FDA approves new targeted breast cancer drug

WASHINGTON (AP) — The Food and Drug Administration has approved a first-of-a-kind breast cancer medication that targets tumor cells while sparing healthy ones.

The drug Kadcyla from Roche combines the established drug Herceptin with a powerful chemotherapy drug and a third chemical linking the medicines together. The chemical keeps the cocktail intact until it binds to a cancer cell, delivering a potent dose of anti-tumor poison.

Cancer researchers say the drug is an important step forward because it delivers more medication while reducing the unpleasant side effects of chemotherapy.

"This antibody goes seeking out the tumor cells, gets internalized and then explodes them from within. So it's very kind and gentle on the patients — there's no hair loss, no nausea, no vomiting," said Dr. Melody Cobleigh of Rush University Medical Center. "It's a revolutionary way of treating cancer."

Cobleigh helped conduct the key studies of the drug at the Chicago facility.

The FDA approved the new treatment for about 20 percent of breast cancer patients with a form of the disease that is typically more aggressive and less responsive to hormone therapy. These patients have tumors that overproduce a protein known as HER-2. Breast cancer is the second most deadly form of cancer in U.S. women, and is expected to kill more than 39,000 Americans this year, according to the National Cancer Institute.

The approval will help Roche's Genentech unit build on the blockbuster success of Herceptin, which has long dominated the breast cancer marketplace. The drug had sales of roughly $6 billion last year.

Genentech said Friday that Kadcyla will cost $9,800 per month, compared to $4,500 per month for regular Herceptin. The company estimates a full course of Kadcyla, about nine months of medicine, will cost $94,000.

FDA scientists said they approved the drug based on company studies showing Kadcyla delayed the progression of breast cancer by several months. Researchers reported last year that patients treated with the drug lived 9.6 months before death or the spread of their disease, compared with a little more than six months for patients treated with two other standard drugs, Tykerb and Xeloda.

Overall, patients taking Kadcyla lived about 2.6 years, compared with 2 years for patients taking the other drugs.

FDA specifically approved the drug for patients with advanced breast cancer who have already been treated with Herceptin and taxane, a widely used chemotherapy drug. Doctors are not required to follow FDA prescribing guidelines, and cancer researchers say the drug could have great potential in patients with earlier forms of breast cancer

Kadcyla will carry a boxed warning, the most severe type, alerting doctors and patients that the drug can cause liver toxicity, heart problems and potentially death. The drug can also cause severe birth defects and should not be used by pregnant women.

Kadcyla was developed by South San Francisco-based Genentech using drug-binding technology licensed from Waltham, Mass.-based ImmunoGen. The company developed the chemical that keeps the drug cocktail together and is scheduled to receive a $10.5 million payment from Genentech on the FDA decision. The company will also receive additional royalties on the drug's sales.

Shares of ImmunoGen Inc. rose 2 cents to $14.32 in afternoon trading. The stock has ttraded in a 52-wek range of $10.85 to $18.10.

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Syrian opposition says Assad cannot be part of deal

CAIRO (Reuters) - The opposition Syrian National Coalition is willing to negotiate a peace deal to end the country's civil war but President Bashar al-Assad must step down and cannot be a party to any settlement, members agreed after debating a controversial initiative by their president.

The meeting of the 70-member Western, Arab and Turkish-backed coalition began on Thursday before Syrian Foreign Minister Walid al-Moualem is due for talks in Moscow, one of Assad's last foreign allies, and as U.N. mediator Lakhdar Brahimi renews efforts for a deal.

After an angry late night session in which coalition president Moaz Alkhatib came under strong criticism from Islamist and liberal members alike for proposing talks with Assad's government without setting what they described as clear goals, the coalition adopted a political document that demands Assad's removal and trial for the bloodshed, members said.

A draft document seen by Reuters that was circulated for debate said Assad cannot be party to any political solution and has to be tried, but did not directly call for his removal.

"We have adopted the political document that sets the parameters for any talks. The main addition to the draft is a clause about the necessity of Assad stepping step down," said Abdelbasset Sida, a member of the coalition's 12 member politburo who has criticized Alkhatib for acting alone.

"We removed a clause about a need for Russian and U.S. involvement in any talks and added that the coalition's leadership has to be consulted before launching any future initiatives," he added.

Still, the agreement marked a softening of tone by the coalition because previously it had insisted that Assad must step down before any talks with his government could begin.

In an indication that Syria's strongman remains defiant, Brahimi said Assad had told him he will remain president until his term ends in 2014 and then run for re-election.

Brahimi told al-Arabiya television he wants to see a transitional government formed in Syria that would not answer to any higher authority and lasts until U.N.-supervised elections take place in the country.

"I am of the view that U.N. peacekeepers should come to Syria as happened in other countries," Brahimi said.

BOMB, AIR STRIKES

The opposition front convened in Cairo on a day when a car bomb jolted central Damascus, killing 53 people, wounding 200 and incinerating cars on a busy highway close to the Russian Embassy and offices of the ruling Baath Party.

Syrian state television blamed the suicide blast on "terrorists". Central Damascus has been relatively insulated from the 23-month conflict that has killed around 70,000 people, but the bloodshed has shattered suburbs around the capital.

In the southern city of Deraa near the border with Jordan, activists said warplanes bombed the old quarter for the first time since March 2011, when the town set in a wheat-growing plain rose up against Assad, starting a national revolt.

A rebel officer in the Tawheed al-Janoub brigade which led an offensive this week in Deraa said there were at least five air strikes on Thursday. The Syrian Observatory for Human Rights said 18 people were killed, including eight rebel fighters.

Coalition member Munther Makhos, who was forced into exile in the 1970s for his opposition to Assad's father, the late President Hafez al-Assad, said supplies from Iran and Russia were giving government forces an awesome firepower advantage.

"It would be surreal to imagine that a political solution is possible. Bashar al-Assad will not send his deputy to negotiate his removal. But we are keeping the door open," Makhos said.

Makhos is the only Alawite in the Islamist-dominated coalition. The Alawite sect, an offshoot of Shi'ite Islam which accounts for about 10 percent of Syria's population but makes up most of the intelligence apparatus and dominates the army and the political system, has generally remained behind Assad.

With Alawites feeling increasingly threatened by a violent Sunni backlash, Alkhatib, a cleric from Damascus who played a role in the peaceful protest movement against Assad at the beginning of the uprising in 2011, has been calling on Alawites to join the revolution, saying their participation will help preserve the social fabric of the country.

Alkhatib's supporters say the initiative has popular support inside Syria from people who want to see a peaceful departure of Assad and a halt to the war that has increasingly pitted his fellow Alawites against Syria's Sunni Muslim majority.

But rebel fighters on the ground, over whom Alkhatib has little control, are generally against the proposal.

The Syrian Islamic Liberation Front, which represents armed brigades, said in a statement it was opposed to Alkhatib's initiative because it ignored the revolt's goal of "the downfall of the regime and all its symbols".

"We are demanding his accountability for the bloodshed and destruction he has wreaked. I think the message is clear enough," said veteran opposition campaigner Walid al-Bunni, who supports Alkhatib.

Alkhatib formulated the initiative in broad terms last month after talks with the Russian and Iranian foreign ministers in Munich but without consulting the coalition, catching the umbrella organization by surprise.

Among Alkhatib's critics is the Muslim Brotherhood, the only organized group in the political opposition.

A Brotherhood source said the group will not scuttle the proposal because it was confident Assad is not interested in a negotiated exit, which could help convince the international community to support the armed struggle for his removal.

"Russia is key," the source said, speaking on condition of anonymity. "We are showing the international community that we are willing to take criticism from the street but the problem is Assad and his inner circle. They do not want to leave."

PLAY FOR RUSSIA

Russia hopes Alkhatib will visit soon in search of a breakthrough. Bunni said Alkhatib would not go to Moscow without the coalition's approval and that he would not be there at the same time as Moualem.

"In my opinion Alkhatib should not go to Moscow until Russia stops sending arms shipments to the Assad regime," Bunni said.

Formal backing by the coalition for Alkhatib's initiative gives it more weight internationally and undermines Assad supporters' argument that the opposition is too divided to be considered a serious player, opposition sources said.

Coalition members and diplomats based in the region said Brahimi asked Alkhatib in Cairo last week to seek full coalition backing for his plan, which resembles the U.N. envoy's own ideas for a negotiated settlement.

One diplomat in contact with the opposition and the United Nations had said a coalition approval of Alkhatib's initiative could help change the position of Russia, which has blocked several United Nations Security Council resolutions on Syria.

The diplomat said only a U.N. resolution could force Assad to the negotiating table, and a U.N. "stabilization force" may still be needed to prevent an all-out slide into a civil war.

"Brahimi has little hope that Assad will agree to any serious talks," the diplomat said. "Differences are narrowing between the United States and Russia about Syria but Moscow remains the main obstacle for Security Council action."

(Editing by Paul Taylor and Mohammad Zargham)

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American Idol: Sudden-Death Round Begins for Men

TV Watch

By Steve Helling

02/21/2013 at 11:00 PM EST

From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj and Keith Urban

George Holz/FOX

On Wednesday, 10 women sang for five spots on American Idol's live shows. On Thursday, it was the remaining guys' turn.

The judges have their own euphemisms when they don't like a performance – it's usually easy to read between the lines: If they compliment a singer on his shoes, he won't advance. On Thursday, Nicki Minaj actually told a contestant, "Kudos to you for being really freshly, nicely groomed." They might as well have had a stagehand pull him offstage with an oversized vaudeville hook.

After several weeks of good behavior by the judges, Thursday's episode showed a spark of life when Nicki – who was wearing her very best Jan Brady wig – began rolling her eyes whenever Randy Jackson spoke. At one point, Ryan Seacrest even tried to get them to kiss and make up. There was talk about lipstick, and Mariah Carey did her best to look at anything other than the awkward air kiss that followed.

But the theatrics did not eclipsed some solid singers – and a few performances that just weren't good enough for the competition.

The Good: Curtis Finch Jr. wowed judges with his version of Luther Vandross's "Superstar." It was oversung. But there was no denying Finch's vocal talent. Charlie Askew's rendition of Elton John's "Rocketman" was interesting and well-suited to his voice. And Devin Velez pleased the crowd when he infused Spanish lyrics into Beyoncé's "Listen." The three of them advanced easily.

The Okay: Elijah Liu chose Bruno Mars's "Talking to the Moon," a song that felt current and new. Paul Jolley sang Keith Urban's "Tonight I'm Gonna Cry." Generally, it's a risky move to sing a song made popular by one of the judges, but Jolley's performance was pleasant, if a little shaky. Both advanced, although the judges were split on their assessment of Jolley.

The Others: Johnny Keiser, Kevin Harris, Chris Watson and Jimmy Smith sang unspectacular versions of various songs that everyone knows. Each of them had a decent voice, but none of their performances were all that unique, and none of them advanced. On the other side of the spectrum, J'DA performed an over-the-top rendition of Adele's "Rumor Has It." It wasn't enough for him to advance, but his performance – at one point he collapsed on the floor but continued singing – was by far the most memorable of the night.

There are ten contestants – five men and five women – who have made it to the next round. Next week, the remaining 20 contestants will complete for the remaining 10 spots – and all will hope the judges don't compliment what they're wearing.

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APNewsBreak: Govs to hear Oregon health care plan

SALEM, Ore. (AP) — Oregon Gov. John Kitzhaber will brief other state leaders this weekend on his plan to lower Medicaid costs, touting an overhaul that President Barack Obama highlighted in his State of the Union address for its potential to lower the deficit even as health care expenses climb.

The Oregon Democrat leaves for Washington, D.C., on Friday to pitch his plan that changes the way doctors and hospitals are paid and improves health care coordination for low income residents so that treatable medical problems don't grow in severity or expense.

Kitzhaber says his goal is to win over a handful of other governors from each party.

"I think the politics have been dialed down a couple of notches, and now people are willing to sit down and talk about how we can solve the problem" of rising health care costs, Kitzhaber told The Associated Press in a recent interview.

Kitzhaber introduced the plan in 2011 in the face of a severe state budget deficit, and he's been talking for two years about expanding the initiative beyond his state. Now, it seems he's found people ready to listen.

Hospital executives from Alabama visited Oregon last month to learn about the effort. And the U.S. Department of Health and Human Services announced Thursday that it's giving Oregon a $45 million grant to help spread the changes beyond the Medicaid population and share information with other states, making it one of only six states to earn a State Innovation Model grant.

Kitzhaber will address his counterparts at a meeting of the National Governors Association. His talk isn't scheduled on the official agenda, but a spokeswoman confirmed that Kitzhaber is expected to present.

"The governors love what they call stealing from one another — taking the good ideas and the successes of their colleagues and trying to figure out how to apply that in their home state," said Matt Salo, director of the National Association of Medicaid Directors.

There's been "huge interest" among other states in Oregon's health overhaul, Salo said, not because the concepts are brand new, but because the state managed to avoid pitfalls that often block health system changes.

Kitzhaber persuaded state lawmakers to redesign the system of delivering and paying for health care under Medicaid, creating incentives for providers to coordinate patient care and prevent avoidable emergency room visits. He has long complained that the current financial incentives encourage volume over quality, driving costs up without making people healthier.

Obama, in his State of the Union address this month, suggested that changes such as Oregon's could be part of a long-term strategy to lower the federal debt by reigning in the growing cost of federally funded health care.

"We'll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn't be based on the number of tests ordered or days spent in the hospital — they should be based on the quality of care that our seniors receive," Obama said.

The Obama administration has invested in the program, putting up $1.9 billion to keep Oregon's Medicaid program afloat over the next five years while providers make the transition to new business models and incorporate new staff and technology.

In exchange, though, the state has agreed to lower per-capita health care cost inflation by 2 percentage points without affecting quality.

The Medicaid system is unique in each state, and Kitzhaber isn't suggesting that other states should adopt Oregon's specific approach, said Mike Bonetto, Kitzhaber's health care policy adviser. Rather, he wants governors to buy into the broad concept that the delivery system and payment models need to change.

That's not a new theory. But Oregon has shown that under the right circumstances massive changes to deeply entrenched business models can gain wide support.

What Oregon can't yet show is proof the idea is working — that it's lowering costs without squeezing on the quality or availability of care. The state is just finishing compiling baseline data that will be used as a basis of comparison.

One factor driving the Obama administration's interest in Oregon's success is the president's health care overhaul. Under the Affordable Care Act, millions more Americans will join the Medicaid rolls after Jan. 1, and the health care system will have to be able to absorb the influx of patients in a logistically and financially sustainable way.

The federal government will pay 100 percent of the costs for those additional patients in the first three years before scaling back to 90 percent in 2020 and beyond.

"There are a lot of governors who are facing the same challenges we're facing in Oregon," Kitzhaber said. "They recognize that the cost of health care is something they're going to have to get their arms around."

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Jobs, factory, inflation data favor easy Fed policy

WASHINGTON (Reuters) - A raft of U.S. economic data on Thursday from claims for jobless aid to factory activity and consumer prices pointed to a still tepid recovery and supported the argument for the Federal Reserve to maintain its monetary stimulus.

The Fed is currently buying $85 billion in bonds per month and has said it would keep up purchases until the labor market outlook improves substantially, although officials are increasingly divided over the wisdom of that course.

"The economy is in a holding pattern. It's not going to strengthen sufficiently to justify an end of the current program," said Millan Mulraine, senior economist at TD Securities in New York.

Initial claims for state unemployment benefits increased 20,000 last week to a seasonally adjusted 362,000, unwinding the bulk of the prior week's decline, the Labor Department said.

A second report from the department showed consumer prices were flat for a second straight month in January as gasoline prices fell and the cost of food held steady.

In the 12 months through January, consumer prices rose 1.6 percent, the smallest gain since July. That suggested there was little inflation pressure to worry the Fed.

Concerns over tepid job growth prompted the U.S. central bank last year to embark on its open-ended bond buying program.

However, minutes of the Fed's January 29-30 policy meeting published on Wednesday showed some policymakers feel the central bank may have to slow or stop the asset purchases before it sees an acceleration in job growth because of concerns over the financial risks of the program.

Those diverging views were evident on Thursday, with two Fed officials signaling support for scaling back the program, while another outlined the case for maintaining bond purchases until well into the second half of the year.

MANUFACTURING SLOWING

News on the manufacturing sector, which has supported the economy's recovery from the 2007-09 recession, was downbeat.

The Philadelphia Fed's business activity index dropped to minus 12.5 in February, the lowest level since June. The index, which measures factory activity in the mid-Atlantic region, had fallen to minus 5.8 in January.

A reading below zero indicates contraction in the region's manufacturing sector. The survey covers factories in eastern Pennsylvania, southern New Jersey and Delaware.

Another report from financial data firm Markit that tries to gauge overall national factory activity showed manufacturing growth slowed in February but remained near a nine-month peak.

"We believe manufacturing activity will continue to expand early in 2013," said Daniel Silver, an economist at JPMorgan in New York.

The claims and factory reports, as well as weak data from Europe weighed on U.S. stocks. The Standard & Poor's 500 index recorded its worst two-day loss since November.

Prices for U.S. government debt rose and the dollar touched a 5-1/2-month high against a basket of currencies.

Growth in the U.S. economy braked sharply in the fourth quarter, but it expanded at a 2.2 percent clip for the full year. Output is being hampered by lackluster demand as employment struggles to gain traction.

Job growth has been far less than the at least 250,000 per month over a sustained period that economists say is needed to significantly reduce the ranks of unemployed. The unemployment rate rose 0.1 percentage point to 7.9 percent in January.

Last week's claims data covered the survey period for the government's closely watched monthly tally of nonfarm jobs. Claims were up 27,000 between the January and February survey periods.

However, the increase probably does not suggest any material change in the pace of job growth given that claims have been very volatile since January because of difficulties smoothing the data for seasonal fluctuations.

Despite the weak factory and jobs data, there is reason for optimism about the economy. The housing market recovery is gaining momentum.

A report from the National Association of Realtors showed existing home sales rose 0.4 percent last month, pushing the supply of homes on the market to a 13-year low. The median home price rose 12.3 percent from a year earlier.

Rising home values should help to support consumer spending.

Although consumer prices excluding food and energy rose 0.3 percent - the largest gain since May 2011 - most of that reflected outsized increases in apparel and education costs.

"January is a tough month because you get a lot of price hikes at the start of the new year and the seasonals have a hard time sort of adjusting," said Omair Sharif, an economist at RBS in Stamford, Connecticut.

"I don't expect the core CPI to maintain that pace of increase in the near term."

(Additional reporting by Jason Lange in Washington and Steven C Johnson in New York; Editing by Andrea Ricci and James Dalgleish)

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Mexico security forces abducted dozens in drug war: rights group

IGUALA, Mexico (Reuters) - Dozens of people were abducted and murdered by Mexican security forces over the past six years during a gruesome war with drug cartels, Human Rights Watch said on Wednesday, urging President Enrique Pena Nieto to overhaul the military justice system.

The rights group said that since 2007 it has documented 149 cases of people who were never seen again after falling into the hands of security forces, and that the government failed to properly investigate the "disappearances."

"The result was the most severe crisis of enforced disappearances in Latin America in decades," the U.S.-based group said. (Human Rights Watch report: http://r.reuters.com/fyk26t)

It recommended reforming Mexico's military justice system and creating a national database to link the missing with the thousands of unidentified bodies that piled up during the military-led crackdown on drug cartels.

The report was a grim reminder of the dark side of the war on drug cartels that killed an estimated 70,000 people during former President Felipe Calderon's six-year presidency.

The report also illustrates the obstacles that President Pena Nieto, who took office in December, faces in trying to stem the violence, restore order over areas of the country controlled by the drug cartels and end abuses by security forces.

For nearly three years, 56-year-old shopkeeper Maria Orozco has sought to discover the fate of her son. She says he was abducted along with five colleagues by soldiers from the nightclub where they worked in Iguala, a parched town south of the Mexican capital.

She says a grainy security video, submitted anonymously, shows the moment in 2010 when local soldiers rounded up the men.

"We used to see the military like Superman or Batman or Robin. Super heroes," said Orozco. "Now the spirit of the whole country has turned against them."

Hers was one of the cases illustrated in the Human Rights Watch report.

Pena Nieto has vowed to take a different tack to his predecessor Calderon and focus on reducing violent crime and extortion rather than on going head to head with drug cartels.

The government last month introduced a long-delayed law to trace victims of the drug war and compensate the families. It says it is moving ahead with plans to roll out a genetic database to track victims and help families locate the disappeared.

"There exists, in theory, a database with more than 27,000 people on it," said Lia Limon, deputy secretary of human rights at Mexico's interior ministry. "It's a job that's beginning."

Still, impunity remains rife. The armed forces opened nearly 5,000 investigations into criminal wrongdoing between 2007 and 2012, but only 38 ended in sentencing, according to Human Rights Watch.

In its report it describes the impact of the disappearances on victims' families, a daily reality for Ixchel Mireles, a 50-year-old librarian from the northern city of Torreon, whose husband Hector Tapia was abducted by men in federal police uniforms.

Neither Mireles nor her daughter has heard from Tapia since that night in June 2010.

"I want him to be alive, but the reality just destroys me," said Mireles. "I just want them to give him back, even if he is dead."

Since her husband's disappearance, Mireles has struggled financially, having lost his 40,000 pesos ($3,143) a month salary. She has moved her daughter to a cheaper university and can barely keep up payments on her house.

"I now travel by foot," she said, noting that Mexico's social security system does not recognize the disappeared.

Some family members of the disappeared have asked for soldiers guilty of rights abuses to be judged like civilians, a move Mexico's Supreme Court has approved.

"To us it just seems that the military is untouchable," said Laura Orozco, 36, who says she witnessed her brother's military-led abduction. "They're bulletproof."

($1 = 12.73 pesos)

(Additional reporting by Michael O'Boyle,; Editing by Simon Gardner, Kieran Murray and Lisa Shumaker)

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American Idol: Women Face Sudden-Death Round

American Idol

By Jamie Bufalino

02/20/2013 at 11:00 PM EST

Mariah Carey

Mario Anzuoni/Reuters/Landov

American Idol threw yet another new twist at its 40 remaining contestants: a sudden-death round.

"One song, one chance, no mercy," Ryan Seacrest said as the first group of 10 female contestants gathered in Las Vegas to try to finally sing their way – in front of a boisterous studio audience – through to the "America votes" phase of the competition.

Five women moved on, five went home.

Kentucky high school junior Jenny Beth Willis, whose rendition of a Trisha Yearwood song earned mixed reviews from the judges, was the first up. Although Keith Urban appreciated her "effortless confidence," Nicki Minaj said her performance lacked excitement (a comment that elicited the first audience boos of the season). Final result: It was the end of the road for Willis.

Tenna Torres, 28, – who attended Mariah Carey's camp for kids as a youngster – took the stage next and impressed the judges with her take on the Natasha Bedingfield's "Soulmate." But she lost style points with Minaj, who didn't like one particular aspect of her look. "Lose the hair," said Minaj, who felt the contestant's coif aged her. Final result: She made it through to the Top 20.

The three most powerful performances of the night all made it to the next round: Nashville's Kree Harrison, who despite taking a decidedly plain-Jane approach to styling, wowed the judges with her version of Patty Griffin's "Up to the Mountain." "You sang the hell out of that song," said Carey.

Angela Miller, 18, of Massachusetts, belted out Jessie J's hit "Nobody's Perfect." But she pretty much was.

And Amber Holcomb, an assistant teacher from Texas, closed the show with a rousing (and well received) rendition of "My Funny Valentine."

For the final spot of the night, it came down to Anchorage, Alaska, resident Adriana Latonio, 17, who tackled Aretha Franklin's "Ain't No Way," and Shubha Vedula, a Michigan high school senior who sang Lady Gaga's "Born This Way."

Although the judges saw potential in both contestants, they ultimately picked Lantonio's powerhouse vocals in a final emotional moment.

Thursday will bring out the guys. The first round of 10 will take the stage to try to make the top 20 – but once again, five will go home.

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Adults get 11 percent of calories from fast food

ATLANTA (AP) — On an average day, U.S. adults get roughly 11 percent of their calories from fast food, a government study shows.

That's down slightly from the 13 percent reported the last time the government tried to pin down how much of the American diet is coming from fast food. Eating fast food too frequently has been seen as a driver of America's obesity problem.

For the research, about 11,000 adults were asked extensive questions about what they ate and drank over the previous 24 hours to come up with the results.

Among the findings:

— Young adults eat more fast food than their elders; 15 percent of calories for ages 20 to 39 and dropping to 6 percent for those 60 and older.

— Blacks get more of their calories from fast-food, 15 percent compared to 11 percent for whites and Hispanics.

— Young black adults got a whopping 21 percent from the likes of Wendy's, Taco Bell and KFC.

The figures are averages. Included in the calculations are some people who almost never eat fast food, as well as others who eat a lot of it.

The survey covers the years 2007 through 2010 and was released Thursday by the Centers for Disease Control and Prevention. The authors couldn't explain why the proportion of calories from fast food dropped from the 13 percent found in a survey for 2003 through 2006.

One nutrition professor cast doubts on the latest results, saying 11 percent seemed implausibly low. New York University's Marion Nestle said it wouldn't be surprising if some people under-reported their hamburgers, fries and milkshakes since eating too much fast food is increasingly seen as something of a no-no.

"If I were a fast-food company, I'd say 'See, we have nothing to do with obesity! Americans are getting 90 percent of their calories somewhere else!'" she said.

The study didn't include the total number of fast-food calories, just the percentage. Previous government research suggests that the average U.S. adult each day consumes about 270 calories of fast food — the equivalent of a small McDonald's hamburger and a few fries.

The new CDC study found that obese people get about 13 percent of daily calories from fast food, compared with less than 10 percent for skinny and normal-weight people.

There was no difference seen by household income, except for young adults. The poorest — those with an annual household income of less than $30,000 — got 17 percent of their calories from fast food, while the figure was under 14 percent for the most affluent 20- and 30-somethings with a household income of more than $50,000.

That's not surprising since there are disproportionately higher numbers of fast-food restaurants in low-income neighborhoods, Nestle said.

Fast food is accessible and "it's cheap," she said.

___

Online:

CDC report: http://www.cdc.gov/nchs/

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Wall Street ends down sharply after Fed minutes

TORONTO, Feb 20 (Reuters) - Canada's Rebecca Marino, a rising star in women's tennis, stepped away from the sport in search of a normal life on Wednesday, weary of battling depression and cyber-bullies. Ranked number 38 in the world two years ago, the 22-year-old admitted she had long suffered from depression and was no longer willing to make the sacrifices necessary to reach the top. "After thinking long and hard, I do not have the passion or enjoyment to drive myself to the level I would like to be at in professional tennis," Marino explained in a conference call. ...

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Insight: Rome will burn, regardless of Italian election result

ROME (Reuters) - Regardless of who wins next weekend's parliamentary election, Italy's long economic decline is likely to continue because the next government won't be strong enough to pursue the tough reforms needed to make its economy competitive again.

Bankers, diplomats and industrialists in Rome and Milan despair at how Italians are shifting allegiances ahead of the February 24-25 vote to favor anti-establishment upstarts and show disgust with the established parties.

That makes it more likely that no bloc will have the political strength to tackle Italy's deep-rooted economic crisis, which has made it Europe's most sluggish large economy for the past two decades.

Final opinion polls predict that the vote will deliver a working majority in both houses for a centre-left coalition governing in alliance with technocrat former prime minister Mario Monti. Political risk consultancy Eurasia assigns this scenario a 50-60 percent probability.

But Italy's election for both chambers of parliament has the potential to tip the euro zone back into instability if the outcome does not produce that result.

The colorful cast of candidates includes disgraced media tycoon Silvio Berlusconi, one of the world's richest men, the bespectacled academic Monti, anti-establishment comedian Beppe Grillo who campaigns from a camper van, and Nichi Vendola, a former communist poet who is the governor of Puglia.

Investors have so far taken a relaxed view, relying on polls produced until the legal deadline for surveys of Feb 10.

One of the best indicators that they are not worried: Italian benchmark 10-year bond yields, which topped six percent during the country's worst political moments in 2011, are now trading around 4.4 percent, almost a full percentage point lower than those of Spain.

Italian stocks have performed broadly in line with the wider European market since January, despite the election and a wave of scandals which has engulfed several leading Italian groups.

But observers in Italy are increasingly nervous that the rosy election scenario favored by investors may not work out.

A jaded electorate, angry about political corruption, economic mismanagement and a national crisis that has impoverished a once-wealthy member of the G7 club of rich nations, could produce a surprise.

Pier Luigi Bersani, the standard-bearer for the centre-left, is a worthy but lackluster former minister whose party has been linked to a banking scandal in the mediaeval Tuscan town of Siena. Support for his party now seems to be fading.

Opponents have latched on to the fact that the ailing bank, Monte dei Paschi, was run by a foundation dominated by political appointees from the centre-left and accused Bersani's party of presiding over a debacle that will cost taxpayers hundreds of millions of euros.

CAMPER VAN POLITICS

Monti, dubbed "Rigor Montis" by one opponent for his austerity policies which critics say hurt growth, is stuck in fourth place and slipping. Detractors say he comes across poorly on the hustings and has been hurt because he formed an election alliance with two discredited centrist politicians who are emblematic of the traditional politics which Monti disavows.

The big gainer in the final days before the election, according to private surveys quoted by experts, is stand-up comedian Beppe Grillo and his anti-establishment 5-Star Movement. Grillo has been on a "tsunami tour" of Italy in a camper van, filling piazzas with his ringing denunciations of the country's political class. He campaigns mainly on the Internet, where his widely read blog features a list of Italy's parliamentarians convicted of a crime (it features 24 names).

"The big question is: what happens to Grillo?" said one senior banker in Milan, speaking on condition of anonymity. "He won't win but he could stop Bersani and Monti from getting enough seats to form an effective government."

Under the electoral law in force for this poll, which almost all Italians agree is in need of reform, voters cast ballots for a party list. The coalition with the most votes is awarded top-up seats in the lower house to give it a 55 percent majority. But in the Senate, the top-up premium applies by region.

Pollsters say the race is too close to call in a few battleground regions but there is a good chance the centre-left will fall short of a majority in the Senate, which has equal law-making powers to the lower house.

A substantial vote for Grillo's movement - and some experts suggest he could top 20 percent - could mean the new parliament is filled with new, inexperienced, anti-establishment deputies who may refuse to do deals with other politicians and block legislation. Bersani and Monti could find themselves without a workable majority in the Senate even in alliance - a scenario which Eurasia believe has a 20-30 percent probability.

"It's hard to see Grillo's movement as a source of stability," said one diplomat, speaking off the record. "There is no chance they would be part of a coalition."

CONVICTION POLITICIAN

Ironically Grillo himself will not be entering parliament regardless of how well his movement does. The shaggy-haired 63-year-old was convicted of manslaughter after three passengers died when a jeep he was driving crashed in 1981, making him ineligible for election under his own party's rules barring convicted criminals from parliament.

"Grillo's agenda is just silly," said one leading Italian columnist, speaking anonymously because his publication did not allow him to be quoted in other media before the vote.

"It's a fuck off policy. He wants to leave Europe, set up people's tribunals, halve public employees. It's the most visible symptom of Italy's political crisis."

The 5-Star Movement is not the only anti-establishment force threatening to make Italy ungovernable. The federalist Northern League, which favors greater autonomy for northern Italy, is polling around five percent nationally. Its leader Roberto Maroni told Reuters last week he would use his seats in parliament in alliance with the centre-right to block a centre-left coalition and prevent it from governing.

The League is particularly important in the Senate as its home region of Lombardy, where the party polls about 15 percent, returns by far the most senators - 49 out of a chamber of 319.

Should Grillo's movement and the Northern League win enough seats to deprive a centre-left coalition with Monti of an overall majority, the most likely outcome is a "grand coalition" of left and right, experts say.

Such a result would unsettle investors because it would be likely to bring centre-right leader former premier Berlusconi, 76, back into government in a key role and Monti would be unlikely to join it.

Berlusconi's own party has boosted its standing in polls over the past month, helped by the former premier's veteran campaigning skill and his dominance of the country's private TV channels. But nobody apart from his own supporters believes he is likely to win this time.

POPE FACTOR

Pope Benedict's unexpected resignation this month has pushed the parliamentary election off the front pages in Italy, giving Berlusconi less print space and TV air time to press his populist message. The main beneficiary appears to be Grillo, whose strategy of ignoring mainstream media and campaigning on the Internet has been unaffected by the news from the Vatican.

Investors above all want a government which will tackle the reasons for Italy's lackluster performance. Italy has hardly grown since the birth of the euro in 1999 and its economy has slumped faster since the 2007 financial crisis than any other in Europe except Greece. Last year, Italy contracted by 2.2 percent, according to official statistics.

Businessmen complain of three main obstacles: stifling bureaucracy, labor laws which offer workers so much protection that they encourage slack performance, and a dysfunctional court system which makes it hard to enforce contracts and collect debts. All are deep-rooted problems and none is likely to be tackled effectively by a weak and divided government.

"Nobody in Italy is ready to make the reforms our country needs right now," said the chief executive of a major Italian company, speaking off the record.

"I am deeply convinced that without a major change in labor flexibility, we will not be able to increase productivity. My personal experience is that Italian labor is fantastic. But if you take a very good worker and tell him his job is completely safe, you will turn him into a slacker."

Italy's byzantine court system - where cases can languish for years - and its legendary bureaucracy are major obstacles to foreign investment and competitiveness, business people and diplomats say. "Foreign companies are surprised by how hard it is to get things done here which we all thought had been agreed in Brussels 20 years ago," said one senior European diplomat.

Monti's technocratic government won plaudits from business for reforming Italy's pension system but its efforts to reform labor laws did not enjoy similar success. Monti's government lasted 13 months until Berlusconi's bloc triggered its collapse by withdrawing support. Some observers in Italy don't believe that the next parliament's make-up will be nearly as conducive to reform as the outgoing one.

MUDDLE-THROUGH OUTCOME

"I want to be optimistic but my best guess is that they will keep to this muddle-through scenario in the next parliament with lackluster results for the economy," said a second senior diplomat. "This country needs a new generation of political leaders."

Key among the concerns of diplomats and business people is the disparate nature of the centre-left coalition leading in polls.

Bersani's election alliance is made up of four main parties, stretching from the former communist Vendola through the Christian left to socialists and centrists. If it is unable to govern alone, as most polls predict, it will need the support of Monti's bloc - itself made up of three parties.

Bankers fear that a government made up of seven different groups of widely varying political hues is highly unlikely to agree on the tough, radical reform measures the country needs.

"If we have a government made up of Bersani, Monti and Vendola, they will argue all the time," said the chief executive. "Bersani and Vendola's capacity for reform is almost zero." Comparing the present Italian centre-left candidate to the former German chancellor whose successful labor reforms belied his socialist roots, he added: "Bersani is no Schroeder".

Bersani's economic spokesman Stefano Fassina insists that the centre-left fully understands the urgency of Italy's economic plight and is committed to deliver on measures to stop the rot. But he puts the emphasis on making the public sector more efficient and persuading Berlin to tone down budget austerity at a European level rather than pursuing labor reform in Italy. Fassina insists that public commitments by Bersani and Vendola on an agreed program will minimize disagreements but he does admit to concern about how a centre-left administration could work with Grillo's unpredictable forces.

"It's impossible to have any discussions with Grillo as a party," he said. "We hope that in parliament some of his MPs will be pragmatic enough to agree on reasonable measures."

With so much uncertainty about the election and the chances fading of it returning a strong, stable reformist government, it is hard to avoid the conclusion that Italy's slow, steady economic decline will continue regardless of the result.

"We've seen a steady economic decline in Italy over the past 20 years and it's very hard to see any outcome from this election which will reverse that. The reforms which would really get the country going again are out of reach," concluded the European diplomat.

(Editing by Peter Millership and Giles Elgood)

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