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In Brief | Nation & World 11-11-12

Demographic shift means U.S. elections look different, too

WASHINGTON — It’s not just the economy, stupid. It’s the demographics — the changing face of America.

The 2012 elections drove home trends that have been embedded in the fine print of birth and death rates, immigration statistics and census charts for years.

America is rapidly getting more diverse, and, more gradually, so is its electorate.

Nonwhites made up 28 percent of the electorate this year, compared with 20 percent in 2000. Much of that growth is coming from Hispanics.

The trend has worked to the advantage of President Barack Obama two elections in a row now and is not lost on Republicans poring over the details of Tuesday’s results.

Spread of pricey prostate cancer therapy questioned

SAN FRANCISCO — When Max Calderon learned he had prostate cancer in 2010, his urologist recommended radiation therapy at a clinic in Salinas, Calif.

Calderon had just turned 77 and wasn’t an ideal candidate for the treatment, according to national guidelines established by 21 U.S. cancer-research centers. Lab tests showed a high probability his cancer had spread, and his advanced age pointed to the use of other therapies.

But he said his urologist, Amir Saffarian, didn’t mention alternatives, so he made 47 trips to the clinic, 28 miles from his home. Calderon said he never saw Saffarian there — even though his records show the urologist billed Medicare and Medicaid $30,000 for the treatment.

“The way they do their business, there’s something fishy going on,” Calderon said in an interview before his death in August at 79, after the cancer metastasized.

Investigators with the Department of Health and Human Services are examining Calderon’s case history to see whether the Salinas clinic and doctors who send patients there are violating laws against making referrals chiefly for financial gain, according to people familiar with the matter.

Neither Saffarian nor Aytac Apaydin and Stephen Worsham, listed in state records as owners of Salinas Valley Urology Associates and its radiation clinic, responded to questions.

The Calderon case has drawn attention to incentives that are channeling men into a treatment that delivers negligible benefits when compared to less expensive care, according to three studies in the past two years and seven doctors who’ve studied prostate treatment. The financial incentives raised concerns in Washington, where the Medicare program on Nov. 1 cut reimbursement rates for radiation treatment.

Like Saffarian, one in five U.S. urologists add to their income by billing for the type of treatment in question, according to the journal Urology Times. Called intensity-modulated radiation therapy, it uses imaging software to focus multiangled X-rays on tumors, aiming to deliver bigger doses with fewer side effects than prior technologies.

Medicare pays up to $40,000 per patient for IMRT, or 645 times what a urologist gets for a standard office visit and as much as 20 times what the federal insurance program pays a surgeon to remove a cancerous prostate gland, according to studies. Reimbursement from private insurers for IMRT can be even higher, urologists say.

The spread of IMRT is helping raise the cost of caring for prostate patients faster than any other cancer group. The National Cancer Institute forecasts 38 percent after-inflation growth by 2020 from the $11.9 billion spent on the disease in 2010. “IMRT is overused, period,” said urologist Matthew Cooperberg of the University of California, San Francisco, who has authored at least 18 studies on prostate treatment.

Mideast nuke talks called off

VIENNA — Attempts to find Arab-Israeli common ground on banning weapons of mass destruction from the Mideast have failed, and high-profile talks on the issue have been called off, diplomats said Saturday.

The two diplomats said the United States, one of the organizers, would likely make a formal announcement soon saying that with tensions in the region remaining high, “time is not opportune” for such a gathering. The diplomats spoke on condition of anonymity because they were not authorized to divulge the cancellation ahead of the formal announcement.

The meeting — to be held in Helsinki, Finland, by year’s end — was on shaky ground since it was agreed to in 2010 by the 189 member nations of the Nuclear Nonproliferation Treaty. Its key sponsors were the U.S., Russia and Britain, but they said such a meeting was only possible if all countries — especially Israel —agreed to attend.

The decision to postpone, if not to scrap it, will cast doubt on the significance of the NPT and its attempts every five years to advance nonproliferation. Any new attempt is unlikely until the NPT conference meets again in 2015.

Hopes for such a meeting were alive as recently as Tuesday, when Iran joined Arab nations in saying it planned to attend, leaving Israel as the only undecided country. Tehran’s announcement came at a Brussels seminar on a Mideast nuclear-free zone also attended by Israel and the Arab countries, and described as largely free of regional tensions. But the two diplomats said the decision to call off the Helsinki meeting had already been made by the time Iran declared Tuesday that it would attend.

Vatican digs in after gay marriage advances in U.S., Europe

VATICAN CITY — The Vatican is digging in after gay marriage initiatives scored big wins this week in the U.S. and Europe, vowing to never stop insisting that marriage can only be between a man and a woman.

In a front-page article in Saturday’s Vatican newspaper L’Osservatore Romano, the Holy See sought to frame itself as the lone voice of courage in opposing initiatives to give same-sex couples legal recognition. In a separate Vatican Radio editorial, the pope’s spokesman asked sarcastically why gay marriage proponents don’t now push for legal recognition for polygamous couples as well.

Catholic teaching holds that homosexuals should be respected and treated with dignity but that homosexual acts are “intrinsically disordered.” The Vatican also opposes same-sex marriage, insisting on the sanctity of marriage between a man and woman as the foundation for society.

The Vatican’s anti-gay marriage media blitz came after three U.S. states approved same-sex marriage by popular vote in the election that returned Barack Obama to the U.S. presidency, Spain upheld its gay marriage law, and France pushed ahead with legislation that could see gay marriage legalized early next year.

By wire sources