Divided U.S. Gives Obama More Time

Doug Mills/The New York Times

Americans voted to give President Obama a second chance to change Washington. More Photos »

Barack Hussein Obama was re-elected president of the United States on Tuesday, overcoming powerful economic headwinds, a lock-step resistance to his agenda by Republicans in Congress and an unprecedented torrent of advertising as a divided nation voted to give him more time.

In defeating Mitt Romney, the president carried Colorado, Iowa, Ohio, New Hampshire, Virginia and Wisconsin, a near sweep of the battleground states, and was holding a narrow advantage in Florida. The path to victory for Mr. Romney narrowed as the night wore along, with Mr. Obama winning at least 303 electoral votes.

A cheer of jubilation sounded at the Obama campaign headquarters in Chicago when the television networks began projecting him as the winner at 11:20 p.m., even as the ballots were still being counted in many states where voters had waited in line well into the night. The victory was far narrower than his historic election four years ago, but it was no less dramatic.

“Tonight in this election, you, the American people, reminded us that while our road has been hard, while our journey has been long, we have picked ourselves up, we have fought our way back,” Mr. Obama told his supporters early Wednesday. “We know in our hearts that for the United States of America, the best is yet to come.”

Mr. Obama’s re-election extended his place in history, carrying the tenure of the nation’s first black president into a second term. His path followed a pattern that has been an arc to his political career: faltering when he seemed to be at his strongest — the period before his first debate with Mr. Romney — before he redoubled his efforts to lift himself and his supporters to victory.

The evening was not without the drama that has come to mark so many recent elections: For more than 90 minutes after the networks projected Mr. Obama as the winner, Mr. Romney held off calling him to concede. And as the president waited to declare victory in Chicago, Mr. Romney’s aides were prepared to head to the airport, suitcases packed, potentially to contest several close results.

But as it became increasingly clear that no amount of contesting would bring him victory, he called Mr. Obama to concede shortly before 1 a.m.

“I wish all of them well, but particularly the president, the first lady and their daughters,” Mr. Romney told his supporters in Boston. “This is a time of great challenges for America, and I pray that the president will be successful in guiding our nation.”

Hispanics made up an important part of Mr. Obama’s winning coalition, preliminary exit poll data showed. And before the night was through, there were already recriminations from Republican moderates who said Mr. Romney had gone too far during the primaries in his statements against those here illegally, including his promise that his get-tough policies would cause some to “self-deport.”

Mr. Obama, 51, faces governing in a deeply divided country and a partisan-rich capital, where Republicans retained their majority in the House and Democrats kept their control of the Senate. His re-election offers him a second chance that will quickly be tested, given the rapidly escalating fiscal showdown.

For Mr. Obama, the result brings a ratification of his sweeping health care act, which Mr. Romney had vowed to repeal. The law will now continue on course toward nearly full implementation in 2014, promising to change significantly the way medical services are administrated nationwide.

Confident that the economy is finally on a true path toward stability, Mr. Obama and his aides have hinted that he would seek to tackle some of the grand but unrealized promises of his first campaign, including the sort of immigration overhaul that has eluded presidents of both parties for decades.

But he will be venturing back into a Congressional environment similar to that of his first term, with the Senate under the control of Democrats and the House under the control of Republicans, whose leaders have hinted that they will be no less likely to challenge him than they were during the last four years.

Michael Cooper contributed reporting.

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Move over, Obama; Twitter had a big night too

WASHINGTON (Reuters) - President Barack Obama called it - in less than 140 characters.

Around 11:15 pm EST, just as the networks were beginning to call the race in his favor, Obama took to Twitter to proclaim himself the winner over Republican candidate Mitt Romney.

"This happened because of you. Thank you," Obama tweeted.

That the president would take his message to Twitter before taking the stage in Chicago underscored the tremendous role social media platforms like Twitter played in the 2012 election.

Minutes later, with the race called in his favor, Obama tweeted again.

"We're all in this together. That's how we campaigned, and that's who we are. Thank you. -bo."

Through the course of a long and bitter presidential campaign, Twitter often served as the new first rough draft of history.

Top campaign aides used the Internet tool to snipe at each other, the candidates used it to get out their messages and political reporters used it to inform and entertain.

On Election Night, the tweets were flowing.

By 10 p.m. EST, with the race still up for grabs, Twitter announced it had broken records.

There were more than 31 million election-related tweets on Tuesday night, making Election Night "the most tweeted about event in U.S. political history," said Twitter spokeswoman Rachael Horwitz. Between 6 p.m. and midnight EST, there were more than 23 million tweets.

Horwitz noted the previous record was 10 million, during the first presidential debate on October 3.

"Twitter brought people closer to almost every aspect of the election this year," Horwitz said. "From breaking news, to sharing the experience of watching the debates, to interacting directly with the candidates, Twitter became a kind of nationwide caucus."

In the moments following Obama's win, Twitter was in a frenzy, with a peak of 327,000 tweets a minute.

Another tweet from Obama, one that read: "Four more years" and showed a picture of him hugging his wife, became the most retweeted tweet in the history of the site.

'FIRST TWITTER ELECTION'

Love it or hate it, Twitter and its role in politics appears to be here to stay.

For Rob Johnson, campaign manager for Texas Republican Governor Rick Perry's failed presidential run, Twitter "changed the dynamic this cycle and will continue to play a bigger role in years to come."

"We no longer click refresh on websites or wait for the paper boy to throw the news on our porch," Johnson said. "We go to Twitter and learn the facts before others read it."

The 2012 race was the first where Twitter played such an important role. Top campaign advisers like Romney's Eric Fehrnstrom and Obama's David Axelrod engaged in Twitter battles through the year.

With many political reporters and campaign staff on Twitter and Facebook, social media websites were often the first place news broke. Some top news stories were kept alive or thrust into the headlines after becoming hot topics on Twitter.

"It was one heckuva echo chamber," Dante Scala, a political science professor at the University of New Hampshire, said in an email.

Johnson said Twitter was the driving force behind some of the year's biggest political news stories.

"The twitterverse shapes the news and public opinion," Johnson said. "The Internet is truly a real and powerful tool in politics."

In future elections, candidates and their campaign staffs will have to include social media as another battleground, Democratic strategist Jamal Simmons said.

"This was the first Twitter election and social media is now fully a part of our election mechanics," Simmons said. "Going forward candidates must have an aggressive social media strategy if they want to win."

(Editing by Mary Milliken and Peter Cooney)

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Quiet media night explodes suddenly, Rove protests

NEW YORK (AP) — Careful media coverage of a close presidential election Tuesday exploded so suddenly Tuesday that it left the bizarre spectacle of Fox News Channel analyst Karl Rove, a major fundraiser for Republican Mitt Romney, publicly questioning his network's declaration that President Barack Obama had been re-elected.

ABC News was also frantically trying to repair a power outage that left much of its set inoperable precisely at the time the election was being decided.

For several hours, election coverage resembled the run-up to a Super Bowl, with plenty of talk signifying little. Then NBC News, at 11:12 p.m. ET, was the first to declare Obama had won by virtue of winning the battleground state of Ohio. "He remains president of the United States for a second term," said anchor Brian Williams.

Other networks followed suit, including Fox five minutes later. But Rove, the former top political aide to President George W. Bush whose on-air presence on Fox this campaign raised some eyebrows because of his prominent role supporting Romney, suggested the call was premature.

"We've got to be careful about calling things when we have like 991 votes separating the candidates and a quarter of the vote left to count ... I'd be very cautious about intruding in this process," said Rove, a behind-the-scenes player in the wild 2000 election between Bush and Al Gore that took weeks to decide. (Gore was on TV Tuesday, too, as anchor of Current TV's election coverage).

It left Rove's colleagues struggling for words.

"That's awkward," said co-anchor Megyn Kelly. She then went backstage to interview on camera two men who were part of Fox's team in charge of making election calls. They had concluded that based on the precincts where votes were left to be counted, Romney couldn't beat Obama.

Later, Rove tried to make light of the encounter. "This is not a cage match," he said. "This is a light intellectual discussion."

As the evening had progressed for Fox and it became clear that Romney, the clear favorite of most of its audience, would find it hard to win, commentators like Sarah Palin and Peggy Noonan looked stricken.

"This was the referendum that Mitt Romney wanted on Barack Obama," said Huffington Post's Howard Fineman on MSNBC. "And guess what? Barack Obama won the referendum. And that's pretty darned emphatic."

Much of ABC's New York election studio was left powerless for about 20 minutes at the height of Tuesday's coverage. The network didn't inform viewers, and tried to compensate by taking anchors Diane Sawyer and George Stephanopoulos away from their desks, and cutting away to crowd shots at Times Square.

Sawyer's relaxed, folksy delivery in her first presidential election night as anchor drew considerable social media attention. The rock group They Might Be Giants tweeted: "and Diane Sawyer declares tonight's winner is ... chardonnay!"

Sawyer and Stephanopoulos were a new election anchor team for ABC, and Scott Pelley led the CBS coverage. Of the three anchors for the biggest broadcast networks, only NBC's Williams was a returnee from 2008.

But it was a far different media world anyway. 2012 was notable for the vast array of outlets that an interested consumer could command to create their own media experience on multiple screens. Web sites offered deep drill-downs in data and social media hosted raucous conversations.

"If you started a drinking game with the words 'exit poll' in it, please stop now. You will die!" tweeted TV critic Tim Goodman.

Obama's Twitter account tweeted a picture of the president hugging first lady Michelle Obama, and it was retweeted more than 400,000 times. Twitter said it was its most retweeted message ever.

Earlier in the evening, journalists took special care not to rely too heavily on exit polls. Perhaps they remembered how misleading exit polls in 2004 led TV networks astray then or perhaps, in CBS' Bob Schieffer's words, its results this year were too contradictory.

News outlets carefully parsed information and sometimes used the same facts for contradictory conclusions.

Fox News analyst Brit Hume noted an exit poll finding that 42 percent of voters said Superstorm Sandy was an important factor in their vote, suggesting that was a positive for Obama since he was widely considered to have been effective in his response. With the same information, the web site Politico headlined: "Exit Survey: Sandy Not a Factor."

There was a certain amount of vamping time, too. Glenn Beck's online network, The Blaze, had a blackboard straight out of the 1960s as a tote board. Beck killed time on the air by asking for cookie dough ice cream from the on-set food bar.

"Waffle cone, please," Beck said.

When Sawyer asked David Muir for the latest news from the Romney campaign, he reported the family had pasta for dinner and the candidate indulged in his favorite peanut butter and honey sandwich.

The media personality with perhaps the most on the line was Nate Silver of The New York Times, whose FiveThirtyEight blog was sought out by 20 percent of the people who visited the newspaper's website on Monday. He has used statistical data throughout the campaign to predict an Obama victory and by Tuesday, had forecast a 90.9 percent chance that Obama would win.

After Obama's victory became clear, Gavin Purcell, producer of "Late Night with Jimmy Fallon," tweeted that "Nate Silver is the only white male winning tonight." CNN's Piers Morgan tweeted Silver an invitation to appear on his show Wednesday.

___

Fox is owned by News Corp.; ABC is owned by The Walt Disney Co.; MSNBC and NBC are controlled by Comcast Corp.; CBS is a division of CBS Corp.; CNN is a unit of Time Warner Inc.

___

Television Writers Frazier Moore in New York and Lynn Elber in Los Angeles contributed to this report.

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Alarm Over India’s Dengue Fever Epidemic

Enrico Fabian for The New York Times

A man at the Yamuna River, an ideal breeding ground for mosquitoes. Filthy standing water abounds in New Delhi. More Photos »

NEW DELHI — An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world’s nations.

“The global dengue problem is far worse than most people know, and it keeps getting worse,” said Dr. Raman Velayudhan, the World Health Organization’s lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India’s capital, where areas of standing water contribute to the epidemic’s growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.

Among them was Neelam, who said her two grandchildren were deathly ill inside. Eight-year-old Sneha got the disease first, followed by Tanya, 7, she said. The girls’ parents treated them at home but then Sneha’s temperature rose to 104 degrees, a rash spread across her legs and shoulders, and her pain grew unbearable.

“Sneha has been given five liters of blood,” said Neelam, who has one name. “It is terrible.”

Officials say that 30,002 people in India had been sickened with dengue fever through October, a 59 percent jump from the 18,860 recorded for all of 2011. But the real number of Indians who get dengue fever annually is in the millions, several experts said.

“I’d conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations,” said Dr. Scott Halstead, a tropical disease expert focused on dengue research.

A senior Indian government health official, who agreed to speak about the matter only on the condition of anonymity, acknowledged that official figures represent a mere sliver of dengue’s actual toll. The government only counts cases of dengue that come from public hospitals and that have been confirmed by laboratories, the official said. Such a census, “which was deliberated at the highest levels,” is a small subset that is nonetheless informative and comparable from one year to the next, he said.

“There is no denying that the actual number of cases would be much, much higher,” the official said. “Our interest has not been to arrive at an exact figure.”

The problem with that policy, said Dr. Manish Kakkar, a specialist at the Public Health Foundation of India, is that India’s “massive underreporting of cases” has contributed to the disease’s spread. Experts from around the world said that India’s failure to construct an adequate dengue surveillance system has impeded awareness of the illness’s vast reach, discouraged efforts to clean up the sources of the disease and slowed the search for a vaccine.

“When you look at the number of reported cases India has, it’s a joke,” said Dr. Harold S. Margolis, chief of the dengue branch at the Centers for Disease Control and Prevention in Atlanta.

Neighboring Sri Lanka, for instance, reported nearly three times as many dengue cases as India through August, according to the World Health Organization, even though India’s population is 60 times larger.

Hari Kumar contributed reporting.

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Fiscal Impasse Leads to Caution After Election

Business leaders and investors on Wall Street reacted cautiously to President Obama’s re-election early Wednesday, warning that the focus would quickly shift from electoral politics to the looming fiscal uncertainty in Washington.

Stocks opened sharply lower in New York, with the Standard & Poor’s 500-stock index down 1.4 percent, while European shares drifted lower and Asian stocks were mixed. While many executives on Wall Street and in other industries favored Mitt Romney, most had already factored in the likelihood of Mr. Obama winning a second term.

“The bottom line is that this looks like a status quo election,” said Dean Maki, chief United States economist at Barclays. “The problem with that is that it doesn’t resolve some of the main sources of uncertainty that are hanging over the economy.”

Companies in some sectors, like hospitals and technology, could see a short-term pop, said Tobias Levkovich, chief United States equity strategist with Citi. Other areas, like financial services as well as coal and mining, could be hurt as investors contemplate a tougher regulatory environment.

Mr. Levkovich predicted that the market would remain volatile between now and mid-January. If Congress and the president cannot come up with a plan to cut the deficit, hundreds of billions in Bush-era tax cuts are set to expire at the beginning of 2013 while automatic spending cuts will sharply cut the defense budget and other programs.

Known as the fiscal cliff, this simultaneous combination of dramatic reductions in government spending and tax increases could push the economy into recession in 2013, economists fear.

In early trading, the Euro Stoxx 50 index, a barometer of euro zone blue chips, fell 1 percent, while the FTSE 100 index in London was 0.4 percent lower.

The S.&P./ASX 200 in Australia closed up 0.7 percent, as did the Hang Seng Index in Hong Kong. The Nikkei 225 stock average in Japan ended trading little changed.

“There’s a huge question mark hanging over what happens in the next few weeks,” said Aric Newhouse, senior vice-president of policy and government relations at the National Association of Manufacturers. “The fiscal cliff is the 800-pound gorilla out there.”

“We can’t wait,” he said. “We think the idea of going over the cliff has to be taken off the table. We’ve got to get to the middle ground.”

For all the anticipation, some observers said the election still left plenty of unanswered questions.

“While we have clarity on the players now, we don’t have any more clarity on what will happen in terms of the fiscal cliff,” Mr. Maki said. “We still have a divided government and they haven’t been able to agree on what to do.”

If the full package of tax increases and spending cuts go into effect, that would equal a $650 billion blow to the economy, Mr. Maki said, equivalent to 4 percent of the gross domestic product.

Mr. Maki envisions a partial compromise, with $200 billion in tax increases and spending cuts. Partly because of that, he estimates, the annual rate of economic growth will dip to 1.5 percent in the first quarter of 2013 from 2.5 percent in the fourth quarter. He predicted that if the full fiscal cliff were to hit, the economy would contract in the first half of 2013.

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Presidential Campaign Over, Voters Take to the Polls

Seth Wenig/Associated Press

A poll worker, Lisa Amico, right, helped voters in an unheated tent serving as a polling site in Staten Island. More Photos »

Americans went to the polls on Tuesday to decide whether to give President Obama a second term or to replace him with Mitt Romney after a long, hard-fought campaign that centered on who would heal the battered economy and what role government should play in the 21st century.

From makeshift voting sites in East Coast communities devastated by Hurricane Sandy to the more typical voting booths set up in school gyms, libraries and town halls across the rest of the country, people began lining up before dawn to cast their ballots — collectively writing the ending to a bitter, expensive presidential campaign in which the candidates, parties, and well-heeled outside groups were on pace to spend some $2.6 billion.

At the polling place at the Elk’s Club in Fairfax, Va., outside Washington, D.C., voters braved temperatures in the low 30s to stand in an hourlong line to vote at 7 a.m.

Mr. Romney, a Republican who served as the governor of Massachusetts, cast his vote Tuesday morning near his home in Belmont, Mass. When a reporter asked him for whom he had voted, Mr. Romney replied, “I think you know.” Mr. Obama, a Democrat, voted Oct. 25 in Chicago — becoming one of more than 31 million people who voted early this year.

If both campaigns could seem small at times, the issues confronting the nation remained big: how to continue to rebuild after the worst economic downturn since the Great Depression; whether to implement Mr. Obama’s health care law to cover the uninsured, or undo it; whether to reshape Medicare for future beneficiaries to try to curb its costs; whether to raise taxes to reduce the federal deficit or to rely on spending cuts alone; how to wind down the war in Afghanistan without opening the region to new dangers; and how to navigate the post-Arab Spring world.

On their frenzied final full day of campaigning, the candidates reprised their central arguments before crowds in the same handful of swing states where the campaign has been waged for much of the last year, as both men have battled for the 270 electoral votes needed to win the presidency. The campaigns were hoping that huge turnout efforts would tilt contested states their way.

For all the twists and turns that the race has taken since the candidates downed their first greasy pork chops on sticks at the Iowa State Fair, those core, competing messages have remained remarkably consistent.

Mr. Obama reminded a crowd in Columbus, Ohio, on Monday how bad things were when he took office, listed his achievements and argued that he has more work to do.

“In 2008, we were in the middle of two wars and the worst economic crisis since the Great Depression,” Mr. Obama said. “Today our businesses have created nearly five and a half million new jobs. The American auto industry has come roaring back. Home values are on the rise. We’re less dependent on foreign oil than any time in the last 20 years. Because of the service and sacrifice of our brave men and women in uniform, the war in Iraq is over. The war in Afghanistan is ending. Al Qaeda’s on the path to defeat. Osama Bin Laden is dead. We’ve made progress these last four years.”

Mr. Romney told a crowd in Lynchburg, Va., on Monday that the country needs a new direction after Mr. Obama. “He’s tried to convince you that these last four years have been a success,” he said. “And so his plan for the next four years is to take all the ideas from the first term — the stimulus, the borrowing, Obamacare, all the rest — and do them over again. He calls that ‘Forward.’ I call it ‘Forewarned.’ The same course we’ve been on won’t lead to a better destination. The same path means $20 trillion of debt at the end of a second term. It means crippling unemployment continuing for another four years. It means stagnant take-home pay. It means depressed home values. And of course, it means a devastated military.”

But at times the campaign has been as notable for what was left unsaid as for what was said.

Both men seemed to avoid speaking of some of their biggest legislative achievements. Mr. Romney rarely invoked the health care law he enacted as the governor of Massachusetts, which was a model for Mr. Obama’s health care law which many Republicans derided as “Obamacare” and which Mr. Romney has vowed to repeal. And Mr. Obama, for his part, rarely spoke about the $787 billion stimulus bill he signed early in his term, which used a combination of tax cuts, aid to states and infrastructure spending to try to bolster the economy — but which was seen as insufficient by some liberals and as inefficient by some conservatives.

For all the clear differences between the two men, they were both somewhat hazy about their plans for the next four years.

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Apple sells three million iPads over first weekend

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Composer, Pulitzer winner Carter dies in NY at 103

NEW YORK (AP) — Classical composer Elliott Carter, whose challenging, rhythmically complex works earned him widespread admiration and two Pulitzer Prizes, died Monday at age 103.

His music publishing company, Boosey & Hawkes, called him an "iconic American composer." It didn't give the cause of his death.

In a 1992 Associated Press interview, Carter described his works as "music that asks to be listened to in a concentrated way and listened to with a great deal of attention."

"It's not music that makes an overt theatrical effect," he said then, "but it assumes the listener is listening to sounds and making some sense out of them."

The complex way the instruments interact in his compositions created drama for listeners who made the effort to understand them, but it made them difficult for orchestras to learn. He said he tried to give each of the musicians individuality within the context of a comprehensible whole.

"This seems to me a very dramatic thing in a democratic society," he said.

While little known to the general public, he was long respected by an inner circle of critics and musicians. In 2002, The New York Times said his string quartets were among "the most difficult music ever conceived," and it hailed their "volatile emotions, delicacy and even, in places, plucky humor."

Carter had remained astonishingly active, taking new commissions even as he celebrated his 100th birthday in December 2008 with a gala at Carnegie Hall.

"I'm always proud of the ones I've just written," he said at the time.

In 2005, his "Dialogues," which had premiered the previous year, was a finalist for the Pulitzer Prize in music. And in 2006, his "Boston Concerto" was nominated for a Grammy Award as best classical contemporary composition.

Carter won his first Pulitzer Prize in 1960 for his Second String Quartet; his second award was in 1973 for his Third String Quartet. The Juilliard String Quartet chose to mark its 45th anniversary in 1991 with a concert of all four Carter string quartets. A fifth quartet came out in 1995.

When the first National Medal of Arts awards were given in 1985, Carter was one of 10 people honored, along with such legends as Martha Graham, Ralph Ellison and Georgia O'Keeffe. The awards were established by Congress in 1984.

The New Grove Dictionary of American Music said that at its best, Carter's music "sustains an energy of invention that is unrivaled in contemporary composition."

Carter said he found Europeans more receptive to his works than his fellow Americans because music in Europe is not purely entertainment but part of the culture, "something that people make an effort to understand."

The lack of widespread attention didn't seem to bother him.

"I don't think it means anything to be popular," he said. "When we see the popular tastes and the popular opinion constantly being manipulated by all sorts of different ways, it seems to me popularity is a meaningless matter."

In 1992, Carter said his favorite piece of music was his Concerto for Orchestra, written in 1969. It was commissioned by the New York Philharmonic for its 125th anniversary season.

"It particularly expresses a picture of the United States as an evolving world of not only people but of nature," he said.

Among his early works were two ballets, "The Minotaur" and "Pocahontas," and his First Symphony. His First String Quartet in 1951 started him on the road to greater critical attention.

Besides composing, Carter wrote extensively about 20th-century music. A collection of articles, "The Writings of Elliott Carter: An American Composer Looks at Modern Music," was published in 1977.

Carter as born in New York in 1908. As a young man he became acquainted with composer Charles Ives, who encouraged his ambitions. He studied literature at Harvard and then studied music in Paris under famed teacher Nadia Boulanger, who also guided Leonard Bernstein, Aaron Copland and Virgil Thompson.

As Carter turned 100, he recalled a visit to the hall in 1924 to see the New York premiere of Igor Stravinsky's revolutionary work "The Rite of Spring."

"I thought it was the greatest thing I ever heard, and I wanted to do like that, too," Carter recalled. "Of course, half the audience walked out, which was even more pleasant to me. It seemed much more exciting than Beethoven and Brahms and the rest of them."

In 1939, he married sculptor Helen H. Frost Jones. They had one son. He is survived by his son and a grandson.

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New Drugs for Lipids Set Off Race

LOS ANGELES — A new class of powerful cholesterol-reducing drugs is showing promising results, potentially offering a new option for people who do not respond to medication now on the market, according to studies presented at a conference of heart specialists here on Monday.

Although the final word on the effectiveness of the drugs is still a few years away, the results so far are so promising that pharmaceutical companies are racing to bring them to market.

In early- and middle-stage trials, use of the experimental drugs reduced so-called bad cholesterol by about 40 to 70 percent in a matter of weeks, equivalent to the reduction achieved by the most effective statins like Lipitor. But it appears that the new drugs can be used along with statins, lowering cholesterol even further.

“With these drugs, together with statins, you can get virtually everyone to the goal,” Dr. Frederick Raal of the University of the Witwatersrand, in Johannesburg, South Africa, who presented one of several studies on these new drugs at the American Heart Association’s scientific meeting here.

The most advanced of the drugs, which as a class are called PCSK9 inhibitors, is only now entering the final stages of clinical trials and is not likely to get to market until 2015 at the earliest.

And there are still some caveats. One is that while the drugs lower cholesterol, it has not yet been shown that they actually reduce the risk of heart attacks, strokes or other cardiovascular problems.

Furthermore, many of the studies so far have lasted no more than 12 weeks and involved fewer than 200 people. Far longer and larger studies are needed to show that the drugs would keep working over a lifetime and would be safe.

So far, however, the studies show “quite good safety,” Dr. Peter Wilson of Emory University said in a presentation here discussing the studies. “This is extremely promising.”

The drugs have to be injected, typically every two to four weeks. That means that the PCSK9 inhibitors are not likely to be widely used for “garden variety high cholesterol,” said Dr. Gordon Tomaselli, chief of cardiology at Johns Hopkins.

Still, millions of Americans cannot lower their cholesterol sufficiently using statins alone, providing a market that could reach billions of dollars in annual sales for a successful drug.

Leading the race so far is the team of Sanofi, the big French drug company, and Regeneron Pharmaceuticals, a biotechnology company in Tarrytown, N.Y.

The companies announced Monday that they were beginning a Phase 3 trial — usually the last step before filing for approval — involving 18,000 patients with a recent heart attack or worsening chest pain who cannot lower their cholesterol with statin therapy alone. The patients will inject themselves once every two weeks with either the drug or a placebo, while continuing to take statins.

The study, which will take at least two years, will determine whether the drug, known by the awkward code name SAR236553/REGN727, can reduce the rate of heart attacks, strokes and other cardiovascular problems.

In a midstage study published recently in The New England Journal of Medicine, patients who took the Sanofi drug plus a high dose of atorvastatin, the generic equivalent of Lipitor, had a mean 73 percent reduction in low-density lipoprotein cholesterol, the so-called bad cholesterol, compared with a 17 percent reduction for those taking only the high dose of the statin.

Amgen seems to be next in line, saying it plans to begin Phase 3 trials early next year. Pfizer and Roche have drugs in midstage clinical trials. Others in pursuit include Eli Lilly & Company and Alnylam.

Dr. Evan A. Stein of the Metabolic and Atherosclerosis Research Center in Cincinnati, said that about 10 to 20 percent of patients could not tolerate statins at all, or at least could not tolerate doses high enough to lower cholesterol sufficiently. Their main alternative now is Merck’s Zetia, which reduces cholesterol about 18 percent.

Dr. Stein, who is a consultant to Amgen, presented the results on Monday of a trial of Amgen’s drug, AMG 145, in such patients.

Patients receiving AMG 145 experienced an average reduction in LDL cholesterol after 12 weeks of 41 to 51 percent, depending on the dose. Those who received both AMG 145 and Zetia had an even greater average reduction — 63 percent. By contrast, those who received Zetia and a placebo had a drop in bad cholesterol of only 15 percent.

After 12 weeks, only 7 percent of the patients on Zetia alone reduced LDL to 100 milligrams per deciliter, which is the goal for many people. About 61 percent of those on the highest dose of AMG 145 did so, as did 90 percent on both AMG 145 and Zetia. The trial results were also published online by The Journal of the American Medical Association.

LDL cholesterol is removed from the blood when it binds to LDL receptors on the surface of liver cells, and then is taken inside the cells. PCSK9 — which stands for proprotein convertase subtilisin/kexin type 9 — also binds to the LDL receptor, and when it does so, the receptor is destroyed along with the LDL.

But if PCSK9 does not bind, the receptor can return to the surface of the cell and remove more cholesterol. The drugs, which in general are proteins known as monoclonal antibodies, block PCSK9 from binding to the receptor.

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Antwerp Journal: Antwerp’s Diamond Industry Facing Challenges

Colin Delfosse for The New York Times

Indian businessmen in the diamond district of Antwerp, Belgium.

ANTWERP, Belgium — Step off the train here and you cannot miss the signs on the stores: Diamond World, Diamond Gallery, Diamond Creations or simply, Diamonds. Of late, there are the banners and posters reading simply, “Antwerp Loves Diamonds.”

Though this Belgian port has had a love affair with diamonds for centuries, of late it seems to be losing some of its passion. For years now, much of the lucrative but labor-intensive business of cutting and polishing stones has been drifting to low-wage centers in the developing world, like Mumbai, Dubai and Shanghai.

More ominously, in recent years, diamond traders have been accused of a range of violations, including tax fraud, money laundering and cheating on customs payments when buying and selling stones.

Local business leaders recognize the threat. This year, they embarked on what local newspapers described as a “charm offensive.” In a 160-page program, titled Project 2020, the World Diamond Center, a trade-promotion group, outlined plans to draw business back to Antwerp by simplifying and accelerating trading via online systems. That, the industry hopes, will win back some of the polishing business lost to Asian countries with new technology, like fully automated diamond polishers, and generally burnish the image of the diamond business in the public’s jaded eye.

“This is our strength,” said Ari Epstein, 36, a lawyer who is chief executive of the World Diamond Center and the son of a diamond trader, whose father emigrated from a village in Romania in the 1960s. “We have the critical mass so that every diamond finds a buyer and seller.”

Antwerp has by no means fallen out of love with the gems. In all, the market employs 8,000 people and creates work indirectly for 26,000 others as insurers, bankers, security guards and drivers. Last year, turnover in the local diamond business amounted to $56 billion, Mr. Epstein said, its best year ever.

While total revenues are expected to drop this year because of the troubled world economy, he acknowledged, a stroll along Hoveniersstraat, or Gardner’s Street, leads through the heart of the market, where almost 85 percent of the world’s uncut diamonds are still traded.

“I come here once a month,” said Sheh Kamliss, a trader in his 30s, who travels from his native India to buy uncut stones and sell polished diamonds. “This is the international market,” he added, chatting with fellow Indian traders outside the Diamond Club of Antwerp, one of many locations where deals are struck.

On any given day but Friday or the Jewish holidays, Hoveniersstraat, with its tiny Sephardic synagogue, is liberally sprinkled with Orthodox Jewish traders, many of them Hasidim.

But their once dominant presence has been squeezed by the arrival of traders from new markets, like Mr. Kamliss. Now people from about 70 nations are present, including Indians, Israelis, Lebanese, Russians, Chinese and others. Along neighboring Lange Herentalsestraat, Rachel’s Kosher Restaurant is now flanked by the Bollywood Indian Restaurant and the Shanti Shop Indian supermarket. In the nearby Jewish quarter, Patel’s Cash & Carry recently installed itself right next to Moszkowitz, the butcher.

Some here say this globalization of the business has opened the door to abuse.

Omega Diamonds, a major market maker, came under investigation and its executives fled Belgium when an employee-turned-whistle-blower revealed in 2006 how Omega had traded diamonds out of Africa for years, avoiding taxes by transacting deals through Dubai, Tel Aviv and Geneva, then moving the profits back to Belgium.

“Because of global changes, the trade routes have changed,” said David Renous, 47, the whistle blower, who is now writing a book on the subject. “New hubs, like Dubai, the Singapore of the Middle East, sometimes close their eyes to criminality.”

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