German Health Care Attracts Foreign Patients

BERLIN — When Jalal Talabani, the president of Iraq, needed advanced medical care for a stroke suffered this week, he flew not to the United States or Britain but to Germany, for treatment here in the capital.

For many Americans, Germany is known as a way station where soldiers wounded in Iraq and Afghanistan received immediate medical care on United States military bases. But it is also a popular destination for wealthy and prominent patients from the Middle East, Russia and beyond, experts say.

Before the Arab Spring uprisings, the Egyptian president Hosni Mubarak traveled to Munich in 2004 for back treatment and to Heidelberg in 2010 to have his gallbladder removed. Last year, President Nursultan Nazarbayev of Kazakhstan reportedly had a surgical procedure on his prostate at the University Medical Center Hamburg-Eppendorf.

According to German government statistics, the number of hospital patients from the United Arab Emirates rose to 1,754 from 339 between 2000 and 2010, the most recent year available. From Saudi Arabia, the figure climbed to 712 from 143. The numbers from Iraq were smaller but still rose to 176 from 95. Over the same period, the number of Russians jumped to 4,873 from 842.

“We have one of the worldwide best health care systems and people from abroad know that,” said Isabella Beyer, research associate in medical tourism at the Bonn-Rhein-Sieg University of Applied Sciences. Mr. Talabani, 79, is among them; he was treated in Germany before for back trouble.

Mr. Talabani is now being cared for at Berlin’s Charité hospital, which is more than 300 years old and is one of Europe’s largest university hospitals. The storied institution was home to several Nobel Prize winners, including Robert Koch and Paul Ehrlich. A spokeswoman for Charité, Manuela Zingl, confirmed that Mr. Talabani was being treated there but said that she could not disclose any information on his condition because of rules on medical privacy.

Mr. Talabani was said to be in “stable” condition after suffering a stroke this week, though there were unconfirmed reports that he was in a coma. He was rushed to the Baghdad Medical City on Monday.

He was treated there by medical experts from Iran, Germany and Britain, according to Iraqi staff members. Barazan Sheik Othman, the head of the presidential media office, said in a telephone interview that Mr. Talabani left for Germany accompanied by doctors after they established that he was well enough to be transferred.

Hospitals and clinics here have increasingly sought to market themselves as a destination for international patients. Ms. Beyer said that Germany benefited from a combination of lower prices than the United States but still provided high-quality care. Shorter waiting times and the proximity to the Middle East also helped.

“Before, a lot flew to Geneva,” said Salah Atamna, 44, whose business, Europe Health, seeks to link up patients from abroad with German hospitals and clinics.

Many wealthy Arabs would fly to Germany in the summer to escape the blistering heat at home, Mr. Atamna said, scheduling their vacation to coincide with an operation or other treatment. They often traveled with family members and large entourages. After the attacks of Sept. 11, 2001, it became harder to acquire visas to the United States, and medical travelers began searching for alternatives.

Duraid Adnan contributed reporting from Baghdad, and Victor Homola from Berlin.

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Stocks gain as traders hope for a budget deal

Stocks closed higher as traders hope that lawmakers and the White House can agree on a budget deal in time to avoid steep tax hikes and cuts in government spending at the beginning of the year.

The Dow Jones industrial average rose 60 points to end at 13,312 Thursday. The Dow waffled between small gains and losses early in the day and moved higher in the afternoon.

The Standard & Poor's 500 index rose eight points to 1,444. The Nasdaq composite rose six to 3,050.

The Republican-controlled House passed a plan to avert the “fiscal cliff,” but President Barack Obama has threatened to veto it.

Rising stocks outnumbered falling ones two-to-one on the New York Stock Exchange. Volume was lighter than usual at 3.6 billion shares.

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Russia bill to ban U.S. adoptions of Russian children advances

MOSCOW — Russia's parliament took a first step Wednesday toward banning the adoption of Russian children by American parents, a move intended as retaliation for an anti-corruption law recently passed by Congress.

The State Duma, the lower house of parliament, voted 399 to 17 in favor of a bill that included the ban and also would annul an adoption agreement between the two countries that Russia ratified in July. The measure still has to be approved by the upper house and signed by President Vladimir Putin, who has sent mixed signals about his support.

The Dima Yakovlev law is named after a Russian boy who died of heatstroke in 2008 after being left in a parked car by his adoptive American father. If approved, the legislation would cut off adoptions as of Jan. 1.

American parents have adopted more than 60,000 Russian children over the last two decades. Americans adopt 1,000 to 3,000 Russian children a year, said Boris Altshuler, who heads Right of the Child, a Moscow-based advocacy group. Russian families adopt about 7,000 children a year, far from enough to meet the country's needs.

The ban is intended to punish the United States for the so-called Magnitsky law, passed by Congress this month and named for Sergei Magnitsky, a Russian lawyer and whistle-blower who died in pretrial custody in Moscow in 2009. The Magnitsky law imposed visa restrictions on a group of Russian officials connected to the lawyer's prosecution and death.

Calling the Magnitsky law unfriendly and provocative, Russian legislators initially retaliated with a bill that included visa bans on an unspecified number of U.S. officials as well as on American parents who mistreat adopted Russian children and judges who are deemed lenient with such parents. The State Duma later added the adoption restrictions, accusing U.S. parents of mistreating and killing adopted Russian children and blaming unspecified middlemen of turning adoption into a corrupt and lucrative business.

"More than 80% of Russian children [adopted abroad] are adopted by the United States, and it is no secret for anyone in Russia today that this is a dirty business," Svetlana Goryacheva, a lawmaker with the Just Russia party, told reporters after the vote. "So today we in Russia are notorious for selling our children, and it is high time to stop it."

Ilya Ponomaryov, the only Duma member to speak out against the adoption ban, said there are 1,500 Russian children, including 49 with serious disabilities, whose adoptions by U.S. parents are awaiting approval in Russian courts.

"Today the State Duma for all practical purposes issued a grave verdict for these seriously sick children, who, I am sure, will languish in Russian orphanages for the rest of their lives without proper love and care," Ponomaryov said in an interview after the vote. "Their last chance is Putin's veto."

Putin warned lawmakers last week against "an excessive response" to the Magnitsky law, but gave his blessing to Wednesday's vote, according to his press secretary, Dmitry Peskov.

In an interview with the Russia-24 television network, Peskov called the U.S. law "an unfriendly act" and said the president understands the Russian lawmakers' tough stance.

The measure faces opposition from human rights groups and some Russian officials, including Foreign Minister Sergei Lavrov and the Kremlin's human rights envoy, Vladimir Lukin.

Besides adding the adoption ban, the measure was amended to suspend the activities of Russian nongovernmental organizations funded by the United States.

Rachel Denber, deputy director of the Europe and Central Asia division of Human Rights Watch, denounced both amendments. The U.S. law is designed to protect Russian citizens from corrupt officials, she said, so a symmetrical Russian response would be a measure aimed at corrupt American officials.

"Instead the Russian lawmakers decided to hit where it hurts more," she said in an interview. "They hit U.S. people who want to adopt Russian children and they hit U.S. organizations and activists who want to promote democracy in Russia."

"I am having a hard time believing that the prohibition of the adoption of Russian children by U.S. families can be in the best interests of Russian orphans," she added.

In the last 15 years, 19 adopted Russian children have died in accidents in the United States, while more than 1,200 adopted children have died in Russian families during the same period, according to Altshuler of Right of the Child.

"Our lawmakers thus sacrifice thousands of Russian orphans by locking them up in institutions instead of letting them have a chance to be adopted in the United States and have a real future," he added.

Altshuler said nearly 300,000 Russian children are in orphanages, about two-thirds of whom have parents who can't or won't support them. He called the situation critical and said that adoptions by Russian families aren't sufficient to resolve it.

Earlier Wednesday, Prime Minister Dmitry Medvedev urged Russians to adopt more children.

"Foreign adoption stems from the weak attention of the state and the society toward orphans," Medvedev said at a gathering of the ruling United Russia party.

sergei.loiko@latimes.com

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Claire Danes and Hugh Dancy welcome a baby boy

NEW YORK (AP) — Claire Danes and Hugh Dancy's "Homeland" just got bigger.

Danes' rep confirms the couple welcomed a baby boy named Cyrus Michael Christopher.

People.com first reported Monday's birth.

It's the first child for 33-year old Danes and 37-year-old Dancy. They were married in 2009.

There's no word yet whether the new mom will attend the Golden Globe Awards on Jan. 13. She's nominated for Best Performance by an Actress in a Television Series for her work on Showtime's "Homeland."

Up next, Dancy stars in NBC's "Hannibal," an adaptation of Thomas Harris' novel "Red Dragon."

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F.D.A. and States Meet About Regulation of Drug Compounders

Mary Calvert/Reuters

Margaret Hamburg, the F.D.A. commissioner, testified on the meningitis outbreak before Congress in November. She addressed the need for greater federal oversight of large compounding pharmacies, which mix batches of drugs on their own, often for much lower prices than major manufacturers charge.

SILVER SPRING, Md. – The Food and Drug Administration conferred with public health officials from 50 states on Wednesday about how best to strengthen rules governing compounding pharmacies in the wake of a national meningitis outbreak caused by a tainted pain medication produced by a Massachusetts pharmacy.

It was the first public discussion of what should be done about the practice of compounding, or tailor-making medicine for individual patients, since the F.D.A. commissioner, Dr. Margaret Hamburg, testified in Congress last month about the need for greater federal oversight of large compounding pharmacies. So far, 620 people in 19 states have been sickened in the outbreak, and 39 of them have died.

Pharmacies fall primarily under state law, and the F.D.A. convened the meeting to get specifics from states on gaps in the regulatory net and how the states see the federal role. Some states said they would prefer to see the F.D.A. handle large-scale compounders like the New England Compounding Center, or N.E.C.C., the Massachusetts pharmacy that was the source of the outbreak.

“The consensus in our group was that there is a role for the F.D.A. to be involved in facilities like N.E.C.C.,” said Cody Wiberg, the executive director of the Minnesota Board of Pharmacy. “If you’re talking about compounding, most states have the authority and resources to handle that. If you’re talking about nontraditional compounding,” he said, referring to large-scale enterprises like N.E.C.C., “fewer states may have the resources to do that.”

Large-scale compounding has expanded drastically since the early 1990s, driven by changes in the health care system, including the rise of hospital outsourcing.

“It is very clear that the health care system has evolved and the role of the compounding pharmacies has really shifted,” Dr. Hamburg said in a telephone interview on Tuesday. She said the laws had not kept pace.

“We need legislation that reflects the current environment and the known gaps in our state and federal oversight systems,” Dr. Hamburg said.

Under current law, compounders are not required to give the F.D.A. access to their books, and about half of all the court orders the agency obtained over the past decade were for pharmacy compounders, although compounders are only a small part of the agency’s regulatory responsibilities.

The F.D.A.'s critics argue that the agency already has all the legal authority it needs to police compounders. They say that many compounders have been operating as major manufacturers, shipping to states across the country, and that the F.D.A. should be using its jurisdiction over manufacturers to regulate those companies’ activities.

“There should be one uniform federal standard that is enforced by one agency – the F.D.A.,” said Michael Carome, deputy director of Public Citizen’s Health Research Group, a nonprofit consumer organization, who has been a critic of the agency’s approach. “They have been lax in enforcing that standard.”

But Dr. Hamburg contends that the distinction is not so simple. Lumping large compounders in with manufacturers would mean they would have to file new drug applications for every product they make, a costly and time-consuming process that is not always necessary for the products they make, like IV feeding tube bags, for example. Dr. Hamburg has proposed creating a new federal oversight category for large-scale compounders, separate from manufacturers.

“What concerns me is the idea that we could assert full authority over some of these facilities as though they were manufacturers, as though there were an on-off, black-white option,” Dr. Hamburg said. “That is a heavy-handed way to regulate a set of activities that can make a huge positive difference in providing necessary health care to people.”

The central problem, state representatives said, is how to define large-scale compounding. Should companies be measured by how much they produce, whether they ship across state lines, the types of products they produce, or some combination of those factors?

“It’s easy to stand at a distance and ask why can’t there be a bright line?” said Jay Campbell, executive director of the North Carolina Board of Pharmacy. “Let’s not let the perfect get in the way of the good. We won’t be able to make a distinction that is razor sharp.”

Large-scale compounders play an important role in the health care supply chain when they produce high-quality products, F.D.A. officials say. They fill gaps during shortages and supply hospitals with products that can be made more safely and cost-effectively in bulk than in individual hospitals.

Officials said they wanted to make sure the products made by such suppliers were safe, but were also concerned about disrupting that supply.

Carmen Catizone, head of the National Association of Boards of Pharmacy, said that states were not equipped to regulate the large-scale compounders and that the F.D.A. needed to find a middle path for regulating them.

“Either hospitals are not going to like the solution, or the manufacturers aren’t going to like the fact that these guys get a shorter path,” he said. “But something’s got to give.”

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Federal regulators take steps to strengthen kids' online privacy [Google+ Hangout]

Columnist David Lazarus talks with Mark Blafkin, spokesman for an organization of app developers, and Alan Simpson of Common Sense Media, an advocacy group for parents.

SAN FRANCISCO -- Federal regulators have taken the first major step in nearly 15 years to strengthen the protection of kids’ online privacy.

The Federal Trade Commission said Wednesday that it has given parents greater control over the information that online services collect from kids 12 and under.

The changes don't go as far as originally proposed after heavy lobbying from the technology and media industry that said the changes would hamper economic growth, stifle innovation and limit the scope and number of online games and educational programs for kids.

Live video chat at 3 p.m.

The FTC began a review of the Children’s Online Privacy Protection Act in 2010. It said the law needed to catch up with the advances in technology and the explosion of mobile devices.

“The Commission takes seriously its mandate to protect children’s online privacy in this ever-changing technological landscape,” FTC Chairman Jon Leibowitz said in a statement. “I am confident that the amendments to the COPPA Rule strike the right balance between protecting innovation that will provide rich and engaging content for children, and ensuring that parents are informed and involved in their children’s online activities.”

Among the steps it has taken, the FTC has made it clear that a child’s location, photographs and videos cannot be collected without a parent’s permission. It also closed a loophole that allowed mobile apps and websites to permit third parties to collect personal information from kids without notifying or obtaining the consent of parents.

It also extended kids’ privacy rules to cover IP addresses, mobile device IDs and other means of identifying a user, requiring services to take “reasonable steps” to release kids’ information only to companies that can keep it “secure and confidential.”

Privacy watchdogs issued statements of support for the rule changes.

 “We are at a critical moment in the growth of the children’s digital marketplace as social networks, mobile phones and gaming platforms become an increasingly powerful presence in the lives of young people,” said Kathryn Montgomery, professor of communications  at American University. “The new rules should help ensure that companies targeting children throughout the rapidly expanding digital media landscape will be required to engage in fair marketing and data collection practices.”

Join us for a live video chat at 3 p.m. on the issue with consumer columnist David Lazarus and Mark Blafkin, a spokesman for ACT, an organization representing app developers, and Alan Simpson, vice president of policy at Common Sense Media, an advocacy group representing families.

ALSO:

FTC investigates mobile apps makers on children's privacy

Giant social network Facebook may give access to children under 13

Parents want more online privacy protections for kids, privacy groups say

Follow me on Twitter @jguynn

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Two more funerals in Newtown; NRA responds to school massacre

NEWTOWN, Conn. -- Two more of the children killed by a gunman who invaded a Connecticut elementary school were buried on Tuesday as officials released new details of the deadly spree that has reshaped the debate over gun control.

The National Rifle Assn., which has been under pressure to comment on the Newtown shootings, broke its silence and issued a statement saying it was ready to offer its plans at a Friday news conference.

“We were shocked, saddened and heartbroken by the news of the horrific and senseless murders in Newtown,” said the pro-gun rights lobbying group, which has repeatedly fought gun-control legislation on the national, state and local levels. “The NRA is prepared to offer meaningful contributions to help make sure this never happens again.”

PHOTOS: Mourning after the massacre

Both funerals were held at St. Rose of Lima Catholic Church, which has been one of the centers for consoling the bereaved and for memorial services that began Friday evening, hours after Adam Lanza opened fire inside Sandy Hook Elementary School.

Primarily using a Bushmaster AR-15-style rifle, Lanza killed 20 children and six adults in the school before turning a handgun on himself, authorities said. The rampage began Friday morning when Lanza killed his mother, Nancy, in the home they shared.

Dr. H. Wayne Carver, the state’s chief medical examiner, told reporters on Tuesday that Nancy Lanza was shot four times in the head with a .22-caliber rifle. She was most likely asleep when she was killed, Carver said, according to the Hartford Courant.

After shooting his mother, Adam Lanza took her car and several of her guns and went to the school, where he forcibly entered and opened fire. The Bushmaster and two handguns were later recovered from the building and a shotgun was found in the car, officials said.

Sandy Hook Elementary remains closed, most likely for months, as investigators continue their work seeking to understand why Lanza did what he did. The hundreds of students at the school are being relocated to a school in nearby Monroe, Conn.

In the rain and cold Tuesday, other Newtown students returned to their schools where teachers were prepared to help them cope with the massacre. Campuses also had a sizable police presence to reassure parents.

One Newtown school, Head O'Meadow Elementary, was locked down Tuesday due to an unspecified threat. The principal told parents to keep their children home, according to a letter from the principal published by WFSB-TV. Police have said they will deal harshly with hoaxes and threats, including two directed over the weekend at St. Rose.

The first funeral Tuesday morning was for James Mattioli, 6. In what has become an ongoing sight, mourners kept their heads down and walked quickly into the building, and refused to comment. The families have repeatedly asked for privacy for their grief, a position backed by local police.

James' funeral was the first of eight to be held at the church. By noon, flowers for the second service, for Jessica Rekos, also 6, had begun to arrive.

James has been described by family members as a budding “numbers guy.” Jessica was a horse enthusiast who wanted cowgirl boots for Christmas, relatives told reporters.

A wake was scheduled Tuesday night for slain teacher Victoria Soto. Police were to be part of an honor guard for Soto, who died trying to protect her students by getting them into a closet and putting her body between the gunman and her charges.

The shootings have reopened the debate on gun-control laws, specifically whether to renew the expired national ban on assault weapons. President Obama has asked his staff to come up with proposals, though no time frame for action has been given. Even staunch pro-gun rights lawmakers have also called for reopening discussion on some bans.

ALSO:

'Puppies for Rent' business in Utah sparks criticism

L.A. girls pay tribute in visit, but Newtown is a day of hearses

'No, no, no': Harrowing 911 call, then 4 dead near Longmont, Colo.

Susman reported from Newtown, Conn., and Muskal from Los Angeles.

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Google Music adds free iTunes-like song-matching feature

Title Post: Google Music adds free iTunes-like song-matching feature
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NY appeals court takes up Cameron Douglas case

NEW YORK (AP) — A lawyer for the son of actor Michael Douglas hopes to convince a New York appeals court that he shouldn't have to spend a decade in prison for drug crimes.

Attorney Paul Shechtman says a 4½-year sentence given to Cameron Douglas that was added to a 5-year prison term he was already serving is "shockingly long." The sentence was added after a drug infraction in prison. But prosecutors say the sentence is reasonable, given the many times Douglas has broken his word to feed a drug and alcohol abuse addiction that stretches to when he was 13.

Shechtman says Cameron Douglas began selling drugs after his father sharply limited his access to family money because he wouldn't enter a drug rehabilitation program.

Arguments on the case are set for Wednesday.

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Samsung set to overtake Nokia as No. 1 cellphone brand worldwide

For the first time in 14 years, Nokia will not be the No. 1 cellphone brand in the world.

Samsung is set to claim the top spot in the mobile handset market, accounting for 29% of worldwide cellphone shipments this year, according to market research firm IHS. That's up from 24% last year.

Nokia, meanwhile, will see its market share this year drop to 24% from 30% in 2011.

This year will mark the first time Samsung will occupy the top position on a yearly basis. The South Korean's rise was helped by strong sales of its smartphones, IHS said.

Global smartphone shipments are projected to rise 35.5% this year, while overall cellphone shipments will increase by about 1%. This rapid growth will propel 2012 smartphone penetration among consumers to 47%, up from 35% last year.

“The competitive reality of the cellphone market in 2012 was ‘live by the smartphone, die by the smartphone,’” said Wayne Lam, senior analyst for wireless communications at IHS. “Smartphones represent the fastest-growing segment of the cellphone market and will account for nearly half of all wireless handset shipments for all of 2012. Samsung’s successes and Nokia’s struggles in the cellphone market this year were determined entirely by the two companies’ divergent fortunes in the smartphone sector.”

Samsung's success has been built on its “fast follower” strategy for design and manufacturing, IHS said. The electronics giant produces dozens of new smartphone models every year that address all segments of the market, from the high end to the low end.

Meanwhile, Finnish-based Nokia is "mired in transitioning its smartphone line to the Windows operating system," resulting in declining shipments for the company, IHS said. Sales of the company’s older phones have plunged, while its new Microsoft Windows 7-based handsets haven’t been able to make up for the loss so far.

Samsung is also pulling ahead of rival Apple in the smartphone market: Samsung and Apple ended 2011 in a neck-and-neck battle for leadership in the smartphone market, with only 1 percentage point of market share separating them. However, entering 2012, Samsung "moved ahead decisively" of Apple with a wide range of Android smartphone offerings at multiple price points, IHS said.

Together, Samsung and Apple smartphones accounted for nearly half of shipments in 2012, up from 39% last year.

IHS said it expects that the smartphone penetration rate in 2013 will elevate smartphones into the majority among all phone segments, at 56%. The change will mark a significant tipping point in the mobile handset market.

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Amazon readying smartphone for mid-2013 launch?

Samsung unveils Galaxy Grand smartphone with a 5-inch screen

Instagram says it will respond to terms-of-service uproar 'very soon'

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