Doctor criticizes George W. Bush use of stent

Former President George W. Bush's decision to have a stent implanted in an artery yesterday when not in the throes of a heart attack makes him a "poster child" for misuse of the sometimes life-saving technology, according to the author of a study that found the risk outweighs the benefits in those cases.

"He is the poster child for the inappropriate use of stenting now," said Dr. David L. Brown, professor of cardiology at the Stony Brook University School of Medicine and an author of a watershed 2012 study that indicated drugs can reduce heart attack risk as effectively as inserting the expanding metal mesh device without risks including heart attack or stroke.

A blockage in Bush's heart artery was discovered during the former president's annual physical. "At the recommendation of his doctors, President Bush agreed to have a stent placed to open the blockage. The procedure was performed successfully this morning, without complication, at Texas Health Presbyterian Hospital," a spokesman said yesterday.

Industry analyst Josh T. Jennings of Cowen & Co. LLC, said three stent makers, including Natick-based Boston Scientific, compete in the U.S., though sales and prices are declining because of increased medication use.

There can be reasons why patients might choose a stent without having had a heart attack, said Dr. John Keaney, chief of cardiovascular medicine at the University of Massachusetts Medical School.

For athletes, the side-effects of heart drugs, particularly beta blockers, can be debilitating, said Keaney, who is not involved in Bush's medical care. Bush is known as a strenuous exercise enthusiast who runs and rides mountain bikes regularly.

"He may not want to take a lot of medications because he does not want the side-effects they bring, which could leave him too weak to continue his activities," Keaney said.

Despite declining sales, stents have been one of the fastest-developing devices in medicine, said Massachusetts General Hospital interventional cardiologist Robert Yeh, who said the future for innovation remains promising. "On the horizon, being tested now are bio-absorbable stents which the body absorbs without leaving any metal."

Jennings said he's not sure if advances will bump up the manufacturers' bottom lines.

"There are fewer stents per case and fewer patients needing angioplasty," Jennings said.

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China fines 3 milk suppliers in price-fixing probe

BEIJING — China announced Wednesday it has fined six milk suppliers, including Mead Johnson and New Zealand's Fonterra, a total of $108 million for price-fixing after an investigation that shook the country's fast-growing dairy market.

The announcement came as China reels from a separate recall of milk supplies from Fonterra this week due to possible contamination.

The investigation reflected intensifying government scrutiny of business practices under China's 5-year-old anti-monopoly law. Most targets so far have been foreign-owned. It was carried out against the backdrop of several Chinese probes of possible bribery, price-fixing and other misconduct by global suppliers of pharmaceuticals and other products.

The Cabinet's National Development and Reform Commission said it imposed fines totaling 668.7 million yuan ($108 million) on the local units of Mead Johnson Nutrition Co., based in Glenview, Illinois; Hong Kong-based Biostime International Holdings Ltd.; Dumex, a unit of France's Danone SA; Abbott Laboratories, in Abbott Park, Illinois; Fonterra Co-operative Group and Dutch-based FrieslandCampina NV.

The companies admitted they violated the anti-monopoly law by setting minimum prices distributors were required to charge, which raised costs for consumers, the NDRC said in a statement. Regulators did not allege direct collusion, known as horizontal price-fixing, among them.

Setting minimum prices is a common practice in some markets, where companies want to maintain an image as a premium brand. But lawyers say Chinese regulators appear to see most such requirements for distributors as illegal.

Beijing is especially concerned about consumer prices at a time when communist leaders face pressure to contain surging living costs.

Three suppliers were found to have violated the law but were spared fines, the NDRC statement said. They were China's Beingmate Group Ltd.; Wyeth Nutrition, a unit of Switzerland's Nestle SA, and Japan's Meiji Dairies Corp.

Milk quality is a sensitive issue in China after six babies died and thousands were sickened in 2008 due to formula tainted with the chemical melamine. That prompted many parents to switch to buying more expensive imported milk.

Thursday's announcement referred to suppliers of milk powder while earlier reports by state media said investigators specifically targeted sellers of powdered infant formula.

Milk suppliers including Nestle and Dutch-based FrieslandCampina announced price cuts of 5 to 12 percent after the investigation was launched.

Mead Johnson was fined 203.8 million yuan ($33 million), Biostime 162.9 million yuan ($26.3 million) and Dumex 172 million yuan ($27.7 million), according to the NDRC statement. FrieslandCampina was fined 48.2 million yuan ($7.8 million), Abbott 77.3 million yuan ($12.5 million) and Fonterra 4.5 million yuan ($720,000).

Some fines were based on companies' annual sales and ranged from 3 to 6 percent of revenue, the agency said.

There have been few court rulings so far on the 2008 anti-monopoly law. That has fed uncertainty about how it will apply to global companies that are eager to expand in the world's second-largest economy.

Chinese regulators have cited the law in ordering changes to acquisitions or business practices. In 2009, they blocked Coca-Cola Co. from buying a Chinese fruit juice producer.

Business groups welcomed the law as a step toward clarifying operating conditions in China. Since then, they have said it is enforced more actively against foreign companies than against their Chinese rivals.

Last week, a Shanghai court ordered U.S.-based health care giant Johnson & Johnson to pay damages to a distributor in a lawsuit filed under the anti-monopoly law. The court said J&J improperly set minimum prices, depriving the local distributor of possible sales.

Meanwhile, China has ordered a recall of Fonterra infant formula after the dairy company announced Saturday that hundreds of tons of infant formula, sports drinks and other products might be tainted with bacteria that could cause botulism.

Also last month, police detained four employees of GlaxoSmithKline on charges they bribed doctors to prescribe the British pharmaceutical giant's drugs.

___

National Development and Reform Commission (in Chinese): www.sdpc.gov.cn

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Experts: Post, Globe different properties

Amazon founder Jeffrey Bezos agreed to shell out $250 million to buy The Washington Post yesterday in an abrupt and shocking acquisition coming just two days after Red Sox owner John Henry purchased The Boston Globe for a bargain $70 million — but industry observers say those prices reflect the properties' different values.

"The Boston Globe is The Boston Globe, The Washington Post is a different kind of story," said Harold Vogel, a media analyst with Vogel Capital Management. "It's much more of a national — international — paper, and it's in the center of the sausage-making, the politics-making capital, so it has a different value than Boston."

Bezos' cash deal includes The Washington Post newspaper, washingtonpost.com and the company's other regional papers, but doesn't include Slate or the Post's company headquarters. The Globe deal, on the other hand, has been seen largely as a real estate transaction with newspapers thrown in, because it includes the company's valuable Morrissey Boulevard property in a prime location just off the Southeast Expressway, in addition to the Worcester Telegram & Gazette.

"Clearly, there are some differences that would seem to make Henry's deal a sweet deal because he's getting real estate that's pretty close to what the purchase price was, so if he tries and doesn't succeed, he has that to fall back on," said Rick Edmonds of Poynter Institute. "I'm not aware of something like that in the Post instance. ... The Post is a bigger deal and it has national and international readership in the way the Globe doesn't."

The Post this year registered 431,149 average daily print circulation, while the Globe showed 172,048, according to the Alliance for Audited Media.

Newspaper analyst John Morton said there were several aspects at play that drove up the cost of the Post to 31⁄2 times the cost of the Globe.

"A stronger market position, no competition, a bigger reputation and probably a buyer who was willing to pay a premium in order to buy it," Morton said.

The Globe's sale had been a poorly kept secret since February when it was first announced, with leaks throughout the process when bidders' names and offer ranges emerged. The fact the Post had even been on the market stunned the industry when the sale news broke yesterday.

"If you had asked me yesterday if the Graham family would ever dispose of The Washington Post, I'd say never," Morton said. The Post was family-owned, built up following a bankruptcy auction purchase in 1933, while the Globe was bought by the New York Times in 1993 for $1.1 billion — its subsequent pennies-on-the-dollar sale showing the losses newspapers have suffered in the Internet era.

Henry yesterday toured the Globe newsroom for the first time since Saturday's announcement, meeting with reporters and editors, but has said he won't go into more specifics about his plans for the New England Media Group until the deal officially closes.

Henry has indicated he wants to bring in other leaders to help him with the "community commitment and effort" of running the Globe but hasn't mentioned any potential partners. Meanwhile, a Federal Communications Commission official said the agency's cross-ownership rules apply to traditional broadcast stations that use the public airwaves, and so don't apply to Henry's New England Sports Network, as a regional cable channel.

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Australian central bank cuts rate to 2.5 percent

CANBERRA, Australia — Australia's central bank has cut its benchmark interest rate by a quarter of a percentage point to a record low 2.5 percent because of slow growth and weakening commodity prices.

The Reserve Bank of Australia's decision at a monthly board meeting Tuesday in the first week of a federal election campaign was expected by economists.

The bank last cut the Official Cash Rate, which is a benchmark for other lending rates, by a quarter point in May following four cuts in 2012.

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Apple losing innovative core?

Apple is in trouble on its own turf — innovative design paired with wow-inducing product releases — showing signs of critical weakness in the pending redesign of one of its signature devices, the iPad, with the iPhone in danger of following suit.

The new iPad due this fall is reportedly designed in the image of the iPad Mini. Not smaller, just with the screen filling more of the body, according to rumors that peg the announcement and release dates at sometime this fall, possibly September.

But here's the puzzling part: There is no indication that Apple has plans to add a major innovation to the fifth generation of its trailblazing tablet. An iPad without a gimmick is like a man without a country. We want something like Retina display, which the third generation tablet introduced. Or a front-facing camera, as was introduced with the second iteration.

And when the fifth generation of the iPad is unveiled, I'd like to see at least one of the following game-changers added to the mix:

• Instant iCloud: Microsoft helped pioneer the idea of instant cloud backup for consumers. When you save a document in Office 365, it's backed up automatically to the so-called SkyDrive cloud service. Apple should rip off this idea, as we know it's had no trouble doing in the past.

• Waterproofing: Taking a page from the Samsung Galaxy S4 Active, outfitting the iPad with a substance-fighting exterior would really help those of us who use our favorite tablet as a recipe card. Not to mention those of us with children who subject our household electronics to daily punishment. Or anyone who wants to work with it out in the weather. Or play with it on the boat.

• Wireless charging: Again, Apple could pretend it invented this technology that is being used in Nokia Lumias and devices in Japan. I truly wouldn't mind the shamelessness of such a move if it meant I could easily charge my iPad on-the-go.

But here's what I expect instead: lots of talk about how amazing the new iPad is because of its new operating system, iOS 7. I expect a similar price structure to today's iPad, and perhaps an iPad Mini with Retina display that will be announced simultaneously.

It's around that same time — just on the brink of the holiday season — that Tim Cook & Co. will release a new iPhone and the final version of iOS 7. They would be smart to follow through with long-rumored plans to introduce a cheaper iPhone. I think many of us are sick of dropping hundreds of dollars on a new smartphone that is guaranteed to be outdated in 18 months. If Apple stops making strides with its iPad, keeping current with the iPhone is the only way it will remain the world's most valuable company.

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The Ticker

Time Warner, CBS in feud

Three million Time Warner Cable customers in New York, Los Angeles, Dallas and other cities remained without access to CBS for a third day yesterday, after the cable provider dropped the network in a spat over fees. Time Warner cut off CBS for viewers in select markets on Friday, saying the network is demanding retransmission fees that are out of line with what it pays other broadcasters. CBS said it had asked the cable provider to continue negotiating while its programming was still on the air.
IBT buying Newsweek

Newsweek is being sold for the second time in just a few years. The owner of the International Business Times said it's buying what is now an online-only brand for an undisclosed sum from InterActiveCorp. The publication ran its last print edition at the end of 2012.

TODAY

 Institute for Supply Management releases its service sector index for July.

TOMORROW

 Commerce Department releases international trade data for June.

 Labor Department releases job openings and labor turnover survey for June.

 CVS Caremark, Walt Disney and 21st Century Fox report quarterly earnings.

 Bristol County Savings Bank has appointed Stephen M. Hardy to the position of commercial lender. He is responsible for developing new business.

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F-250’s check engine light keeps coming on

My 2003 Ford F-250 6-liter turbo diesel with 57,000 "babied" miles is a costly concern. For three years, the "check engine" light comes on while driving. Two-thousand miles back, the Ford dealer replaced the turbo (rebuilt) and EGR valve at a cost of $3,000. Recently I took it back for the engine light and was told that I need a new turbo and EGR valve. I was informed that the turbo was not performing to its peak as the variable vanes were possibly corroded due to lack of use. Frankly, it seems to be running fine, even though the engine light is on.

Did the dealer offer any help with the cost of replacing the turbo and EGR valve after just 2,000 miles? More to the point, in order to identify the problem, it is important to record the DTC fault codes that triggered the check engine light. Without the specific fault codes, we can only guess at the issue.

My Alldata automotive database pulled up TSB 09-16-5, dated August 2009, that addresses low performance/turbo issues. It describes the possibility of "coking" in the turbocharger. This can occur when oil that lubricates the turbo bearings bakes or "cokes" from residual heat after shutting down the engine. Over time these deposits can build up to the point of impeding the response of the variable vanes in the turbo, causing high or low exhaust pressure leading to under or overboost and inaccurate EGR function.

It seems unlikely that the vanes have corroded in just 2,000 miles, but the coking deposits may well be causing the issue. Ask the Ford dealer three things — the precise DTC fault codes downloaded, whether cleaning the vanes in your turbo would help, and finally, will they pay part or all of the cost of replacing a 2,000-mile-old turbo?

I live in Florida by the ocean and I took my 2007 Nissan 350Z to the dealership recently to have my oil changed. I received the invoice and checkup paper, which said the air filter needs replacing in the near future. What the heck does that mean? Shouldn't they have asked me and done it when I was there? And also, how long before I should have it changed out?

The answer to each of your questions can be found in the owner's manual for your vehicle. On my radio shows, I used to ask callers if they'd found the 10 dollar bill every carmaker leaves in the pages of the owner's manual. The "what?' response confirmed that they'd never read the manual. Good fun!

In this case, I think the dealer was being a "good guy" by reminding you of an upcoming scheduled maintenance item, specifically air cleaner replacement. Nissan recommends replacement at 30,000-mile intervals. Might your Z be approaching 30,000, 60,000 or 90,000 miles?

I have a 2009 Chevy Malibu LT. Since May my interior lights have been going on and off sporadically. When I go over bumps, they flicker. In the morning on my way to work, they are completely off. Then around lunchtime when it's hot, they are on — all day and night until I park it in a cool location. When it's 65 degrees or less outside, the lights are off. I feel like it's heat-induced, but am not sure how to fix the problem.

Since the illuminated entry system controlled by the body control module (BCM) turns on the interior lights when a door switch is activated, I'd focus on the door switches. When they close, the circuit in the BCM is grounded and the lights illuminate. Perhaps heat is expanding an involved component just enough to electrically trigger the switch. Check that the dimmer switch is not rotated to the point of turning on the lights and you could try switching the dome light to the "off" position. The BCM should turn off the courtesy lights after 20 minutes.

Paul Brand, author of "How to Repair Your Car," is an automotive troubleshooter, driving instructor and former race-car driver. Readers may write to him at: Star Tribune, 425 Portland Ave. S., Minneapolis, Minn., 55488 or via email at paul brand@startribune.com. Please explain the problem in detail and include a daytime phone number. Because of the volume of mail, we cannot provide personal replies.

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Nurse at botched Ohio transplant sues over firing

COLUMBUS, Ohio — A veteran nurse present during a botched kidney transplant at an Ohio hospital last summer has sued for wrongful termination.

The lawsuit filed Friday in Columbus seeks $25,000 for Melanie Lemay, a nurse suspended then fired after a different nurse accidentally threw away a viable kidney as medical waste during the procedure last August.

After the error, the hospital apologized and put an administrator and two nurses on paid leave. Lemay alleges her subsequent termination was based on violating policies and procedures that didn't exist on the day of the operation.

The 30-year employee of the hospital alleges that operating room policies that hospital administrators turned over to investigators from the Department of Health and Human Services had an effective date of Aug. 16 — six days after the surgery.

An investigative report on the incident indicated no policy or procedures other than those dated Aug. 16 were presented to investigators as in place on the day of the failed procedure.

The suit states the other nurse failed to log out of the hospital computer system when she went on break, which required Lemay to make entries under that nurse's chart. Lemay said the second nurse did not ask for a status update on the transplant or the patient when she returned from lunch and proceeded to remove the kidney from the room and dispose of it.

Lemay says she did not see the items being removed nor know the other nurse had removed them. She was fired for violating policies on communications, logging out, and failing to stop the other nurse from removing items from the operation room before the procedure was concluded, the suit states.

University spokesman Tobin Klinger declined comment Saturday. "It would be inappropriate for us to comment on pending litigation," he said.

Besides the personnel actions, the hospital voluntarily suspended its kidney transplant program from August to December.

A report by a surgeon hired by the hospital to review its program called it "baffling" that the nurse would accidentally dispose of the viable kidney. At the same time, he found no problems with the systems that would have indicated the hospital was at risk for such a mistake. The nurse who threw out the organ resigned within weeks.

The family of the woman set to receive the kidney that day and her brother, who was her live donor, filed suit against the hospital last week alleging medical negligence and seeking $25,000 for each of eight plaintiffs.

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BMW 328i is all about performance

A sports sedan traditionally includes a manual gearbox and rear-wheel-drive that provide drivers with a more intimate connection with the road, but the BMW 328i challenges that with an eight-speed automatic transmission and all-wheel drive — features that will give a sports sedan purist pause.

My first impression as I slid into the driver's seat of our 328i tester was that the sedan was more about performance driving than luxury and comfort. That's not to say that the 328i lacks a well-appointed cabin. It's extremely comfortable with eight-way adjustable firm leather seats with the right amount of padding on the doors and center console to keep a driver comfortable yet alert and awake.

Our test BMW had a turbocharged in-line four-cylinder engine that put out 240 horsepower. BMW brands its all-wheel-drive feature as xDrive, in which power is distributed with a rear-wheel drive bias — a hard-to-live-without ­option for year-round New England driving.

The 328i's modest turbo provided plenty of might for around town and back-road driving. The extra gears from the eight-speed automatic transmission provided smooth and instantaneous power for passing on the highway. The sedan also has an auto start-stop function that turns the engine off when the car stops to conserve fuel. The feature can be deactivated if it becomes annoying.

The sedan has three driving modes — a fuel-sipping eco pro, comfort and sport. Switching to sport mode distinctively increased engine RPMs and acceleration. Toggling between the modes also changed the feel of the electronic-controlled steering. Four-wheel independent suspension allowed for spirited cornering with the ability to smooth out bridge expansion joints and other road bumps. Ventilated brakes, stability and traction controls provided peace of mind.

BMW takes safety technology to another level with its lane departure warning function. The feature not only uses warning lights to alert drivers if they unintentionally exit their lane but also sends an additional alert by vibrating the steering wheel.

Our test model, which topped out at just over $52,000, returned 33 mpg highway and 22 mpg city. While those gas mileage numbers are respectable, they are offset by the ­sedan's premium fuel require­ment.

The 328i has four optional equipment lines — luxury, modern, sport and M sport. Our tester equipped with the modern package was elegantly styled. Under­stated aluminum trim on the grille, intakes, and front and rear bumpers played well against the mineral gray metallic ex­terior paint. And the 18-inch turbine-style alloy wheels served as a re­minder of the sedan's performance abilities.

A 6.5-inch flat screen display in the center of the dashboard highlights the 328i's cockpit. Navigation and radio functions were easily accessed via a large dial located beside the shift lever. I found the 328i had good front and rear legroom and a spacious trunk. A split folding rear seat-back helps to create more trunk capacity. However, I found the sedan had limited storage along the doors and the center console cup holders­ were on the small side and too close together.

The 328i's all-wheel-drive option is a must-have for Northeast driving,­ and I personally liked the eight-speed automatic trans­mission. Sports ­sedan purists can drop the xDrive feature and go with a six-speed manual. Not enough power? More power can be found with the BMW 335i turbocharged six-cylinder.

There are plenty of other­ sports sedans worthy of consideration, but few can match the resale value of the BMW.

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Stretch out, entertain 
in Middleton

This large-scale home in Middleton is built for both entertaining and family living.

The four-bedroom single family at 11 Shipley Court sits on an acre of land in a 12-home subdivision about a mile from the center of town. The home has almost 5,500 square feet of living space on three levels, including a large finished basement with a full kitchen. Built in 2006, the home, which includes an in-ground saltwater pool and attached three-car garage, is on the market for $1,275,000.

The impressive exterior has blue clapboard with a fieldstone entryway and dormer, along with white trim. A covered entrance leads into a double-height foyer with a large brass chandelier and two coat closets. Off to the right, through French doors, is a home office/study.

The entire first floor has oak floors, and this includes the showpiece space — an enormous open kitchen/­dining/family room area with an adjoining formal dining room that's made for large-scale entertaining.

The expansive recessed-lighted kitchen has more than 35 custom cherrywood cabinets, rust-colored granite counters with tumbled-marble backsplash and a large central island and built-in bar area with a wine cooler. Off to one side is a large pantry. High-end appliances include two Thermador wall ovens, a Bosch dishwasher and a professional-grade Wolf gas stovetop with a center griddle.

There's a formal dining room off to the left, and an informal one adjoining the kitchen with glass doors that lead out to a rear deck. The deck overlooks the in-ground pool and a professionally landscaped yard with lots of trees, bushes, a garden area and a large grass backyard.

Back inside, the family room continues the entertainment theme. The large room with a columned entrance features a fieldstone-faced floor-to-ceiling gas fireplace, built-in bookcases and custom media center cabinetry with surround-sound speakers in the 10-foot ceilings.

On the other side of the kitchen sits a wing that could be an in-law or au pair suite, with a large room that could be a fifth bedroom and en-suite full bathroom. There's also direct access from a side hallway to the home's attached three-car garage.

Four bedrooms are on the second floor, off a stylish turning staircase in the foyer.

The master bedroom suite sits at the right end of the house, featuring a large bedroom with vaulted ceilings, oak floors and a marble-­surround gas fireplace. Off this room is a huge walk-in closet with built-in wardrobe and shelving areas. The en suite master bathroom has limestone floors and walls, and a raised whirlpool tub and glass-enclosed steam shower. There are limestone-topped vanities on either side of the entrance.

There are three other decent-sized carpeted children's bedrooms on this floor, each with two large double-door closets. In between sits a bathroom with ceramic tile floors and walls and a granite-topped double vanity. There's also a big laundry room on this floor with a granite counter for folding clothes as well as a sink.

The home's basement was finished by the current owners in 2007 into a large, recessed-lit entertainment area with ceramic tile floors that opens out onto the in-ground pool area built at the same time. There's a full kitchen here with custom cherrywood cabinets, granite counters and stainless steel appliances, a full ceramic-tiled bathroom and even a home gym. The unfinished areas of the basement hold the home's three-zone propane gas heating system, central air and central vacuum systems.

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