F.D.A. Requires Cuts to Dosages of Ambien and Other Sleep Drugs

WASHINGTON — For two decades, millions of Americans have taken Ambien to help them sleep at night. But for years, the Food and Drug Administration has gotten complaints that people felt drowsy the morning after taking the medicine or its successors, and sometimes got into car accidents.

On Thursday, after laboratory studies and driving tests confirming the risks of drowsiness, the agency said that women should be taking half as much.

The new recommendation applies to drugs containing the active ingredient zolpidem, by far the most widely used sleep aid. Using lower doses means less of the drug will remain in the blood in the morning hours, and will reduce the risk that people who use it will be impaired while driving.

Sleeping pills have boomed in popularity with the increasingly frantic pace of modern American life. According to IMS, a health care information and technology company, about 60 million prescriptions were dispensed in 2011, up about 20 percent since 2006. About 40 million were for products containing zolpidem.

The agency’s announcement was focused on women because they take longer to metabolize the drug than men. An estimated 10 percent to 15 percent of women will have a level of zolpidem in their blood that could impair driving eight hours after taking the pill, while only about 3 percent of men do, said Dr. Robert Temple, an official in the agency’s Center for Drug Evaluation and Research.

Reports of aftereffects from sleeping pills have circulated for years, and some doctors questioned why the drug agency took so long to act. Mishaps with sleepy driving — and even strange acts of texting, eating or having sex in the night without any memory of it in the morning — have long been familiar to the medical community.

“In this case, the F.D.A. may be behind the 8-ball,” said Daniel Carlat, an associate clinical professor of psychiatry at Tufts University, referring to residual drowsiness. “This has been a known problem. Few doctors will be surprised hearing about this. They’ll say, ‘Oh yeah, we’ve already seen this in our patients.’ ”

He added that Thursday’s announcement “will be good for public health because it will get patients to ask their doctors about the appropriate dosage.”

Agency officials acknowledged that they had received about 700 reports of driving mishaps with people on zolpidem over the years, with a spike in 2007 after a change in labeling caused more people to call in complaints. But they said it was not easy to draw a direct connection between the reports and the drug. Patients often did not remember what time they took the pill. Sometimes they had been drinking.

It was not until the drug agency reviewed driving simulation studies from controlled trials of the drug Intermezzo, which was approved in 2011 for middle-of-the-night waking, that a more complete picture of the risks emerged. The agency linked the driving simulation information with data from manufacturers on the amount of zolpidem in patients’ blood and determined that levels above about 50 nanograms per milliliter increased the risk of crashing while driving, said Dr. Ellis Unger, an official at the agency’s Center for Drug Evaluation and Research.

Dr. Unger said that all makers of new sleeping drugs would now be asked to conduct driving trials; a spokeswoman clarified that it would not be required.

“A lot of people are wondering about the elephant in the room,” Dr. Unger said. “Why did this take so long? This is science, and our thinking evolves over time.”

The drug agency told manufacturers that the recommended dose for women should be lowered to 5 milligrams from 10 for immediate-release products like Ambien, Edluar and Zolpimist. Doses for extended-release products should be lowered to 6.25 milligrams from 12.5, the agency said. Most sleeping drugs containing zolpidem are now generic.

For men, the agency informed manufacturers that labels should recommend that health care providers should “consider” prescribing lower doses.

Patients taking the higher doses should continue them for the time being, officials said, but should consult with their doctors about lowering them. Doctors can still prescribe the higher dose if the lower one does not work. The lower doses are already commercially available, Dr. Unger said, as they are recommended for older patients.

Sanofi, the manufacturer of Ambien and Ambien CR, said in a statement that it agreed that people taking zolpidem “should always talk to their doctor about the most appropriate dose,” and that the label “provides important information” to determine what that is. The company added that it “stands behind the significant clinical data demonstrating the safety and efficacy of Ambien.”

The drug has also been known to cause sleepwalking incidents, and Dr. Unger said there was evidence that the lower dose might ease such events, though it is weaker than the evidence about next-morning-drowsiness. Dr. Carlat said one of his patients discovered that her weight gain while on the drug was from midnight trips to the kitchen she did not even remember taking.

Dr. Daniel Kripke, professor emeritus of psychiatry at the University of California, San Diego, and a leading critic of sleeping pills, welcomed the move but said the agency was still not doing enough to investigate other possible side effects.

“It’s a very small step in the right direction,” he said. He added that sleeping medications like zolpidem might increase total sleep time by 20 minutes a night, but that most studies suggest that the use of sleeping pills impairs a person’s performance the next day.

Critics of the drug agency said the label on Intermezzo, which very clearly denotes the risks for women, indicate that the agency was aware of these problems earlier.

But Thomas Roth, director of the sleep center at Henry Ford Hospital in Detroit who has been a consultant to sleeping pill makers, said that the drug agency had always been concerned about the potential risks with driving, “but they care about it more now.” He said he believed the lower dose would still be effective for many patients.

Agency officials say all patients are unique and doses will need to be tailored. They say the drugs should be prescribed at the lowest dose required.

Dr. Daniel J. Buysse, professor of psychiatry at the University of Pittsburgh School of Medicine, said he already prescribed the lower dose when he feels it is necessary, by telling patients to cut a tablet in half along the score.

“This just tells me, maybe be a little bit more cautious,” said Dr. Buysse, who has been a consultant for drug companies including the maker of Ambien. “But I do not think it will have a big effect on what I do.”

Andrew Pollack contributed reporting from San Francisco.

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Anthem's mail-order policy may have crossed a legal line

Anthem Blue Cross may be breaking California law by requiring some policyholders to buy their prescription drugs from a single mail-order pharmacy, according to the state attorney general's office.

Anthem, the state's largest for-profit health insurer, had notified members with conditions such as HIV/AIDS and cancer that they will have to buy their medications from the mail-order pharmacy CuraScript or pay full price at a retail drugstore.

Other Anthem members, including those with chronic conditions such as diabetes, face no such requirement.

"California law clearly states that no one can be discriminated against because of a medical condition," said Lynda Gledhill, a spokeswoman for Atty. Gen. Kamala D. Harris. "If patients are being required to get their prescriptions from a certain pharmacy because of their condition, that is likely illegal."

She declined to comment on specific measures officials may take if Anthem proceeds with its policy switch, but stressed that the attorney general's office "treats very seriously cases involving restricting access to care."

Darrel Ng, an Anthem spokesman, said the insurer's policies "do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws." He also said other insurers have similar policies.

I sought the attorney general's opinion after the California Department of Managed Health Care voiced concern that Anthem hadn't done a good enough job informing people about the change, which was scheduled to take effect Jan. 1 but has been delayed until March 1.

Along with the postponement, Anthem said it would clarify possible exemptions to the new rule. But that didn't mollify critics.

"This is still a very serious issue," said David Balto, a Washington antitrust lawyer and former policy director for the Federal Trade Commission. "It affects some of the most vulnerable people in society."

When I broke the news in November that Anthem was imposing the new requirement for so-called specialty medications used to treat major illnesses, the insurer said the limitation would help keep costs down for patients and businesses.

State healthcare officials didn't challenge that assumption. But they said Anthem failed to make it clear that some members may be able to avoid the mail-order-only requirement.

"That was our primary concern," said Marta Green, a spokeswoman for the Department of Managed Health Care. "There are individuals for whom a mail-order pharmacy may not be appropriate."

For example, people taking a variety of meds may benefit from face-to-face contact with a pharmacist, rather than dealing with a mail-order drugstore's call center. A pharmacist, for instance, would be in a better position to explain how different drugs interact.

Or consider the case of Irvine resident Jeffrey Beckwith, 60, who had a liver transplant in 1995 and ever since has received 90-day refills for his specialty meds. He told me that, thanks to Anthem's policy change, he'll now only get 30 days' worth of pills at a time.

Anthem's Ng said the company will "highlight the process to request a hardship waiver" so that Beckwith and others could try to avoid using the mail-order pharmacy.

Ng provided a copy of the revised notice being sent to people requiring specialty meds. It says at the very bottom that "if this specialty mandate poses a hardship for you, you may file a grievance with Anthem" or request a form to seek an exemption.

Balto, the former FTC official, has been retained by retail drugstores to challenge Anthem's requirement. He said cutting off personal access to a pharmacist can have dire consequences for people with HIV/AIDS who may require a "cocktail" of drugs to manage their condition.

"You may have to take them in a particular order or at particular times," Balto said. "As you go, you may have to adjust your doses. Not being able to speak with your own pharmacist can have very serious repercussions."

California's Unruh Civil Rights Act (Section 51 of the Civil Code) specifies that all people must be treated equally "no matter what their sex, race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status or sexual orientation."

Section 12926.1 of the California Government Code says that "physical and mental disabilities include, but are not limited to, chronic or episodic conditions such as HIV/AIDS, hepatitis, epilepsy, seizure disorder, diabetes, clinical depression, bipolar disorder, multiple sclerosis and heart disease."

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Through new budget, Brown maps out sweeping change in state

SACRAMENTO — The days of catastrophic deficits behind him, Gov. Jerry Brown is set to propose a state budget Thursday that would shift the Capitol's focus from fiscal triage to sweeping policy changes in education, criminal justice and healthcare.

Brown is expected to use his spending plan to shake up California's public university systems, according to administration officials. The governor has long complained that they are bloated and inefficient, and he wants to attach strings to some of their funding.

He has also signaled that the state's court and prison budgets could be cut, including a shift of 16,000 inmates to cheaper, lower-security housing.

The governor wants to change how the state funds its nearly 10,000 public schools, and he will present his plan for implementing President Obama's healthcare overhaul.

Although he is largely free of the financial crisis that has long gripped state government, Brown has made clear that many of his proposals would reshape the way California spends the money it has rather than create costly new programs. The revenue from tax hikes passed by voters in November is spoken for, and Brown said this week that he would be dogged about keeping spending in check.

"If we don't do that," he said, "then we have an illusion that things are good and we go back to this money-today, no-money tomorrow."

Legislative leaders, emboldened by their new Democratic supermajorities in the Senate and Assembly, are likely to test his resolve. They have already suggested they'll push to restore many government services that were rolled back in recent years.

The tussle among the governor, lawmakers and lobbyists representing interests with a stake in the roughly $95-billion general fund typically lasts for months. Lawmakers have until June to pass a final budget.

Meanwhile, remnants of red ink remain. Legislative analysts say Brown will need to close a deficit of $1.9 billion. The governor has signaled that cuts in the state court and prison budgets could help cover that shortfall.

Court officials said they've been told to expect a $200-million cut. The court system's administrative director, Judge Steven Jahr, called that scenario a "potential crisis that would further cripple our justice system." Other officials warned of potential courthouse closures and reduced hours.

The governor also wants to end federal control of the healthcare system in state prisons. If he succeeds, Sacramento could save hundreds of millions of dollars by ending contracts with out-of-state prisons used to alleviate overcrowding. He would also retake control of prison medical spending, which is now determined by a federal overseer.

"We're wasting a lot of money on nonsense" in the prisons, Brown told reporters Tuesday.

Even in areas where spending will increase under state formulas and federal law — public schools, universities and healthcare — Brown will face obstacles in determining how the money is spent.

The University of California and California State University systems were each promised at least $125 million more this year. Brown wants to tie some future funding to graduation rates and acceptance of transfer students from the state's community colleges.

Brown also wants the universities to more aggressively embrace online teaching, which he says could reduce the need for higher student fees.

University officials, who have bristled at many of those suggestions, are already saying the promised money is not enough. The University of California has said tuition hikes are likely unless state funding is increased by more than $400 million, a number the governor has said is unrealistic. He has not yet provided his own figure.

The governor will also propose a radical shift in the way elementary and secondary schools are funded, seeking to direct more money to districts that serve poor students and English learners, who cost more to educate than other students.

Brown wants to give local districts more control over the money they receive from the state, eliminating mandates for smaller classes, spending on new technology and dozens of other requirements set in Sacramento.

Education and legislative leaders have expressed support for the governor's goals — and skepticism about the administration's ability to ensure that money will be used in the way he intends.

Brown's proposed budget will outline his plans for expanding health coverage under the new federal healthcare law, which is set to require increased coverage beginning in January 2014. The law will put hundreds of thousands of new enrollees into California's public insurance program, but the governor has raised concerns about what that will cost.

In addition, Brown has said the state may reduce the roughly $2 billion it gives to counties to care for the uninsured, amid objections from advocates and county officials.

"There needs to be a safety net that survives even after health reform is fully implemented," said Anthony Wright, executive director of Health Access California, which promotes expanded health coverage.

This year, Brown has a new $1 billion to spend, generated by a change in corporate taxes that voters approved as Proposition 39 in November. Half of the money is dedicated to clean-energy programs, and Brown is expected to use most of that for a proposal to increase energy efficiency at thousands of public schools. The rest goes to the general fund.

While his plans will be subject to negotiations with lawmakers, Brown made it clear he feels his hand is strengthened by his recent victories at the polls.

"My position," he said, "has become more strategically important."

anthony.york@latimes.com

chris.megerian@latimes.com

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‘Smart’ potty or dumb idea? Wacky gadgets at CES

LAS VEGAS (AP) — From the iPotty for toddlers to the 1,600-pound mechanical spider and the host of glitch-ridden “smart” TVs, the International CES show is a forum for gadget makers to take big — and bizarre — chances.

Many of the prototypes introduced at the annual gadget show over the years have failed in the marketplace. But the innovators who shop their wares here are fearless when it comes to pitching new gizmos, many of which are designed to solve problems you didn’t know you had.

A search for this year’s strangest (and perhaps least useful) electronic devices yielded an extra-loud pair of headphones from a metal band, an eye-sensing TV that didn’t work as intended and more. Take a look:

—MOTORHEADPHONES

Bass-heavy headphones that borrow the names of hip-hop luminaries like Dr. Dre have become extremely popular. Rock fans have been left out of the party — until now. British metal band Motorhead, famous for playing gut-punchingly loud, is endorsing a line of headphones that “go to eleven” and are hitting U.S. stores now.

Says lead singer and bassist Lemmy Kilmister, explaining his creative input: “I just said make them louder than everybody else’s. So that’s the only criteria, and that it should reflect every part of the sound, not just the bass.”

The Motorheadphone line consists of three over-the-ear headphones and six in-ear models. The initiative came from a Swedish music-industry veteran, and distribution and marketing is handled by a Swedish company, Krusell International AB.

WHO IT’S FOR: People who don’t care about their hearing. According to Kilmister, the headphones are ideal for Motorhead fans. “Their hearing is already damaged, they better buy these.”

PRICE: Prices range from $ 50 to $ 130.

—EYE-SENSING TV

A prototype of an eye-sensing TV from Haier didn’t quite meet viewers eye-to-eye. An on-screen cursor is supposed to appear where the viewer looks to help, say, select a show to watch. Blinking while controlling the cursor is supposed to result in a click. In our brief time with the TV, we observed may quirks and comic difficulties.

For one, the company’s demonstrator Hongzhao Guo said the system doesn’t work that well when viewers wear eyeglasses. (That kind of defeats the purpose of TV, no?) But it turns out, one bespectacled reporter was able to make it work. But the cursor appeared a couple inches below where the viewer was looking. This resulted in Guo snapping his fingers to attract the reporter’s eye to certain spots. The reporter dutifully looked, but the cursor was always a bit low. Looking down to see the cursor only resulted in it moving further down the TV screen.

WHO IT’S FOR: People too lazy to move their arms.

“It’s easy to do,” Guo said, taking the reporter’s place at the demonstration. He later said the device needs to be recalibrated for each person. It worked fine for him, but the TV is definitely not ready for prime-time.

—PARROT FLOWER POWER

A company named after a bird wants to make life easier for your plants. A plant sensor called Flower Power from Paris-based Parrot is designed to update your mobile device with a wealth of information about the health of your plant and the environment it lives in. Just stick the y-shaped sensor in your plant’s soil, download the accompanying app and — hopefully — watch your plant thrive.

“It basically is a Bluetooth smart low-energy sensor. It senses light, sunlight, temperature, moisture and soil as well as fertilizer in the soil. You can use it either indoors or outdoors,” said Peter George, vice president of sales and marketing for the Americas at Parrot. The device will be available sometime this year, the company said.

WHOT IT’S FOR: ‘Brown-thumbed’ folk and plants with a will to live.

PRICE: Unknown.

—HAPIFORK

If you don’t watch what you put in your mouth, this fork will — or at least try to. Called HAPIfork, it’s a fork with a fat handle containing electronics and a battery. A motion sensor knows when you are lifting the fork to your mouth. If you’re eating too fast, the fork will vibrate as a warning. The company behind it, HapiLabs, believes that using the fork 60 to 75 times during meals that last 20 to 30 minutes is ideal.

But the fork won’t know how healthy or how big each bite you take will be, so shoveling a plate of arugula will likely be judged as less healthy than slowly putting away a pile of bacon. No word on spoons, yet, or chopsticks.

WHO IT’S FOR? People who eat too fast. Those who want company for their “smart” refrigerator and other kitchen gadgets.

PRICE: HapiLabs is launching a fundraising campaign for the fork in March on the group-fundraising site Kickstarter.com. Participants need to pay $ 99 to get a fork, which is expected to ship around April or May.

— IPOTTY

Toilet training a toddler is no picnic, but iPotty from CTA Digital seeks to make it a little easier by letting parents attach an iPad to it. This way, junior can gape and paw at the iPad while taking care of business in the old-fashioned part of the plastic potty. IPotty will go on sale in March, first on Amazon.com.

There are potty training apps out there that’ll reward toddlers for accomplishing the deed. The company is also examining whether the potty’s attachment can be adapted for other types of tablets, beyond the iPad.

“It’s novel to a lot of people but we’ve gotten great feedback from parents who think it’d be great for training,” said CTA product specialist Camilo Gallardo.

WHO IT’S FOR: Parents at their wit’s end.

PRICE: $ 39.99

—MONDO SPIDER, TITANOBOA

A pair of giant hydraulic and lithium polymer battery controlled beasts from Canadian art organization eatART caught some eyes at the show. A rideable 8-legged creature, Mondo Spider weighs 1,600 pounds and can crawl forward at about 5 miles per hour on battery power for roughly an hour. The 1,200-pound Titanoboa slithers along the ground at an as yet unmeasured speed.

Computer maker Lenovo sponsored the group to show off the inventions at CES.

Hugh Patterson, an engineer who volunteers his time to making the gizmos, said they were made in part to learn more about energy use. One lesson from the snake is that “side winding,” in which the snake corkscrews its way along the ground, is one of the most efficient ways of moving along soft ground, like sand.

Titanoboa was made to match the size of a 50-foot long reptile whose fossilized remains were dated 50 million years ago, when the world was 5 to 6 degrees warmer. The creature was built “to provoke discussion about climate change,” Patterson said.

The original version of Mondo Spider, meanwhile, first appeared at the Burning Man arts gathering in Nevada in 2006.

WHO IT’S FOR: Your inner child, Burning Man participants, people with extra-large living rooms.

PRICE: The spider’s parts cost $ 26,000. The Titanoboa costs $ 70,000. Engineers provided their time for free and both took “thousands of hours” to build, Patterson said.

___

Ortutay contributed from New York. AP Technology Writer Peter Svensson and Luke Sheridan from AP Television contributed to this story from Las Vegas.

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Adele to make post-baby debut at Golden Globes

BEVERLY HILLS, Calif. (AP) — Adele is coming to the Golden Globes.

The executive producer of the show says the 24-year-old Grammy-winning pop star is set to make her first post-baby appearance at Sunday's ceremony, where she is nominated for original song for the James Bond theme "Skyfall."

Adele welcomed her first child, with boyfriend Simon Konecki, in October. The singer has kept a low profile since announcing her pregnancy in June after sweeping the Grammy Awards last February with six wins.

Her single, "Skyfall," will compete at the Golden Globes with Taylor Swift's song from "The Hunger Games," Jon Bon Jovi's number from "Stand Up Guys," Keith Urban's track from "Act of Valor," and "Suddenly" from "Les Miserables."

The Globes will be presented Sunday at the Beverly Hilton Hotel.

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Pap Test May Prove Useful at Detecting More Types of Cancer, Study Suggests

The Pap test, which has prevented countless deaths from cervical cancer, may eventually help to detect cancers of the uterus and ovaries as well, a new study suggests.

For the first time, researchers have found genetic material from uterine or ovarian cancers in Pap smears, meaning that it may become possible to detect three diseases with just one routine test.

But the research is early, years away from being used in medical practice, and there are caveats. The women studied were already known to have cancer, and while the Pap test found 100 percent of the uterine cancers, it detected only 41 percent of the ovarian cancers. And the approach has not yet been tried in women who appear healthy, to determine whether it can find early signs of uterine or ovarian cancer.

On the other hand, even a 41 percent detection rate would be better than the status quo in ovarian cancer, particularly if the detection extends to early stages. The disease is usually advanced by the time it is found, and survival rates are poor. About 22,280 new cases were expected in the United States in 2012, and 15,500 deaths. Improved tests are urgently needed.

Uterine cancer has a better prognosis, but still kills around 8,000 women a year in the United States.

These innovative applications of the Pap test are part of a new era in which advances in genetics are being applied to the detection of a wide variety of cancers or precancerous conditions. Scientists are learning to find minute bits of mutant DNA in tissue samples or bodily fluids that may signal the presence of hidden or incipient cancers.

Ideally, the new techniques would find the abnormalities early enough to cure the disease or even prevent it entirely. But it is too soon to tell.

“Is this the harbinger of things to come? I would answer yes,” said Dr. Bert Vogelstein, director of the Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins University, and a senior author of a report on the Pap test study published on Wednesday in the journal Science Translational Medicine. He said the genomes of more than 50 types of tumors had been sequenced, and researchers were trying to take advantage of the information.

Similar studies are under way or are being considered to look for mutant DNA in blood, stool, urine and sputum, both to detect cancer and also to monitor the response to treatment in people known to have the disease.

But researchers warn that such tests, used for screening, can be a double-edged sword if they give false positive results that send patients down a rabbit hole of invasive tests and needless treatments. Even a test that finds only real cancers may be unable to tell aggressive, dangerous ones apart from indolent ones that might never do any harm, leaving patients to decide whether to watch and wait or to go through surgery, chemotherapy and radiation with all the associated risks and side effects.

“Will they start recovering mutations that are not cancer-related?” asked Dr. Christopher P. Crum, a professor at Harvard Medical School who was not involved in the research.

But he also called the study a “great proof of principle,” and said, “Any whisper of hope to women who suffer from endometrial or ovarian cancer would be most welcome.”

DNA testing is already performed on samples from Pap tests, to look for the human papillomavirus, or HPV, which causes cervical cancer. Dr. Vogelstein and his team decided to try DNA testing for cancer. They theorized that cells or DNA shed from cancers of the ovaries and the uterine lining, or endometrium, might reach the cervix and turn up in Pap smears.

The team picked common mutations found in these cancers, and looked for them in tumor samples from 24 women with endometrial cancer and 22 with ovarian cancer. All the cancers had one or more of the common mutations.

Then, the researchers performed Pap tests on the same women, and looked for the same DNA mutations in the Pap specimens. They found the mutations in 100 percent of the women with endometrial cancer, but in only 9 of the 22 with ovarian cancer. The test identified two of the four ovarian cancers that had been diagnosed at an early stage.

Finally, the team developed a test that would look simultaneously for cancer-associated mutations in 12 different genes in Pap samples. Used in a control sample of 14 healthy women, the test found no mutations — meaning no false-positive results.

Dr. Luis A. Diaz, the other senior author of the report and an associate professor of oncology at Johns Hopkins, called the research a step toward a screening test that at first blush appears very effective at detecting endometrial cancer, though obviously less so at finding ovarian cancer.

“Probably one of the most exciting features of this approach,” Dr. Diaz said, “is that we wanted a test that would seamlessly integrate with routine medical practice that could be utilized with the same test that women get every day all over the world, the Pap smear.”

But, he added: “We can’t say it’s ready for prime time. Like all good science, it needs to be validated.”

He and other members of the team said it might be possible to improve the detection rate for ovarian cancer by looking for more mutations and by changing the technique of performing Pap tests to increase the likelihood of capturing cells from the ovary. The change might involve timing the test to a certain point in a woman’s monthly cycle, using a longer brush to collect cells from deeper within the cervix or prescribing a drug that would raise the odds of cells being shed from the ovary.

The technique also needs to be tested in much larger groups of women, including healthy ones, to find out whether it works, particularly at finding cancers early enough to improve survival. And studies must also find out whether it generates false positive results, or identifies cancers that might not actually need to be treated.

Michael H. Melner, a program director in molecular genetics and biochemistry for the American Cancer Society, called the research “very promising,” in part because it is based on finding mutations.

“It tells you not just that cancer is there, but which mutation is there,” Dr. Melner said. “As we learn more and more about which mutations are associated with more or less severe forms of cancer, it’s more information, and possibly more diagnostic.”

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SEC enforcement chief is latest to leave agency

Robert Khuzami, who revamped the Securities and Exchange Commission's enforcement division after the agency failed to stop Bernard Madoff's Ponzi scheme, is stepping down. He's pictured above at a news conference in November. (Sean Gardner / Getty Images)

By Andrew Tangel

January 9, 2013, 5:21 p.m.

Robert Khuzami, who revamped the Securities and Exchange Commission's enforcement division after the agency failed to stop Bernard Madoff's Ponzi scheme, is stepping down.

Khuzami, a former federal prosecutor and general counsel for Deutsche Bank, becomes the latest senior SEC official to leave as President Obama's second term gets underway.

Mary Schapiro stepped down as chairman of the agency in mid-December. The SEC lost two other major figures last month: Robert Cook, who was head of the SEC's division of trading and markets; and Meredith Cross, who was director of the agency's division of corporation finance.

Quiz: How well do you remember 2012?

The void means Chairman Elisse Walter could significantly reshape the agency by picking their replacements.

Aside from Schapiro, Khuzami was the most visible regulator after Madoff's fraud and the financial crisis that plunged the economy into turmoil.

During Khuzami's tenure, the SEC brought major insider-trading cases, many of them resulting from the investigation of hedge fund manager Raj Rajaratnam.

The SEC also embarked on a major overhaul of how it collects and analyzes tips and complaints. The agency also launched a program that offered leniency in exchange for cooperation in investigations, and opened an office to gather complaints from whistle-blowers.

“Rob’s leadership and bold ideas transformed and reinvigorated the enforcement program,” Walter said in a statement. “Under his direction, the division not only produced record results, but embraced changes that in the years to come will enable the talented staff to better protect investors through increased efficiency, expertise, and strategic focus.”

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Boy accused of killing neo-Nazi father opts not to testify

The Riverside boy accused of murdering his neo-Nazi father decided not to take the witness stand Tuesday, bringing an end to testimony in a juvenile court trial that attracted nationwide interest.

Riverside County Superior Court Judge Jean P. Leonard must decide whether the boy knew it was wrong to shoot and kill his father as he slept on the family's living room couch in May 2011. If found responsible for the murder, the boy could remain in juvenile custody until he is 23.

The boy was 10 years old when he shot Jeffrey Hall, regional director of a neo-Nazi organization called the National Socialist Movement.

Closing arguments are scheduled to begin Wednesday morning and the judge said she expects to release her ruling Monday.

Testimony and evidence in the case, which began in October, revolved around the boy's upbringing and a family life steeped in the hatred and violence of the neo-Nazi movement, with psychologists focusing on whether those circumstances altered his capacity to realize that killing his father was wrong.

Chief Deputy Dist. Atty. Michael Soccio argued that the boy plotted to kill his father because of fears that the father was about to divorce the boy's stepmother and break up the family. Soccio presented evidence that the boy expressed remorse within hours after the shooting.

Public Defender Matthew Hardy focused on the boy's abusive home life, where gunplay and neo-Nazi gatherings were commonplace. Witnesses testified that Hall beat his son repeatedly, often in drunken or drug-addled rages.

Social workers responded to the Hall household more than 20 times. At the time of the shooting, the boy was a dependent of the court, an effort designed in part to shield him from further abuse, Hardy said.

Clinical psychologist Anna Salter, a mental health expert called by the prosecution, testified that the boy's birth mother used heroin, LSD and other drugs while she was pregnant, which she called "devastating" to the boy's development. The boy also has an extensive history of violence dating to when he was 3. In school, he once tried to strangle a teacher with a telephone cord, she said.

Hall and his first wife divorced shortly after the boy was born. Hall won full custody when the boy was 3.

If the judge rules that the boy did not comprehend that his actions were wrong, he would be set free. If she finds the boy responsible for the killing, a hearing will be held to determine where to place him.

phil.willon@latimes.com

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U.S. Franciscan friars go digital, accept prayer requests via text

NEW YORK (Reuters) – The largest group of Franciscan friars in the United States is offering the faithful a new way to pray in the digital age by accepting prayer requests via text messages.

The Friars of Holy Name Province, who staff 40 parishes and have colleges, soup kitchens and food centers along the eastern seaboard, as well as groups in Peru and Tokyo, are among a few religious groups offering this type of digital service.

Its “Text a Prayer Intention to a Franciscan Friar” initiative, which is described as faith at your fingertips, is a novel way for Roman Catholics to connect.

“People are always saying to friars, ‘Can you say a prayer for me?’ Or ‘Can you remember my mother who has cancer?’” Father David Convertino, the New York-based executive director of development for the Franciscan Friars of the Holy Name Province, said in an interview.

“I was thinking that a lot of people text everything now, even more than email, so why not have people have the ability to ask us to pray for them … by texting.”

The faithful simply text the word ‘prayer’ to 306-44, free of charge. A welcome message from the friars comes up along with a box to type in the request. When the it is sent, the sender receives a reply.

The intentions are received on a website and will be included collectively in the friars’ prayers twice a day and at Mass.

It is one of several ways the friars hope to reach a younger audience, increase the number of faithful and spread the faith. They have already renovated their website and the next step is moving into Facebook and tweeting.

“If the Pope can tweet, friars can text,” said Father David.

The friars also have a presence on LinkedIn and have been streaming some of their church services.

“We’re trying,” said Father David when asked if the friars are well into the digital age, adding that they were “rushing madly into the 19th century.”

Most of the 325 friars, whose average age is about 60, are comfortable with the technology.

“We have a friar who is 80 who was texting today,” said Father David.

The friars are following the example of 85-year-old Pope Benedict, the leader of the world’s 1.2 billion Roman Catholics, whom the Vatican said had 2.1 million followers on Twitter just eight days after sending his first tweet.

The Pontiff tweets in several languages, including Arabic, and plans to add Latin and Chinese to them.

“We’re really excited about this working,” said Father David, about the new program. “I think we’ll be able to keep up (with all the intentions). That’s what we do, we pray for people.”

(Reporting by Patricia Reaney; Editing by Piya Sinha-Roy)

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Ned Wertimer, doorman on 'Jeffersons,' dies at 89

LOS ANGELES (AP) — Ned Wertimer, who played Ralph the Doorman on all 11 seasons of the CBS sitcom "The Jeffersons," has died.

Wertimer's manager Brad Lemack said Tuesday that the 89-year-old actor died at a Los Angeles-area nursing home on Jan. 2, following a November fall at his home in Burbank.

A native of Buffalo, N.Y., and a Navy pilot during World War II, Wertimer had one-off roles on dozens of TV shows from the early 1960s through the late 1980s, including "Car 54 Where Are You?" and "Mary Tyler Moore."

But he was best known by far as Ralph Hart, the uniformed, mustachioed doorman at the luxury apartment building on "The Jeffersons," the "All In the Family" spinoff that ran from 1975 to 1985.

The show's star, Sherman Hemsley, died July 24.

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