Frontiers Of Medicine Being diagnosed with breast cancer can make a person feel powerless, but there are some things women can dO tO potentially improve hOW they feelthroughout the process. Here are some strategies recommended by experts and others that are still being explored—that may enhance the effectiveness and reduce the side effects of treatment. —A. S. Surprising things that may improve breast- cancer treatment H E A し T H Y E A T ー N G Y 0 G A P H Y S ー C A し A C T ー V ー T Y A healthy diet filled with IOts Of fruits Up tO 80 % Of women with breast cancer Exercising during treatment won't be easy and vegetables, which contain fiber and in North America use complementary for everyone, but it can be worthwhile or integrative therapies, and one Of the when women feel uptO it. "Exercise is antioxidants, iS good preventive medicine. When researchers in a 2016 study asked most studied Of those is yoga. A steady one Ofthe bestthings women can dO forthemselves," says Dr. Ann Partridge, women whatthey had eaten as teenagers, practice may even lessen the side effects Of treatment.ln a 2017 study, doing yoga director Of the Program for Young Women those whO reported eating about three with Breast Cancer at Dana-Farber Cancer servings Of fruit a day as teens had a atleast twice a week improved sleep and reduced daytime drowsiness in women lnstitute. ・・ Walking three tO five times a week 25 % lower risk ofdeveloping breast can make a huge difference in howyou feel cancerlater on than those whO ate less. with breast cancer.lt may 引 SO help after during treatment. " lt's good for the brain t00. Eating well throughout treatment is SO treatment is over. A 2016 study Of 200 helpful, says Partridge. "Take care ofyour breast-cancer survivors found that women A study Of 87 breast-cancer survivors found that those whO did 12 weeks Of exercise temple," she says. You don't necessarily whO practiced yoga had less fatigue have tO startjuicing, but "don't overdo it and fewer markers Of inflammation than scored better on some cognitive tests than with carbs or comfort foods. women WhO didn't exercise. those whO didn't. M E D ー T A T ー 0 N lt's a 0 important tO take good care Of your mind, says Partridge. "When you are emotionally not dOing well, you feel things more physically. " Partridge says that when people feeltired, stressed or upset, they may perceive their physical symptoms Of cancer as worse. She recommends adopting calming practices like mindfulness meditation. A 2014 review Of research found that meditation is effective at treating symptoms of mood disorders that are common among women with a recent breast-cancer diagnosis, like anxiety and depression. T R E A T M E N T T ー M ー N G Research is stillin the very early stages. But in 2014 , researchers atthe Weizmann lnstitute Of Science found evidence in mice that cancer treatment might be more effective in the evening. 旧 their study, a mouse's daytime production Of steroid hormones hindered the effects Of certain receptors that are targeted by cancer drugs. Scientists don't know if humans may be more receptive tO treatment at night, but if evening treatment proves effective, shifting care a few hours may be a simple waytO make medications more powerful. S し E E P SIeep is criticalfor good health, and experts recommend that adults get seven tO nine hours each night. Growing evidence 引 SO suggests that the amount Of sleep a woman gets each night is linked tO a better chance Of survival from breast cancer.ln a 2016 study, researchers discovered that women whO sleptless than five hours a night on average before they were diagnosed with breast cancer were nearly 1.5 times as likely tO die from their disease as women whO reported sleeping seven tO eight hours a night. ILLUSTRATIONS BY 」 AMES KIM
Frontiers Of Medicine From diagnosis tO treatment, breast-cancer care is all about finding th e right options for the right woman at the right time An d ⅳ u Approach t0 Breast Cancer By AIic e Park women live longer with the disease. Broader THE ANNOUNCEMENT FROM JUI. IA LOUIS-DREYFUS that she has been diagnosed with breast cancer sc reening, it turned out, 0 代 e Ⅱ contributed tO a high rate 0f false-positive readings, which prompted came with bOth a revelation and a warning. Her tweet revealing her diagnosis alSO contained many women tO get unnecessary testing and some important reminders: that breast cancer iS biopsies that came with serious complications. lt simply doesn't make sense t0 apply the same advice the most C01 れ mon type Of cancer among women to all women about when and how often they in the U. S. , affecting 1 in 8 over their lifetime, and that while the disease does not discriminate, should get mammograms, when the risk for breast screening and treatment strategies, especially in cancer varies depending on WhO the 、 V01 蝨 an iS. the U. S. , often do. Treatments and cancer care are alSO becoming A cancer diagnosis is one Of the most personal more bespoke, reflecting what doctors are learning experiences a woman can go through. Yet the about whO benefits, and whO doesn't, from certain strategies that doctors have used for detecting therapies. Women now have more information about their disease—down tO the very DNA Of and treating the disease are only just beginning tO be optimized for individual women. lt wasn't their tumors—than ever before, SO they can make until 2009 , for example, that recommendations more informed decisions about hOW aggressively for breast-cancer screening With mammograms they want tO be treated. Scientists alSO have an were changed from ones that broadly called for evolving understanding Of hOW women can better most women over 40 tO get tested every year. NOW endure treatment with fewer side effects—and they most expert groups agree that women should start have plenty 0f options t0 d0 SO, from getting more getting mammograms at age 45 or 50 , repeating the sleep t0 practicing yoga or eating healthfully. As process about every Other year. The exact schedule breast-cancer care gets 1 れ ore personal, women are should be determined after women and their becoming empowered tO make better decisions, doctors consider risk factors like family history and research is even revealing what they should and smoking habits. lt became clear that screening know about the potential biases ofthe doctors who adVice needed tO become more personalized after treat them. A breast-cancer diagnosis is still a life- data failed t0 show that the previous guidelines changingjourney,. But now women have more Ofthe led to fewer breast-cancer deaths or even helped custom t001S they need tO effectively navigate it. ロ
Frontiers Of Medicine I treated breast cancer for years as a doctor. Then I was diagnosed HOW DNA can guide cancer treatments Genes already reveal a lOt about hOW breast cancer works. Doctors test for inherited mutations that can make women more vulnerable tO developingthe disease, such as those affecting BRCAI and BRCA2. About 10 % Of people with breast cancer in the U. S. have atleast one Of these, and knowing that allows a woman tO choose the most appropriate treatment for her. But perhaps the greatest value Of genetictestingtoday is the ability tO analyze the DNAoftumors them- selves. Commercial tests as well as proprietary onesthat majorcancer centers have developed are increas- ingly used tO scan dozens Of genes for mutations that can predict hOW likely a canceris tO return. A genetic score that suggests a IOW chance Of recurrence may help women choose less aggressive treatment—including preserving their breasts rather than having a mastectomy. Genetic information can even iden- tify the women whO don't need che- motherapy. Recent studies suggest that nearly half ofwomen diagnosed with certain types Of early-stage breast cancercan avoid the grueling effects ofthe toxic treatment and still have the same five-year survival rate as women whO get chemo. "These tests are giving people the confidence tO begin tO back 0 幵 on chemotherapy for some women," says Dr,. EriC Winer, director Ofthe breast oncology center at Dana-Farber Cancer lnstitute. "With these tests, we are able tO be that much more refined and precise about hOW we give treatments. " —A. P. 既 to 1 既 Percentage Of breast cancers attributable tO inherited gene mutations By PameIa Munster, M. D. WAS A CANCER EXPERT LONG BEFORE I WAS A PATIENT.• in control and invulnerable. Yet all 0f that changed with one phone call. Seeing the familiar number from my university's radiology department, I knew it would be a "finding ofconcern. " With a pang of sadness, I wondered which of my patients I would soon be calling with bad news. But the bad news was about my recent mammogram. Nothing prepared me for the sickening sense offoreboding and fear that gripped me that day. At 48 , I was not ready for breast cancer. For me, unlike most Ofmy patients, the decisions aboutwhich treatments tO choose were the easy parts. I never doubted that a double mastectomy was the right choice, since I had a strong family history ofthe disease. Yet as awoman, I still wrestled with the need for such a drastic step. When I thought it was all behind me, after almost a year Of tests, frequent visits tO the doctor's offce and multiple surgeries, I found out that I carried the BRCA gene. This inherited gene is likely going to affect other family members and made me worry about my 10-year-old daughter. The BRCA gene puts me at high risk for ovarian cancer, which 'Doctors live in a meant I needed tO remove my ovaries and fallopian tubes. The night before the surgery to remove my ovaries, I asked my friend world ofstatistics and patient how it would feel t0 have my ovaries removed. She andprobabilities, stared at me with bewilderment. "HOW can the thiefofso many れ d we 0 工 te ovaries ask a question like this? ” she asked. Although I could use numbers tO explain the surgery and its medical and emotional consequences, reassure patients. I had no idea how I would feel about losing more precious body These numbers parts and going intO menopause overnight. feel very different Doctors live ⅲ a world Of statistics and probabilities, and when it iS we Often use numbers tO reassure patients. numbers feel very different when it is your cancer. I knew there was already a your cancer. 2 % -3 % chance offinding ovarian cancer during that surgery. As a doctor, I interpreted this tO mean that there was a 97 % chance ofbeing cancer-free—something I thought should be reassuring tO patients. Yet none Ofthe favorable statistics let me rest until I got the call from the pathologist that I was cancer-free. Oncologists are among the most compassionate doctors I know. Yet it takes a tOll tO stay in a difflcult conversation, and few ofus can truly comprehend the profound sense ofupheavalthat a cancer diagnosis brings. lt was dffcult tO be out ofcontrol, at the mercy 0f the kindness and skills ofmedical professionals. But I am lucky. Buoyed by friends and family, I continue to work in cancer research and With the most courageous patients. 、 lost important, I am more at ease with difflcult conversations in clinic now, because as a patient I know I needed tO have them. Munster is 0 co-leader Ofthe Centerfor BRCA Research at the University 可 C 和 r ⅲ 0 , Sa 〃 Francisco 7 21t0 70 Number ofgenes being studied in breast-cancer tumors
0 0 intended tO enhance recreation oppor- a gun ShOP. when you have someone tunities on federal land, were provisions slaughtering kids ⅲ a grade school, if that allowing the purchase and use 0f "sup- isn't enough, what is? ” pressors; ” similar tO silencers used by the But it's foolish to say nothing could military and the restraints on the regula- have diminished the scale of the Vegas tion Of armor piercing bullets. massacre. The evening 0f Oct. 3 , law- it'll be a hand grenade, or it will be a knife enforcement Off ℃ ials said that 12 Of THE HORROR IN LAS VEGAS seemed tO or an ” he said. the 23 weapons in Paddock's suite were change nothing at the Capit01. House Later, on Oct. 3 , Senate majority leader equipped with bump stocks of the kind Speaker Paul Ryan, a Republican, pro- Mitch McConneII do dged querie s about that had first received government per- moted the virtues Of mental-health care guns and ended his weekly Q&A with mission for manufacture in 2010. Demo- when he met with reporters Oct. 3. TO his reporters at the CapitOl after just three cratic Senator Dianne Feinstein, WhO has le 仕 stood Steve Scalise, a member ofRy- raised the alarm about bump stocks for questions. "lt's premature tO be discuss- an's leadership team, who was back 0 Ⅱ the ing legislative solutions, ifthere are any, years , s aid she planned t0 revive her ban job for the first time in months after a dis- McConnell said. ln many corners a sense on such accessones. "ThiS iS the least we gruntled shooter ambushed congressio- Of hopelessness settled over the post- should do; ” the California Democrat said. nal Republicans on a softball field in May. Vegas debate. "lf Sandy H00k didn't re- Her bill, introduced the next day, imme- ln an interview days earlier, Scalise had sult in legislation that either eliminated diately drew widespread support among told 60 Minutes that the attack on him or restricted the type Ofguns that can be Democrats. Republicans kept a skeptical did not diminish his belief in the Second sold, or the people to whom they can be distance, at least at first. Amendment and credited his security de- sold, nothing will ever change,' says Pat- Meanwhile, other Democrats are tail with saving his life. "lf it's not a gun, rick Dunphy, an attorney wh0 has sued shooting for symbolic victories, House 24 TIME Oct0ber 16 , 2017 More 市 0 れ 527Pe 叩厄 were wounded in the attack,forcing medics tO cart 0W0 ア some ViCtims in wheelbarrows
If their initial reaction to the opening salvos at 10 : 08 p. m. on Sunday, Oct. 1 had been confusion, the 22 , 000 concertgoers spent the next nine tO 11 minutes Of pro- tracted gunfire trapped in a nightmare that, for so many Americans, has some- how become grimly familiar: the shaky cell-phone fo otage of carnage , the photo- graphs Of innocent victims in the news- paper, the profiles ofhorror and heroism. There was the 48-year-01d woman who heard her husband, a father of four, C01- lapse on the asphalt next to her, and the young man wh0 sprinted alongside his eight-months'-pregnant wife, running for their lives. There was the 30-year-oId woman wh0 lay on top 0fher 21-year-01d brother to protect him from the hail of bullets, "because he has big goals in life. ” But when the shooting ended, this ter- ror would be in a class apart. Stephen Pad- dock, 64 , who smashed the windows of his 32nd-floor Mandalay Bay Resort and Casino suite and trained an assault-style semiautomatic weapon on the helpless souls four football fields away, broke an- Other dismal record for American murder. At least 58 dead, at least 527 wounded, by a man whO, for no immediately discern- ible reason, lugged an arsenal 0f23 weap- ons intO his high-roller suite and then rained ofhundreds upon hundreds ofbul- lets into a tightly packe d crowd. Twelve ofhis high-powered rifles were modified with legal parts that made them function like automatic weapons, capable Of un- leashing nine rounds per second, a rate offire rarely seen offthe field ofwar. The military-grade rounds, fired from what seemed tO be large-capacity magazines, produced so much gun smoke they set 0ff the detectors in Paddock's suite. Year after year, mass shootings have broken record after record for casualties. From a university in Virginia tO a gay dance club in Orlando, the body count has increased, creating an image Of an unstoppable national slaughter. High- profile battles over background checks and gun-show loopholes have stalled on Capit01 Hill, even as gun-rights advocates introduce new provisions tO weaken the Drapes b 卍 ow om the 32 れ d 00r hotel suite 砒 Ma d Ba. 易 where the ShOOter t00 た aim at concertgoers existing constraints. But it's not an unfixable problem. New laws could at least limit the carnage when a murderer opens up on a crowd. we have decided that grenade launchers should not be widely available; why should we not say the same for devices that allow bullets to be fired at a rate of more than 400 rounds per minute? Nor is the politi- cal divide as unbridgeable as it appears. The NationaI Rifle Association (NRA) and its allies are not all-powerful: the lobby relies 0 Ⅱ the intensity Of a small cadre Of fervent supporters, and it does lose races, such as last year's campaign tO re- place Senator Harry Reid 0fNevada. The majority Of gun owners believe in some form of regulation, and several Republi- can Senators have suggested they are open tO compromlse. The challenge in bringing change is that the debate over gun rights isn't re- ally about guns at all. lt's about what they represent: cherished freedoms, a rever- ence for independence. The guns are a re- Jection ofpolitical correctness that creeps intO everything. Even the most incremen- tal move tO constrain deadly weaponry seems tO many Americans tO cut against their rights. ln the blood-soaked scene on the Vegas Strip, those deeply held be- liefs collide with our collective horror. The question now, as the victims try tO make sense Of slaughter on a military scale, is where do we draw the line? IF THAT IS a political question, it is has proven a confounding one. There are an estimated 265 million guns in the U. S. , ac- cording tO one study from Harvard and Northeastern universities—・ greater than the tOtal number ofvotes cast in last year's presidential election. They are owned by 30 % ofthe adult population. That's not a constituency tO be dismissed. But not all gun owners are against all forms Of gun control. A Quinnipiac University poll ⅲ June 2017 showed 94 % ofvoters support background checks for all gun buyers— including 93 % 0fRepublicans. The same poll found that a majority, 57 % , believed guns are t00 easy t0 buy, and only 35 % thought more people carrying guns would make Americans safer. A Pew survey Of gun owners found that almost 30 % 0f them support stricter gun laws. "There's a complete disconnect; ” said Senator Amy Klobuchar, a Minnesota Democrat. UN ー H ー B E. UNSPEAKABLEE THE LANGUAGE OF TRAGEDY BY KATY STEINMETZ As the country reacted tO the shooting, many people invoked words that we turn towhen experience has slipped the bonds Of description, when language seems tO Offer us merethimbles tO emptya well. A photographeratthe scene said the car- nage and chaos was "incomparable" nothing could be relative. The shooter's brothersaid he was "completelydumb- founded," a word that means he felt desti- tute Ofthe facultyofspeech. Many people attempting tO find something meaningful tO say called the event "unspeakable. " Others said, 爿 have nowords. President Trump described the event by its indescribable nature t00 , saying we "cannotfathom" the feelings Ofthe 59 families whO lost a parent, a child, a brother 0 「 a sister. TO fathom something, in the oldest sense, is tO encircle it with extended arms. You cannot putyour arms around the deadliest mass shooting in modern American history, especially while the hospitals are still full. You cannot put your arms around such IOSS and confusion. Merriam-Webster editor atlarge Peter SokoIowski says the online dictionary saw a spike in searches for surreal, which means "marked by the intense irrational reality Of a dream. " AS Sokolowski has said, a word that fits a feeling can bring "some kind Of orderto somebody's life in that moment. " Surreal suggests that the event doesn't abide by logic. Searchingforwords tO describe an eventwhere SO many losttheir lives iS in some ways no different from finding words fO 「 a card you send tO someone WhO has justlost a parent orchild. There are few good words for that either, because the linear order ofletters and sentences iS a cheap representation Of the messy VOid that hurts SO much and remains SO long after a person is gone. Tryingto sum it up and getting it wrong can be an insult tO the grief, SO we describe it by what it isn't: clear, comprehensible, somethingthat can be summed up. By the time police arrived at the Las Vegas shooter's hotelroom, he was already dead from an apparent suicide. 旧 remarks on Oct. 2 , Trump described the shooter by what he had done, saying he had committed "an act Of pure evil." Even that meaning bOiIs down tO what it is not: the first definition Of evil is the "antithesis Of good.
0 e ー the roar Of the guitar, The rapid を叩 pop 叩 exploded around Doris Huser, 29. She and her the g び e erupted. At first 8-year-old daughter had been in the bath- room, but when the shooting began, they the CO び 0 y - m 5i0 fans pushed back into the crowd, toward the sound ofthe bullets, in search ofHuser's at the Route 91 Harvest 5-year-01d son and her developmentally disabled sister. They could feel the bul- FestivaIi 0 Las Vegas lets pinging 0 圧 the concession stands, ricocheting Off the pavement around thought the loudspeakers them. About 50 yards away, Tyler Reeve, a 36-year-01d country artist and song- were malfunctioning 0 ー writer, dove intO a production trailer with that the pyrotechnics five friends and lay on the floor as hun- dreds of rounds rang out. "lt was like a ad gone awry. But as war zone; ” he says. Piles Of bOdies were everywhere. B100d collected ⅲ pools. the bodies crumpled, the Everyone was screaming. Melissa Bayer, who had just le 仕 a nearby Hooters, wit- crowd began tO grasp the nessed the mayhem 仕 om a hundred yards away. This a mass shooting, she thought. hO ″ 0 ー that was び nf01d ⅲ This is what it looks like. 20 TIME October 16 , 2017 PREVIOUS PAGES: MAGNUM; T 工 IS PAGE: AP/S 工 UTTERSTOCK
Why more women are getting a double mastectomy By Alexandra SifferIin DESPITE HAVING MORE TREATMENT options, women With cancer ln one breast are increasingly choosing tO remove bOth breasts—even though experts say the procedure does not necessarily lead tO better outcomes. A recent study published inJAMA Sur- gery found that the increase is driven in part by their surgeons. Doctors generally discourage contralateral prophylactic mastectomy—also known as CPM, or the removal ofahealthy breastwhen the other has cancer—for women at an average riSk for additional breast cancer. They dO rec- ommend it for women at a higher risk, like those with a mutation ⅲ the BRCA gene, which greatly increases the risk 0f getting the disease. Even SO, the rate at which women With cancer in one breast chose tO remove bOth increased nearly sixfold from 1998 to 2011 , largely among younger women with early-stage unilat- eral breast cancer and without genetic risk factors—in Other words, women WhO are candidates for less aggressive treatment. Survival for these women isn't higher than it iS for women WhO choose less aggressive options like lumpectomy, also called breast-conserving surgery, ⅲ which only a portion 0f the affected breast is removed. A March 2016 study by researchers at the Duke Cancer lnsti- tute looked at about 4 , 000 women whO had breast-cancer surgery and found that removing b oth bre asts did not marke dly improve a woman's quality oflife. SO Why are women choosing the more invaslve option more Often? There are likely several reasons for what experts are calling a surge in women undergoing CPM—including a woman's doctor. The study ⅲ JAMA Surgery found that sur- geons account for 20 % Of the variation in rates Of women removing bOth breasts. ln the study, researchers surveyed 5 , 080 women with early-stage breast cancer and an average risk for cancer in the other breast, along with 377 of their surgeons. They found that while the doc- tors largely agreed on what they would initially recommend—breast-conserving surgery over CPM—there was variabil- ity ⅲ what was ultimately performed. A woman had only a 4 % chance of under- going CPM if she went 朝 a surgeon who was among those WhO were the most re- luctant tO perform the procedure and most favored breast-conserving surgery. But if a woman went tO a surgeon WhO was among those whO were the most open t0 performing CPM and favored breast-conserving surgery the least, the likelihood of getting CPM was 34 %. The most common reason surgeons gave for being willing to perform CPM, even if they were initially reluctant, was 'tO give patients peace Of mind ” and "avoid patient conflict ”—not tO reduce recurrence or improve survival. emotional reactions tO frequently prime patients tO desire the most aggressive approach' ” says study au- thor Dr. Steven Katz, a professor in the School ofPublic HeaIth at the University ofMichigan. "Our results underscore that most surgeons tOday favor less aggressive approaches t0 surgery, and it's challeng- ing for them tO communicate with their patients that bigger is not better. ” ln previous research, Katz found that a woman's fear about cancer recurrence or her desire tO avoid regret can also lead tO a decision between her and her doctor tO choose more aggressive surgery,. Since there is variability in what doctors ultimately agree tO perform, women may want tO consider visiting more than one doctor before deciding on a treatment plan, Katz says. His research shows that 95 % ofbreast-cancer patients are treated by the first physician they see. "lf a patient is not totally in line with what's being recommended, get a second opinion; ” he says. ロ 3 Drop in breast-cancer death rates from 1989 to 2015 ; 322 , 600 breast-cancer deaths were averted during that period 897 lncrease in the rate at which women with cancer in one breast chose double mastectomy from 1998 tO 2011 SIXFOLD lncrease in the rate at which women with cancer in one breast chose double mastectomy from 1998 tO 2011 H 0 W C 0 M M 0 N ー S B R E A S T C A N C E R ? Female breast cancer represents 15 % Ofa 〃 new cancer cases in the し S. About 1 in 8 U. S. women is diagnosed with breast cancer 37
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Milestones DIED Hugh Hefner S. I. Newhouse Purveyor 可 Media magnate the PIayboy By Tina Brown 工åntas リ INTHE SUMMEROF 1985 , S. I. Newhouse, chairman of Condé Nast publications, HUGH HEFNER, WHO the newspaper and maga- died at 91 on Sept. 27 , zine empire he co-inherited lived a dream and knew from his father, offered me it. After he created a lift back to the offce ⅲ b in 1953 , the his limo after our monthly magazine and its bunny- lunch. SmaII, shy and neb- emblazoned empire bishy, Si, as he was known, limned a glossy world Of was the only power that fun for the sophisticated counted at Condé Nast. modern man, embodied What was unique—and by HefhimseIf. There Newhouse, whO died 砒 age 89 0 れ Oct. 1 , 砒 the Co れ d き Nast most endearing—about Si was no shame but lots of Building inNew ⅸ City onAug. 21 , 1989 was that he never behaved sex, personified by nude like a media mogul. As we centerfolds. drove back to the offce, he the magazine editors tell- intO the express elevator tO But the bunnies who suddenly said, "You know, ing them only t0 plug Ran- the 14th floor. populated the PI 6 there's no such thing as real dom House books. They'd And yet look what this realm weren't a dream; Just take no notice. Or say power in America. modest man achieved. they were real women. "What do you mean? ” I I gave Random House a list Though Hefner touted His taste and ambition led said. "Well; ” he said, "the ofbooks by authors I told him tO assemble a roster Of the progressive workhe President has no power. the m t0 buy. lt wouldn't some Of the best editors in did tO free women from Congress can thwart him. last five minute s. America and gave them the sexual repression, he alSO l'm supposed t0 have We were now out ofthe proudly obj ectified them resources tO dO their best media power, but I can't get car, walking past a news- Work without interference. and, in later decades, arrested! ” stand stacked with the He was the great antihero some shine came offthe "You have power; ” I said, magazine titles he owned. ofmedia whose passing cocktail glass. Many saw you sometimes choose He stopped to wait for the every writer and editor— the Playboy fantas ia as not tO exercise it. ” "But elevator. "As for the New and reader-•— should mourn. dated or worse, and busi- hOW could I exercise it? ” he 物ⅸ well, I find it very ness tOOk a hit on the 8 ′ 0 Ⅳ was editor-in-chief Of Vanity said, as we cruised toward hard to get [its editor]Wil- 0ther side, partly due t0 a Fair, editor Of the New YO e 「 and founded The Daily Beast; her the building he owned. liam Shawn on the phone. ” proliferation ofraunchier memoir The Vanity Fair Diaries will With that he disappeared options. And yet Hefner "Say I wrote a memo tO be published in November never gave up the fantasy that made his fortune— a fantasy that, thanks to him, had become an indel- ible part ofthe 20th cen- tury dreamsc 叩 e ・ —LILY ROTHMAN DIED の一 A トト 39 、一 3 僕一 M ーー 2 ト一 NVH9 ・ S 【」 3 工ト 39 、こ一ーココ 31 イ 9 NOB 】 3 のつ 0 工 M3N ~ V9V 一 0N3 コ vg ーコ 0 ト v 」 1 一 0N38 】 NO 一工の」 Prize in Physics, by scientists Rainer Weiss, Barry Barish and KipThorne, fO 「 theirdiscoveries in gravitational waves. >The 2017 NobeI Prize in Chemistry, by researchers 」 acques Dubochet, 」 oachim Frank and Richard Henderson, fO 「 pioneering a new technique tO visuaiize biological molecules. and her friend Ronald Goldman. ELECTED Jagmeet Singh , as leader of Canada's leftist New Democratic Pa rty, making him the country's firstleader ofcolor Ofa major political party. WON The 2017 NobeI made famous in the DIED 1970S by celebrities 」 TaIabani, such as 」 Ohn Lennon, Kurdish leaderwho at 93. campaigned fora sovereign state and AS を D became the first non- 0 」 . Simpson, om Arab President Of lraq, prison, after serving at 83. nine years fO 「 an 》 CIinical psychologist armed robbery in Arthur 」 ano も who 2007 コ n 1995 the pioneered "primal former fOOtba 旧 egend scream" therapy, was acquitted Of the controversial murdering hiS ex-wife psychotherapy method NiCOIe Brown Simpson
0 も 0 g linesfor gasoline, 石た e this one in Sa れ 1u0 れ 0 れ Sept. 30 , were 0 common sight after the storm; president Trump tosses 0 ro れ 0 工を aper towels intO decade, people have been leaving in historic num- Puert0 Rico began September ⅲ its usual place, bers; more PuertO Ricans Ⅱ 0 、 live on the mainland on the dim edge ofAmericans' awareness. Just after Maria made landfall, a poll found that nearly halfof than on the island, and Maria will accelerate the ex- odus. The Climate lmpact Lab estimates that the Americans did not know Puerto Ricans were U. S. citi- storm could knock back per capita economic out- zens. That likely wouldn't be true a month later, but put by 21 % over the next 15 years. the confusion is understandable, given the island's lt's possible the storm will underscore the mes- muddy history with the mainland. sage many Puert0 Ricans have already absorbed: that Claimed for Spain by Christopher COIumbus a population 0f brown-skinned, Spanish-speaking on his second trip tO the New World, Puert0 RiC0 Americans counts forless. Yet senior Puerto Rican Of- ("Rich Port ” ) was taken along with Cuba and other is- ficials reckon that, along with sea cows, the storm can lands by the U. S. in the 1898 Spanish-American War. also produce a fresh start. Trump himself provided lt has remained part ofthe U. S. ever since, in no small the first evidence of the transformation during his part by ch0ice. Repeatedly if narrowly, voters have trip. Speaking ofthe territory's $ 73 billion debt, the opted tO maintain the status quo as a U. S. territory, President said, "We're going tO have tO wipe that out. ” though with 10 times as many people as the 0ther A White House offcial later disavowed the promise, four U. S. territories combined. Puerto Ricans are in- and a recovery package is only just taking sh 叩 e ⅲ deed citizens, but they have no voting representa- Congress. But it was wind at the back ofthose urging tive in Congress and cannot VOte for President. The both sides, supplicant island and historical master, commonwealth arrangement leaves PuertO RiCO in tO escape a shared history. the gray zone that is familiar in bOth Latin America and the Caribbean, where economic, political and in- IF PUERTO RICO 、 A STATE, it would rank in termittent military domination by the U. S. has been area near Connecticut, the nation's richest. But in a fact oflife ever since the Monroe Doctrine. Only in terms ofincome, it would displace Mississippi as the PuertO RiCO, it's more direct. poorest ofthe poor. The poverty rate is about 45 %. When the U. S. Navy needed a bombing range, it "lfwe're going tO rebuild and reconstruct, it has set one up on Vieques, an islet Off the main island's t0 be for the right reasons; ” says Cruz, the San Juan eastern shore. ln 1976 , Congress gave PuertO Rico mayor. "We have tO reshape our society. As awful as a financial boon by allowing companies tO operate this has been, it's an opportunity." ln her baseball there tax-free. Twenty years later, Congress began to cap and glasses, Cruz has been at the vortex 0f the phase out the law. The island's government contin- political storm that followed the meteorological one. ued to spend, however, bridging the growing chasm She called out FEMA and parried the fusillade from by issuing bonds it could not pay off. Legally unable Trump. Yet even she hesitated to publicly broach tO de clare bankruptcy, it surrendered control of its the issue Of whether the emergency could restore finances, again by an act of Congress, to a federally the island's autonomy. 'We are all shying away from appointed oversight board. "This board is strangely that, because we don't want the discourse to change, reminiscent Of the Executive Council, which ruled she tells TIME. "We don't want it to be about politics, the island between 1900 and 1917 , " writes Jorge we want it tO be about 1 ⅳ es. ” Duany Of Florida lnternational University. PuertO "Of course; ” she adds, 'politics affect lives. ” Ricans call it the "junta. ” NOTE: DAMAGE IS A HIGH ・ RANGE ESTIMATE. IRMA ESTIMATE INCLUDES DAMAGE TO GEORGIA, PUERTO RICO AND THE U. S. VIRGIN ISLANDS. SOURCES: MERCATUS CENTER; BLS: MOODY'S ANALYTICS; CENSUS A population already i ng DEBT Per capita S20 , 366 PU ERTO R ℃ 0 $2 , 144 U. S. UNEMPLOYMENT August 2017 10 上 PUERTO R ℃ 0 4 IJ. S. WAGES Average weekly S509 PUERTO R ℃ 0 $1 , 121 U. S.