Europe: Germany: Funds for Global Health Fund Reinstated

Signaling that it was pleased with changes in the Global Fund to Fight AIDS, Tuberculosis and Malaria, Germany announced Thursday that it would reinstate the annual pledge of 200 million euros (about $267 million) it had made since the fund’s early days. In 2011, Germany temporarily held back half its contribution and threatened to hold back future funds in protest against inefficiencies, thefts by some grantee countries and infighting among the fund’s top executives. Other contributions dried up, forcing the fund to cancel a planned round of grants. Since then, both the fund’s executive director and inspector general have departed, and it was run for one year by a Brazilian banker; he devised an overhaul of the grant-making process that is to take effect next month. In November, Dr. Mark Dybul, the Bush administration’s global AIDS czar, became the new executive director. The fund recently announced that it cut its operating expenses by 5 percent in 2012 while still making 26 percent more in grants than it did in 2011. Of the grants that had been audited, Dr. Dybul said, only 0.5 percent had been lost to fraud. The fund plans a new fund-raising round for later this year. The United States is the fund’s largest supporter, providing roughly a third of its budget.

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Pictures from the Week in Business

The port of Tokyo. Following the lead of their counterparts in the United States, Japan’s central bankers announced on Tuesday what they called a groundbreaking effort to reinvigorate the country’s long-moribund economy and defeat deflation. With no room left to cut interest rates and previous steps unsuccessful, the Bank of Japan is taking a page from the Federal Reserve’s playbook and will pump trillions more yen into the economy by directly buying government bonds and other assets.

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St. Gallen Journal: Swiss City Fears for Cultural Legacy in Wake of a Bank’s Fall

Daniel Auf der Mauer for The New York Times

Bach concerts sponsored by the bank Wegelin were sometimes held at the St. Laurentius church in St. Gallen.

ST. GALLEN, Switzerland — Given the modest size of its offices, a trim neo-Classical building off the marketplace, it is easy to underestimate the imprint of the bank once called Wegelin on this compact Swiss city.

It is not just that it was the oldest bank in Switzerland, founded by local textile merchants in 1741. Its senior managing partner, Konrad Hummler, was the son of a former mayor, chairman of the board of the Neue Zürcher Zeitung, the Zurich daily that is the country’s leading newspaper, and the prolific author of columns in which he often denounced the business practices of bigger Swiss banks, like UBS.

But most important, Wegelin, which closed its doors this month, was a significant sponsor of cultural institutions in the area. Among its projects, in 2006 Mr. Hummler, a passionate music lover and amateur violinist, established the Johann Sebastian Bach Foundation, with the goal of financing the performance and recording of the entire vocal works of the German composer, more than 200 cantatas, a task expected to last more than 20 years.

Moreover, the bank was dedicated to preserving the architectural substance of the town. In 2007, Wegelin paid almost $2 million for a significant part of the late Gothic convent of St. Catherine, a former nunnery with a soaring chapel and vaulted cloister that was in considerable disrepair. It then underwrote a painstaking restoration of the chapel with its 19th-century organ, and other portions of the buildings. The idea was to use them eventually for performances of Bach’s works and other music.

The bank and Mr. Hummler also had close ties to the local business school, and at any given time several dozen students might be employed in its training programs.

Now, all this is jeopardized. Last year, Wegelin was charged in the United States with illegally helping American citizens avoid taxes. Under the shock of these charges, Wegelin was split up and its valuable assets placed with another local bank, Raiffeisen. Its bad assets remained with Wegelin, though its name was changed to Notenstein Privatbank, for a medieval guild in St. Gallen.

Wegelin executives eventually pleaded guilty before a court in New York to helping Americans avoid taxes on $1.2 billion of assets between 2002 and 2010, and agreed to pay restitution and fines of almost $60 million. Entering the plea, one of Mr. Hummler’s closest associates, Otto Bruderer, told the court that Wegelin had always believed it was in compliance with Swiss law, adding that “such conduct was common in the Swiss banking industry.”

The news shook St. Gallen. “It was extremely surprising,” said Leonie Schwendimann, who runs a small bookshop across from St. Laurentius, the Protestant church where Bach concerts sponsored by the bank are occasionally held.

Ms. Schwendimann, who often attended the concerts and was a friend of Rudolf Lutz, the baroque specialist who directed the series, voiced concern for their future. “It would be a great loss,” she said. Of the bank’s disappearance, she added, “You have to take care of your business.”

It seemed only coincidental that posters around town advertised the latest piece at the town theater, a sharp critique of the financial world by the Swiss playwright Urs Widmer titled “The End of Money,” featuring a full-length photograph of a banker with donkey’s ears.

Madeleine Herzog, responsible for culture in the city government, called the bank’s restoration of St. Catherine’s convent “exemplary.” But she was concerned about the future without Wegelin. “It was planned for the buildings to be used for cultural events, but that lies now in the responsibility of the bank’s new owners,” she said. “What their concrete plans are, what the future of the Bach cycle is,” she said, “that is not known.”

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Voice of Te'o prankster? Couric plays voicemails

NEW YORK (AP) — The person Manti Te'o says was pretending to be his online girlfriend told the Notre Dame linebacker "I love you" in voicemails that were played during his interview with Katie Couric.

Taped earlier this week and broadcast Thursday, the hour-long talk show featured three voicemails that Te'o claims were left for him last year. Te'o said they were from the person he believed to be Lennay Kekua, a woman he had fallen for online but never met face-to-face.

After the first message was played, Te'o said: "It sounds like a girl, doesn't it?"

"It does," Couric responded.

The interview was the All-American's first on camera since his tale of inspired play after the deaths of his grandmother and girlfriend on the same day in September unraveled as a bizarre hoax in an expose by Deadspin.com on Jan. 16.

Te'o's parents appeared with him for part of the interview and backed up his claim that he wasn't involved in the fabrication, saying they, too, had spoken on the phone with a person they believed to be Kekua.

Couric addressed speculation that the tale was concocted by Te'o as a way to cover up his sexual orientation. Asked if he were gay, Te'o said "no" with a laugh. "Far from it. Faaaar from that."

He also said he was "scared" and "didn't know what to do" after receiving a call on Dec. 6 — two days before the Heisman Trophy presentation — from a person who claimed to be his "dead" girlfriend.

The first voicemail, he said, was from what was supposed to be Kekua's first day of chemotherapy for leukemia.

"Hi, I am just letting you know I got here and I'm getting ready for my first session and, um, just want to call you to keep you posted. I miss you. I love you. Bye," the person said.

In the second voicemail, the person was apparently upset by someone else answering Te'o's phone.

The third voicemail was left on Sept. 11, according to Te'o, the day he believed Kekua was released from the hospital and the day before she "died."

"Hey babe, I'm just calling to say goodnight," the person on the voicemail said. "I love you. I know that you're probably doing homework or you're with the boys. ... But I just wanted to say I love you and goodnight and I'll be ok tonight. I'll do my best. Um, yeah, so get your rest and I'll talk to you tomorrow. I love you so much, hon. Sweet dreams."

Couric suggested the person who left those messages might have been Ronaiah Tuisasosopo, a 22-year-old man from California, who Te'o said has apologized to him for pulling the hoax.

"Do you think that could have been a man on the other end of the phone?" she asked.

"Well, it didn't sound like a man," Te'o said. "It sounded like a woman. If he somehow made that voice, that's incredible. That's an incredible talent to do that. Especially every single day."

Tuiasosopo has not spoken publicly since news of the hoax broke. The Associated Press has learned that a home in California where Te'o sent flowers to the Kekua family was once a residence of Tuiasosopo and has been in his family for decades.

Also on Thursday, the woman whose pictures were used in fake online accounts for Kekua said Tuiasosopo confessed to her in a 45-minute phone conversation as the scheme unraveled.

Diane O'Meara spoke with The Associated Press in a telephone interview. She said Tuiasosopo told her he'd been "stalking" her Facebook profile for five years and stealing photos.

O'Meara's attorney, Jim Artiano, said they had not decided on whether to take any legal action.

The 23-year-old O'Meara, of Long Beach, Calif., said she knew Tuiasosopo from high school and he contacted her through Facebook on Dec. 16. She said that, over the next three weeks, Tuiasosopo got in touch with her several times, attempting to get photos and video of O'Meara. She said he made up a story about wanting them to help cheer up a cousin who was injured in a car crash.

O'Meara learned her identity had been stolen on Jan. 13 when she was contacted by Deadspin.com.

The next day she got in touch with Tuiasosopo.

"When I contacted Ronaiah I got a very bizarre vibe from him, he became very nervous, he wasn't asking the questions I expected. He was asking 'Who contacted you? What did they say?'" O'Meara said.

Later that day, he confessed, O'Meara said. She said she asked Tuiasosopo why he didn't simply stop the hoax.

"He told me he wanted to end the relationship," O'Meara said. "He said he wanted to stop the relationship between Lennay and Manti, but Manti didn't want Lennay to break up with him ... He said he tried to stop the game many times."

When news of the hoax broke a few days later, O'Meara said she received a text from Tuiasosopo asking her to call him as soon as possible. O'Meara said she didn't respond.

___

Associated Press writer Tami Abdollah contributed to this report from Los Angeles.

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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Frances, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

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Starbucks Earnings Increased 13% in Latest Quarter

The company’s results were helped by a 6 percent increase in global sales at cafes open at least a year.

The performance reflects the turnaround Starbucks has made since its struggles during the recession. After bringing back its founder, Howard Schultz, as chief executive in 2008, the company embarked on a reorganization that included closing underperforming stores in the United States.

Mr. Schultz has said that the company has the ability to keep growing even through a turbulent economy because most people see Starbucks as an “affordable luxury.”

Starbucks said it earned $432.2 million, or 57 cents a share, in the quarter, up from $382.1 million, or 50 cents a share, a year earlier. Revenue in the period ending Dec. 30, the first quarter of Starbucks’s fiscal year, rose 11 percent, to $3.8 billion. Analysts had expected a profit of 57 cents a share and revenue of $3.85 billion, according to FactSet.

Shares rose 11 cents on Thursday, to $54.57 a share.

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The Making of Yair Lapid, Israel’s New Power Broker

Oliver Weiken/European Pressphoto Agency

Yair Lapid spoke to reporters in Tel Aviv on Wednesday, a day after his centrist party became the second-largest faction in Parliament.

TEL AVIV — They pitched tents along Rothschild Boulevard and took to the streets in unprecedented numbers, hundreds of thousands demonstrating against the rising costs of gas, apartments, even cottage cheese.

Back on the genteel boulevard on Wednesday, many of those middle-class protesters from 2011 said they had taken their grievances to the ballot box the day before, helping to catapult Yair Lapid, a suave, handsome journalist-turned-populist-politician, into Israel’s newest power broker.

“He spoke out the strongest about how everything in this country is upside down,” said Elad Shoshan, 28, who works with computers and rents an apartment on a cheaper street off the boulevard.

Echoing his candidate’s mantra, Roni Klein, 52, an accountant, said, “My wife and I work, and still it is very hard for us to finish the month.”

Mr. Lapid’s new, centrist Yesh Atid party shocked the political establishment by winning 19 of Parliament’s 120 seats, becoming Israel’s second-largest faction and a crucial partner for Prime Minister Benjamin Netanyahu, whose relatively poor showing left him scrambling to form a stable coalition.

While Mr. Netanyahu remains all but assured of serving a third term — Mr. Lapid said Wednesday that he would not unite with Arab lawmakers to stop him — Yesh Atid’s ascendance promises to shift the government’s focus to pocketbook concerns despite the pressing foreign policy issues Israel faces.

Mr. Lapid’s campaign hardly challenged Mr. Netanyahu’s policies on the Iranian nuclear threat, the tumult in the Arab world or the Israeli-Palestinian conflict. This was the first election in memory in which such existential security issues were not emphasized, as a growing majority of Israelis see them as too tough to tackle. Even Mr. Netanyahu barely spoke about Iran, his raison d’être.

Instead, voters and analysts alike said Mr. Lapid had captured the hearts of Israel’s silent majority with his personal charm and a positive, inclusive message that harnessed the everyday frustrations that fueled the huge social justice protests in 2011.

One pollster found that about 40 percent of Mr. Lapid’s supporters defined themselves as right-leaning, and in Israel’s coalition system, many saw his success as a tactical move by voters not to oust Mr. Netanyahu but to nudge him to broaden the agenda.

On Wednesday, the prime minister embraced Mr. Lapid’s platform, promising a government “as broad as possible” that would bring change on three fronts: affordable housing, government reform and forcing ultra-Orthodox Jews to “share the burden” of military service and taxes.

Some saw the results as a victory for secular Jews at a time of conflict with the ultra-Orthodox over resources and religious pluralism. Mr. Lapid’s stronghold was here in coastal Tel Aviv and its bourgeois suburbs, where he won about 1 in 4 votes cast, and Modiin, a fast-growing bedroom community halfway between here and Jerusalem.

Tamar Hermann, a political scientist and vice president of Israel’s Open University, called Mr. Lapid “the epitome of the Israeli dream” and described his voters as “the mainstream of the mainstream.”

“This is the kind of voting you can take your kids to and teach them a lesson in civic fulfillment without taking any risks,” Professor Hermann said. “They are complaining, but this is a kind of the zeitgeist, not real agony, not real suffering, not real dissatisfaction with the basic cornerstone of the system. It’s just polishing here and there.”

The election results were widely seen as a rebuke to the status quo, but not necessarily a call for change in approach to contentious questions like what to do about the Palestinians. While Mr. Lapid has called for a return to negotiations, he shares Mr. Netanyahu’s skepticism about the lack of a partner, saying this week, “I don’t think the Arabs want peace.” He opposes division of Jerusalem and made his foreign policy speech in Ariel, a sprawling Jewish settlement 12 miles into the West Bank that the Palestinians see as problematic for the viability of their state.

“The majority of Israelis came to the conclusion that there will be no new Middle East,” Mr. Lapid said over cappuccino here last month. “What we want is not a happy marriage, but a decent divorce.”

Instead, the change voters were seeking was more about the nature of politics itself.

Irit Pazner Garshowitz contributed reporting.

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Seau's family sues NFL over brain injuries

Add Junior Seau's family to the thousands of people who are suing the NFL over the long-term damage caused by concussions.

Seau's ex-wife and four children sued the league Wednesday, saying the former linebacker's suicide was the result of brain disease caused by violent hits he sustained while playing football.

The wrongful death lawsuit, filed in California Superior Court in San Diego, blames the NFL for its "acts or omissions" that hid the dangers of repetitive blows to the head. It says Seau developed chronic traumatic encephalopathy (CTE) from those hits, and accuses the NFL of deliberately ignoring and concealing evidence of the risks associated with traumatic brain injuries.

Seau died at age 43 of a self-inflicted gunshot in May. He was diagnosed with CTE, based on posthumous tests, earlier this month.

An Associated Press review in November found that more than 3,800 players have sued the NFL over head injuries in at least 175 cases as the concussion issue has gained attention in recent years. The total number of plaintiffs is 6,000 when spouses, relatives and other representatives are included.

Scores of the concussion lawsuits have been brought together before U.S. District Judge Anita B. Brody in Philadelphia.

"Our attorneys will review it and respond to the claims appropriately through the court," the NFL said in a statement Wednesday.

Helmet manufacturer Riddell Inc., also is a defendant, with the Seau family saying Riddell was "negligent in their design, testing, assembly, manufacture, marketing, and engineering of the helmets" used by NFL players. The suit says the helmets were unreasonably dangerous and unsafe.

Riddell issued a statement saying it is, "confident in the integrity of our products and our ability to successfully defend our products against challenges."

Seau was one of the best linebackers during his 20 seasons in the NFL, retiring in 2009.

"We were saddened to learn that Junior, a loving father and teammate, suffered from CTE," the family said in a statement released to the AP. "While Junior always expected to have aches and pains from his playing days, none of us ever fathomed that he would suffer a debilitating brain disease that would cause him to leave us too soon.

"We know this lawsuit will not bring back Junior. But it will send a message that the NFL needs to care for its former players, acknowledge its decades of deception on the issue of head injuries and player safety, and make the game safer for future generations."

Plaintiffs are listed as Gina Seau, Junior's ex-wife; Junior's children Tyler, Sydney, Jake and Hunter, and Bette Hoffman, trustee of Seau's estate.

The lawsuit accuses the league of glorifying the violence in pro football, and creating the impression that delivering big hits "is a badge of courage which does not seriously threaten one's health."

It singles out NFL Films and some of its videos for promoting the brutality of the game.

"In 1993's 'NFL Rocks,' Junior Seau offered his opinion on the measure of a punishing hit: 'If I can feel some dizziness, I know that guy is feeling double (that)," the suit says.

The NFL consistently has denied allegations similar to those in the lawsuit.

"The NFL, both directly and in partnership with the NIH, Centers for Disease Control and other leading organizations, is committed to supporting a wide range of independent medical and scientific research that will both address CTE and promote the long-term health and safety of athletes at all levels," the league told the AP after it was revealed Seau had CTE.

The lawsuit claims money was behind the NFL's actions.

"The NFL knew or suspected that any rule changes that sought to recognize that link (to brain disease) and the health risk to NFL players would impose an economic cost that would significantly and adversely change the profit margins enjoyed by the NFL and its teams," the Seaus said in the suit.

The National Institutes of Health, based in Bethesda, Md., studied three unidentified brains, one of which was Seau's, and said the findings on Seau were similar to autopsies of people "with exposure to repetitive head injuries."

"It was important to us to get to the bottom of this, the truth," Gina Seau told the AP then. "And now that it has been conclusively determined from every expert that he had obviously had CTE, we just hope it is taken more seriously. You can't deny it exists, and it is hard to deny there is a link between head trauma and CTE. There's such strong evidence correlating head trauma and collisions and CTE."

In the final years of his life, Seau went through wild behavior swings, according to Gina and to 23-year-old son, Tyler. There also were signs of irrationality, forgetfulness, insomnia and depression.

"He emotionally detached himself and would kind of 'go away' for a little bit," Tyler Seau said. "And then the depression and things like that. It started to progressively get worse."

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Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

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Edging From Europe, Britain Adds to Continent’s Unease

Oli Scarff/Getty Images

Prime Minister David Cameron of Britain speaking in London on Wednesday.

BRUSSELS — The French are engaged in a lonely military adventure in Africa. The Germans are preoccupied with domestic elections rather than regional affairs. Unemployment in some countries is at historic highs and economies across Europe are still mired in recession.

Now Prime Minister David Cameron of Britain has added to Europe’s malaise, vowing to reduce British entanglement with the European Union — or allow his people to vote in a referendum to leave the bloc altogether.

The pledge from the British prompted swift retorts from France and Germany, which said no member has the option of “cherry picking” whatever European rules it wants to enforce. But it reflected a growing sense of unease, not only in Britain but across the Continent, that while the acute phase of the financial crisis has passed, the challenge to Europe’s mission and even its membership has not.

Even the United States has injected itself into the matter, with an unusually public insistence that Britain, a close ally, stay in the union, fearing that its departure would heighten centrifugal forces that would weaken Europe as a diplomatic, military and financial partner.

With the threat of a sudden breakup of the euro zone appearing to recede in recent months, Europe has seen a resurgence of narrow national interests that risks swamping always-elusive common goals. The bickering is undercutting hopes in some circles that the struggle to save the euro had laid the groundwork for “more Europe.”

“As pressure from the financial markets recedes and a sense of urgency lifts, the appetite for serious reform is melting away like butter in the sun,” said Thomas Klau, head of the Paris office of the European Council on Foreign Relations. “Now that markets no longer hold a knife under leaders’ throats, they are slipping back into their normal mode, which is to manage their own immediate reality.”

For Mr. Cameron, with elections coming in 2015, that means heading off a challenge from the hard-right, anti-Europe U.K. Independence Party, known as UKIP, while shoring up support for his government, which recently admitted that its unpopular austerity program would have to be extended to 2018, analysts said. He is also anxious to avoid the sort of ruinous intraparty split over Europe that bedeviled the prime ministerships of two of his Conservative predecessors, Margaret Thatcher and John Major.

That comes against a backdrop of declining public support for British membership in Europe — only 45 percent last year, down from 51 percent in 2011, in polls conducted by the Pew Research Global Attitudes Project.

Mr. Cameron’s speech Wednesday in London calling for a referendum had been in the works for some time but, Mr. Klau noted, it was delivered at a moment when the European Union had begun to declare victory over doomsayers who predicted the common currency and even the whole union could crumble. This mood of calm, Mr. Klau said, has given leaders “the political space” to turn their eyes from Europe toward more pressing and, for politicians seeking re-election, far more important domestic concerns.

The decision by President François Hollande of France to send troops to Mali to halt an advance by rebels with ties to Islamist extremists reprises a long tradition of French interventions in its former African colonies — and has bolstered the Socialist president’s previously flagging popularity.

The French move has been supported by the European Union, whose member states share French fears about the spread of radicalism across the Mediterranean. But it has superseded the bloc’s own ambitions to become a serious player in global affairs and still left the French to fight mostly on their own. The union is sending some military trainers.

Europe’s economic troubles, meanwhile, are far from over, with much of the Continent expected to be in recession this year. Even Germany seems to be losing momentum — its economy contracted by 0.5 percent in the final months of last year. Elsewhere, unemployment is soaring to levels that could threaten grave social unrest, with more than a quarter of working-age people in Greece and Spain without jobs.

Alan Cowell contributed reporting from London.

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