chairman Matthew Barzun during a meeting in Chicago: Make time for us on the president's fundraising schedule, and we will bring in money.

"We originally offered [to raise] $6 million, and they said, 'Do you think you can do 12?' And we said, 'We'll try,'" Muñoz recalled.

A large share came at high-dollar events, such as a fundraiser Obama headlined at the Los Angeles home of actors Antonio Banderas and Melanie Griffith. But organizers also worked the phones. Concern about the GOP presidential challengers, who quarreled in the primaries over who would be tougher on illegal immigrants, helped spur contributions.

Latino donors "just didn't feel that the Republicans even understood their point of view," Lopez said. "And frankly, a lot of them said, 'I've never been asked,' which was our hunch."

Alex Nava, a 36-year-old commercial litigation lawyer in San Antonio, had given a few hundred dollars to Obama's 2008 campaign. He felt little incentive to give more, he said, because "any money I gave would be lost in the larger shuffle."

Then Muñoz called and explained how they hoped to demonstrate Latino fundraising power.

"I wanted to be part of that," said Nava, who donated the $5,000 maximum to the 2012 campaign.

A similar sentiment motivated Amalia Perea Mahoney, a 59-year-old art gallery owner in Chicago. Mahoney volunteered for Obama's campaign in 2008, but had never raised money. That changed after she attended a Futuro Fund briefing at Obama headquarters.

"I thought it was a great tool to get the Latinos a seat at the table," said Mahoney, who ultimately brought in between $200,000 and $500,000.

Some of the wooing was done by Obama, who met with about 20 prominent Latinos at a Washington hotel in early 2012.

"We felt part of the process, not just on the bleachers watching," said Ralph Patino, a 55-year-old trial lawyer in Coral Gables, Fla. He now has a photo of Obama with the group displayed in his law firm.

He and his wife, Elizabeth, gave more than $150,000 to the campaign and the Democratic Party, along with nearly $10,000 to the inaugural committee. They were among top donors who met the president and first lady, as well as Biden and his wife, at the White House on Friday.

Elizabeth Patino, a 37-year-old lawyer, said she was now contemplating jumping into politics, perhaps running for city commissioner this spring.

"I didn't know that I had this piece in me that really likes the political world," she said. "I was always somewhat afraid of it. But seeing how Latinos could come together and make such a great impact on a national level — it's just intoxicating."

matea.gold@latimes.com

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A 'Courage Board' for All Conditions

Rating: 9/10 Nearly flawless; buy it now

It’s easy to guess what The Hovercraft was built for just by looking at it: The short swallowtail and the big blunted nose all scream “powder hound.”

I did my first series of tests in early December up in Lake Tahoe, and there was a lot more crust, ice and grooms than powder, so I took it out without expecting much. I got waaay more than I figured I would: The board held its edge just fine in the groomers, but there was no surprise there. The shock came when I crossed over to the shaded side of the mountain, when the soft groomers turned into icy crud. I was fully expecting the Jones to sketch out and leave me butt-checking all over the place, but The Hovercraft’s edge sliced right into the ice and held it as well as it did the soft stuff. No transition, no adjustments — the board just went from soft snow to ice without skipping a beat.

It was so odd that it took me most of the morning before I really trusted it. But by lunchtime, I was flying down the mountain at speeds I wouldn’t dare with any of the other boards we tested. The board’s great bite is thanks to the Jones’ underfoot camber and so-called Magne-Traction edges, which essentially act like a serrated blade to bite into hard snow. These features combine to give the board a huge amount of precision and control in hard snow.

A few weeks later, I was finally able to take it out on Mt. Shasta’s backcountry to hit some deep stuff. It excelled there as well (entirely as expected) thanks to the rockered and blunted nose, which let the board float on top of the soft stuff, while the short, stiff tail made it easy to kick back and keep the nose up.

Bottom line: I’ve never seen a board perform so well in such a wide range of snow conditions. During my multi-mountain testing session of The Hovercraft snowboard, I let one of my friends ride it. He echoed my own thoughts with one simple statement: “This thing just does whatever you ask it to do.”

WIRED Simply some of the best all-mountain performance I’ve seen. Great float on powder, plus a locked-in grip on ice and crud. Seamlessly transitions from soft to hard snow. Shockingly lightweight construction.

TIRED Blunt nose and swallowtail design means you’re not gonna be riding a lot of switch.

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Legend, 2 Chainz, MC Lyte honored at Hip-Hop Ball

WASHINGTON (AP) — John Legend believes hip-hop played its part in helping Barack Obama become president, and he’s proud at how the genre has matured over the years.

“I think hip-hop had a role in making sure we elected a black president in America because we made it so that black people were in people’s homes … through our music and through our culture,” the R&B crooner said Sunday night at the Hip-Hop Inaugural Ball.

“I think it made Barack Obama and more people like him possible, so I’m really thankful for hip-hop and the role it plays in society,” he continued.

Legend was awarded the humanitarian award at Sunday’s event, and it was one of many honors handed out at the Harman Center for Arts.

Hip-hop pioneers MC Lyte and Doug E. Fresh were both given lifetime achievement awards. Fresh even hit the stage, beat boxing while comedian-actor-singer Wayne Brady cooed Marvin Gaye’s “What’s Going On?” At one point, Brady even busted out his own rhymes.

Rapper Yo Yo earned a roaring cheer when she hit the stage to honor MC Lyte; Lil Mama also paid tribute to the “Ruffneck” rapper.

2 Chainz, who had a breakthrough year with his Grammy-nominated solo debut and multiple rap hits, earned the street soldier award for encouraging young voters as a spokesperson for the Hip-Hop Caucus’ “Respect My Vote!” campaign.

“Doing my thing on the charts is one thing, but to be getting honored on another avenue, it just feels like a blessing,” he said in an interview. “I’m keeping my head leveled and staying humble.”

Actress Rosario Dawson won the vanguard award for her work as chairman of the Voto Latino organization.

“It’s time to step out of the shadows. It’s time to not just be talked about by other people, it’s time to take the leadership ourselves and that first step of leadership is voting,” Dawson said of the importance of the Latino vote.

Rappers Swizz Beatz and Meek Mill also earned honors at the event, attended by a few hundred hip-hop fans, including model Tyson Beckford, former NBA star Dikembe Mutumbo and Victor Cruz of the New York Giants. La La Anthony and Terrence J hosted the ball.

British singer Marsha Ambrosius also delivered a rousing performance, and playful jokes about Obama.

“I got a call from the president and he asked me to perform his favorite song,” she said before singing the R&B jam “Hope She Cheats on You (With a Basketball Player).”

Then she sang “Butterflies,” a song she co-wrote for Michael Jackson’s 2001 “Invincible” album.

“This might have been his favorite,” she said.

___

Follow Mesfin Fekadu on Twitter at http://twitter.com/MusicMesfin

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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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How M.I.T. Ensnared a Hacker, Bucking a Freewheeling Culture

Months earlier, the mysterious visitor had used the school’s computer network to begin copying millions of research articles belonging to Jstor, the nonprofit organization that sells subscription access to universities.

The visitor was clever — switching identifications to avoid being blocked by M.I.T.’s security system — but eventually the university believed it had shut down the intrusion, then spent weeks reassuring furious officials at Jstor that the downloading had been stopped.

However, on Jan. 3, 2011, according to internal M.I.T. documents obtained by The New York Times, the university was informed that the intruder was back — this time downloading documents very slowly, with a new method of access, so as not to alert the university’s security experts.

“The user was now not using any of the typical methods to access MITnet to avoid all usual methods of being disabled,” concluded Mike Halsall, a senior security analyst at M.I.T., referring to the university’s computer network.

What the university officials did not know at the time was that the intruder was Aaron Swartz, one of the shining lights of the technology world and a leading advocate for open access to information, with a fellowship down the road at Harvard.

Mr. Swartz’s actions presented M.I.T. with a crucial choice: the university could try to plug the weak spot in its network or it could try to catch the hacker, then unknown.

The decision — to treat the downloading as a continuing crime to be investigated rather than a security threat that had been stopped — led to a two-day cat-and-mouse game with Mr. Swartz and, ultimately, to charges of computer and wire fraud. Mr. Swartz, 26, who faced a potentially lengthy prison term and whose trial was to begin in April, was found dead of an apparent suicide in his Brooklyn apartment on Jan. 11.

Mr. Swartz’s supporters called M.I.T.’s decision a striking step for an institution that prides itself on operating an open computer network and open campus — the home of a freewheeling programming culture. M.I.T.’s defenders viewed the intrusion as a computer crime that needed to be taken seriously.

M.I.T. declined to confirm any of these details or comment on its actions during the investigation. The university’s president, L. Rafael Reif, said last week, “It pains me to think that M.I.T. played any role in a series of events that have ended in tragedy.” He appointed a professor, Hal Abelson, to analyze M.I.T.’s conduct in the investigation. To comment now, a spokeswoman for the university said, would be “to get ahead of that analysis.”

Early on Jan. 4, at 8:08 a.m., according to Mr. Halsall’s detailed internal timeline of the events, a security expert was able to locate that new method of access precisely — the wiring in a network closet in the basement of Building 16, a nondescript rectangular structure full of classrooms and labs that, like many buildings on campus, is kept unlocked.

In the closet, Mr. Halsall wrote, there was a netbook, or small portable computer, “hidden under a box,” connected to an external hard drive that was receiving the downloaded documents.

At 9:44 a.m. the M.I.T. police were called in; by 10:30 a.m., the Cambridge police were en route, and by 11 a.m., Michael Pickett, a Secret Service agent and expert on computer crime, was on the scene. On his recommendation, a surveillance camera was installed in the closet and a second laptop was connected to the network switch to track the traffic.

There may have been a reason for the university’s response. According to the timeline, the tech team detected brief activity from China on the netbook — something that occurs all the time but still represents potential trouble.

E-mails among M.I.T. officials that Tuesday in January 2011 highlight the pressures university officials felt over a problem they thought they had solved. Ann J. Wolpert, the director of libraries, wrote to Ellen Finnie Duranceau, the official who was receiving Jstor’s complaints: “Has there ever been a situation similar to this when we brought in campus police? The magnitude, systematic and careful nature of the abuses could be construed as approaching criminal action. Certainly, that’s how Jstor views it.”

Some of Mr. Swartz’s defenders argue that collecting and providing evidence to the government without a warrant may have violated federal and state wiretapping statutes.

John Schwartz contributed reporting.

This article has been revised to reflect the following correction:

Correction: January 21, 2013

An earlier version of this article misquoted part of statement by a spokeswoman for the Massachusetts Institute of Technology. Referring to a review of M.I.T.’s conduct that was commissioned by the university’s president, she said to comment now on the events surrounding Aaron Swartz’s arrest would be “to get ahead of that analysis,” not “to get ahead of that investigation.” 

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U.S., other nations await Algeria death toll

CAIRO—

The U.S., Britain and other countries sought to learn the fate of their citizens Sunday after Algeria announced that the death toll from a hostage crisis at a remote gas refinery was expected to rise beyond a previous estimate of 23.

It was another painstaking day for security officials trying to determine how a band of Islamist militants overran the gas complex last week, and for families and nations awaiting word of new deaths. Britain confirmed that three of its citizens were killed and three are unaccounted for.

Algerian officials said security teams defusing mines and booby-trap explosives at the Sahara desert site had found “numerous” bodies, according to the Associated Press. Algerian communications minister Mohamed Said Belaid was quoted by the state news agency as saying: "I am afraid unfortunately to say that the death toll will go up."

As many as seven U.S. hostages are missing, along with about 14 Japanese. Other captives included Norwegians, Malaysians and French. Algerian officials said a final death count would be released in the coming hours.

Nearly 700 Algerians and 107 foreigners had been freed or had escaped from the gas field in eastern Algeria during the four-day, bloody ordeal that ended Saturday. Officials said at least 23 hostages and 32 militants had been killed. But discrepancies remained over the nationalities of the dead and the exact number of those who died.

“The priority now must be to get everybody home from Algeria," said British Prime Minister David Cameron. "This is a stark reminder once again of the threat we face from terrorism the world over. We have had successes in recent years in reducing the threat from some parts of the world, but the threat has grown particularly in northern Africa.”

Cameron, who had earlier appeared irritated that the Algerians did not inform foreign capitals before troops first stormed the refinery Thursday, tempered his criticism.

"People will ask questions about the Algerian response to these events,” he said. “But I would just say that the responsibility for these deaths lies squarely with the terrorists who launched this vicious and cowardly attack. And I'd also say that when you’re dealing with a terrorist incident on this scale, with up to 30 terrorists, it is extremely difficult to respond and to get this right in every respect.”

 The natural gas complex at In Amenas -- near the Libyan border -- is operated by BP, Statoil and Sonatrach, the Algerian national oil company. BP said four of its employees were missing.

Militants linked to Al Qaeda in the Islamic Maghreb raided the facility before dawn  Wednesday. They claimed it was to avenge French airstrikes on Islamic rebels in neighboring Mali. But officials from the U.S. and other countries indicated the attack was planned ahead of this month’s French military action. 

Belaid said the militants were "nationals of Arab and African countries, and of non-African countries."

jeffrey.fleishman@latimes.com

(Times staff writer Henry Chu in London contributed to this report)   

 

 

 

 

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Wired Science Space Photo of the Day: Soap Bubble Nebula

Informally known as the "Soap Bubble Nebula", this planetary nebula (officially known as PN G75.5+1.7) was discovered by amateur astronomer Dave Jurasevich on July 6th, 2008. It was noted and reported by Keith Quattrocchi and Mel Helm on July 17th, 2008. This image was obtained with the Kitt Peak Mayall 4-meter telescope on June 19th, 2009 in the H-alpha (orange) and [OIII] (blue) narrowband filters. In this image, north is to the left and east is down.

PN G75.5+1.7 is located in the constellation of Cygnus, not far from the Crescent Nebula (NGC 6888). It is embedded in a diffuse nebula which, in conjunction with its faintness, is the reason it was not discovered until recently. The spherical symmetry of the shell is remarkable, making it very similar to Abell 39.

Image: T. A. Rector/University of Alaska Anchorage, H. Schweiker/WIYN and NOAO/AURA/NSF [high-resolution] Read NOAO Conditions of Use before downloading

Caption: NOAO

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