Kerry is easily confirmed as secretary of State

WASHINGTON — The Senate voted overwhelmingly Tuesday to confirm Sen. John F. Kerry (D-Mass.) as secretary of State, filling a crucial national security spot in President Obama's second-term Cabinet.

Kerry, who ran for president as the Democratic nominee in 2004, will replace Hillary Rodham Clinton, who steps down as America's top diplomat Friday.

After the 94-3 vote, Kerry submitted a letter of resignation, effective Friday, to give up the Senate seat he has held since 1985. He will take the oath of office in a private ceremony.

In a White House statement, Obama praised Kerry as "a champion of American global leadership."

"John has earned the respect of leaders around the world and the confidence of Democrats and Republicans in the Senate, and I am confident he will make an extraordinary secretary of State," Obama said.

Obama's nominee for secretary of Defense, Chuck Hagel, has his confirmation hearing Thursday. Unlike Kerry, the former Republican senator from Nebraska is expected to face considerable opposition in the Senate.

Kerry failed to win only three Republican votes — from Sens. John Cornyn and Ted Cruz, both of Texas, and Sen. James M. Inhofe of Oklahoma.

A spokesman for Cornyn said Kerry supported liberal positions that most Texans opposed. Cruz has criticized Kerry, a decorated Vietnam combat veteran, as anti-military.

Earlier Tuesday, Kerry received the unanimous endorsement of the Senate Foreign Relations Committee in a voice vote. He served on the committee for 28 years and was chairman for the last four.

Sen. Bob Corker (R-Tenn.), the ranking Republican on the committee, praised Kerry as a "realist" on foreign affairs issues, and said he had always been "open to discussion" with members of the other party.

Several Republican senators had promoted Kerry for the job as an alternative to Susan Rice, the U.S. ambassador to the United Nations. Rice withdrew her name from consideration amid mounting Republican criticism of her statements on TV talk shows after the deadly Sept. 11 attacks on the U.S. mission in Benghazi, Libya.

Kerry faces formidable challenges in his new job.

Obama's first administration made little headway at solving foreign policy problems in Iran, Syria, North Korea and elsewhere. Kerry also will deal with a White House that prefers to keep decisions on key issues of war and peace in its own hands.

During his confirmation hearing last week and other appearances, Kerry gave some signals of what he intends to emphasize.

He said he would begin an effort to renew Israeli-Palestinian peace negotiations, a process that has been nearly dead since the Obama administration's opening initiative was abandoned two years ago.

Kerry also said he intended to work toward preventing global warming. The momentum of that effort also slowed in Obama's first term.

His resignation from the Senate starts the clock on a special election in Massachusetts to fill his seat until his term expires in January 2015. Gov. Deval Patrick, a Democrat, is expected to call the election on June 25.

Patrick will name an interim senator to serve until voters go to the polls. Possible candidates include Victoria Reggie Kennedy, widow of the late Sen. Edward M. Kennedy; and former Rep. Barney Frank, who has publicly expressed interest in the temporary posting.

Former Republican Sen. Scott Brown, who lost an expensive 2012 reelection bid against Democrat Elizabeth Warren, has yet to signal whether he will run again. He is said to be considering a 2014 campaign for governor.

As Kerry moved toward his new role, Clinton did a final televised group interview with students and journalists at locations around the world. She was asked whether she intended to run for president in 2016.

"I right now am not inclined to do that," she said. Her immediate priority, she said, was "catching up on about 20 years of sleep deprivation."

paul.richter@latimes.com

michael.memoli@latimes.com

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<em>The Hobbit</em> Earns More in Worldwide Box Office Than <em>Fellowship</em> or <em>Two Towers</em>

Movie critics of America, foreign audiences would just like to remind you that you’re not the boss of them, thank you very much. After all, not only did the critics complain when Peter Jackson expanded J.R.R. Tolkien’s The Hobbit into three movies (although, please remember: it could be worse), but the first of those movies failed to make the grade for many professional moviegoers, with this particular parish describing it as “attempting to recreate the Lord of the Rings trilogy with the nostalgic desperation of a college freshman trying to get back together with his high school girlfriend.”

So, you’d think that such a disappointing movie would be a flop at the box office, right? Guess again: As of this last weekend, The Hobbit: An Unexpected Journey has made more money worldwide than either Lord of the Rings: The Fellowship of the Ring or Lord of the Rings: The Two Towers managed in their entire time in movie theaters.

The international box office total for The Hobbit is currently $939,862,965, with almost 69 percent of that amount coming from non-U.S. audiences ($646,300,000, to be specific), continuing the upwards trend of Jackson’s Middle-earth movies. In comparison, The Fellowship of the Ring made $869,349,688 in terms of worldwide box office ($555,985,574 of which came from moviegoers outside of the U.S.; that’s 64 percent of the total for the less math-inclined amongst you), and The Two Towers collected a total of $923,285,627 from the world’s box office, with 63.2 percent of that amount ($583,495,746) coming from non-domestic release.

The only Tolkien movie to have made more money worldwide than The Hobbit is 2005′s Lord of the Rings: Return of the King, which grossed a total of $1,119,110,941 internationally during its time in theaters, with 66.3 percent of that – or $742,083,616 in practical terms – coming from non-American theaters.

In the U.S. alone, things are a little different. Currently, The Hobbit is lagging behind all three of Jackson’s earlier Tolkien movies, with “just” $293,562,965 in domestic box office, although there are all manner of reasons for that, not least of which is the fact that it is still in the middle of its theater run, only in release for 46 days versus the 243 days, 250 days and 170 days that Fellowship, Towers and Return enjoyed, respectively.

At current rate — it made $8,948,729 last week alone, and remains in the box office top 10 more than a month after release — it’s likely that The Hobbit will end up eclipsing The Fellowship of the Ring (Total domestic gross: $313,364,114) at least before leaving theaters, if not also The Two Towers (Total domestic gross: $339,789,881). Return of the King, however, can likely relax on its throne made of the $377,027,325 it brought in from American audiences during its time in theaters.

So, what can be learned from this? Perhaps we should chalk it up to the power of a recognizable brand; note that each successive Lord of the Rings movie was more financially successful than the one before, and that The Hobbit was seemingly unaffected by poor reviews ahead of release. In fact, it had the most impressive U.S. opening weekend, with $84,617,303 — significantly higher than even Return of the King‘s $72,629,713 and almost twice that of Fellowship of the Ring‘s $47,211,490.

Some things may simply be critic-proof, which likely comes as a relief to Warner Bros. with two more Hobbits waiting in the wings for 2013 and 2014 respectively. If the box office returns hold up, maybe talk of a final trilogy based upon material in The Silmarillion won’t seem as outlandish after all.

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Justin Timberlake’s new album ’20/20′ is due out in March

(Reuters) – Singer-turned-actor Justin Timberlake has set a March date for his comeback album – his first in more than six years.

RCA Records said on Tuesday “The 20/20 Experience,” the former N’Sync boy band member’s follow-up to 2006′s “FutureSex/LoveSounds” and only his third album ever, would be released on March 19.

In recent years, Timberlake, 31, has focused more on films and business ventures ranging from restaurants to a clothing line, and reviving social networking site Myspace, of which he is part owner. He remarked in a recent video that creating music involved “physical torture” for him.

“Suit & Tie,” the first single off his forthcoming album, fell short of sales expectations for its first week. The song, featuring rapper Jay-Z, sold 314,000 downloads last week. Industry experts had expected about 350,000 downloads.

Top menswear designer Tom Ford collaborated with Timberlake, designing suits worn in the “Suit & Tie” video as well as styling the production and the release’s artwork.

Timberlake will perform his first concert in five years during a private Super Bowl-weekend event in New Orleans on February 2 at an invitation-only concert.

Timberlake posted on Twitter about the forthcoming game, saying among other things: “This is gonna be a GREAT Super Bowl!” and “Oh wait … I don’t have tickets. Dammit! Anybody know anybody?? LOL!”

(Reporting by Chris Michaud; Editing by Jill Serjeant and Philip Barbara)

Music News Headlines – Yahoo! News

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Report Links Rodriguez and Others to Clinic and P.E.D.’s

Investigators for Major League Baseball created an improvised war room in the commissioner’s Park Avenue offices in Manhattan in recent months, mapping out potential evidence that would tie an anti-aging clinic in Coral Gables, Fla., to the possible use of performance-enhancing drugs by some of baseball’s more prominent players. 

But because the investigators cannot compel witnesses to talk, they could do nothing more than scrutinize the clinic. As a result, they found themselves mere spectators Tuesday as a weekly Miami newspaper reported that it had obtained medical records from the clinic that tied a half-dozen players — Alex Rodriguez, Melky Cabrera, Gio Gonzalez, Bartolo Colon, Nelson Cruz and Yasmani Grandal — to the use of banned substances like human growth hormone.

The newspaper, Miami New Times, said it had received the records from a former employee of the clinic, which is now closed, and that they included handwritten notations listing various drugs that were reportedly distributed to various players. At least some of those documents were displayed online by the newspaper. However, the documents have not been independently authenticated, and Rodriguez, the Yankees slugger, and Gonzalez, a standout pitcher for the Washington Nationals, both issued statements denying they had been patients at the clinic.

Anthony Bosch, the operator of the clinic, known as Biogenesis of America, also issued a statement of denial through his lawyer, saying the Miami New Times article was “filled with inaccuracies, innuendos and misstatements in fact.”

“Mr. Bosch vehemently denies the assertions that MLB players such as Alex Rodriguez and Gio Gonzalez were treated or associated with him,” the statement added.

Nevertheless, despite the denials, Major League Baseball, long suspicious of the clinic’s actions, will continue to proceed in the belief that the assertions in the article have merit. Major League Baseball has been particularly curious about Rodriguez, who admitted in 2009 that he used performance enhancers from 2001 to 2003, but who has denied in several meetings with baseball’s investigators that he has done so since.

But what exactly baseball can do about Rodriguez, or any of the other players named, is unclear.

Because the potential evidence does not involve failed drug tests, baseball is back where it has been in the past, seeking perhaps to punish players without having the necessary evidence to do so. In the case of the Biogenesis clinic, baseball’s investigators did travel to Florida to meet with members of the Drug Enforcement Administration, who were taking a close look at the facility.

But whether federal authorities would share with baseball any evidence they develop on the clinic is unclear. In other instances over the last decade, that has not happened.

“If the feds are not going to prosecute this case, it would be much better for us for them to give us some usable evidence like the documents so we can do our job and suspend the players,” a baseball official said. “We could be in discipline hell if that doesn’t happen.”

That official knows that baseball has had little success in suspending players for violating the drug testing program when the players have not actually tested positive. Of the roughly 40 players who have been suspended for violating the testing program since 2005, only a handful have been suspended based on evidence developed by baseball’s investigators or from medical records or court documents.

The most high-profile instance of a suspension without a drug test occurred in 2005 when relief pitcher Jason Grimsley was barred for 50 games after federal authorities unsealed court documents that showed that Grimsley admitted to a federal agent that he had used human growth hormone.

As for the Florida clinic, it has been on the radar of both baseball and the federal government since at least 2009, when investigators uncovered evidence that the slugger Manny Ramirez had received a banned drug from the facility. Ramirez was ultimately suspended 50 games for that infraction.

Last summer, baseball’s investigators began to take another look at the clinic after Cabrera, then leading the National League in hitting as the San Francisco Giants’ starting left fielder, tested positive for elevated testosterone. In the course of that positive test, two people in baseball said, baseball’s investigators uncovered evidence that an employee for Cabrera’s agents, Sam and Seth Levinson, had hatched a cover-up scheme to deceive a baseball arbitrator and have the suspension for the positive drug test thrown out.

Angered, baseball officials began investigating the employee, Juan Nunez, and the Levinsons.

Steve Eder and Alain Delaquérière contributed reporting from New York, and Lizette Alvarez from Miami.

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F.D.A. Approves Genetic Drug to Treat Rare Disease

The Food and Drug Administration approved a new drug Tuesday that not only treats a rare inherited disorder that causes extremely high cholesterol levels and heart attacks by age 30, but does so using a long-sought technology that can shut off specific genes that cause disease.

The drug, Kynamro, which was invented by Isis Pharmaceuticals and will be marketed by Sanofi’s Genzyme division, is unlikely to be a blockbuster. It has some worrisome side effects and there might be no more than a few hundred people in the United States with the disease, known as homozygous familial hypercholesterolemia, or HoFH.

Still, Kynamro could become the first commercial success for the gene silencing technique, which is known as antisense, and which some experts say is finally poised to fulfill its promise after over two decades of research and numerous disappointments.

“What many people have been waiting for is validation where someone actually makes a profit and where patients actually benefit,” said Arthur M. Krieg, chief executive of RaNA Therapeutics, an antisense drug developer in Cambridge, Mass.

Isis, which is based in Carlsbad, Calif., has been pursuing antisense technology since the company’s founding in 1989, spending about $2 billion. It had one drug approved in 1998 for an infection associated with AIDS, but the drug did not sell well and some experts said it did not really use the gene-silencing mechanism.

Isis’s experience contrasts with that of Gilead Sciences, which was also founded in the late 1980s to pursue antisense technology. It gave up after several years — selling the patents it no longer needed to Isis — and went on to develop antiviral drugs using other techniques. It is now a biotech superstar with a market value of $59.8 billion, compared with $1.4 billion for Isis.

Stanley T. Crooke, the founder and chief executive of Isis since its inception, said the long period of development was not unusual for a new technology.

“I told people it would be at least 20 years and $2 billion before we knew if the technology would work,” he said in an interview Tuesday. “We think it’s a seminal day for the technology and the company.”

Isis or its partners are developing drugs to lower triglycerides, treat spinal muscular atrophy and reduce scarring from operations, among other things. The partners include Biogen Idec, Pfizer and AstraZeneca.

Two rival antisense companies, Sarepta Therapeutics and Prosensa are developing drugs for muscular dystrophy that have shown promise in early clinical trials.

Still, Dr. Cy Stein, a longtime antisense researcher, said it was too early to say that antisense had arrived. There have been false dawns in the field before.

Antisense drugs work essentially by shooting the messenger. The recipe to make a protein is carried from a gene in the nucleus into the body of a cell by a single strand of RNA, called messenger RNA.

Antisense drugs are small snippets of synthetic DNA or RNA that bind to that messenger RNA in a way that inactivates or destroys it.

In theory, an antisense drug can be made to shut down any gene, providing a means to develop a virtually unlimited number of drugs. But in practice, it has been difficult to deliver the drugs into cells with sufficient potency and lack of toxicity. Companies have developed ways to chemically modify the drugs to help in that regard.

Kynamro, known generically as mipomersen, inhibits action of a gene, apolipoprotein B, that is involved in the formation of particles that carry cholesterol in the blood.

If untreated, people with HoFH can have levels of LDL cholesterol, the so-called bad cholesterol, as high as 1,000 milligrams per deciliter. A level of 130 or less for LDL is generally considered desirable.

Statins work for these patients and have helped increase the typical life span to 33 years, from 18, but further cholesterol reduction is needed. Patients can also have their blood cleansed of cholesterol by being connected to a machine for a few hours once a week.

Patients in the main clinical trial of Kynamro started with LDL levels of around 400. After 26 weeks of treatment, those getting Kynamro had a mean decline in LDL cholesterol of 24.7 percent compared with a decline of 3.3 percent for those getting a placebo.

The label for Kynamro will carry a boxed warning about potential liver damage. Other side effects include injection-site reactions and flulike symptoms.

Kynamro will share the market with Juxtapid, a drug developed by Aegerion Pharmaceuticals that won approval last month.

In October, an F.D.A. advisory committee voted 13-to-2 in favor of approval of Juxtapid but only 9-to-6 in favor of Kynamro, largely because of concern about side effects. Juxtapid is a once-a-day pill, while Kynamro is injected once a week.

Genzyme has not announced the price for Kynamro but it might be similar to that of Juxtapid, which costs $235,000 to $295,000 a year, similar to some other drugs for extremely rare conditions.

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Bipartisan group sees change in politics on immigration reform

A bipartisan coalition of senators said Monday they have created a set of principles based upon which they hope lawmakers will pass immigration reform by summer.

WASHINGTON — Declaring that the politics of immigration  “have been turned upside down,” a bipartisan group of senators Monday outlined common principles for comprehensive immigration reform and expressed optimism that legislation granting legal status to most of the country's 11 million illegal immigrants could be realized by this summer.

One day before President Obama launches a campaign-style push for his vision of immigration reform, representatives of the so-called Group of Eight senators acknowledged previous false starts on the issue, and obstacles that probably lie ahead — particularly in determining how to increase the flow of legal immigration.

But, after an election in which the share of the nonwhite vote continued to grow and swung overwhelmingly toward Obama, the lawmakers said that the path forward was as clear as ever.

Arizona Sen. John McCain, the GOP’s 2008 presidential nominee and a past proponent of comprehensive reform, said the change in favor of taking action came down to one word: “Elections.”

PHOTOS: President Obama’s second inauguration

“The Republican Party is losing the support of our Hispanic citizens. And we realize that there are many issues in which we think we are in agreement with our Hispanic citizens, but this is a preeminent issue with those citizens,” he said at a Capitol Hill news conference. 

“For the first time ever, there's more political risk in opposing immigration reform than in supporting it,” added Sen. Charles E. Schumer (D-N.Y.).

The Senate blueprint, drafted during weeks of closed-door meetings by leading senators from each party, is more conservative than Obama's proposal, which the president plans to unveil Tuesday in a speech in Las Vegas. But its provisions for legalizing millions of undocumented immigrants go further than measures that failed to advance in Congress in previous years — a reminder of how swiftly the politics of immigration have shifted since the November election.

The Senate proposal would allow most of those in the country illegally to obtain probationary legal status immediately by paying a fine and back taxes and passing a background check. That would make them eligible to work and live in the U.S. They could earn a green card — permanent residency — after the government certifies that the U.S.-Mexican border has become secure, but might face a lengthy process before becoming citizens.

Obama is expected to push for a faster citizenship process that would not be conditional on border security standards being met first. The structure of the citizenship process will probably be among the most hotly debated parts of any immigration plan.

PHOTOS: A look ahead at 2013’s political battles

Less controversial provisions would tighten requirements on employers to check the immigration status of new workers; increase the number of visas for high-skill jobs; provide green cards automatically to people who earn master's degrees or PhDs in science, technology or math at U.S. universities; and create an agricultural guest-worker program.

Schumer said lawmakers are aiming for full legislative language to be put forward by March, which will then work its way through the committee process. A vote in the Senate could come by late spring or summer, he said.

“We still have a long way to go, but this bipartisan blueprint is a major breakthrough,” he said.

Though their effort was running parallel to the president’s, Democratic Sen. Richard J. Durbin of Illinois said he and Schumer spoke with Obama on Sunday and that the president “cheered us on.” McCain said Obama’s public campaign for it would be helpful to their cause.

Still, many conservatives on Capitol Hill remain skeptical about sweeping immigration legislation and could prove a major obstacle to any compromise.

“The last time we talked about this in 2007, it sounded very seductive. When we saw the details, it was clear it wouldn’t work,” Sen. Jeff Sessions (R-Ala.) said in an interview Monday. Sessions said he was particularly concerned that the Obama administration is not committed to securing the borders against future illegal immigration.

Similar criticism from Republican lawmakers doomed a 2007 immigration bill pushed by President George W. Bush and seniors Senate Democrats.

PHOTOS: President Obama’s past

Today, 22 GOP senators who opposed the 2007 plan remain in the Senate, including Minority Leader Mitch McConnell (R-Ky.). By contrast, just two of the 12 Republicans who backed the compromise six years ago are still in Congress — McCain and South Carolina's Lindsey Graham.

Republican resistance to an immigration overhaul promises to be even more intense in the House, where many conservative lawmakers are leery of any proposal that would provide a mechanism for immigrants here illegally to gain citizenship, a key demand on the left.

“When you legalize those who are in the country illegally, it costs taxpayers millions of dollars, costs American workers thousands of jobs and encourages more illegal immigration,” said Rep. Lamar Smith (R-Texas), the former chairman of the House Judiciary Committee. “By granting amnesty, the Senate proposal actually compounds the problem by encouraging more illegal immigration.”

Staff writers Brian Bennett and Lisa Mascaro contributed to this report.

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noam.levey@latimes.com

Twitter: @noamlevey

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Supernova Remnants: Dazzling Entrails of Violent Stellar Death

Even in death, there can be great beauty. Consider supernova remnants, the results of massive stars dying in great explosions, creating some of the most spectacular cosmic objects around.

Every 50 years or so, a star in our galaxy with more than 10 times the mass of our sun will expire. When such stars die, they go supernova, one of the most violent events in our universe. These explosions shoot off tons of material from the central star at up to 10 percent the speed of light.

Though the area surrounding stars seems empty, it is usually home to vast amounts of interstellar gas and dust. The supernova’s outburst runs into this surrounding material, creating a shockwave and heating it to temperatures greater than 10,000 Celsius. Over thousands of years, the local structure of the gas and dust shapes the stellar outpouring into shells, filaments, and other diffuse forms. Astronomers call these objects supernova remnants.

Supernova explosions and the remnants they leave behind have wide-ranging effects. They heat up the interstellar medium, creating complex chemistry out in space, and are responsible for accelerating protons and other atomic nuclei, which go zipping around the universe as cosmic rays. Perhaps most importantly, supernova explosions generate and liberate heavy elements, such as oxygen, carbon, and all metals, distributing them out into the wider cosmos. These elements eventually find their way into planetary systems, making life possible on at least one world that we know of.

Here, we take a look at some of the most famous and beautiful supernova remnants, giving you a chance to contemplate life, death, and cycles of renewal in the universe.

Above:

The supernova remnant N186 D appears as a bright pink spot at the top of this new image released by NASA on Jan. 28, spewing off tremendous amounts of X-rays. Located in the Large Magellanic Cloud about 160,000 light-years away, the remnant is blowing a huge bubble (the giant structure below the bright spot) as hot wind carves out a shock wave in the surrounding material.

Image: X-ray: NASA/CXC/Univ of Michigan/A.E.Jaskot, Optical: NOAO/CTIO/MCELS

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The CW orders “The Hundred” drama pilot, two others

LOS ANGELES (TheWrap.com) – The CW has gone post-apocalyptic with its pilot orders.

The network has placed an order for the drama pilot “The Hundred,” based on the upcoming book series by Kass Morgan (which has received an initial two-book order from Little, Brown).

The pilot will be set 97 years after a nuclear war has destroyed civilization, when a spaceship housing humanity’s lone survivors sends 100 juvenile delinquents back to Earth in hopes of possibly re-populating the planet.

Jason Rothenberg is writing as well as executive producing the project, which comes from Warner Bros. Television and Alloy Entertainment, with Alloy’s Leslie Morgenstein and Gina Girolamo also executive-producing.

The network has also ordered the sci-fi drama “Oxygen,” about a romance between a human girl and an alien boy.

“Passion and politics threaten the peace and an epic romance ignites between a human girl and an alien boy when he and eight others of his kind (The Orion 9) are integrated into a suburban high school ten years after they and hundreds of others landed on Earth and were immediately consigned to an internment camp where they’ve been imprisoned ever since,” a logline for the show explains.

Meredith Averill (“The Good Wife”) is writing and executive-producing “Oxygen,” which comes from CBS Television Studios, Ole Productions, Isla de Babel SL and 360 Powwow LLC.

Josh Appelbaum, Andre Nemec, Scott Rosenberg, Richard Shepard, Bryan Furst, Sean Furst and Daniel Gutman are also executive producing.

Finally, “Reign” promises to tell the “previously unknown and untold story of Mary Queen of Scots,” detailing the secret history of survival at French Court “amidst fierce foes, dark forces, and a world of sexual intrigue.” Stephanie Sengupta (“Hawaii Five-0″) and Laurie McCarthy (“Ghost Whisperer”) are writing and executive producing the pilot, which is being produced by CBS Television Studios.

TV News Headlines – Yahoo! News

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Personal Health: Keeping Blood Pressure in Check

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

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

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

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Jane Brody speaks about hypertension.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How to Measure Your Blood Pressure

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

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

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

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

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

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

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

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Advertising: Playing Whac-a-Mole With Piracy Sites

OVER the years, the fight against online piracy has led to countless lawsuits by media companies and to escalating levels of law enforcement, all with mixed results.

Lately, though, new attention has turned to an aspect of online commerce that critics say finances online piracy: advertising.

Prodding from the White House and a recent academic report have put pressure on the online advertising industry to prevent ads — for jeans, say, or car insurance — from appearing on a page offering a free download of Season 2 of “Game of Thrones.” Yet these efforts have also been slow to produce results, in part because of the complexity of the online ad system.

This month, the University of Southern California’s Annenberg Innovation Lab released a report that ranked 10 ad networks on the amount of business they do with sites suspected of engaging in piracy, with Google and Yahoo placing high on the list. Ad networks use advanced computer algorithms to place ads on Web sites. They can be run by agencies, publishers or others.

The implicit criticism of the report is that the operators of these networks know which sites traffic in copyright infringement and therefore could keep ads — and ad money — away from them if they wanted to.

“Brands make sure that their ads never show up on porn sites, so we’re basically saying, why not do the same with piracy sites?” said Jonathan Taplin, the director of the Innovation Lab, which is part of U.S.C.’s Annenberg School for Communication and Journalism.

But some of the ad networks cited by the report have disputed its methodology and meaning. And even its supporters complain that the online ad system — a chain of Web sites, ad servers, digital publishers and agency trading desks that buy and sell ads at a rapid pace — operates in a way that makes it difficult to know where to point the finger.

The researchers studied the fragments of computer code that were appended to the ads they found on sites suspected of piracy over a year. The sites were drawn from a report by Google listing sites that had received the most complaints from copyright holders.

Representatives of Google and OpenX, two of the largest companies on U.S.C.’s list, did not deny the prevalence of their codes. But they disputed its meaning, saying that their technology is widely used by third parties — like ad agency trading desks and advertisers — so the presence of their code did not necessarily implicate them in a transaction.

“To grossly overcalculate our network, you’re also grossly overcalculating how many of these sites we are funding,” said Andrea Faville, a Google spokeswoman. Mitch Stoltz, a staff lawyer at the Electronic Frontier Foundation, was more aggressive, calling the U.S.C. report “a little bit of analysis resting on false premises.”

The report comes a year after the failure of the Stop Online Piracy Act, a Congressional bill that would have given additional powers to federal law enforcement to prosecute copyright infringement. The bill was supported by the media and entertainment world, but activists and technology companies said it would violate due process and privacy.

Since then, the government has tried to press industry to regulate itself.

“We believe that effective enforcement must involve private sector stakeholder efforts,” Victoria Espinel, the United States intellectual property enforcement coordinator, said in a statement. “Voluntary best practices must be practical and effective, must respect privacy, due process, competition, free speech, and must protect legitimate uses of the Internet.”

A lack of progress toward self-regulation has frustrated media companies. They say the opacity of the online ad system makes it nearly impossible to hold any party responsible for the ads.

“The ecosystem for online ads is incredibly complicated,” said Cary Sherman, chief executive of the Recording Industry Association of America. “Everybody can point the finger at other people.”

One example is programmatic buying, a technique used by networks to place ads on sites based primarily on demographics. As a result, a brand may not know every site where its ad will appear.

One solution floated in the ad business is a blacklist of offending Web sites. Dick O’Brien, the executive vice president and director of government relations at the American Association of Advertising Agencies, a trade group, said this would be difficult. “If an organization like ours tries to create a list and organize a boycott, that opens us up to antitrust issues,” he said.

Advertising agencies, including OMD, a digital agency part of the Omnicom Media Group, one of the largest agencies in the world, said they were examining the report, but so far little significant action has been taken. Stephen Kline, the senior counsel for privacy and regulatory matters at the Omnicom Media Group, described the challenge for brands and agencies to identify piracy sites that appear as quickly as they disappear as “a little bit of Whac-a-Mole.”

As Mr. Taplin of the Innovation Lab sees it, Google has effectively provided a blacklist with its Transparency Report, which lists the sites that have received the most takedown requests from copyright owners. But these are only requests, not proof of illegal behavior.

The next edition of the U.S.C. report is due in mid-February. Mr. Taplin said it would name brands that advertise on pirate sites. In an interview, he said he was not ready to identify those brands, but he noted that insurance companies were among the biggest offenders.

Mr. Taplin said the report had not been done for any media company or organization, but, as a veteran of the music and film industries, he also made no secret of his sympathies with Big Content.

He told the story of his friend Levon Helm of the Band, who died last year. (Mr. Taplin was a producer of the band’s 1978 concert film, “The Last Waltz.”) Mr. Helm, he said, had to tour, despite having cancer, to make up for money he lost from royalties, in part because of piracy.

“That didn’t seem fair to me.”

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