SciTimes Update: Recent Developments in Health and Science News

Charles A. Nelson Lab, University of Minnesota

Studying the infant brain. From the book:  "Raising America: Experts, Parents and a Century of Advice About Children" by Ann Hulbert.

Wednesday in Science, babies who know what’s on your mind, a sinkhole in China, coral reefs in crisis and a soldier who can now talk with his hands. Check out these and other headlines from around the Web.

Baby Mind Readers: Even babies as young as 1 ½ can guess what other people are thinking, LiveScience.com reports. Previously, scientists thought this ability to understand other people’s perspectives emerged much later in children.

Time Wasters: An explosion in technology aimed at helping people manage their time and tasks may actually be making it harder, reports The Wall Street Journal. Many people choose something that doesn’t fit the way they think and work, or they jump from one tool to another, wasting time and energy.

More Housework, Less Sex: Married men who spend more time doing traditionally female chores, like cooking, cleaning and shopping, report having less sex than husbands who don’t do as much, reports The Houston Chronicle. Conversely, men who did more manly chores, such as yard work, paying bills and auto repairs, reported having more sex.

Roman Tag Artists: A facelift of the Colosseum in Rome that began last fall has revealed centuries of graffiti, National Geographic reports.

Sinkhole Swallows Building: An enormous sinkhole opened up under a building complex in China’s southern city of Guangzhou Tuesday, swallowing five shops and one building. Watch the video from The Christian Science Monitor.

Sandwiched Generation: More middle-aged adults are caring for both children and aging parents, reports USA Today. About 15 percent of American adults in their 40s and 50s provided financial support to both an aging parent and a child in 2012, according to a survey of 2,511 adults from the Pew Social and Demographic Trends Project.

Misleading Trials: A rare peek into drug company documents reveals troubling differences between publicly available information and materials the company holds close to its chest, reports ScienceNews.org. In comparing public and private descriptions of drug trials conducted by the pharmaceutical giant Pfizer, researchers discovered discrepancies,including changes in the number of study participants and inconsistent definitions of protocols and analyses.

Reuters

A diver swam past a healthy colony of Caribbean elkhorn coral near Molasses Reef, Florida, in 2009.

Coral in Crisis: Coral reefs are producing less calcium carbonate and growth rates have slowed dramatically, reports Science News.

Severe Flu Cases Among Chinese: A genetic variant commonly found in Chinese people may help explain why some got seriously ill with swine flu, reports The Boston Globe. The discovery could help pinpoint why flu viruses hit some populations particularly hard and change how they are treated.

Video by AssociatedPress

Double-Arm Transplant Recipient: Feels Amazing

Double-Arm Transplant Soldier Speaks: Brendan Marrocco, a soldier who lost all four limbs in Iraq and then received a double-arm transplant said he hated living without arms. “Not having arms takes so much away from you. Even your personality, you know. You talk with your hands. You do everything with your hands, and when you don’t have that, you’re kind of lost for a while,” the 26-year-old New Yorker told reporters Tuesday at Johns Hopkins Hospital, reports The Associated Press.

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Today's Economist: Casey B. Mulligan: The Health Care Law and Retirement Savings

Casey B. Mulligan is an economics professor at the University of Chicago. He is the author of “The Redistribution Recession: How Labor Market Distortions Contracted the Economy.”

Because of its definition of affordability, beginning next year the Affordable Care Act may affect retirement savings.

Employer contributions to employee pension plans are exempt from payroll and personal income taxes at the time that they are made, because the employer contributions are not officially considered part of the employee’s wages or salary (employer health insurance contributions are treated much the same way). The contributions are taxed when withdrawn (typically when the worker has retired), at a rate determined by the retiree’s personal income tax situation.

Employees are sometimes advised to save for retirement in this way in part because the interest, dividends and capital gains accrue without repeated taxation. In addition, people sometimes expect their tax brackets to be lower when retired than they are when they are working.

These well-understood tax benefits of pension plans will change a year from now if the act is implemented as planned. Under the act, wages and salaries of people receiving health insurance in the law’s new “insurance exchanges” will be subject to an additional implicit tax, because wages and salaries will determine how much a person has to pay for health insurance.

While much about the Affordable Care Act is still being digested by economists, they have long recognized that high marginal tax rates lead to fringe benefit creation. And the Congressional Budget Office has concluded that the act will raise marginal tax rates.

Were an employer to reduce wages and salaries (or fail to increase them) and compensate employees by introducing an employer-matching pension plan, the employee is likely to benefit by receiving additional government assistance with his health-insurance costs. The pension contributions will add to the worker’s income during retirement, except that the income of elderly people does not determine health-insurance eligibility to the same degree, because the elderly participate in Medicare, most of which is not means-tested.

Take, for example, a person whose four-member household would earn $95,000 a year if his employer were not making contributions to a pension plan or did not offer one. He would be ineligible for any premium assistance under the Affordable Care Act because his family income would be considered to be about 400 percent of the poverty line.

If instead the employer made a $4,000 contribution to a pension plan and reduced the employee’s salary so that household income was $91,000, the employee would save the personal income and payroll tax on the $4,000 and would become eligible for about $2,600 worth of health-insurance premium assistance under the act. (The employer would come out ahead here, too, by reducing its payroll tax obligations).

Even though the Affordable Care Act is known as a health-insurance law, in effect it could be paying for a large portion of employer contributions to pension plans. This has the potential of changing retirement savings and the relative living standards of older and working-age people.

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Ukrainian General Given Life Sentence in Killing of Journalist

Sergey Dolzhenko/European Pressphoto Agency

Gen. Oleksei Pukach listened to his sentence from the defendant's cage during a court session of the Pechersk district court on charges of murder of the journalist Georgy Gongadze in Kiev, Ukraine, on Tuesday.

MOSCOW — A Ukrainian court sentenced a former security official to life in prison on Tuesday for the death of Georgy Gongadze, a journalist whose mysterious death in 2000 provoked an international outcry and helped set off protests against the president at the time, Leonid D. Kuchma.

The former security official, Gen. Oleksei Pukach, who once headed a surveillance department for Ukraine’s Interior Ministry, testified that he had not intended to kill Mr. Gongadze, but strangled him with a belt accidentally in the course of an interrogation. He is the highest-ranking official to be convicted in Mr. Gongadze’s death.

Mr. Gongadze went missing in September 2000 and his body was found two months later, beheaded, in a forest 75 miles from Kiev, the capital. He had infuriated the president, Mr. Kuchma, with muckraking publications in Ukrainskaya Pravda, an Internet newspaper he had founded.

Suspicions of official involvement grew with the release of covert recordings made by one of Mr. Kuchma’s bodyguards, in which the a man who sounded like the president spoke of Mr. Gongadze, telling a subordinate to “throw him out, give him to the Chechens.”

The killing came to epitomize the role that crime had come to play in Ukrainian politics and provoked a wave of demonstrations that some describe as the first manifestation of the 2004 Orange Revolution.

Three former police officers who stood trial over Mr. Gongadze’s death said that he had climbed into what he believed to be a taxi and was taken to a location outside Kiev, where he was beaten and strangled, doused with gasoline and burned.

General Pukach said he had been trying to force Mr. Gongadze to confess to espionage, something Mr. Gongadze refused to do, though he did admit accepting $400,000 from Western diplomats for passing on information.

Volodymyr Shilov, a prosecutor, said that General Pukach had testified that he was carrying out an order, but would not say what the order was or who issued it, according to the Interfax news agency. But just before guards took him away on Tuesday, General Pukach gave a revealing response to journalists who asked him to comment on the verdict, telling them to direct their questions to Mr. Kuchma and his chief of staff, Volodymyr Lytvyn.

“Ask Kuchma and Lytvyn, they’ll tell you everything,” he said, shaking his finger angrily, according to television coverage of the trial. “I told everything during the investigation and trial. So ask Lytvyn and Kuchma about their motives and intentions.”

The trial was mostly closed to journalists, who were allowed to be present only for the verdict and sentencing. But a lawyer representing Mr. Gongadze’s widow complained that the investigation and trial were flawed and inconsistent, overlooking evidence that General Pukach had intended to kill Mr. Gongadze.

“He spoke clearly about receiving an order to kill burn and bury him, and he was prepared for this,” said the lawyer, Valentyna Telychenko, in comments broadcast on television. “He brought a shovel and a canister of gasoline, meaning his actions were directed toward murder, and nothing else.”

General Pukach testified that he had been ordered to conduct surveillance by Ukraine’s interior minister — a man who was found dead in 2005, hours before he was to be questioned by prosecutors in the matter. Officials called it a suicide, though Ukrainian news agencies said he had suffered two gunshot wounds.

This article has been revised to reflect the following correction:

Correction: January 29, 2013

An earlier version of this article misstated, on first reference, the year of Georgy Gongadze’s death. It was in 2000, not 2002.

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Streaming Shakes Up Music Industry’s Model for Royalties

Jim Wilson/The New York Times

Zoe Keating published on her blog the details of what she made in royalties from the Web streaming of her music. It wasn’t a lot.

Like plenty of music fans, Sam Broe jumped at the chance to join Spotify two summers ago, and he hasn’t looked back.

Spotify, which began streaming music in Sweden in 2008, lets users choose from millions of songs over the Internet free or by subscription, and is increasingly seen as representing the future of music consumption. Mr. Broe, a 26-year-old from Brooklyn, said that having all that music at his fingertips helped him trim his monthly music budget from $30 to the $10 fee he pays for Spotify’s premium service.

“The only time I download anything on iTunes is in the rare case that I can’t find it on Spotify,” he said.

A decade after Apple revolutionized the music world with its iTunes store, the music industry is undergoing another, even more radical, digital transformation as listeners begin to move from CDs and downloads to streaming services like Spotify, Pandora and YouTube.

As purveyors of legally licensed music, they have been largely welcomed by an industry still buffeted by piracy. But as the companies behind these digital services swell into multibillion-dollar enterprises, the relative trickle of money that has made its way to artists is causing anxiety at every level of the business.

Late last year, Zoe Keating, an independent musician from Northern California, provided an unusually detailed case in point. In voluminous spreadsheets posted to her Tumblr blog, she revealed the royalties she gets from various services, down to the ten-thousandth of a cent.

Even for an under-the-radar artist like Ms. Keating, who describes her style as “avant cello,” the numbers painted a stark picture of what it is like to be a working musician these days. After her songs had been played more than 1.5 million times on Pandora over six months, she earned $1,652.74. On Spotify, 131,000 plays last year netted just $547.71, or an average of 0.42 cent a play.

“In certain types of music, like classical or jazz, we are condemning them to poverty if this is going to be the only way people consume music,” Ms. Keating said.

The way streaming services pay royalties represents a major shift in the economic gears that have been underlying the industry for decades.

From 78 r.p.m. records to the age of iTunes, artists’ record royalties have been counted as a percentage of a sale price. On a 99-cent download, a typical artist may earn 7 to 10 cents after deductions for the retailer, the record company and the songwriter, music executives say. One industry joke calls the flow of these royalties a “river of nickels.”

In the new economics of streaming music, however, the river of nickels looks more like a torrent of micropennies.

Spotify, Pandora and others like them pay fractions of a cent to record companies and publishers each time a song is played, some portion of which goes to performers and songwriters as royalties. Unlike the royalties from a sale, these payments accrue every time a listener clicks on a song, year after year.

The question dogging the music industry is whether these micropayments can add up to anything substantial.

“No artist will be able to survive to be professionals except those who have a significant live business, and that’s very few,” said Hartwig Masuch, chief executive of BMG Rights Management.

Spotify has 20 million users in 17 countries, with five million of them paying $5 to $10 a month to eliminate the ads seen by freeloaders.

In a recent interview, Sean Parker, a board member, said he believed Spotify would eventually attract enough subscribers to help return the music industry to its former glory — that is, to the days before Mr. Parker’s first major enterprise, Napster, came along.

“I believe that Spotify is the company that will make it succeed,” said Mr. Parker, who is also a former president of Facebook. “It’s the right model if you want to build the pot of money back up to where it was in the late ’90s, when the industry was at its peak. This is the only model that’s going to get you there.”

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Well: Ask Well: Long-Term Use of Nicotine Gum

In small doses, like those contained in the gum, nicotine is generally considered safe. But it does have stimulant properties that can raise blood pressure, increase heart rate and constrict blood vessels. One large report from 2010 found that compared to people given a placebo, those who used nicotine replacement therapies had a higher risk of heart palpitations and chest pains.

That’s one reason that nicotine gum should, ideally, be used for no more than four to six months, said Lauren Indorf, a nurse practitioner with the Cleveland Clinic’s Tobacco Treatment Center. Yet up to 10 percent of people use it for longer periods, in some cases for a decade or more she said.

Some research has raised speculation that long-term use of nicotine might also raise the risk of cancer, though it has mostly involved laboratory and animal research, and there have not been any long-term randomized studies specifically addressing this question in people. One recent report that reviewed the evidence on nicotine replacement therapy and cancer concluded that, “the risk, if any, seems small compared with continued smoking.”

Ultimately, the biggest problem with using nicotine gum for long periods is that the longer you stay on it, the longer you remain dependent on nicotine, and thus the greater your odds of a smoking relapse, said Ms. Indorf. “What if the gum is not available one day?” she said. “Your body is still relying on nicotine.”

If you find yourself using it for longer than six months, it may be time to consider switching to sugar-free gum or even another replacement therapy, like the patch or nasal spray.

“Getting people on a different regimen helps them break the gum habit and can help taper them off nicotine,” Ms. Indorf said.

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Well: Ask Well: Long-Term Use of Nicotine Gum

In small doses, like those contained in the gum, nicotine is generally considered safe. But it does have stimulant properties that can raise blood pressure, increase heart rate and constrict blood vessels. One large report from 2010 found that compared to people given a placebo, those who used nicotine replacement therapies had a higher risk of heart palpitations and chest pains.

That’s one reason that nicotine gum should, ideally, be used for no more than four to six months, said Lauren Indorf, a nurse practitioner with the Cleveland Clinic’s Tobacco Treatment Center. Yet up to 10 percent of people use it for longer periods, in some cases for a decade or more she said.

Some research has raised speculation that long-term use of nicotine might also raise the risk of cancer, though it has mostly involved laboratory and animal research, and there have not been any long-term randomized studies specifically addressing this question in people. One recent report that reviewed the evidence on nicotine replacement therapy and cancer concluded that, “the risk, if any, seems small compared with continued smoking.”

Ultimately, the biggest problem with using nicotine gum for long periods is that the longer you stay on it, the longer you remain dependent on nicotine, and thus the greater your odds of a smoking relapse, said Ms. Indorf. “What if the gum is not available one day?” she said. “Your body is still relying on nicotine.”

If you find yourself using it for longer than six months, it may be time to consider switching to sugar-free gum or even another replacement therapy, like the patch or nasal spray.

“Getting people on a different regimen helps them break the gum habit and can help taper them off nicotine,” Ms. Indorf said.

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DealBook: Gleacher to Leave His Investment Bank

9:32 a.m. | Updated with interview with Mr. Gleacher

Eric J. Gleacher, a veteran deal maker who participated in the fight over RJR Nabisco, said on Tuesday that he would leave the investment bank he founded about 23 years ago.

The departure of Mr. Gleacher as chairman comes months after his struggling firm hired Credit Suisse to explore a sale.

Gleacher & Company disclosed last month that the Nasdaq stock market had initiated a move to delist the investment bank, after its stock price lingered below $1 for months. The firm is appealing the decision.

Mr. Gleacher, 72, told DealBook in an interview on Tuesday that his decision was prompted in part by finishing work on the sale of Archstone, a massive real estate company once owned by Lehman Brothers. Since the deal was announced in late November, he has been approached by a number of companies seeking advice, and he is weighing opportunities to essentially become a freelance adviser.

“As the business model on Wall Street changes, I’m looking forward to working with C.E.O.’s and investors in helping them realize their goals,” he said. “I’m looking forward to doing so in an independent manner.”

(He has been contemplating a move for some time, having put up his Manhattan town house for sale earlier this month.)

Mr. Gleacher, a former Marine and long one of Wall Street’s top golfers, founded his company after having become one of the top deals bankers on Wall Street during the 1980s. He founded the mergers department at Lehman Brothers in 1978, and then led Morgan Stanley‘s deal team from 1985 to 1990.

He then founded his firm, maintaining it for years as an independent merger advisory shop. He sold it to the British bank Natwest in 1995, but bought it back four years later.

Mr. Gleacher and his partners decided in 2009 to sell their business to Broadpoint Securities, a small brokerage, giving rise to the current Gleacher & Company. But the firm struggled, burdened with rising regulatory constraints and tepid deal activity.

Under Thomas Hughes, Gleacher & Company’s chief executive, the investment bank has sold off businesses in an attempt to revive its flagging fortunes. In the fall, the firm explored a potential sale to a larger concern, Stifel Financial, but the talks fell apart over price, according to people briefed on the matter.

It is unclear whether the investment bank is still pursuing a sale. Mr. Hughes suggested in a statement that the firm continued to weigh its options.

“We will continue to grow our M.&A. and capital-raising capabilities in line with the vision we have described previously, a vision that Eric helped author,” Mr. Hughes said. “On behalf of the company, I want to wish Eric the best in his future endeavors.”

While striking off on his own will allow him more personal time, Mr. Gleacher added that he intended to keep busy.

“To me, retirement is just time allocation,” he said. “I’ve always just enjoyed what I’ve done.”

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India Ink: At Literature Festival, Yearning for Bollywood Past

Nostalgia for classic Bollywood cinema reigned at the Jaipur Literature Festival, which celebrated 100 years of Indian cinema with several sessions featuring veteran actors and writers, who offered critiques of contemporary Indian film-making.

In the session titled “Bollywood and National Narrative,” Javed Akhtar, the Indian poet and lyricist who scripted several popular Hindi films in the 1970s and ’80s, said that India is a nation of great “movie buffs,” noting that perhaps it was the only country where temples dedicated to movie stars exist.

“If you watch cinema carefully, it tells you a lot about the last 60 to 70 years in India,” Mr. Akhtar, 68, said.

The influence of society on filmmaking was so ingrained that drawing a list of a villain’s character over the years gives a sense of the socioeconomic history of the country, he said. In the 1940s, the villain was the zamindar, or landlord, who exploited the oppressed farmers, he noted. But today, he said, there is no such clear-cut character in society because the line between the heroes and the villains has become blurred.

Pointing to a generational shift in the art of storytelling in Bollywood, Mr. Akhtar argued that nowadays the screenplay is driven by a formulaic method that is aimed at a young, affluent audience who wants to have a good time at the theater and is not willing to engage with serious subjects.

“There is no shortage of stories, but an average producer wants a brand new story that has come before,” he said.

Wistfully, he commented that with the exception of a handful of films, the young generation of filmmakers had “left literature, poetry, art and aesthetics behind.”

But he also said he was hopeful that the next 10 years would usher in an era of more depth in film-making.

In another session on Bollywood, titled “Sex and Sensibility: Women in Cinema,” Shabana Azmi, the veteran Bollywood actress, along with Prasoon Joshi, lyricist, writer and poet, discussed the role of cinema in creating gender perceptions.

Ms. Azmi, who has also worked as a social activist on several issues including women’s rights, argued that Hindi cinema has created an ideal of womanhood based on mythological constructs taken from epics like the Ramayana. While the character of the vamp was created to satisfy men’s sexual appetites, the ideal woman was docile, submissive and had no sexuality, she said.

“The movies are setting the wrong kinds of role models for young girls,” she said.

Mr. Joshi said it was time that “we realize we are not only mirroring society we are shaping it. People are emulating cinema in their daily lives.”

In a fiery debate among the panelists, a consensus was reached that it was ultimately those involved in the business of film-making who were responsible for perpetuating the stereotypes.

“We are all culpable,” Ms. Azmi said.

The younger generation of writers may have been criticized by some veterans for the lack of sensibility in their work, but even they seemed to agree that some of the more recent films did not have a moral compass.

“The line between the hero and the antihero is blurring, and that is very dangerous,” said Mr. Joshi, who is 41. “The antihero is becoming cool. Crime can’t become cool.”

During a session on screenwriting, Jaideep Sahni, a screenwriter and lyricist who has some notable films to his credit, including “Kholsa Ka Ghosla” and “Chake De India” warned against having too much nostalgia for the past. He grew up watching films in the 1980s and the 1990s, and “they had bad scripts,” he said.

“There was a tyranny of listening to the same thing again and again,” he said.

He said a certain kind of popular, commercial entertainment was being considered the “be all and end all” but is having a negative impact on cinema.

However, the screenwriter, who is in his 40s, defended young screenwriters and lyricists like him, saying that they watched old films and listened to old Bollywood music but made films about the present times.

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Bits Blog: Google Says Electronic Snooping by Governments Should Be More Difficult

If a government wants to peek into your Web-based e-mail account, it is surprisingly easy, most of the time not even requiring a judge’s approval.

That is a problem, according to Google, which said it had received 21,389 requests for information about 33,634 of its users in the second half of last year, an increase of 70 percent in three years. Google handed over some personal data in two-thirds of those cases.

The vast majority of the requests came from the United States government. In the last six months, United States officials made 8,438 requests for data, and Google complied with at least part of the request 88 percent of the time. (One of those, most likely, was for access to the Gmail account of Paula Broadwell, which ultimately revealed her affair with David H. Petraeus, formerly C.I.A. director.)

To mark Data Privacy Day on Monday (a holiday that, no doubt, you have highlighted on your calendar in eager anticipation), Google is trying to rally support against broad government access to personal online data.

“We want to be sure we’re taking our responsibilities really seriously, protecting our users’ information and being transparent about it,” David Drummond, Google’s chief legal officer, said in a rare interview.

“We want people to know that we are not going to just roll over but we are going to make sure that governments around the world follow standards and do this in a reasonable way that strikes the balance,” he added.

The heart of the issue is that the law grants more protection to a piece of paper on your desk than it does to an e-mail stored online. The Electronic Communications Privacy Act was enacted in 1986, years before widespread use of e-mail or cloud storage, or the invention of social networking.

“People probably assume that all their communications, whether it’s physical letters or phone calls or e-mails, are protected by the Fourth Amendment and the police have to go to a judge to get a warrant,” said Trevor Timm, a privacy advocate studying surveillance at the Electronic Frontier Foundation. “In fact, that’s not the case.”

For instance, the law says the police do not need a search warrant, which requires a judge to agree there is probable cause, to read e-mail messages that are more than 180 days old.

Congress is expected to consider amendments to the 1986 law this year. Meanwhile, the Obama administration has been pushing for Web companies to allow easier electronic wiretapping.

In the United States, 68 percent of requests for Google users’ information come in the form of subpoenas, which do not require a judge’s approval. The rest are search warrants or other types of court orders.

Google said it had been fighting the broad use of subpoenas by requiring search warrants for detailed personal data — beyond things like a user’s name, location, phone number and time that an e-mail was sent — even if the law seems to say a subpoena is enough.

In a primer published on Monday, Google says it requires a search warrant to share Gmail messages, private YouTube videos, stored voicemails or text messages on Google Voice and private blog posts on Blogger.

Though Google has sometimes struggled over the years to earn users’ trust in how it handles personal data, the company stands out in its efforts to protect users against government requests for data.

“Google’s been kind of a pioneer,” Mr. Timm said.

Since 2010, it has published its transparency report, outlining the number of government requests it receives for users’ data or to remove content from the Web. Companies including Twitter, which employs several former Google lawyers, have followed suit. Mr. Drummond says he wants other Web companies to do so, too.

Google says it scrutinizes each government request, narrows the scope if possible, and notifies users of the request if it is not prohibited by law.

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Well: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

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How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

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