A question of access? Mental health and gun violence

As President Obama faces opposition from gun rights advocates over his recent proposals to combat gun violence, the challenge he faces of fixing flaws in the mental health care system may prove just as difficult a battle.

Mr. Obama outlined plans aimed at preventing mass shootings and reducing broader gun violence in the United States last week, while signing 23 executive actions that did not require Congressional approval. Alongside proposed changes to gun laws including universal background checks, a stronger ban on assault weapons and new restrictions on ammunition and magazines, mental health emerged as a core feature of the president's plan to prevent further tragedies like the Dec. 14 shooting in Newtown, Conn.

The executive actions related to mental health included:

• A letter to health care providers clarifying that no federal law prohibits them from reporting threats of violence to law enforcement authorities
• Incentives for schools to hire school resource officers
• A letter to state health officials clarifying the scope of mental health services that Medicaid plans must cover
• Finalization of regulations clarifying essential health benefits and parity requirements within health insurance exchanges
• A commitment to finalizing mental health parity regulations
• The launch of a national dialogue led by the departments of Health and Human Services and Education on mental health
• A Presidential Memorandum directing the Centers for Disease Control to research the causes and prevention of gun violence
• Clarification that the new health care law does not prohibit doctors from asking their patients about guns in their homes

Noting that it was the first of its kind to focus on mental health since 2007 -- and long overdue -- Iowa Sen. Tom Harkin chaired a hearing of the Senate Health, Education, Labor and Pensions Committee Thursday.

Harkin laid out that while Newtown has brought the issue to the forefront of discussion, mental illness only accounts for a small proportion of violent crimes.

Experts estimate only a small percentage of violent crimes -- less than 5 percent -- are caused by mentally ill people.

"People with mental illness are much more likely to be the victims of violent crimes than perpetrators of violence," said Harkin, who called mental health care's shortcomings a public health problem.

A common theme throughout the hearing was to avoid stigmatizing people with mental illness while discussing gun violence and problems facing mental health care.

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Mental health expert: "We can and must intervene early"

Pamela S. Hyde, administrator for the government's Substance Abuse and Mental Health Services Administration (SAMHSA) laid out the scope of the mental health care problem during the hearing (video at left). Of the 45 million U.S. adults suffering from mental illness, only 38.5 percent receive the treatment they need, she said. For children, only one in five receive necessary treatment for diagnosable mental disorders. Despite showing symptoms, many children and adults experience significant delays getting into treatment. Hyde argues that if the system shifts to a focus on early intervention, more people can be helped.

"Cost, access and recognition of the problems are the primary reason this treatment is not received. However it doesn't have to be this way," said Hyde. "For most of these conditions, prevention works, treatment is effective and people do in fact recover."

Mental health care spending has been dramatically cut in recent years. A 2011 report from the National Alliance on Mental Health that looked at state-by-state mental health budgets reported $1.6 billion in state funding cuts from 2009 through 2012. Medicaid cuts at this time also negatively affected mental health care, the report showed. States are mulling increases in funding in light of the Newtown shooting.

And the health care system may only become more burdened in the near future: A July 2012 study by the Institute of Medicine, an advisory medical organization to the government, found an aging baby boomer population could cause a mental health care crisis by 2030, when the number of U.S. seniors is expected to double and necessary resources will be woefully lacking.

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The dangerous stigma of mental illness

Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University Medical Center in New York City, told CBS News senior correspondent John Miller in December that mental health care is a societal problem because the U.S. has not taken on the treatment of mental illness as effectively as it could.

"I think mental health is a big issue," Lieberman said at the time. "It's definitely related to the frequency of these seemingly senseless and wanton killings that occur. And the way it relates is that unfortunately, individuals who have specific forms of mental illness, if untreated, can be more prone to act in a way which is socially destructive and results in harm or killing like we saw happen."

Lieberman said a person who needs treatment for mental illness often faces barriers such as insurance coverage and accessibility to care, in addition to stigma -- while people getting treated for a disease like cancer face fewer "disincentives" to getting the best care.

Following the president's announcement, Lieberman told CBSNews.com that the new proposals are "on the right track" in terms of addressing issues in the mental health system, but much work remains to clarify how these actions will be implemented.

By getting more people with mental illness, impulse disorders and substance abuse issues into constant treatment, he said, they may be prevented from ever getting to a point where they are showing symptoms of mental illness -- and acting on violent impulses.

"Trying to say we should only do something when they get dangerous is very late in the process," said Lieberman.

Details on the president's proposals still need to be worked out, said Lieberman, who is also president-elect of the American Psychiatric Association. For example, the Mental Health Parity Act, which the president wanted to finalize in his executive actions, requires that mental health benefits are covered by insurance, similar to non-psychiatric health care benefits. However, the rules to determine what services are covered, how people become reimbursed and other stipulations have not been established, he said. The president also asked for clarification on Medicaid mental health services, which now typically covers people who have severe forms of mental illness. Lieberman argues policymakers may find that these services are not adequate, and broader services are needed.

Right now, doctors cannot provide mental health care services in what Lieberman refers to as a "financially viable way." He explains that patients seeking help for mental health may require a lot of support, not only from a doctor who may provide medication, but from therapists, case managers and social and vocational rehabilitation counselors who need to be more actively involved in the patient's lives. These team-based "multi-element treatment approaches" have been shown in studies to be effective, however these types of paid services just aren't available for people suffering from mental health problems. Meanwhile, a person with heart disease may see a cardiologist, a surgeon, a different doctor about stent management, a nutritionist for lifestyle tips, and other providers all covered by insurance.

"In mental health care it's the same thing -- you can't just see a psychiatrist and get a prescription," he said. "This is not just throwing different services at the problem, there's good evidence that these things work."

Dr. Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University School of Medicine, who has published several research papers on gun violence and mental health for more than a decade, agrees the current mental health system represents a complex public health problem facing the United States.

"The mental health system in the country, if you can call it that, is fragmented and grossly under-resourced," Swanson told CBSNews.com in an email. "It needs a lot of things, and more research into how to fix it -- at a time when there are more mentally ill people incarcerated than in hospitals -- is one of the needed things," he said.

A 2011 paper by Swanson published in Psychiatric Services examines the lack of data available on firearm use against strangers, and how it is impossible to reliably predict which specific individuals would engage in the most serious acts of violence.

But even if more CDC research stemming from the president's proposals strengthens the available data pool, Swanson argues these egregious acts of violence may still be impossible to predict.

Play Video

Can a mental disorder make someone violent?

"I think more access to evidence-based treatment and less access to guns, taken together, would have an impact on gun violence, at least on the margins. But prevent mass shootings? That's hard to say," Swanson said. "Those are almost inherently unpredictable, and often perpetrated by people with no gun-disqualifying mental health or criminal record -- until it's too late. Most of the measures in the President's proposal, even if enacted and implemented perfectly, would not necessarily have prevented the shootings in Tucson, Aurora, or Newtown."

While concerns persist on how the president's proposals will be implemented, the announcement was supported by various health organizations that had previously submitted recommendations to Vice President Joe Biden's White House Task Force on Gun Violence Prevention.

"NAMI applauds the President's plan for its significant provisions to strengthen and expand mental health services," Michael Fitzpatrick, executive director of the National Alliance on Mental Illness said in a statement following the proposals. "The mental health care system has long been broken. The challenge is not to fix it, but to build it anew, focusing on early screening, diagnosis, treatment and prevention. The President's plan takes important steps toward meeting that challenge."

Dr. Dilip V. Jeste, president of the American Psychiatric Association, added in statement, "We are heartened that the Administration plans to finalize rules governing mental health parity under the 2008 Mental Health Parity and Addiction Equity Act, the Affordable Care Act, and Medicaid. "We are glad that the President has clarified that doctors are not prohibited from asking their patients about guns in their homes. The APA has consistently advocated for such a position."

The American Academy of Pediatrics also offered its support.

"In addition to addressing firearm regulations, we must improve access to quality mental health care both to help prevent violent acts and to assist victims of trauma," AAP President Dr. Thomas K. McInerny, said in a statement following the proposals. "The AAP agrees with the President that we must improve the identification of mental illnesses through increased screening, address inadequate insurance coverage and high out-of-pocket costs that create barriers to access, strengthen the overall quality of mental health access, and improve and expand the Medicaid reimbursement policy to include mental health and developmental services.

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Will Women Register for Selective Service?

Jan 24, 2013 5:53pm

Defense Secretary Leon Panetta today lifted the ban on women serving in combat positions, opening the door to more than 200,000  new military posts and raising a number of important questions, including: Will women eventually be eligible for the draft?

By law, all male U.S. citizens and permanent residents must register with the Selective Service System within 30 days of their 18th birthday. Registration puts those “male persons” on the list the government uses if ever the draft returns and conscription in the military is deemed necessary in a time of war.

As of a 1994 review, women were still exempt from registering because they did not serve in combat positions. Today’s change in Pentagon policy, however, could ultimately result in a change to the law.

But it will take more than just the stroke of the defense secretary’s pen for the Selective Service Act to include mention of women.

With any change to personnel policies, the Defense Department  is “required to provide an analysis of its impact on the Selective Service Act,” said a senior Pentagon official said on the condition of anonymity.  “So that will be part of the notification to Congress.”

But what comes next is  unclear.

“With regard to what will happen from there, I can’t say,” said the official.

Defense Secretary Leon Panetta later admitted to reporters that he, too, did not know the potential impact of the change to the Selective Service Act.

“That’s not our operation,” said Panetta.

Known for his use of colorful language, Panetta then said, “I don’t know who the hell controls Selective Service, if you want to know the truth.”

“But, you know,” Panetta added. “Whoever does, they’re going to have to exercise some judgment based on what we just did.”

The Selective Service System is a federal agency independent of the Department of Defense.

SHOWS: World News

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Benghazi blame-game is useless

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STORY HIGHLIGHTS

• Anthony Cordesman: Questions for Hillary Clinton on Benghazi attack inevitable, important


• But political blame game useless, a discouraging message to diplomats, military advisers, he says


• He says in hindsight, warnings, pleas for support mistakenly make crisis seem obvious


• Writer: U.S. must focus forward: encourage, support risk-takers doing crucial work in field

Editor's note: Anthony H. Cordesman holds the Arleigh A. Burke Chair in Strategy at the Center for Strategic and International Studies. Follow CSIS on Twitter.

(CNN) -- Politics are politics, and partisan congressional challenges over the death of Ambassador Chris Stevens and other Americans in Benghazi, Libya, last September were inevitable.

But while some of the questions Secretary of State Hillary Clinton was asked in her appearance before the Senate Foreign Relations Committee bordered on politics at their worst, some represented democracy at its best: A legitimate challenge of how the government works. The fact is, we do need to ask serious questions about the way our diplomats function, how they are deployed and protected.

In her responses, Clinton took responsibility, as the top official in every department always must. The question now, however, is what, if anything, will we really learn from the events that led to the deaths of Stevens and his colleagues?

Anthony H. Cordesman

Do we actually learn something from their courage and sacrifice, and the similar experience of other American diplomats and officers that have faced similar attacks in the past? Or do we go on playing a pointless blame game, creating a climate that discourages our diplomats, U.S. military advisory teams and intelligence officers from taking necessary risks -- and relies even more on fortifying our embassies.

Three lessons here. The first: Virtually every post mortem that relies on the blame game has the same result. There is always someone who asked for more resources and warned of the risk before the event. There are always enough intelligence indicators so that once you go back -- knowing the pattern of actual events -- it becomes possible to predict the past with 20-20 hindsight.

The problem is that the post mortems and hearings tend to be useless. Every prudent security officer has always asked for more; the indicators that could provide warning with 20-20 hindsight will still be buried in a flood of other reporting that warns of crises that don't take place; U.S. officials will still have to deal with what intelligence experts call "noise" -- the vast amount of reporting and other data that make it impossible to sort out the right information until the event actually occurs and the patterns are known. All of this makes it hard to know what request or warning ever matters.

Opinion: Algeria hostage crisis shows jihadists on rise

Yes, intelligence and warning can always be improved if the post mortem is realistic and objective. But the resulting improvements will never be enough. No one will ever assess all the risks correctly, U.S. diplomats and other Americans will be vulnerable when they operate in a hostile environment, and risk-taking will remain inevitable.

The second lesson is that we cannot deal with crises like the political upheavals in the Arab world, or the more direct threats that countries like Iran and North Korea can pose, unless our diplomats and military advisers take risks -- and more casualties -- in the process.

Stevens and those around him did what had to be done. These are the teams that can help lead unstable countries towards democracy and stability. They are the crucial to our counterterrorism efforts in the field and to building up the military security capabilities of developing states. They are key to uniting given factions, creating effective governance, and persuading states to move toward development and greater concern for human rights.

They can only be effective if they are on the scene, work with the leaders and factions involved, and often go into harms way where there are terrorist and military threats. Like Stevens, they cannot wait for perfect security, stay in a safe area, or minimize risks and deal with the realities of Libya, filled with local power struggles, extremist elements and potential threats.

We need risk-takers. We need them in any country that is going through the kind of upheavals taking place in Libya, as well as in countries where our enemies operate, and semi-war zones like Afghanistan, Iraq, Somalia, Syria, and Yemen. We need diplomats, U.S. military advisory teams, and intelligence officers that reach far beyond our embassies and go into high risk zones. We need to reward and honor those risk-takers, not those who shelter in safety and avoid the risks they should take or fear their career will be damaged if anyone is killed or hurt.

Opinion: Algeria crisis is a wakeup call for America

The third lesson is that we do need to steadily strengthen our ability to provide secure mobility, better intelligence, better communications, and better protection for those diplomats, U.S. military advisory teams and intelligence officers. We need to be able to better provide emergency help to those American NGO personnel and businessmen who take similar risks.

We need both an administration and a Congress that look beyond the blame game and understand that some things are worth spending money on. We need them to understand that what we once called the Arab Spring is clearly going to be the Arab Decade, and we face different but equally real risks in the field in Asia, Africa, and Latin America.

It is far better -- and cheaper even, in the medium term -- to fund strong U.S. country teams, military advisers, counterterrorism teams and development efforts than to let nations collapse, to let extremists take over, to lose allies, and see American NGOs and businesses unable to operate.

We need to see what new methods and investments can protect our people in the field and reduce the risks they should be taking. The answer may be special communications, intelligence system, helicopters and armored vehicles, emergency response teams and new career security personnel to replace contractors and foreign nationals.

What the answer is not is partisan blame, risk avoidance, punishing those who do take risks for the result, and failing to make the improvements in security for risk takers -- while building larger fortress embassies. If you want to honor the Americans lost in the line of duty, focus on the future and not the past.

The opinions expressed in this commentary are solely those of Anthony Cordesman

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'Avatar' director Cameron accused over screenplay

LOS ANGELES: A US judge ordered director James Cameron to hand over drafts of the screenplay for "Avatar" Wednesday, to lawyers for a man claiming he wrote the script on which the 3D blockbuster was based.

Eric Ryder is seeking compensation from Cameron and his production company Lightstorm Entertainment, claiming that the 2009 Oscar-nominated film is based on a story he wrote called "K.R.Z. 2068."

He filed a lawsuit in December 2011, saying he spent two years developing the story. On Wednesday Los Angeles Superior Court Judge Alan Rosenfield ordered Cameron's lawyers to turn over screenplay drafts.

"We have to be careful and sensitive about ideas and information," said the judge.

But he denied a request by Ryder's lawyers to grant access to the personal calendars of Cameron and Jon Landau, the chief operating officer of Cameron's Lightstorm Entertainment Inc.

Ryder's lawyer K. Andrew Kent said his legal team will also get access to backup tapes from computers used by Cameron.

"Avatar," about a paraplegic US marine with split loyalties after being sent to a distant world wanted for its mining potential, was seen as a breakthrough in the use of 3D technology, and has grossed more than US$2.7 billion worldwide.

- AFP/jc

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Clinton angrily rejects GOP criticism on Benghazi

STORY HIGHLIGHTS

• NEW: Secretary of state completes more than five hours of sometimes contentious hearings


• Libya wanted to provide security, but lacked the capacity, Clinton said


• "I take responsibility," Clinton tells Senate committee


• Clinton's appearance before Congress was delayed due to health issues

Washington (CNN) -- At times angry and choked with emotion, Secretary of State Hillary Clinton on Wednesday took on Republican critics of her department's handling of the September terrorist attack in Libya that killed the U.S. ambassador and three other Americans, but repeatedly distanced herself from a direct role in specific situations.

"As I have said many times since September 11, I take responsibility," Clinton told two long-anticipated congressional hearings examining the attack that became a major issue in the November presidential election.

Conservative Republicans challenged Clinton on the lack of security at the diplomatic compound in Benghazi, where Ambassador Christopher Stevens and three others were killed, as well as the erroneous account provided four days later by U.N. Ambassador Susan Rice that the attack grew spontaneously from a protest over an anti-Islam film produced in the United States.

Sen. Ron Johnson, a tea party backed Wisconsin Republican serving his first term, persistently questioned Clinton on Wednesday morning about what he described as Rice "purposely misleading" the American people.

Security Clearance: Clinton lays out daunting security challenges in North Africa

"We were misled that there were supposedly protests and something sprang out of that, an assault sprang out of that and that was easily ascertained that that was not the fact," Johnson said, adding that "the American people could have known that within days."

Shouting and gesturing with her arms in frustration, Clinton shot back: "With all due respect, the fact is we had four dead Americans. Was it because of a protest or was it because of guys out for a walk one night decided they'd go kill some Americans?"

Her fists shaking, she continued: "What difference, at this point, does it make? It is our job to figure out what happened and do everything we can to prevent it from ever happening again, senator."

Another conservative, Sen. Rand Paul of Kentucky, told Clinton she should have been fired for not reading cables from Stevens and others in Libya.

Later in the day, conservative GOP Rep. Jeff Duncan of South Carolina accused Clinton of "national security malpractice" by letting the Benghazi consulate "become a death trap."

Duncan also questioned Clinton's claim of taking responsibility, noting she still had her job and the State Department officials cited for culpability by an independent review also remained on the payroll, though on forced leave pending possible further steps.

#whatdifferencedoesitmake: Clinton quote goes viral on Twitter

At both hearings, which together totaled more than five hours, Clinton acknowledged the "systemic breakdown" cited by an Accountability Review Board she appointed and noted she had accepted all 29 of its recommendations, adding her department was taking additional steps to increase security at U.S. diplomatic facilities around the world.

However, she also told both the Senate Foreign Relations Committee and House Foreign Affairs Committee that she had no direct role in the handling of requests by Stevens and other diplomats for increased security that were denied, saying: "I didn't see those requests. They didn't come to me."

In reference to the erroneous talking points by Rice that were aired on September 16, Clinton told the Senate panel that she was focused at that time on ensuring the safety of U.S. personnel at other facilities where protests were taking place.

"I was pretty occupied about keeping our people safe, doing what needed to be done," Clinton said, adding "I wasn't involved in the talking points process."

Ticker: What Benghazi hearing could say about 2016 White House

At one point, Clinton attempted to wrap up the issue, saying: "If you wish to fault the administration, it's that we didn't have a clear picture, and we probably didn't do as clear a job explaining that we did not have a clear picture, until days later, creating what I think are legitimate questions."

The independent report from the review board said it did not find "that any individual U.S. government employee engaged in misconduct or willfully ignored his or her responsibilities" leading up to the attack. However, one State Department official resigned and three others were placed on administrative leave after the report was released in December.

One of the GOP's harshest critics of the administration over the Benghazi attack, Sen. John McCain of Arizona, called Clinton's testimony unsatisfactory.

He said her department had yet to fully disclose all e-mails and other communication from Stevens and others in Benghazi, noting the American people, including the family and loved ones of those killed, deserved full answers.

Critics also complain the assailants remain at large, and Clinton noted that "we continue to hunt the terrorists responsible for the attacks in Benghazi and are determined to bring them to justice."

She told Wednesday's hearings that the FBI is pursuing what she called "very positive leads."

In her opening statement to both panels, Clinton said the Benghazi attack didn't happen in a vacuum but was part of a "broader strategic challenge in North Africa and the wider region."

Clinton's Benghazi statement: 'Not just a matter of policy -- it's personal'

She defended her department's response, saying there was "timely" and "exceptional" coordination between the State Department and the Pentagon on the night of the attack

"No delays in decision making. No denials of support from Washington or from the military," Clinton said. The review panel's report "said our response saved American lives in real time -- and it did," she added.

Clinton also said she directed the response to the attack from the State Department that night and "stayed in close contact with officials from across our government and the Libyan government."

In addition, Clinton said she immediately took steps to beef up security at U.S. posts around the world and to implement the review panel's 29 recommendations.

Clinton made clear that the security situation in North Africa and the Middle East remained threatening in the wake of the Arab Spring upheaval, with longtime leaders ousted in Egypt, Tunisia and Libya.

The fledgling Libyan leadership turned out to be unable to fulfill traditional security commitments to the U.S. diplomatic compound, she said.

"What I found with the Libyans was willingness but not capacity," she said.

Clinton also warned that weapons from Libya have turned up in Algeria and elsewhere, adding that "this Pandora's Box if you will" represented a major security threat.

"The Arab Spring has ushered in a time when al Qaeda is on the rise," she said. "The world in many ways is even more dangerous because we lack a central command [in al Qaeda] and have instead these nodes that are scattered throughout North Africa and other places."

Clinton expressed particular concern at events in Mali, where well-armed Tuareg militia, who had been working for former Libyan leader Moammar Gadhafi, came home just as al Qaeda in the Islamic Maghreb (AQIM) gravitated toward the area.

The size and topography of northern Mali, with its endless desert and caves, made for a long but necessary struggle, she said, adding that "we cannot permit northern Mali to become a safe haven."

Overall, she said, at least 20 U.S. diplomatic outposts "are under a serious threat environment as I speak to you."

Wednesday's committee appearances were some of the last acts for Clinton before she leaves her post as long planned, and Clinton showed a personal side in discussing what happened.

"For me, this is not just a matter of policy," she told the Senate panel. "It's personal."

In reference to the return of remains of the four slain Americans, Clinton said in a voice choked with emotion: "I stood next to President Obama as the Marines carried those flag-draped caskets off the plane at Andrews. I put my arms around the mothers and fathers, sisters and brothers, sons and daughters."

Democrats on both panels made a point of praising Clinton's service and noted that House Republicans have voted to cut funding for diplomatic security. However, Republicans rejected any connection between budget resources and vulnerability at the Benghazi compound, citing a report by a State Department financial officer.

Clinton faces hearings with numbers on her side

The hearings provided Republicans with a final opportunity to question Clinton, considered a possible presidential contender in 2016, on camera before she leaves office. After the September attack, conservative Republicans focused on the issue to attack the Obama administration's handling of the Libyan revolution and the overall Arab Spring upheaval.

Several legislators made references on Wednesday to Clinton's possible political future, with Republican Steve Chabot of Ohio drawing a laugh from the secretary when he said: "I wish you the best in your future endeavors. Mostly."

Polls show strong public support for Clinton and her performance as secretary of state, with an ABC News/Washington Post survey released Wednesday showing 67% of respondents had a favorable impression of her.

Clinton was originally scheduled to testify last month but postponed her appearance as she was treated for illness, a concussion and a blood clot near her brain. The country's top diplomat returned to work just over two weeks ago.

Pentagon releases official timeline of Benghazi attack

CNN's Jake Tapper, Elise Labott, Tim Lister and Ted Barrett contributed to this report.

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Women now equal men in lung cancer deaths

U.S. women who smoke today have a much greater risk of dying from lung cancer than they did decades ago, partly because they are starting younger and smoking more - that is, they are lighting up like men, new research shows.

Men who smoke have long had higher lung cancer death rates, but now women have caught up in their risk of dying from smoking-related illnesses. Lung cancer risk leveled off in the 1980s for men but is still rising for women, the study found.

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New cancer screening guides for heavy smokers

"It's a massive failure in prevention," said one study leader, Dr. Michael Thun of the American Cancer Society. And it's likely to repeat itself in places like China and Indonesia where smoking is growing, he said. About 1.3 billion people worldwide smoke.

The research is in Thursday's New England Journal of Medicine. It is one of the most comprehensive looks ever at long-term trends in the effects of smoking and includes the first generation of U.S. women who started early in life and continued for decades, long enough for health effects to show up.

The U.S. has more than 35 million smokers - about 20 percent of men and 18 percent of women. The percentage of people who smoke is far lower than it used to be; rates peaked around 1960 in men and two decades later in women.

In 2009, 205,974 people in the United States were diagnosed with lung cancer, including 110,190 men and 95,784 women, according to the Centers for Disease Control and Prevention. That same year, 87,694 men and 70,387 women passed away from the disease.

Researchers wanted to know if smoking is still as deadly as it was in the 1980s, given that cigarettes have changed (less tar), many smokers have quit, and treatments for many smoking-related diseases have improved.

They also wanted to know more about smoking and women. The famous surgeon general's report in 1964 said smoking could cause lung cancer in men, but evidence was lacking in women at the time since relatively few of them had smoked long enough.

One study, led by Dr. Prabhat Jha of the Center for Global Health Research in Toronto, looked at about 217,000 Americans in federal health surveys between 1997 and 2004.

A second study, led by Thun, tracked smoking-related deaths through three periods - 1959-65, 1982-88 and 2000-10 - using seven large population health surveys covering more than 2.2 million people.

Among the findings:

- The risk of dying of lung cancer was more than 25 times higher for female smokers in recent years than for women who never smoked. In the 1960s, it was only three times higher. One reason: After World War II, women started taking up the habit at a younger age and began smoking more.

-A person who never smoked was about twice as likely as a current smoker to live to age 80. For women, the chances of surviving that long were 70 percent for those who never smoked and 38 percent for smokers. In men, the numbers were 61 percent and 26 percent.

-Smokers in the U.S. are three times more likely to die between ages 25 and 79 than non-smokers are. About 60 percent of those deaths are attributable to smoking.

-Women are far less likely to quit smoking than men are. Among people 65 to 69, the ratio of former to current smokers is 4-to-1 for men and 2-to-1 for women.

-Smoking shaves more than 10 years off the average life span, but quitting at any age buys time. Quitting by age 40 avoids nearly all the excess risk of death from smoking. Men and women who quit when they were 25 to 34 years old gained 10 years; stopping at ages 35 to 44 gained 9 years; at ages 45 to 54, six years; at ages 55 to 64, four years.

-The risk of dying from other lung diseases such as emphysema and chronic bronchitis is rising in men and women, and the rise in men is a surprise because their lung cancer risk leveled off in 1980s.

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Shocking ads: Tips from smokers

Changes in cigarettes since the 1960s are a "plausible explanation" for the rise in non-cancer lung deaths, researchers write. Most smokers switched to cigarettes that were lower in tar and nicotine as measured by tests with machines, "but smokers inhaled more deeply to get the nicotine they were used to," Thun said. Deeper inhalation is consistent with the kind of lung damage seen in the illnesses that are rising, he said.

Scientists have made scant progress against lung cancer compared with other forms of the disease, and it remains the leading cause of cancer deaths worldwide. More than 160,000 people die of it in the U.S. each year.

The federal government, the Canadian Institutes of Health Research, the Bill and Melinda Gates Foundation, the cancer society and several universities paid for the new studies. Thun testified against tobacco companies in class-action lawsuits challenging the supposed benefits of cigarettes with reduced tar and nicotine, but he donated his payment to the cancer society.

Smoking needs more attention as a health hazard, Dr. Steven A. Schroeder of the University of California, San Francisco, wrote in a commentary in the journal.

"More women die of lung cancer than of breast cancer. But there is no `race for the cure' for lung cancer, no brown ribbon" or high-profile advocacy groups for lung cancer, he wrote.

Kathy DeJoseph, 62, of suburban Atlanta, finally quit smoking after 40 years - to qualify for lung cancer surgery last year.

"I tried everything that came along, I just never could do it," even while having chemotherapy, she said.

It's a powerful addiction, she said: "I still every day have to resist wanting to go buy a pack."

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Pentagon to Allow Women in Combat

Defense Secretary Leon Panetta will lift a longstanding ban on women serving in combat, according to senior defense officials.

The services have until this May to come up with a plan to implement the change, according to a Defense Department official.

That means the changes could come into effect as early as May. The services will have until January 2016 to complete the implementation of the changes.

The military services will also have until Janurary 2016 to seek waivers for certain jobs -- but those waivers will require a personal approval from the secretary of defense and will have to be based on rationales other than the direct combat exclusion rule.

The move to allow women in combat, first reported by the Associated Press, was not expected this week, although there has been a concerted effort by the Obama administration to further open up the armed forces to women.

The Joint Chiefs of Staff unanimously recommended in January to Secretary Panetta that the direct combat exclusion rule should be lifted.

"I can confirm media reports that the secretary and the chairman are expected to announce the lifting of the direct combat exclusion rule for women in the military," said a senior Defense Department official. "This policy change will initiate a process whereby the services will develop plans to implement this decision, which was made by the secretary of defense upon the recommendation of the Joint Chiefs of Staff."

Chairman of the Joint Chiefs Gen. Martin Dempsey sent Panetta a memo earlier this month entitled, "Women in Service Implementation Plan."

"The time has come to rescind the direct combat exclusion rule for women and to eliminate all unnecessary gender-based barriers to service," the memo read.

Adek Berry/AFP/Getty Images

"To implement these initiatives successfully and without sacrificing our warfighting capability or the trust of the American people, we will need time to get it right," he said in the memo, referring to the 2016 horizon.

Women have been officially prohibited from serving in combat since a 1994 rule that barred them from serving in ground combat units. That does not mean they have been immune from danger or from combat.

As Martha Raddatz reported in 2009, women have served in support positions on and off the frontlines in Iraq and Afghanistan, where war is waged on street corners and in markets, putting them at equal risk. Hundreds of thousands of women deployed with the military to those two war zones over the past decade. Hundreds have died.

READ MORE: Female Warriors Engage in Combat in Iraq, Afghanistan

Woman have been able to fly combat sorties since 1993. In 2010, the Navy allowed them on submarines. But lifting restrictions on service in frontline ground combat units will break a key barrier in the military.

READ MORE: Smooth Sailing for First Women to Serve on Navy Submarines

READ MORE: Female Fighter Pilot Breaks Gender Barriers

Panetta's decision will set a January 2016 deadline for the military service branches to argue that there are military roles that should remain closed to women.

In February 2012 the Defense Department opened up 14,500 positions to women that had previously been limited to men and lifted a rule that prohibited women from living with combat units.

Panetta also directed the services to examine ways to open more combat roles to women.

However, the ban on direct combat positions has remained in place.

Advocates for equality in the services will be pleased. On Capitol Hill today, retired Chief Master Sgt. Cindy McNally, a victim of sexual assault in the military, said placing women in combat roles would help equalize the services and actually cut down on sexual assaults, which have emerged as a major problem in the military.

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Defterios: What keeps Davos relevant

STORY HIGHLIGHTS

• Since the late 20th Century, the ski resort of Davos has been synonymous with the World Economic Forum


• Defterios: I first came to Davos as a relatively junior correspondent, two months after the Berlin Wall fell


• Fall of Communism, China's opening, removal of apartheid in South Africa unfolded in the 90s
  
  


• It's the inter-play between geo-politics and business is what keeps the forum relevant

Davos (CNN) -- Veterans of Davos often refer to nature's awe-inspiring work as the Magic Mountain.

The name comes from an early 20th century novel by Thomas Mann -- reflecting on life in an alpine health retreat, and the mystery of time in this breath-taking setting.

Read more from John Defterios: Why Egypt's transition is so painful

Since the late 20th century, this ski resort has been synonymous with the World Economic Forum, which represents networking on its grandest scale.

This year nearly 40 world leaders -- a record for this annual meeting -- 2000 plus executives and it seems an equal number of people in the media, like yours truly, are in pursuit of them all. The setting is certainly more chaotic then a decade ago. The agendas of the Fortune 500 chief executives are to filled with bi-lateral meetings and back door briefings to allow for the spontaneity that made this venue unique.

Davos gets ready for leaders' gathering

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I first came to Davos as a relatively junior correspondent in 1990, two months after the fall of the Berlin Wall. It was arguably then, after nearly two decades in the conference business, when the forum became a fixture on the global calendar.

Quest: U.S. economy to dominate Davos 2013

I can remember, quite vividly, working out of a bunker (like we do today) in the Davos Congress Centre. West German Chancellor Helmut Kohl sat side-by-side with his East German counterpart Hans Modrow. That meeting before the global community helped set the stage for monetary union, a huge unification fund for what became Eastern Germany and shortly thereafter German elections.

The early 90s at Davos were dominated by European reconstruction after the fall of communism. Former party bosses came to the forum to convince business leaders that a transition to market economics could be delivered. Boris Yeltsin made his Davos appearance during that chaotic transition from the USSR to today's Russia.

Davos 2013: New year, same old problems?

In 1992, Chinese Premier Li Peng used the setting here in the Alps to articulate plans for the country's economic opening up to the world. Not by chance, the architect of Washington's engagement with Beijing, the former U.S. Secretary of State Henry Kissinger also took a high profile that year.

Again only two years later in 1994, Yasser Arafat and Shimon Peres walked hand in hand on stage, holding a public dialogue leading up to the creation and recognition of the Palestinian Authority.

The World Economic Forum, as the saying goes, was positioned to be in the right place at the right time. While the author of the Magic Mountain talked about the complexity of time around World War I, in the 1990s time was compressed here.

The fall of communism, the lowering of global trade barriers, the opening up of China, the removal of apartheid in South Africa and the proliferation of the internet all unfolded in that decade.

Interactive: How's your economic mood?

As those events came together, so too did the major players as they made the journey to Davos. Michael Bloomberg, evolving as a global name in financial data and now the Mayor of New York City, sat alongside Microsoft CEO Bill Gates. U.S. President Bill Clinton outlined his party's historic move to the political center before a packed audience of global business executives.

To spice things up, rock stars and actors, as they became activists, chose the Davos platform: Bono, Richard Gere, Sharon Stone, Brad and Angelina would have the wealthiest and most powerful corporate titans freeze in their tracks.

Earlier this week, I walked into the main plenary hall as workers put the final touches on the stage and lighting. It is a venue which has welcomed countless political leaders and business executives, during internet booms and banking busts, in the midst of a Middle East crisis and even during the lead up to two Gulf Wars.

But that inter-play between geo-politics and business -- during the best and worst of times -- is what keeps the forum relevant. It allows this setting at the base of the Magic Mountain to endure and recreate something unique during what Mann rightly described as the ongoing complexity of our times.

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Marines beat a retreat in Beyonce lip-sync flap

WASHINGTON: The US Marine Corps beat a hasty retreat Tuesday from a furore over whether Beyonce lip-synched "The Star-Spangled Banner" at President Barack Obama's public inauguration ceremony.

First, the New York Times quoted a US Marine Band spokeswoman as saying that, just before Beyonce took the stage Monday, the musicians learned a version of the national anthem it had pre-recorded with her would be used.

"We don't know why," said the spokeswoman, Master Sergeant Kristin duBois. "But that is what we were instructed to do... It's not because Beyonce can't sing. We all know Beyonce can sing. We all know the Marine Band can play."

But later, the Marine Corps said only that a pre-recorded version of the band's musical track was played to the crowd outside the Capitol after Obama was sworn into office for a second term.

Since the band did not have a chance to rehearse with Beyonce beforehand, "it was determined that a live performance by the band was ill-advised for such a high-profile event," it said.

But as for Beyonce's vocal performance, it added: "No one in the Marine Band is in a position to assess whether it was live or pre-recorded."

Beyonce's publicist did not respond to emails Tuesday, leaving it unclear as to whether or not the R&B diva had pulled off the biggest karaoke number in the history of US presidential inaugurations, or somehow just mimed the words.

Also unexplained was a black-and-white Instagram photo, supposedly taken Sunday, of Beyonce in a wool beret and cardigan in a recording studio with three soldiers behind her. She appeared to be listening intently to something.

Equally mysterious was why Beyonce removed the ear monitor mid-way through the song. Singers performing over an instrumental track might do so if the playback is clashing with what's coming out of the loudspeakers.

One way or another, fans of Beyonce -- who sang "The Star-Spangled Banner" live at last year's Super Bowl and returns to the American football classic in February as its half-time act -- rallied behind her on Twitter.

"Who cares that Beyonce Lip #Sync the National Anthem, it was recorded live an hour before. You try singing in that cold," tweeted one fan, referring to Monday's near-freezing temperatures in Washington.

"Beyonce certainly acted like a diva ... but I don't see how that can be compared to Lance Armstrong cheating for 7 straight years at the least," said another Twitter user, referring to the disgraced cyclist.

"Beyonce is the best lip-syncer I've seen," added a third fan. "Because she surely fooled me."

The US Marine Band is the premier musical ensemble of the US Marine Corps. It's also known as the President's Own for its longstanding connection with the White House and important national events.

It played live for most of Monday's inauguration on the Capitol steps, but prior to any major event, it routinely goes into the studio to record its repertoire as a precautionary measure.

"Each piece of music scheduled for performance in the Inauguration is pre-recorded for use in case of freezing temperatures, equipment failure or extenuating circumstances," the Marine Corps statement said.

Pop star Kelly Clarkson and folk singer James Taylor also performed at the inauguration.

- AFP/jc

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Israeli election could halt rightward swing

STORY HIGHLIGHTS

• Netanyahu's party wins but the centrists do well, exit polls say


• Will the new government be more centrist or move right?


• Yesh Atid comes in second, Labor third, exit polling says


• The far-right Jewish Home gets 12 seats

Jerusalem (CNN) -- Prime Minister Benjamin Netanyahu's party got the most votes in Israel's national election Tuesday, but a respectable showing by centrists could slow or halt a rightward swing in the government.

Netanyahu's Likud Beitenu won 31 Knesset seats in the Israel election, according to three TV exit polls, gaining the most as expected. Jewish Home, an extreme right party with a charismatic leader named Naftali Bennett, got 12 seats.

But the Yesh Atid party, a centrist movement devoted to helping the middle class and halting military draft exemptions for ultra-Orthodox civilians, came in a surprising second place with 19 seats, according to two exit polls, and 18, according to a third.

Netanyahu told weary but elated supporters early Wednesday he plans to form a government "as broad as possible" and pursue his goals with "many partners."

"I believe the results of the election represent an opportunity to make changes that the people of Israel want to see and that will serve all citizens of the state of Israel," he said. "I plan to lead those changes and to that end we must establish a government that is as broad as possible, and I've already started out on that task."

He cited a number of principles a new government will embrace: security, preventing Iran from obtaining nuclear weapons, economic responsibility in the face of the global financial crisis, diplomatic responsibility, increasing equality in sharing burdens, and lowering the cost of living, including the cost of apartments.

"It is a great privilege but it is also a great responsibility," he said. "I believe the results of the elections represent an opprotunity to make changes that the people of Israel want to see and (that) will serve all of the citizens of the state of Israel."

But the centrists and leftists attracted waves of voters displeased with, among other things, Israel's high cost of living, and more supportive of talks with Palestinians. At first glance, the initial result reflects a politically polarized electorate, with possibly an edge to the rightists.

Yossi Beilin, a politician who is staunchly in the peace camp and one of the chief architects of the Israeli-Palestinian peace initiative called the Oslo Accords, said he thinks that it will be impossible for Netanyahu to form his own government and he hopes none of the center-left parties join his government.

"The center-left in Israel is alive and kicking. It's almost the majority, or half and half," he told CNN. "All the talks about the demise of the left are over for the time being."

Yesh Atid's leader is a dynamic figure -- Yair Lapid, a longtime prominent journalist whose late father, Tommy Lapid, led Shinui, a onetime secularist party that took on the influence and power of the ultra-Orthodox.

Yesh Atid also calls for reforming the governmental system, improving education, jump-starting the economy through small-business assistance, and providing housing assistance for military veterans and young couples.

The Labor Party, whose leader Shelly Yacimovich campaigned solely on economic concerns, pulled 17 seats. Before the election, she was expected to finish in second place, so that is a surprise. She and other centrists were working to tap into the disaffected Israelis who took to the Tel Aviv streets in 2011 to protest frustrating economic conditions.

Hatnua, the party of former Foreign Minister Tzipi Livni who is focused on talks with Palestinians, gained seven seats. Another poll says Meretz, a longtime left-wing party, gained seven seats.

"Politics is often about expectations," said David Makovsky, an Israeli analyst at the the Washington Institute for Near East Policy.

"Once the public thought that Netanyahu was a shoo-in, it assumed his victory and looked for a fresh face that would be focused on issues that he has not prioritized. This explains the meteoric rise of a new party (Yesh Atid) which said it would focus on the middle class and find a way so the ultra-Orthodox participate in burden-sharing by joining either the compulsory army or civilian form of mandatory service.

One party in Israel never gets a parliamentary majority of more than 60 seats, so parties must rely on coalition-building. The question is whether Netanyahu will stay on the right or center.

Will Netanyahu form a right-wing coalition with Jewish Home and religious blocs like Shas -- which earned between 11 and 13 seats, exit polls show? Or will he move to the center and try to form a coalition with Yesh Atid, for example, and others? Or is it possible that a center-left coalition could be cobbled together, without the right-wing?

Netanyahu and his party sensed Yesh Atid's momentum. He called on his backers to come out and vote.

"The Likud government is in danger, go vote for us for the sake of the country's future," he was quoted as saying.

After the exit polls rolled in, he thanked Israelis on Facebook for his showing and indicated that he wants to "a very wide government" as the hard work of coalition building begins on Wednesday.

"The (election) results observed are a great opportunity for many changes for the benefit of all citizens of Israel. The complications ahead of us are many and wide, as from tonight I will start my efforts to form a very wide government as possible."

Michael Singh, managing director at the Washington institute, said the result reflects polarized politics in Israel. He said the immediate consequences of the result is that coalition building will be quite difficult and time-consuming.

The worst-case scenario would be government paralysis and maybe another election sooner rather than later. While he said it's possible that a centrist coalition could emerge led by Yesh Atid, which means "there is a future," and Labor, he thinks Netanyahu and Lapid will form a government.

After the results came in, Likud celebrated. Danny Danon, Likud party member and expected to serve in the next Knesset, was asked why the Israeli-Palestinian peace process hasn't been front-and-center in the campaign.

Both talks and the issue of Iran were not as prominent among factors as expected by many observers. Domestic issues, in contrast, played a large role in the campaign.

Israel has no partner among Palestinians, Danon said, and noted that peace initiatives have been tried but they haven't borne fruit. He cited the situation in Gaza, where militants fire missiles into Israel despite the country's departure from that Palestinian territory. Israel launched an offensive against Palestinian militants in Gaza last year after enduring missile fire on its territory.

The next government, he said, will reach out to Palestinians "but will also continue to make sure Israelis are strong and safe."

Israel doesn't "want to see an al Qaeda state in our backyard," Danon said.

Makovsky said the election is good news for the Obama administration, which has had prickly relations with the right-wing Netanyahu government. It comes after a high turnout -- the percentage of eligible voters who cast a vote was 66.6%, just 1% more than the 2009 election.

"It's unclear if Netanyahu wanted a pure right-wing option in the first place," he said.

"But Washington can breathe a sigh of relief that Netanyahu will need to reach accommodation with some parties at the center of the map who essentially would like to see progress on the Palestinian issue as well as on economic issues."

CNN's Joe Sterling reported from Atlanta. CNN's Sara Sidner, Kareem Khadder and Nicola Goulding reported from Israel.

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