Antismoking Outlays Drop Despite Tobacco Revenue

Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.

Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.

States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.

The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.

“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.

Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.

Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.

The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.

The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.

Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.

“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”

Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.

The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.

An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.

Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.

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Antismoking Outlays Drop Despite Tobacco Revenue

Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.

Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.

States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.

The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.

“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.

Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.

Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.

The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.

The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.

Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.

“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”

Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.

The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.

An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.

Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.

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Typhoon Said to Have Killed Hundreds in Philippines

Erik De Castro/Reuters

Residents transported the body of victim in the southern Philippines on Wednesday.

MANILA —Rescue teams were trying to reach isolated villages in the southern Philippines on Wednesday after a powerful out-of-season typhoon tore through the region, leaving more than 270 people dead, officials said.

NASA

Typhoon Bopha moved toward the Philippines on Monday.

Karlos Manlupig/Associated Press

Relatives mourned in New Bataan on Wednesday.

Karlos Manlupig/Associated Press

Residents assessed the damage to their homes on the southern Philippine island of Mindanao on Tuesday after a typhoon struck.

Typhoon Bopha packed winds of up to 100 miles per hour when it struck Tuesday, bringing torrential rains that flattened entire villages, leaving thousands homeless, as well as washing out roads and bridges needed by rescue personnel trying to reach stricken regions.

A national disaster official, Benito Ramos, said at a news conference Wednesday afternoon that 274 deaths had been confirmed, with 339 people known to be injured and 279 missing.

The storm was weakening and leaving the Philippines on Wednesday. The Philippines is hit by more than 20 powerful tropical storms per year, but Bopha struck remote communities off the usual storm path that are not accustomed to such strong typhoons.

In December of last year, Tropical Storm Washi killed more than 1,200 people and left hundreds of thousands homeless. Officials this year called for mandatory early evacuations of vulnerable communities.

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Gadgetwise Blog: Q&A: Changing a PC's Start-up Routine

I installed the Windows 8 preview on an old laptop, but now the computer won’t start up unless I have the DVD in the drive. Help!

When you installed the Windows 8 software on the computer from the DVD, the system may have been switched to start up from the disc drive instead of the hard drive, and never switched back. Unless the hard drive is damaged, you can usually fix this by adjusting a setting in the computer’s BIOS — Basic Input/Output System, a bit of software built into the hardware.

To do so, restart the PC and watch the screen for information about which key to press to change the normal start-up routine or adjust the BIOS. This key varies by manufacturer, but it is often the F2, F8, F10 or the Delete key; your computer’s manual should have instructions.

Once you press the key and land on the text-based BIOS Setup Utility screen, use the keyboard’s right arrow key to move to the Boot menu. Use the down arrow key to get to the Boot Device Priority area and hit the Enter key. Here, you can change the first boot device from the disc drive to the hard drive. Select the option from the on-screen menu to save the setting and exit the BIOS Setup Utility. The computer should now start up from the hard drive and not require the DVD in the disc drive.

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The New Old Age Blog: For the Old, Less Sense of Whom to Trust

There’s a reason so many older people fall for financial scams, new research suggests. They don’t respond as readily to visual cues that suggest a person might be untrustworthy, and their brains don’t send out as many warning signals that ignite a danger ahead gut response.

The research, published Monday in the Proceedings of the National Academy of Sciences, is the first to show that older adults’ vulnerability to fraud may be rooted in age-related neurological changes.

Specifically, researchers from the University of California, Los Angeles, found that an area in the brain known as the anterior insula was muted when older people looked at photographs of suspicious-looking individuals. This part of the brain activates gut-level feelings that help individuals interpret the reliability of other people and assess potential risks and rewards associated with social interactions.

In one part of the U.C.L.A. study, both younger and older adults were asked to evaluate the trustworthiness of people portrayed in 60 photographs while undergoing brain scans. When the younger adults (21 altogether, from 23 to 46 years of age) labeled a person “not trustworthy,” their anterior insulas lit up. But this wasn’t true for older adults (23 altogether, age 55 to 80).

“The warning signals that convey a sense of potential danger to younger adults just don’t seem to be there for older adults,” said Shelley Taylor, the lead researcher and a psychology professor at U.C.L.A.

In another part of the study, researchers asked 119 older adults (55 to 84 years old) and 24 younger adults (age 20 to 42) to rate people in photographs as trustworthy, neutral or untrustworthy. Signs they were potentially untrustworthy included people with insincere smiles, averted gazes and postures that “leaned away” rather than toward the camera, among others, Dr. Taylor said.

Older adults were equally adept at identifying people judged to be trustworthy or neutral, but much more likely to miss signs of those who may be untrustworthy and view suspicious-looking people as approachable, the study found.

“We believe what’s going on is that older adults have a bias toward positive emotional experience and this keeps them from recognizing negative cues,” Dr. Taylor said.

This so-called “positivity effect” has been documented through research by Laura Carstensen, a professor of psychology and public policy at Stanford University, and it explains why older adults are, on the whole, happier than younger adults.

Asked to comment about the new study, Ms. Carstensen said in an e-mail that it was “very well done,” and observed that for older adults, “there are likely many benefits of looking on the bright side. However, there are likely some contexts where looking away from the negative and focusing on the positive is not good,” including financial scams and fraud.

Alexander Todorov, a professor of psychology at Princeton University, called the findings “interesting,” but warned that “there is an implicit assumption that these trustworthiness evaluations based on facial appearance are accurate. This is far from clear.”

Dr. Taylor became acutely aware of financial fraud practiced on the elderly almost 20 years ago when her elderly father handed $17,000 to two men who approached him on the street and walked with him to his bank.

“I got descriptions of the two men from someone who lived nearby — one had few teeth, both were dressed in a slovenly manner, and they’d been seen sleeping in doorways and were using the drug rehab center nearby,” the professor explained in an e-mail.

In other words, they would have been viewed skeptically by most people, but weren’t seen in that light by Dr. Taylor’s father.

Statistics show that financial exploitation of the elderly is on the rise. According to a study published last year by the MetLife Mature Market Institute and the National Committee for the Prevention of Elder Abuse, elder financial abuse — everything from fraudulent sweepstakes to bank accounts emptied out by guardians — totaled $2.9 billion in 2010, a 12 percent increase from only two years before.

Earlier this year, the Government Accountability Office weighed in on the issue, noting the inadequacy of existing safeguards and calling for a new national strategy to address the problem.

On Tuesday my colleague Paula Span wrote about a just-published consumer guide, “Protect Your Pocketbook,” intended for older adults and families who wanted to understand what put them at risk, how to prevent fraud, and where to turn for help.

As for Dr. Taylor, she advises that seniors never agree on the spot to a phone offer or a pitch from a door-to-door salesman. “Either hang up or wait and get someone else involved in your life to evaluate what’s being presented,” she said.

With financial fraud, almost half the time seniors end up being taken in by a caretaker or someone posing as a friend. “Make absolutely sure that you’ve carefully checked out the people taking care of an older relative,” or any “surprising new friend” that you’ve never heard of before that’s now on the scene, she tells family members.

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The New Old Age Blog: For the Old, Less Sense of Whom to Trust

There’s a reason so many older people fall for financial scams, new research suggests. They don’t respond as readily to visual cues that suggest a person might be untrustworthy, and their brains don’t send out as many warning signals that ignite a danger ahead gut response.

The research, published Monday in the Proceedings of the National Academy of Sciences, is the first to show that older adults’ vulnerability to fraud may be rooted in age-related neurological changes.

Specifically, researchers from the University of California, Los Angeles, found that an area in the brain known as the anterior insula was muted when older people looked at photographs of suspicious-looking individuals. This part of the brain activates gut-level feelings that help individuals interpret the reliability of other people and assess potential risks and rewards associated with social interactions.

In one part of the U.C.L.A. study, both younger and older adults were asked to evaluate the trustworthiness of people portrayed in 60 photographs while undergoing brain scans. When the younger adults (21 altogether, from 23 to 46 years of age) labeled a person “not trustworthy,” their anterior insulas lit up. But this wasn’t true for older adults (23 altogether, age 55 to 80).

“The warning signals that convey a sense of potential danger to younger adults just don’t seem to be there for older adults,” said Shelley Taylor, the lead researcher and a psychology professor at U.C.L.A.

In another part of the study, researchers asked 119 older adults (55 to 84 years old) and 24 younger adults (age 20 to 42) to rate people in photographs as trustworthy, neutral or untrustworthy. Signs they were potentially untrustworthy included people with insincere smiles, averted gazes and postures that “leaned away” rather than toward the camera, among others, Dr. Taylor said.

Older adults were equally adept at identifying people judged to be trustworthy or neutral, but much more likely to miss signs of those who may be untrustworthy and view suspicious-looking people as approachable, the study found.

“We believe what’s going on is that older adults have a bias toward positive emotional experience and this keeps them from recognizing negative cues,” Dr. Taylor said.

This so-called “positivity effect” has been documented through research by Laura Carstensen, a professor of psychology and public policy at Stanford University, and it explains why older adults are, on the whole, happier than younger adults.

Asked to comment about the new study, Ms. Carstensen said in an e-mail that it was “very well done,” and observed that for older adults, “there are likely many benefits of looking on the bright side. However, there are likely some contexts where looking away from the negative and focusing on the positive is not good,” including financial scams and fraud.

Alexander Todorov, a professor of psychology at Princeton University, called the findings “interesting,” but warned that “there is an implicit assumption that these trustworthiness evaluations based on facial appearance are accurate. This is far from clear.”

Dr. Taylor became acutely aware of financial fraud practiced on the elderly almost 20 years ago when her elderly father handed $17,000 to two men who approached him on the street and walked with him to his bank.

“I got descriptions of the two men from someone who lived nearby — one had few teeth, both were dressed in a slovenly manner, and they’d been seen sleeping in doorways and were using the drug rehab center nearby,” the professor explained in an e-mail.

In other words, they would have been viewed skeptically by most people, but weren’t seen in that light by Dr. Taylor’s father.

Statistics show that financial exploitation of the elderly is on the rise. According to a study published last year by the MetLife Mature Market Institute and the National Committee for the Prevention of Elder Abuse, elder financial abuse — everything from fraudulent sweepstakes to bank accounts emptied out by guardians — totaled $2.9 billion in 2010, a 12 percent increase from only two years before.

Earlier this year, the Government Accountability Office weighed in on the issue, noting the inadequacy of existing safeguards and calling for a new national strategy to address the problem.

On Tuesday my colleague Paula Span wrote about a just-published consumer guide, “Protect Your Pocketbook,” intended for older adults and families who wanted to understand what put them at risk, how to prevent fraud, and where to turn for help.

As for Dr. Taylor, she advises that seniors never agree on the spot to a phone offer or a pitch from a door-to-door salesman. “Either hang up or wait and get someone else involved in your life to evaluate what’s being presented,” she said.

With financial fraud, almost half the time seniors end up being taken in by a caretaker or someone posing as a friend. “Make absolutely sure that you’ve carefully checked out the people taking care of an older relative,” or any “surprising new friend” that you’ve never heard of before that’s now on the scene, she tells family members.

Read More..

Free-Messaging Apps Siphon Profits from Cellular Providers

For a long time, opening a cellphone bill was scary for the parents of teenagers. Charges for texting could reach hundreds of dollars a month, prompting many families to sign up for unlimited plans. But at perhaps $20 a month for each family member, that quickly added up, too.

Lucas Jackson/Reuters

A man uses his Apple iPhone in New York in September. Cellphone users are sending more text messages than ever, but increasingly they are free — thanks to the Internet.

Apps like Facebook Messenger, top, and WhatsApp, bottom, send their messages using the Internet rather than cellular networks. The shift could cost wireless companies billions of dollars.

Relief is on the way. Cellphone users are sending more text messages than ever, but increasingly they are free — thanks to the Internet. While that is good news for consumers, it could cost the world’s wireless companies tens of billions of dollars in lost revenue.

Standard texting, the kind where you send abbreviation-filled messages over a cellphone network, has been in decline in many parts of the world, and now appears to be shrinking in the United States. That is because smartphones can use free Internet-powered services that send messages over data networks instead, and those services are attracting millions of users.

The shift is opening an opportunity for big companies like Facebook and Apple and smaller start-ups like WhatsApp and Kik, which are making aggressive grabs at this market, aiming to put themselves at the center of how people communicate in the smartphone era.

Peter Deng, a product director at Facebook who oversees its Messenger software, said that text messaging was “ripe for innovation” because it had been held back by outdated technology.

“It’s limited to 160 characters,” Mr. Deng said, “and it’s not at all rich in its expression. People want to connect deeply with each other, and they don’t want to be constrained by various technical boundaries and decisions made 20 years ago.”

Unlike ordinary text messages, Facebook’s messaging service allows people to see when their friends are typing a reply and when messages are received, among other features, he said.

Standard texting is still popular. CTIA, the wireless industry trade group, said that in the first half of this year, Americans sent 1.107 trillion text messages. But that was down 2.6 percent from the 1.137 trillion messages sent in the first half of last year. Ovum, a mobile communications research firm, estimates that by 2016, Internet-based message services will have eaten up $54 billion in revenue that carriers could have made from text messaging.

For years, text messages have been a source of pure profit for carriers because it costs nearly nothing to deliver them. In response to the rise of Internet services, they have been overhauling their pricing plans to stay profitable.

Verizon Wireless and AT&T, for example, offer new plans that include unlimited texting and phone calls, while charging bigger fees for using Internet data, which is likely to be their main source of growth. (Internet messaging over a carrier’s data network does use up some of a customer’s monthly data allotment, but it is a tiny amount relative to, say, watching a video.)

John Walls, vice president for public affairs at CTIA, said carriers were always expanding their services by offering things like all-you-can-eat texting plans and the ability to donate to charity via text. He noted that 72,000 text messages were being sent every second of every day.

“I hardly think the end is in sight for texts,” Mr. Walls said.

For Internet companies, messaging will never be a cash cow. But they have other reasons to get excited about this market.

Facebook benefits if more people use its messaging service, because those people are likely to spend more time on its Web site and mobile apps, seeing more ads. On Tuesday the company said it would allow Android users in some countries to sign up for its messaging service with just a phone number, no Facebook account required, partly because this might eventually persuade non-Facebook users to cave in and sign up for an account. That feature will come to the United States at some point, Facebook said.

Apple’s free texting service, iMessage, comes installed on iPhones, iPads and iPod Touch devices, where it automatically routes messages over the Internet if they are being sent to another Apple device. The service also works with the Messages app on Apple’s computers. That could encourage people to continue buying Apple products to keep in touch with family and friends cheaply and easily. Even the design of iMessage makes people feel like they’re in a special clique: an iMessage shows up on an Apple device as a blue bubble, while a normal text message from a non-Apple phone is green.

Perhaps the most talked-about player in texting right now is the small start-up WhatsApp, based in Mountain View, Calif. The 30-person company, founded by Jan Koum and Brian Acton, two former Yahoo executives, says its service is used in more than 100 countries. Its app is one of the most popular in the world on iPhones and Android devices, and on the BlackBerry it is even bigger than Research in Motion’s own messaging service.

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Assad Facing Setbacks as Syrian Capital Is Besieged

Narciso Contreras/Associated Press

A kitchen in a residence in Aleppo, Syria, damaged Sunday in fighting between Free Syrian Army fighters and government forces.

BEIRUT, Lebanon — Fierce fighting on the battlefield and setbacks on the diplomatic front increased pressure on the embattled Syrian government as fresh signs emerged on Tuesday of a sustained battle for control of the capital.

News reports quoted activists as saying fighting was raging in the southern suburbs of Damascus and near the international airport for a fifth straight day as government forces sought to dislodge rebels and reverse their recent gains.

While the government has superior firepower and rebels are reporting heavy losses, loyalist forces have been carrying out a serious counteroffensive in the suburbs without being able to subdue the insurgents.

The latest reports followed developments on Monday when a senior Turkish official said that Russia had agreed to a new diplomatic approach to seek ways to persuade President Bashar al-Assad to relinquish power, a possible weakening in Russia’s steadfast support for the government.

In Damascus, a prominent Foreign Ministry spokesman was said to have left the country amid reports of his defection, and both President Obama and Secretary of State Hillary Rodham Clinton issued warnings that any use of chemical weapons by a desperate government would be met with a strong international response. The NATO secretary general, Anders Fogh Rasmussen, echoed this warning on Tuesday.

“The possible use of chemical weapons would be completely unacceptable to the whole international community,” Mr. Rasmussen said, according to Agence France-Presse.

A Western diplomat confirmed that there were grave concerns in United States intelligence circles that Syrian leaders could resort to the use of the weapons as their position deteriorates.

The Syrian Foreign Ministry, repeating earlier statements, told state television that the government “would not use chemical weapons, if it had them, against its own people under any circumstances.”

The United Nations said it was withdrawing nonessential international staff from Syria, and the European Union said it was reducing activities in Damascus “to a minimum,” as security forces pummeled the suburbs with artillery and airstrikes in a struggle to seal off the city from its restive outskirts and control the airport road. A senior Russian official spoke for the first time in detail about the possibility of evacuating Russian citizens.

The United Nations World Food Program reported on Tuesday that “the recent escalation of violence in Syria is making it more difficult to reach the country’s hardest-hit areas.”

“Food insecurity is on the rise due to bread shortages and higher food prices in many parts of the country. High prices are also affecting neighboring countries hosting Syrian refugees,” the organization said in a statement.

“Road access to and from Damascus has become more dangerous, making it difficult to dispatch food from World Food Program warehouses to some parts of the country, the organization said, adding that there had been increasing indiscriminate attacks on its trucks in different parts of the country.

It also said it would relocate seven nonessential staff members to neighboring Jordan while about “20 international and 100 national W.F.P. staff remain in the country to carry out the emergency operation to feed 1.5 million vulnerable Syrians.” Mr. Assad has held on longer than many had predicted at the start of the 21-month uprising. He still has a strong military advantage and undiminished support from his closest ally, Iran. Military analysts doubt the rebels are capable of taking Damascus by force, and one fighter interviewed on Monday said the government counteroffensive was taking a heavy toll. There were still no firm indications from Russia that it was ready to join Turkey and Western nations in insisting on Mr. Assad’s immediate departure.

But the latest grim developments follow a week of events that suggested the Assad government was being forced to fight harder to keep its grip on power. Rebels threatened its vital control of the skies, using surface-to-air missiles to down a fighter plane and other aircraft. The opposition also gained control of strategic military bases and their arsenals, and forced the government to shut down the Damascus airport periodically. The Internet was off for two days.

A Russian political analyst with contacts at the Foreign Ministry said that “people sent by the Russian leadership” who had contact with Mr. Assad two weeks ago described a man who has lost all hope of victory or escape.

“His mood is that he will be killed anyway,” Fyodor Lukyanov, editor of a Russian foreign affairs journal and the head of an influential policy group, said in an interview in Moscow, adding that only an “extremely bold” diplomatic proposal could possibly convince Mr. Assad that he could leave power and survive.

“If he will try to go, to leave, to exit, he will be killed by his own people,” Mr. Lukyanov said, speculating that security forces dominated by Mr. Assad’s minority Alawite sect would not let him depart and leave them to face revenge. “If he stays, he will be killed by his opponents. He is in a trap. It is not about Russia or anybody else. It is about his physical survival.”

Anne Barnard reported from Beirut, Lebanon, and Ellen Barry from Moscow. Reporting was contributed by Alan Cowell in London, Sebnem Arsu in Istanbul, Peter Baker in Washington, Hwaida Saad, Neil MacFarquhar and Hania Mourtada in Beirut, and Christine Hauser in New York.

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Gadgetwise Blog: Q&A: Locking Up the Mac

I’m new to Macs. What is FileVault and do I need to use it?

FileVault is a data-security feature built into the Mac’s OS X operating system. With FileVault, you can encrypt the Mac’s hard drive to keep its contents locked up with a password, even if someone gets access to your computer. FileVault can also encrypt the data on external drives and can be used to completely erase the Mac’s hard drive when it comes time to recycle the computer.

As to whether you need to use FileVault, it depends on your personal need for file security and keeping your data confidential. You can get a better idea of how it might fit into your computing life from Apple’s current guide to the software on its site. Some versions of Windows include a similar feature, BitLocker.

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Software Programs Help Doctors Diagnose, but Can’t Replace Them

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

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