Changes to Agriculture Highlight Cuba’s Problems

HAVANA — Cuba’s liveliest experiment with capitalism unfolds every night in a dirt lot on the edge of the capital, where Truman-era trucks lugging fresh produce meet up with hundreds of buyers on creaking bicycle carts clutching wads of cash.

“This place, it feeds all of Havana,” said Misael Toledo, 37, who owns three small food stores in the city. “Before, you could only buy or sell in the markets of Fidel.”

The agriculture exchange, which sprang up last year after the Cuban government legalized a broader range of small businesses, is a vivid sign of both how much the country has changed, and of all the political and practical limitations that continue to hold it back.

President Raúl Castro has made agriculture priority No. 1 in his attempt to remake the country. He used his first major presidential address in 2007 to zero in on farming, describing weeds conquering fallow fields and the need to ensure that “anyone who wants can drink a glass of milk.”

No other industry has seen as much liberalization, with a steady rollout of incentives for farmers. And Mr. Castro has been explicit about his reasoning: increasing efficiency and food production to replace imports that cost Cuba hundreds of millions of dollars a year is a matter “of national security.”

Yet at this point, by most measures, the project has failed. Because of waste, poor management, policy constraints, transportation limits, theft and other problems, overall efficiency has dropped: many Cubans are actually seeing less food at private markets. That is the case despite an increase in the number of farmers and production gains for certain items. A recent study from the University of Havana showed that market prices jumped by nearly 20 percent in 2011 alone. And food imports increased to an estimated $1.7 billion last year, up from $1.4 billion in 2006.

“It’s the first instance of Cuba’s leader not being able to get done what he said he would,” said Jorge I. Domínguez, vice provost for international affairs at Harvard, who left Cuba as a boy. “The published statistical results are really very discouraging.”

A major cause: poor transportation, as trucks are in short supply, and the aging ones that exist often break down.

In 2009, hundreds of tons of tomatoes, part of a bumper crop that year, rotted because of a lack of transportation by the government agency charged with bringing food to processing centers.

“It’s worse when it rains,” said Javier González, 27, a farmer in Artemisa Province who described often seeing crops wilt and rot because they were not picked up.

Behind him were the 33 fertile, rent-free acres he had been granted as part of a program Mr. Castro introduced in 2008 to encourage rural residents to work the land. After clearing it himself and planting a variety of crops, Mr. Gonzalez said, he was doing relatively well and earned more last year than his father, who is a doctor, did.

But Cuba’s inefficiencies gnawed at him. Smart, strong, and ambitious, he had expansion plans in mind, even as in his hand he held a wrench. He was repairing a tractor part meant to be grading land. It was broken. Again.

The 1980s Soviet model tractor he bought from another farmer was as about good as it gets in Cuba. The Cuban government maintains a monopoly on selling anything new, and there simply is not enough of anything — fertilizer, or sometimes even machetes — to go around.

Government economists are aware of the problem. “If you give people land and no resources, it doesn’t matter what happens on the land,” said Joaquin Infante of the Havana-based Cuban National Association of Economists.

But Mr. Castro has refused to allow what many farmers and experts see as an obvious solution to the shortages of transportation and equipment: Let people import supplies on their own. “It’s about control,” said Philip Peters, a Cuba analyst with the Lexington Institute, a Virginia-based research group.

Other analysts agree, noting that though the agricultural reforms have gone farther than other changes — like those that allow for self-employment — they remain constrained by politics.

“The government is not ready to let go,” said Ted Henken, a Latin American studies professor at Baruch College. “They are sending the message that they want to let go, or are trying to let go, but what they have is still a mechanism of control.”

For many farmers, that explains why land leases last for 10 years with a chance to renew, not indefinitely or the 99 years offered to foreign developers. It is also why many farmers say they will not build homes on the land they lease, despite a concession this year to allow doing so.

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Karzai Implicates Pakistan in Attack on Afghan Spy Chief

KABUL, Afghanistan — The suicide bomber who tried to assassinate Afghanistan’s powerful new intelligence chief came from Pakistan and the attack was organized with the help of a sophisticated foreign intelligence service, President Hamid Karzai said Saturday.

Mr. Karzai said he would ask for clarification from Pakistan’s president, when the two men meet later this month, on whether Pakistan’s intelligence service was involved in any way. He said he wanted Pakistan’s help in easing ordinary Afghans’ suspicions that Pakistani interests were behind the attack — if not directly organizing it, then at least providing help.

The audacious assassination attempt on Asadullah Khalid, who had been leading the National Directorate of Security since September, has taken out of action an important figure in the war against the insurgency. It took place on Thursday when an unidentified attacker smuggled a bomb into a meeting at a guesthouse in central Kabul with Mr. Khalid.

“We will be seeking a lot of clarifications from Pakistan because we know that this man who came in the name of a guest to meet with Asadullah Khan Khalid came from Pakistan,” Mr. Karzai said at a news conference at the presidential palace here. “We know that for a fact, it is clear.”

The bomb, which Afghan authorities said was concealed around the attacker’s groin, left Mr. Khalid seriously injured.

The Taliban claimed responsibility, but Mr. Karzai said the attack was too sophisticated to be the work of the Taliban alone.

“This is not the work of Taliban,” he said. “This is a very professional and well-engineered attack. Taliban are not able to do this, but there are strong and skilled hands involved in the attack.”

Mr. Khalid, in his ascendancy to the top of the Afghan intelligence service, had emerged as one of the Taliban’s fiercest opponents and was also a strong critic of Pakistan’s influence in the country.

Mr. Karzai provided no evidence linking the attack to Pakistan. The government regularly accuses Pakistan of involvement in attacks, and has done so after assaults on other senior Afghan officials in recent years.

The president drew a distinction between different groups of the Taliban and said some were clearly controlled by the intelligence agencies of neighboring countries, although he said he had no evidence of where. “This is the work of a complicated, sophisticated and professional intelligence agency,” he said.

Mr. Karzai also said the attack was an effort to undermine progress toward meaningful negotiations. “Whenever the peace talks are getting closer to a conclusion or success being achieved in the peace process or hopes being achieved, we face such attacks,” he said.

Many Afghans have raised questions about how an attacker could get so close to such a powerful man regarded as an extremely sophisticated operator.

Mr. Karzai admitted that a security screening had failed, but the government’s statement that the bomb was concealed around the attacker’s groin suggests why it was not detected: an invasive search would have violated Afghanistan’s traditional mores.

Mr. Karzai said Mr. Khalid himself had prevented a more thorough search out of respect for his guest and Afghan tradition.

Mr. Karzai also said Mr. Khalid had told him the evening before the attack about the planned meeting. There was no information about who the attacker was, but Mr. Khalid told him that he hoped the meeting would advance the country’s peace and security, the president said.

Mr. Karzai visited Mr. Khalid on Thursday at a hospital in Kabul before he was taken to better medical facilities at Bagram Air Base, one of the largest coalition bases in Afghanistan.

According to Western officials, Mr. Khalid has serious abdominal injuries and will need multiple operations. Mr. Karzai on Saturday offered few details of the injuries, but said that Mr. Khalid was improving and was now fully conscious and able to speak, and move his hands.

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Rebels Declare Damascus Airport a ‘Fair Target,’ Reports Say

Odd Andersen/Agence France-Presse — Getty Images

A rebel fighter carrying his son after Friday Prayers in Aleppo.

BEIRUT, Lebanon — As fighting raged in the suburbs of the Syrian capital, Damascus, and gunfire could be heard from the city center, rebels seeking the overthrow of President Bashar al-Assad were reported on Friday to have declared the capital’s main airport a “fair target,” warning travelers that they used it at their peril.

Against the backdrop of battlefield uncertainty, diplomacy also seemed to have made little perceptible progress. Secretary of State Hillary Rodham Clinton repeated calls for the ouster of President Assad, but said there had been no “great breakthrough” in talks she held Thursday in Dublin with her Russian counterpart, Sergey V. Lavrov, and Lakhdar Brahimi, the special Syria envoy of the United Nations and the Arab League.

“It was an important meeting, but just the beginning,” she said, speaking in Belfast, Northern Ireland, before flying back to Washington.

“I don’t think anyone believes  that there was some great breakthrough. Nobody should have any illusions about how hard this remains. But all of us with any influence on the process, with any influence on the regime or the opposition, needs to be engaged with Brahimi for a concerted, sincere push to see what is possible.”

“The advancing developments on the ground,” she said, “are increasingly dangerous.”

“The United States stands with the Syrian people in insisting that any transition process result in a  unified, democratic Syria in which all citizens are represented,” Mrs. Clinton continued. “And a future of this kind cannot possibly include Assad. So we go into these discussions with a clear sense of what we want to see accomplished but a realistic understanding of how difficult it still is.”

Russia has been Mr. Assad’s most durable backer throughout the crisis and has resisted efforts to push him out of power. After the Dublin talks, Mr. Lavrov was quoted as saying that he would not make “optimistic predictions” and that Mr. Brahimi, the special envoy, knows that the chance of success is “far from 100 percent.”

The bleak assessment came as government and rebel forces were locked in sustained battle, particularly to the south of the capital where, in recent days, the airport has been caught up in fighting for the capital’s suburbs and has been closed to civilian flights for days at a time.

Apart from its importance as a logistical center, the airport, 12 miles south of the capital, holds symbolic value. Its loss would boost the rebels’ ability to depict Mr. Assad as isolated and beleaguered.

Nabil al-Amir, a spokesman for an insurgent military group attacking the airport south of Damascus, said rebels “who have been putting the airport under siege decided yesterday that the airport is a fair target,” Reuters reported.

“The airport is now full of armored vehicles and soldiers,” Mr. Amir said, seeming to suggest that it was firmly in government control. “Civilians who approach it now do so at their own risk.”

News reports also suggested that government forces were seeking to bring in reinforcements for a counterattack designed to reverse rebel gains on the fringes of the city.

The rebel threat seemed to deepen the uncertainties of the military campaign for Damascus where visiting reporters say that the sound of government artillery fire pounding outlying suburbs is clearly audible from the city center — once a haven of tranquillity even as the uprising against Mr. Assad evolved from peaceful protest in March 2011 to civil war.

Activists said government forces backed by tanks were heading toward two southwestern suburbs, covering their effort to advance with rocket and mortar fire.

Overnight, sounds of gunfire were heard in central Damascus near a major road, Baghdad Street.

On the southern edge of the city, in Tadamon, where antigovernment sentiment is strong and clashes have taken place all week, rebel fighters took control of a checkpoint, the Local Coordinating Committees, an antigovernment activist network, reported.

In the central city of Homs, a car bomb exploded just before noon near a mosque in the wealthy residential area of Inshaat, neighboring the restive Baba Amr neighborhood, and many people were reported injured, residents and activists said.

There was no immediate claims of responsibility, but a demonstration denouncing the government broke out shortly afterward.

Anne Barnard reported from Beirut, Alan Cowell from London and Michael R. Gordon from Belfast, Northern Ireland. Hala Droubi contributed reporting from Dubai, United Arab Emirates.

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Drafters of Communications Treaty Are Split on Internet Issue

PARIS — Nearly a week into a global conference to draft a treaty on the future of international telecommunications, delegates remain divided on a fundamental question: should the Internet feature in the discussions?

The United States says no, arguing that including it in an intergovernmental agreement could result in regulations that would hamper its development, which has been led by the private sector.

To try to win this point early in the proceedings, the United States delegation has pushed a proposal to restrict the application of the treaty to traditional telecommunications operators, excluding Internet companies, as well as private and government networks.

So far, however, the United States has been rebuffed.

Terry Kramer, the head of the American delegation, said the proposal, co-sponsored by Canada, had generated support from American allies in Europe, Latin America and the Asia-Pacific region. Other countries, including Russia and some African and Middle Eastern nations, have apparently resisted, favoring a broader definition of telecommunications that could include the Internet.

“Fundamentally, to us, this conference should not be about the Internet sector,” Mr. Kramer said by telephone from Dubai in the United Arab Emirates, where the meeting is taking place under the auspices of the International Telecommunication Union. “There are some pretty big differences of opinion on this.”

Russia, as expected, has introduced a proposal to shift oversight over the Internet, including the address system, to an international body, contending that the United States wields too much influence over this. The address function is now handled by the Internet Corporation for Assigned Names and Numbers, a private body that operates under a United States government contract.

“We fundamentally disagree with that,” Mr. Kramer said, referring to the Russian proposal. “Once governments are in that role, they are in position to decide how the Internet operates, what kind of information flows there, et cetera.”

Campaigners against restrictions on the Internet have also expressed concerns about proposals to bolster security and to crack down on spam — fearing that this could be used as a pretext for censorship — as well as about a proposed technical standard for “deep packet inspection.” This refers to technology that can be used to examine the content of traffic that passes through telecommunications networks.

It is unclear which, if any, of these initiatives might make it into the final treaty. The talks are set to continue through next week, and Mr. Kramer has pledged to block any proposals that would threaten the integrity of the Internet. The telecommunication union says proposals will be adopted only if they meet with widespread support at the conference, whose goal is to update regulations that date to 1988.

Groups that favor an open Internet have criticized the process as lacking transparency. While some meetings are going on behind closed doors, the union moved to provide webcasts of the plenary sessions, in which delegates from more than 190 countries are debating the proposals.

On Wednesday, however, access to the webcasts and other material on the union’s Web site was briefly blocked; the group said hackers appeared to have been responsible.

“Some delegates were frustrated at being unable to access some of the online working documents that were being considered by the meeting,” the union said in a statement. “However, a spirit of camaraderie prevailed, with those who had access to up-to-date online versions of the texts willingly sharing with other delegates in order to keep discussions moving forward.”

So far, fears that the conference could turn raucous have not come to pass.

“The world is having a conversation,” said Sally Shipman Wentworth, senior manager of public policy at the Internet Society, whose members include Internet companies, governance groups and others. “The meeting rooms are full, and everyone wants to have a chance to be heard. It’s been pretty collegial so far.”

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3 Charged With Plotting to Export Carbon Fiber to Iran

Three people have been charged with conspiring to illegally export to Iran and China a superstrong material called carbon fiber that can be used to make machines that can enrich uranium, federal prosecutors in Manhattan said on Wednesday.

Iran has been pursuing carbon-fiber technology for years, and has had difficulty in obtaining the material. Enriched uranium can be used as fuel for nuclear reactors and atom bombs.

Another man was charged in a purported scheme to illegally export to Iran via South Korea components for helicopters that could be used for military purposes, the authorities said.

Three of the four men have been arrested. One of them, Hamid Reza Hashemi, 52, a dual United States and Iranian citizen who runs a company in Tehran that the United States government says has been trying to obtain carbon-fiber technology, was arrested on Saturday at Kennedy International Airport as he entered the country, prosecutors said.

Another defendant, Peter Gromacki, 48, of Middletown, N.Y., was accused of arranging for the export of more than 6,000 pounds of carbon fiber from the United States to China via Belgium, in violation of federal law, the government said.

“The law prohibits the exportation of goods to Iran and certain goods to China,” said George Venizelos, who heads the Federal Bureau of Investigation’s New York office.

A third defendant, Amir Abbas Tamimi, 40, an Iranian accused in the purported helicopter-component deal, was arrested at Kennedy Airport in October, the authorities said. He and Mr. Hashemi are being held without bond, while Mr. Gromacki was released on bond, the government said.

The fourth defendant, Murat Taskiran, a Turk accused in the purported carbon-fiber scheme, has not yet been arrested.

The charges do not specify precisely what the government believes the carbon-fiber technology was going to be used for in Iran.

But Preet Bharara, the United States attorney in Manhattan, whose office is prosecuting the men, said “carbon fiber in the wrong hands poses a serious threat” to the national security of the United States.

“Two of these defendants are charged with arranging its export to Iran, where it most assuredly had the potential to end up in the wrong hands,” Mr. Bharara said.

The government charged that in March and April 2008, Mr. Hashemi and Mr. Taskiran worked with an unidentified European broker to arrange for the shipment of carbon fiber from the United States to Iran through Europe and Dubai.

Carbon fiber is used to make rotors for centrifuges, which are used to enrich uranium.

The government also charged that this year Mr. Hashemi sent messages to the European broker, indicating that he wanted to travel to the United States to see a carbon-fiber-winding machine that he wanted to buy. Such machines can be used to make the rotors.

Lawyers for the three men who have been arrested could not be reached for comment Wednesday evening.

William J. Broad contributed reporting.

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McAfee Antivirus Software Pioneer Arrested in Guatemala City

MEXICO CITY — The antivirus software pioneer John McAfee was arrested in Guatemala City on Wednesday after he slipped over the border from his home in Belize where police want to question him in their investigation of the murder of his neighbor.

Jorge Dan Lopez/Reuters

John McAfee spoke during an interview in Guatemala City on Wednesday.

The interior minister, Mauricio Lopez Bonilla, told The Associated Press that Mr. McAfee, 67, had been arrested on charges of entering Guatemala illegally. He said that Mr. McAfee had been arrested at a hotel in the capital and taken to a detention center for migrants who are in the nation illegally.

Mr. McAfee had been on the run for almost a month since his neighbor, Gregory Faull, on the Belizean island of Ambergris Caye was found dead at his home on Nov. 11. Police there cited Mr. McAfee as a “person of interest” in their investigation, but Mr. McAfee disapppeared.

But he did not disappear from the Internet. He kept up a continuous stream of comment on his blog and on Twitter, accusing the Belizean authorities of persecuting him.

On Tuesday, he resurfaced in Guatemala, dressed in a suit, his blond curls dyed dark brown.

Accompanied by his 20-year-old Belizean girlfriend, Samantha Venagas, and his Guatemalan lawyer, Telésforo Guerra, Mr. McAfee said that he would seek political asylum in Guatemala. Mr. Guerra, a former Guatemalan attorney general, told reporters at a chaotic news conference outside the Supreme Court that his client was being persecuted because he refused to pay Belizean authorities off any longer.

Mr. McAfee has not been associated with the software company that bears his name since 1994, when he sold it and began to pursue his other interests. He ran a yoga retreat and then built a complex in New Mexico to indulge his hobby of flying motorized ultralight airplanes.

He moved to Belize about four years ago, buying properties on the mainland and on Ambergris Caye. It was there that he clashed with Mr. Faull, who complained about the unleashed dogs that Mr. McAfee kept on his property.

On Nov. 9, several of the dogs were found dead. They had been poisoned.

During his time in Belize, Mr. McAfee had apparently become interested in developing a designer drug called MDPV. He posted extensively about his experiments on a Web site.

But he attracted the attention of Belizean authorities, who raided one of his properties in April. He spent a night in jail, but law enforcement officials found no evidence that he was producing methamphetamine and dropped the charges.

After that experience, though, Mr. McAfee appeared to become increasingly convinced that he was being persecuted by the Belizean government. Officials deny that they are persecuting him.

Mr. Guerra told Guatemalan reporters late Wednesday that since there was no warrant for Mr. McAfee’s arrest and since his client was not a fugitive, he would seek to have his client released and returned to the hotel where he would remain under guard.

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Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

Read More..

Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

Read More..

Dispute Flares Over Energy Exploration in South China Sea

BEIJING — China and two of its neighbors, Vietnam and India, were locked in a new dispute on Tuesday over energy exploration in the South China Sea, a signal that Beijing plans to continue its hard line in the increasingly contentious waterway.

Vietnam accused a Chinese fishing boat of cutting a seismic cable attached to one of its vessels exploring for oil and gas near the Gulf of Tonkin, an act apparently intended to inhibit Vietnam from pursuing energy deposits.

Vietnam said Tuesday that in retaliation, it would send out new patrols, which would include the marine police, to guard against increasing encroachment by Chinese fishing boats in the South China Sea. India, which operates several joint ventures with Vietnam’s national energy company, Petro Vietnam, said it would consider sending navy vessels to protect its interests in the South China Sea.

The latest episode followed an announcement by Hainan Province in southern China last week that Chinese vessels would board and search ships in contested areas of the waterway, which includes vital shipping lanes through which more than a third of global trade moves.

The new tensions among China, Vietnam and India illustrate in stark terms the competition in the South China Sea for what are believed to be sizable deposits of oil and gas.

Some energy experts in China see the sea as an important new energy frontier close to home that could make China less dependent on its huge oil imports from the Middle East.

On Monday, China’s National Energy Administration named the South China Sea as the main offshore site for natural gas production. Within two years, China aims to produce 150 billion cubic meters of natural gas from fields in the sea, a significant increase from the 20 billion cubic meters produced so far, the agency said.

Earlier this year, China’s third-largest energy company, the state-owned China National Offshore Oil Corporation, began drilling with a rig in deep water in nondisputed waters off the southern coast of China.

The escalation in the South China Sea comes less than a month after Xi Jinping took office as China’s leader. Mr. Xi appears to have taken a particular interest in the South China Sea and the serious dispute between China and Japan over the islands known as Diaoyu in China and as Senkaku in Japan. Whether any of China’s most recent actions in the South China Sea were associated with Mr. Xi was not clear.

But Mr. Xi does lead a small group of policy makers clustered in the Maritime Rights Office, which serves to coordinate agencies within China, according to Zhu Feng, a professor of international relations at Peking University, and other Chinese experts. The unit is part of the office of the Foreign Affairs Leading Small Group, Mr. Zhu said. The leading small group, now headed by Mr. Xi, is widely believed to be China’s central policy-making group.

China’s Foreign Ministry reiterated on Tuesday that China opposed oil and gas development by other countries in disputed waters of the sea. China maintains that it has “undisputed” sovereignty over the South China Sea, and that only China is allowed to develop the energy resources.

“We hope that concerned countries respect China’s position and rights,” said the Foreign Ministry spokesman, Hong Lei.

Vietnam, which has long been wary of China but enjoys a relationship through its governing Communist Party, summoned the Chinese ambassador on Monday to protest the cutting of the seismic cable, the Vietnamese news media reported.

A Web site run by Petro Vietnam, the oil company, reported that the company’s exploration vessel Binh Minh 02 had its seismic cable severed by a Chinese fishing vessel on Friday. In May 2011, the Vietnamese authorities said a similar cable of the Binh Minh 02 was cut by three Chinese surveillance ships, resulting in weeks of anti-China protests in Hanoi.

In its decree on the new patrols, Vietnam said that civilian ships, supported by the marine police and a border force, would be deployed starting next month to stop foreign vessels that violate fishing laws in waters claimed by Vietnam.

A senior official of Petro Vietnam, Pham Viet Dung, was quoted in the Vietnamese news media as saying that large numbers of Chinese fishing boats, many of them substantial vessels, had recently entered waters claimed by Vietnam. The fishing vessels interfered with the operations of the oil company, he said.

India, whose state-run oil company, the Oil and Natural Gas Corporation, has a 45 percent interest in exploration with Petro Vietnam, also reacted strongly.

The head of the Indian Navy, Adm. D. K. Joshi, said that India was prepared to send navy vessels to protect its interests in the sea. “Now, are we preparing for it? Are we having exercises of that nature? The short answer is ‘yes,’ ” Admiral Joshi told reporters in India.

The most recent moves by China in the South China Sea have not won total support at home. Mr. Zhu, the professor, said he did not believe that China had become more assertive in the South China Sea.

But, he said, “the cable cutting is really unfriendly.”

Bree Feng contributed reporting.

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Video Games: Little Inferno; Hitman; Assassin’s Creed III; Persona 4 Golden; Angry Birds Star Wars; My Little Pony

Ubisoft

Ratonhnhaké:ton is a half-British, half-Mohawk assassin in Revolutionary America.

Released on Nov. 18

Developed by Tomorrow Corporation

For PC, Mac, Linux and Wii U

Rated T for Teen (drug reference and crude humor)

Here’s an odd one. Little Inferno is an interactive fireplace. It’s an emotional, interactive fireplace with a story line and some notions about the dangers of amusing ourselves with distracting trifles.

At first this strange creation appears to be a simple puzzle game consisting of little more than a fireplace, a catalog of items to burn and 99 clues that challenge the player to burn these things in proper combinations. One clue is “Movie Night.” Burn the popcorn. Burn the TV. A weirder one is “Bike Pirate.” Burn the wooden bike. Burn the pirate.

As you play, an unseen character begins to send letters. They burn, too, but something seems off. The messages are alternately cheerful and sad, a wee bit wicked and increasingly desperate.

The purpose of the pyromaniac pastime becomes smoky with doubt. Why are we doing this? What are we missing? It’s odd enough to play a new video game that questions our decision to play video games. That it’s an interactive fireplace game that does this is all the stranger and more wonderful. It’s a yule log for our times.

HITMAN

Absolution

Released on Nov. 20

Developed by IO Interactive

Published by Square Enix

For PC, Xbox 360 and

PlayStation 3

Rated M for Mature (intense violence, partial nudity and strong language)

It’s a vile, dangerous world in Hitman: Absolution. Nearly everyone is in need of a good killing, and Agent 47, the depilated murder machine at the center of the long-running Hitman franchise, is just the man for the job.

Absolution is consistent with the setup of past Hitman games: At the start of a level, 47 is given an assassination target, and he must make his way through semi-open areas by any of a number of possible routes. The reactive artificial intelligence keeps things enjoyably unpredictable, and the best levels feel like a buffet of sadistic improvisation.

The story is pure B-movie hogwash. It’s mostly enjoyable in a certain exploitive way, but it often feels as if the writers were trying too hard.

When it gets cooking, Hitman: Absolution evokes the feeling of a deadly, measured dance. It’s a tango between you and the computer, with each party alternately taking the lead through arenas that shift and upset expectations.

ASSASSIN’S CREED III

Released on Oct. 30

Developed and published by Ubisoft

For PlayStation 3, Xbox 360, Wii U and PC

Rated M for Mature (blood, intense violence, sexual themes and strong language)

Assassin’s Creed III is really the fifth major Assassin’s Creed game. The numbering signifies that this new historical epic is a shift, as this Ubisoft series about the ancestral lives of a man named Desmond Miles leaps to its third era. Finished with the 12th-century crusades and 15th-century Renaissance Italy, Assassin’s Creed now lets us do interactive historical tourism in Boston, New York and the nearby woods of Revolutionary America.

Assassin’s Creed games are lavish action-adventure blockbusters. In this new one, we primarily play as a young, bitter, half-British, half-Mohawk greenhorn assassin named Ratonhnhaké:ton, who finds himself crossing paths and sometimes doing the bidding of Sam Adams, Paul Revere, George Washington and other real figures. Most of the bad guys are red coats with slow-firing muskets. We’re best with a tomahawk and a bow and arrow.

The new game involves a lot of climbing and killing across a sprawling landscape of bustling cities and gorgeous frontier. Add in a mix of awkwardly instituted horseback riding, homestead building, trading, trapping, hunting and, at the wheel of your own tall-masted warship, epic naval combat. There is much to do and witness in a ripped-from-the-history-books adventure that is refreshingly unwilling to ignore the unsavory aspects of America’s birth. A lengthy production cycle didn’t spare the game from a wealth of bugs that are only now being patched out.

The series’s low-key multiplayer games of competitive assassination return, but the star of this epic is something that might seem almost quaint: Assassin’s Creed III is easily the best tree-climbing simulator in history.

PERSONA 4 GOLDEN

Released on Nov. 20

Developed and published by Atlus

For PlayStation Vita

Rated M for Mature (violence, alcohol reference and partial nudity)

Persona 4 Golden is part turn-based role-playing game, part high school simulator and a rerelease of a celebrated PlayStation 2 game on the portable Vita.

These edited and condensed reviews are from the writers and editors of the gaming Web site Kotaku.com. Full reviews are at kotaku.com/nytselects.

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