Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast-cancer data and a professor of biostatistics at the University of Texas’ M.D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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DealBook: Tribune Hire Banks to Weigh a Sale of Its Newspapers

4:43 p.m. | Updated

The Tribune Company has hired investment banks to weigh a sale of its top newspapers, including The Chicago Tribune and The Los Angeles Times, the media conglomerate said on Tuesday.

The media company, which emerged from bankruptcy late last year, has retained JPMorgan Chase and Evercore Partners as advisers, a spokesman for Tribune said.

The spokesman, Gary Weitman, added that the move was prompted by unsolicited expressions of interest in the newspapers from various suitors.

“Hiring outside financial advisors will help us determine whether that interest is credible, allow us to consider all of our options, and fulfill our fiduciary responsibility to our shareholders and employees,” he said in the statement.

Tribune’s move comes as little surprise. Speculation has been swirling around the media industry for some time that a number of potential suitors had emerged for the company’s holdings. That group may include News Corporation, which is in the middle of spinning off its newspaper holdings from its far bigger Fox entertainment operations. That new company may consider acquisitions as a way to gain more clout and reap cost savings.

Another potential buyer is Aaron Kushner, who owns a group of newspapers that include the Orange County Register and who has been publicly vocal about his interest in the Tribune properties.

Peter Liguori, Tribune’s recently appointed chief executive, told The Los Angeles Times last month that he had not ruled out a sale of the company’s newspaper brands but added that he wasn’t “going into this job with a fire-sale sign.”

Tribune is considered likely to hold onto its newspapers, which also include The Baltimore Sun and The Hartford Courant, if the price it fetches is not high enough.

A sale would help Tribune focus more on its bigger broadcasting operations, which includes WGN America and 24 stations across the country. Mr. Liguori himself is a television veteran, having formerly worked in News Corp.’s TV division and at Discovery Communications.

Tribune filed for bankruptcy protection in 2008, just one year after the media concern was taken over by the billionaire Samuel Zell in a deal that relied heavily on borrowed money.

The company emerged from Chapter 11 protection on Dec. 31, under the control of the investment firms Oaktree Capital and Angelo, Gordon, as well as JPMorgan.

It left bankruptcy in relatively healthy financial condition, reporting about $9.8 billion in assets and $1.3 billion in liabilities as of Dec. 30.

Evercore was hired earlier this month to advise The New York Times Company as it considers a sale of its New England media assets, principally The Boston Globe.

Shares in Tribune, which trade over the counter, were up 1.3 percent on Tuesday at $53.50. That values the media conglomerate at about $3 billion.

News of the hiring of the banks was reported earlier by CNBC.

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Skepticism Surrounds Resumption of Nuclear Talks With Iran

ALMATY, Kazakhstan — Talks between Iran and six world powers over its nuclear program resume here on Tuesday after a break of eight months, but there is a general atmosphere of gloom about their prospects for success, even if narrowly defined.

Since talks in Moscow last June, Iran has continued to increase its stockpile of uranium enriched to 20 percent purity, has begun to install a new generation of centrifuges and has not yet completed an agreement on inspection of suspect military sites with the International Atomic Energy Agency, a deal originally advertised as all but done last May.

With presidential elections in Iran scheduled for June, senior Western diplomats involved with these talks expressed skepticism that Tehran’s chief negotiator, Saeed Jalili, would be willing to make compromises that could be portrayed as weakness at home.

Mr. Jalili is the personal representative of Iran’s supreme leader, Ayatollah Ali Khamenei, considered the dominant voice on the nuclear issue. Ayatollah Khamenei has recently expressed continued mistrust of the United States and its intentions, saying that he would not allow the kind of bilateral talks between Washington and Tehran that most analysts think would be crucial to any resolution.

At the same time, Iran has taken some of its stockpile of 20 percent enriched uranium and converted it into reactor fuel, which cannot easily be turned back. The conversion means that Iran now has less of the uranium needed to make a bomb, reducing the sense of urgency among the six powers, and Israel, that its nuclear program needs to be slowed.

But the total Iranian stockpile of 20 percent enriched uranium has nonetheless grown since November to 167 kilograms from 135 kilograms, according to the most recent I.A.E.A. report — closer to, if still significantly below, the 240 kilograms or 250 kilograms many experts consider necessary, once enriched further, to produce a nuclear weapon.

Iran denies that its nuclear program has any military aim. The six world powers, the so-called P5-plus-1 group, which are the five permanent members of the United Nations Security Council — Britain, China, France, Russia and the United States — and Germany, want Iran to obey Security Council resolutions ordering it to suspend enrichment and open itself up fully to I.A.E.A. inspectors, to ensure that there is no effort to build a nuclear weapon.

To press Iran to comply, the Security Council, the United States and the European Union have created an increasingly painful set of economic sanctions on Iran, as part of a dual-track strategy — negotiations and sanctions. Iran has for its part insisted that as a precondition for serious negotiations, the world should lift all the sanctions and recognize Iran’s “right to enrich,” which Iran asserts it has as a signatory to the Nuclear Nonproliferation Treaty.

The negotiations have been tedious, with Iran appearing to be playing for time, diplomats say. The six powers had asked for a resumption of these talks as early as December, but Iran rejected dates and sites before finally suggesting and agreeing upon Almaty. The choice pleased Western diplomats for its symbolic value, since Kazakhstan, when it became independent of the Soviet Union, freely relinquished the nuclear weapons it had inherited from Moscow. American officials are holding up Kazakhstan, one of the world’s largest producers of uranium and a maker of nuclear fuel, as an example to Iran of the benefits of peaceful nuclear energy and compliance with the I.A.E.A.

President Nursultan Nazarbayev of Kazakhstan appealed to Tehran in a New York Times Op-Ed article in March 2012 to abandon what he suggested was its pursuit of nuclear power status. “Kazakhstan’s experience shows that nations can reap huge benefits from turning their backs on nuclear weapons,” he wrote.

While expectations are low, the six hope to leave here with some momentum and signs of Iranian willingness to engage in what all have agreed should be a reciprocal and step-by-step process of lifting sanctions in return for Iranian actions to comply.

“Iran needs to understand that there is an urgent need to make concrete and tangible progress” in these talks, said Michael Mann, the spokesman for Catherine Ashton, the European Union’s foreign policy chief and chairwoman of the P5-plus-1 group.

Mr. Mann said that the six powers have together “prepared a good and updated offer for the talks which we believe is balanced and a fair basis for constructive talks” and that is “also responsive to Iranian ideas.”

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AP source: Tom Brady gets 3-year extension

A person familiar with the contract tells The Associated Press that Tom Brady has received a three-year extension from the New England Patriots worth about $27 million.

The person spoke on condition of anonymity because the extension has not been announced.

The 35-year-old two-time league MVP was signed through 2014, and has said he wants to play five more years. By redoing his contract Monday, Brady also has cleared nearly $15 million from New England's salary cap.

The three-time Super Bowl champion will make far less in those three seasons than the going rate for star quarterbacks. Brady currently has a four-year, $72 million deal with $48 million guaranteed.

Sports Illustrated first reported the extension.

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Books: Gauging Faces and Bodies in the Botox Age

You never know what a little vanity will do for a person’s health. Some people bloom in their quest for physical improvement, others wither, and a few are completely destroyed. Despite centuries’ worth of efforts to penetrate the complicated thickets where health and beauty intertwine, there is always more to explore, as two new books make clear.

Dr. Eric Finzi, a dermatologist in the Washington area, has produced what may be the first authorized biography of botulinum toxin, the fearsome poison that, bottled into mild-mannered Botox, enhances foreheads everywhere. This little molecule does its good work by paralyzing muscles: In the forehead it inactivates the frown-producing corrugators, while used elsewhere on the head and body it can alleviate migraine headaches, stop problem sweating and ease the spasticity associated with a range of neurological diseases.

But even those who know all about the drug’s physical effects will be intrigued by Dr. Finzi’s narrative, because it turns out that cosmetic Botox may not be all about vanity after all. Research studies, including some by Dr. Finzi, have found that the substance appears to alleviate depression more safely and perhaps more effectively than the usual treatments.

That result at first seems trivial and obvious: If you stop frowning at people, they’ll like you more  and treat you better, and you won’t feel so blue. But the process turns out to be considerably more sophisticated and complicated, because it appears to apply even to people without visible frown lines.

Dr. Finzi calls it “noncosmetic cosmetic surgery” and traces the postulated mechanism to some of the lesser-known work of William James and Charles Darwin. Both thinkers argued that facial expressions are not just the outward manifestations of emotion, but vital links in the unconscious neurological processes that create emotion. In other words, if you cannot smile, you will never be as happy as if you could, and if you cannot frown, you will be unable to experience the full intensity of the negative emotions manifested by frowning, depression included.

This “facial feedback hypothesis” has found some modern confirmation in a study showing that injections of Botox into the forehead seem to inhibit activation of the amygdala, the brain structure thought to regulate all gut-wrenching emotion.

Dr. Finzi expands his narrative with a discussion of the subtleties of common facial expressions, including homage to interested parties like Norman Cousins and his idea that laughter could cure disease.

But the book’s major focus is the frown: Dr. Finzi offers anecdotes suggesting that taming overactive corrugators may save marriages and boost careers, and then, spinning some of the still largely debatable theories linking depression and anger with chronic disease, he postulates that Botox treatments may someday prove to help forestall heart disease and cancer.

That’s quite a set of achievements for one bad little molecule, gram for gram the most potent toxin we know. Dr. Finzi is no stylist, but the momentum of his argument keeps the reader with him for the duration (and undoubtedly quite a few overactive corrugators will be soothed into submission as a result).

The complexities of the face almost pale in comparison with those of the torso, as Abigail C. Saguy makes clear in “What’s Wrong With Fat?” “Once you put down this book you will never hear the word ‘obesity’ the same way again,” she promises, and she is absolutely correct.

Dr. Saguy, a sociologist at U.C.L.A., methodically teases out all the overtones of the loaded words we use to describe big bodies. These bodies are, after all, neither good nor bad, just big.

But “fat” often implies the coexistence of sloth, gluttony and self-indulgence. “Obesity” equals disease to medical professionals, while in the world of public health it is a raging epidemic with substantial global mortality. Those immersed in the conventional ideals of beauty see being overweight as an aesthetic disaster, but others find it sexually irresistible, and to activists “fat” has become a rallying cry, with weight-based discrimination a violation of social justice as deplorable as that stemming from race or gender.

In fact, the concept of bigness has become so laden with overtones good and bad — guilt, blame, fear, anger and desire, among others — that finding a value-free way to describe men and women who are larger than average has become almost impossible. “Heavy,” “plus-size,” “corpulent” and “fleshy” all carry weighty implications in one sphere or another.

Dr. Saguy analyzes it all, and asks why. She winds up paying particular attention to the debate in the medical world over the actual health consequences of being fat: Studies keep confounding the reigning supposition that thin is best with evidence that modestly overweight may be even better. Meanwhile, those who are larger than average are routinely blamed for their size, a phenomenon augmented by deplorably simplistic media coverage (unlike anorexia, interestingly enough, which is remarkably free of the same connotations of personal fault).

Much of Dr. Saguy’s text is academic and requires some determination to penetrate, but she also provides immensely readable nuggets, notably a brief discussion of her experiences attending an annual convention of the National Association to Advance Fat Acceptance, where, seven months pregnant, she underwent a funhouse-mirror body-image transformation worthy of Alice in Wonderland. Like Dr. Finzi’s narrative deficiencies, hers fade into unimportance in the face of fascinating and illuminating material.

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Media Decoder Blog: Online Piracy Alert System to Begin This Week

The Copyright Alert System, a program of escalating warnings and prods against people suspected of online copyright infringement, is finally going into effect this week, more than a year and a half after the plan was announced as part of an agreement between the entertainment industry and five major Internet service providers.

The Center for Copyright Information, the organization created to administer the system, announced on Monday that the Internet providers would begin putting it in place “over the course of the next several days,” though it gave no specifics. The Internet companies are AT&T, Cablevision, Comcast, Verizon and Time Warner Cable.

In the alert system, media companies monitor online traffic through a third party and can complain to Internet providers if a file is downloaded illegally. The suspected violator is then given the first of six warnings, some of which carry “educational” messages and must be acknowledged. After the fifth and sixth warnings, the customer’s Internet speed can be slowed to a crawl.

The Center for Copyright Information says it will not ask for repeat offenders’ Internet access to be blocked, but most service providers have the right to do that if a customer violates its terms of service. The findings can be contested for a $35 fee, to be refunded if an appeal is successful.

The introduction of the alert system has been notably slow. Nearly a year passed before the group had a leader in place, and its own prediction failed when it said in October that the system would be coming in two months. Part of the reason for that might be the relationships between media companies and Internet service providers, which in the past have often been adversarial over issues of piracy and control.

So-called graduated response programs like the Copyright Alert System have been tried in other countries, with mixed results. France’s Hadopi law, passed in 2009, set up a system of three “strikes,” culminating in a fine. More than a million warnings have been issued through that plan, but a recent government report said that its effects were “hard to evaluate precisely.”

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Palestinians Dispute Israeli Finding on Prisoner’s Death

JERUSALEM — The Israeli Health Ministry said Sunday night that preliminary autopsy findings could not determine the cause of death of a 30-year-old Palestinian prisoner, which Israeli officials had at first attributed to a heart attack. But Palestinian officials said the lack of heart damage coupled with bruising on the man’s chest, back and neck suggested that he was tortured during interrogation.

“The signs that appeared during the autopsy show clearly that he was subjected to severe torture that led immediately to his death,” Issa Qaraka, the Palestinian minister of prisoner affairs, said at an evening news conference in Ramallah, after being briefed by a Palestinian pathologist who attended the autopsy of the prisoner, Arafat Jaradat, who died Saturday.

“I hold Israel fully responsible for killing Arafat Jaradat,” added Mr. Qaraka, who earlier on Sunday called for an international investigation into the death. “The Israeli story was forged and full of lies.”

The 4,500 Palestinians in Israeli jails refused meals on Sunday to protest Mr. Jaradat’s death, and hundreds of Palestinians demonstrated in several cities and villages in the West Bank and Gaza Strip.

After days of such demonstrations, which have included violent clashes between Palestinians and Israeli soldiers and settlers, Prime Minister Benjamin Netanyahu’s special envoy, Isaac Molho, sent a message to the Palestinian leadership on Sunday that Israeli officials described as an “unequivocal demand to restore quiet.” Israel also transferred to the Palestinian Authority $100 million in tax revenue it had been withholding.

But a senior Israeli official said the government would not accede to Palestinian requests to release four prisoners who have been on a long-term hunger strike or 123 people who have been detained since before the signing of the Oslo Accords in 1993. “Some of these people are accused of very heinous crimes,” the official said, speaking on the condition of anonymity because he was not authorized to discuss the matter with the news media. “They’re saying that every Palestinian hunger striker should have a get-out-of-jail-free card. You can’t have a system like that. It’s not sustainable.”

After weeks of intensifying protests in solidarity with the hunger strikers, attention turned Sunday to Mr. Jaradat, who relatives said worked at a gas station, was the father of a 4-year-old girl and a 2-year-old boy, and came from a family in which all the men had spent time in Israeli jails. He was arrested last Monday over throwing stones at Israeli cars near a West Bank settlement during November’s conflict between Israel and the Gaza Strip.

Palestinian officials said that Mr. Jaradat admitted the stone-throwing but denied heaving fire bombs. He also confessed to tossing rocks in a 2006 protest, they said. His detention was extended 12 days at a hearing on Thursday, during which his lawyer said that Mr. Jaradat complained of severe pain in his back and neck that he attributed to his interrogation.

“When he was under interrogation, the interrogator told him, ‘Say goodbye to your kids,’ ” Mr. Jaradat’s uncle, Musa, said at a news conference on Sunday morning.

Mr. Qaraka, the prisoner affairs minister, said Sunday night that the autopsy showed “severe” bruising in multiple areas: the right side of the chest, the upper right part of the back, upper left shoulder and along the spine near the bottom of the neck. The pathologist reported no blood clotting or sign of heart damage, he added, but did see two broken ribs, an injury inside the lower lip and blood around the nostrils.

The Palestinian prime minister, Salam Fayyad, issued a statement expressing “deep sorrow and shock” over Mr. Jaradat’s death, saying there was a “need to promptly disclose the true reasons that led to his martyrdom.”

Few issues resonate more deeply in Palestinian society than the plight of prisoners: about 800,000 have been detained in Israeli jails since 1967, according to Palestinian leaders; Mr. Jaradat was the 203rd to die in that time.

Several leaders and commentators warned Sunday that the death, coming amid a severe financial crisis in the West Bank, could lead to extended protests, with most predicting a largely nonviolent movement of civil disobedience like the one Palestinians undertook from 1987 to 1993 rather than the campaign of suicide bombings that began in 2000.

“I know these guys and I see the signs,” Binyamin Ben-Eliezer, a left-leaning member of Israel’s Parliament and a former defense minister, said on Israel Radio.

Alex Fishman, a columnist, wrote on Sunday in the newspaper Yediot Aharanot, “The highway leading to an intifada is wide open,” adding that Mr. Jaradat’s death “is liable to become the opening shot.”

Ghassan Khatib, a Palestinian analyst, pointed out that in addition to mounting outrage over the treatment of prisoners and violence by Israeli settlers, the Palestinian Authority’s failure to issue paychecks on time had prompted teachers to call a strike starting Tuesday; health care workers are already in the middle of a two-week walkout.

Nabil A. Shaath, the Palestinian commissioner for international relations, said in an interview that the West Bank leadership was “doing our best to keep calm” and that “violent confrontation absolutely is not our plan.”

“I don’t know how much people can be contained,” Mr. Shaath said of the Jaradat case. “I don’t think anybody is planning an intifada. The question is how much accidents, incidents like this might lead to an anger that can explode.”

Jodi Rudoren reported from Jerusalem, and Khaled Abu Aker from Ramallah, West Bank. Fares Akram contributed reporting from the Gaza Strip.

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Johnson wins 2nd Daytona 500; Patrick finishes 8th

DAYTONA BEACH, Fla. (AP) — A big first for Danica Patrick, but an even bigger second for Jimmie Johnson.

Patrick made history up front at the Daytona 500 Sunday, only to see Johnson make a late push ahead of her and reclaim his spot at the top of his sport.

It was the second Daytona victory for Johnson, a five-time NASCAR champion who first won "The Great American Race" in 2006.

Patrick, the first woman to win the pole, also became the first woman to lead the race. She was running third on the last lap, but faded to eighth at the finish.

There were several crashes during the race, none approaching the magnitude of the wreck that injured more than two dozen fans a day earlier in a second-tier race on the same track.

Johnson raced past defending NASCAR champion Brad Keselowski on the final restart and pulled out to a sizable lead that nobody challenged over the final six laps.

Dale Earnhardt Jr. settled for second as Hendrick Motorsports drivers went 1-2 in the new Chevrolet SS. Mark Martin was third in a Michael Waltrip Racing Toyota.

Keselowski, who overcame two accidents earlier in the race, wound up fourth in the new Ford that Penske Racing is fielding this year.

Patrick was clearly disappointed with her finish. But she admitted she wasn't sure what move to make if she was going to try for the win.

"You know I kept thinking about it the whole time," she said. "You spend a lot of time thinking what to do when the opportunity comes."

Patrick became the first woman in history to lead laps in the 500 when she passed Michael Waltrip on a restart on Lap 90. She stayed on the point for two laps, then was shuffled back to third. She ended up leading five laps, another groundbreaking moment for Patrick, who in 2005 as a rookie became the first woman to lead the Indianapolis 500.

Janet Guthrie was the first woman to lead laps at NASCAR's top Cup Series, in 1977 at Ontario, where she led five laps under caution.

The field was weakened by an early nine-car accident that knocked out race favorite Kevin Harvick and sentimental favorite Tony Stewart.

Harvick had won two support races coming into the 500 to cement himself as the driver to beat, but the accident sent him home with a 42nd place finish.

Stewart, meanwhile, dropped to 0-for-15 in one of the few races the three-time NASCAR champion has never won.

"If I didn't tell you I was heartbroken and disappointed, I'd be lying to you," Stewart said.

That accident also took former winner Jamie McMurray, his Chip Ganassi Racing teammate Juan Pablo Montoya, and Kasey Kahne out of contention.

The next accident — involving nine cars — came 105 laps later and brought a thankful end to Speedweeks for Carl Edwards. He was caught in his fifth accident since testing last month, and this wreck collected six other Ford drivers.

The field suddenly had six Toyota drivers at the front as Joe Gibbs Racing and Michael Waltrip Racing drivers took control of the race. But JGR's day blew up — literally — when the team was running 1-2-3 with Matt Kenseth, Denny Hamlin and Kyle Busch setting the pace.

Kenseth went to pit road first with a transmission issue, and Busch was right behind him with a blown engine. Busch was already in street clothes watching as Hamlin led the field.

"It's a little devastating when you are running 1-2-3 like that," Busch said.

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Major Banks Aid in Payday Loans Banned by States

Major banks have quickly become behind-the-scenes allies of Internet-based payday lenders that offer short-term loans with interest rates sometimes exceeding 500 percent.

With 15 states banning payday loans, a growing number of the lenders have set up online operations in more hospitable states or far-flung locales like Belize, Malta and the West Indies to more easily evade statewide caps on interest rates.

While the banks, which include giants like JPMorgan Chase, Bank of America and Wells Fargo, do not make the loans, they are a critical link for the lenders, enabling the lenders to withdraw payments automatically from borrowers’ bank accounts, even in states where the loans are banned entirely. In some cases, the banks allow lenders to tap checking accounts even after the customers have begged them to stop the withdrawals.

“Without the assistance of the banks in processing and sending electronic funds, these lenders simply couldn’t operate,” said Josh Zinner, co-director of the Neighborhood Economic Development Advocacy Project, which works with community groups in New York.

The banking industry says it is simply serving customers who have authorized the lenders to withdraw money from their accounts. “The industry is not in a position to monitor customer accounts to see where their payments are going,” said Virginia O’Neill, senior counsel with the American Bankers Association.

But state and federal officials are taking aim at the banks’ role at a time when authorities are increasing their efforts to clamp down on payday lending and its practice of providing quick money to borrowers who need cash.

The Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau are examining banks’ roles in the online loans, according to several people with direct knowledge of the matter. Benjamin M. Lawsky, who heads New York State’s Department of Financial Services, is investigating how banks enable the online lenders to skirt New York law and make loans to residents of the state, where interest rates are capped at 25 percent.

For the banks, it can be a lucrative partnership. At first blush, processing automatic withdrawals hardly seems like a source of profit. But many customers are already on shaky financial footing. The withdrawals often set off a cascade of fees from problems like overdrafts. Roughly 27 percent of payday loan borrowers say that the loans caused them to overdraw their accounts, according to a report released this month by the Pew Charitable Trusts. That fee income is coveted, given that financial regulations limiting fees on debit and credit cards have cost banks billions of dollars.

Some state and federal authorities say the banks’ role in enabling the lenders has frustrated government efforts to shield people from predatory loans — an issue that gained urgency after reckless mortgage lending helped precipitate the 2008 financial crisis.

Lawmakers, led by Senator Jeff Merkley, Democrat of Oregon, introduced a bill in July aimed at reining in the lenders, in part, by forcing them to abide by the laws of the state where the borrower lives, rather than where the lender is. The legislation, pending in Congress, would also allow borrowers to cancel automatic withdrawals more easily. “Technology has taken a lot of these scams online, and it’s time to crack down,” Mr. Merkley said in a statement when the bill was introduced.

While the loans are simple to obtain — some online lenders promise approval in minutes with no credit check — they are tough to get rid of. Customers who want to repay their loan in full typically must contact the online lender at least three days before the next withdrawal. Otherwise, the lender automatically renews the loans at least monthly and withdraws only the interest owed. Under federal law, customers are allowed to stop authorized withdrawals from their account. Still, some borrowers say their banks do not heed requests to stop the loans.

Ivy Brodsky, 37, thought she had figured out a way to stop six payday lenders from taking money from her account when she visited her Chase branch in Brighton Beach in Brooklyn in March to close it. But Chase kept the account open and between April and May, the six Internet lenders tried to withdraw money from Ms. Brodsky’s account 55 times, according to bank records reviewed by The New York Times. Chase charged her $1,523 in fees — a combination of 44 insufficient fund fees, extended overdraft fees and service fees.

For Subrina Baptiste, 33, an educational assistant in Brooklyn, the overdraft fees levied by Chase cannibalized her child support income. She said she applied for a $400 loan from Loanshoponline.com and a $700 loan from Advancemetoday.com in 2011. The loans, with annual interest rates of 730 percent and 584 percent respectively, skirt New York law.

Ms. Baptiste said she asked Chase to revoke the automatic withdrawals in October 2011, but was told that she had to ask the lenders instead. In one month, her bank records show, the lenders tried to take money from her account at least six times. Chase charged her $812 in fees and deducted over $600 from her child-support payments to cover them.

“I don’t understand why my own bank just wouldn’t listen to me,” Ms. Baptiste said, adding that Chase ultimately closed her account last January, three months after she asked.

A spokeswoman for Bank of America said the bank always honored requests to stop automatic withdrawals. Wells Fargo declined to comment. Kristin Lemkau, a spokeswoman for Chase, said: “We are working with the customers to resolve these cases.” Online lenders say they work to abide by state laws.

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