Dolly Parton talks dreams, love, plastic surgery

NEW YORK (Reuters) – Although Dolly Parton has cemented her place in country and popular music, pop culture, and as an entrepreneur and philanthropist, she still, on occasion, gets nervous.

Her new book, “Dream More: Celebrate the Dreamer in You” encourages readers to overcome their fears, believe in their passions and keep taking risks.

The “I Will Always Love You” singer/songwriter, 66, who has written more than 3,000 songs and sold more than 100 million records, talked to Reuters about the message of the book, which was published this week.

Q. You say you put off writing this book?

A. “It’s just a simple little book. It’s not meant to save the world, or it’s not a complete book of how to be successful, but I think there is enough stuff in it for people to see kinda how I conduct my business and kinda what my thoughts are. And the good part is that all the money, if it sells good, goes to Imagination Library.”

Q. Right – your nonprofit quest to get kids to read?

A. “It’s one of the reasons I wanted to write this too, because I usually do concerts every year, for the foundation to make money to afford a lot of books, but I am not on tour now.”

Q. Talk about your 2009 commencement address at the University of Tennessee. Were you nervous?

A. “Well, yes, when I am out of my element doing things. I am not that educated and I didn’t go that far in school and I thought, ‘What am I going to say to these educated people, not just these kids who have just graduated college and are probably brilliant, but all these professionals and all these teachers?’ And I thought, ‘Oh, I am not smart enough’, but I thought, ‘Well, at least I am a hometown girl. At least they can see that in America, you can start from humble beginnings, that everybody can make it.”

Q. Which is one of the book’s messages, overcoming fears?

A. “Any time I am in a situation where I am just not comfortable, I am uneasy, but that doesn’t mean I won’t go on with it, just like the speech. And that I won’t be good at it, but there are just some things I would prefer not to do!”

Q. Success doesn’t equal happiness, yet you seem so hopeful and modest?

A. “I am always hopeful as a person, I have been since I was little…I really want things to be good. As I mention in the book, I wake up everyday expecting it to be good, and if it is not, then I try to set about changing it before I go to sleep at night.”

Q. Would you describe yourself as religious or spiritual?

A. “Just spiritual, I am not religious. Although I grew up in a very religious family, but…I am no fanatic by any stretch of the word, and I am no angel, believe me. I wrote a song called ‘The Seeker’ many, many years ago, and it says ‘I am a seeker, just a poor sinful creature, there is no one weaker than I am.’

“People say, ‘What do you regret?’ I say, ‘I can’t say that I regret anything because at the time I was doing it, whatever it was, it seemed to be the thing to be doing at the time.’

“I have a good friend base, I have a good husband. So I have a lot of things and people who help me and guide me. I have never had to go to a psychiatrist, but I would if I thought that I needed to.

Q. But we are in New York, Dolly! No psychiatrist?

A. “Well yes (laughs), I guess not. But I do that in my songs, I write my feelings out and then I have such a strong faith and then I have such good friends. I am very close to several of my sisters, and we just talk about everything and anything….And my best friend Judy, there is nothing I can’t tell her, even if it is the awful-est thing in the world.”

Q. You recently had to deny gay rumors. Who is your greatest love?

“My husband is my greatest love, I have been with him 48 years…He is my best buddy.”

Q. Why do you think people always wonder about him?

A. “They don’t think he really exists! When I was doing my show, we were thinking about having a different guy knock on the door every night, as my husband, and then one night he would be a midget, and one night he would be a black man, and one night he would be like a boxer or a wrestler, all these different things that people imagine what my husband looks like.”

Q. You say that looking so artificial works for you, as it lets you prove how real you are. Why all the plastic surgery?

A. “Because I need it. Why does anybody get it?”

Q. Why do you think you need it?

A. “Because I am in show business. I am not a natural beauty. And I am on camera all the time. And I just always see, like if I need – Oh take one of my chins off, at least! – Or whatever. I mean, I don’t go to extremes with it. I just do little bits and pieces, just to try and keep things touched up, just tweaking.”

(Reporting by Christine Kearney, editing by Jill Serjeant and Carol Bishopric)

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A slick stereotype: L.A. drivers unable to handle the rain

Far removed from the many SigAlerts and traffic accidents caused by the rain, umbrella-toting pedestrians stroll on the Huntington Beach Pier before dawn on Thursday. (Mark Boster / Los Angeles Times / November 29, 2012)

By Kate Mather, Los Angeles Times

November 29, 2012, 7:56 p.m.

You know what they say: L.A. drivers can't handle the rain.

Many motorists didn't disprove the stereotype Thursday as rain slickened roadways and snarled the morning commute. The California Highway Patrol reported more than three times as many accidents (294) between 12:01 a.m. and 4:30 p.m. Thursday than in the same time period a week ago (90), on Thanksgiving.

Although there were some morning crashes that shut down area freeways — including a jackknifed big rig on the 5 Freeway in Glendale and a fatal crash on the 134 in Toluca Lake — CHP Officer Ed Jacobs said most were single-car spinouts.

"People are driving too fast for the roadway," Jacobs said. "Slow down. It's really simple. There is no other thing to do."

Of the many jokes about the storm shared via social media, many focused on traffic.

"Los Angeles + rain = Carmageddon," @Nick_Favorite wrote.

"The only thing worse than LA drivers? LA drivers in the rain," @LiliannaEvelyn said.

But drivers, beware. More wet weather is in store for California through the weekend. Forecasters said scattered showers should persist as a series of storms passes through the area, the strongest of which should hit Sunday afternoon and evening.

Jacobs called the number of reported accidents "huge" but said it was typical for a rainy day in Los Angeles.

But is it proof L.A. drivers can't handle the rain?

"You'll have to draw your own conclusion on that one," Jacobs said.

kate.mather@latimes.com

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he’s a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America’s battlefields and an “honest conversation about the country’s history.”

___

Online:

http://www.traceadkins.com

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Medicare Is Faulted in Electronic Medical Records Conversion

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

Mike Spencer/Wilmington Star-News, via Associated Press

Celeste Stephens, a nurse, leads a session on electronic records at New Hanover Regional Medical Center in Wilmington, N.C.

Centers for Medicare and Medicaid Services

Marilyn Tavenner, acting administrator for Medicare.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

Medicare “faces obstacles” in overseeing the electronic records incentive program “that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the investigators concluded. The report was prepared by the Office of Inspector General for the Department of Health and Human Services, which oversees Medicare.

The investigators contrasted the looser management of the incentive program with the agency’s pledge to more closely monitor Medicare payments of medical claims. Medicare officials have indicated that the agency intends to move away from a “pay and chase” model, in which it tried to get back any money it has paid in error, to one in which it focuses on trying to avoid making unjustified payments in the first place.

Late Wednesday, a Medicare spokesman said in a statement: “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable. Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance.”

The government’s investment in electronic records was authorized under the broader stimulus package passed in 2009. Medicare expects to spend nearly $7 billion over five years as a way of inducing doctors and hospitals to adopt and use electronic records. So far, the report said, the agency has paid 74, 317 health professionals and 1,333 hospitals. By attesting that they meet the criteria established under the program, a doctor can receive as much as $44,000 for adopting electronic records, while a hospital could be paid as much as $2 million in the first year of its adoption. The inspector general’s report follows earlier concerns among regulators and others over whether doctors and hospitals are using electronic records inappropriately to charge more for services, as reported by The New York Times last September, and is likely to fuel the debate over the government’s efforts to promote electronic records. Critics say the push for electronic records may be resulting in higher Medicare spending with little in the way of improvement in patients’ health. Thursday’s report did not address patient care.

Even those within the industry say the speed with which systems are being developed and adopted by hospitals and doctors has led to a lack of clarity over how the records should be used and concerns about their overall accuracy.

“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. The association, which contends more study is needed to determine whether hospitals and doctors actually are abusing electronic records to increase their payments, says it supports more clarity.

Although there is little disagreement over the potential benefits of electronic records in reducing duplicative tests and avoiding medical errors, critics increasingly argue that the federal government has not devoted enough time or resources to making certain the money it is investing is being well spent.

House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.

In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.” She said Medicare was trying to determine whether electronic records had been used in any fraudulent billing but she insisted that the current efforts to certify the systems and address the concerns raised by the Republicans and others were adequate.

This article has been revised to reflect the following correction:

Correction: November 30, 2012

An article on Thursday about a federal report critical of Medicare’s performance in assuring accuracy as doctors and hospitals switch to electronic medical records misstated, in some copies, the timing of a statement from a Medicare spokesman in response to the report. The statement was released late Wednesday, not late Thursday.

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Most Americans Face Lower Tax Burden Than in the 80s

What Is Fair?:
Taxes are still a hot topic after the presidential election. But as a country that spends more than it collects in taxes, are we asking the right taxpayers to pay the right amounts?

BELLEVILLE, Ill. — Alan Hicks divides long days between the insurance business he started in the late 1970s and the barbecue restaurant he opened with his sons three years ago. He earned more than $250,000 last year and said taxes took more than 40 percent. What’s worse, in his view, is that others — the wealthy, hiding in loopholes; the poor, living on government benefits — are not paying their fair share.

Kirsten Luce for The New York Times

"I don't have the answer of where to pull back. I want the state parks to stay open. I want, I want, I want. I want Big Bird, I think it's beautiful. What don't I want? I don't know," said Anita Thole, a safety supervisor for a utility contractor.

“It feels like the harder we work, the more they take from us,” said Mr. Hicks, 55, as he waited for a meat truck one recent afternoon. “And it seems like there’s an awful lot of people in the United States who don’t pay any taxes.”

These are common sentiments in the eastern suburbs of St. Louis, a region of fading factory towns fringed by new subdivisions. Here, as across the country, people like Mr. Hicks are pained by the conviction that they are paying ever more to finance the expansion of government.

But in fact, most Americans in 2010 paid far less in total taxes — federal, state and local — than they would have paid 30 years ago. According to an analysis by The New York Times, the combination of all income taxes, sales taxes and property taxes took a smaller share of their income than it took from households with the same inflation-adjusted income in 1980.

Households earning more than $200,000 benefited from the largest percentage declines in total taxation as a share of income. Middle-income households benefited, too. More than 85 percent of households with earnings above $25,000 paid less in total taxes than comparable households in 1980.

Lower-income households, however, saved little or nothing. Many pay no federal income taxes, but they do pay a range of other levies, like federal payroll taxes, state sales taxes and local property taxes. Only about half of taxpaying households with incomes below $25,000 paid less in 2010.

The uneven decline is a result of two trends. Congress cut federal taxation at every income level over the last 30 years. State and local taxes, meanwhile, increased for most Americans. Those taxes generally take a larger share of income from those who make less, so the increases offset more and more of the federal savings at lower levels of income.

In a half-dozen states, including Connecticut, Florida and New Jersey, the increases were large enough to offset the federal savings for most households, not just the poorer ones.

Now an era of tax cuts may be reaching its end. The federal government depends increasingly on borrowed money to pay its bills, and many state and local governments are similarly confronting the reality that they are spending more money than they collect. In Washington, debates about tax cuts have yielded to debates about who should pay more.

President Obama campaigned for re-election on a promise to take a larger share of taxable income above roughly $250,000 a year. The White House is now negotiating with Congressional Republicans, who instead want to raise some money by reducing tax deductions. Federal spending cuts also are at issue.

If a deal is not struck by year’s end, a wide range of federal tax cuts passed since 2000 will expire and taxes will rise for roughly 90 percent of Americans, according to the independent Tax Policy Center. For lower-income households, taxation would spike well above 1980 levels. Upper-income households would lose some but not all of the benefits of tax cuts over the last three decades.

Public debate over taxes has typically focused on the federal income tax, but that now accounts for less than a third of the total tax revenues collected by federal, state and local governments. To analyze the total burden, The Times created a model, in consultation with experts, which estimated total tax bills for each taxpayer in each year from 1980, when the election of President Ronald Reagan opened an era of tax cutting, up to 2010, the most recent year for which relevant data is available.

The analysis shows that the overall burden of taxation declined as a share of income in the 1980s, rose to a new peak in the 1990s and fell again in the 2000s. Tax rates at most income levels were lower in 2010 than at any point during the 1980s.

Governments still collected the same share of total income in 2010 as in 1980 — 31 cents from every dollar — because people with higher incomes pay taxes at higher rates, and household incomes rose over the last three decades, particularly at the top.

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Kuang-hsun Ting dies at 97; bishop led Protestant church in China

Bishop Kuang-hsun Ting, who was one of the most influential Christian figures in China as the longtime leader of the country's government-sanctioned Protestant church, has died. He was 97.

Ting died Nov. 22 at his home in Nanjing, according to statements from religious organizations he led. A cause of death was not given.

For many years, Ting headed the Three-Self Patriotic Movement and the China Christian Council, the two government-sanctioned Protestant organizations that together form the official Protestant church in China. He was also the longtime president of the Nanjing Union Theological Seminary and helped launch the Amity Foundation, serving as board president of that social service organization until his death.

Ting's close cooperation with China's Communist Party and central government earned him both praise and criticism throughout his long career. Supporters said he had helped protect and promote the interests of Protestants in China, while critics accused him of being too close to the government and at times even joining in the persecution of unregistered or "house" churches.

"He has a positive legacy in many people's eyes because he pushed forward Protestant Christianity and its interests in China, albeit under the scope of the government," said Carsten T. Vala, an expert on Chinese Protestant Christianity who teaches at Loyola University in Maryland. "But he was also a lightning rod, seen by those in the house churches as having compromised by leading the Communist Party-controlled church."

As head of the official church, Ting was often in a tough position as he balanced religious and political demands, said Fenggang Yang, director of Purdue University's Center on Religion and Chinese Society.

"He had to make compromises, otherwise the Protestants could suffer even more," Yang said. "Did he personally totally agree with the government or government policy? Maybe not. I think he also tried to help the government-sanctioned churches and some house churches. But many house churches don't see it that way."

Born Sept. 20, 1915, in Shanghai, Ting studied at St. John's University in that city and was ordained an Anglican priest in 1942. He served as mission secretary for the Student Christian Movement in Canada and later studied at Columbia University and Union Theological Seminary in New York.

In the early 1950s, he was on the staff of the World Student Christian Federation in Geneva, then returned to China. In 1955, he was ordained an Anglican bishop, a title he retained for the rest of his life.

Richard J. Mouw, president of Fuller Theological Seminary in Pasadena and a friend, said Ting had helped create an indigenous Christianity in China.

"He tried to find a way in which the church could remain true to itself but be a partner to government and other cultural forces in China," Mouw said. He was "a deeply Christian person coping as best he could with the demands of government, while keeping alive the essentials of Christianity in China."

Ting's survivors include two sons.

rebecca.trounson@latimes.com

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Family learns of student’s death on Facebook

ATLANTA (AP) — The parents of a south Georgia college student first learned from Facebook that their daughter had been found dead in a dormitory study room shortly before Thanksgiving. Now, they hope that Facebook and other social media sites can help solve the death of 17-year-old Jasmine Benjamin, which police are investigating as a homicide.

The Valdosta State University freshman was found unresponsive on a study room couch on Nov. 18.

A family friend forwarded the Facebook post about the teen’s death to her parents before they were officially notified by authorities, said A. Thomas Stubbs, an attorney for the victim’s mother, Judith Brogdon, and her stepfather, James Jackson. But many questions remain unanswered about how she died.

The family has hired a private investigator, and a new Facebook site has been set up in hopes that students and others might share tips.

While some Facebook comments have already been turned over to law enforcement officers, the family hopes friends, classmates or others who noticed suspicious comments will also alert authorities.

“Anything that reveals a little more information than what’s publicly known about her death, those are the kind of comments police are looking for as someone who might warrant a closer examination,” Stubbs said.

Also of interest are “unusual comments or unusually timed comments about her death,” he said.

Police detectives have canvassed dormitories and interviewed several students on the campus, located about 250 miles south of the family’s home in Gwinnett County, outside Atlanta.

Benjamin wanted to follow the career path of her mother and become a nurse.

Police say they’re treating the case as a homicide, though autopsy results are not complete and they can’t say for certain whether she was killed. There were no obvious signs of a crime when her body was found, but an autopsy raised questions, authorities have said.

“We’re providing what resources are necessary to assist Valdosta State University police in solving this crime,” Georgia Bureau of Investigation spokesman John Bankhead said. “The crime lab is expediting evidence from this incident.”

Shortly after Benjamin’s parents learned of her death from Facebook, Lawrenceville police officers knocked on the doors of the family home to inform them officially that their daughter was dead, Stubbs said.

“As frustrating as that may be for the family to learn that way, they understand it’s a different world,” Stubbs said.

The family has yet to learn the possible timeframe of when their daughter died, and police have not shared any theories about how she was killed, Stubbs said.

“We know that they have looked at the phone records, video records that they can find in the school,” he said. Beyond that, they’ve been going through legal procedures that are required to obtain records from Facebook Inc.

The family hired Martinelli Investigations Inc. of Lawrenceville to assist in the investigation.

Private investigator Robin Martinelli said Wednesday that any video near the scene, even if may seem insignificant, could prove helpful in the investigation.

“It wouldn’t matter if it was two weeks before, two hours before or 20 minutes before,” she said.

Martinelli said she’s confident that police are working diligently to follow up on leads, but private investigators can often provide valuable assistance, she said.

“On any homicide, they’re going to work around the clock aggressively every minute, and they’re doing that,” she said.

She said Jasmine Benjamin was a strong student who showed great potential. “Her favorite color was purple, her nickname was Jazzy,” she said.

“She wanted to help people, plain and simple,” her stepfather, James Jackson, told WSB-TV. “That was her goal in life. That’s all she talked about since she was young — ‘I want to be able to help people.’”

Valdosta State campus police, city police and the GBI were working together to conduct interviews and collect evidence, the university said in a statement Tuesday. University officials said they couldn’t release any further information.

Martinelli hopes students away at college keep in touch with their parents — and give them the passwords to social networking sites and their cell phones in case anything happens.

“If you have passcodes to your computer, your phone, please tell your parents,” she said. “Don’t tell everybody in the world, but tell your parents your passcodes.”

She said some of the best advice parents can give students is this: “They should listen to their gut,” she said. “If they walk into a situation and it’s not feeling right, leave.”

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Adele’s “21″ sells 10 million, Rihanna leads Billboard

LOS ANGELES (Reuters) – British singer and Grammy darling Adele reached the 10 million sales mark in the United States on Wednesday with her heartbreak album “21″ becoming the first by British woman to reach the milestone, Nielsen SoundScan said.

“21,” released in February 2011, produced the hits “Someone Like You” and “Rolling In The Deep” and became the top-selling album of 2011. Earlier this year, Adele swept the Grammy Awards with six, including song, record and album of the year.

“21″ became the third album to cross 10 million in 2012, along with Linkin Park‘s “Hybrid Theory” and Usher’s “Confessions.” But it is the only album to reach the milestone in less than two years in the last decade, Nielsen said.

“What an incredible honor,” Adele said in a statement. “A huge, huge thank you to my American fans for embracing this record on such a massive level.”

“21″ will receive the diamond certification from the Recording Industry Association of America, marking its 10 million milestone, joining the ranks of albums by artists such as Michael Jackson, The Beatles and Madonna.

“Adele‘s unique talent is a gift to music fans, and her success is certainly cause for a celebration of Diamond magnitude,” Cary Sherman, RIAA’s chairman & CEO, said in a statement.

Adele, 24, is enjoying the success of her latest single “Skyfall,” the official theme song for the James Bond film of the same name. It has sold more than 2 million copies worldwide. The singer also gave birth to her first child earlier this year.

On the Billboard 200 chart this week, R&B star Rihanna scored her first No. 1 album with “Unapologetic,” selling 238,000 copies.

She held off new entries from “American Idol” winner Phillip Phillips, who landed at No. 4 with his debut album “The World From the Side of the Moon,” and country-rock singer Kid Rock, who rounded out the top five with his latest album “Rebel Soul.”

(Reporting By Piya Sinha-Roy Editing by Jill Serjeant, Grant McCool and Andre Grenon)

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Well: Weight Loss Surgery May Not Combat Diabetes Long-Term

Weight loss surgery, which in recent years has been seen as an increasingly attractive option for treating Type 2 diabetes, may not be as effective against the disease as it was initially thought to be, according to a new report. The study found that many obese Type 2 diabetics who undergo gastric bypass surgery do not experience a remission of their disease, and of those that do, about a third redevelop diabetes within five years of their operation.

The findings contrast with the growing perception that surgery is essentially a cure for Type II diabetes. Earlier this year, two widely publicized studies reported that surgery worked better than drugs, diet and exercise in causing a remission of Type 2 diabetes in overweight people whose blood sugar was out of control, leading some experts to call for greater use of surgery in treating the disease. But the studies were small and relatively short, lasting under two years.

The latest study, published in the journal Obesity Surgery, tracked thousands of diabetics who had gastric bypass surgery for more than a decade. It found that many people whose diabetes at first went away were likely to have it return. While weight regain is a common problem among those who undergo bariatric surgery, regaining lost weight did not appear to be the cause of diabetes relapse. Instead, the study found that people whose diabetes was most severe or in its later stages when they had surgery were more likely to have a relapse, regardless of whether they regained weight.

“Some people are under the impression that you have surgery and you’re cured,” said Dr. Vivian Fonseca, the president for medicine and science for the American Diabetes Association, who was not involved in the study. “There have been a lot of claims about how wonderful surgery is for diabetes, and I think this offers a more realistic picture.”

The findings suggest that weight loss surgery may be most effective for treating diabetes in those whose disease is not very advanced. “What we’re learning is that not all diabetic patients do as well as others,” said Dr. David E. Arterburn, the lead author of the study and an associate investigator at the Group Health Research Institute in Seattle. “Those who are early in diabetes seem to do the best, which makes a case for potentially earlier intervention.”

One of the strengths of the new study was that it involved thousands of patients enrolled in three large health plans in California and Minnesota, allowing detailed tracking over many years. All told, 4,434 adult diabetics were followed between 1995 and 2008. All were obese, and all underwent Roux-en-Y operations, the most popular type of gastric bypass procedure.

After surgery, about 68 percent of patients experienced a complete remission of their diabetes. But within five years, 35 percent of those patients had it return. Taken together, that means that most of the subjects in the study, about 56 percent — a figure that includes those whose disease never remitted — had no long-lasting remission of diabetes after surgery.

The researchers found that three factors were particularly good predictors of who was likely to have a relapse of diabetes. If patients, before surgery, had a relatively long duration of diabetes, had poor control of their blood sugar, or were taking insulin, then they were least likely to benefit from gastric bypass. A patient’s weight, either before or after surgery, was not correlated with their likelihood of remission or relapse.

In Type 2 diabetes, the beta cells that produce insulin in the pancreas tend to wear out as the disease progresses, which may explain why some people benefit less from surgery. “If someone is too far advanced in their diabetes, where their pancreas is frankly toward the latter stages of being able to produce insulin, then even after losing a bunch of weight their body may not be able to produce enough insulin to control their blood sugar,” Dr. Arterburn said.

Nonetheless, he said it might be the case that obese diabetics, even those whose disease is advanced, can still benefit from gastric surgery, at least as far as their quality of life and their risk factors for heart disease and other complications are concerned.

“It’s not a surefire cure for everyone,” he said. “But almost universally, patients lose weight after weight loss surgery, and that in and of itself may have so many health benefits.”

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The Next War: In Federal Budget Cutting, F-35 Fighter Jet Is at Risk

Luke Sharrett for The New York Times

Vice Adm. David Venlet was named to lead the Joint Strike Fighter program in 2010 after problems had left it behind schedule and over budget.

LEXINGTON PARK, Md. — The Marine version of the F-35 Joint Strike Fighter, already more than a decade in the making, was facing a crucial question: Could the jet, which can soar well past the speed of sound, land at sea like a helicopter?

Luke Sharrett for The New York Times

An F-35B, the Marine Corps version of the Joint Strike Fighter.

On an October day last year, with Lt. Col. Fred Schenk at the controls, the plane glided toward a ship off the Atlantic coast and then, its engine rotating straight down, descended gently to the deck at seven feet a second.

There were cheers from the ship’s crew members, who “were all shaking my hands and smiling,” Colonel Schenk recalled.

The smooth landing helped save that model and breathed new life into the huge F-35 program, the most expensive weapons system in military history. But while Pentagon officials now say that the program is making progress, it begins its 12th year in development years behind schedule, troubled with technological flaws and facing concerns about its relatively short flight range as possible threats grow from Asia.

With a record price tag — potentially in the hundreds of billions of dollars — the jet is likely to become a target for budget cutters. Reining in military spending is on the table as President Obama and Republican leaders in Congress look for ways to avert a fiscal crisis. But no matter what kind of deal is reached in the next few weeks, military analysts expect the Pentagon budget to decline in the next decade as the war in Afghanistan ends and the military is required to do its part to reduce the federal debt.

Behind the scenes, the Pentagon and the F-35’s main contractor, Lockheed Martin, are engaged in a conflict of their own over the costs. The relationship “is the worst I’ve ever seen, and I’ve been in some bad ones,” Maj. Gen. Christopher Bogdan of the Air Force, a top program official, said in September. “I guarantee you: we will not succeed on this if we do not get past that.”

In a battle that is being fought on other military programs as well, the Pentagon has been pushing Lockheed to cut costs much faster while the company is fighting to hold onto a profit. “Lockheed has seemed to be focused on short-term business goals,” Frank Kendall, the Pentagon’s top weapons buyer, said this month. “And we’d like to see them focus more on execution of the program and successful delivery of the product.”

The F-35 was conceived as the Pentagon’s silver bullet in the sky — a state-of-the art aircraft that could be adapted to three branches of the military, with advances that would easily overcome the defenses of most foes. The radar-evading jets would not only dodge sophisticated antiaircraft missiles, but they would also give pilots a better picture of enemy threats while enabling allies, who want the planes, too, to fight more closely with American forces.

But the ambitious aircraft instead illustrates how the Pentagon can let huge and complex programs veer out of control and then have a hard time reining them in. The program nearly doubled in cost as Lockheed and the military’s own bureaucracy failed to deliver on the most basic promise of a three-in-one jet that would save taxpayers money and be served up speedily.

Lockheed has delivered 41 planes so far for testing and initial training, and Pentagon leaders are slowing purchases of the F-35 to fix the latest technical problems and reduce the immediate costs. A helmet for pilots that projects targeting data onto its visor is too jittery to count on. The tail-hook on the Navy jet has had trouble catching the arresting cable, meaning that version cannot yet land on carriers. And writing and testing the millions of lines of software needed by the jets is so daunting that General Bogdan said, “It scares the heck out of me.”

With all the delays — full production is not expected until 2019 — the military has spent billions to extend the lives of older fighters and buy more of them to fill the gap. At the same time, the cost to build each F-35 has risen to an average of $137 million from $69 million in 2001.

The jets would cost taxpayers $396 billion, including research and development, if the Pentagon sticks to its plan to build 2,443 by the late 2030s. That would be nearly four times as much as any other weapons system and two-thirds of the $589 billion the United States has spent on the war in Afghanistan. The military is also desperately trying to figure out how to reduce the long-term costs of operating the planes, now projected at $1.1 trillion.

“The plane is unaffordable,” said Winslow T. Wheeler, an analyst at the Project on Government Oversight, a nonprofit group in Washington.

Todd Harrison, an analyst at the Center for Strategic and Budgetary Assessments, a research group in Washington, said Pentagon officials had little choice but to push ahead, especially after already spending $65 billion on the fighter. “It is simultaneously too big to fail and too big to succeed,” he said. “The bottom line here is that they’ve crammed too much into the program. They were asking one fighter to do three different jobs, and they basically ended up with three different fighters.”

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