FDA approves new targeted breast cancer drug

WASHINGTON (AP) — The Food and Drug Administration has approved a first-of-a-kind breast cancer medication that targets tumor cells while sparing healthy ones.

The drug Kadcyla from Roche combines the established drug Herceptin with a powerful chemotherapy drug and a third chemical linking the medicines together. The chemical keeps the cocktail intact until it binds to a cancer cell, delivering a potent dose of anti-tumor poison.

Cancer researchers say the drug is an important step forward because it delivers more medication while reducing the unpleasant side effects of chemotherapy.

"This antibody goes seeking out the tumor cells, gets internalized and then explodes them from within. So it's very kind and gentle on the patients — there's no hair loss, no nausea, no vomiting," said Dr. Melody Cobleigh of Rush University Medical Center. "It's a revolutionary way of treating cancer."

Cobleigh helped conduct the key studies of the drug at the Chicago facility.

The FDA approved the new treatment for about 20 percent of breast cancer patients with a form of the disease that is typically more aggressive and less responsive to hormone therapy. These patients have tumors that overproduce a protein known as HER-2. Breast cancer is the second most deadly form of cancer in U.S. women, and is expected to kill more than 39,000 Americans this year, according to the National Cancer Institute.

The approval will help Roche's Genentech unit build on the blockbuster success of Herceptin, which has long dominated the breast cancer marketplace. The drug had sales of roughly $6 billion last year.

Genentech said Friday that Kadcyla will cost $9,800 per month, compared to $4,500 per month for regular Herceptin. The company estimates a full course of Kadcyla, about nine months of medicine, will cost $94,000.

FDA scientists said they approved the drug based on company studies showing Kadcyla delayed the progression of breast cancer by several months. Researchers reported last year that patients treated with the drug lived 9.6 months before death or the spread of their disease, compared with a little more than six months for patients treated with two other standard drugs, Tykerb and Xeloda.

Overall, patients taking Kadcyla lived about 2.6 years, compared with 2 years for patients taking the other drugs.

FDA specifically approved the drug for patients with advanced breast cancer who have already been treated with Herceptin and taxane, a widely used chemotherapy drug. Doctors are not required to follow FDA prescribing guidelines, and cancer researchers say the drug could have great potential in patients with earlier forms of breast cancer

Kadcyla will carry a boxed warning, the most severe type, alerting doctors and patients that the drug can cause liver toxicity, heart problems and potentially death. The drug can also cause severe birth defects and should not be used by pregnant women.

Kadcyla was developed by South San Francisco-based Genentech using drug-binding technology licensed from Waltham, Mass.-based ImmunoGen. The company developed the chemical that keeps the drug cocktail together and is scheduled to receive a $10.5 million payment from Genentech on the FDA decision. The company will also receive additional royalties on the drug's sales.

Shares of ImmunoGen Inc. rose 2 cents to $14.32 in afternoon trading. The stock has ttraded in a 52-wek range of $10.85 to $18.10.

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Wall Street rebounds on HP results, Fed officials' views

NEW YORK (Reuters) - U.S. stocks rose on Friday as Dow component Hewlett-Packard surged on strong results and comments from Fed officials allayed fears that the central bank would curtail its stimulus measures.

Federal Reserve Chairman Ben Bernanke downplayed worries that the Fed has fueled asset bubbles that could hurt the economy in a private meeting with bond dealers and investors earlier this month, Bloomberg reported on Friday.

Bernanke's view helped ease fears that the central bank may end its easy money policies. Minutes from the Federal Reserve's January meeting hit markets on Wednesday as investors interpreted divergent opinions on the benefit of stimulus as a sign the measures may be halted sooner than thought.

"They are in uncharted territory with divergent views," said Jack Ablin, chief investment officer at BMO Private Bank in Chicago. "I could see some pretty heated opinions on what the ultimate outcome is, so I do believe there is dissension."

Hewlett-Packard Co shares jumped more than 12 percent and gave one of the biggest boosts to both the Dow and the S&P 500 after the personal computer maker's quarterly revenue and forecasts beat expectations. Hewlett-Packard's stock rose to $19.20 at the close, up 12.3 percent for the day.

The Dow Jones industrial average <.dji> gained 119.95 points, or 0.86 percent, to 14,000.57 at the close. The Standard & Poor's 500 Index <.spx> rose 13.18 points, or 0.88 percent, to 1,515.60. The Nasdaq Composite Index <.ixic> added 30.33 points, or 0.97 percent, to end at 3,161.82.

With Bernanke's reported comments much on their minds in Friday's session, investors will want the Fed chairman to reiterate his remarks publicly when he speaks before the Senate Banking Committee on Tuesday. That would echo comments made by two top Fed officials on Friday.

Boston Fed President Eric Rosengren and Fed Governor Jerome Powell both defended the U.S. central bank's asset-buying program, arguing that the policy helps the U.S. economy.

The S&P 500 shed 1.9 percent over the previous two sessions, its worst two-day drop since early November, following the release of the Fed's minutes on Wednesday. The selloff marked the end of seven back-to-back weeks of gains for stocks.

For the week, the S&P 500 slipped 0.3 percent and the Nasdaq lost nearly 1 percent. Only the Dow ended the week with a gain - up just 0.1 percent.

HP's results come near the end of a relatively strong earnings season in which 70 percent of S&P 500 companies beat analysts' expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data.

"Overall, the earnings supports were better than expected in this cycle," said Peter Jankovskis, co-chief investment officer at OakBrook Investments LLC in Lisle, Illinois. "We may see the market rising during the month of March."

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 6 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

But with only a handful of companies left to report earnings, investors are looking ahead to the possibility of hefty automatic budget cuts that could happen on March 1.

A large option investor appeared to be adjusting a bearish view on the SPDR S&P 500 Trust fund while locking in previously established gains, in a possible hedge ahead of the automatic budget cuts that are set to take effect at the beginning of next month. The play involved weekly puts, expiring next Friday.

"An institutional investor appears to be rolling down and increasing in size a defensive hedge timed to match the March 1 deadline for the sequester," said Henry Schwartz, president of options analytics firm Trade Alert.

The trader sold 132,000 $149 to $150 weekly put spreads for 22 cents as shares of the exchange-traded fund had traded near $151.14 on Friday morning. The transaction entailed the sale of $150 weekly puts to buy the $149 weekly puts. In addition, the investor purchased another 42,000 $149 weekly puts, which increases the size of the hedge to 174,000 contracts.

"It is likely this large position protects an existing underlying long position in a portfolio," Schwartz said.

In another political risk factor, Italians go to the polls this weekend in an election that could threaten reforms in the indebted country. Silvio Berlusconi's resurgence has thrown the vote wide open, with deep uncertainty over whether the poll can produce the strong government the country needs.

Inconclusive Greek elections last year sparked a protracted selloff and a period of uncertainty in markets.

In the tech sector, Marvell Technology Group Ltd forecast results this quarter that were largely above analysts' expectations. Marvell gained market share in the hard-disk drive and flash-storage businesses. The stock rose 4.4 percent to $9.89.

Texas Instruments Inc raised its dividend by a third and boosted its stock-buyback program, driving its stock up 5.2 percent to $34.18.

The PHLX semiconductor index <.sox> gained 2.1 percent.

"Dividends growing are another way the market's level is justified, if not especially attractive at these levels," said Rex Macey, chief investment officer of Wilmington Trust in Atlanta, who manages about $20 billion in assets.

On the downside, Abercrombie & Fitch dropped 4.5 percent to $46.86 after the youth-oriented clothing retailer reported a drop in fourth-quarter comparable sales, even as its latest quarterly earnings topped estimates.

Insurer American International Group Inc posted fourth-quarter results that beat analysts' expectations. AIG's stock advanced 3.1 percent to $38.45.

About three stocks rose for every one that fell on both the New York Stock Exchange and Nasdaq.

Around 5.8 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, below the 20-day moving average of around 6.51 billion shares.

(Additional Reporting by Ryan Vlastelica and Doris Frankel; Editing by Kenneth Barry and Jan Paschal)

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3 Convicted in Britain Over Terrorist Plot

LONDON — Three men accused of plotting what prosecutors said would have been the most devastating terrorist attacks in Britain since the London transit system bombings of July 2005 were convicted Thursday after a 12-week trial. The judge hearing the case told the men to expect sentences of life imprisonment.

Prosecutors said the three men — Irfan Naseer, 31, Irfan Khalid, 27, and Ashik Ali, 27, all British citizens from the industrial city of Birmingham in the English Midlands — planned to detonate up to eight homemade bombs in rucksacks in crowded places, the method used by the four suicide bombers who killed 52 other people on London subway trains and buses in 2005.

That attack prompted MI5, the domestic security service, and police forces across the country to rapidly expand their counterterrorism efforts. Officials at MI5 and at Scotland Yard have said that the authorities track dozens of active terrorist cells, and they cite a series of successful prosecutions and the absence of any attack that led to mass casualties in Britain since the transit bombings as evidence of their success.

The court in Birmingham was told that the authorities had the three defendants under close surveillance from an early stage, along with nine co-conspirators, six of whom have pleaded guilty to terrorism charges. The police officer who led the surveillance, Detective Inspector Adam Gough, described the three men, all Muslims, as “committed, passionate extremists,” and added, “They had a real stated intention to kill and maim as many people as they possibly can.”

The men were still discussing potential targets and weapons when they were arrested in September 2011 as they drove across Birmingham, prosecutors said. From bugged conversations and police questioning, the court heard, the men were known to have discussed using rucksack bombs, rifle attacks on crowded streets and targeted strikes against British soldiers; more arcane methods were also mentioned, including putting poison on the car-door handles of intended victims and fitting long blades to the hoods and wheels of cars to be driven onto crowded sidewalks to scythe people down.

Mr. Naseer, said to be the ringleader, was described at the trial as a “fantasist” who had been teased and nicknamed Chubby at school for being overweight and who resolved as he grew into adulthood, gaining a pharmacy degree, to make a name for himself as a violent jihadist. He and his associates spoke frequently of their hatred for Britain, particularly after British troops occupied Afghanistan and Iraq, the prosecution said.

Two of the men, Mr. Naseer and Mr. Khalid, were tracked by the security services leaving Britain and entering terrorist training camps linked to Al Qaeda on the Pakistan-Afghanistan border. Later, the prosecution said, the two arranged for four other young Birmingham men to travel to Pakistan for terrorist training. Those four were among the six who pleaded guilty at an earlier trial.

The prosecution said that the three main Birmingham plotters were overheard criticizing the 2005 transit attackers for failing to include loose nails in their bombs to make them more lethal. The court heard that Mr. Naseer and his fellow plotters were heavily influenced by the extremist propaganda of Anwar al-Awlaki, the American-born cleric who was killed by an American drone strike in Yemen in September 2011. They learned of Mr. Awlaki’s teachings from an English-language magazine, Inspire, that was founded by Mr. Awlaki and distributed over the Internet, the prosecution said; it claimed that it was from the magazine that they took the idea of attaching blades to the wheels of cars and creating what the magazine called “the ultimate mowing machine.”

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PHOTO: Seth MacFarlane Lets Popcorn Fly in New Oscar Promo

02/21/2013 at 04:45 PM EST

Seth MacFarlane isn't crying over spilled popcorn.

Before he gets down to the business of hosting on Sunday's 85th Annual Academy Awards, MacFarlane 39, posed in a lighthearted set of promotional photos, leading up to Hollywood's biggest night.

In one of the shots, the Family Guy creator is holding a tub of popcorn – but in the next, the kernels are flying everywhere, much to the star's delight. In another shot, MacFarlane does his best impression of Oscar himself.

MacFarlane will make his Academy Awards hosting debut live on ABC from the Dolby Theatre in Hollywood.

Previously, MacFarlane shot a silly video promo pretending to be Daniel Day-Lewis.  

Seth MacFarlane

BOB D'AMICO / ABC

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Flu shot doing a poor job of protecting elderly

ATLANTA (AP) — It turns out this year's flu shot is doing a startlingly dismal job of protecting senior citizens, the most vulnerable age group.

The vaccine is proving only 9 percent effective in people 65 and older against the harsh strain of the flu that is predominant this season, the Centers for Disease Control and Prevention said Thursday.

Health officials are baffled as to why this is so. But the findings help explain why so many older people have been hospitalized with the flu this year.

Despite the findings, the CDC stood by its recommendation that everyone over 6 months get flu shots, the elderly included, because some protection is better than none, and because those who are vaccinated and still get sick may suffer less severe symptoms.

"Year in and year out, the vaccine is the best protection we have," said CDC flu expert Dr. Joseph Bresee.

Overall, across the age groups studied, the vaccine's effectiveness was found to be a moderate 56 percent, which means those who got a shot have a 56 percent lower chance of winding up at the doctor with the flu. That is somewhat worse than what has been seen in other years.

For those 65 and older, the vaccine was only 27 percent effective against the three strains it is designed to protect against, the worst level in about a decade. It did a particularly poor job against the tough strain that is causing more than three-quarters of the illnesses this year.

It is well known that flu vaccine tends to protect younger people better than older ones. Elderly people have weaker immune systems that don't respond as well to flu shots, and they are more vulnerable to the illness and its complications, including pneumonia.

But health officials said they don't know why this year's vaccine did so poorly in that age group.

One theory, as yet unproven, is that older people's immune systems were accustomed to strains from the last two years and had more trouble switching gears to handle this year's different, harsh strain.

The preliminary data for senior citizens is less than definitive. It is based on fewer than 300 people scattered among five states.

But it will no doubt surprise many people that the effectiveness is that low, said Michael Osterholm, a University of Minnesota infectious-disease expert who has tried to draw attention to the need for a more effective flu vaccine.

Among infectious diseases, flu is considered one of the nation's leading killers. On average, about 24,000 Americans die each flu season, according to the CDC.

This flu season started in early December, a month earlier than usual, and peaked by the end of year. Hospitalization rates for people 65 and older have been some of the highest in a decade, at 146 per 100,000 people.

Flu viruses tend to mutate more quickly than others, so a new vaccine is formulated each year to target the strains expected to be the major threats. CDC officials have said that in formulating this year's vaccine, scientists accurately anticipated the strains that are circulating this season.

Because of the guesswork involved, scientists tend to set a lower bar for flu vaccine. While childhood vaccines against diseases like measles are expected to be 90 or 95 percent effective, a flu vaccine that's 60 to 70 percent effective in the U.S. is considered pretty good. By that standard, this year's vaccine is OK.

For senior citizens, a flu vaccine is considered pretty good if it's in the 30 to 40 percent range, said Dr. Arnold Monto, a University of Michigan flu expert.

A high-dose version of the flu shot was recently made available for those 65 and older, but the new study was too small to show whether that has made a difference.

The CDC estimates are based on about 2,700 people who got sick in December and January. The researchers traced back to see who had gotten shots and who hadn't. An earlier, smaller study put the vaccine's overall effectiveness at 62 percent, but other factors that might have influenced that figure weren't taken into account.

The CDC's Bresee said there is a danger in providing preliminary results because it may result in people doubting — or skipping — flu shots. But the figures were released to warn older people who got shots that they may still get sick and shouldn't ignore any serious flu-like symptoms, he said.

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Online:

CDC report: http://www.cdc.gov/mmwr

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Wall Street ends lower on growth worries

NEW YORK (Reuters) - U.S. stocks fell for a second straight day on Thursday and the S&P 500 posted its worst two-day loss since November after reports cast doubt over the health of the U.S. and euro-zone economies.

But a late-day rally helped stocks erase some of their losses with most of the pullback concentrated in the technology- heavy Nasdaq. The move suggested investors were still willing to buy on dips even after the sharp losses in the last session.

In Europe, business activity indexes dealt a blow to hopes that the euro zone might emerge from recession soon, showing the downturn across the region's businesses unexpectedly grew worse this month.

"The PMI numbers out of Europe were really a blow to the market," said Jack De Gan, chief investment officer at Harbor Advisory in Portsmouth, New Hampshire. "The market was expecting signs that recovery is still there, but the numbers just highlighted that the euro-zone problem is still persistent."

U.S. initial claims for unemployment benefits rose more than expected last week while the Federal Reserve Bank of Philadelphia said its index of business conditions in the U.S. mid-Atlantic region fell in February to the lowest in eight months.

Gains in Wal-Mart Stores Inc shares helped cushion the Dow. The shares gained 1.5 percent to $70.26 after the world's largest retailer reported earnings that beat expectations, though early February sales were sluggish.

The Dow Jones industrial average <.dji> fell 46.92 points, or 0.34 percent, to 13,880.62 at the close. The Standard & Poor's 500 Index <.spx> lost 9.53 points, or 0.63 percent, to 1,502.42. The Nasdaq Composite Index <.ixic> dropped 32.92 points, or 1.04 percent, to close at 3,131.49.

The two-day decline marked the U.S. stock market's first sustained pullback this year. The Standard & Poor's 500 has fallen 1.8 percent over the period and just managed to hold the 1,500 level on Thursday. Still, the index is up 5.3 percent so far this year.

The abrupt reversal in markets, which started on Wednesday after minutes from the Federal Reserve's January meeting suggested stimulus measures may end earlier than thought, looks set to halt a seven-week winning streak for stocks that had lifted the Dow and the S&P 500 close to all-time highs.

Wall Street will soon face another test with the upcoming debate in Washington over the automatic across-the-board spending cuts put in place as part of a larger congressional budget fight. Those cuts, set to kick in on March 1 unless lawmakers agree on an alternative, could depress the economy.

Semiconductor stocks ranked among the weakest of the day, pressuring the Nasdaq as the Philadelphia Semiconductor Index <.sox> fell 1.8 percent. Intel Corp fell 2.3 percent to $20.25 while Advanced Micro Devices lost 3.7 percent to $2.60 as the S&P 500's biggest percentage decliner.

The Dow also got a helping hand from personal computer maker Hewlett-Packard Co , which rose 2.3 percent to end the regular session at $17.10. The company was scheduled due to report first-quarter results after the closing bell.

Shares of Boeing Co rose 1.6 percent to $76.01 as a senior executive was set to meet with the head of the U.S. Federal Aviation Administration on Friday and present a series of measures to prevent battery failures that grounded its 787 Dreamliner fleet, according to a source familiar with the plans.

In other company news, shares of supermarket operator Safeway Inc jumped 14.1 percent to $22.97 after the company reported earnings that beat expectations.

Shares of VeriFone Systems Inc tumbled nearly 43 percent to $18.24 after the credit-card swipe machine maker forecast first- and second-quarter profits well below expectations.

Of the 427 companies in the S&P 500 that have reported results so far, 69.3 percent have exceeded analysts' expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data through Thursday morning.

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 5.9 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

Berry Petroleum Co jumped 19.3 percent to $46.02 after oil and gas producer Linn Energy LLC said it would buy the company in an all-stock deal valued at $4.3 billion, including debt. Linn Energy shares advanced 2.8 percent to $37.68.

About two stocks fell for everyone that rose on the New York Stock Exchange and Nasdaq. About 7.64 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, well above the 20-day moving average of around 6.6 billion shares.

(Editing by Jan Paschal)

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IHT Special: Lebanon Voting Plan Stirs Sectarian Fervor

BEIRUT — A controversial draft law to overhaul Lebanon’s electoral system gained traction Tuesday when a parliamentary joint committee supported it, raising the possibility that voters will in future be able to cast ballots only for candidates from their own sect.

Proponents say the law would protect their communities and ensure fairer elections. Opponents say it would further entrench sectarianism in a sharply divided country.

“Election law was one of the last things that wasn’t codified in sectarian terms,” said Emile Hokayem, an analyst with the International Institute for Strategic Studies, or I.I.S.S., in Bahrain.

The change, known as the Orthodox Proposal, was first supported by Christian parties that felt their communities were misrepresented in past elections.

Lebanon’s political system is largely governed by sectarian quotas and criteria. Under an agreement reached at independence in 1943, the president is always a Maronite Christian, the prime minister a Sunni Muslim and the speaker of Parliament a Shiite. Parliamentary seats are split evenly between Christians and Muslims: Each specific sect within these groups — for example Greek Orthodox Christians or Druze Muslims — is allocated a set number of seats.

The number of seats allocated to each group is now quite arbitrary since there has been no census in Lebanon since 1932. Quotas and electoral districts have been adjusted since, but the demographic base for the system remains the 80-year-old, and visibly obsolete, poll.

The system, intended to promote coexistence, has instead become a driving factor in Lebanon’s conflicts over the years, most notably its 15-year civil war.

In past elections, Lebanon was divided into electoral districts — 26 in 2009, up from 14 in the previous two elections, in 2000 and 2005. In each district, seats were allocated on a sectarian basis, but voters could cast ballots for any candidate, with one vote for every available seat, regardless of sect.

Christian parties have argued that the system allowed many seats reserved for their communities to be decided by Muslim votes.

In Lebanon’s second-largest city, Tripoli, for example, two parliamentary seats are reserved for Christian sects, but the overwhelming majority of residents are Sunni Muslims. Even if every Christian in the city voted en bloc for two candidates, the outcome could still be determined by Sunni voters.

In other districts, seats are only allocated to one sect despite the presence of other groups.

“There is a really deep feeling within the Christian community today in Lebanon that it’s time to stop this injustice,” said Farid El Khazen, a member of Parliament from the Free Patriotic Movement, a Christian party, who supports the draft law.

As well as limiting voters’ choices to candidates from their own sect, the proposal would replace local voting districts with a single, nationwide poll.

The parliamentary committee vote Tuesday showed support for the proposal from Amal and Hezbollah — the principle Shiite factions — as well as the main Christian parties. Among the plan’s harshest critics have been the Sunni-affiliated Future Movement, the Druze-backed Progressive Socialist Party and President Michel Suleiman.

Rhetoric for and against the law has been fervent. Opponents have called it unconstitutional and warned that it would encourage extremism. Saad Hariri, leader of the Future Movement and a former prime minister, took to Twitter to call Tuesday a “black day” for the Lebanese Parliament.

But Michel Aoun, head of the Free Patriotic Movement, said that Tuesday was the happiest day in Lebanon’s history.

Parliamentary elections are slated for June but could be delayed. The proposal needs to go before the entire Parliament, and if passed could be vetoed by the president. The outcome remains unclear.

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Can You Guess Which Star Was First To Wear Elizabeth Taylor's $6 Million Emerald Necklace?

Stylewatch
Style News Now

02/20/2013 at 11:15 AM ET

Nate Beckett/Splash News Online; Popperfoto/Getty

On Tuesday night, Julianne Moore did what few women would be able to: She did justice to one of Elizabeth Taylor‘s most prized pieces of jewelry.

The dazzling emerald-and-diamond necklace, purchased for Taylor by future husband Richard Burton while they were on location for Cleopatra in Rome, was a staple in the legendary star’s wardrobe; she even wore it to accept her Oscar in 1967.

It was one of eight Bulgari pieces that the jewelry house purchased from her 2011 Christie’s auction and now have on display at their Rodeo Drive flagship.

“The room absolutely stopped when [Moore] entered” in the necklace, a source at Bulgari’s pre-Oscars party, thrown to celebrate Taylor’s jewels, tells PEOPLE. “Kirsten Dunst exclaimed, ‘Are you wearing one of her pieces?’”

And Moore looked lovely in the necklace, which sold for more than $6 million at auction, though she went a distinctly non-Taylor route by offsetting it with sleek hair and a very simple Alexander McQueen dress. Regardless, we bet Taylor, who wore her fanciest jewelry to sit around the house, would have been pleased.

Tell us: What would you wear with Taylor’s $6 million emerald necklace?

–Alex Apatoff, reporting by Jennifer Garcia

PHOTOS: SEE MORE OF ELIZABETH TAYLOR’S JAW DROPPING JEWELRY HERE!

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Obama administration tackles colonoscopy confusion

WASHINGTON (AP) — It's one part of the new health care law that seemed clear: free coverage for preventive care under most insurance plans.

Only it didn't turn out that way.

So on Wednesday, the Obama administration had to straighten out the confusion.

Have you gone for a colonoscopy thinking it was free, only to get a hefty bill because the doctor removed a polyp?

No more.

Taking out such precancerous growths as part of a routine colon cancer screening procedure will now be considered preventive care.

"Polyp removal is an integral part of a colonoscopy," the Department of Health and Human Services said in guidance posted on its website. That conclusion has the backing of several leading medical societies, the department noted.

Also addressed in the notice was genetic testing for breast cancer, coverage of over-the-counter products such as aspirin for heart care and nicotine patches for smoking, and birth control for women. Unlike formal regulations, the guidance does not have the force of law, but advocates for patients say insurers would be ill-advised to ignore it.

President Barack Obama's health care law required most private health plans to cover preventive care at no additional charge to patients. It also expanded preventive coverage without copayments for Medicare recipients. For workers and their families, the expense is borne by the company health plan, which passes on some of those costs in the form of higher premiums. Advocates say preventive care saves the health care system money over time.

Colonoscopy is an expensive test that can cost more than $1,000. It's recommended for adults 50 and over, and has become a rite of passage for aging baby boomers.

News that it would be covered free under the health care law got attention, but that was followed quickly by a letdown when many insurers started charging if a polyp or two was discovered and removed during the procedure.

"Insurers were reclassifying it from a preventive test to a diagnostic procedure," said Stephen Finan, policy director for the American Cancer Society Cancer Action Network. "In some cases the cost-sharing was a significant amount of money."

His group was among several that complained to the administration.

Other free preventive services addressed in Wednesday's guidance:

—Insurers must cover testing, if ordered by a doctor, for rare BRCA genes that dramatically increase the risk of breast cancer. Such tests can cost as much as $3,000.

—Over-the-counter products such as aspirin for heart care and nicotine patches for smoking cessation are covered with a doctor's prescription.

—Insurers won't be able to fulfill the law's requirement to cover contraception as preventive care for women if they only pay for birth control pills. A full range of FDA-approved methods must be covered, including long-acting implant and intrauterine devices. Birth control methods for men are not covered as preventive care.

If a health plan does not have a network doctor who performs a particular preventive service, a patient can see a doctor out-of-network without facing copays or additional charges.

Also Wednesday, the government came out with final rules on the benefits that health plans catering to individuals and small businesses will have to offer starting next year, when new insurance markets called exchanges open in each state.

The coverage generally is better than what's now available to people buying individual policies, but close to what medium-size companies offer, with some important improvements in areas such as mental health care.

Benefits include hospital and outpatient care, emergency services, maternity and newborn care, prescriptions, prevention, rehabilitation and ongoing assistance for people with potentially disabling conditions, and dental and vision care for children.

All plans will have to cover the same benefits, but their premiums and cost sharing will vary. There will be four level of coverage — bronze, silver, gold and platinum. Bronze plans will cover 60 percent of expected costs while platinum plans will cover 90 percent.

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Online:

Health and Human Services Department: http://tinyurl.com/au6lzeo

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Wall Street ends down sharply after Fed minutes

DEAR ABBY: My boyfriend, "Doug" (24), and I (22) have been in a long-distance relationship for a year, but we were friends for a couple of years before that. I had never had a serious relationship before and lacked experience. Doug has not only been in two other long-term relationships, but has had sex with more than 15 women. One of them is an amateur porn actress.I knew about this, but it didn't bother me until recently. Doug had a party, and while he was drunk he told one of his buddies -- in front of me -- that he should watch a certain porn film starring his ex-girlfriend. ...

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