Paid apps are history






This week marked an important moment in the evolution of the iOS app market. As Pages just slipped out of the iPad top 10 highest grossing apps chart, there are now no paid apps among the ten applications that generate most revenue on the iPad. When the iPad application market was born a few years ago, it was dominated by relatively stiffly priced applications, mimicking the PC software or game console software markets. But over the past couple of years, app vendors have realized that free apps with clever in-app purchasing hooks create much more revenue than paid apps.


[More from BGR: BlackBerry 10 browser smokes iOS 6 and Windows Phone 8 in comparison test [video]]






The same applies to the iPhone — there is only one paid app among the twenty highest grossing iPhone apps today. It is notable that some of the highest grossing apps have relatively low download volumes. Clash of Clans has been the top-grossing iPad application for all of January, but it is only ranked 53rd on the iPad download chart. Hay Day is the seventh-biggest application when it comes to revenue generation on the iPhone, but is only ranked at #104 when it comes to download volume.


[More from BGR: Galaxy S IV benchmarks may confirm 1.8GHz CPU and Android 4.2]


Leading app developers have figured out how to decouple download volume from revenue generation by creating free games that seduce their fans into paying steadily for in-app features. The types of of games that require a $ 0.99 or a $ 2.99 fee per download are turning into something resembling nostalgia items. For a stark example of how badly the revenue generation power of paid apps has faded, consider that the current #1 paid app on iPhone, Wood Camera, is 46th on the iPhone chart that lists top-grossing apps.  The future belongs to free apps.


This article was originally published on BGR.com


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Armstrong turns emotional in 2nd part of interview


CHICAGO (AP) — Lance Armstrong finally cracked.


Not while expressing deep remorse or regrets, though there was plenty of that in Friday night's second part of Armstrong's interview with Oprah Winfrey.


It wasn't over the $75 million in sponsorship deals that evaporated over the course of two days, or having to walk away from the Livestrong cancer charity he founded and called his "sixth child." It wasn't even about his lifetime ban from competition, though he said that was more than he deserved.


It was another bit of collateral damage that Armstrong said he wasn't prepared to deal with.


"I saw my son defending me and saying, 'That's not true. What you're saying about my dad is not true,'" Armstrong recalled.


"That's when I knew I had to tell him."


Armstrong was near tears at that point, referring to 13-year-old Luke, the oldest of his five children. He blinked, looked away from Winfrey, and with his lip trembling, struggled to compose himself.


It came just past the midpoint of the hourlong program on Winfrey's OWN network. In the first part, broadcast Thursday, the disgraced cycling champion admitted using performance-enhancing drugs when he won seven straight Tour de France titles.


Critics said he hadn't been contrite enough in the first half of the interview, which was taped Monday in Austin, but Armstrong seemed to lose his composure when Winfrey zeroed in on the emotional drama involving his personal life.


"What did you say?" Winfrey asked.


"I said, 'Listen, there's been a lot of questions about your dad. My career. Whether I doped or did not dope. I've always denied that and I've always been ruthless and defiant about that. You guys have seen that. That's probably why you trusted me on it.' Which makes it even sicker," Armstrong said.


"And uh, I told Luke, I said," and here Armstrong paused for a long time to collect himself, "I said, 'Don't defend me anymore. Don't.'


"He said OK. He just said, 'Look, I love you. You're my dad. This won't change that."


Winfrey also drew Armstrong out on his ex-wife, Kristin, whom he claimed knew just enough about both the doping and lying to ask him to stop. He credited her with making him promise that his comeback in 2009 would be drug-free.


"She said to me, 'You can do it under one condition: That you never cross that line again,'" Armstrong recalled.


"The line of drugs?" Winfrey asked.


"Yes. And I said, 'You've got a deal,'" he replied. "And I never would have betrayed that with her."


A U.S. Anti-Doping Agency report that exposed Armstrong as the leader of an elaborate doping scheme on his U.S. Postal Service cycling team included witness statements from at least three former teammates who said Kristin Armstrong participated in or at least knew about doping on the teams and knew team code names for EPO kept in her refrigerator. Postal rider Jonathan Vaughters testified that she handed riders cortisone pills wrapped in foil.


Armstrong said in the first part of the interview that he had stayed clean in the comeback, a claim that runs counter to the USADA report.


And that wasn't the only portion of the interview likely to rile anti-doping officials.


Winfrey asked Armstrong about a "60 Minutes Sports" interview in which USADA chief executive Travis Tygart said a representative of the cyclist had offered a donation that the agency turned down.


"Were you trying to pay off USADA?" she asked.


"No, that's not true," he replied, repeating, "That is not true."


Winfrey asks the question three more times, in different forms.


"That is not true," he insisted.


USADA spokeswoman Annie Skinner replied in a statement: "We stand by the facts both in the reasoned decision and in the '60 Minutes' interview."


Armstrong has talked with USADA officials, and a meeting with Tygart near the Denver airport reportedly ended in an argument over the possibility of modifying the lifetime ban. A person familiar with those conversations said Armstrong could provide information that might get his ban reduced to eight years. By then, he would be 49. The person spoke on condition of anonymity because he was discussing a confidential matter.


After retiring from cycling in 2011, Armstrong returned to triathlons, where he began his professional career as a teenager, and he has told people he's desperate to get back.


Winfrey asked if that was why he agreed to the interview.


"If you're asking me, do I want to compete again ... the answer is hell, yes," Armstrong said. "I'm a competitor. It's what I've done my whole life. I love to train. I love to race. I love to toe the line — and I don't expect it to happen."


Yet just three questions later, a flash of the old Armstrong emerged.


"Frankly," he said, "this may not be the most popular answer, but I think I deserve it. Maybe not right now ... (but) if I could go back to that time and say, 'OK, you're trading my story for a six-month suspension?' Because that's what people got."


"What other people got?" Winfrey asked.


"What everybody got," he replied.


Eleven former Armstrong teammates, including several who previously tested positive for PEDs, testified about the USPS team's doping scheme in exchange for more lenient punishments. Armstrong said in the first part of the interview that he knew his "fate was sealed" when his most trusted lieutenant, George Hincapie, who was alongside him for all seven Tour wins between 1999-2005, was forced to give Armstrong up to anti-doping authorities,


"So I got a death penalty and they got ... six months," Armstrong resumed. "I'm not saying that that's unfair, necessarily, but I'm saying it's different."


Armstrong said the most "humbling" moment in the aftermath of the USADA report was leaving Livestrong lest his association damage the foundation's ability to raise money and continue its advocacy programs on behalf of cancer victims.


Originally called the Lance Armstrong Foundation, the cyclist created it the year after he was diagnosed with a form of testicular cancer that had spread to his brain and lungs. Doctors gave him 50-50 odds of surviving.


"I wouldn't at all say forced out, told to leave," he said of Livestrong. "I was aware of the pressure. But it hurt like hell. ...


"That was the lowest," Armstrong said. "The lowest."


Armstrong's personal fortune had sustained a big hit days earlier. One by one, his sponsors called to end their associations with him: Nike; Trek Bicycles; Giro, which manufactures cycling helmets and other accessories; Anheuser-Busch.


"That was a $75 million day," Armstrong said.


"That just went out of your life," Winfrey said.


"Gone."


"Gone?" Winfrey repeated.


"Gone," he replied, "and probably never coming back."


So was there a moral to his story?


"I can look at what I did," he said. "Cheating to win bike races, lying about it, bullying people. Of course, you're not supposed to do those things. That's what we teach our children."


Armstrong paused to compose himself before a final mea culpa.


"I just think it was about the ride and losing myself, getting caught up in that, and doing all those things along the way that enabled that," he said. "The ultimate crime is, uh, is the betrayal of those people that supported me and believed in me.


"They got lied to."


___


AP Sports Writer Jim Vertuno in Austin, Texas, and National Writer Eddie Pells in Denver contributed to this report.


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Business Briefing | Medicine: F.D.A. Clears Botox to Help Bladder Control



Botox, the wrinkle treatment made by Allergan, has been approved to treat adults with overactive bladders who cannot tolerate or were not helped by other drugs, the Food and Drug Administration said on Friday. Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity. “Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence,” Dr. Hylton V. Joffe, director of the F.D.A.’s reproductive and urologic products division, said in a statement. “Today’s approval provides an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.”


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Analysis: Amid Tears Lance Armstrong Leaves Unanswered Questions in Oprah Winfrey Interview





In an extensive interview with Oprah Winfrey that was shown over two nights, Lance Armstrong admitted publicly for the first time that he doped throughout his cycling career. He revealed that all seven of his Tour de France victories were fueled by doping, that he never felt bad about cheating, and that he had covered up a positive drug test at the 1999 Tour with a backdated doctor’s prescription for banned cortisone.




Armstrong, the once defiant cyclist, also became choked up when he discussed how he told his oldest child that the rumors about Armstrong’s doping were true.


Even with all that, the interview will most likely be remembered for what it was missing.


Armstrong had not subjected himself to questioning from anyone in the news media since United States antidoping officials laid out their case against him in October. He chose not to appeal their ruling, leaving him with a lifetime ban from Olympic sports.


He personally chose Winfrey for his big reveal, and it went predictably. Winfrey allowed him to share his thoughts and elicited emotions from him, but she consistently failed to ask critical follow-up questions that would have addressed the most vexing aspects of Armstrong’s deception.


She did not press him on who helped him dope or cover up his drug use for more than a decade. Nor did she ask him why he chose to take banned performance-enhancing substances even after cancer had threatened his life.


Winfrey also did not push him to answer whether he had admitted to doctors in an Indianapolis hospital in 1996 that he had used performance-enhancing drugs, a confession a former teammate and his wife claimed they overheard that day. To get to the bottom of his deceit, antidoping officials said, Armstrong has to be willing to provide more details.


“He spoke to a talk-show host,” David Howman, the director general of the World Anti-Doping Agency, said from Montreal on Friday. “I don’t think any of it amounted to assistance to the antidoping community, let alone substantial assistance. You bundle it all up and say, ‘So what?’


Jeffrey M. Tillotson, the lawyer for an insurance company that unsuccessfully withheld a $5 million bonus from Armstrong on the basis that he had cheated to win the Tour de France in 2004, said his client would make a decision over the weekend about whether to sue Armstrong. If it proceeds, the company, SCA Promotions, will seek $12 million, the total it paid Armstrong in bonuses and legal fees.


“It seemed to us that he was more sorry that he had been caught than for what he had done,” Tillotson said. “If he’s serious about rehabbing himself, he needs to start making amends to the people he bullied and vilified, and he needs to start paying money back.”


Armstrong, who said he once believed himself to be invincible, explained in the portion of the interview broadcast Friday night that he started to take steps toward redemption last month. Then, after dozens of questions had already been lobbed his way, he became emotional when he described how he told his 13-year-old son, Luke, that yes, his father had cheated by doping. That talk happened last month over the holidays, Armstrong said as he fought back tears.


“I said, listen, there’s been a lot of questions about your dad, my career, whether I doped or did not dope, and I’ve always denied, I’ve always been ruthless and defiant about that, which is probably why you trusted me, which makes it even sicker,” Armstrong said he told his son, the oldest of his five children. “I want you to know it’s true.”


At times, Winfrey’s interview seemed more like a therapy session than an inquisition, with Armstrong admitting that he was narcissistic and had been in therapy — and that he should be in therapy regularly because his life was so complicated.


In the end, the interview most likely accomplished what Armstrong had hoped: it was the vehicle through which he admitted to the public that he had cheated by doping, which he had lied about for more than a decade. But his answers were just the first step to clawing back his once stellar reputation.


On Friday, Armstrong appeared more contrite than he had during the part of the interview that was shown Thursday, yet he still insisted that he was clean when he made his comeback to cycling in 2009 after a brief retirement, an assertion the United States Anti-Doping Agency said was untrue. He also implied that his lifetime ban from all Olympic sports was unfair because some of his former teammates who testified about their doping and the doping on Armstrong’s teams received only six-month bans.


Richard Pound, the founding chairman of WADA and a member of the International Olympic Committee, said he was unmoved by Armstrong’s televised mea culpa.


“If what he’s looking for is some kind of reconstruction of his image, instead of providing entertainment with Oprah Winfrey, he’s got a long way to go,” Pound said Friday from his Montreal office.


Armstrong acknowledged to Winfrey during Friday’s broadcast that he has a long way to go before winning back the public’s trust. He said he understood why people recently turned on him because they felt angry and betrayed.


“I lied to you and I’m sorry,” he said before acknowledging that he might have lost many of his supporters for good. “I am committed to spending as long as I have to to make amends, knowing full well that I won’t get very many back.”


Armstrong also said that the scandal has cost him $75 million in lost sponsors, all of whom abandoned him last fall after Usada made public 1,000 pages of evidence that Armstrong had doped.


“In a way, I just assumed we would get to that point,” he said of his sponsors’ leaving. “The story was getting out of control.”


In closing her interview, Winfrey asked Armstrong a question that left him perplexed.


“Will you rise again?” she said.


Armstrong said: “I don’t know. I don’t know. I don’t know what’s out there.”


Then, as the interview drew to a close, Armstrong said: “The ultimate crime is the betrayal of these people that supported me and believed in me.”


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China Objects After Shell Is Fired From Myanmar





BANGKOK — China said Thursday that it had expressed “grave concern” to the Myanmar government after a shell, apparently fired during fighting between Myanmar troops and ethnic rebels, landed in Chinese territory, and a Chinese government spokesman called for an immediate cease-fire.




The Chinese response was unusually strong given the close ties between the two countries in recent years, and it suggested that China was growing increasingly impatient and nervous about the Myanmar government’s campaign against ethnic Kachin rebels.


“China has lodged urgent representation to Myanmar over the incident, to express grave concerns and dissatisfaction,” said Hong Lei, a spokesman for China’s Foreign Ministry, who called for a cease-fire, according to the official Xinhua news agency.


Daw Aung San Suu Kyi, the opposition leader in Myanmar’s Parliament, called for an immediate stop to the fighting. But her comments, reported by the Irrawaddy online news site, were equivocal. She said she could not help more forcefully to resolve the conflict because she was not on the ethics committee.


“That doesn’t mean that I don’t take responsibility for the matter or that I don’t care about it, but different committees should respect each other and not interfere in each other’s work,” she said.


Myanmar’s government has repeatedly said that it wants to negotiate with the Kachin rebels, “We want to reduce our offensive and return to talks,” U Ye Htut, a spokesman for President Thein Sein, said in an interview with The Irrawaddy online news site that was posted on Thursday.


But the military appears to be accelerating its campaign against the Kachin using heavy artillery, attack helicopters and other aircraft to flush out guerrillas from their positions surrounding Laiza, a town along the border with China tha is the headquarters of the Kachin Indepedence Army..


Human Rights Watch on Friday called on Myanmar to stop what it described as “indiscriminate” shelling of Laiza, where three civilians were killed earlier this week from what rebels said was an attack by government troops.


Xinhua said the artillery shell was the fourth “bomb” dropped inside China since Dec. 30, when three others landed in Chinese territory.


Bertil Lintner, a specialist on Myanmar’s ethnic groups, said China feared an influx of refugees and further damage to trade along the border. The fighting has disrupted a number of Chinese hydroelectric projects in Myanmar, as well as jade mining.


“They are getting increasingly annoyed with what’s going on at the border,” Mr. Lintner said. “But the Chinese don’t really know what to do. They can’t antagonize the K.I.A.,” he said, referring to the Kachin Independence Army, “and they can’t antagonize the Burmese government either.”


Kachin rebels still control swaths of territory along the border with China, including areas where Chinese companies own plantations.


The Chinese government dealt directly with the Kachin for more than two decades, including the 17-year period when a cease-fire with the government allowed the Kachin to control border trade and maintain a degree of autonomy. The cease-fire collapsed in June 2011.


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ASUS in talks with Microsoft to develop a Windows Phone 8 smartphone






The PC industry is in shambles and manufacturers have begun to explore new options to increase revenue. According to The Wall Street Journal, ASUS (2357) is in talks with Microsoft (MSFT) on a licensing deal to offer Windows Phone 8 device. This makes sense for ASUS since smartphone shipments increased by nearly 50% in 2012, compared to a mere 3.2% growth in computer shipments, and the company already has experience in the mobile world after developing a variety of Android tablets.


[More from BGR: Cable companies called ‘monopolies that stifle competition and innovation’]






Benson Lin, the company’s corporate vice president of mobile communication products, revealed in a recent interview that ASUS was hoping to bring its PadFone, a smartphone that can dock into a larger tablet, to the Windows 8 ecosystem.


[More from BGR: Clash of the bantams: The bloody smartphone battle that will take shape in 2013]


“With our Padfone concept, the phone plus tablet, I think it makes sense for Windows 8,” Lin said. “There is no target timeline…but we are interested in making Windows phones.”


The executive also said that ASUS has been in talks with a variety of American carriers in the hopes that its smartphones will launch in the United States in 2013.


This article was originally published on BGR.com


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Armstrong admits doping: 'I'm a flawed character'


CHICAGO (AP) — He did it. He finally admitted it. Lance Armstrong doped.


He was light on the details and didn't name names. He mused that he might not have been caught if not for his comeback in 2009. And he was certain his "fate was sealed" when longtime friend, training partner and trusted lieutenant George Hincapie, who was along for the ride on all seven of Armstrong's Tour de France wins from 1999-2005, was forced to give him up to anti-doping authorities.


But right from the start and more than two dozen times during the first of a two-part interview Thursday night with Oprah Winfrey on her OWN network, the disgraced former cycling champion acknowledged what he had lied about repeatedly for years, and what had been one of the worst-kept secrets for the better part of a week: He was the ringleader of an elaborate doping scheme on a U.S. Postal Service team that swept him to the top of the podium at the Tour de France time after time.


"I'm a flawed character," he said.


Did it feel wrong?


"No," Armstrong replied. "Scary."


"Did you feel bad about it?" Winfrey pressed him.


"No," he said. "Even scarier."


"Did you feel in any way that you were cheating?"


"No," Armstrong paused. "Scariest."


"I went and looked up the definition of cheat," he added a moment later. "And the definition is to gain an advantage on a rival or foe. I didn't view it that way. I viewed it as a level playing field."


Wearing a blue blazer and open-neck shirt, Armstrong was direct and matter-of-fact, neither pained nor defensive. He looked straight ahead. There were no tears and very few laughs.


He dodged few questions and refused to implicate anyone else, even as he said it was humanly impossible to win seven straight Tours without doping.


"I'm not comfortable talking about other people," Armstrong said. "I don't want to accuse anybody."


Whether his televised confession will help or hurt Armstrong's bruised reputation and his already-tenuous defense in at least two pending lawsuits, and possibly a third, remains to be seen. Either way, a story that seemed too good to be true — cancer survivor returns to win one of sport's most grueling events seven times in a row — was revealed to be just that.


"This story was so perfect for so long. It's this myth, this perfect story, and it wasn't true," he said.


Winfrey got right to the point when the interview began, asking for yes-or-no answers to five questions.


Did Armstrong take banned substances? "Yes."


Did that include the blood-booster EPO? "Yes."


Did he do blood doping and use transfusions? "Yes."


Did he use testosterone, cortisone and human growth hormone? "Yes."


Did he take banned substances or blood dope in all his Tour wins? "Yes."


In his climb to the top, Armstrong cast aside teammates who questioned his tactics, yet swore he raced clean and tried to silence anyone who said otherwise. Ruthless and rich enough to settle any score, no place seemed beyond his reach — courtrooms, the court of public opinion, even along the roads of his sport's most prestigious race.


That relentless pursuit was one of the things that Armstrong said he regretted most.


"I deserve this," he said twice.


"It's a major flaw, and it's a guy who expected to get whatever he wanted and to control every outcome. And it's inexcusable. And when I say there are people who will hear this and never forgive me, I understand that. I do. ...


"That defiance, that attitude, that arrogance, you cannot deny it."


Armstrong said he started doping in mid-1990s but didn't when he finished third in his comeback attempt.


Anti-doping officials have said nothing short of a confession under oath — "not talking to a talk-show host," is how World Anti-Doping Agency director general David Howman put it — could prompt a reconsideration of Armstrong's lifetime ban from sanctioned events.


He's also had discussions with officials at the U.S. Anti-Doping Agency, whose 1,000-page report in October included testimony from nearly a dozen former teammates and led to stripping Armstrong of his Tour titles. Shortly after, he lost nearly all his endorsements, was forced to walk away from the Livestrong cancer charity he founded in 1997, and just this week was stripped of his bronze medal from the 2000 Olympics.


Armstrong could provide information that might get his ban reduced to eight years. By then, he would be 49. He returned to triathlons, where he began his professional career as a teenager, after retiring from cycling in 2011, and has told people he's desperate to get back.


Initial reaction from anti-doping officials ranged from hostile to cool.


WADA president John Fahey derided Armstrong's defense that he doped to create "a level playing field" as "a convenient way of justifying what he did — a fraud."


"He was wrong, he cheated and there was no excuse for what he did," Fahey said by telephone in Australia.


If Armstrong "was looking for redemption," Fahey added, "he didn't succeed in getting that."


USADA chief Travis Tygart, who pursued the case against Armstrong when others had stopped, said the cyclist's confession was just a start.


"Tonight, Lance Armstrong finally acknowledged that his cycling career was built on a powerful combination of doping and deceit," Tygart said. "His admission that he doped throughout his career is a small step in the right direction. But if he is sincere in his desire to correct his past mistakes, he will testify under oath about the full extent of his doping activities."


Livestrong issued a statement that said the charity was "disappointed by the news that Lance Armstrong misled people during and after his cycling career, including us."


"Earlier this week, Lance apologized to our staff and we accepted his apology in order to move on and chart a strong, independent course," it said.


The interview revealed very few details about Armstrong's performance-enhancing regimen that would surprise anti-doping officials.


What he called "my cocktail" contained the steroid testosterone and the blood-booster erythropoetein, or EPO, "but not a lot," Armstrong said. That was on top of blood-doping, which involved removing his own blood and weeks later re-injecting it into his system.


All of it was designed to build strength and endurance, but it became so routine that Armstrong described it as "like saying we have to have air in our tires or water in our bottles."


"That was, in my view, part of the job," he said.


Armstrong was evasive, or begged off entirely, when Winfrey tried to connect his use to others who aided or abetted the performance-enhancing scheme on the USPS team


When she asked him about Italian doctor Michele Ferrari, who was implicated in doping-related scrapes and has also been banned from cycling for life, Armstrong replied, "It's hard to talk about some of these things and not mention names. There are people in this story, they're good people and we've all made mistakes ... they're not monsters, not toxic and not evil, and I viewed Michele Ferrari as a good man and smart man and still do."


But that's nearly all Armstrong would say about the physician that some reports have suggested educated the cyclist about doping and looked after other aspects of his training program.


He was almost as reluctant to discuss claims by former teammates Tyler Hamilton and Floyd Landis that Armstrong told them, separately, that he tested positive during the 2001 Tour de Suisse and conspired with officials of the International Cycling Union officials to cover it up — in exchange for a donation.


"That story wasn't true. There was no positive test, no paying off of the labs. There was no secret meeting with the lab director," he said.


Winfrey pressed him again, asking if the money he donated wasn't part of a tit-for-tat agreement, "Why make it?"


"Because they asked me to," Armstrong began.


"This is impossible for me to answer and have anybody believe it," he said. "It was not in exchange for any cover-up. ... I have every incentive here to tell you yes."


Finally, he summed up the entire episode this way: "I was retired. ... They needed money."


Ultimately, though, it was Landis who did the most damage to Armstrong's story. Landis was stripped of the 2006 Tour title after testing positive and wound up on the sport's fringes looking for work. Armstrong said his former teammate threatened to release potentially destructive videos if he wasn't given a spot on the team. That was in 2009, when Armstrong returned to the Tour after four years off.


Winfrey asked whether Landis' decision to talk was "the tipping point."


"I'd agree with that. I might back it up a little and talk about the comeback. I think the comeback didn't sit well with Floyd," Armstrong recalled.


"Do you regret now coming back?"


"I do. We wouldn't be sitting here if I didn't come back," he said.


The closest Armstrong came to contrition was when Winfrey asked him about his apologies in recent days, notably to former teammate Frankie Andreu, who struggled to find work in cycling after Armstrong dropped him from the USPS team, as well as his wife, Betsy. Armstrong said she was jealous of his success, and invented stories about his doping as part of a long-running vendetta.


"Have you made peace?" Winfrey asked.


"No," Armstrong replied, "because they've been hurt too badly, and a 40-minute (phone) conversation isn't enough."


He also called London Sunday Times reporter David Walsh as well as Emma O'Reilly, who worked as a masseuse for the USPS team and later provided considerable material for a critical book Walsh wrote about Armstrong and his role in cycling's doping culture.


Armstrong subsequently sued for libel in Britain and won a $500,000 judgment against the newspaper, which is now suing to get the money back. Armstrong was, if anything, even more vicious in the way he went after O'Reilly. He intimated she was let go from the Postal team because she seemed more interested in personal relationships than professional ones.


"What do you want to say about Emma O'Reilly?" Winfrey asked.


"She, she's one of these people that I have to apologize to. She's one of these people that got run over, got bullied."


"You sued her?"


"To be honest, Oprah, we sued so many people I don't even," Armstrong said, then paused, "I'm sure we did."


Near the end of the first interview installment, Winfrey asked about a federal investigation of Armstrong that was dropped by the Justice Department without charges.


"When they dropped the case, did you think: 'Now, finally over, done, victory'?"


Armstrong looked up. He exhaled.


"It's hard to define victory," he said. "But I thought I was out of the woods."


___


AP Sports Writers Jim Vertuno in Austin, Texas, Eddie Pells in Denver and Dennis Passa in Melbourne contributed to this report.


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Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

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DealBook: Michael Dell’s Empire in a Buyout Spotlight

The computer empire of Michael S. Dell spreads across a campus of low-slung buildings in Round Rock, Tex.

But his financial empire — estimated at $16 billion — occupies the 21st floor of a dark glass skyscraper on Fifth Avenue in Manhattan.

It is there that MSD Capital, started by Mr. Dell 15 years ago to manage his fortune, has quietly built a reputation as one of the smartest investors on Wall Street. By amassing a prodigious portfolio of stocks, companies, real estate and timberland, Mr. Dell has reduced his exposure to the volatile technology sector and branched out into businesses as diverse as dentistry and landscaping.

Now, Mr. Dell is on the verge of making one of the biggest investments of his life. The 47-year-old billionaire and his private equity backers are locked in talks to acquire Dell, the company he started with $1,000 as a teenager three decades ago, in a leveraged buyout worth more than $20 billion. MSD could play a role in the Dell takeover, according to people briefed on the deal.

The private equity firm Silver Lake has been in negotiations to join with Mr. Dell on a transaction, along with other potential partners like wealthy Asian investors or foreign funds. Mr. Dell would be expected to roll his nearly 16 percent ownership of the company into the buyout, a stake valued at about $3.5 billion. He could also contribute additional personal money as part of the buyout.

That money is managed by MSD, among the more prominent so-called family offices that are set up to handle the personal investments of the wealthy. Others with large family offices include Bill Gates, whose Microsoft wealth financed the firm Cascade Investment, and New York’s mayor, Michael R. Bloomberg, who set up his firm, Willett Advisors, in 2010 to manage his personal and philanthropic assets.

“Some of these family offices are among the world’s most sophisticated investors and have the capital and talent to compete with the largest private equity firms and hedge funds,” said John P. Rompon, managing partner of McNally Capital, which helps structure private equity deals for family offices.

A spokesman for MSD declined to comment for this article. The buyout talks could still fall apart.

In 1998, Mr. Dell, then just 33 years old — and his company’s stock worth three times what it is today — decided to diversify his wealth and set up MSD. He staked the firm with $400 million of his own money, effectively starting his own personal money-management business.

To head the operation, Mr. Dell hired Glenn R. Fuhrman, a managing director at Goldman Sachs, and John C. Phelan, a principal at ESL Investments, the hedge fund run by Edward S. Lampert. He knew both men from his previous dealings with Wall Street. Mr. Fuhrman led a group at Goldman that marketed specialized investments like private equity and real estate to wealthy families like the Dells. And Mr. Dell was an early investor in Mr. Lampert’s fund.

Mr. Fuhrman and Mr. Phelan still run MSD and preside over a staff of more than 100 overseeing Mr. Dell’s billions and the assets in his family foundation. MSD investments include a stock portfolio, with positions in the apparel company PVH, owner of the Calvin Klein and Tommy Hilfiger brands, and DineEquity, the parent of IHOP and Applebee’s.

Among its real estate holdings are the Four Seasons Resort Maui in Hawaii and a stake in the New York-based developer Related Companies.

MSD also has investments in several private businesses, including ValleyCrest, which bills itself as the country’s largest landscape design company, and DentalOne Partners, a collection of dental practices.

Perhaps MSD’s most prominent deal came in 2008, in the middle of the financial crisis, when it joined a consortium that acquired the assets of the collapsed mortgage lender IndyMac Bank from the federal government for about $13.9 billion and renamed it OneWest Bank.

The OneWest purchase has been wildly successful. Steven Mnuchin, a former Goldman executive who led the OneWest deal, has said that the bank is expected to consider an initial public offering this year. An I.P.O. would generate big profits for Mr. Dell and his co-investors, according to people briefed on the deal.

Another arm of MSD makes select investments in outside hedge funds. Mr. Dell invested in the first fund raised by Silver Lake, the technology-focused private equity firm that might now become his partner in taking Dell private.
MSD’s principals have already made tidy fortunes. In 2009, Mr. Fuhrman, 47, paid $26 million for the Park Avenue apartment of the former Lehman Brothers chief executive Richard S. Fuld. Mr. Phelan, 48, and his wife, Amy, a former Dallas Cowboys cheerleader, also live in a Park Avenue co-op and built a home in Aspen, Colo.

Both are influential players on the contemporary art scene, with ARTNews magazine last year naming each of them among the world’s top 200 collectors. MSD, too, has dabbled in the visual arts. In 2010, MSD bought an archive of vintage photos from Magnum, including portraits of Marilyn Monroe and Mahatma Gandhi, and has put the collection on display at the University of Texas, Mr. Dell’s alma mater.

Just as the investment firms Rockefeller & Company (the Rockefellers, diversifying their oil fortune) and Bessemer Trust (the Phippses, using the name of the steelmaking process that formed the basis of their wealth) started out as investment vehicles for a single family, MSD has recently shown signs of morphing into a traditional money management business with clients beside Mr. Dell.

Last year, for the fourth time, an MSD affiliate raised money from outside investors when it collected about $1 billion for a stock-focused hedge fund, MSD Torchlight Partners. A 2010 fund investing in distressed European assets also manages about $1 billion. The Dell family is the anchor investor in each of the funds, according to people briefed on the investments.

MSD has largely remained below the radar, though its name emerged a decade ago in the criminal trial of the technology banker Frank Quattrone on obstruction of justice charges. Prosecutors introduced an e-mail that Mr. Fuhrman sent to Mr. Quattrone during the peak of the dot-com boom in which he pleaded for a large allotment of a popular Internet initial public offering.

“We know this is a tough one, but we wanted to ask for a little help with our Corvis allocation,” Mr. Fuhrman wrote. “We are looking forward to making you our ‘go to’ banker.”

The e-mail, which was not illegal, was meant to show the quid pro quo deals that were believed to have been struck between Mr. Quattrone and corporate chieftains like Mr. Dell — the bankers would give executives hot I.P.O.’s and the executives, in exchange, would hold out the possibility of giving business to the bankers. (Mr. Quattrone’s conviction was reversed on appeal.)

The MSD team has also shown itself to be loyal to its patron in other ways.

On the MSD Web site, in the frequently asked questions section, the firm asks and answers queries like “how many employees do you have” and “what kind of investments do you make.”

In the last question on the list, MSD asks itself, “Do you use Dell computer equipment?” The answer: “Exclusively!”


This post has been revised to reflect the following correction:

Correction: January 18, 2013

An earlier version of this article misstated when an MSD affiliate raised money from outside investors for a hedge fund. It was last year, not earlier this year. The article also misstated which hedge fund and its focus. It was MSD Torchlight Partners, a stock-focused hedge fund, not MSD Energy Partners, an energy-focused hedge fund.

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India Ink: A Hospital Network With a Vision

Fixes looks at solutions to social problems and why they work.

As the United States struggles to find new business models for health care, some innovators are looking to other industries, ones that provide high-quality services for low prices. In a recent article in The New Yorker, for example, Atul Gawande suggests that the Cheesecake Factory restaurant chain — with its size, central control and accountability for the customer experience — could be a model of sorts for health care. That’s not as outlandish as it seems. The world’s largest provider of eye care has found success by directly adapting the management practices of another big-box food brand, one that is not often associated with good health: McDonald’s.

Aravind can practice compassion successfully because it is run like a McDonald’s.

In 1976, Dr. Govindappa Venkataswamy — known as Dr. V — retired from performing eye surgery at the Government Medical College in Madurai, Tamil Nadu, a state in India’s south. He decided to devote his remaining years to eliminating needless blindness among India’s poor. Twelve million people are blind in India, the vast majority of them from cataracts, which tend to strike people in India before 60 — earlier than in the West. Blindness robs a poor person of his livelihood and with it, his sense of self-worth; it is often a fatal disease. A blind person, the Indian saying goes, is “a mouth with no hands.”

Dr. V started by establishing an 11-bed hospital with six beds reserved for patients who could not pay and five for those who would pay modest rates. He persuaded his siblings to join him in mortgaging their houses, pooling their savings and pawning their jewels to build it. Today, the Aravind Eye Care System is a network of hospitals, clinics, community outreach efforts, factories, and research and training institutes in south India that has treated more than 32 million patients and has performed 4 million surgeries. And it is still largely run by Dr V’s siblings and their spouses and children — he has at least 21 relatives who are eye surgeons. (Aravind’s story is well-told in depth in a new book, “Infinite Vision.”)

Aravind is not just a health success, it is a financial success. Many health nonprofits in developing countries rely on government help or donations, but Aravind’s core services are sustainable: patient care and the construction of new hospitals are funded by fees from paying patients. And at Aravind, patients pay only if they want to. The majority of Aravind’s patients pay only a symbolic amount, or nothing at all.

Dr V was guided by the teachings of the radical Indian nationalist and mystic Sri Aurobindo (Aravind is a southern Indian variation of Aurobindo), who located man’s search for his divine nature not in turning away from the world, but by engaging with it.

This philosophy, however, has produced a sustainable business model because of the other major influence on Dr. V: McDonald’s. Sri Aurobindo and McDonald’s are an unlikely pair. But Aravind can practice compassion successfully because it is run like a McDonald’s, with assembly-line efficiency, strict quality norms, brand recognition, standardization, consistency, ruthless cost control and above all, volume.

Aravind’s efficiency allows its paying patients to subsidize the free ones, while still paying far less than they would at other Indian hospitals. Each year, Aravind does 60 percent as many eye surgeries as the United Kingdom’s National Health System, at one one-thousandth of the cost.

Aravind’s ideas reach around the world. It runs hospitals in other parts of India with partners. It is also host to a parade of people who come to learn how it works, and it sends staff to work with other organizations. So far about 300 hospitals in India and in other countries are using the Aravind model. All are eye hospitals. But Aravind has also trained staff from maternity hospitals, cancer centers, and male circumcision clinics, among other places. Some share Aravind’s social mission. Others simply want to operate more efficiently.

The vast majority of people blind from cataracts in rural India have no idea why they are blind, nor that a surgery exists that can restore their sight in a few minutes. Aravind attracts these patients in two ways. First, it holds eye camps — 40 a week around the states of Tamil Nadu and Kerala. The camps visit villages every few months, offering eye exams, basic treatments, and fast, cheap glasses. Patients requiring surgery are invited with a family member to come to the nearest of Aravind’s nine hospitals; all transport and lodging, like the surgery, is free.

When Aravind surveyed the impact of its camps, it found to its dismay that they only attracted 7 percent of people in a village who needed care, mainly because they were infrequent. To provide a permanent presence in rural areas, Aravind established 36 storefront vision centers. They are staffed by rural women recruited and given two years’ training by Aravind. They have cameras, so doctors at Aravind’s hospitals can do examinations remotely. These centers increase Aravind’s market penetration to about 30 percent within one year of operation.

At Aravind’s hospitals, free patients lodge on a mat on the floor in a 30-person dormitory. Paying patients can choose various levels of luxury, including private, air-conditioned rooms. All patients get best-practice cataract surgeries, but paying patients can choose more sophisticated surgeries with faster recoveries (but not higher success rates). The doctors are identical, rotating between the free and paid wings.

Also standard for all patients is the Aravind assembly line. Dr. V spent a few days at McDonalds’ Hamburger University in Oak Brook,, Ill., but that visit was a product of his longstanding obsession with efficiency. “This man would go into an airport and walk around with the janitor and see how he cleans the toilet,” said Dr. S. Aravind, an eye surgeon with a masters degree in business who is Aravind’s director of projects. (He is Dr. V’s nephew, also named for Sri Aurobindo.) “He would go to a five star hotel and follow the catering people.”

Doctors are hard to find and expensive, so the surgical system is set up to get the most out of them. Patients are prepared before surgery and bandaged afterwards by Aravind-trained nurses. The operating room has two tables. The doctor performs a surgery — perhaps 5 minutes — on Table 1, sterilizes her hands and turns to Table 2. Meanwhile, a new patient is prepped on Table 1. Aravind doctors do more than 2,000 surgeries a year; the average at other Indian hospitals is around 300. As for quality, Aravind’s rate of surgical complications is half that of eye hospitals in Britain.

This volume is key to Aravind’s ability to offer free care. The building and staff costs are the same no matter how many surgeries each doctor performs. High volume means that these fixed costs are spread among vastly more people.

In the 1980s, Aravind faced a dilemma. A new surgery, which implanted a lens in the patient’s eye, had become the gold standard for treating cataracts. But these lenses were not made in India, and Aravind could persuade manufacturers to reduce their cost only from $100 to $70 per lens. Should Aravind begin providing first-class treatment for paying patients and second-class treatment for free ones? Or should it try to get enough money from paid patients to cover intraocular lenses for all? Neither was acceptable.

The solution was to get into manufacturing. In 1992, Aravind set up Aurolab, which now makes lenses (for $2 apiece), sutures and medicines. Aurolab is now a major global supplier of intraocular lenses and has driven down the price of lenses made by other manufacturers as well.

Aravind could not do its work without paying patients, of course — they subsidize free patients. They also improve service, by demanding high quality for their money. But it also works the other way around: the free patients improve service and price for patients who pay. “One of our big advantages is the scale of the work we do,” said Dr. Aravind. “You become a good resource center for training doctors, nurses, everybody. Because of high volume, doctors get better at what they do. They can develop subtle specialties.” And free patients make cost control a priority. “If 60 percent of your patients are paying very little or nothing, your cost structure is attuned towards that,” Dr. Aravind said.


Whenever there is an innovator like Aravind, the question arises: how replicable is this? Do you need a Dr. V? Or is there a system that ordinary mortals can adapt?

The answer is a little of both. Other hospitals can and do successfully use the model. Lions Clubs International, which has worked to prevent blindness for more than a century, finances and supports a training institute. Aravind also works with the Berkeley-based Seva Foundation to grow eye hospitals in other countries. “There are a lot of eye hospitals in the developing world. Almost every single one is considerably underproducing,” said Suzanne Gilbert, the director of Seva’s Center for Innovation in Eye Care. “Surgical programs so often focus on the technique being used. Often the same level of scrutiny not applied to management, human resources and other systems that make the surgery work.”

Seva has worked with Aravind to establish hospitals in other countries (the Lumbini Eye Institute in Nepal has been particularly successful).  But its campaign to turn those hospitals into training centers has gone slowly. It’s hard to build those hospitals to be able to reach out while keeping good quality,” said Gilbert.   Seva was aiming to have 100 hospitals in the network by 2015, but has scaled back that goal.

“Of the 300 hospitals (that use Aravind’s model), I’d say 20 percent get the whole thing,” said Dr. Aravind. “Another 50 percent pick up pieces — how to make your operating tables more efficient, for example.  And the rest struggle.”

Combining paid and free care in a self-sufficient hospital is not possible for most health specialties. “The essential ingredient is volume that straddles the socioeconomic spectrum,” said Jaspal Sandhu, a Berkeley engineer who has studied Aurolab, and who is co-founder of the Gobee Group, a design firm that works with organizations to increase their social impact. “If you’re focusing on rich diseases or poor diseases, this model in existing form can’t really play out. The nice thing about cataracts is that it doesn’t greatly discriminate. And a cataract is a one-time hit. There’s a cure for it. You can treat it in a couple of days and it won’t come back.”

Male circumcision — an AIDS prevention measure — fits this description, and the World Health Organization’s guidelines for scaling up male circumcision uses Aravind’s principles. “When I was a doctor in a government hospital we did between 8 and maybe 12 circumcisions in a day per doctor,” said Dino Rech, a South African physician who has overseen the expansion of circumcision in several countries.  “With this model, the slowest doctors are doing 40 in a day — up to 60 for the faster ones.”

The McDonald’s part is the easiest piece of the Aravind model to export. More difficult to replicate is Aravind’s commitment to serving the largest number of free patients possible — indeed, to aim to eventually serve all of them. What’s needed, said Dr. Aravind, “is not leadership in the sense of organizing and making it work. It’s leadership that comes from empathizing with the community.”

Aravind spends a lot of resources recruiting free patients. “Never restrict demand. Build your capacity to meet the demand,” Dr. Aravind said. This community outreach work is the easiest part to sacrifice, he said. “This is where mission and leadership come in. People try to justify it with many things — we’ll build a bigger organization, then we’ll go back to community. If you have a choice between your paying and your free patients — well, the team is watching how you prioritize. Here’s its been internalized that this is the way we deal with any issue.  If someone can embody that, they can be like our founder.”

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Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and the author of, most recently, “Join the Club: How Peer Pressure Can Transform the World” and the World War II spy story e-book “D for Deception.”

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