Well: Can Foods Affect Colon Cancer Survival?

A new study suggests that what you eat may affect your chances of surviving colon cancer.

The research is among the first to look at the impact that specific nutrients have on the likelihood of disease recurrence in people with colon cancer, one of the leading causes of cancer death in the United States. It found that people treated for Stage 3 disease, in which tumor cells have spread to lymph nodes, had greatly increased chances of dying of it or experiencing a recurrence if their diets were heavy in carbohydrate-rich foods that cause spikes in blood sugar and insulin.

The patients who consumed the most carbohydrates and foods with high glycemic loads — a measure of the extent to which a serving of food will raise blood sugar — had an 80 percent greater chance of dying or having a recurrence during the roughly seven-year study period than those who had the lowest levels. Stage 3 colon cancer patients typically have a five-year survival rate of about 50 to 65 percent.

The study, however, was observational, meaning it could only highlight an association between carbohydrates and cancer outcomes without proving direct cause and effect. The researchers also obtained some of their data from food questionnaires that required patients to recall details about their diets, a method that can be unreliable.

Still, the researchers, who published their findings in The Journal of the National Cancer Institute, believe insulin may play a critical role in colon cancer recurrence. Chronically high insulin levels have been linked to cancer recurrence and mortality in previous research, and people with a history of Type 2 diabetes or elevated plasma C-peptide, a marker of long-term insulin production, have also been found to have an increased risk of colon cancer. One hypothesis is that insulin may fuel the growth of cancer cells and prevent cell death, or apoptosis, in cancer cells that have spread.

“It’s not simply that all carbs are bad or that you should avoid all sugar,” said Dr. Jeffrey A. Meyerhardt, the lead author of the study and an associate professor of medicine at the Dana-Farber Cancer Institute in Boston. It’s not as simple as ‘sugar causes cancer to grow.’”

He added: “Different carbs and sugar lead to different responses in your body. I think people should focus on a well-balanced diet” and substitute foods associated with lower glycemic loads or carbs for foods that have higher levels.

Earlier research published by Dr. Meyerhardt’s group showed that Stage 3 colon cancer patients who most closely followed a Western-style diet — with high intakes of meat, fat, refined grains and sugary desserts — had a threefold increase in recurrence and death from the disease compared with those who most strongly deviated from Western patterns of eating.

For this study, Dr. Meyerhardt and his team wanted to see to what extent carbohydrate intake could influence the progression of the disease, so they followed about 1,000 Stage 3 colon cancer patients taking part in a clinical trial sponsored by the National Cancer Institute. The patients, who had all had surgery and chemotherapy as part of their treatments, provided information on their diets and lifestyle habits. But the researchers went beyond just carbohydrate and sugar intake, taking into account glycemic measures.

The glycemic index, an increasingly popular nutritional measure, looks at the rate at which carbohydrate-containing foods raise a person’s fasting level of blood sugar and subsequent need for insulin. Sugary drinks, white bread and other highly processed carbohydrates rank higher on the index, while those that are digested more slowly, like brown rice, many vegetables, unrefined grains and legumes, have a lower index value.

Another barometer, however, is the glycemic load, which refers to the blood sugar effect of a standard serving of a food. A glycemic load of 10 or less for a food is generally considered low, while 20 or more is high. The latest study showed that glycemic load and total carbohydrate intake were the best predictors of cancer recurrence and mortality, and the link was strongest in people who were overweight or obese.

Dr. Meyerhardt said the findings suggest that colon cancer patients would be wise to keep glycemic load in mind while making food decisions, looking for ways to work into their diets foods that rank lower on the scale.

“So if you think about beverages, most juices and certainly sodas have a higher glycemic load than flavored waters and tomato juice and things like that,” he said. “Fruits like a date or raisins have very high glycemic loads, whereas fresh fruits like an apple, orange or cantaloupe all have sugar but have a very low glycemic load. Substitute brown rice for white, whole grains instead of white bread, and instead of having a starchy potato as your side dish, substitute beans and vegetables.”

One expert who was not involved in the research, Somdat Mahabir, a nutritional epidemiologist with the National Cancer Institute’s division of cancer control and population sciences, said the findings from the latest study must be borne out in further research. But in the meantime, making dietary changes that reduce glycemic load is a reasonable recommendation for colon cancer patients, he said, since it can only be helpful, not harmful.

“The results of the current study need to be confirmed, but the current indications are that diet is important to colon cancer survival,” Dr. Mahabir said.

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Syrian Jet Strikes Close to Border With Turkey

Murad Sezer/Reuters

Syrians fled from Ras al-Ayn after an airstrike by Syrian forces on Monday.

GAZIANTEP, Turkey — A Syrian MIG-25 jet bombed the rebel-held town of Ras al-Ain a few yards from the Turkish border on Monday, Syrian witnesses said.

Veli Gurgah/Anadolu Agency, via European Pressphoto Agency

Smoke rose from Ras al-Ayn as it was bombed.

Murad Sezer/Reuters

Syrians crossed into Turkey after the airstrike.

Murad Sezer/Reuters

A boy was wounded in the attack.

The attack demolished at least 15 buildings and killed many civilians, Nezir Alan, a doctor who witnessed the bombing, said. Local officials, quoted by The Associated Press, said at least six people were killed, but Dr. Alan said the toll was higher.

“We pulled bodies of 12 people from the rubble and are now trying to reach bodies of 8 others,” he said in a telephone interview. “There are around 70 injured, 50 of whom were in critical condition, and they are being transferred to Turkish hospitals across the border.”

Turkish fighter jets were seen in Turkish airspace shortly after the explosion, and a Syrian helicopter hovered above Ras al-Ain, which is only few yards from Ceylanpinar, a Turkish border town, Syrian witnesses said. “The plane appeared in seconds, dropped a bomb and killed children. Here is total chaos,” Dr. Alan said.

Ambulances were rushed to Ceylanpinar, Haber Turk, a private news television station, reported.

Windows of shops and houses in Ceylanpinar were shattered, and people on both sides of the border were seen running in panic, while military vehicles raced down streets as a huge cloud of smoke hung over the area, Haber Turk footage showed minutes after the explosion.

There were no immediate reports of any deaths or injuries on the Turkish side of the border.

Clashes in Ras al-Ain have intensified in recent days, prompting thousands of Syrians to seek refuge in Turkey.

Civilians in Ceylanpinar and other nearby towns were advised not to travel in areas close to the border.

Five Turkish civilians were killed in October when a Syrian shell landed in Akcakale, another border town about 75 miles west of Ceylanpinar, an act that prompted the Turkish Parliament to revise engagement rules and allow the military to retaliate in case of a direct threat from the border region.

The Turkish Army has increased its deployment along the 550-mile border with Syria since June, after Syria shot down a Turkish military jet, straining already tense relations between Ankara and Damascus.

The Turkish government is also considering asking NATO to station Patriot missiles in its border region to counter potential attacks from Syria.

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Hurricane Sandy and the Disaster-Preparedness Economy

Jeffrey Phelps for The New York Times

An assembly line at a Generac Power Systems plant. Generac makes residential generators, coveted items in the wake of Hurricane Sandy.

FOLKS here don’t wish disaster on their fellow Americans. They didn’t pray for Hurricane Sandy to come grinding up the East Coast, tearing lives apart and plunging millions into darkness.

But the fact is, disasters are good business in Waukesha. And, lately, there have been a lot of disasters.

This Milwaukee suburb, once known for its curative spring waters and, more recently, for being a Republican stronghold in a state that President Obama won on Election Day, happens to be the home of one of the largest makers of residential generators in the country. So when the lights go out in New York — or on the storm-savaged Jersey Shore or in tornado-hit Missouri or wherever — the orders come pouring in like a tidal surge.

It’s all part of what you might call the Mad Max Economy, a multibillion-dollar-a-year collection of industries that thrive when things get really, really bad. Weather radios, kerosene heaters, D batteries, candles, industrial fans for drying soggy homes — all are scarce and coveted in the gloomy aftermath of Hurricane Sandy and her ilk.

It didn’t start with the last few hurricanes, either. Modern Mad Max capitalism has been around a while, decades even, growing out of something like old-fashioned self-reliance, political beliefs and post-Apocalyptic visions. The cold war may have been the start, when schoolchildren dove under desks and ordinary citizens dug bomb shelters out back. But economic fears, as well as worries about climate change and an unreliable electronic grid have all fed it.

 Driven of late by freakish storms, this industry is growing fast, well beyond the fringe groups that first embraced it. And by some measures, it’s bigger than ever.

Businesses like Generac Power Systems, one of three companies in Wisconsin turning out generators, are just the start.

The market for gasoline cans, for example, was flat for years. No longer. “Demand for gas cans is phenomenal, to the point where we can’t keep up with demand,” says Phil Monckton, vice president for sales and marketing at Scepter, a manufacturer based in Scarborough, Ontario. “There was inventory built up, but it is long gone.”

Even now, nearly two weeks after the superstorm made landfall in New Jersey, batteries are a hot commodity in the New York area. Win Sakdinan, a spokesman for Duracell, says that when the company gave away D batteries in the Rockaways, a particularly hard-hit area, people “held them in their hands like they were gold.”

Sales of Eton emergency radios and flashlights rose 15 percent in the week before Hurricane Sandy — and 220 percent the week of the storm, says Kiersten Moffatt, a company spokeswoman. “It’s important to note that we not only see lifts in the specific regions affected, we see a lift nationwide,” she wrote in an e-mail. “We’ve seen that mindfulness motivates consumers all over the country to be prepared in the case of a similar event.”

Garo Arabian, director of operations at B-Air, a manufacturer based in Azusa, Calif., says he has sold thousands of industrial fans since the storm. “Our marketing and graphic designer is from Syria, and he says: ‘I don’t understand. In Syria, we open the windows.’ ”

But Mr. Arabian says contractors and many insurers know that mold spores won’t grow if carpeting or drywall can be dried out within 72 hours. “The industry has grown,” he says, “because there is more awareness about this kind of thing.”

Retailers that managed to stay open benefited, too. Steve Rinker, who oversees 11 Lowe’s home improvement stores in New York and New Jersey, says his stores were sometimes among the few open in a sea of retail businesses.

Predictably, emergency supplies like flashlights, lanterns, batteries and sump pumps sold out quickly, even when they were replenished. The one sought-after item that surprised him the most? Holiday candles. “If anyone is looking for holiday candles, they are sold out,” he says. “People bought every holiday candle we have during the storm.”

If the hurricane was a windfall for Lowe’s, its customers didn’t seem to mind. Rather, most appeared exceedingly grateful when Mr. Rinker, working at a store in Paterson, N.J., pointed them toward a space heater, or a gasoline can, that could lessen the misery of another day without power.

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Mind Faded, Darrell Royal’s Wisdom and Humor Intact Till End

Three days before his death last week at 88, Darrell Royal told his wife, Edith: “We need to go back to Hollis” — in Oklahoma. “Uncle Otis died.”

“Oh, Darrell,” she said, “Uncle Otis didn’t die.”

Royal, a former University of Texas football coach, chuckled and said, “Well, Uncle Otis will be glad to hear that.”

The Royal humor never faded, even as he sank deeper into Alzheimer’s disease. The last three years, I came to understand this as well as anyone. We had known each other for more than 40 years. In the 1970s, Royal was a virile, driven, demanding man with a chip on his shoulder bigger than Bevo, the Longhorns mascot. He rarely raised his voice to players. “But we were scared to death of him,” the former quarterback Bill Bradley said.

Royal won 3 national championships and 167 games before retiring at 52. He was a giant in college football, having stood shoulder to shoulder with the Alabama coach Bear Bryant. Royal’s Longhorns defeated one of Bryant’s greatest teams, with Joe Namath at quarterback, in the 1965 Orange Bowl. Royal went 3-0-1 in games against Bryant.

Royal and I were reunited in the spring of 2010. I barely recognized him. The swagger was gone. His mind had faded. Often he stared aimlessly across the room. I scheduled an interview with him for my book “Courage Beyond the Game: The Freddie Steinmark Story.” Still, I worried that his withering mind could no longer conjure up images of Steinmark, the undersize safety who started 21 straight winning games for the Longhorns in the late 1960s. Steinmark later developed bone cancer that robbed him of his left leg.

When I met with Royal and his wife, I quickly learned that his long-term memory was as clear as a church bell. For two hours, Royal took me back to Steinmark’s recruiting trip to Austin in 1967, through the Big Shootout against Arkansas in 1969, to the moment President Richard M. Nixon handed him the national championship trophy in the cramped locker room in Fayetteville. He recalled the day at M. D. Anderson Hospital in Houston the next week when doctors informed Steinmark that his leg would be amputated if a biopsy revealed cancer. Royal never forgot the determined expression on Steinmark’s face, nor the bravery in his heart.

The next morning, Royal paced the crowded waiting room floor and said: “This just can’t be happening to a good kid like Freddie Steinmark. This just can’t be happening.”

With the love of his coach, Steinmark rose to meet the misfortune. Nineteen days after the amputation, he stood with crutches on the sideline at the Cotton Bowl for the Notre Dame game. After the Longhorns defeated the Fighting Irish, Royal tearfully presented the game ball to Steinmark.

Four decades later, while researching the Steinmark book, I became close to Royal again. As I was leaving his condominium the day of the interview, I said, “Coach, do you still remember me?” He smiled and said, “Now, Jim Dent, how could I ever forget you?” My sense of self-importance lasted about three seconds. Royal chuckled. He pointed across the room to the message board next to the front door that read, “Jim Dent appt. at 10 a.m.”

Edith and his assistant, Colleen Kieke, read parts of my book to him. One day, Royal told me, “It’s really a great book.” But I can’t be certain how much he knew of the story.

Like others, I was troubled to see Royal’s memory loss. He didn’t speak for long stretches. He smiled and posed for photographs. He seemed the happiest around his former players. He would call his longtime friend Tom Campbell, an all-Southwest Conference defensive back from the 1960s, and say, “What are you up to?” That always meant, “Let’s go drink a beer.”

As her husband’s memory wore thin, Edith did not hide him. Instead, she organized his 85th birthday party and invited all of his former players. Quarterback James Street, who engineered the famous 15-14 comeback against Arkansas in 1969, sat by Royal’s side and helped him remember faces and names. The players hugged their coach, then turned away to hide the tears.

In the spring of 2010, I was invited to the annual Mexican lunch for Royal attended by about 75 of his former players. A handful of them were designated to stand up and tell Royal what he meant to them. Royal smiled through each speech as his eyes twinkled. I was mesmerized by a story the former defensive tackle Jerrel Bolton told. He recalled that Royal had supported him after the murder of his wife some 30 year earlier.

“Coach, you told me it was like a big cut on my arm, that the scab would heal, but that the wound would always come back,” Bolton said. “It always did.”

Royal seemed to drink it all in. But everyone knew his mind would soon dim.

The last time I saw him was June 20 at the County Line, a barbecue restaurant next to Bull Creek in Austin. Because Royal hated wheelchairs and walkers, the former Longhorn Mike Campbell, Tom’s twin, and I helped him down the stairs by wrapping our arms around his waist and gripping the back of his belt. I ordered his lunch, fed him his sandwich and cleaned his face with a napkin. He looked at me and said, “Was I a college player in the 1960s?”

“No, Coach,” I said. “But you were a great player for the Oklahoma Sooners in the late 1940s. You quarterbacked Oklahoma to an 11-0 record and the Sooners’ first national championship in 1949.”

He smiled and said, “Well, I’ll be doggone.”

After lunch, Mike Campbell and I carried him up the stairs. We sat him on a bench outside as Tom Campbell fetched the car. In that moment, the lunch crowd began to spill out of the restaurant. About 20 customers recognized Royal. They took his photograph with camera phones. Royal smiled and welcomed the hugs.

“He didn’t remember a thing about it,” Tom Campbell said later. “But it did his heart a whole lot of good.”

Jim Dent is the author of “The Junction Boys” and eight other books.

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Mind Faded, Darrell Royal’s Wisdom and Humor Intact Till End

Three days before his death last week at 88, Darrell Royal told his wife, Edith: “We need to go back to Hollis” — in Oklahoma. “Uncle Otis died.”

“Oh, Darrell,” she said, “Uncle Otis didn’t die.”

Royal, a former University of Texas football coach, chuckled and said, “Well, Uncle Otis will be glad to hear that.”

The Royal humor never faded, even as he sank deeper into Alzheimer’s disease. The last three years, I came to understand this as well as anyone. We had known each other for more than 40 years. In the 1970s, Royal was a virile, driven, demanding man with a chip on his shoulder bigger than Bevo, the Longhorns mascot. He rarely raised his voice to players. “But we were scared to death of him,” the former quarterback Bill Bradley said.

Royal won 3 national championships and 167 games before retiring at 52. He was a giant in college football, having stood shoulder to shoulder with the Alabama coach Bear Bryant. Royal’s Longhorns defeated one of Bryant’s greatest teams, with Joe Namath at quarterback, in the 1965 Orange Bowl. Royal went 3-0-1 in games against Bryant.

Royal and I were reunited in the spring of 2010. I barely recognized him. The swagger was gone. His mind had faded. Often he stared aimlessly across the room. I scheduled an interview with him for my book “Courage Beyond the Game: The Freddie Steinmark Story.” Still, I worried that his withering mind could no longer conjure up images of Steinmark, the undersize safety who started 21 straight winning games for the Longhorns in the late 1960s. Steinmark later developed bone cancer that robbed him of his left leg.

When I met with Royal and his wife, I quickly learned that his long-term memory was as clear as a church bell. For two hours, Royal took me back to Steinmark’s recruiting trip to Austin in 1967, through the Big Shootout against Arkansas in 1969, to the moment President Richard M. Nixon handed him the national championship trophy in the cramped locker room in Fayetteville. He recalled the day at M. D. Anderson Hospital in Houston the next week when doctors informed Steinmark that his leg would be amputated if a biopsy revealed cancer. Royal never forgot the determined expression on Steinmark’s face, nor the bravery in his heart.

The next morning, Royal paced the crowded waiting room floor and said: “This just can’t be happening to a good kid like Freddie Steinmark. This just can’t be happening.”

With the love of his coach, Steinmark rose to meet the misfortune. Nineteen days after the amputation, he stood with crutches on the sideline at the Cotton Bowl for the Notre Dame game. After the Longhorns defeated the Fighting Irish, Royal tearfully presented the game ball to Steinmark.

Four decades later, while researching the Steinmark book, I became close to Royal again. As I was leaving his condominium the day of the interview, I said, “Coach, do you still remember me?” He smiled and said, “Now, Jim Dent, how could I ever forget you?” My sense of self-importance lasted about three seconds. Royal chuckled. He pointed across the room to the message board next to the front door that read, “Jim Dent appt. at 10 a.m.”

Edith and his assistant, Colleen Kieke, read parts of my book to him. One day, Royal told me, “It’s really a great book.” But I can’t be certain how much he knew of the story.

Like others, I was troubled to see Royal’s memory loss. He didn’t speak for long stretches. He smiled and posed for photographs. He seemed the happiest around his former players. He would call his longtime friend Tom Campbell, an all-Southwest Conference defensive back from the 1960s, and say, “What are you up to?” That always meant, “Let’s go drink a beer.”

As her husband’s memory wore thin, Edith did not hide him. Instead, she organized his 85th birthday party and invited all of his former players. Quarterback James Street, who engineered the famous 15-14 comeback against Arkansas in 1969, sat by Royal’s side and helped him remember faces and names. The players hugged their coach, then turned away to hide the tears.

In the spring of 2010, I was invited to the annual Mexican lunch for Royal attended by about 75 of his former players. A handful of them were designated to stand up and tell Royal what he meant to them. Royal smiled through each speech as his eyes twinkled. I was mesmerized by a story the former defensive tackle Jerrel Bolton told. He recalled that Royal had supported him after the murder of his wife some 30 year earlier.

“Coach, you told me it was like a big cut on my arm, that the scab would heal, but that the wound would always come back,” Bolton said. “It always did.”

Royal seemed to drink it all in. But everyone knew his mind would soon dim.

The last time I saw him was June 20 at the County Line, a barbecue restaurant next to Bull Creek in Austin. Because Royal hated wheelchairs and walkers, the former Longhorn Mike Campbell, Tom’s twin, and I helped him down the stairs by wrapping our arms around his waist and gripping the back of his belt. I ordered his lunch, fed him his sandwich and cleaned his face with a napkin. He looked at me and said, “Was I a college player in the 1960s?”

“No, Coach,” I said. “But you were a great player for the Oklahoma Sooners in the late 1940s. You quarterbacked Oklahoma to an 11-0 record and the Sooners’ first national championship in 1949.”

He smiled and said, “Well, I’ll be doggone.”

After lunch, Mike Campbell and I carried him up the stairs. We sat him on a bench outside as Tom Campbell fetched the car. In that moment, the lunch crowd began to spill out of the restaurant. About 20 customers recognized Royal. They took his photograph with camera phones. Royal smiled and welcomed the hugs.

“He didn’t remember a thing about it,” Tom Campbell said later. “But it did his heart a whole lot of good.”

Jim Dent is the author of “The Junction Boys” and eight other books.

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Cultural Studies: Hurricane Sandy Reveals a Life Unplugged

BLANK screens. Cellphones on the fritz. Wii games sitting dormant in darkened rec rooms. For a swath of teenagers and preteens on the East Coast, the power failures that followed Hurricane Sandy last month represented the first time in their young lives that they were totally off the grid, without the ability to text, play Minecraft, video-chat, check Facebook, or send updates to Twitter.

If they wanted to talk to a friend, they had to do it in person. If their first post-storm instincts were to check a weather app, they resigned themselves to battery-run radios.

As the full scope of the storm’s damage became obvious, it was clear these inconveniences were hardly grave. And because most children, and adults, eventually found some kind of connection via an unaffected neighbor (or Starbucks), the withdrawal was often more of a tech diet than a total fast.

But the storm provided a rare glimpse of a life lived offline. It drove some children crazy, while others managed to embrace the experience of a digital slowdown. It also produced some unexpected ammunition for parents already eager to curb the digital obsessions of their children.

Early this year, when Michelle Obama revealed rather draconian rules about technology for her daughters (no TV, cellphones or computers during the week except for homework), Pam Abel Davis of South Orange, N.J., used the news to threaten her tech-addled children with Obama-esque regulations. “My son in first grade signed a pledge for ‘TV turnoff’ during the week to win a gold medal,” said Ms. Davis, a senior program officer at the Robin Hood Foundation. “But it was too much. He said, ‘Mom, let’s just go for the silver.’ ”

The storm hit Ms. Davis’s neighborhood hard but spared her home, which became a charging station for friends of her daughter, Lucy Reynal, 13. Then last Sunday, electricity was shut off while fallen trees were cleared from the road, and within minutes the house emptied out, no longer useful to the teenage power vultures.

“Lucy almost had a heart attack when the Wi-Fi went down, until she saw pictures of the devastation all around us,” Ms. Davis said. “I had just bought a hand-cranked phone charger, thinking it would be a kitschy Hanukkah gift. We were winding it ferociously, sweating and running out of breath.”

Hegemony over the car adapter that provided precious power resembled a scene from “Lord of the Flies,” according to Gail Horwood of Scarsdale, N.Y., an executive at a consumer health care company. Bridget, 15, and Lila, 11, unearthed every ancient defunct flip phone in the family’s past and tried to arrange sleepovers where they could recharge. There was a throwback moment: Lila had to study for a test of state capitals, so as the lights were flickering just before the blackout, she found a childhood jigsaw puzzle of the United States. But any resourceful return to old-school methods were not expected to last.

“Not a chance,” Ms. Horwood said. “It’s a digital world, and they live in it.”

The Zanders of South Salem, N.Y., experienced a blackout last year, “so we’re getting good at the 1800s in our house,” said Lauren Handel Zander, who runs an executive life-coaching company. Her three children “live for Mommy’s iPad,” she said, likening the first days of the blackout to rehab. “It’s like coming off drugs,” she said. “There’s a 48-hour withdrawal until they’re not asking about the TV every other minute.”

The Zander children did enjoy the unusual undivided attention of a working mom. “Mommy got parked,” Ms. Zander said ruefully. “I’m not as ‘on’ if my kid is attached to one of those devices. I played Clue. I haven’t played Clue in a very long time. We got to hang out more, which was an entire family adjustment, but it’s a good problem to have.”

Among the parents who spoke with pride about newfound family time when their children were forced offline, there were honest admissions about the joy-kill of too much bonding. One 10-year-old boy in Lower Manhattan sweetly told his mother, “This gives us a chance to talk.” After three hours of “and that’s why they need to ditch Sanchez and make Tebow the starter,” she was silently pleading for someone to turn the power on.

“For the first three days, I was full of maternal pride,” said Marjorie Ingall, a writer in the East Village. “’Look at my children: reading by candlelight, cutting out paper dolls, engaged in such brilliant imaginative play. We are so ‘Little House on the Prairie.’ Then Day 3 hit and the charm of screenless togetherness wore off. I was genuinely concerned that we were all going to kill each other.”

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Changing of the Guard: Chinese Communist Party Faces Calls for Democracy

BEIJING — As the Communist Party’s 18th Congress approached, Li Weidong, a scholar of politics, made plans to observe a historic leadership battle in one of the world’s great nations.

Instead of staying in Beijing to monitor China’s once-a-decade transfer of power, Mr. Li boarded a plane.

“I’m going to the United States to study the elections,” Mr. Li said in a telephone interview during a stopover in Paris. After witnessing the American presidential election on Tuesday, Mr. Li went on the radio for another interview. “I still think China’s politics remain prehistoric,” he said. “I often joke that the Chinese civilization is the last prehistoric civilization left in the world.”

With China at a critical juncture, there is a rising chorus within the elite expressing doubt that the 91-year-old Communist Party’s authoritarian system can deal with the stresses bearing down on the nation and its 1.3 billion people. Policies introduced after 1978 by Deng Xiaoping lifted hundreds of millions out of poverty and transformed the country into the world’s second-largest economy. But the way party leaders have managed decades of growth has created towering problems that critics say can no longer be avoided.

Many of those critics have benefited from China’s stunning economic gains, and their ranks include billionaires, intellectuals and children of the party’s revolutionary founders. But they say the party’s agenda, as it stands today, is not visionary enough to set China on the path to stability. What is needed, they say, is a comprehensive strategy to gradually extricate the Communist Party, which has more than 80 million members, from its heavy-handed control of the economy, the courts, the news media, the military, educational institutions, civic life and just the plain day-to-day affairs of citizens.

Only then, the critics argue, can the government start to address the array of issues facing China, including rampant corruption, environmental degradation, and an aging population whose demographics have been skewed because of the one-child policy.

“In order to build a real market economy, we have to have real political reform,” said Yang Jisheng, a veteran journalist and a leading historian of the Mao era. “In the next years, we should have a constitutional democracy plus a market economy.”

For now, however, party leaders have given no indication that they intend to curb their role in government in a meaningful way.

“We will never copy a Western political system,” Hu Jintao, the departing party chief, said in a speech on Thursday opening the weeklong congress.

The party’s public agenda, which Mr. Hu described in detail in his 100-minute address, was laid out in a 64-page report that is in part intended to highlight priorities for the new leaders, who will be announced later this month. Much of the document had retrograde language that emphasized ideology stretching back to Mao and had little in the way of bold or creative thinking, said Qian Gang, the director of the China Media Project at the University of Hong Kong.

Most telling, there was no language signaling that the incoming Politburo Standing Committee, the group that rules China by consensus, would support major changes in the political system, whose perversions many now say are driving the nation toward crisis.

While Chinese who are critical of the current system generally do not expect a wholesale adoption of a Western model, they do favor at least an openness to bolder experimentation.

“To break one-party rule right now is probably not realistic, but we can have factions within the party made public and legalized, so they can campaign against each other,” said Mr. Yang, who added that there was no other way at the moment to ensure political accountability.

Only in the last few years has the idea of liberalizing the political system gained currency, and urgency, among a broad cross-section of elites. Before that, as the West foundered at the onset of the global financial crisis, many here pointed to the triumph of a “China model” or “Beijing consensus” — a mix of authoritarian politics, a command economy and quasi-market policies.

But the way in which China weathered the crisis — with the injection of $588 billion of stimulus money into the economy and an explosion of lending from state banks — led to a spate of large infrastructure projects that may never justify their cost. As a result, many economists now say that China’s investment-driven, export-oriented economic model is unsustainable and needs to shift toward greater reliance on Chinese consumers.

Constant lip-service is paid to that goal, and on Saturday, Zhang Ping, a senior official, reiterated that stance. But it will not be easy for the new leaders to carry it out. At the root of the current economic model is the political system, in which party officials and state-owned enterprises work closely together, reaping enormous profits from the party’s control of the economy. Under Mr. Hu’s decade-long tenure, these relationships and the dominance of state enterprises have only strengthened.

“What happens in this kind of economy is that wealth concentrates where power is,” said Mr. Yang, the journalist.

The 400 or so incoming members of the party’s Central Committee, Politburo and Politburo Standing Committee, as well as their friends and families, have close ties to the most powerful of China’s 145,000 state-owned enterprises. The growing presence of princelings — the children of notable Communist officials — in the party, the government and corporations could mean an even more closely meshed web of nepotism. It is a system that Xi Jinping, anointed to be the next party chief and president and himself a member of the “red nobility,” would find hard to unravel, even if he wanted to.

Mia Li contributed research.

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Obama Says Vote Validates His Efforts on Taxes

WASHINGTON — President Obama said Friday that he would insist that tax increases on affluent Americans be part of any agreement to avoid a year-end fiscal crisis, setting up a possible confrontation with Congressional Republicans who say they will oppose a rise in tax rates for the rich.

In his first remarks from the White House since his re-election, Mr. Obama made it clear that he believed his victory had validated his relentless campaign call for wealthier Americans to pay more and that he expected Republicans to heed that message.

“I just want to point out this was a central question during the election,” he said in brief remarks in the East Room. “It was debated over and over again. And on Tuesday night, we found out that the majority of Americans agree with my approach.”

Mr. Obama said he had invited Congressional leaders to the White House next week to begin talks as they return for a lame-duck session of Congress. He said he was willing to make some concessions as long as the final fiscal bargain was properly balanced between new tax revenue and spending cuts.

“I’m not wedded to every detail of my plan,” Mr. Obama said. “I’m open to compromise.”

At the same time, he encouraged Congress to quickly pass an extension of the existing lower rates for those making under $250,000 even while the broader negotiations take place.

“While there may be disagreement in Congress over whether or not to raise taxes on folks making over $250,000 a year, nobody — not Republicans, not Democrats — want taxes to go up for folks making under $250,000 a year,” he said. “So let’s not wait.”

The president’s comments came shortly after Speaker John A. Boehner, who had been striking a conciliatory tone since Republican election losses in the Senate and the House, told reporters that Republicans had won a mandate of their own by retaining control of the House and that he supported continuing rates enacted in the Bush-era tax cuts for all income levels.

“Raising tax rates will slow down our ability to create the jobs that everyone says they want,” said Mr. Boehner, who said he favored generating any new federal revenue to offset the deficit by closing tax loopholes and limiting deductions.

“It’s clear that there are a lot of special interest loopholes in the tax code, both corporate and personal,” he said. “It’s also clear that there are all kinds of deductions, some of which make sense; others don’t. And by lowering rates and cleaning up the tax code, we know we’re going to get more economic growth.”

The president and Mr. Boehner were careful with their language and left room for compromise despite their fundamental differences about shifting more of the tax burden to high-income Americans. Mr. Boehner would not be very specific on what his goal might be for raising new federal tax dollars.

“I don’t want to box myself in,” he said. “I don’t want to box anybody else in. I think it’s important for us to come to an agreement with the president. But this is his opportunity to lead.”

The speaker, who has struggled with his more conservative rank and file in the past, said he was confident that he could pass a deal if one was reached with the White House. “When the president and I have been able to come to an agreement, there has been no problem getting it passed here in the House,” he said.

House Republican leadership aides found some positive signals in Mr. Obama’s combative tone. They noted that he never specified he wants tax rates to rise, only that he wants additional revenues generated by taxes on the rich. That would give both sides the latitude to devise a restructured tax code that eliminates or limits tax deductions and credits for the rich — or that follows Mitt Romney’s proposal to cap deductions at a set limit for rich households, though many analysts say that approach alone cannot raise the revenue Democrats want.

Any agreement to avert a fiscal crisis in January, when hundreds of billions of dollars in automatic tax increases and spending cuts kick in, now revolves around the definition of tax increases. Mr. Boehner is holding the line against any increase in tax rates, even for the richest Americans, who currently are in the 35 percent tax bracket. But he is leaving open the possibility of a tax overhaul that raises more revenue than the existing code.

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The New Old Age Blog: More Time to Enroll in Medicare If You Live in Storm Areas

Medicare beneficiaries battered by Hurricane Sandy have one fewer problem to worry about: Federal officials have extended the Dec. 7 deadline to enroll in a private medical or drug plan for next year for those still coping with storm damage.

The Centers for Medicare and Medicaid Services “understands that many Medicare beneficiaries have been affected by this disaster and wants to ensure that all beneficiaries are able to compare their options and make enrollment choices for 2013,” Arrah Tabe-Bedward, acting director for the Medicare Enrollment and Appeals Group, wrote in a Nov. 7 letter to health insurance companies and state health insurance assistance programs.

Beneficiaries hit by the storm can still enroll after the Dec. 7 midnight deadline if they call Medicare’s 24-hour information line: 1-800-MEDICARE (1-800-633-4227). Representatives will be able to review available plans and complete the enrollment process over the phone.

“We are committed to giving people with Medicare the information and the time they need to make important decisions about their coverage,” a Medicare spokeswoman, Isabella Leung, said in an e-mail message. Medicare officials have not set a new deadline but have encouraged beneficiaries to make their decisions soon if possible.

People currently in a plan will be automatically re-enrolled for next year in the same plan.

The extra time also applies to any beneficiaries who normally get help from family members or others to sort through dozens of plans, but who have been unable to do so this year because they live in areas affected by the storm. Neither beneficiaries nor those who provide them assistance will be required to prove that they experienced storm damage.

“This is a really important recognition by CMS to accommodate Medicare enrollees affected by Hurricane Sandy,” said Leslie Fried, director for policy and programs at the National Council on Aging, an advocacy group in Washington.

After the hurricane, the Obama administration declared Connecticut, New Jersey, New York and Rhode Island “major disaster areas,” according to the Federal Emergency Management Agency. In addition, FEMA issued emergency declarations for parts of Delaware, the District of Columbia, Maryland, Massachusetts, New Hampshire, Pennsylvania, Virginia and West Virginia.

More than four million older people in those states are enrolled in drugs-only plans, and more than 2.8 million have Medicare Advantage policies, which includes medical and drug coverage.

Susan Jaffe is a writer for Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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The New Old Age Blog: More Time to Enroll in Medicare If You Live in Storm Areas

Medicare beneficiaries battered by Hurricane Sandy have one fewer problem to worry about: Federal officials have extended the Dec. 7 deadline to enroll in a private medical or drug plan for next year for those still coping with storm damage.

The Centers for Medicare and Medicaid Services “understands that many Medicare beneficiaries have been affected by this disaster and wants to ensure that all beneficiaries are able to compare their options and make enrollment choices for 2013,” Arrah Tabe-Bedward, acting director for the Medicare Enrollment and Appeals Group, wrote in a Nov. 7 letter to health insurance companies and state health insurance assistance programs.

Beneficiaries hit by the storm can still enroll after the Dec. 7 midnight deadline if they call Medicare’s 24-hour information line: 1-800-MEDICARE (1-800-633-4227). Representatives will be able to review available plans and complete the enrollment process over the phone.

“We are committed to giving people with Medicare the information and the time they need to make important decisions about their coverage,” a Medicare spokeswoman, Isabella Leung, said in an e-mail message. Medicare officials have not set a new deadline but have encouraged beneficiaries to make their decisions soon if possible.

People currently in a plan will be automatically re-enrolled for next year in the same plan.

The extra time also applies to any beneficiaries who normally get help from family members or others to sort through dozens of plans, but who have been unable to do so this year because they live in areas affected by the storm. Neither beneficiaries nor those who provide them assistance will be required to prove that they experienced storm damage.

“This is a really important recognition by CMS to accommodate Medicare enrollees affected by Hurricane Sandy,” said Leslie Fried, director for policy and programs at the National Council on Aging, an advocacy group in Washington.

After the hurricane, the Obama administration declared Connecticut, New Jersey, New York and Rhode Island “major disaster areas,” according to the Federal Emergency Management Agency. In addition, FEMA issued emergency declarations for parts of Delaware, the District of Columbia, Maryland, Massachusetts, New Hampshire, Pennsylvania, Virginia and West Virginia.

More than four million older people in those states are enrolled in drugs-only plans, and more than 2.8 million have Medicare Advantage policies, which includes medical and drug coverage.

Susan Jaffe is a writer for Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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