News Analysis: Getting Polio Campaigns Back on Track

How in the world did something as innocuous as the sugary pink polio vaccine turn into a flash point between Islamic militants and Western “crusaders,” flaring into a confrontation so ugly that teenage girls — whose only “offense” is that they are protecting children — are gunned down in the streets?

Nine vaccine workers were killed in Pakistan last week in a terrorist campaign that brought the work of 225,000 vaccinators to a standstill. Suspicion fell immediately on factions of the Pakistani Taliban that have threatened vaccinators in the past, accusing them of being American spies.

Polio eradication officials have promised to regroup and try again. But first they must persuade the killers to stop shooting workers and even guarantee safe passage.

That has been done before, notably in Afghanistan in 2007, when Mullah Muhammad Omar, spiritual head of the Afghan Taliban, signed a letter of protection for vaccination teams. But in Pakistan, the killers may be breakaway groups following no one’s rules.

Vaccination efforts are also under threat in other Muslim regions, although not this violently yet.

In Nigeria, another polio-endemic country, the new Islamic militant group Boko Haram has publicly opposed it, although the only killings that the news media have linked to polio were those of two police officers escorting vaccine workers. Boko Haram has killed police officers on other missions, unrelated to polio vaccinations.

In Mali, extremists took over half of the country in May, declaring an Islamic state. Vaccination is not an issue yet, but Mali had polio cases as recently as mid-2011, and the virus sometimes circulates undetected.

Resistance to polio vaccine springs from a combination of fear, often in marginalized ethnic groups, and brutal historical facts that make that fear seem justified. Unless it is countered, and quickly, the backlash threatens the effort to eradicate polio in the three countries where it remains endemic: Pakistan, Afghanistan and Nigeria.

In 1988, long before donors began delivering mosquito nets, measles shots, AIDS pills, condoms, deworming drugs and other Western medical goods to the world’s most remote villages, Rotary International dedicated itself to wiping out polio, and trained teams to deliver the vaccine.

But remote villages are often ruled by chiefs or warlords who are suspicious not only of Western modernity, but of their own governments.

The Nigerian government is currently dominated by Christian Yorubas. More than a decade ago, when word came from the capital that all children must swallow pink drops to protect them against paralysis, Muslim Hausas in the far-off north could be forgiven for reacting the way the fundamentalist Americans of the John Birch Society did in the 1960s when the government in far-off Washington decreed that, for the sake of children’s teeth, all drinking water should have fluoride.

The northerners already had grievances. In 1996, the drug company Pfizer tested its new antibiotic, Trovan, during a meningitis outbreak there. Eleven children died. Although Pfizer still says it was not to blame, the trial had irregularities, and last year the company began making payments to victims.

Other rumors also spring from real events.

In Pakistan, resistance to vaccination, low over all, is concentrated in Pashtun territory along the Afghan border and in Pashtun slums in large cities. Pashtuns are the dominant tribe in Afghanistan but a minority in Pakistan among Punjabis, Sindhis, Baluchis and other ethnic groups. Many are Afghan refugees and are often poor and dismissed as medieval and lawless.

Pakistan’s government is friendly with the United States while the Pashtuns’ territory in border areas has been heavily hit by American Taliban-hunting drones, which sometimes kill whole families.

So, when the Central Intelligence Agency admitted sponsoring a hepatitis vaccination campaign as a ruse to get into a compound in Pakistan to confirm that Osama bin Laden was there, and the White House said it had contemplated wiping out the residence with a drone missile, it was not far-fetched for Taliban leaders to assume that other vaccinators worked for the drone pilots.

Even in friendly areas, the vaccine teams have protocols that look plenty suspicious. If a stranger knocked on a door in Brooklyn, asked how many children under age 5 were at home, offered to medicate them, and then scribbled in chalk on the door how many had accepted and how many refused — well, a parent might worry.

In modern medical surveys — though not necessarily on polio campaigns — teams carry GPS devices so they can find houses again. Drones use GPS coordinates.

The warlords of Waziristan made the connection specific, barring all vaccination there until Predator drones disappeared from the skies.

Dr. Bruce Aylward, a Canadian who is chief of polio eradication for the World Health Organization, expressed his frustration at the time, saying, “They know we don’t have any control over drone strikes.”

The campaign went on elsewhere in Pakistan — until last week.

The fight against polio has been hampered by rumors that the vaccine contains pork or the virus that causes AIDS, or is a plot to sterilize Muslim girls. Even the craziest-sounding rumors have roots in reality.

The AIDS rumor is a direct descendant of Edward Hooper’s 1999 book, “The River,” which posited the theory — since discredited — that H.I.V. emerged when an early polio vaccine supposedly grown in chimpanzee kidney cells contaminated with the simian immunodeficiency virus was tested in the Belgian Congo.

The sterilization claim was allegedly first made on a Nigerian radio station by a Muslim doctor upset that he had been passed over for a government job. The “proof” was supposed to be lab tests showing it contained estrogen, a birth control hormone.

The vaccine virus is grown in a broth of live cells; fetal calf cells are typical. They may be treated with a minute amount of a digestive enzyme, trypsin — one source of which is pig pancreas, which could account for the pork rumor.

In theory, a polio eradicator explained, if a good enough lab tested the vaccine used at the time the rumor started, it might have detected estrogen from the calf’s mother, but it would have been far less estrogen than is in mother’s milk, which is not accused of sterilizing anyone. The trypsin is supposed to be washed out.

In any case, polio vaccine is now bought only from Muslim countries like Indonesia, and Muslim scholars have ruled it halal — the Islamic equivalent of kosher.

Reviving the campaign will mean quelling many rumors. It may also require adding other medical “inducements,” like deworming medicine, mosquito nets or vitamin A, whose immediate benefits are usually more obvious.

But changing mind-sets will be a crucial step, said Dr. Aylward, who likened the shootings of the girls to those of the schoolchildren in Newtown, Conn.

More police involvement — what he called a “bunkerized approach” — would not solve either America’s problem or Pakistan’s, he argued. Instead, average citizens in both countries needed to rise up, reject the twisted thinking of the killers and “generate an understanding in the community that this kind of behavior is not acceptable.”

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News Analysis: Getting Polio Campaigns Back on Track

How in the world did something as innocuous as the sugary pink polio vaccine turn into a flash point between Islamic militants and Western “crusaders,” flaring into a confrontation so ugly that teenage girls — whose only “offense” is that they are protecting children — are gunned down in the streets?

Nine vaccine workers were killed in Pakistan last week in a terrorist campaign that brought the work of 225,000 vaccinators to a standstill. Suspicion fell immediately on factions of the Pakistani Taliban that have threatened vaccinators in the past, accusing them of being American spies.

Polio eradication officials have promised to regroup and try again. But first they must persuade the killers to stop shooting workers and even guarantee safe passage.

That has been done before, notably in Afghanistan in 2007, when Mullah Muhammad Omar, spiritual head of the Afghan Taliban, signed a letter of protection for vaccination teams. But in Pakistan, the killers may be breakaway groups following no one’s rules.

Vaccination efforts are also under threat in other Muslim regions, although not this violently yet.

In Nigeria, another polio-endemic country, the new Islamic militant group Boko Haram has publicly opposed it, although the only killings that the news media have linked to polio were those of two police officers escorting vaccine workers. Boko Haram has killed police officers on other missions, unrelated to polio vaccinations.

In Mali, extremists took over half of the country in May, declaring an Islamic state. Vaccination is not an issue yet, but Mali had polio cases as recently as mid-2011, and the virus sometimes circulates undetected.

Resistance to polio vaccine springs from a combination of fear, often in marginalized ethnic groups, and brutal historical facts that make that fear seem justified. Unless it is countered, and quickly, the backlash threatens the effort to eradicate polio in the three countries where it remains endemic: Pakistan, Afghanistan and Nigeria.

In 1988, long before donors began delivering mosquito nets, measles shots, AIDS pills, condoms, deworming drugs and other Western medical goods to the world’s most remote villages, Rotary International dedicated itself to wiping out polio, and trained teams to deliver the vaccine.

But remote villages are often ruled by chiefs or warlords who are suspicious not only of Western modernity, but of their own governments.

The Nigerian government is currently dominated by Christian Yorubas. More than a decade ago, when word came from the capital that all children must swallow pink drops to protect them against paralysis, Muslim Hausas in the far-off north could be forgiven for reacting the way the fundamentalist Americans of the John Birch Society did in the 1960s when the government in far-off Washington decreed that, for the sake of children’s teeth, all drinking water should have fluoride.

The northerners already had grievances. In 1996, the drug company Pfizer tested its new antibiotic, Trovan, during a meningitis outbreak there. Eleven children died. Although Pfizer still says it was not to blame, the trial had irregularities, and last year the company began making payments to victims.

Other rumors also spring from real events.

In Pakistan, resistance to vaccination, low over all, is concentrated in Pashtun territory along the Afghan border and in Pashtun slums in large cities. Pashtuns are the dominant tribe in Afghanistan but a minority in Pakistan among Punjabis, Sindhis, Baluchis and other ethnic groups. Many are Afghan refugees and are often poor and dismissed as medieval and lawless.

Pakistan’s government is friendly with the United States while the Pashtuns’ territory in border areas has been heavily hit by American Taliban-hunting drones, which sometimes kill whole families.

So, when the Central Intelligence Agency admitted sponsoring a hepatitis vaccination campaign as a ruse to get into a compound in Pakistan to confirm that Osama bin Laden was there, and the White House said it had contemplated wiping out the residence with a drone missile, it was not far-fetched for Taliban leaders to assume that other vaccinators worked for the drone pilots.

Even in friendly areas, the vaccine teams have protocols that look plenty suspicious. If a stranger knocked on a door in Brooklyn, asked how many children under age 5 were at home, offered to medicate them, and then scribbled in chalk on the door how many had accepted and how many refused — well, a parent might worry.

In modern medical surveys — though not necessarily on polio campaigns — teams carry GPS devices so they can find houses again. Drones use GPS coordinates.

The warlords of Waziristan made the connection specific, barring all vaccination there until Predator drones disappeared from the skies.

Dr. Bruce Aylward, a Canadian who is chief of polio eradication for the World Health Organization, expressed his frustration at the time, saying, “They know we don’t have any control over drone strikes.”

The campaign went on elsewhere in Pakistan — until last week.

The fight against polio has been hampered by rumors that the vaccine contains pork or the virus that causes AIDS, or is a plot to sterilize Muslim girls. Even the craziest-sounding rumors have roots in reality.

The AIDS rumor is a direct descendant of Edward Hooper’s 1999 book, “The River,” which posited the theory — since discredited — that H.I.V. emerged when an early polio vaccine supposedly grown in chimpanzee kidney cells contaminated with the simian immunodeficiency virus was tested in the Belgian Congo.

The sterilization claim was allegedly first made on a Nigerian radio station by a Muslim doctor upset that he had been passed over for a government job. The “proof” was supposed to be lab tests showing it contained estrogen, a birth control hormone.

The vaccine virus is grown in a broth of live cells; fetal calf cells are typical. They may be treated with a minute amount of a digestive enzyme, trypsin — one source of which is pig pancreas, which could account for the pork rumor.

In theory, a polio eradicator explained, if a good enough lab tested the vaccine used at the time the rumor started, it might have detected estrogen from the calf’s mother, but it would have been far less estrogen than is in mother’s milk, which is not accused of sterilizing anyone. The trypsin is supposed to be washed out.

In any case, polio vaccine is now bought only from Muslim countries like Indonesia, and Muslim scholars have ruled it halal — the Islamic equivalent of kosher.

Reviving the campaign will mean quelling many rumors. It may also require adding other medical “inducements,” like deworming medicine, mosquito nets or vitamin A, whose immediate benefits are usually more obvious.

But changing mind-sets will be a crucial step, said Dr. Aylward, who likened the shootings of the girls to those of the schoolchildren in Newtown, Conn.

More police involvement — what he called a “bunkerized approach” — would not solve either America’s problem or Pakistan’s, he argued. Instead, average citizens in both countries needed to rise up, reject the twisted thinking of the killers and “generate an understanding in the community that this kind of behavior is not acceptable.”

Read More..

As Envoy Meets Syria’s Assad, Russia Signals New Pessimism

BEIRUT, Lebanon — Lakhdar Brahimi, the special envoy seeking an end to the Syria crisis, held an urgent meeting with President Bashar al-Assad in Damascus on Monday as new signs emerged that Mr. Assad’s grip on power was weakening and that Russia, his most important foreign backer, was moving forward with efforts to evacuate Russian diplomats and other expatriates from the country.

Mr. Brahimi, the Algerian statesman who has been the special Syria representative for the United Nations and Arab League for the past three months, did not specify the substance or tone of his discussion with Mr. Assad, describing it only in general terms in brief remarks afterward.

“The president expressed his view regarding the current situation and I briefed him on the meetings I had in several capitals with officials from different countries inside and outside the region,” Mr. Brahimi told reporters, according to an account posted on the United Nations’s Web site. “I also told him about the steps that in my view need to be taken to help the Syrian people find a way out of this crisis.”

But one member of Syria’s political opposition who said he had spoken with Mr. Brahimi’s aides said the envoy had advocated a plan for a negotiated solution first proposed in June. The opposition member, Mohamed Sarmini, said the proposal would temporarily leave Mr. Assad in power but curb his authority and create a transitional government that would theoretically remove Mr. Assad from power later — an arrangement that some members of the opposition had previously rejected as inadequate.

Another prominent opposition member, who requested anonymity because of the delicacy of the talks, said he understood that Mr. Brahimi had been intending to deliver a “final warning” to Mr. Assad. “This is a final proposal for Bashar to leave with his team, especially his military and intelligence officials,” said the opposition member, who was not in Syria.

The official Syrian state news agency, SANA, said nothing about the specifics of what was discussed at the meeting, but that Mr. Assad had “stressed the Syrian government’s keenness” to pursue efforts that “preserve the sovereignty and independence of the homeland.”

Mr. Brahimi was scheduled to meet with opposition members in Damascus on Tuesday, according to Hassan Abdel Azim, a longtime domestic dissident who  took a favorable view of the envoy’s visit, reflecting the splits within the opposition movement and especially between exile and domestic opponents.

“We are going to listen first to his proposals.  We support the Brahimi initiative, and we don’t say it has failed at all," he said.  "Our priority for the time being is breaking the circle of violence, and transforming the solution to the crisis from military to political.”

Mr. Brahimi arrived in Damascus on Sunday as new mayhem gripped the country. His entourage was forced to drive in from Lebanon instead of flying because of insurgent threats to attack commercial traffic at the Damascus airport.

Some of the worst violence appeared to be in the town of Halfaya, in west-central Syria, where activists reported that dozens of people had been killed when a Syrian warplane dropped bombs on a bakery.

The attack, and the number of casualties, could not be immediately confirmed. A local activist said he ran to the bakery soon after he heard a warplane followed by explosions and the sound of ambulances. “There were bodies everywhere,” said the activist, who gave his name as Samer.

Photographs he took after the attack showed bodies in a heap on a bloody sidewalk outside a low-slung, heavily damaged building.

The Syrian Observatory for Human Rights, a Britain-based anti-Assad group with a network of contacts inside Syria, said Monday that it had collected the names of 43 victims, and that 15 more were unidentified.  All but three of the victims were men, the group said.

The reasons for the attack were unclear, but activists speculated that it was a government response to the arrival of rebel fighters in Halfaya. The rebels occupied the town last week after embarking on a broad offensive to seize territory around the city of Hama, where the government has kept tight control after suppressing protests in the city last year. In several days of fighting, civilians have been caught between the warring sides, a volatile development in a part of the country where members of Syria’s many sects live among one another in neighboring villages.

Human rights groups have accused the government of indiscriminate attacks on or near bakeries in the past, especially in the northern city of Aleppo. In a three-week period in the summer, Human Rights Watch documented 10 separate bombings on bakeries in the city.

Top Russian diplomats said that Mr. Brahimi, perhaps trying to broker a deal that would help ease Mr. Assad out, may visit Russia as soon as this week. Russian officials have sought to distance themselves from Mr. Assad in recent weeks as the nearly two-year-old conflict in Syria has worsened, although they still strongly oppose military intervention in favor of a negotiated transition. Some Russian expatriates working in Syria were abducted earlier this month.

Russian security officials were quoted in Monday’s edition of Kommersant, a Russian daily newspaper, as saying that diplomats in Damascus would be evacuated with the help of special forces, if necessary. Authorities are also prepared to dispatch 100 officers from a special armed unit of Russia’s foreign intelligence service, called “Screen,” which was last used to evacuate Russian diplomats from Baghdad in 2003. The newspaper quoted an intelligence source saying the officers were “ready for a transfer to Damascus, however the order from above has not been given.”

Ruslan R. Aliyev, an analyst with the Center for the Analysis of Strategy and Technologies, a defense research group based in Moscow, said renewed discussion of evacuations by Russia’s Foreign Ministry reflected what he described as Moscow’s deeply pessimistic prognosis for the region.

Russia’s foreign minister, Sergey V. Lavrov, said on Saturday that several countries in the region had offered Mr. Assad asylum, but he added that Moscow would not mediate on their behalf.

It was the third visit to Syria by Mr. Brahimi since he assumed his post in August, and it occurred as fighting grew worse in the eastern and southern suburbs of Damascus, where rebel commanders say they are trying to establish staging grounds for attacks on the capital.

West-central Syria has become the latest front in the war, with the rebels attacking government checkpoints and other positions in an effort to disrupt the military’s supply lines and to push south from opposition strongholds in northern Syria. The offensive has led to growing fears for civilians in the area.

On Friday, a group of rebel fighters posted a video in which they threatened to shell Christian villages unless residents forced government loyalists to leave. Local church leaders have pleaded for peace and an end to sectarian strife.

Kareem Fahim reported from Beirut, and Ellen Barry from Moscow. Reporting was contributed by Hwaida Saad from Beirut, Hala Droubi from Jidda, Saudi Arabia, and Rick Gladstone from New York.

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Digital Domain: Smart Parking Has a Learning Curve, Too

PLACE “smart” in front of a noun and you immediately have something that somehow sounds improved.

In its current state, however, “smart parking” is in some ways little different from regular parking. The term refers to a beguiling technology, now being tested in several cities, that uses sensors to determine whether a particular spot on the street or in a parking garage is occupied or vacant. When a car has overstayed its allotted time, the technology can also send the information to a parking enforcement officer with ticket book in hand.

The sensors’ data can also be used to adjust parking prices, using higher rates to create more turnover on the busiest blocks and lower prices to draw drivers to blocks with underused spaces.

Smart-parking technology for on-street spaces is expensive, and still in its early stages. The largest examples are pilot projects with costs covered primarily by grants from the federal Department of Transportation. In San Francisco, the SFpark pilot project uses sensors from StreetSmart Technology for 7,000 of the city’s 28,000 meters. In Los Angeles, LA Express Park has installed sensors from Streetline for 6,000 parking spots on downtown streets.

Cities are marketing the programs as experiments in using demand-based pricing to reduce traffic congestion — the kind caused by circling drivers desperately seeking parking spots — and to make more spaces available at any specific time. Drivers are encouraged to use mobile apps to check parking availability and pricing, though coverage is not universal. Parker, for example, from Streetline, gives detailed information about on-street parking for Los Angeles, but not for San Francisco.

SFpark is using “smart pricing” to achieve a target of having one parking space available most of the time in the areas it covers, says Jay Primus, the SFpark program manager. SFpark, he says, “de-emphasizes inconvenient time limits and instead uses smart pricing” to achieve those targets. The same spot, for example, may have different parking rates for different times of day. That intraday pricing is adjusted at multimonth intervals, but theoretically, it could be altered on the fly, depending on availability at any given hour.

One way to increase availability would be to use sensor technology to deter drivers from the tactic of staying parked in one place and repeatedly feeding the meter. Or a system might reset the meter automatically when a vehicle leaves a spot, so any remaining time is zeroed out. But meter resetting is “a fairly politically charged issue,” says Zia Yusuf, the C.E.O. of Streetline, and his company doesn’t provide it. (Many cities have found that midblock payment kiosks that replace individual meters solve this problem handily.)

In San Francisco, the sensor technology installed by Streetsmart Technology has been bedeviled by electromagnetic interference from overhead trolley lines. Mr. Primus says the vehicle-detection sensing is only about 90 percent accurate.

Daniel E. Mitchell, a senior transportation engineer who manages LA Express Park for the City of Los Angeles, says the accuracy of his program’s sensors has been in the mid-90 percent range, but he sees that as inadequate for automatically issuing tickets. Even if the sensors were 97 percent accurate, Mr. Mitchell says, “you’d have 3 percent of your customers experiencing a problem and that would be too many.”

Smart-parking apps aren’t as useful as might be expected for drivers seeking open spots. When a parking space is vacated, there is a short delay before a sensor’s signal moves through the wireless network, reaches the centralized system and finally arrives on a driver’s phone. But if other cars are circling, even a 30-second or one-minute wait can be too long.

As for parking enforcement, San Francisco and Los Angeles have begun to use the sensor technology to dispatch officers to cars that have stayed past their limits. That’s far more efficient that having officers roam streets in search of random meter violations.

Program officials in both cities say that they don’t yet know how many more tickets are being issued as a result of the new systems. But opportunities for “improved enforcement operations,” as a Streetline promotional video delicately refers to it, seem enormous. Mr. Yusuf says that without smart parking, “no more than 8 to 10 percent of parking payment violations are ticketed.”

AS smart parking spreads, I’ll miss the comfort of knowing that when I accidentally stay a few minutes too long in a parking spot, I may get a reprieve. After all, the enforcement officer two blocks away still has to check every meter between us before discovering my mistake.

When I shared those feelings with Mr. Yusuf, he pointed out that the technology could distinguish between those whose paid time elapsed just a few minutes previously and those who have been parked for hours. He argues that cities “want to attract more drivers to the downtown area, and it is the blatant offenders they want to target.”

Making such distinctions would be smart enforcement.

Randall Stross is an author based in Silicon Valley and a professor of business at San Jose State University. E-mail: stross@nytimes.com.

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Advertising: Selling Made in U.S.A., but Very Carefully

BRANDS reviving the “Made in the U.S.A.” slogan to attract buyers for American-produced goods are relying less on patriotism and more on data that shows consumers are willing to pay a premium for better quality, quicker availability and product safety.

But many companies are stepping gingerly, avoiding sweeping claims and spelling out what “Made in the U.S.A.” means for their products. Consumers are more shrewd about how few consumer goods actually are made in the United States, leaving companies less wiggle room about the origin of products.

The Whirlpool Corporation, for example, specified in full-page print advertisements this year that 80 percent of its appliances “sold in the U.S. come from our U.S. factories.” Despite its deep American roots, the 101-year-old company — which makes Maytag, Amana, KitchenAid and Jenn-Air products — has, like other corporate giants, moved some manufacturing abroad.

As a result of its centennial celebrations last year, some consumers have urged the company to talk more about its American origins, said William Beck, a senior marketing director at Whirlpool, which spent $57.4 million in 2011 on advertising, according to Kantar Media, a WPP unit.

In recent months, the appliance giant has been underlining its American factories, and noting in its overall brand advertising that it employs about 22,000 workers (15,000 of them at its manufacturing plants), and spends $7.4 million annually on operating and maintaining its factories in Iowa, Ohio, Oklahoma and Tennessee.

But Whirlpool, whose ad drew a full-page rebuttal from the International Association of Machinists and Aerospace Workers accusing it of shutting factories in the United States, said nostalgia and similar sentiments do not drive its sales. “Whirlpool’s key differentiating points are quality and innovation,” said Mr. Beck, and “the icing is that, hey, we’re made in the United States.”

Whirlpool does not share its market research, but other market studies show that customers increasingly take note of where a product is made. Perception Research Services International, in a September study, found that four out of five shoppers notice a “Made in the U.S.A.” label on packaging, and 76 percent of them said they would be more likely to buy a product because of the label.

While shoppers, especially those over 35, say they want to help the economy by buying United States-made goods, “the motivating factors actually may be quality and safety,” said Jonathan Asher, executive vice president of Perception Research Services. The company, which is based in Teaneck, N.J., surveyed 1,400 consumers last summer. “People are paying attention in categories that are ingested like food, medicine and personal care products, but less so in electronics, office supplies and appliances,” he said.

In a separate study, the Boston Consulting Group found that 80 percent of consumers surveyed said they would be willing to pay more for “Made in the U.S.A.” products than for those carrying a “Made in China” label.

They would pay the biggest differential for items like baby food and wooden toys, and a smaller percentage for electronics, apparel and appliances, said Kate Manfred, director of the group’s Center for Consumer and Customer Insight in the Americas, which released the study in mid-November.

“Safety and quality, and keeping jobs in America, are the important factors,” she said.

Bixbi, a Boulder, Colo., pet treat provider, has relied on safety to increase sales. The company, which started in 2008 amid revelations of tainted dog food ingredients imported from overseas, sells dog treats made from locally raised chickens and other animals.

“Our sales have grown 600 percent each year,” said James Crouch, who founded the small company with his brother, Michael. “Locally sourced is a key advantage.”

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N.Y.U. and Others Offer Shorter Courses Through Medical School

Training to become a doctor takes so long that just the time invested has become, to many, emblematic of the gravity and prestige of the profession.

But now one of the nation’s premier medical schools, New York University, and a few others around the United States are challenging that equation by offering a small percentage of students the chance to finish early, in three years instead of the traditional four.

Administrators at N.Y.U. say they can make the change without compromising quality, by eliminating redundancies in their science curriculum, getting students into clinical training more quickly and adding some extra class time in the summer.

Not only, they say, will those doctors be able to hang out their shingles to practice earlier, but they will save a quarter of the cost of medical school — $49,560 a year in tuition and fees at N.Y.U., and even more when room, board, books, supplies and other expenses are added in.

“We’re confident that our three-year students are going to get the same depth and core knowledge, that we’re not going to turn it into a trade school,” said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.

At this point, the effort involves a small number of students at three medical schools: about 16 incoming students at N.Y.U., or about 10 percent of next year’s entering class; 9 at Texas Tech Health Science Center School of Medicine; and even fewer, for now, at Mercer University School of Medicine’s campus in Savannah, Ga. A similar trial at Louisiana State University has been delayed because of budget constraints.

But Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing, and the deans of all three schools say that if the approach works, they will extend the option to larger numbers of students.

“You’re going to see this kind of three-year pathway become very prominent across the country,” Dr. Abramson predicted.

The deans say that getting students out the door more quickly will accomplish several goals. By speeding up production of physicians, they say, it could eventually dampen a looming doctor shortage, although the number of doctors would not increase unless the schools enrolled more students in the future.

The three-year program would also curtail student debt, which now averages $150,000 by graduation, and by doing so, persuade more students to go into shortage areas like pediatrics and internal medicine, rather than more lucrative specialties like dermatology.

The idea was supported by Dr. Ezekiel J. Emanuel, a former health adviser to President Obama, and a colleague, Victor R. Fuchs. In an editorial in the Journal of the American Medical Association in March, they said there was “substantial waste” in the nation’s medical education. “Years of training have been added without evidence that they enhance clinical skills or the quality of care,” they wrote. They suggested that the 14 years of college, medical school, residency and fellowship that it now takes to train a subspecialty physician could be reduced by 30 percent, to 10 years.

That opinion, however, is not universally held. Other experts say that a three-year medical program would deprive students of the time they need to delve deeply into their subjects, to consolidate their learning and to reach the level of maturity they need to begin practicing, while adding even more pressure to a stressful academic environment.

“The downside is that you are really tired,” said Dr. Dan Hunt, co-secretary of the Liaison Committee on Medical Education, the accrediting agency for medical schools in the United States and Canada. But because accreditation standards do not dictate the fine points of curriculum, the committee has approved N.Y.U.’s proposal, which exceeds by five weeks its requirement that schools provide at least 130 weeks of medical education.

The medical school is going ahead with its three-year program despite the damage from Hurricane Sandy, which forced NYU Langone Medical Center to evacuate more than 300 patients at the height of the storm and temporarily shut down three of its four main teaching hospitals.

Dr. Abramson of N.Y.U. said that postgraduate training, which typically includes three years in a hospital residency, and often fellowships after that, made it unnecessary to try to cram everything into the medical school years. Students in the three-year program will have to take eight weeks of class before entering medical school, and stay in the top half of their class academically. Those who do not meet the standards will revert to the four-year program.

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N.Y.U. and Others Offer Shorter Courses Through Medical School

Training to become a doctor takes so long that just the time invested has become, to many, emblematic of the gravity and prestige of the profession.

But now one of the nation’s premier medical schools, New York University, and a few others around the United States are challenging that equation by offering a small percentage of students the chance to finish early, in three years instead of the traditional four.

Administrators at N.Y.U. say they can make the change without compromising quality, by eliminating redundancies in their science curriculum, getting students into clinical training more quickly and adding some extra class time in the summer.

Not only, they say, will those doctors be able to hang out their shingles to practice earlier, but they will save a quarter of the cost of medical school — $49,560 a year in tuition and fees at N.Y.U., and even more when room, board, books, supplies and other expenses are added in.

“We’re confident that our three-year students are going to get the same depth and core knowledge, that we’re not going to turn it into a trade school,” said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.

At this point, the effort involves a small number of students at three medical schools: about 16 incoming students at N.Y.U., or about 10 percent of next year’s entering class; 9 at Texas Tech Health Science Center School of Medicine; and even fewer, for now, at Mercer University School of Medicine’s campus in Savannah, Ga. A similar trial at Louisiana State University has been delayed because of budget constraints.

But Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing, and the deans of all three schools say that if the approach works, they will extend the option to larger numbers of students.

“You’re going to see this kind of three-year pathway become very prominent across the country,” Dr. Abramson predicted.

The deans say that getting students out the door more quickly will accomplish several goals. By speeding up production of physicians, they say, it could eventually dampen a looming doctor shortage, although the number of doctors would not increase unless the schools enrolled more students in the future.

The three-year program would also curtail student debt, which now averages $150,000 by graduation, and by doing so, persuade more students to go into shortage areas like pediatrics and internal medicine, rather than more lucrative specialties like dermatology.

The idea was supported by Dr. Ezekiel J. Emanuel, a former health adviser to President Obama, and a colleague, Victor R. Fuchs. In an editorial in the Journal of the American Medical Association in March, they said there was “substantial waste” in the nation’s medical education. “Years of training have been added without evidence that they enhance clinical skills or the quality of care,” they wrote. They suggested that the 14 years of college, medical school, residency and fellowship that it now takes to train a subspecialty physician could be reduced by 30 percent, to 10 years.

That opinion, however, is not universally held. Other experts say that a three-year medical program would deprive students of the time they need to delve deeply into their subjects, to consolidate their learning and to reach the level of maturity they need to begin practicing, while adding even more pressure to a stressful academic environment.

“The downside is that you are really tired,” said Dr. Dan Hunt, co-secretary of the Liaison Committee on Medical Education, the accrediting agency for medical schools in the United States and Canada. But because accreditation standards do not dictate the fine points of curriculum, the committee has approved N.Y.U.’s proposal, which exceeds by five weeks its requirement that schools provide at least 130 weeks of medical education.

The medical school is going ahead with its three-year program despite the damage from Hurricane Sandy, which forced NYU Langone Medical Center to evacuate more than 300 patients at the height of the storm and temporarily shut down three of its four main teaching hospitals.

Dr. Abramson of N.Y.U. said that postgraduate training, which typically includes three years in a hospital residency, and often fellowships after that, made it unnecessary to try to cram everything into the medical school years. Students in the three-year program will have to take eight weeks of class before entering medical school, and stay in the top half of their class academically. Those who do not meet the standards will revert to the four-year program.

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Syrian Airstrikes Reportedly Kill Dozens at Bakery

BEIRUT, Lebanon — A Syrian warplane was reported to have conducted airstrikes that killed dozens of people lined up for bread at a bakery in the central town of Hilfaya, according to antigovernment activists in the area.

The attack, and its toll, could not immediately be confirmed. Samer, a local activist in the town, said he ran to the bakery soon after he heard a warplane, followed by bomb explosions and finally the sound of ambulances. “There were bodies everywhere,” he said, adding that he saw tens of bodies taken away in cars.

Photographs he said he took at the bakery showed bodies in a heap on a bloody sidewalk outside a low-slung building that was blackened with soot and stained with patches of blood, high on the walls. Amateur video showing what activists said was the aftermath of the attack showed roughly a dozen people lying on the ground, some wounded and several apparently dead.

In one of Samer’s photograph, a man stared in shock at the scene, with his hands resting on his head, while another carried body parts. Bystanders searched for survivors under rubble from the building. Another man picked up a piece of bread, lying next to someone’s slippers.

The reason for the attack was unclear, but activists said that rebel fighters occupied Hilfaya last week as part of a broader offensive to seize territory around the city of Hama, where the government has kept tight control after suppressing protests in the city last year.

Civilians have been caught between the two sides. On Friday, rebel fighters posted a video threatening to attack Christian villages with artillery while asserting that the residents were shielding government loyalists. In the last few days, Hilfaya has come under repeated shelling from loyalist positions in a neighboring village, activists said.

The bakery was one of three in the city. When word spread on Sunday that a flour shipment from Turkey had come in, people began lining up around noon, waiting for their turn at its windows for bread after a stretch of days when the bakeries had been idled. At least three bombs fell near the bakery, Samer and other activists said.

The attack came as the international envoy to Syria, Lakhdar Brahimi, arrived in the capital, Damascus, where he was expected to meet with President Bashar al-Assad. His visit had been rumored but not previously announced, signaling concerns about security as the fighting between opposition fighters and the government intensified in the capital.

Mr. Brahimi made no public comment on Sunday, and the Syrian information minister said during a news conference that he had no knowledge of the envoy’s visit. Mr. Brahimi traveled by land from Beirut because of fighting between the rebels and government forces near the Damascus airport, Lebanese airport officials told The Associated Press.

His visit was likely to add fuel to the speculation about a deal to remove Mr. Assad from power. Rebel forces have claimed gains near government strongholds, and international aid agencies are warning of a growing humanitarian crisis in the winter months.

Russia, one of Syria’s most reliable allies, has recently sent signals that it is distancing itself from the Syrian president. On Saturday, the Russian foreign minister, Sergey V. Lavrov, said several countries in the region had offered Mr. Assad asylum, while adding that Moscow was not willing to mediate on their behalf.

Ellen Barry contributed reporting from Moscow; Hala Droubi from Jidda, Saudi Arabia; and Hwaida Saad from Beirut.

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Amazon Book Reviews Deleted in a Purge Aimed at Manipulation

Giving raves to family members is no longer acceptable. Neither is writers’ reviewing other writers. But showering five stars on a book you admittedly have not read is fine.

After several well-publicized cases involving writers buying or manipulating their reviews, Amazon is cracking down. Writers say thousands of reviews have been deleted from the shopping site in recent months.

Amazon has not said how many reviews it has killed, nor has it offered any public explanation. So its sweeping but hazy purge has generated an uproar about what it means to review in an era when everyone is an author and everyone is a reviewer.

Is a review merely a gesture of enthusiasm or should it be held to a higher standard? Should writers be allowed to pass judgment on peers the way they have always done offline or are they competitors whose reviews should be banned? Does a groundswell of raves for a new book mean anything if the author is soliciting the comments?

In a debate percolating on blogs and on Amazon itself, quite a few writers take a permissive view on these issues.

The mystery novelist J. A. Konrath, for example, does not see anything wrong with an author indulging in chicanery. “Customer buys book because of fake review = zero harm,” he wrote on his blog.

Some readers differ. An ad hoc group of purists has formed on Amazon to track its most prominent reviewer, Harriet Klausner, who has over 25,000 reviews. They do not see how she can read so much so fast or why her reviews are overwhelmingly — and, they say, misleadingly — exaltations.

“Everyone in this group will tell you that we’ve all been duped into buying books based on her reviews,” said Margie Brown, a retired city clerk from Arizona.

Once a populist gimmick, the reviews are vital to making sure a new product is not lost in the digital wilderness. Amazon has refined the reviewing process over the years, giving customers the opportunity to rate reviews and comment on them. It is layer after layer of possible criticism.

“A not-insubstantial chunk of their infrastructure is based on their reviews — and all of that depends on having reviews customers can trust,” said Edward W. Robertson, a science fiction novelist who has watched the debate closely.

Nowhere are reviews more crucial than with books, an industry in which Amazon captures nearly a third of every dollar spent. It values reviews more than other online booksellers like Apple or Barnes & Noble, featuring them prominently and using them to help decide which books to acquire for its own imprints by its relatively new publishing arm.

So writers have naturally been vying to get more, and better, notices. Several mystery writers, including R. J. Ellory, Stephen Leather and John Locke, have recently confessed to various forms of manipulation under the general category of “sock puppets,” or online identities used to deceive. That resulted in a widely circulated petition by a loose coalition of writers under the banner, “No Sock Puppets Here Please,” asking people to “vote for book reviews you can trust.”

In explaining its purge of reviews, Amazon has told some writers that “we do not allow reviews on behalf of a person or company with a financial interest in the product or a directly competing product. This includes authors.” But writers say that rule is not applied consistently.

In some cases, the ax fell on those with a direct relationship with the author.

“My sister’s and best friend’s reviews were removed from my books,” the author M. E. Franco said in a blog comment. “They happen to be two of my biggest fans.” Another writer, Valerie X. Armstrong, said her son’s five-star review of her book, “The Survival of the Fattest,” was removed. He immediately tried to put it back “and it wouldn’t take,” she wrote.

In other cases, though, the relationship was more tenuous. Michelle Gagnon lost three reviews on her young adult novel “Don’t Turn Around.” She said she did not know two of the reviewers, while the third was a longtime fan of her work. “How does Amazon know we know each other?” she said. “That’s where I started to get creeped out.”

Mr. Robertson suggested that Amazon applied a broad brush. “I believe they caught a lot of shady reviews, but a lot of innocent ones were erased, too,” he said. He figures the deleted reviews number in the thousands, or perhaps even 10,000.

The explosion of reviews for “The 4-Hour Chef” by Timothy Ferriss shows how the system has evolved from something spontaneous to a means of marketing and promotion. On Nov. 20, publication day, dozens of highly favorable reviews immediately sprouted. Other reviewers quickly criticized Mr. Ferriss, accusing him of buying supporters.

He laughed off those suggestions. “Not only would I never do that — it’s unethical — I simply don’t have to,” he wrote in an e-mail, saying he had sent several hundred review copies to fans and potential fans. “Does that stack the deck? Perhaps, but why send the book to someone who would hate it? That doesn’t help anyone: not the reader, nor the writer.”

As a demonstration of social media’s grip on reviewing, Mr. Ferriss used Twitter and Facebook to ask for a review. “Rallying my readers,” he called it. Within an hour, 61 had complied.

A few of his early reviews were written by people who admitted they had not read the book but were giving it five stars anyway because, well, they knew it would be terrific. “I am looking forward to reading this,” wrote a user posting under the name mhpics.

A spokesman for Amazon, which published “The 4-Hour Chef,” offered this sole comment for this article: “We do not require people to have experienced the product in order to review.”

The dispute over reviews is playing out in the discontent over Mrs. Klausner, an Amazon Hall of Fame reviewer for the last 11 years and undoubtedly one of the most prolific reviewers in literary history.

Mrs. Klausner published review No. 28,366, for “A Red Sun Also Rises” by Mark Hodder. Almost immediately, it had nine critical comments. The first accused it of being “riddled with errors in grammar, spelling and punctuation.” The rest were no more kind. The Harriet Klausner Appreciation Society had struck again.

Mrs. Klausner, a 60-year-old retired librarian who lives in Atlanta, has published an average of seven reviews a day for more than a decade. “To watch her in action is unbelievable,” said her husband, Stanley. “You see the pages turning.”

Mrs. Klausner, who says ailments keep her home and insomnia keeps her up, scoffs at her critics. “You ever read a Harlequin romance?” she said. “You can finish it in one hour. I’ve always been a speed reader.” She has a message for her naysayers: “Get a life. Read a book.”

More than 99.9 percent of Mrs. Klausner’s reviews are four or five stars. “If I can make it past the first 50 pages, that means I like it, and so I review it,” she said. But even Stanley said, “She’s soft, I won’t deny that.”

The campaign against Mrs. Klausner has pushed down her reviewer ratings, which in theory makes her less influential. But when everything is subject to review, the battle is never-ending.

Ragan Buckley, an aspiring novelist active in the campaign against Mrs. Klausner under the name “Sneaky Burrito,” is a little weary. “There are so many fake reviews that I’m often better off just walking into a physical store and picking an item off the shelf at random,” she said.

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Genetic Gamble : Drugs Aim to Make Several Types of Cancer Self-Destruct

C.J. Gunther for The New York Times

Dr. Donald Bergstrom is a cancer specialist at Sanofi, one of three companies working on a drug to restore a tendency of damaged cells to self-destruct.

For the first time ever, three pharmaceutical companies are poised to test whether new drugs can work against a wide range of cancers independently of where they originated — breast, prostate, liver, lung. The drugs go after an aberration involving a cancer gene fundamental to tumor growth. Many scientists see this as the beginning of a new genetic age in cancer research.

Great uncertainties remain, but such drugs could mean new treatments for rare, neglected cancers, as well as common ones. Merck, Roche and Sanofi are racing to develop their own versions of a drug they hope will restore a mechanism that normally makes badly damaged cells self-destruct and could potentially be used against half of all cancers.

No pharmaceutical company has ever conducted a major clinical trial of a drug in patients who have many different kinds of cancer, researchers and federal regulators say. “This is a taste of the future in cancer drug development,” said Dr. Otis Webb Brawley, the chief medical and scientific officer of the American Cancer Society. “I expect the organ from which the cancer came from will be less important in the future and the molecular target more important,” he added.

And this has major implications for cancer philanthropy, experts say. Advocacy groups should shift from fund-raising for particular cancers to pushing for research aimed at many kinds of cancer at once, Dr. Brawley said. John Walter, the chief executive officer of the Leukemia and Lymphoma Society, concurred, saying that by pooling forces “our strength can be leveraged.”

At the heart of this search for new cancer drugs are patients like Joe Bellino, who was a post office clerk until his cancer made him too sick to work. Seven years ago, he went into the hospital for hernia surgery, only to learn he had liposarcoma, a rare cancer of fat cells. A large tumor was wrapped around a cord that connects the testicle to the abdomen. “I was shocked,” he said in an interview this summer.

Companies have long ignored liposarcoma, seeing no market for drugs to treat a cancer that strikes so few. But it is ideal for testing Sanofi’s drug because the tumors nearly always have the exact genetic problem the drug was meant to attack — a fusion of two large proteins. If the drug works, it should bring these raging cancers to a halt. Then Sanofi would test the drug on a broad range of cancers with a similar genetic alteration. But if the drug fails against liposarcoma, Sanofi will reluctantly admit defeat.

“For us, this is a go/no-go situation,” said Laurent Debussche, a Sanofi scientist who leads the company’s research on the drug.

The genetic alteration the drug targets has tantalized researchers for decades. Normal healthy cells have a mechanism that tells them to die if their DNA is too badly damaged to repair. Cancer cells have grotesquely damaged DNA, so ordinarily they would self-destruct. A protein known as p53 that Dr. Gary Gilliland of Merck calls the cell’s angel of death normally sets things in motion. But cancer cells disable p53, either directly, with a mutation, or indirectly, by attaching the p53 protein to another cellular protein that blocks it. The dream of cancer researchers has long been to reanimate p53 in cancer cells so they will die on their own.

The p53 story began in earnest about 20 years ago. Excitement ran so high that, in 1993, Science magazine anointed it Molecule of the Year and put it on the cover. An editorial held out the possibility of “a cure of a terrible killer in the not too distant future.”

Companies began chasing a drug to restore p53 in cells where it was disabled by mutations. But while scientists know how to block genes, they have not figured out how to add or restore them. Researchers tried gene therapy, adding good copies of the p53 gene to cancer cells. That did not work.

Then, instead of going after mutated p53 genes, they went after half of cancers that used the alternative route to disable p53, blocking it by attaching it to a protein known as MDM2. When the two proteins stick together, the p53 protein no longer functions. Maybe, researchers thought, they could find a molecule to wedge itself between the two proteins and pry them apart.

The problem was that both proteins are huge and cling tightly to each other. Drug molecules are typically tiny. How could they find one that could separate these two bruisers, like a referee at a boxing match?

In 1996, researchers at Roche noticed a small pocket between the behemoths where a tiny molecule might slip in and pry them apart. It took six years, but Roche found such a molecule and named it Nutlin because the lab was in Nutley, N.J.

But Nutlins did not work as drugs because they were not absorbed into the body.

Roche, Merck and Sanofi persevered, testing thousands of molecules.

At Sanofi, the stubborn scientist leading the way, Dr. Debussche, maintained an obsession with p53 for two decades. Finally, in 2009, his team, together with Shaomeng Wang at the University of Michigan and a biotech company, Ascenta Therapeutics, found a promising compound.

The company tested the drug by pumping it each day into the stomachs of mice with sarcoma.

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