Longer tamoxifen use cuts breast cancer deaths

Breast cancer patients taking the drug tamoxifen can cut their chances of having the disease come back or kill them if they stay on the pills for 10 years instead of five years as doctors recommend now, a major study finds.

The results could change treatment, especially for younger women. The findings are a surprise because earlier research suggested that taking the hormone-blocking drug for longer than five years didn't help and might even be harmful.

In the new study, researchers found that women who took tamoxifen for 10 years lowered their risk of a recurrence by 25 percent and of dying of breast cancer by 29 percent compared to those who took the pills for just five years.

In absolute terms, continuing on tamoxifen kept three additional women out of every 100 from dying of breast cancer within five to 14 years from when their disease was diagnosed. When added to the benefit from the first five years of use, a decade of tamoxifen can cut breast cancer mortality in half during the second decade after diagnosis, researchers estimate.

Some women balk at taking a preventive drug for so long, but for those at high risk of a recurrence, "this will be a convincer that they should continue," said Dr. Peter Ravdin, director of the breast cancer program at the UT Health Science Center in San Antonio.

He reviewed results of the study, which was being presented Wednesday at a breast cancer conference in San Antonio and published by the British medical journal Lancet.

About 50,000 of the roughly 230,000 new cases of breast cancer in the United States each year occur in women before menopause. Most breast cancers are fueled by estrogen, and hormone blockers are known to cut the risk of recurrence in such cases.

Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors — sold as Arimidex, Femara, Aromasin and in generic form — do the job with less risk of causing uterine cancer and other problems.

But the newer drugs don't work well before menopause. Even some women past menopause choose tamoxifen over the newer drugs, which cost more and have different side effects such as joint pain, bone loss and sexual problems.

The new study aimed to see whether over a very long time, longer treatment with tamoxifen could help.

Dr. Christina Davies of the University of Oxford in England and other researchers assigned 6,846 women who already had taken tamoxifen for five years to either stay on it or take dummy pills for another five years.

Researchers saw little difference in the groups five to nine years after diagnosis. But beyond that time, 15 percent of women who had stopped taking tamoxifen after five years had died of breast cancer versus 12 percent of those who took it for 10 years. Cancer had returned in 25 percent of women on the shorter treatment versus 21 percent of those treated longer.

Tamoxifen had some troubling side effects: Longer use nearly doubled the risk of endometrial cancer. But it rarely proved fatal, and there was no increased risk among premenopausal women in the study — the very group tamoxifen helps most.

"Overall the benefits of extended tamoxifen seemed to outweigh the risks substantially," Dr. Trevor Powles of the Cancer Centre London wrote in an editorial published with the study.

The study was sponsored by cancer research organizations in Britain and Europe, the United States Army, and AstraZeneca PLC, which makes Nolvadex, a brand of tamoxifen, which also is sold as a generic for 10 to 50 cents a day. Brand-name versions of the newer hormone blockers, aromatase inhibitors, are $300 or more per month, but generics are available for much less.

The results pose a quandary for breast cancer patients past menopause and those who become menopausal because of their treatment — the vast majority of cases. Previous studies found that starting on one of the newer hormone blockers led to fewer relapses than initial treatment with tamoxifen did.

Another study found that switching to one of the new drugs after five years of tamoxifen cut the risk of breast cancer recurrence nearly in half — more than what was seen in the new study of 10 years of tamoxifen.

"For postmenopausal women, the data still remain much stronger at this point for a switch to an aromatase inhibitor," said that study's leader, Dr. Paul Goss of Massachusetts General Hospital. He has been a paid speaker for a company that makes one of those drugs.

Women in his study have not been followed long enough to see whether switching cuts deaths from breast cancer, as 10 years of tamoxifen did. Results are expected in about a year.

The cancer conference is sponsored by the American Association for Cancer Research, Baylor College of Medicine and the UT Health Science Center.

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Wall Street flat, Freeport offsets China comments

Facebook (FB) announced on Tuesday that it will begin opening Facebook Messenger to consumers who do not have a Facebook account, starting in countries like India and South Africa, and later rolling out the service in the United States and Europe. This is a belated acknowledgement of a staggering strategic mistake Facebook made two years ago. That is when the messaging app competition was still wide open and giants like Facebook or Google (GOOG) could have entered the competition. WhatsApp, the leading messaging app firm, had just 1 million users as late as December 2009. By the end of 2010, that number had grown to 10 million. Right now, it likely tops 200 million, though there is no current official number

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Assad Suffering Reversals in Fighting and Diplomacy

Thair Al-Khalidieh/Shaam News Network, via Reuters

A Free Syrian Army fighter battled government forces in Homs, Syria, on Monday.

BEIRUT, Lebanon — Fierce fighting on the battlefield and setbacks on the diplomatic front increased pressure on the embattled Syrian government as fresh signs emerged on Tuesday of a sustained battle for control of the capital, Damascus.

News reports quoted activists as saying that fighting was raging in the southern suburbs of Damascus and near the international airport for a fifth straight day as government forces sought to dislodge rebels and reverse their recent gains.

While the government has superior firepower and rebels are reporting heavy losses, loyalist forces have been carrying out a serious counteroffensive in the suburbs without being able to subdue the insurgents.

The latest reports followed developments on Monday when a senior Turkish official said that Russia had agreed to a new diplomatic approach to seek ways to persuade President Bashar al-Assad to relinquish power, a possible weakening in Russia’s steadfast support for the Syrian government.

In Damascus, a prominent Foreign Ministry spokesman was said to have left the country amid reports of his defection, and President Obama and Secretary of State Hillary Rodham Clinton issued warnings that any use of chemical weapons by a desperate government would be met with a strong international response. The NATO secretary general, Anders Fogh Rasmussen, echoed this warning on Tuesday.

“The possible use of chemical weapons would be completely unacceptable to the whole international community,” Mr. Rasmussen said, according to Agence France-Presse.

A Western diplomat confirmed that there were grave concerns in United States intelligence circles that Syrian leaders could resort to the use of the weapons as their position deteriorates.

The Syrian Foreign Ministry, repeating earlier statements, told state television that the government “would not use chemical weapons, if it had them, against its own people under any circumstances.”

The United Nations said it was withdrawing nonessential international staff from Syria, and the European Union said it was reducing activities in Damascus “to a minimum,” as security forces pummeled the suburbs with artillery and airstrikes in a struggle to seal off the city from its restive outskirts and control the airport road. A senior Russian official spoke for the first time in detail about the possibility of evacuating Russian citizens.

The United Nations World Food Program reported on Tuesday that “the recent escalation of violence in Syria is making it more difficult to reach the country’s hardest-hit areas.”

“Food insecurity is on the rise due to bread shortages and higher food prices in many parts of the country. High prices are also affecting neighboring countries hosting Syrian refugees,” the organization said in a statement.

“Road access to and from Damascus has become more dangerous, making it difficult to dispatch food from World Food Program warehouses to some parts of the country, the organization said, adding that there had been increasing indiscriminate attacks on its trucks in different parts of the country.

It also said it would relocate seven nonessential staff members to neighboring Jordan while about “20 international and 100 national W.F.P. staff remain in the country to carry out the emergency operation to feed 1.5 million vulnerable Syrians.” Mr. Assad has held on longer than many had predicted at the start of the 21-month uprising. He still has a strong military advantage and undiminished support from his closest ally, Iran. Military analysts doubt the rebels are capable of taking Damascus by force, and one fighter interviewed on Monday said the government counteroffensive was taking a heavy toll. There were still no firm indications from Russia that it was ready to join Turkey and Western nations in insisting on Mr. Assad’s immediate departure.

But the latest grim developments follow a week of events that suggested the Assad government was being forced to fight harder to keep its grip on power. Rebels threatened its vital control of the skies, using surface-to-air missiles to down a fighter plane and other aircraft. The opposition also gained control of strategic military bases and their arsenals, and forced the government to shut down the Damascus airport periodically. The Internet was off for two days.

A Russian political analyst with contacts at the Foreign Ministry said that “people sent by the Russian leadership” who had contact with Mr. Assad two weeks ago described a man who has lost all hope of victory or escape.

“His mood is that he will be killed anyway,” Fyodor Lukyanov, editor of a Russian foreign affairs journal and the head of an influential policy group, said in an interview in Moscow, adding that only an “extremely bold” diplomatic proposal could possibly convince Mr. Assad that he could leave power and survive.

“If he will try to go, to leave, to exit, he will be killed by his own people,” Mr. Lukyanov said, speculating that security forces dominated by Mr. Assad’s minority Alawite sect would not let him depart and leave them to face revenge. “If he stays, he will be killed by his opponents. He is in a trap. It is not about Russia or anybody else. It is about his physical survival.”

Anne Barnard reported from Beirut, Lebanon, and Ellen Barry from Moscow. Reporting was contributed by Alan Cowell in London, Sebnem Arsu in Istanbul, Peter Baker in Washington, Hwaida Saad, Neil MacFarquhar and Hania Mourtada in Beirut, and Christine Hauser in New York.

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Taylor Swift & Harry Styles Hold Hands After Long Night in NYC

By Tim Nudd

12/04/2012 at 10:20 AM EST

Taylor Swift and Harry Styles

Alequin/Bosch/INF

They're getting closer by the day.

After strolling together in Central Park on Sunday, Taylor Swift and Harry Styles graduated to publicly holding hands early Tuesday after a long night in New York City.

The pop star and her potential boy-band beau were photographed arriving at her hotel after 4 a.m. – she in a thigh-length black coat, he in dark pants and a T-shirt.

Styles, 18, and his band One Direction performed at Madison Square Garden on Monday night, while Swift, 22, attended and performed at the 2012 Ripple of Hope Awards a dozen blocks north at the New York Marriott Marquis.

They met up after at One Direction's afterparty.

At the Ripple of Hope Awards, Swift was honored for her commitment to social causes by the Robert F. Kennedy Center for Justice & Human Rights. Several members of the Kennedy family – though reportedly not Swift's ex-boyfriend, Conor Kennedy – were in attendance.

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Tapping citizen-scientists for a novel gut check

WASHINGTON (AP) — The bacterial zoo inside your gut could look very different if you're a vegetarian or an Atkins dieter, a couch potato or an athlete, fat or thin.

Now for a fee — $69 and up — and a stool sample, the curious can find out just what's living in their intestines and take part in one of the hottest new fields in science.

Wait a minute: How many average Joes really want to pay for the privilege of mailing such, er, intimate samples to scientists?

A lot, hope the researchers running two novel citizen-science projects.

One, the American Gut Project, aims to enroll 10,000 people — and a bunch of their dogs and cats too — from around the country. The other, uBiome, separately aims to enroll nearly 2,000 people from anywhere in the world.

"We're finally enabling people to realize the power and value of bacteria in our lives," said microbiologist Jack Gilbert of the University of Chicago and Argonne National Laboratory. He's one of a team of well-known scientists involved with the American Gut Project.

Don't be squeamish: Yes, we share our bodies with trillions of microbes, living communities called microbiomes. Many of the bugs, especially those in the intestinal tract, play indispensable roles in keeping us healthy, from good digestion to a robust immune system.

But which combinations of bacteria seem to keep us healthy? Which ones might encourage problems like obesity, diabetes or irritable bowel syndrome?

And do diet and lifestyle affect those microbes in ways that we might control someday?

Answering those questions will require studying vast numbers of people. Getting started with a grassroots movement makes sense, said National Institutes of Health microbiologist Lita Proctor, who isn't involved with the new projects but is watching closely.

After all, there was much interest in the taxpayer-funded Human Microbiome Project, which last summer provided the first glimpse of what makes up a healthy bacterial community in a few hundred volunteers.

Proctor, who coordinated that project, had worried "there would be a real ick factor. That has not been the case," she said. Many people "want to engage in improving their health."

Scott Jackisch, a computer consultant in Oakland, Calif., ran across American Gut while exploring the science behind different diets, and signed up last week. He's read with fascination earlier microbiome research: "Most of the genetic matter in what we consider ourselves is not human, and that's crazy. I wanted to learn about that."

Testing a single stool sample costs $99 in that project, but he picked a three-sample deal for $260 to compare his own bacterial makeup after eating various foods.

"I want to be extra, extra well," said Jackisch, 42. Differing gut microbes may be the reason "there's no one magic bullet of diet that people can eat and be healthy."

It's clear that people's gut bacteria can change over time. What this new research could accomplish is a first look at how different diets may play a role, said American Gut lead researcher Rob Knight of the University of Colorado, Boulder.

One challenge is making sure participants don't expect that a map of their gut bacteria can predict their future health, or suggest lifestyle changes, anytime soon.

"I understand I'm not going to be able to say, 'Oh, my gosh, I'll be susceptible to this,'" said Bradley Heinz, 26, a financial consultant in San Francisco. He is paying uBiome $119 to analyze both his gut and mouth microbiomes; just the gut is $69.

"The more people that participate, the more information comes out and the more that everybody benefits," he added.

Participants can sign up for either project via the social fundraising site Indiegogo.com over the next month. They also can send scrapings from the skin, mouth and other sites, to analyze that bacteria. Sign up enough family members or body sites, or be tracked over time, and the price can rise into the thousands. American Gut researchers plan some free testing for those who can't afford the fees, to try to increase the experiment's diversity.

Don't forget the pets: "We sleep with them, play with them, they often eat our food," said American Gut co-founder Jeff Leach, an anthropologist. What bacteria we have in common is the next logical question.

Already, American Gut researchers are preparing to compare what they find in the typical U.S. gut with a few hundred people in rural Namibia, who eat what's described as hunter-gatherer fare. Also, Leach will spend three months living in Namibia next year, and is storing his own stool samples for before-and-after comparison.

But diet isn't the only factor. Your bacterial makeup starts at birth: Babies absorb different microbes when they're born vaginally than when they're born by C-section, a possible explanation for why cesareans raise the risk for certain infections. Taking antibiotics, especially in early childhood, can alter this teeming inner world, and it's not clear if there are lasting consequences.

Then there's your environment, such as the infections spread in hospitals. In February, a new University of Chicago hospital building opens and Gilbert will test the surfaces, the patients and their health workers to see how quickly bad bugs can move in and identify which bacteria are protective.

Whatever the findings, all the research marks "a huge teachable moment" about how we interact with microbes, Leach said.

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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Online:

www.indiegogo.com/americangut

www.indiegogo.com/ubiome

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Wall Street flat, awaits movement on fiscal cliff talks

NEW YORK (Reuters) - Stocks were little changed in early trading on Tuesday as the market remains hostage to negotiations in Washington on how to avert a "fiscal cliff" that could push the U.S. economy into recession.

Republicans in Congress proposed steep spending cuts to bring down the budget deficit on Monday but gave no ground on President Barack Obama's call to raise taxes on the wealthiest Americans, and the proposal was quickly dismissed by the White House.

Headlines about the back-and-forth preliminary proposals by Republicans and Democrats have fixated the market. Still, many investors expect the two sides to come up with a deal before the year-end deadline, which could trigger a rally in equities.

"Support (for the market) is based on a belief that Washington will come to some agreement before we go over the fiscal cliff," said Art Hogan, managing director of Lazard Capital Markets in New York.

Hogan added, "On the first show of flexibility from either side, we'll get a relief rally."

Despite sudden moves in the market on the latest headlines about the fiscal cliff in recent days, a measure of investor anxiety has held surprisingly flat.

The CBOE volatility index <.vix>, a gauge of market anxiety, slipped to 16 and has not traded above 20 since July following its 2012 high near 28 hit in June. The VIX's 10-day Average True Range, an internal volatility measure, is at its lowest since early 2007.

Obama will meet with U.S. governors at the White House on Tuesday to talk about the fiscal cliff, a $600 billion package of tax hikes and federal spending cuts that would begin January 1.

The president is also expected to talk about the fiscal cliff during an interview scheduled for 12:30 p.m. (1730 GMT) on Bloomberg TV.

Coach became the latest company to advance the date of its next dividend payment. Expectations of higher taxes on dividends kicking in in 2013 have pushed many companies to pay special dividends this year or advance their next pay-back to investors.

The Dow Jones industrial average <.dji> rose 27.92 points, or 0.22 percent, to 12,993.52. The S&P 500 <.spx> edged up 0.44 points, or 0.03 percent, to 1,409.90. The Nasdaq Composite <.ixic> fell 4.44 points, or 0.15 percent, to 2,997.76.

Toll Brothers shares rose 1.8 percent to $33.01 after the largest U.S. luxury homebuilder reported a higher quarterly profit and said new orders rose sharply.

MetroPCS Communications shares dropped 6.5 percent to $10.07 after Sprint Nextel appeared unlikely to make a counter-offer for the wireless service provider.

Shares of Pep Boys-Manny Moe and Jack were down 12.4 percent at $9.36 a day after the release of the auto parts retailer's results.

(Reporting by Rodrigo Campos; Editing by Kenneth Barry)

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Syria Moves Its Chemical Weapons and Gets Another Warning

WASHINGTON — The Syrian military’s movement of chemical weapons in recent days has prompted the United States and several allies to repeat their warning to President Bashar al-Assad that he would be “held accountable” if his forces used the weapons against the rebels fighting his government.

The warnings, which one European official said were “deliberately vague to keep Assad guessing,” were conveyed through Russia and other intermediaries.

What exactly the Syrian forces intend to do with the weapons remains murky, according to officials who have seen the intelligence from Syria. One American official provided the most specific description yet of what has been detected, saying that “the activity we are seeing suggests some potential chemical weapon preparation,” which goes beyond the mere movement of stockpiles among Syria’s several dozen known sites. But the official declined to offer more specifics of what those preparations entailed.

Over the weekend, the activity in Syria prompted a series of emergency communications among the Western allies, who have long been developing contingency plans in case they decided to intervene in an effort to neutralize the chemical weapons, a task that the Pentagon estimates would require upward of 75,000 troops. But there were no signs that preparations for any such effort were about to begin.

So far, President Obama has been very cautious about intervening in Syria, declining to arm the opposition groups directly, or even to formally recognize a newly formed coalition of opposition forces that the United States helped create.

But at a news conference in August, Mr. Obama told reporters that any evidence that Mr. Assad was moving the weapons in a threatening way or making use of them is “a red line for us” that could prompt direct American intervention. “That would change my calculus,” he added. “That would change my equation.”

American officials would not say over the weekend whether the activity they were now seeing edged toward the limit set by Mr. Obama. “These are desperate times for Assad, and this may simply be another sign of desperation,” one senior American diplomat, who has been deeply involved in the effort to try to dissuade Mr. Assad’s forces from using the chemical weapons, said Sunday.

A senior Israeli official said the movement of the chemical weapons, and the apparent preparations to use them, could be a bluff, intended as a warning to the West at a moment when NATO and the United States were debating greater support to opposition groups.

“It’s very hard to read Assad,” one senior Israeli official said. “But we are seeing a kind of action that we’ve never seen before,” he said, declining to elaborate.

The White House refused to comment on the intelligence reports, which have been shared with senior members of Congress. But a senior administration official, asked about the concerns, issued a new warning to the Syrians.

“The president has made it clear that the use of chemical weapons in Syria would cross a red line for the United States,” the official said. “We consistently monitor developments related to Syria’s stockpiles of chemical weapons, and are in regular contact with international partners who share our concern.

“The Assad regime must know that the world is watching, and that they will be held accountable by the United States and the international community if they use chemical weapons or fail to meet their obligations to secure them.”

Representative Mike Rogers, a Michigan Republican who heads the House Intelligence Committee, declined to comment on the new intelligence reports but said in a statement late Sunday: “We are not doing enough to prepare for the collapse of the Assad regime, and the dangerous vacuum it will create. Use of chemical weapons by the Assad regime would be an extremely serious escalation that would demand decisive action from the rest of the world."

Several months ago, the United States military quietly sent a task force of more than 150 planners and other specialists to Jordan to help the armed forces there to, among other things, prepare for the possibility that Syria would lose control of its chemical weapons. Turkey has asked NATO for two batteries of the Patriot antimissile system, in part as protection against Syrian missiles that might come into Turkish territory. In making their case, the Turks have raised the possibilities that chemical weapons could be used in the warheads.

This is not the first time activity at stockpile sites has been detected. Defense Secretary Leon E. Panetta said on Sept. 28 that there had been “some movement” of Syria’s chemical weapons stockpiles to put them in more secure locations. “While there’s been some limited movement, again, the major sites still remain in place, still remain secure,” he said at the time.

But the new activity appears to be of a different nature, and officials are no longer willing to say that all the sites remain secure. “We’re worried about what the military is doing,” one official said, “but we’re also worried about some of the opposition groups,” including some linked to Hezbollah, which has set up camps near some of the chemical weapons depots.

Since the crisis began in Syria and concern has been focused on the country’s vast stockpile, the United States and its allies have increased electronic eavesdropping and other surveillance activities of the sites. A senior defense official said that no United States troops had been put on heightened alert in response to the activity, although the Pentagon was prepared to do so, if necessary.

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Nokia debunks rumor that it may be considering shift to Android

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David Oliver Relin, Co-Author of Three Cups of Tea, Commits Suicide at 49

By Maggie Coughlan

12/03/2012 at 10:45 AM EST

David Oliver Relin, a journalist who co-authored the controversial best-selling book Three Cups of Tea, has committed suicide, the New York Times reports. He was 49.

Relin, who co-wrote the 2006 book with Greg Mortenson about how Mortenson, a former mountain climber, started building schools in Pakistan and Afghanistan, "suffered emotionally and financially as basic facts in the book were called into question," the Times says.

His family said Relin "suffered from depression" but would not give further details surrounding his death.

As a journalist during the '90s, Relin focused on telling humanitarian stories including articles about child soldiers and traveling to Vietnam. This work was what led Viking Books to pair him with Mortenson.

Three Cups of Tea sold over four million copies, but in 2011 60 Minutes and author Jon Krakauer – who released an E-book titled Three Cups of Deceit – both questioned the validity of major points in the book.

Relin did not speak publicly about the accusations, but hired a lawyer to defend him in a federal lawsuit that claimed he and Mortenson defrauded readers. The suit was dismissed earlier this year.

Relin is survived by his wife, Dawn; his mother, Marjorie; his stepfather Cary Ratcliff; and his sisters Rachel Relin and Jennifer Cherelin.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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