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.

"The result of this trial will have a major, immediate impact on premenopausal women," Ravdin said.

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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NYC Subway Pusher Charged With Murder

A New York City man was charged today with murder for shoving another man onto subway tracks where he was struck and killed by an oncoming train.

Naeem Davis, 30, was charged after being questioned by police since Tuesday about the death of Ki-Suck Han, 58, of Queens, N.Y.

The charges include murder second degree: intentional, as well as murder second degree: depraved indifference.

He is charged with murdering Han "with depraved indifference" not because he intended to kill Han, but because his lack of regard for Han's life resulted in the death. Two sources involved in Davis' arrest and charging say there is a question whether he intended to kill Han or whether his death was an unintended consequence of an altercation.

NYC Man Pushed on Subway Tracks, Killed by Train Watch Video

Davis admitted to police while explaining the incident that he shoved Han in a way that caused him to fall onto the subway tracks, according to multiple sources involved with the investigation.

Han struggled to pull himself up from the shoulder-high track bed and back onto the platform at the 49th Street and Seventh Avenue station around 12:30 p.m. on Monday, but was hit and killed by a Q train when it barrelled into the station.

Davis could be heard arguing with Han before the fatal shove, according to surveillance video from the station. Davis told police that Han was harassing him and would not leave him alone, so he pushed Han.

Detectives are investigating whether the altercation began at the subway station turnstile and whether Han had jumped that turnstile and bumped Davis.

Police are also awaiting toxicology results on Han, who was found with an empty pint bottle of vodka on him when he died, according to sources.

Davis has no currently known mental illness history. He has prior arrests for minor charges, although the search of his arrest record is not complete. Those arrests in New York City appear to be peddler related.

He is expected to be arraigned this evening in New York.

Han death shocked New York City and the moment was frozen in the city's psyche by a photograph that captured Han with his arms and head above the platform staring at the oncoming train.

A doctor who was standing nearby attempted to perform CPR on Han, but he was pronounced dead at Roosevelt Hospital shortly after the accident.

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Clashes erupt in Egypt despite proposal to end crisis

CAIRO (Reuters) - Islamists fought protesters outside the Egyptian president's palace on Wednesday, while inside the building his deputy proposed a way to end a crisis over a draft constitution that has split the most populous Arab nation.

Stones and petrol bombs flew between opposition protesters and supporters of President Mohamed Mursi, and the Interior Ministry said 32 people had been arrested and three police vehicles destroyed.

Two Islamists were hit in the legs by what their friends said were bullets fired during clashes in streets around the compound in northern Cairo. One of them was bleeding heavily. And a leftist group said Islamists had cut off the ear of one of its members.

Medical sources said 33 people had been wounded, but despite reports of fatalities, the Health Ministry said there had been no deaths.

Riot police were deployed between the two sides in Cairo to try to stop confrontations that flared after dark despite an attempt by Vice President Mahmoud Mekky to ease the crisis.

Mekky said amendments to disputed articles in the draft constitution could be agreed with the opposition. A written agreement could then be submitted to the next parliament, to be elected after a referendum on the constitution on December 15.

"There must be consensus," he told a news conference, saying opposition demands had to be respected to reach a solution.

Prime Minister Hisham Kandil called for calm to "give the opportunity" for efforts underway to start a national dialogue.

Facing the gravest crisis of his six-month-old tenure, Mursi has shown no sign of buckling to the protests, confident that Islamists can win the referendum and a parliamentary election to follow.

Many Egyptians yearn for an end to political upheaval that began with the overthrow of Hosni Mubarak in February 2011 and which has hurt the economy as investors and tourists have fled.

Protests spread to other cities, and offices of the Brotherhood's political party in Ismailia and Suez were torched.

Egypt's opposition coalition blamed Mursi for the violence and said it was ready for dialogue if the Islamist leader scrapped a decree he issued on November 22 that gave him wide powers and shielded his decisions from judicial review.

DIALOGUE

"We hold President Mursi and his government completely responsible for the violence happening in Egypt today," opposition coordinator Mohamed ElBaradei told a news conference.

"We are ready for dialogue if the constitutional decree is cancelled ... and the referendum on this constitution is postponed," he said of the document written by an Islamist-led assembly that the opposition says ignores its concerns.

But liberals, leftists, Christians, ex-Mubarak followers and others opposed to Mursi have yet to generate a mass movement or a grassroots base to challenge the Brotherhood, which has come out on top in two elections since Mubarak's overthrow.

"Today what is happening in the Egyptian street, polarisation and division, is something that could and is actually drawing us to violence and could draw us to something worse," said ElBaradei, the former head of the U.N. nuclear watchdog.

Opposition leaders have previously urged Mursi to retract the November 22 decree, defer the referendum and agree to revise the constitution, but have not echoed calls from street protesters for his overthrow and the "downfall of the regime".

Mursi has said his decree was needed to prevent courts still full of judges appointed by ousted strongman Hosni Mubarak from derailing a constitution vital for Egypt's political transition.

Earlier on Wednesday Islamist supporters of Mursi tore down tents erected outside the presidential palace by leftist foes who had begun a sit-in there.

"They hit us and destroyed our tents. Are you happy, Mursi? Aren't we Egyptians too?" asked protester Haitham Ahmed.

Mohamed Mohy, a pro-Mursi demonstrator who was filming the scene, said: "We are here to support our president and his decisions and save our country from traitors and agents."

Mekky said street mobilisation by both sides posed a "real danger" to Egypt. "If we do not put a stop to this phenomenon right away ... where are we headed? We must calm down."

CALLS FOR RESTRAINT

U.S. Secretary of State Hillary Clinton weighed into Egypt's political debate, saying dialogue was urgently needed on the new constitution, which should "respect the rights of all citizens".

Clinton and Mursi worked together last month to broker a truce between Israel and Hamas Islamists in the Gaza Strip.

Washington is worried about rising Islamist power in Egypt, a staunch U.S. security partner under Mubarak, who preserved the U.S.-brokered peace treaty Cairo signed with Israel in 1979.

British Foreign Secretary William Hague called for restraint on all sides. He said Egypt's authorities had to make progress on the transition in an "inclusive manner" and urged dialogue.

The Muslim Brotherhood had summoned supporters to an open-ended demonstration at the presidential palace, a day after about 10,000 opposition protesters had encircled it for what organizers dubbed a "last warning" to Mursi.

State institutions, with the partial exception of the judiciary, have mostly fallen in behind Mursi.

The army, the muscle behind all previous Egyptian presidents in the republic's six-decade history, has gone back to barracks, having apparently lost its appetite to intervene in politics.

In August Mursi sacked Mubarak-era army commander and defense minister Mohamed Hussein Tantawi and removed the sweeping powers that the military council, which took over after Mubarak fell, had grabbed two months earlier.

Investors have seized on hopes that Egypt's turbulent transition, which has buffeted the economy for two years, may soon head for calmer waters, sending stocks 1.6 percent higher after a 3.5 percent rally on Tuesday.

Egypt has turned to the IMF for a $4.8 billion loan after the depletion of its foreign currency reserves. The government said on Wednesday the process was on track and its request would go to the IMF board as expected.

The board is due to review the facility on December 19.

Elijah Zarwan, a fellow with the European Council on Foreign Relations, said that if Egypt was to find a compromise solution to its crisis, it would not be through slogans and blows.

"It will be through quiet negotiation, not through dueling press conferences, street brawls, or civil strife," he said.

(Additional reporting by Tom Perry and Tamim Elyan; Writing by Alistair Lyon and Edmund Blair; Editing by Andrew Roche and Will Waterman)

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Golf: McIlroy named US PGA Tour Player of Year

PONTE VEDRA BEACH, Florida: Rory McIlroy, whose four US PGA Tour victories in 2012 included a major title at the PGA Championship, was named the US tour's Player of the Year on Tuesday.

US tour members vote on the award, which made the 23-year-old from Northern Ireland the youngest player to be named Player of the Year since then 21-year-old Tiger Woods in 1997.

McIlroy authored a strong finish to the season, including his eight-shot PGA Championship triumph at Kiawah Island, winning the money title and the Vardon Trophy for lowest adjusted scoring average.

"It's just a great way to end what has been a great year, my best season so far," McIlroy said.

McIlroy became the third European in five years to capture the award. Ireland's Padraig Harrington won it in 2008, and England's Luke Donald received it last year.

The tour does not announce the voting numbers for the award, but the ballot for Player of the Year also included Woods, who had three wins this season, Jason Dufner, Masters Champion Bubba Watson and Brandt Snedeker, who captured his second title of the season at the Tour Championship to claim the FedEx Cup playoff crown.

John Huh, the only rookie to make it to the Tour Championship, was named Rookie of the Year.

Huh, who secured his card in qualifying-school, won a tournament in Mexico in February that was played opposite the WGC Match Play Championship.

At Playa Del Carmen, Huh parred all eight playoff holes to beat Australian Robert Allenby in a marathon playoff for the title.

After his PGA Championship triumph, McIlroy went on to win the Deutsche Bank Championship and the BMW Cchampionship at Crooked Stick.

McIlroy's other victory was earlier in the season, when he held of Woods to win the Honda Classic and reach number one in the world for the first time.

He surrendered and regained the top spot several times over the season until settling in at number one with his strong late form.

"I think everyone knows that my game wasn't where I wanted it to be through the start of the summer and leading up to the PGA," McIlroy said on a conference call.

Once he had the second major of his career under his belt, however, he was off and running.

"From that I gained a lot of confidence, knowing that I could win my second major," he said. "And I went on from there."

PGA Tour commissioner Tim Finchem, said McIlroy's professionalism was as striking as his game.

"He has handled himself in terrific fashion," Finchem said. "He has been very direct with the media and entertaining to the fans inside and outside the ropes. He is at a very young age already making a very solid contribution to what is the most important asset of the PGA Tour, and that is the image of its players."

- AFP/fa

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FDI: Congress woos Mulayam, Maya for Rajya Sabha numbers

NEW DELHI: With the BSP continuing to resist the Congress's persuasion to openly support the decision to allow foreign retail chains into the country, the government on Tuesday furiously cranked up its efforts to dodge a likely defeat in Rajya Sabha.

On a day when the SP and the BSP, serial saviours of the government in crunch situations, slammed the FDI decision in the Lok Sabha debate, the government was preoccupied with the worry of losing the numbers game in the other House. Unlike in the Lok Sabha, where the SP and BSP can help the government clear the numbers test by merely abstaining, the UPA will need the direct support of one of the UP outfits to score a certain win.

The BSP, just like the SP, did not join other non-UPA parties in insisting on a debate in Rajya Sabha under a voting clause, Rule 168 to be precise, besides declaring in Lok Sabha its inability to join communal forces: code for the BJP. However, the Congress's hopes of persuading the BSP to turn its indirect assistance into open support by voting against the opposition failed to materialize on Tuesday, leading UPA managers to fish for all possible numbers in the upper House.

Congress sources said the BSP has expressed its inability to move beyond abstention during the vote in LS on Wednesday, citing the SP's decision not to vote with the government and arguing that it cannot afford to cede political mileage to its main foe.

BSP chief Mayawati told Congress's emissaries that she would reveal her hand just before the Lok Sabha vote, at a meeting of her MPs she has called at 4 pm. However, Congress managers recognize that she may find it difficult to take a line different from Mulayam Singh Yadav, given their intense rivalry in UP; as well as that she may find it difficult to behave differently in RS when the upper House takes up the vote on Friday.

After an urgent meeting, Congress sources expressed hope that the government would squeak through by four votes if it manages to ensure the presence of all the members who are non-aligned — a category that covers Independents, the unattached as well as all nominated members except Sachin Tendulkar.

The absence of the BSP and the SP will reduce RS's effective strength to 220, leaving the opposition with a wafer-thin edge. The anti-FDI column has 110 votes, pushing the government into a situation where the absence of even one of its members can lead to a politically embarrassing defeat. The BSP, with 15 members, can tilt the scales decisively.

In contrast, the government is sure of smooth sailing in LS: its confidence reflected in its nonchalance when the SP and BSP launched a severe attack on FDI. With 43 seats between them, the two UP outfits can tilt the scales decisively in LS in case they choose to translate their rhetoric against FDI into a vote against government's decision, taking the number of anti-FDI votes to 261 as against 245 committed for the UPA.

In attacking FDI, Mulayam was unambiguous. Yet, his barbs elicited earnest nods from the Congress brass led by Sonia Gandhi. The FDI vote is another demonstration of how the Congress has successfully balanced arch-rivals from UP into backing the Centre.

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CDC says US flu season starts early, could be bad

NEW YORK (AP) — Flu season in the U.S. is off to its earliest start in nearly a decade — and it could be a bad one.

Health officials on Monday said suspected flu cases have jumped in five Southern states, and the primary strain circulating tends to make people sicker than other types. It is particularly hard on the elderly.

"It looks like it's shaping up to be a bad flu season, but only time will tell," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

The good news is that the nation seems fairly well prepared, Frieden said. More than a third of Americans have been vaccinated, and the vaccine formulated for this year is well-matched to the strains of the virus seen so far, CDC officials said.

Higher-than-normal reports of flu have come in from Alabama, Louisiana, Mississippi, Tennessee and Texas. An uptick like this usually doesn't happen until after Christmas. Flu-related hospitalizations are also rising earlier than usual, and there have already been two deaths in children.

Hospitals and urgent care centers in northern Alabama have been bustling. "Fortunately, the cases have been relatively mild," said Dr. Henry Wang, an emergency medicine physician at the University of Alabama at Birmingham.

Parts of Georgia have seen a boom in traffic, too. It's not clear why the flu is showing up so early, or how long it will stay.

"My advice is: Get the vaccine now," said Dr. James Steinberg, an Emory University infectious diseases specialist in Atlanta.

The last time a conventional flu season started this early was the winter of 2003-04, which proved to be one of the most lethal seasons in the past 35 years, with more than 48,000 deaths. The dominant type of flu back then was the same one seen this year.

One key difference between then and now: In 2003-04, the vaccine was poorly matched to the predominant flu strain. Also, there's more vaccine now, and vaccination rates have risen for the general public and for key groups such as pregnant women and health care workers.

An estimated 112 million Americans have been vaccinated so far, the CDC said. Flu vaccinations are recommended for everyone 6 months or older.

On average, about 24,000 Americans die each flu season, according to the CDC.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

A strain of swine flu that hit in 2009 caused a wave of cases in the spring and then again in the early fall. But that was considered a unique type of flu, distinct from the conventional strains that circulate every year.

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Online:

CDC: http://www.cdc.gov/flu/weekly

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Obama Sees 'Potential' for Averting the Fiscal Cliff

President Obama says he sees "potential" for averting the "fiscal cliff" in 28 days, but that no deal will get done unless Republicans consent to raise income-tax rates on the top 2 percent of U.S. earners.

"We're going to have to see the rates on the top 2 percent go up and we're not going to be able to get a deal without it," Obama told Bloomberg TV in his first televised interview since the Nov. 6 election.

Obama suggested that Republican opposition to any increase in tax rates has stifled progress in negotiations and at least partly explains why he has not met more regularly with House Speaker John Boehner.

"Speaker Boehner and I speak frequently," he said. "I don't think the issue right now has to do with sitting in a room.

"Unfortunately, the speaker's proposal right now is still out of balance," he added, referring to the GOP plan unveiled Monday that would extend all income tax rates at current levels while imposing changes to Medicare and Social Security.

The GOP proposal would achieve $2.2 trillion in deficit reduction in the next decade, including $800 billion in higher taxes through elimination of loopholes and deductions, slower annual cost-of-living increases for Social Security benefits and a higher eligibility age for Medicare.

Jessica Kourkounis/Getty Images

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The plan contrasts sharply with the White House proposal, which calls for $1.6 trillion in new tax revenue -- largely from higher rates on upper-income earners -- modest unspecified savings from Medicare and a new burst of economic stimulus spending.

Both sides have dismissed out of hand the opposing proposal, raising the prospect of continued gridlock as the economy hurdles toward the "cliff."

Income tax rates for the top 2 percent of Americans remain the immediate sticking point. Obama insists that rates must rise at the end of the year as part of any deal; Republicans oppose increasing rates on the wealthy.

Unless Obama and Republicans reach a compromise, a sweeping set of automatic, across-the-board tax hikes and deep spending cuts will take effect, potentially throwing the U.S. economy back into recession.

The "cliff" scenario results from a failure by Congress and the administration at previous intervals to take steps to reduce federal deficits and debt.

In the Bloomberg interview, Obama said he could be flexible on tax rates and entitlement overhaul, but only in broader discussions next year about revamping the tax code and social safety-net programs.

"Let's let [rates on higher-income earners] go up and then let's set up a process with a time certain at the end of 2013, or the fall of 2013, where we work on tax reform, we look at what loopholes and deductions both Democrats and Republicans are willing to close and it's possible that we may be able to lower rates by broadening the base at that point," he said.

The president also said he's "willing to look at anything" that might strengthen entitlements and extend their financial solvency, but did not specify further.

Republicans continued to rebuff the president's proposal Tuesday, claiming the $1.6 trillion package of tax increases could not pass either house of Congress, including the Democrat-controlled Senate.

"Only one person in the country can deliver the members of his party to support a deal that he makes, and that is the president," said Senate Minority Leader Mitch McConnell.

He praised House Republicans for "trying to move the process forward" with their proposal, but stopped short of endorsing it. Some conservative advocacy groups have been assailing GOP leaders this week for consenting to any tax revenue increases in a deal with Obama.

"With our latest offer we have demonstrated there is a middle ground solution that can cut spending and bring in revenue without hurting American small businesses," Boehner said in a statement today.

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NATO warns Syria not to use chemical weapons

BRUSSELS/BEIRUT (Reuters) - NATO told Syrian President Bashar al-Assad on Tuesday that any use of chemical weapons in his fight against encroaching rebel forces would be met by an immediate international response.

The warning from NATO Secretary-General Anders Fogh Rasmussen came as U.S. government sources said Washington had information that Syria was making what could be seen as preparations to use its chemical arsenal.

Syrian forces meanwhile bombarded rebel districts near Damascus in a sustained counter-attack to stem rebel gains around Assad's power base as the insurgency may be entering a decisive phase.

International concern over Syria's intentions has been heightened by reports that its chemical weapons have been moved and could be prepared for use.

"The possible use of chemical weapons would be completely unacceptable for the whole international community and if anybody resorts to these terrible weapons I would expect an immediate reaction from the international community," Rasmussen told reporters at the start of a meeting of alliance foreign ministers in Brussels.

The chemical threat made it urgent for the alliance to send Patriot anti-missile missiles to Turkey, Rasmussen said.

The French Foreign Ministry referred to "possible movements on military bases storing chemical weapons in Syria" and said the international community would react if they were used.

Britain has told the Syrian government that any use of chemical weapons would have "serious consequences", Foreign Secretary William Hague said.

U.S. President Barack Obama on Monday told Assad not to use chemical weapons, without saying how the United States might respond. The Foreign Ministry in Damascus said it would never use such weapons against Syrians.

CLASSIFIED INTELLIGENCE

The U.S. has collected what has been described as highly classified intelligence information demonstrating that Syria is making what could be construed as preparations to use elements of its extensive chemical weapons arsenal, two U.S. government sources briefed on the issue said.

One of the sources said that there was no question that the US "Intelligence community" had received information pointing to "preparations" under way in Syria related to chemical weapons. The source declined to specify what kind of preparations had been reported, or how close the intelligence indicated the Syrians were to deploying or even using the weapons.

Western military experts say Syria has four suspected chemical weapons sites, and it can produce chemical weapons agents including mustard gas and sarin, and possibly also VX nerve agent. The CIA has estimated that Syria possesses several hundred liters of chemical weapons and produces hundreds of tonnes of agents annually.

The fighting around Damascus has led foreign airlines to suspend flights and prompted the United Nations and European Union to reduce their presence in the capital, adding to a sense that the fight is closing in.

The army fightback came a day after the Syrian foreign ministry spokesman was reported to have defected in a potentially embarrassing blow to the government.

The Syrian Observatory for Human Rights said 200 people were killed across Syria on Monday, more than 60 of them around Damascus. Assad's forces bombarded districts to the south-east of the capital on Tuesday, near to the international airport, and in the rebel bastion of Daraya to the south-west.

Opposition footage posted on the Internet showed a multiple rocket launcher fire 20 rockets, which activists said was filmed at the Mezze military airport in Damascus.

Reuters could not independently verify the footage due to the government's severe reporting restrictions.

In central Damascus, shielded for many months from the full force of a civil war in which 40,000 people have been killed, one resident reported hearing several loud explosions.

"I have heard four or five thunderous blows. It could be barrel bombs," she said, referring to makeshift bombs which activists say Assad's forces have dropped from helicopters on rebel-dominated areas.

MORTAR ATTACK

The state news agency said that 28 students and a teacher were killed near the capital when rebels fired a mortar bomb on a school. Rebels have targeted government-held residential districts of the capital.

The mainly Sunni Muslim rebel forces have made advances in recent weeks, seizing military bases, including some close to Damascus, from forces loyal to Assad, who is from Syria's Alawite minority linked to Shi'ite Islam.

Faced with creeping rebel gains across the north and east of the country, and the growing challenge around the capital, Assad has increasingly resorted to air strikes against the insurgents.

A diplomat in the Middle East said Syrian Foreign Ministry spokesman Jihad Makdissi had left the country and defected, while the British-based Observatory said it had information that he flew from Beirut on Monday afternoon heading for London.

In Beirut, a diplomat said Lebanese officials had confirmed that Makdissi spent several days in Beirut before leaving on Monday, but could not confirm his destination.

"We're aware of reports that he has defected and may be coming to the UK. We're seeking clarification," a Foreign Office spokeswoman in London said.

Makdissi was the public face to the outside world of Assad's government as it battled the 20-month-old uprising. But he had barely appeared in public for several weeks before Monday's report of his defection.

He had little influence in a system largely run by the security apparatus and the military. But Assad's opponents will see the loss of such a high profile figure, if confirmed, as further evidence of a system crumbling from within.

The United Nations and European Union both said they were reducing their presence in Syria in response to the escalated violence around the capital.

A spokesman for U.N. humanitarian operations said the move would not stop aid deliveries to areas which remained accessible to relief convoys.

"U.N.-funded aid supplies delivered through SARC (Syrian Arab Red Crescent) and other charities are still moving daily where the roads are open," Jens Laerke told Reuters in Geneva.

"We have not suspended our operation, we are reducing the non-essential international staff."

Three remaining international staff at the European Union delegation, who stayed on in Damascus after the departure of most Western envoys, crossed the border into Lebanon on Tuesday after pulling out of the Syrian capital.

(Additional reporting by David Brunnstrom in Brussels, Khaled Yacoub Oweis in Cairo, Erika Solomon, Oliver Holmes and Ayat Basma in Beirut, Mark Hosenball, Mohammed Abbas and David Cutler in London, and Stephanie Nebehay in Geneva; Editing by Giles Elgood)

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Republicans make 'fiscal cliff' counter-offer

WASHINGTON: Republicans on Monday laid out a proposal for closing the huge US deficit that raises half the income proposed by President Barack Obama and opposes a higher tax rate increase for the rich.

Their $2.2 trillion deficit reduction proposal agreed to the permanent extension of tax cuts, a move that would mitigate much of the impact of the looming fiscal cliff.

But they did not immediately address Obama's call to modify or delay the drastic "sequester" spending cuts slated to begin on January 1 that could sharply slow growth.

Instead they proposed slashing $1.2 trillion from federal spending over 10 years, including $600 billion from Medicare, which covers health insurance for the elderly.

In a letter to Obama, top Republicans assailed his focus on raising government income by $1.6 trillion rather than spending cuts to right the deficit as "neither balanced nor realistic."

And they rejected Obama's insistence on extending the tax cuts only for middle class households, while raising rates for the wealthy.

"The proposal also includes four times as much tax revenue as spending cuts, in stark contrast to the 'balanced approach' on which you campaigned," they said.

The Republicans countered with $800 billion in tax increases through "pro-growth tax reform" that lowers tax rates but boosts income by closing loopholes and special deductions for companies and households.

And against Obama's $600 billion in spending cuts, the Republicans proposed a $1.2 trillion package based on a plan first introduced a year ago that was rejected in Congress.

"This is by no means an adequate long-term solution, as resolving our long-term fiscal crisis will require fundamental entitlement reform," the letter said.

But it called the Republican proposal "fair middle ground that allows us to avert the fiscal cliff without hurting our economy and destroying jobs."

- AFP/fa

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Samajwadi Party keeps UPA in suspense over FDI vote

LUCKNOW: The Samajwadi Party is still playing a guessing game over the vote on FDI in Parliament. Political pundits have not ruled out the possibility of the SP voting against the Foreign Direct Investment (FDI), at least in Rajya Sabha, to gain political edge over the Bahujan Samaj Party if it abstains from voting. SP chief Mulayam Singh Yadav will, however, take the final call on his party's stance in Lok Sabha.

Lok Sabha will debate and vote on FDI under Rule 184 while Rajya Sabha will do the same under Rule 168. Both the rules entail voting. The results may end up embarrassing the UPA ahead of 2014 general elections if it falls short of the numbers, albeit there is no threat to its survival.

Given the conflict of political interests, SP may stand against arch rival BSP in both the Houses without posing any immediate threat to the UPA. The party is trying to achieve dual goals: one, to show that it will not side with the UPA; and, second, to gain political edge over the BSP. Although SP leader Ram Gopal Yadav on Thursday stated that the party would not allow passage of FDI in Rajya Sabha, hours later Mulayam contradicted him claiming that the party was yet to decide on the issue.

The UPA is in minority in Rajya Sabha with 87 MPs and unlikely to reach 122 majority mark as it will require roping in "outside-supporters" like the BSP (15 MPs), SP (nine) and RJD (two) which totals 113 votes. The UPA can bank on nine out of the 10 nominated MPs whom it backed except Sachem Tendulkar who is playing the ongoing Test series against England. The UPA can also count on the remaining seven independent and those from smaller parties to cross the 122 mark.

A vote against FDI will help SP strengthen its ties with the Left parties, as a result of which he hopes to become third front's prime minister in 2014. Most SP leaders favour voting against FDI. The mood is a binding factor for Mulayam's new found bonhomie with veteran Congressman ND Tewari, who is believed to be depending on Mulayam to settle scores with the party. Tewari, sources said, has assured Mulayam of support from at least three of his loyalists, who are sitting Congress MPs, after 2014 elections.

SP's only concern is that voting against the FDI will see it aligning with the BJP which is set to reject FDI in multi-brand retail.

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