News Inspiration

Art and Commerce Meet in Miami Beach

Label: Business

Katie Orlinsky for The New York Times

Visitors at the V.I.P. opening of Art Basel Miami Beach.

MIAMI — Mera Rubell was taking time out from greeting the hundreds of visitors at her family’s sprawling contemporary art center here to vent.

“It’s the height of arrogance to dismiss — — ,” she began.

Jason, her son, interrupted: “It’s arrogance. It’s a completely uninteresting story.”

For the moment her husband, Don, had given up on trying to get a word in.

The Rubells, deans of Miami’s bustling art scene, were pushing back against a chorus of complaints that has been growing louder in the weeks leading up to Art Basel Miami Beach, the annual art pilgrimage that began Wednesday and ends Sunday.

Prominent art writers and critics, including Sarah Thornton, Felix Salmon, Will Gompertz and Dave Hickey, have been attacking the art world, arguing that the staggering sums of money being spent on works are distorting judgments about art and undermining its long-term cultural significance.

“Money talks loudly and easily drowns out other meanings,” Ms. Thornton wrote in TAR magazine in a recent article, “Top 10 Reasons NOT to Write About the Art Market.”

In its special edition for the opening day of the fair, The Art Newspaper asked whether “the art world is facing a crisis of values” because of the “pernicious influence of the market on art.”

And in the eyes of many critics, Art Basel Miami Beach — or what Simon Doonan, writing in Slate last week, labeled a “promo-party cheese-fest” — has become a symbol of everything that’s wrong with the art market. The fair’s extraordinary success in just over a decade, and its celebration of wretched excess, have triggered a backlash.

But the Rubells, along with a growing number of other prominent collectors, art dealers and curators, are having none of it. The backlash against the backlash has begun.

“The market supports artists,” Jason Rubell said. Given the limited amount of government support for the arts, he added, “it’s an industry that without commerce doesn’t exist. What do people want — to go back to the recession?”

Ms. Rubell was annoyed that critics seemed to ignore the social, economic and cultural transformation of Miami that the fair and collectors like her have helped bring about. She noted that the Rubells’ 45,000-square-foot art center — where one huge gallery is now filled with works by Oscar Murillo, a 26-year-old Colombian immigrant who lived with and was supported by the Rubells while he created dozens of mural-sized canvases — used to be a Drug Enforcement Administration storage center.

Outside, in the center’s courtyard, visitors like Martha Stewart admired the French artist Bernar Venet’s collaboration with Bugatti, the superluxury sports car brand, on a one-of-a-kind Veyron Grand Sport Venet car (a price hasn’t been set, a Bugatti spokeswoman said, but will undoubtedly be in “the higher end of the millions”).

“I’m grateful to Bugatti, Perrier, Bank of America and other companies,” Ms. Rubell declared. “Their support helps facilitate quality programs and opens exhibits like this” — the Murillo show — “to the public.”

In Miami Beach, at the main fair, the consumer-oriented glitter abounds this week: coffee carts with $20-a-glass Ruinart Champagne; Davidoff cigar rollers; BMW’s artist-designed cars; and Takashi Murakami’s $70,000-and-up commissioned portraits. One could almost imagine that the Barbara Kruger work on display at L&M gallery — a super-sized sign reading “Greedy” on one line and an unprintable expletive on the next — had an invisible subtitle telling the wealthy V.I.P.’s who had come to shop, “I’m Talking to You — Yeah, You!”

Of course, rich patrons have always supported artists, Don Rubell pointed out, from the pharaohs to the Medicis. Today, multimillion-dollar sales represent only a silk-thin layer of a deeply varied and thriving art market. The art world, Mr. Rubell asserted, is “actually becoming more democratic.”

“There’s 20 ancillary fairs” in addition to the high-end main event of Art Basel, he said. “Whatever amount of money you have in your pocket, you can enter this magical world of art.”

The notion that the art market contains multitudes is one with which Marc Glimcher, part of the family dynasty that runs the Pace Gallery, said he agreed.

Justices to Take Up Generic Drug Case

Label: Health

WASHINGTON — The Supreme Court said on Friday that it would decide whether a pharmaceutical company should be allowed to pay a competitor millions of dollars to keep a generic copy of a best-selling drug off the market.

Stephen Crowley/The New York Times

Ralph Neas, head of the Generic Pharmaceutical Association, said the case would alter the marketing of new generics.

The case could settle a decade-long battle between federal regulators, who say the deals violate antitrust law, and the pharmaceutical industry, which contends that they are really just settlements of disputes over patents that protect the billions of dollars they pour into research and development.

Three separate federal circuit courts of appeal have ruled over the last decade that the deals were allowable. But in July a federal appeals court in Philadelphia — which covers the territory where many big drug makers are based — said the arrangements were anticompetitive.

Both sides in the case supported the petition for the Supreme Court to decide the case, each arguing that the conflicting appeals court decisions would inject uncertainty into their operations.

By keeping lower-priced generic drugs off the market, drug companies are able to charge higher prices than they otherwise could. Last year, the Congressional Budget Office estimated that a Senate bill to outlaw those payments would lower drug costs in the United States by $11 billion and would save the federal government $4.8 billion over 10 years.

Senator Charles E. Grassley, an Iowa Republican who co-sponsored the Senate bill, which never came to the floor for a vote, praised the decision.

The Federal Trade Commission first filed the suit in question in 2009. Jon Leibowitz, chairman of the F.T.C., said, “These pay-for-delay deals are win-win for the drug companies, but big losers for U.S. consumers and taxpayers.”

Generic drug makers say that the payments preserve a system that has saved American consumers hundreds of billions of dollars.

“This case could determine how an entire industry does business because it would dramatically affect the economics of each decision to introduce a new generic drug,” Ralph G. Neas, president of the Generic Pharmaceutical Association, said in a statement. “The current industry paradigm of challenging patents on branded drugs in order to bring new generics to market as soon as possible has produced $1.06 trillion in savings over the past 10 years.”

The case will review a decision by the United States Court of Appeals for the 11th Circuit, based in Atlanta, which in the spring ruled in favor of the drug makers, Watson Pharmaceuticals and Solvay Pharmaceuticals. Watson had applied for federal approval to sell a generic version of AndroGel, a testosterone replacement drug made by Solvay.

While courts have long held that paying a competitor to stay off the market creates unfair competition, the pharmaceuticals case is different because it involves patents, whose essential purpose is to prevent competition.

When a generic manufacturer seeks approval to market a copy of a brand-name drug, it also often files a lawsuit challenging a patent that the drug’s originator says prevents competition.

Last year, for the third time since 2003, the 11th Circuit upheld the agreements as long as the allegedly anticompetitive behavior that results — in this case, keeping the generic drug off the market — is the same thing that would take place if the brand-name company’s patent were upheld.

Two other federal circuit courts, the Second Circuit and the Federal Circuit, have ruled similarly. But in July, the Third Circuit Court of Appeals said that those arrangements were anticompetitive on their face and violated antitrust law.

The agreements are also affected by a peculiar condition in the law that legalized generic competition for prescription drugs. That law, known as the Hatch-Waxman Act, gives a 180-day period of exclusivity to the first generic drug maker to file for approval of a generic copy and to file a lawsuit challenging the brand-name drug’s patent.

Brand-name drug companies have taken advantage of that law, finding that they can settle the patent suit by getting the generic company to agree to stay out of the market for a period of time. Because that generic company also has exclusivity rights, no other generic companies can enter the market.

Michael A. Carrier, a professor at Rutgers School of Law-Camden, said that while there were provisions in the law under which a generic company could forfeit that exclusivity, “they really are toothless in practice.”

One wild card could still prevent the Supreme Court from definitively settling the question. In granting the petition to hear the case, the Supreme Court said that Justice Samuel A. Alito Jr. recused himself, taking no part in the consideration or decision.

That opens the possibility that a 4-4 decision could result, upholding the lower court case that went against the F.T.C. and in favor of the drug makers. But it would leave the broader question for another day.

The case is Federal Trade Commission v. Watson Pharmaceuticals et al, No. 12-416.

Justices to Take Up Generic Drug Case

Label: Lifestyle

Stephen Crowley/The New York Times

Ralph Neas, head of the Generic Pharmaceutical Association, said the case would alter the marketing of new generics.

Both sides in the case supported the petition for the Supreme Court to decide the case, each arguing that the conflicting appeals court decisions would inject uncertainty into their operations.

Senator Charles E. Grassley, an Iowa Republican who co-sponsored the Senate bill, which never came to the floor for a vote, praised the decision.

Generic drug makers say that the payments preserve a system that has saved American consumers hundreds of billions of dollars.

When a generic manufacturer seeks approval to market a copy of a brand-name drug, it also often files a lawsuit challenging a patent that the drug’s originator says prevents competition.

The case is Federal Trade Commission v. Watson Pharmaceuticals et al, No. 12-416.

In Private Manning Case, Jailers Become the Accused

Label: Technology

Patrick Semansky/Associated Press

Pfc. Bradley Manning faces a potential life sentence if convicted of leaking documents.

FORT MEADE, Md. — In a half-empty courtroom here, with a crew of fervent supporters in attendance, Pfc. Bradley Manning and his lawyer have spent the last two weeks turning the tables on the government.

Private Manning faces a potential life sentence if convicted on charges that he gave WikiLeaks, the antisecrecy organization, hundreds of thousands of confidential military and diplomatic documents. But for now, he has been effectively putting on trial his former jailers at the Quantico, Va., Marine Corps base. His lawyer, David E. Coombs, has grilled one Quantico official after another, demanding to know why his client was kept in isolation and stripped of his clothing at night as part of suicide-prevention measures.

Mr. Coombs, a polite but relentless interrogator who stands a foot taller than his client, has laid bare deep disagreements inside the military: psychiatrists thought the special measures unnecessary, while jail commanders ignored their advice and kept the suicide restrictions in place. In a long day of testimony last week, Private Manning of the Army, vilified as a dangerous traitor by some members of Congress but lauded as a war-crimes whistle-blower on the political left, heartened his sympathizers with an eloquent and even humorous performance on the stand.

“He was engaged, chipper, optimistic,” said Bill Wagner, 74, a retired NASA solar physicist who is a courtroom regular, dressed in the black “Truth” T-shirt favored by Private Manning’s supporters.

Private Manning, who turns 25 on Dec. 17 and looks much younger, was quietly attentive during Friday’s court session, in a dress uniform, crew-cut blond hair and wire-rimmed glasses. If his face were not already familiar from television news, he might have been mistaken for a first-year law student assisting the defense team.

It seemed incongruous that he has essentially acknowledged responsibility for the largest leak of classified material in history. The material included a quarter-million State Department cables whose release may have chilled diplomats’ ability to do their work discreetly but also helped fuel the Arab Spring; video of American helicopter crews shooting people on the ground in Baghdad who they thought were enemy fighters but were actually Reuters journalists; field reports on the wars in Iraq and Afghanistan; and confidential assessments of the detainees locked up at Guantánamo Bay, Cuba.

As the military pursues the case against Private Manning, the Justice Department continues to explore the possibility of charging WikiLeaks’ founder, Julian Assange, or other activists with the group, possibly as conspirators in Private Manning’s alleged offense. Federal prosecutors in Alexandria, Va., are still assigned to that investigation, according to law enforcement officials, but it is not clear how active they have been lately in presenting evidence to a grand jury.

The current tone of the legal proceedings against Private Manning is most likely temporary. His lawyer is asking the judge overseeing the case to throw out the charges on the ground that his pretrial treatment was unlawful, but that outcome appears unlikely.

As a fallback, Mr. Coombs is hoping the court will at least give Private Manning extra credit against any ultimate sentence for the time he spent held under harsh conditions at Quantico and earlier in Kuwait, where he was kept in what he described as “an animal cage.” After the uproar about his treatment, including public criticism from the State Department’s top spokesman and the United Nations’ top torture expert, military officials moved Private Manning in April 2011 from Quantico to a new prison at Fort Leavenworth, Kan., where he has not faced the same restrictions on clothing, sleeping conditions and conversation with other inmates.

As if to underscore the gravity of his legal predicament, Private Manning offered last month to plead guilty to lesser charges that could send him to prison for 16 years. Prosecutors have not said whether they are interested in such a deal, which would mean they would have to give up seeking a life sentence for the most serious charges: aiding the enemy and violating the Espionage Act.

Friday’s court session was attended by a dozen Manning loyalists, including Thomas A. Drake, the former National Security Agency official who was accused of leaking documents and pleaded guilty to a minor charge last year. They heard the commander of the Quantico brig, or military jail, explain why she refused Private Manning’s request to be taken off “prevention of injury” status.

Scott Shane reported from Fort Meade, and Charlie Savage from Washington.

The Human Price: Bangladesh Fire Exposes Safety Gap in Supply Chain

Label: Business

ASHULIA, Bangladesh — The fire alarm shattered the monotony of the Tazreen Fashions factory. Hundreds of seamstresses looked up from their machines, startled. On the third floor, Shima Akhter Pakhi had been stitching hoods onto fleece jackets. Now she ran to a staircase.

But two managers were blocking the way. Ignore the alarm, they ordered. It was just a test. Back to work. A few women laughed nervously. Ms. Pakhi and other workers returned to their sewing tables. She could stitch a hood to a jacket in about 90 seconds. She arranged the fabric under her machine. Ninety seconds. Again. Ninety more seconds. She sewed six pieces, maybe seven.

Then she looked up.

Smoke was filtering up through the three staircases. Screams rose from below. The two managers had vanished. Power suddenly went out throughout the eight-story building. There was nowhere to escape. The staircases led down into the fire. Iron grilles blocked the windows. A man cowering in a fifth-floor bathroom called his mother to tell her he was about to die.

“We all panicked,” Ms. Pakhi said. “It spread so quickly. And there was no electricity. It was totally dark.”

Tazreen Fashions Ltd. operated at the beginning of the global supply chain that delivers clothes made in Bangladesh to stores in Europe and the United States. By any measure, the factory was not a safe place to work. Fire safety preparations were woefully inadequate. The building itself was under construction — even as sewing work continued inside — and mounds of flammable yarn and fabric were illegally stored on the ground floor near electrical generators.

Yet Tazreen was making clothing destined for some of the world’s top retailers. On the third floor, where firefighters later recovered 69 bodies, Ms. Pakhi was stitching sweater jackets for C&A, a European chain. On the fifth floor, workers were making Faded Glory shorts for Walmart. Ten bodies were recovered there. On the sixth floor, a man named Hashinur Rahman put down his work making True Desire lingerie for Sears and eventually helped save scores of others. Inside one factory office, labor activists found order forms and drawings for a licensee of the United States Marine Corps that makes commercial apparel with the Marines’ logo.

In all, 112 workers were killed in a blaze last month that has exposed a glaring disconnect among global clothing brands, the monitoring system used to protect workers and the factories actually filling the orders. After the fire, Walmart, Sears and other retailers made the same startling admission: They say they did not know that Tazreen Fashions was making their clothing.

But who, then, is ultimately responsible when things go so wrong?

The global apparel industry aspires to operate with accountability that extends from distant factories to retail stores. Big brands demand that factories be inspected by accredited auditing firms so that the brands can control quality and understand how, where and by whom their goods are made. If a factory does not pass muster, it is not supposed to get orders from Western customers.

Tazreen Fashions was one of many clothing factories that exist on the margins of this system. Factory bosses had been faulted for violations during inspections conducted on behalf of Walmart and at the behest of the Business Social Compliance Initiative, a European organization.

Yet Tazreen Fashions received orders anyway, slipping through the gaps in the system by delivering the low costs and quick turnarounds that buyers — and consumers — demand. C&A, the European retailer, has confirmed ordering 220,000 sweaters from the factory. But much of the factory’s business came through opaque networks of subcontracts with suppliers or local buying houses. Labor activists, combing the site of the disaster, found labels, order forms, design drawings and articles of clothing from many global brands.

Walmart and Sears have since said they fired the suppliers that subcontracted work to Tazreen Fashions. Yet some critics have questioned how a company like Walmart, one of the two biggest buyers in Bangladesh and renowned for its sophisticated global supply system, could have been unaware of the connection.

Julfikar Ali Manik contributed reporting from Ashulia, and Steven Greenhouse from New York.

Drug Makers Challenge Pill Disposal Law in California

Label: Health

Brand name drug makers and their generic counterparts rarely find themselves on the same side of an issue, but now they are making an exception. They have teamed up to fight a local law in California, the first in the nation, that makes them responsible for running — and paying for — a program that would allow consumers to turn in unused medicines for proper disposal.

Such so-called drug take-back programs are gaining in popularity because of a growing realization that those leftover pills in your medicine cabinet are a potential threat to public health and the environment.

Small children might accidentally swallow them and teenagers will experiment with them, advocates of the laws say. Prescription drug abusers can, and are, breaking into homes in search of them. Unused pills are sometimes flushed down the toilet, so pharmaceuticals are now polluting waterways and even drinking water. One study found the antidepressant Prozac in the brains of fish.

Most such take-back programs are run by local or other government agencies. But increasingly there are calls to make the pharmaceutical industry pay.

“We feel the industry that profits from the sales of these products should have the financial responsibility for proper management and disposal,” said Miriam Gordon, California director of Clean Water Action, an advocacy group.

In July, Alameda County, Calif., which includes Oakland and Berkeley, became the first locality to enact such a requirement. Drug companies have to submit plans for accomplishing it by July 1, 2013.

But the industry plans to file a lawsuit in United States District Court in Oakland on Friday, hoping to have the law struck down. The suit is being filed by the Pharmaceutical Research and Manufacturers of America, or PhRMA, which represents brand-name drug companies, the Generic Pharmaceutical Association and the Biotechnology Industry Organization.

James M. Spears, general counsel of PhRMA, said the Alameda ordinance violated the Constitution in that a local government was interfering with interstate commerce, a right reserved for Congress.

“They are telling a company in New Jersey that you have to come in and design and implement and pay for a municipal service in California,” he said in an interview.

“This program is one where the cost is shifted to companies and individuals who are not located in Alameda County and who won’t be served by it.”

Mr. Spears, who is known as Mit, said that the program would cost millions of dollars a year to run and that pharmaceutical companies were “not in the waste disposal business.” He said it would be best left to sanitation departments and law enforcement agencies, which must be involved if narcotics, like pain pills, were to be transported.

Nathan A. Miley, the president of the Alameda County Board of Supervisors and the champion of the legislation, said late Thursday, “It’s just unfortunate that PhRMA would fight this because it would be pennies for them.”

“We will win legally and will win in the court of public opinion as well,” Mr. Miley said.

The battle in Alameda could set the direction for other states and localities. Legislators in seven states have introduced bills to require drug companies to pay for take-back programs in the last few years, said Scott Cassel, founder and chief executive of the Product Stewardship Institute, a nonprofit group that advocates such programs. But none of the bills have passed.

Mr. Cassel said about 70 similar “extended producer responsibility” laws have been enacted in 32 states for other products, like electronic devices, mercury-containing thermometers, fluorescent lamps, paint and batteries. He said he was not aware that any had been struck down on constitutional grounds.

The pharmaceutical industry already pays for take-back programs in some other countries. The law in Alameda is modeled partly on the system in British Columbia and two other Canadian provinces. There, the industry formed the Post-Consumer Pharmaceutical Stewardship Association, which runs the programs.

Consumers can take unused drugs back to pharmacies, from which they are periodically collected. Drug companies pay for the program in proportion to their market share, said Ginette Vanasse, executive director of the association. The program for British Columbia, with a population over four million, costs about $500,000 a year, she said.

The extent of the problem of unused pills and how best to handle them are matters of debate.

The United States Geological Survey has found various drugs, including antidepressants, antibiotics, heart medicines and hormones, in waterways it has sampled. Sewage treatment plants and drinking water treatment plants are not meant to remove pharmaceuticals.

Still, it is not known what effect the chemicals might have. “It’s a hard-to-pin-down problem,” said Sonya Lunder, a senior analyst at the Environmental Working Group, an advocacy group. It is thought that trace amounts in drinking water are probably not harmful. But larger amounts found in wastewater could be having an impact on wildlife.

It is also unclear whether take-back programs will help. Experts generally agree that the bigger source of pollution is urine and feces containing the remnants of drugs that are ingested, not the unused pills flushed down the toilet.

PhRMA also argues that take-back programs will not help much with the problem of drug abuse either. Mr. Spears said that it was better to have consumers tie up unused pills in a plastic bag and throw them in the trash. That is more effective, he said, because people would not have to travel to a collection point. Such collection points could become targets for thieves and drug abusers.

McAfee Antivirus Software Pioneer Arrested in Guatemala City

Label: Business

MEXICO CITY — The antivirus software pioneer John McAfee was arrested in Guatemala City on Wednesday after he slipped over the border from his home in Belize where police want to question him in their investigation of the murder of his neighbor.

The interior minister, Mauricio Lopez Bonilla, told The Associated Press that Mr. McAfee, 67, had been arrested on charges of entering Guatemala illegally. He said that Mr. McAfee had been arrested at a hotel in the capital and taken to a detention center for migrants who are in the nation illegally.

Mr. McAfee had been on the run for almost a month since his neighbor, Gregory Faull, on the Belizean island of Ambergris Caye was found dead at his home on Nov. 11. Police there cited Mr. McAfee as a “person of interest” in their investigation, but Mr. McAfee disapppeared.

But he did not disappear from the Internet. He kept up a continuous stream of comment on his blog and on Twitter, alleging that he was being persecuted by the Belizean authorities.

On Tuesday, he resurfaced in Guatemala, dressed in a suit, his blond curls dyed dark brown.

Accompanied by his 20-year-old Belizean girlfriend, Samantha Venagas, and his Guatemalan lawyer, Telésforo Guerra, Mr. McAfee said that he would seek political asylum in Guatemala. Mr. Guerra, a former Guatemalan attorney general, who has defended some of the country’s more notorious politicians, told reporters at a chaotic news conference outside the Supreme Court that his client was being persecuted because he refused to pay Belizean authorities off any longer.

Mr. McAfee has not been associated with the software company that bears his name since 1994, when he sold it and began to pursue his other interests. He ran a yoga retreat and then built a complex in New Mexico to indulge his hobby of flying motorized ultralight airplanes.

He moved to Belize about four years ago, buying properties on the mainland and on Ambergris Caye. It was there that he clashed with Mr.

Faull, who complained about the unleashed dogs Mr. McAfee kept on his property.

On November 9, several of the dogs were found dead. They had been poisoned.

During his time in Belize, Mr. McAfee had apparently become interested in developing a designer drug called MDPV. He posted extensively about his experiments on a Web site.

But he attracted the attention of Belizean authorities, who raided one of his properties in April. He spent a night in jail, but law enforcement officials found no evidence that he was producing methamphetamine and dropped the charges.

After that experience, though, Mr. McAfee appeared to become increasing convinced that he was being persecuted by the Belizean government. Officials deny that they are persecuting him and Belize’s Prime Minister Dean Barrow has said only that Mr. Mcfee is “bonkers.”

Extended Use of Breast Cancer Drug Suggested

Label: Health

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.