PAKET UMROH BULAN FEBRUARI MARET APRIL MEI 2018




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saco-indonesia.com, Kanker Payudara juga merupakan penyakit yang dapat disebabkan oleh sel ganas (kanker) yang tumbuh pada jaringan payudara. Sel-sel ini biasanya akan muncul pada saluran atau lobula di payudara. Sel-sel kanker ini juga dapat menyebar di antara jaringan atau organ yang ada dan ke bagian tubuh lainnya.

Seberapa umumkah Kanker Payudara?

Kanker Payudara juga merupakan penyebab kematian kedua terbesar bagi wanita saat ini. Di Singapura, 1 dari 16 wanita akan terdiagnosa mengidap kanker payudara dalam masa hidupnya. Wanita etnis Cina telah memiliki resiko yang lebih tinggi jika dibandingkan dengan etnis Melayu atau India sekitar 10% hingga 20%. Kasus tertinggi telah terjadi pada kelompok umur 55-59 tahun. Resiko terkena kanker payudara meningkat seiring bertambahnya usia. Kabar baiknya sekarang adalah banyak wanita kini mampu untuk melawan kanker payudara karena telah melakukan pendeteksian dini serta peningkatan kualitas pengobatan.

Apa Penyebabnya?

Faktor pemicu kanker ini belum dapat diketahui. Namun hal ini juga bisa ditelusuri dari sejarah keluarga yang telah mengidap kanker payudara, siklus menstruasi dini, atau kemungkinan faktor resiko lainnya. Karena begitu sulit untuk dapat dipastikan, masing-masing kita telah memiliki resiko terkena kanker payudara, khususnya saat kita berusia 40 tahun atau lebih. Walaupun faktor penyebabnya masih tidak diketahui, akan tetapi penyembuhan total sangat dimungkinkan dengan pendeteksian dini melalui pemeriksaan payudara secara reguler.
 
Diagnosa & Pemeriksaan

Bagaimana cara mendiagnosa?

Pemeriksaan Klinis – Khususnya bila benjolan, keluarnya cairan dari puting, atau perubahan payudara yang tidak biasa terjadi.

Mamogram – Metode ini juga dapat mendeteksi perubahan seperti kepadatan yang tidak normal atau terjadinya deposit kalsium.

Ultrasound Scan – Metode ini juga digunakan untuk dapat mendeteksi pada area khusus yang telah ditemukan dalam pemeriksaan mamogram atau dapat dilakukan untuk dapat mendeteksi kondisi abnormal yang tidak terlihat pada mamogram. Sebuah ultrasound scan juga dapat membedakan antara massa yang solid, yang kemungkinan kanker, atau kista yang berisi cairan yang biasanya bukan merupakan kanker.

Magnetic Resonance Imaging, MRI – Pada beberapa kasus, pasien harus menjalani sken MRI untuk dapat memperoleh hasil pemeriksaan yang lebih jelas pada area yang diduga terkena kanker. Metode ini juga sangat berguna bagi wanita yang berusia muda karena pada usianya mereka memiliki kepadatan jaringan payudara yang lebih besar dan tes visual konvensional seperti mamogram ataupun ultrasound menjadi kurang sensitif dan spesifik untuk mendeteksi kanker payudara.

          
Apa itu Biopsi?
          

Teknik biopsi umum

Untuk dapat memastikan kanker payudara, sebuah biopsi harus dilakukan di mana bagian dari jaringan sel yang diduga kanker diangkat dan diperiksa dengan mikroskop.
          

    Aspirasi Jarum Halus (FNA)
    Biopsi Jarum Inti (Core Needle) atau Biopsi Tru-cut
    Biopsi Eksisi (Excision Biopsy)

 
Bagaimana Kanker Payudara diperiksa?


A. TAHAPAN/LUAS PENYEBARAN
      TAHAPAN     LUAS PENYEBARAN     TINGKAT RATA-RATA KESELAMATAN PADA MASA
5-TAHUNAN(%)
      0     Kanker non-invasif     99
      I     Kanker invasif kecil
(kurang dari 2 cm tanpa penyebaran ke arah kelenjar getah bening aksila)     90
      II     

Kanker invasif
(antara 2-5cm atau/dengan penyebaran pada kelenjar getah bening)
    70
      III     Kanker invasif besar
(lebih dari 5cm dengan penyebaran pada kulit atau beberapa kelenjar getah bening)     40
      IV     

Penyebaran yang luas atau Kanker metastatis
    20


B. KARAKTERISTIK KANKER PAYUDARA YANG BERDAMPAK PADA KAMBUH DAN KESELAMATAN
Tingkat Histologis Tumor

Merujuk pada seberapa banyak sel tumor yang telah memiliki kemiripan dengan sel normal dilihat dari mikroskop; skala tingkat 1 sampai dengan 3. Tumor tingkat 3 mengandung sel kanker yang sangat abnormal dan tumbuh pesat. Semakin tinggi tingkat histologis tumor, semakin besar resiko kanker payudara kembali.
          
Kelenjar Getah Bening

Jumlah kelenjar getah bening yang berada di ketiak, di sisi yang sama pada payudara yang terkena kanker, bisa jadi indikator penting. Semakin besar jumlah kelenjar yang positif diasosiasikan dengan kemungkinan terburuk dan merujuk kepada perawatan dan pengobatan yang lebih agresif.
            
Ukuran Tumor

Secara umum, semakin besar ukuran tumor, semakin besar kemungkinan untuk kanker payudara kembali menyerang.
          
ER/PR

Sekitar duapertiga dari semua kanker payudara telah memiliki tingkat esterogen yang signifikan dan/atau reseptor progesteron. Mereka dirujuk sebagai tumor reseptor esterogen positif (ER+). Tumor ER+ cenderung tumbuh kurang agresif dan dapat diobati dengan pengobatan menggunakan hormon.
            
HER2/erbB2

HER2 adalah sebuah protein yang telah ditemukan pada permukaan dari sel kanker tertentu. Sebuah tumor juga dapat digambarkan sebagai HER2-positif apabila tumor tersebut telah memiliki lebih banyak reseptor HER2 dibanding dengan yang lain. Sekitar 20-25% dari semua kanker payudara memiliki tumor dengan label HER2-positif. Tumors HER2-positif cenderung tumbuh lebih cepat daripada jenis-jenis kanker payudara lainnya.

Dengan mengetahui apakah sebuah kanker adalah HER2-positif dapat mempengaruhi pilihan pengobatan yang dapat diambil, karena wanita dengan tumor sejenis ini dapat diuntungkan dengan obat yang disebut trastuzumab (Herceptin®).

 
Pengobatan & Perawatan

Bagaimana kanker payudara diobati?

Pilihan pengobatan dan prognosis (peluang kesembuhan) tergantung dari tahapan kanker (apakah kanker tersebut hanya ada di payudara atau sudah menyebar ke bagian tubuh lainnya), tipe kanker payudara, karakteristik dari sel kanker dan apakah kanker tersebut ditemukan pada sisi payudara yang lain. Usia seorang wanita, status menopausal (apakah wanita tersebut masih memiliki siklus haid) dan kondisi kesehatan umumnya juga dapat mempengaruhi pilihan pengobatan dan prognosis.
 
Bedah

Pembedahan adalah umum untuk mengangkat kanker. Beberapa bentuk prosedur bedah termasuk:

1)    Bedah dengan mempertahankan payudara

    Lumpektomi atau Wide Local Excision – pengangkatan kanker dan sedikit jaringan di sekitarnya.
    Quadrantektomi – pengangkatan kanker dengan mengangkat lebih banyak jaringan disekitarnya dibandingkan dengan lumpektomi. Untuk prosedur quadrantektomi, seperempat bagian dari payudara diangkat.

2)    Mastektomi – pengangkatan seluruh bagian payudara dengan atau tanpa jaringan kelenjar getah bening di bawah aksila.
 
3)    Saat bedah payudara, beberapa sel kelenjar getah bening di bawah ketiak juga akan diambil untuk pemeriksaan.

 
Terapi Sistemik

    Kemoterapi
    Terapi Hormon
    Herceptin®

 
          
Radioterapi

Radioterapi dengan menggunakan sinar berenergi tinggi yang ditargetkan untuk dapat membunuh sel-sel kanker. Tujuannya adalah untuk dapat membunuh sel kanker yang mungkin tersisa di sekitar payudara.

Radioterapi sangatlah vital setelah prosedur bedah yang mempertahankan payudara, seperti lumpektomi, karena sebagian besar jaringan payudara dibiarkan utuh. Terapi ini juga akan mengurangi kemungkinan kembalinya kanker payudara.

Pada umumnya, wanita yang telah menjalani prosedur masektomi tidak memerlukan radioterapi. Akan tetapi, untuk beberapa kasus, prosedur ini perlu dilakukan untuk dapat merawat dinding dada dan kelenjar getah bening yang ada pada ketiak, bila resiko kembalinya kanker secara lokal masih tinggi.


Editor : dian sukmawati

KANKER PAYUDARA

JAKARTA, Saco- Indonesia.com - Data Badan Nasional Penanggulangan Bencana menunjukkan, bencana hidrometeorologi yang didominasi banjir selama Januari-Mei 2013 menewaskan 252 jiwa. Sementara itu, berdasarkan data Walhi, dalam periode sama tercatat 348 orang meninggal.

”Data BNPB itu bersifat sementara. Sesuai pengalaman, hasil penghitungan pada akhir tahun jumlahnya bisa tiga kali lipatnya,” kata Kepala Pusat Data, Informasi, dan Humas BNPB Sutopo Purwo Nugroho, Senin (3/6/2013), di Jakarta.

Menurut Sutopo, terdapat 573 kejadian bencana di seluruh Indonesia. Hampir 95 persennya bencana hidrometeorologi banjir, longsor, puting beliung, dan gelombang tinggi.

Korban terdampak dan mengungsi 512.080 orang, 30.525 rumah rusak, dan puluhan fasilitas umum seperti sekolah dan rumah ibadah rusak. Banjir mendominasi, dari 573 kejadian, ada 212 banjir, 195 puting beliung, dan 138 longsor. Tanah longsor menyebabkan kematian paling banyak, yaitu 115 orang. Lalu, banjir 94 orang.

Manajer Penanganan Bencana Walhi Mukri Friatna mengungkapkan, bencana hidrometeorologi tahun 2013 diperkirakan lebih besar dibandingkan dengan tahun sebelumnya. Dari 34 provinsi, tak satu pun bebas dari bencana hidrometeorologi.

”Walhi mendorong pemerintah berani menyatakan bahwa banyaknya bencana hidrometeorologi akibat kerusakan lingkungan, ulah manusia. Bukan hanya karena curah hujan ekstrem,” kata Mukri.

Data Walhi, lima bulan terakhir ada 776 bencana melanda 3.846 desa/kelurahan di 1.584 kecamatan dan 311 kabupaten/kota. Sebanyak 348 orang meninggal, 44 di antaranya karena pertambangan. Namun, banjir mendominasi (579), kemudian longsor (129), banjir rob (36), dan lainnya.

Bencana dalam pendekatan regional, di Sumatera tersering di Aceh, 44 kali bencana. Di Jawa, terbanyak di Jawa Timur (90). Di Kalimantan, bencana terbanyak di Kalimantan Selatan (13). Di Sulawesi, bencana terbanyak di Sulawesi Selatan (22). Di regional Bali, Nusa Tenggara, Maluku, dan Papua, bencana terbanyak di NTT (30). (NAW)

Sumber : Kompas.com
Editor :Liwon Maulana(galipat)
Selama Lima Bulan, 252 Tewas karena Bencana Hidrometeorologi

saco-indonesia.com, Memberikan apresiasi kepada anggota Komunitas FansClub JKT48 sekaligus telah memanfaatkan momen libur akhir tahun, Indosat telah mengajak 50 anggota terbaik untuk hangout seharian bersama personel JKT48.

Ke 50 anggota ini telah mendapat kesempatan untuk makan siang, meet & greet dan berfoto bersama personel JKT48, yang kemudian dilanjutkan dengan Nonton Film terbaru box office dan ditutup dengan Dinner dan Nonton langsung Konser Teater JKT48 di Teater JKT48 FX.

Ke-50 anggota Komunitas FansClub JKT48 ini juga merupakan anggota yang telah terpilih dari 15 ribu member komunitas JKT48 nasional, yang telah diseleksi dengan melihat reload dari masing-masing anggota mulai bulan Juni sampai November 2013 dan mereka adalah anggota dengan reload tertinggi dari seluruh Indonesia.

Program apresiasi ini juga merupakan salah satu komitmen kami bagi para member komunitas JKT48 terbaik dari seluruh Indonesia, sambil memanfaatkan liburan seru bersama IM3, ujar Agus Nurudin, Group Head National Channel Management Indosat, dalam siaran pers.

JKT48 telah dipilih selain karena sebagai Brand Ambassador Indosat IM3 juga telah mempunyai banyak fans yang sangat loyal. Program apresiasi dan retensi semacam ini rutin diberikan Indosat sebagai bentuk penghargaan atas loyalitas para anggota komunitas dalam menggunakan produk Indosat.

Dengan program apresiasi ini diharapkan para anggota komunitas semakin setia dan terus menggunakan produk Indosat serta menjadi word of mouth dalam mempromosikan produk dan layanan Indosat, tambah Agus.

Komunitas JKT48 juga merupakan bagian dari anggota komunitas Sahabat IM3 yaitu komunitas anak muda di sekolah-sekolah yang saat ini sudah berjumlah belasan ribu komunitas sekolah yang tersebar di seluruh Indonesia.

Para siswa yang telah tergabung dalam komunitas Sahabat IM3 ini juga akan menikmati berbagai keuntungan diantaranya tarif telepon dan SMS murah ke sesama teman sekolahnya dalam satu komunitas.

Selain itu indosat juga bekerja sama dengan sekolah untuk dapat mendukung kegiatan belajar mengajar dengan pemberian sarana mengajar ke sekolah seperti akses internet, super WiFi, finger print, mendukung kegiatan sekolah seperti pentas seni serta aktifitas lain yang berguna bagi sekolah.


Editor : Dian Sukmawati

INDOSAT PILIH 50 PELANGGAN HANGOUT

Haji adalah ibadah wajib bagi umat Islam yang mampu melaksanakannya, baik mampu secara fisik,mental, maupun finansial.

Menurut para ulama, kewajiban menunaikan ibadah haji dan umrah diterima oleh Rasulullah SAW pada tahun 6 Hijriah/628 Masehi. Untuk menjalankan perintah Allah SWT tersebut, pada tanggai 6 Dzulqa’dah tahun 6 Hijriah, Rasulullah SAW bersama 1.500 pengikutnya bertolak menuju Makkah untuk melaksanakan umrah.

Namun, di tengah perjalanan tepatnya di daerah Hudaibiyah yang berjarak sekitar sembilan mil dari Makkah, mereka dicegat oleh orang- orang kafir. Menghindari pertumpahan darah, kaum muslimin bersedia melakukan perundingan dengan orang-orang kafir.

Dalam perundingan itu, sebuah kesepakatan yang kemudian dikenal dengan Perjanjian Hudaibiyah diteken oleh kedua belah pihak. Salah satu butir dalam isi perjanjian tersebut adalah bahwa kaum muslim tidak diperkenankan melaksanakan ibadah haji tahun itu. Mereka baru diizinkan pada tahun berikutnya, itu pun hanya dalam waktu tiga hari.

Sebelum Rasulullah SAW melakukan ibadah haji, konon beliau sudah pernah melakukan umrah sebanyak empat kali. Demikian diriwayatkan dari Aisyah, Ibnu Umar, dan Anas bin Malik. Umrah pertama dilakukan pada tahun 6 Hijriah/628 Masehi atau dikenal dengan umrah Hudaibiyah.

Umrah kedua dilakukan pada tahun berikutnya, umrah ketiga pada bulan Dzulqa’dah tahun yang sama, dan umrah keempat ketika beliau mengerjakan ibadah haji.

Selain riwayat dari tiga tokoh di atas, ada banyak informasi lain tentang berapa kali Rasulullah SAW menunaikan ibadah. Namun dari berbagai informasi tersebut, pendapat paling sahih menyatakan bahwa Nabi hanya melakukan umrah sebanyak tiga kali.

Umrah pertama dilaksanakan pada tahun 7 Hijriah/629 Masehi, umrah kedua dilakukan pada tahun 8 Hijriah/630 Masehi dan dikenal dengan umrah Dzulqa’dah atau umrah Ji’ranah, dan umrah ketiga terjadi pada tahun 10 Hijriah/632 Masehi, yaitu ketika Nabi mengerjakan Haji Wada’.

Manasik haji yang dikenalkan oleh Rasulullah SAW adalah penyempurna dari manasik haji para nabi sebelumnya, termasuk manasik haji Nabi Ibrahim AS.

Manasik haji yang dikenalkan oleh Rasulullah SAW dapat diuraikan dalam urutan, yaitu: ihram; thawaf; shalat dua rakaat di Maqam Ibrahim; sa’i (berlari-lari kecil) antara bukit Shafa dan Marwah; wukuf di Padang Arafah; bermalam di Muzdalifah; melempar Jumrah Aqabah; menyembelih binatang kurban; melaksanakan thawaf ifadhah; tahallul atau bercukur; mabit atau menginap di Mina; melempar tiga jumrah pada Hari Tasyriq (tanggai 11, 12, dan 13 Dzulhijjah); dan melakukan tawaf wada’ atau tawaf perpisahan.

Sewaktu mengerjakan Haji Wada’ atau haji terakhir, Rasulullah SAW berpesan agar umat Islam mengikuti manasik atau tata cara haji yang beliau contohkan. Manasik haji tidak boleh dimodifikasi sebab ditetapkan secara langsung melalui wahyu Allah SWT.

Demikianlah ritual haji yang disyariatkan kepada Nabi Adam AS, Nabi Ibrahim AS, hingga Nabi Muhammad SAW. Setiap ritual haji yang diturunkan kepada nabi-nabi tersebut mengalami penyempurnaan dan pembersihan dari segala macam pencemaran.

Sumber : http://www.jurnalhaji.com

Baca Artikel Lainnya : ARAB JAHILIYAH BERHAJI?

CARA NABI MUHAMMAD SAW MELAKSANAKAN MANASIK HAJI

saco-indonesia.com, Polisi telah berhasil membekuk pelaku pembunuhan Nurul Hakiki yang berusia (20) tahun , anak seorang guru ngaji, yang tewas terikat dan dimasukkan dalam karung. Ternyata, pembunuh tersebut adalah sang kekasih.

Kapolres Sumbawa AKBP Karsiman telah mengungkapkan, pelaku pembunuhan tersebut telah dilakukan oleh HA yang berusia (30) tahun yang tak lain kekasih korban. HA tinggal tak jauh dari tempat tinggal Nurul di Kecamatan Badas, Kota Sumbawa.

"Pengungkapan kasus ini serta keberhasilan dalam menangkap HA pada Rabu (22/1) sekitar pukul 08.00 Wita, berkat kerja keras anggota dan oleh didukung masyarakat, termasuk keluarga korban," kata Karsiman, Kamis (23/1).

Nurul telah dibunuh dengan cara dijerat di bagian lehernya saat berada di rumah HA. Korban telah dihabisi sekitar pukul 21.00 WITA, kemudian jasadnya telah dimasukkan ke dalam karung. Selang satu jam, pelaku telah membawa karung berisi jenazah ke bawah Jembatan Kembar, atau sekitar dua kilometer dari rumah HA.

"Mayat dimasukkan dalam karung hanya untuk dapat memudahkan tersangka membawanya, di samping untuk menyamarkan agar tidak diketahui orang," ungkap kapolres.

Kasus pembunuhan ini telah terungkap ketika Mursali yang berusia (50) tahun , warga Tanjung Pasir Desa Labuan yang kesehariannya menjadi pemulung, menemukan sebuah karung mencurigakan, saat sedang mengais sampah di kolong Jembatan Kembar Saliperate, Jumat (27/12) sekitar pukul 07.00 WITA.

Setelah karung dibuka, ternyata isinya adalah jenazah seseorang bernama Nurul Hakiki, gadis yang tinggalnya di Karang Padak, Desa Labuan, Badas.

Jasad putri seorang guru ngaji ini telah ditemukan dalam keadaan terbungkus di dalam karung. Tak sehelai benang pun menempel di tubuhnya, kecuali sebuah 'bra' yang sudah terbalik.


Editor : Dian Sukmawati

ANAK GADIS GURU NGAJI DIBUNUH OLEH KEKASIHNYA SENDIRI

Ms. Rendell was a prolific writer of intricately plotted mystery novels that combined psychological insight, social conscience and teeth-chattering terror.

Ruth Rendell, Novelist Who Thrilled and Educated, Dies at 85

Mr. Mankiewicz, an Oscar-nominated screenwriter for “I Want to Live!,” also wrote episodes of television shows such as “Star Trek” and “Marcus Welby, M.D.”

Don Mankiewicz, Screenwriter in a Family Film Tradition, Dies at 93
Photo
 
United’s first-class and business fliers get Rhapsody, its high-minded in-flight magazine, seen here at its office in Brooklyn. Credit Sam Hodgson for The New York Times

Last summer at a writers’ workshop in Oregon, the novelists Anthony Doerr, Karen Russell and Elissa Schappell were chatting over cocktails when they realized they had all published work in the same magazine. It wasn’t one of the usual literary outlets, like Tin House, The Paris Review or The New Yorker. It was Rhapsody, an in-flight magazine for United Airlines.

It seemed like a weird coincidence. Then again, considering Rhapsody’s growing roster of A-list fiction writers, maybe not. Since its first issue hit plane cabins a year and a half ago, Rhapsody has published original works by literary stars like Joyce Carol Oates, Rick Moody, Amy Bloom, Emma Straub and Mr. Doerr, who won the Pulitzer Prize for fiction two weeks ago.

As airlines try to distinguish their high-end service with luxuries like private sleeping chambers, showers, butler service and meals from five-star chefs, United Airlines is offering a loftier, more cerebral amenity to its first-class and business-class passengers: elegant prose by prominent novelists. There are no airport maps or disheartening lists of in-flight meal and entertainment options in Rhapsody. Instead, the magazine has published ruminative first-person travel accounts, cultural dispatches and probing essays about flight by more than 30 literary fiction writers.

 

Photo
 
Sean Manning, executive editor of Rhapsody, which publishes works by the likes of Joyce Carol Oates, Amy Bloom and Anthony Doerr, who won a Pulitzer Prize. Credit Sam Hodgson for The New York Times

 

An airline might seem like an odd literary patron. But as publishers and writers look for new ways to reach readers in a shaky retail climate, many have formed corporate alliances with transit companies, including American Airlines, JetBlue and Amtrak, that provide a captive audience.

Mark Krolick, United Airlines’ managing director of marketing and product development, said the quality of the writing in Rhapsody brings a patina of sophistication to its first-class service, along with other opulent touches like mood lighting, soft music and a branded scent.

“The high-end leisure or business-class traveler has higher expectations, even in the entertainment we provide,” he said.

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Some of Rhapsody’s contributing writers say they were lured by the promise of free airfare and luxury accommodations provided by United, as well as exposure to an elite audience of some two million first-class and business-class travelers.

“It’s not your normal Park Slope Community Bookstore types who read Rhapsody,” Mr. Moody, author of the 1994 novel “The Ice Storm,” who wrote an introspective, philosophical piece about traveling to the Aran Islands of Ireland for Rhapsody, said in an email. “I’m not sure I myself am in that Rhapsody demographic, but I would like them to buy my books one day.”

In addition to offering travel perks, the magazine pays well and gives writers freedom, within reason, to choose their subject matter and write with style. Certain genres of flight stories are off limits, naturally: no plane crashes or woeful tales of lost luggage or rude flight attendants, and nothing too risqué.

“We’re not going to have someone write about joining the mile-high club,” said Jordan Heller, the editor in chief of Rhapsody. “Despite those restrictions, we’ve managed to come up with a lot of high-minded literary content.”

Guiding writers toward the right idea occasionally requires some gentle prodding. When Rhapsody’s executive editor asked Ms. Russell to contribute an essay about a memorable flight experience, she first pitched a story about the time she was chaperoning a group of teenagers on a trip to Europe, and their delayed plane sat at the airport in New York for several hours while other passengers got progressively drunker.

“He pointed out that disaster flights are not what people want to read about when they’re in transit, and very diplomatically suggested that maybe people want to read something that casts air travel in a more positive light,” said Ms. Russell, whose novel “Swamplandia!” was a finalist for the 2012 Pulitzer Prize.

She turned in a nostalgia-tinged essay about her first flight on a trip to Disney World when she was 6. “The Magic Kingdom was an anticlimax,” she wrote. “What ride could compare to that first flight?”

Ms. Oates also wrote about her first flight, in a tiny yellow propeller plane piloted by her father. The novelist Joyce Maynard told of the constant disappointment of never seeing her books in airport bookstores and the thrill of finally spotting a fellow plane passenger reading her novel “Labor Day.” Emily St. John Mandel, who was a finalist for the National Book Award in fiction last year, wrote about agonizing over which books to bring on a long flight.

“There’s nobody that’s looked down their noses at us as an in-flight magazine,” said Sean Manning, the magazine’s executive editor. “As big as these people are in the literary world, there’s still this untapped audience for them of luxury travelers.”

United is one of a handful of companies showcasing work by literary writers as a way to elevate their brands and engage customers. Chipotle has printed original work from writers like Toni Morrison, Jeffrey Eugenides and Barbara Kingsolver on its disposable cups and paper bags. The eyeglass company Warby Parker hosts parties for authors and sells books from 14 independent publishers in its stores.

JetBlue offers around 40 e-books from HarperCollins and Penguin Random House on its free wireless network, allowing passengers to read free samples and buy and download books. JetBlue will start offering 11 digital titles from Simon & Schuster soon. Amtrak recently forged an alliance with Penguin Random House to provide free digital samples from 28 popular titles, which passengers can buy and download over Amtrak’s admittedly spotty wireless service.

Amtrak is becoming an incubator for literary talent in its own right. Last year, it started a residency program, offering writers a free long-distance train trip and complimentary food. More than 16,000 writers applied and 24 made the cut.

Like Amtrak, Rhapsody has found that writers are eager to get onboard. On a rainy spring afternoon, Rhapsody’s editorial staff sat around a conference table discussing the June issue, which will feature an essay by the novelist Hannah Pittard and an unpublished short story by the late Elmore Leonard.

“Do you have that photo of Elmore Leonard? Can I see it?” Mr. Heller, the editor in chief, asked Rhapsody’s design director, Christos Hannides. Mr. Hannides slid it across the table and noted that they also had a photograph of cowboy spurs. “It’s very simple; it won’t take away from the literature,” he said.

Rhapsody’s office, an open space with exposed pipes and a vaulted brick ceiling, sits in Dumbo at the epicenter of literary Brooklyn, in the same converted tea warehouse as the literary journal N+1 and the digital publisher Atavist. Two of the magazine’s seven staff members hold graduate degrees in creative writing. Mr. Manning, the executive editor, has published a memoir and edited five literary anthologies.

Mr. Manning said Rhapsody was conceived from the start as a place for literary novelists to write with voice and style, and nobody had been put off that their work would live in plane cabins and airport lounges.

Still, some contributors say they wish the magazine were more widely circulated.

“I would love it if I could read it,” said Ms. Schappell, a Brooklyn-based novelist who wrote a feature story for Rhapsody’s inaugural issue. “But I never fly first class.”

Rhapsody, a Lofty Literary Journal, Perused at 39,000 Feet

ate in February, Dr. Ben Carson, the celebrated pediatric neurosurgeon turned political insurrectionist, was trying to check off another box on his presidential-campaign to-do list: hiring a press secretary. The lead prospect, a public-relations specialist named Deana Bass, had come to meet him at the dimly lit Capitol Hill office of Carson’s confidant and business manager, Armstrong Williams. Carson sat back and scrutinized her from behind a small granite table, as life-size cardboard cutouts of more conventional politicians — President Obama, with a tight smile, and Senator John McCain, glowering — loomed behind each of his shoulders. (The mock $3 bill someone had left on a table in Williams’s waiting room undercut any notion that this was a bipartisan zone; it featured Obama wearing a turban.)

Bass seemed momentarily speechless, and not just because no one had warned her that a New York Times reporter would be sitting in on her job interview. Though she knew Williams — a jack-of-all-trades entrepreneur who owns several television stations and a public-affairs business and who hosts a daily talk-radio show — through Washington’s small circle of black conservatives, the two hadn’t spoken in years until he called her two days earlier. He had been struggling to come up with the perfect national spokesperson, he told her. Then, at the gym, her name popped into his head; Williams was fairly certain she was the one. Sitting across from a likely candidate for president, Bass was adjusting to the idea that her life might be about to take a sudden chaotic turn.

“It’s like getting the most random call on a Monday that you simply do not see coming,” she said. “Oftentimes, that is how the Lord works.”

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His life in brain surgery
has prepared him for the
presidency, he maintains,
better than lives in
politics have for his rivals.

Carson concurred: “It’s always how he works in my life.” Carson is soft-spoken and often talks with his eyes half closed, frequently punctuating his sentences with a small laugh, even if the humor of his statement is not readily apparent. Bass told Carson that she had been a Republican staff member on Capitol Hill then worked for the Republican National Committee. In 2007 she started a Christian public-relations firm with her sister. She enjoyed working on the Hill, she said, but the pay wasn’t as high as the hours were long. “We figured that we worked like slaves for other people, and we wanted to work for ourselves.”

Carson stopped her. “You know you can’t mention that word, right?” Carson waited a beat, then laughed, and Williams and Bass joined in. He was getting to the point; he needed a professional who could help him check his penchant for creating uncontrolled controversy just by talking.

The Ben Carson movement began in 2013, when Carson, a neurosurgeon, whose operating-room prowess and up-from-poverty back story had made him the subject of a television movie and a regular on the inspirational-speaking circuit, was invited to address the annual National Prayer Breakfast in Washington. With Barack Obama sitting just two seats away, Carson warned that “moral decay” and “fiscal irresponsibility” could destroy America just as it did ancient Rome. He proposed a substitute for Obamacare — Health Savings Accounts, which, he said, would end any talk of “death panels” — and a flat-tax based on the concept of tithing. His address, combined with the president’s stony reaction, was a smash with Republican activists. Speaking and interview requests flooded in. Carson, then 61, announced his planned retirement a few weeks later, freeing his calendar to accept just about all of them. In the months that followed, his rhetoric became increasingly strident. The claim that drew the most attention, perhaps, was that Obamacare was “the worst thing that has happened in this nation since slavery.”

Bass’s own use of the word prompted Carson to ask her what she thought about that incident. She considered for a moment.

“If you want to reach people and have them even understand what you’re saying, there is a way to do it, without that hyperbole, that might be. . . . ” She paused. “I just think it’s important not to shut people off before they —”

Carson jumped in. “That doesn’t allow them to hear what you’re saying?”

Bass nodded.

Likening Obamacare to slavery — and slavery was incomparably worse, Carson said — had its political advantages for a candidacy like his. It was the kind of statement that stoked the angriest of the Republican voters: conservative stalwarts who can’t hear enough bad things about Obama. This, in turn, led to more talk-radio and Fox News appearances, more book sales, more donations to the super PAC started in his name, more support in the polls. (The day before the meeting, one poll of Republican voters showed Carson statistically tied for first place with Jeb Bush and Scott Walker.)

Rhetorical excess was good for business, but Carson now wants to be seen as more than a novelty candidate. He has come to learn that such extreme analogies, while true to his views, aren’t especially presidential. They alienate more moderate voters and, perhaps even more damaging, reinforce the impression that he is not “serious” — that he is another Herman Cain, the black former Godfather’s Pizza chief executive who rose to the top of the early presidential polls in 2011 but then bowed out before the Iowa caucuses, largely because of leaked allegations of sexual misconduct, which he denied but from which he never recovered. Cain lingers as a cautionary tale for the party as much as for a right-leaning candidate like Carson. The fact that Cain, with his folksy sayings (“shucky ducky”) and misnomers (“Ubeki-beki-beki-beki-stan-stan”), reached the top of the national polls — much less that he was eventually followed there by the likes of Michele Bachmann, Newt Gingrich and Rick Santorum, who all topped one or another poll in the 2012 primary season — wound up being a considerable embarrassment for the eventual nominee, Mitt Romney, and for the longtime party regulars who were trying to fast-track his way to the nomination.

Carson liked Bass and, without directly saying so, made it clear the job was hers for the taking. Carson’s campaign chairman, Terry Giles — a white lawyer whose clients have included the comedian Richard Pryor and the stepson of the model Anna Nicole Smith and who helped reconcile the business interests of the descendants of the Rev. Martin Luther King Jr. — had assembled a mostly white campaign team, including many from the 2012 Gingrich effort, and Carson wanted a person of color to speak for him. Bass said she would have to mull it over, pray about it. Carson nodded approvingly. “Pray about it,” he said. “See what you think.”

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Williams knew the party was intent on protecting the eventual 2016 nominee from the same embarrassment Romney suffered. Already, suspiciously tough articles about Carson were showing up in conservative magazines and on right-wing websites. “They’re protecting these establishment candidates,” Williams said. “This is coming from within the house. This is family.” At the very least, he wanted to make sure that Carson didn’t do their work for them. (Carson would commit another unforced error a week later, when he told CNN that homosexuality was clearly a choice, because a lot of people go in prison straight and “when they come out, they’re gay”; he later apologized.)

“We need somebody to protect him, sometimes, from himself,” he told Bass — laughing, but only half kidding.

A candidacy like Carson’s presents a new kind of problem to the establishment wing of the G.O.P., which, at least since 1980, has selected its presidential nominees with a routine efficiency that Democrats could only envy. The establishment candidate has usually been a current or former governor or senator, blandly Protestant, hailing from the moderate, big-business wing of the party (or at least friendly with it) and almost always a second-, third- or fourth-time national contender — someone who had waited “his turn.” These candidates would tack predictably to the right during the primaries to satisfy the evangelicals, deficit hawks, libertarian leaners and other inconvenient but vital constituents who made up the “base” of the party. In return, the base would, after a brief flirtation with some fantasy candidate like Steve Forbes or Pat Buchanan, “hold their noses” and deliver their votes come November. This bargain was always tenuous, of course, and when some of the furthest-right activists turned against George W. Bush, citing (among other apostasies) his expansion of Medicare’s prescription drug benefit, it began to fall apart. After Barack Obama defeated McCain in 2008, the party’s once dependable base started to reconsider the wisdom of holding their noses at all.

Photo
 
Republican candidates at a pre-straw-poll debate, held at Iowa State University in 2011. Credit Chip Somodevilla/Getty Images

This insurgent attitude was helped along by changes in the nomination rules. In 2010, the Republican National Committee, hoping to capture the excitement of the coast-to-coast Democratic primary competition between Obama and Hillary Clinton, introduced new voting rules that required many of the early voting states to award some delegates to losing candidates, based on their shares of the vote. The proportional voting rules would encourage struggling candidates to stay in the primaries even after successive losses, as Clinton did, because they might be able to pull together enough delegates to take the nomination in a convention-floor fight or at least use them to bargain for a prime speaking slot or cabinet post.

This shift in incentives did not go unnoticed by potential 2012 candidates, nor did changes in election law that allowed billionaire donors to form super PACs in support of pet candidacies. At the same time, increasingly widespread broadband Internet access allowed candidates to reach supporters directly with video and email appeals and supporters to send money with the tap of a smartphone, making it easier than ever for individual candidates to ignore the wishes of the party.

Into this newly chaotic Republican landscape strode Mitt Romney. There could be no doubt that it was his turn, and yet his journey to the nomination was interrupted by one against-the-odds challenger after another — Cain, Michele Bachmann, Newt Gingrich, Rick Santorum, Ron Paul; always Ron Paul. It was easy to dismiss the 2012 primaries as a meaningless circus, but the onslaught did much more than tarnish the overall Republican brand. It also forced Romney to spend money he could have used against Obama and defend his right flank with embarrassing pandering that shadowed him through the general election. It was while trying to block a surge from Gingrich, for instance, that Romney told a debate audience that he was for the “self-deportation” of undocumented immigrants.

At the 2012 convention in Tampa, a group of longtime party hands, including Romney’s lawyer, Ben Ginsberg, gathered to discuss how to prevent a repeat of what had become known inside and outside the party as the “clown show.” Their aim was not just to protect the party but also to protect a potential President Romney from a primary challenge in 2016. They forced through new rules that would give future presumptive nominees more control over delegates in the event of a convention fight. They did away with the mandatory proportional delegate awards that encouraged long-shot candidacies. And, in a noticeably targeted effort, they raised the threshold that candidates needed to meet to enter their names into nomination, just as Ron Paul’s supporters were working to reach it. When John A. Boehner gaveled the rules in on a voice vote — a vote that many listeners heard as a tie, if not an outright loss — the hall erupted and a line of Ron Paul supporters walked off the floor in protest, along with many Tea Party members.

At a party meeting last winter, Reince Priebus, who as party chairman is charged with maintaining the support of all his constituencies, did restore some proportional primary and caucus voting, but only in states that held voting within a shortened two-week window. And he also condensed the nominating schedule to four and a half months from six months, and, for the first time required candidates to participate in a shortened debate schedule, determined by the party, not by the whims of the networks. (The panel that recommended those changes included names closely identified with the establishment — the former Bush White House spokesman Ari Fleischer, the Mississippi committeeman Haley Barbour and, notably, Jeb Bush’s closest adviser, Sally Bradshaw.)

Grass-roots activists have complained that the condensed schedule robs nonestablishment candidates — “movement candidates” like Carson — of the extra time they need to build momentum, money and organizations. But Priebus, who says the nomination could be close to settled by April, said it helped all the party’s constituencies when the nominee was decided quickly. “We don’t need a six-month slice-and-dice festival,” Priebus said when we spoke in mid-March. “While I can’t always control everyone’s mouth, I can control how long we can kill each other.”

All the rules changes were built to sidestep the problems of 2012. But the 2016 field is shaping up to be vastly different and far larger. A new Republican hints that he or she is considering a run seemingly every week. There are moderates like Gov. John Kasich of Ohio and former Gov. George Pataki of New York; no-compromise conservatives like Senator Ted Cruz of Texas and former Senator Rick Santorum of Pennsylvania; business-wingers like the former Hewlett-Packard chief executive Carly Fiorina; one-of-a-kinds like Donald Trump — some 20 in all, a dozen or so who seem fairly serious about it. That opens the possibility of multiple candidates vying for all the major Republican constituencies, some of them possibly goaded along by super-PAC-funding billionaires, all of them trading wins and collecting delegates well into spring.

Giles says his candidate can capitalize on all that chaos. Rivals may laugh, but Giles argues that if Carson can make a respectable showing in Iowa, then win in South Carolina — or at least come in second should a home-state senator, Lindsey Graham, run — and come in second behind Bush or Senator Marco Rubio in their home state of Florida, he could be positioned to make a real run. But that would depend on avoiding pitfalls like Carson’s ill-considered comments on homosexuality. Rather than capitalizing on the chaos, Carson may only contribute to it.

Ben Carson is, in many ways, the ideal Republican presidential candidate. With a not-too-selective reading of his life story, conservative voters can — and do — see in him an inspiring, up-from-nowhere African-American who shares their beliefs, a right-wing answer to Barack Obama. Before he was born, his parents moved to Detroit from rural Tennessee as part of the second great migration. His father, Robert Solomon Carson, worked at a Cadillac factory. His mother, Sonya — who herself had grown up as one of 24 children and left school at third grade — cleaned houses. When Carson was 8, Sonya discovered that Robert was keeping a second family. She moved, with her two sons, into a rundown group house. It was in a part of town that Carson described to me as crawling with “big rats and roaches and all kinds of horrible things.” Sonya worked several jobs at a time and made up the shortfall with food stamps. (Carson has called for paring back the social safety net but not doing away with it.)

Carson recounts this story in his best-selling 1990 memoir, “Gifted Hands,” which also became the basis for a 2009 movie on TNT, starring Cuba Gooding Jr. as Carson. Raised as a Seventh Day Adventist, Carson realized that he wanted to become a physician during a church sermon about a missionary doctor who, while serving overseas, was almost attacked by thieves but found safety by putting his faith in God. When Carson, then 8, told his mother his new dream, “She said, ‘Absolutely, you could do it, you could do anything,’ ” he told me. Forced by his mother to read two extra books a week, he made it to Yale, then to medical school at the University of Michigan, where he decided to specialize in neurosurgery. He was selected for residency at Johns Hopkins Children’s Center, where he was named director of pediatric neurosurgery at 33, becoming the youngest person, and the first black person, to hold the title. He drew national attention by conducting a succession of operations that had never been performed successfully, most famously planning and managing the first separation of conjoined twins connected through major blood vessels in the brain.

Carson, a two-time Jimmy Carter voter, traces his conservative political awakening to a patient he met during the Reagan years. During a routine obstetrics rotation, he found himself treating an unwed pregnant teenager who had run away from her well-to-do parents. When Carson asked her how she was getting by, she informed him she was on public assistance; this led him to ponder the fact that the government was paying for the result of what he did not view as a “wise decision.” The incident, he says, fed his growing sense that the welfare system too often saps motivation and rewards irresponsible behavior. (When we spoke, he suggested that the government should cut off assistance to would-be unwed mothers, but only after warning them that it would do so within a certain amount of time, say five years. “I bet you’d see a dramatic decrease in unwed motherhood.”)

Carson’s friends at Hopkins say they do not remember him being particularly outspoken about his conservatism. He devoted most of his public engagement to urging poor kids in bad neighborhoods to use “these fancy brains God gave us,” through weekly school visits, student hospital tours and, ultimately, a multimillion-dollar scholarship program. “His issues were always medical care for the poor, education for the poor, equal opportunity — helping the less fortunate and really inspiring them as an example,” a mentor who named him to the chief pediatrics-neurosurgery post at Hopkins, Dr. Donlin Long, told me.

Even when Carson got the chance, in 1997, to speak in front of President Bill Clinton, at the national prayer breakfast, he mostly discussed the lack of role models for black children who were not sports stars or rappers. (There was possibly an oblique reference to Clinton’s sex scandals, when he told the audience that, if they are always honest, they won’t have to worry later about “skeletons in the closet.”)

Photo
 
Ben Carson at CPAC on Feb. 26 in Oxon Hill, Md. Credit Dolly Faibyshev for The New York Times

In 2011, Carson’s politics took a strident turn, mirroring that of many in his party during the Obama years. “America the Beautiful,” his sixth book, which he wrote with Candy Carson, his wife of 39 years, included a get-tough-on-illegal-immigration message and offered anti-establishment praise for the Tea Party. It suggested that blacks who voted for Obama only because he was black were themselves practicing a form of racism. (Earlier this year he admitted to Buzzfeed that portions of the book were lifted directly from several sources without proper attribution.) His prayer-breakfast performance in 2013, and the extremity of his remarks in the months afterward (Obamacare is the worst thing since slavery; the United States is “very much like Nazi Germany”; allowing same-sex marriage could lead to allowing bestiality), left some of his old friends bewildered. Students at Johns Hopkins University School of Medicine protested his planned convocation address there in 2013, and he eventually backed out. When I asked Carson about the view at Hopkins that he had changed, he said his themes are still the same: “hard work, self-reliance, helping other people.” If he had become more overtly political, he said, it was only because the Obama years had led him to believe that “we’re really moving in a direction that is very, very destructive.”

None of this went unnoticed by campaign professionals. In August 2013, John Philip Sousa IV and Vernon Robinson, each of whom professes to be a virtual stranger to Carson, and who had previously been active in the anti-illegal-immigration movement, started the National Draft Ben Carson for President Committee. Sousa was just coming off a campaign to defend the sheriff of Maricopa County, Arizona, Joe Arpaio, from a recall effort, and he told me that he found Carson’s lack of political experience refreshing. “We have 500 guys and gals with probably a collective 5,000 years experience, and look at the mess we’re in,” he said.

Many others in the party feel the same way. Carson’s PAC finished 2014 with more than $13 million in donations, more than Ready for Hillary. Much of its money has gone toward further fund-raising, but Sousa — the great-grandson of the famous composer — points out that their effort has already built far more than just a war chest, organizing leaders in all 99 of Iowa’s counties. Regardless, Carson credits the fund-raising success of Sousa and Robinson with persuading him to enter the race.

Very early the morning after the job interview, Carson was in a black S.U.V., heading from Washington to the Gaylord National Resort and Convention Center in Oxon Hill, Md., where he was to give the opening candidate speech of the Conservative Political Action Conference. The event, which functions as an early tryout for Republican presidential contenders, tends to skew rightward in its audience, drawing many of the same sorts of people who shouted at Boehner in Tampa. As such, it tends to favor anti-establishment candidates, but the news leading up to this year’s event was that Jeb Bush hoped to make inroads there.

It was still dark when we set out, and I joked with Carson about the hour, telling him he’d better get used to it. He retorted that his career in pediatric brain surgery made him no stranger to early mornings. This is a big theme of Carson’s presidential pitch: that neither the rigors of the campaign nor those of the White House can faze a man who held children’s lives in his hands. His life in brain surgery has prepared him for the presidency, he maintains, better than lives in politics have for his rivals. At the very least, he says, it conditioned him against getting too worked up about any problem that isn’t life threatening. “I mean, it’s grueling, but interestingly enough, I don’t feel the pressure,” he said.

At the convention hall, we were quickly surrounded by admirers. Two women were already waiting to meet him — white, middle-aged volunteers for Carson’s super PAC, who had traveled from South Carolina. One of them, Chris Horne, was holding a dog-eared and taped Bible. A founding member of the Charleston Tea Party who went on to work for Gingrich’s successful South Carolina primary campaign in 2012, Horne lamented over the attacks that Carson was sure to face. “You served us, you served the Lord, just don’t let them steal that from you,” she said. Her friend told him, “You’ve got God behind you!” Such religious evocations trailed Carson constantly while I walked the CPAC floor with him. Evangelicals are impressed not only with his devotion to their politics but also with his career path; as one of them told me, what’s more pro-life than saving babies?

During our ride to the conference, Carson told me his speech was not looking to “feed the beast.” When his appointed time came, he kept his remarks as tame as promised. “Real compassion” meant “using our intellect” to help people “climb out of dependency and realize the American dream,” he said. The national debt is going to “destroy us,” Obamacare was about “redistribution and control,” but Republicans better come forward with their own alternative before they repeal it, he said.

Because his speech was first, and it started several minutes early, the auditorium was slow to fill. Still, the first day saw a crush of people seeking autographs and pictures as he roamed the hall. The Draft Carson committee’s 150 volunteers swarmed the auditorium, collecting emails and handing out “Run Ben Run” stickers. After a quick interview with Sean Hannity, the conservative-radio and Fox News host — his second in two days — Carson was off to Tampa.

In the hours that followed his talk, the hall offered a view in miniature of what the next 12 to 14 months might hold for the party. Chris Christie, sitting across from the tough-minded talk-radio host Laura Ingraham, boasted about his multiple vetoes of Planned Parenthood funding, his refusal to raise income taxes and his belief that “sometimes people need to be told to sit down and shut up.” Cruz, an audience favorite, warning his fellow Republicans against falling for a “squishy moderate,” declared, “Take all 125,000 I.R.S. agents and put ’em on our Southern border!” Gov. Scott Walker of Wisconsin, surging in polls, boasted that if he could face down the 100,000 union supporters who protested his legislation limiting collective bargaining for public employees, he could certainly handle ISIS. The next day, the traditional CPAC favorite Rand Paul spoke, packing the hall with his supporters who chanted “President Paul.” He warned, counter to the overall hawkish tenor of the event, that “we should not succumb to the notion that a government inept at home will somehow become successful abroad.” But he also vowed to end foreign aid to countries whose citizens are seen burning American flags. “Not one penny more to these haters of America.”

Perhaps the defining moment came near the end of the conference, when Jeb Bush spoke. In a neat trick of political gamesmanship — and a show of establishment muscle — his team had bused in an ample cheering section for the dozens of cameras on hand for his appearance. But a small contingent of Tea Party activists and Rand Paul supporters staged a walk out. When Bush began a question-and-answer session, they turned and left the auditorium to chant “U.S.A., U.S.A.” in the hallway, led by a man in colonial garb waving a huge “Don’t Tread on Me” banner. Plenty of other detractors stayed in the hall and peppered Bush’s remarks with booing as he stood by positions unpopular with the conservative grass roots: support for the Common Core standards and an immigration overhaul that provides a “path to legal status” for undocumented immigrants. Bush took it all in good humor, but finally seemed to give up.

“For those who made an ‘oo’ sound — is that what it was? — I’m marking you down as neutral,” he said. “And I want to be your second choice.”

Bush strategists told me they would not repeat Romney’s mistakes. Of course they would love to glide to an early nomination, they said, but they are prepared for a long contest and won’t be wasting any energy bending under pressure from a Paul or a Cruz or a Carson.

No one doubts that the pressure will increase, though. Despite the best wishes of the party’s leaders, GOP primary voters have given little indication that they will narrow the field quickly.

Before I left, I spotted Newt Gingrich, himself a fleeting presidential front-runner during those strange primary days of 2012. I asked him whether he thought all the party maneuvering — all the attempts to change the rules and fast-track the process — would preclude someone from presenting the sort of outside primary challenge he had carried out in the last election.

“No,” he told me, as if it was the most obvious thing in the world. “Look at where Ben Carson is right now.”

Jim Rutenberg is the chief political correspondent for the magazine. His most recent feature was about Megyn Kelly.

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WASHINGTON — A decade after emergency trailers meant to shelter Hurricane Katrina victims instead caused burning eyes, sore throats and other more serious ailments, the Environmental Protection Agency is on the verge of regulating the culprit: formaldehyde, a chemical that can be found in commonplace things like clothes and furniture.

But an unusual assortment of players, including furniture makers, the Chinese government, Republicans from states with a large base of furniture manufacturing and even some Democrats who championed early regulatory efforts, have questioned the E.P.A. proposal. The sustained opposition has held sway, as the agency is now preparing to ease key testing requirements before it releases the landmark federal health standard.

The E.P.A.’s five-year effort to adopt this rule offers another example of how industry opposition can delay and hamper attempts by the federal government to issue regulations, even to control substances known to be harmful to human health.

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Document: The Formaldehyde Fight

Formaldehyde is a known carcinogen that can also cause respiratory ailments like asthma, but the potential of long-term exposure to cause cancers like myeloid leukemia is less well understood.

The E.P.A.’s decision would be the first time that the federal government has regulated formaldehyde inside most American homes.

“The stakes are high for public health,” said Tom Neltner, senior adviser for regulatory affairs at the National Center for Healthy Housing, who has closely monitored the debate over the rules. “What we can’t have here is an outcome that fails to confront the health threat we all know exists.”

The proposal would not ban formaldehyde — commonly used as an ingredient in wood glue in furniture and flooring — but it would impose rules that prevent dangerous levels of the chemical’s vapors from those products, and would set testing standards to ensure that products sold in the United States comply with those limits. The debate has sharpened in the face of growing concern about the safety of formaldehyde-treated flooring imported from Asia, especially China.

What is certain is that a lot of money is at stake: American companies sell billions of dollars’ worth of wood products each year that contain formaldehyde, and some argue that the proposed regulation would impose unfair costs and restrictions.

Determined to block the agency’s rule as proposed, these industry players have turned to the White House, members of Congress and top E.P.A. officials, pressing them to roll back the testing requirements in particular, calling them redundant and too expensive.

“There are potentially over a million manufacturing jobs that will be impacted if the proposed rule is finalized without changes,” wrote Bill Perdue, the chief lobbyist at the American Home Furnishings Alliance, a leading critic of the testing requirements in the proposed regulation, in one letter to the E.P.A.

Industry opposition helped create an odd alignment of forces working to thwart the rule. The White House moved to strike out key aspects of the proposal. Subsequent appeals for more changes were voiced by players as varied as Senator Barbara Boxer, Democrat of California, and Senator Roger Wicker, Republican of Mississippi, as well as furniture industry lobbyists.

Hurricane Katrina in 2005 helped ignite the public debate over formaldehyde, after the deadly storm destroyed or damaged hundreds of thousands of homes along the Gulf of Mexico, forcing families into temporary trailers provided by the Federal Emergency Management Agency.

The displaced storm victims quickly began reporting respiratory problems, burning eyes and other issues, and tests then confirmed high levels of formaldehyde fumes leaking into the air inside the trailers, which in many cases had been hastily constructed.

Public health advocates petitioned the E.P.A. to issue limits on formaldehyde in building materials and furniture used in homes, given that limits already existed for exposure in workplaces. But three years after the storm, only California had issued such limits.

Industry groups like the American Chemistry Council have repeatedly challenged the science linking formaldehyde to cancer, a position championed by David Vitter, the Republican senator from Louisiana, who is a major recipient of chemical industry campaign contributions, and whom environmental groups have mockingly nicknamed “Senator Formaldehyde.”

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Formaldehyde in Laminate Flooring

In laminate flooring, formaldehyde is used as a bonding agent in the fiberboard (or other composite wood) core layer and may also be used in glues that bind layers together. Concerns were raised in March when certain laminate flooring imported from China was reported to contain levels of formaldehyde far exceeding the limit permitted by California.

Typical

laminate

flooring

CLEAR FINISH LAYER

Often made of melamine resin

PATTERN LAYER

Paper printed to resemble wood,

or a thin wood veneer

GLUE

Layers may be bound using

formaldehyde-based glues

CORE LAYER

Fiberboard or other

composite, formed using

formaldehyde-based adhesives

BASE LAYER

Moisture-resistant vapor barrier

What is formaldehyde?

Formaldehyde is a common chemical used in many industrial and household products as an adhesive, bonding agent or preservative. It is classified as a volatile organic compound. The term volatile means that, at room temperature, formaldehyde will vaporize, or become a gas. Products made with formaldehyde tend to release this gas into the air. If breathed in large quantities, it may cause health problems.

WHERE IT IS COMMONLY FOUND

POTENTIAL HEALTH RISKS

Pressed-wood and composite wood products

Wallpaper and paints

Spray foam insulation used in construction

Commercial wood floor finishes

Crease-resistant fabrics

In cigarette smoke, or in the fumes from combustion of other materials, including wood, oil and gasoline.

Exposure to formaldehyde in sufficient amounts may cause eye, throat or skin irritation, allergic reactions, and respiratory problems like coughing, wheezing or asthma.

Long-term exposure to high levels has been associated with cancer in humans and laboratory animals.

Exposure to formaldehyde may affect some people more severely than others.

By 2010, public health advocates and some industry groups secured bipartisan support in Congress for legislation that ordered the E.P.A. to issue federal rules that largely mirrored California’s restrictions. At the time, concerns were rising over the growing number of lower-priced furniture imports from Asia that might include contaminated products, while also hurting sales of American-made products.

Maneuvering began almost immediately after the E.P.A. prepared draft rules to formally enact the new standards.

White House records show at least five meetings in mid-2012 with industry executives — kitchen cabinet makers, chemical manufacturers, furniture trade associations and their lobbyists, like Brock R. Landry, of the Venable law firm. These parties, along with Senator Vitter’s office, appealed to top administration officials, asking them to intervene to roll back the E.P.A. proposal.

The White House Office of Management and Budget, which reviews major federal regulations before they are adopted, apparently agreed. After the White House review, the E.P.A. “redlined” many of the estimates of the monetary benefits that would be gained by reductions in related health ailments, like asthma and fertility issues, documents reviewed by The New York Times show.

As a result, the estimated benefit of the proposed rule dropped to $48 million a year, from as much as $278 million a year. The much-reduced amount deeply weakened the agency’s justification for the sometimes costly new testing that would be required under the new rules, a federal official involved in the effort said.

“It’s a redlining blood bath,” said Lisa Heinzerling, a Georgetown University Law School professor and a former E.P.A. official, using the Washington phrase to describe when language is stricken from a proposed rule. “Almost the entire discussion of these potential benefits was excised.”

Senator Vitter’s staff was pleased.

“That’s a huge difference,” said Luke Bolar, a spokesman for Mr. Vitter, of the reduced estimated financial benefits, saying the change was “clearly highlighting more mismanagement” at the E.P.A.

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The review’s outcome galvanized opponents in the furniture industry. They then targeted a provision that mandated new testing of laminated wood, a cheaper alternative to hardwood. (The California standard on which the law was based did not require such testing.)

But E.P.A. scientists had concluded that these laminate products — millions of which are sold annually in the United States — posed a particular risk. They said that when thin layers of wood, also known as laminate or veneer, are added to furniture or flooring in the final stages of manufacturing, the resulting product can generate dangerous levels of fumes from often-used formaldehyde-based glues.

Industry executives, outraged by what they considered an unnecessary and financially burdensome level of testing, turned every lever within reach to get the requirement removed. It would be particularly onerous, they argued, for small manufacturers that would have to repeatedly interrupt their work to do expensive new testing. The E.P.A. estimated that the expanded requirements for laminate products would cost the furniture industry tens of millions of dollars annually, while the industry said that the proposed rule over all would cost its 7,000 American manufacturing facilities over $200 million each year.

“A lot of people don’t seem to appreciate what a lot of these requirements do to a small operation,” said Dick Titus, executive vice president of the Kitchen Cabinet Manufacturers Association, whose members are predominantly small businesses. “A 10-person shop, for example, just really isn’t equipped to handle that type of thing.”

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Becky Gillette wants strong regulation of formaldehyde. Credit Beth Hall for The New York Times

Big industry players also weighed in. Executives from companies including La-Z-Boy, Hooker Furniture and Ashley Furniture all flew to Washington for a series of meetings with the offices of lawmakers including House Speaker John Boehner, Republican of Ohio, and about a dozen other lawmakers, asking several of them to sign a letter prepared by the industry to press the E.P.A. to back down, according to an industry report describing the lobbying visit.

Within a matter of weeks, two letters — using nearly identical language — were sent by House and Senate lawmakers to the E.P.A. — with the industry group forwarding copies of the letters to the agency as well, and then posting them on its website.

The industry lobbyists also held their own meeting at E.P.A. headquarters, and they urged Jim Jones, who oversaw the rule-making process as the assistant administrator for the agency’s Office of Chemical Safety and Pollution Prevention, to visit a North Carolina furniture manufacturing plant. According to the trade group, Mr. Jones told them that the visit had “helped the agency shift its thinking” about the rules and how laminated products should be treated.

The resistance was particularly intense from lawmakers like Mr. Wicker of Mississippi, whose state is home to major manufacturing plants owned by Ashley Furniture Industries, the world’s largest furniture maker, and who is one of the biggest recipients in Congress of donations from the industry’s trade association. Asked if the political support played a role, a spokesman for Mr. Wicker replied: “Thousands of Mississippians depend on the furniture manufacturing industry for their livelihoods. Senator Wicker is committed to defending all Mississippians from government overreach.”

Individual companies like Ikea also intervened, as did the Chinese government, which claimed that the new rule would create a “great barrier” to the import of Chinese products because of higher costs.

Perhaps the most surprising objection came from Senator Boxer, of California, a longtime environmental advocate, whose office questioned why the E.P.A.’s rule went further than her home state’s in seeking testing on laminated products. “We did not advocate an outcome, other than safety,” her office said in a statement about why the senator raised concerns. “We said ‘Take a look to see if you have it right.’ ”

Safety advocates say that tighter restrictions — like the ones Ms. Boxer and Mr. Wicker, along with Representative Doris Matsui, a California Democrat, have questioned — are necessary, particularly for products coming from China, where items as varied as toys and Christmas lights have been found to violate American safety standards.

While Mr. Neltner, the environmental advocate who has been most involved in the review process, has been open to compromise, he has pressed the E.P.A. not to back down entirely, and to maintain a requirement that laminators verify that their products are safe.

An episode of CBS’s “60 Minutes” in March brought attention to the issue when it accused Lumber Liquidators, the discount flooring retailer, of selling laminate products with dangerous levels of formaldehyde. The company has disputed the show’s findings and test methods, maintaining that its products are safe.

“People think that just because Congress passed the legislation five years ago, the problem has been fixed,” said Becky Gillette, who then lived in coastal Mississippi, in the area hit by Hurricane Katrina, and was among the first to notice a pattern of complaints from people living in the trailers. “Real people’s faces and names come up in front of me when I think of the thousands of people who could get sick if this rule is not done right.”

An aide to Ms. Matsui rejected any suggestion that she was bending to industry pressure.

“From the beginning the public health has been our No. 1 concern,” said Kyle J. Victor, an aide to Ms. Matsui.

But further changes to the rule are likely, agency officials concede, as they say they are searching for a way to reduce the cost of complying with any final rule while maintaining public health goals. The question is just how radically the agency will revamp the testing requirement for laminated products — if it keeps it at all.

“It’s not a secret to anybody that is the most challenging issue,” said Mr. Jones, the E.P.A. official overseeing the process, adding that the health consequences from formaldehyde are real. “We have to reduce those exposures so that people can live healthy lives and not have to worry about being in their homes.”

The Uphill Battle to Better Regulate Formaldehyde

As governor, Mr. Walker alienated Republicans and his fellow Democrats, particularly the Democratic powerhouse Richard J. Daley, the mayor of Chicago.

Dan Walker, 92, Dies; Illinois Governor and Later a U.S. Prisoner

The live music at the Vice Media party on Friday shook the room. Shane Smith, Vice’s chief executive, was standing near the stage — with a drink in his hand, pants sagging, tattoos showing — watching the rapper-cum-chef Action Bronson make pizzas.

The event was an after-party, a happy-hour bacchanal for the hundreds of guests who had come for Vice’s annual presentation to advertisers and agencies that afternoon, part of the annual frenzy for ad dollars called the Digital Content NewFronts. Mr. Smith had spoken there for all of five minutes before running a slam-bang highlight reel of the company’s shows that had titles like “Weediquette” and “Gaycation.”

In the last year, Vice has secured $500 million in financing and signed deals worth hundreds of millions of dollars with established media companies like HBO that are eager to engage the young viewers Vice attracts. Vice said it was now worth at least $4 billion, with nearly $1 billion in projected revenue for 2015. It is a long way from Vice’s humble start as a free magazine in 1994.

Photo
 
At the Vice after-party, the rapper Action Bronson, a host of a Vice show, made a pizza. Credit Jesse Dittmar for The New York Times

But even as cash flows freely in Vice’s direction, the company is trying to keep its brash, insurgent image. At the party on Friday, it plied guests with beers and cocktails. Its apparently unrehearsed presentation to advertisers was peppered with expletives. At one point, the director Spike Jonze, a longtime Vice collaborator, asked on stage if Mr. Smith had been drinking.

“My assistant tried to cut me off,” Mr. Smith replied. “I’m on buzz control.”

Now, Vice is on the verge of getting its own cable channel, which would give the company a traditional outlet for its slate of non-news programming. If all goes as planned, A&E Networks, the television group owned by Hearst and Disney, will turn over its History Channel spinoff, H2, to Vice.

The deal’s announcement was expected last week, but not all of A&E’s distribution partners — the cable and satellite TV companies that carry the network’s channels — have signed off on the change, according to a person familiar with the negotiations who spoke on the condition of anonymity because the talks were private.

A cable channel would be a further step in a transformation for Vice, from bad-boy digital upstart to mainstream media company.

Keen for the core audience of young men who come to Vice, media giants like 21st Century Fox, Time Warner and Disney all showed interest in the company last year. Vice ultimately secured $500 million in financing from A&E Networks and Technology Crossover Ventures, a Silicon Valley venture capital firm that has invested in Facebook and Netflix.

Those investments valued Vice at more than $2.5 billion. (In 2013, Fox bought a 5 percent stake for $70 million.)

Then in March, HBO announced that it had signed a multiyear deal to broadcast a daily half-hour Vice newscast. Vice already produces a weekly newsmagazine show, called “Vice,” for the network. That show will extend its run through 2018, with an increase to 35 episodes a year, from 14.

Michael Lombardo, HBO’s president for programming, said when the deal was announced that it was “certainly one of our biggest investments with hours on the air.”

Vice, based in Brooklyn, also recently signed a multiyear $100 million deal with Rogers Communications, a Canadian media conglomerate, to produce original content for TV, smartphone and desktop viewers.

Vice’s finances are private, but according to an internal document reviewed by The New York Times and verified by a person familiar with the company’s financials, the company is on track to make about $915 million in revenue this year.

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Vice showed a highlight reel of its TV series at the NewFronts last week in New York. Credit Jesse Dittmar for The New York Times

It brought in $545 million in a strong first quarter, which included portions of the new HBO deal and the Rogers deal, according to the document. More of its revenue now comes from these types of content partnerships, compared with the branded content deals that made up much of its revenue a year ago, the company said.

Mr. Smith said the company was worth at least $4 billion. If the valuation gets much higher, he said he would consider taking the company public.

“I don’t care about money; we have plenty of money,” Mr. Smith, who is Vice’s biggest shareholder, said in an interview after the presentation on Friday. “I care about strategic deals.”

In the United States, Vice Media had 35.2 million unique visitors across its sites in March, according to comScore.

The third season of Vice’s weekly HBO show has averaged 1.8 million viewers per episode, including reruns, through April 12, according to Brad Adgate, the director of research at Horizon Media. (Vice said the show attracted three million weekly viewers when repeat broadcasts, online and on-demand viewings were included.)

For years, Mr. Smith has criticized traditional TV, calling it slow and unable to draw younger viewers. But if all the deals Vice has struck are to work out, Mr. Smith may have to play more by the rules of traditional media. James Murdoch, Rupert Murdoch’s son and a member of Vice’s board, was at the company’s presentation on Friday, as were other top media executives.

“They know they need people like me to help them, but they can’t get out of their own way,” Mr. Smith said in the interview Friday. “My only real frustration is we’re used to being incredibly dynamic, and they’re not incredibly dynamic.”

With its own television channel in the United States, Vice would have something it has long coveted even as traditional media companies are looking beyond TV. Last year, Vice’s deal with Time Warner failed in part because the two companies could not agree on how much control Vice would have over a 24-hour television network.

Vice said it intended to fill its new channel with non-news programming. The company plans to have sports shows, fashion shows, food shows and the “Gaycation” travel show with the actress Ellen Page. It is also in talks with Kanye West about a show.

It remains to be seen whether Vice’s audience will watch a traditional cable channel. Still, Vice has effectively presold all of the ad spots to two of the biggest advertising agencies for the first three years, Mr. Smith said.

In the meantime, Mr. Smith is enjoying Vice’s newfound role as a potential savior of traditional media companies.

“I’m a C.E.O. of a content company,” Mr. Smith said before he caught a flight to Las Vegas for the boxing match on Saturday between Floyd Mayweather Jr. and Manny Pacquiao. “If it stops being fun, then why are you doing it?”

As Vice Moves More to TV, It Tries to Keep Brash Voice

Mr. Miller, of the firm Weil, Gotshal & Manges, represented companies including Lehman Brothers, General Motors and American Airlines, and mentored many of the top Chapter 11 practitioners today.

Harvey R. Miller, Renowned Bankruptcy Lawyer, Dies at 82

The 6-foot-10 Phillips played alongside the 6-11 Rick Robey on the Wildcats team that won the 1978 N.C.A.A. men’s basketball title.

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Children playing last week in Sandtown-Winchester, the Baltimore neighborhood where Freddie Gray was raised. One young resident called it “a tough community.”
Todd Heisler/The New York Times

Children playing last week in Sandtown-Winchester, the Baltimore neighborhood where Freddie Gray was raised. One young resident called it “a tough community.”

Hard but Hopeful Home to ‘Lot of Freddies’

Hard but Hopeful Home to ‘Lot of Freddies’

As he reflected on the festering wounds deepened by race and grievance that have been on painful display in America’s cities lately, President Obama on Monday found himself thinking about a young man he had just met named Malachi.

A few minutes before, in a closed-door round-table discussion at Lehman College in the Bronx, Mr. Obama had asked a group of black and Hispanic students from disadvantaged backgrounds what could be done to help them reach their goals. Several talked about counseling and guidance programs.

“Malachi, he just talked about — we should talk about love,” Mr. Obama told a crowd afterward, drifting away from his prepared remarks. “Because Malachi and I shared the fact that our dad wasn’t around and that sometimes we wondered why he wasn’t around and what had happened. But really, that’s what this comes down to is: Do we love these kids?”

Many presidents have governed during times of racial tension, but Mr. Obama is the first to see in the mirror a face that looks like those on the other side of history’s ledger. While his first term was consumed with the economy, war and health care, his second keeps coming back to the societal divide that was not bridged by his election. A president who eschewed focusing on race now seems to have found his voice again as he thinks about how to use his remaining time in office and beyond.

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Obama Speaks of a ‘Sense of Unfairness’

Obama Speaks of a ‘Sense of Unfairness’

At an event announcing the creation of a nonprofit focusing on young minority men, President Obama talked about the underlying reasons for recent protests in Baltimore and other cities.

By Associated Press on Publish Date May 4, 2015. Photo by Stephen Crowley/The New York Times.

In the aftermath of racially charged unrest in places like Baltimore, Ferguson, Mo., and New York, Mr. Obama came to the Bronx on Monday for the announcement of a new nonprofit organization that is being spun off from his White House initiative called My Brother’s Keeper. Staked by more than $80 million in commitments from corporations and other donors, the new group, My Brother’s Keeper Alliance, will in effect provide the nucleus for Mr. Obama’s post-presidency, which will begin in January 2017.

“This will remain a mission for me and for Michelle not just for the rest of my presidency but for the rest of my life,” Mr. Obama said. “And the reason is simple,” he added. Referring to some of the youths he had just met, he said: “We see ourselves in these young men. I grew up without a dad. I grew up lost sometimes and adrift, not having a sense of a clear path. The only difference between me and a lot of other young men in this neighborhood and all across the country is that I grew up in an environment that was a little more forgiving.”

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Organizers said the new alliance already had financial pledges from companies like American Express, Deloitte, Discovery Communications and News Corporation. The money will be used to help companies address obstacles facing young black and Hispanic men, provide grants to programs for disadvantaged youths, and help communities aid their populations.

Joe Echevarria, a former chief executive of Deloitte, the accounting and consulting firm, will lead the alliance, and among those on its leadership team or advisory group are executives at PepsiCo, News Corporation, Sprint, BET and Prudential Group Insurance; former Secretary of State Colin L. Powell; Senator Cory Booker, Democrat of New Jersey; former Attorney General Eric H. Holder Jr.; the music star John Legend; the retired athletes Alonzo Mourning, Jerome Bettis and Shaquille O’Neal; and the mayors of Indianapolis, Sacramento and Philadelphia.

The alliance, while nominally independent of the White House, may face some of the same questions confronting former Secretary of State Hillary Rodham Clinton as she begins another presidential campaign. Some of those donating to the alliance may have interests in government action, and skeptics may wonder whether they are trying to curry favor with the president by contributing.

“The Obama administration will have no role in deciding how donations are screened and what criteria they’ll set at the alliance for donor policies, because it’s an entirely separate entity,” Josh Earnest, the White House press secretary, told reporters on Air Force One en route to New York. But he added, “I’m confident that the members of the board are well aware of the president’s commitment to transparency.”

The alliance was in the works before the disturbances last week after the death of Freddie Gray, the black man who suffered fatal injuries while in police custody in Baltimore, but it reflected the evolution of Mr. Obama’s presidency. For him, in a way, it is coming back to issues that animated him as a young community organizer and politician. It was his own struggle with race and identity, captured in his youthful memoir, “Dreams From My Father,” that stood him apart from other presidential aspirants.

But that was a side of him that he kept largely to himself through the first years of his presidency while he focused on other priorities like turning the economy around, expanding government-subsidized health care and avoiding electoral land mines en route to re-election.

After securing a second term, Mr. Obama appeared more emboldened. Just a month after his 2013 inauguration, he talked passionately about opportunity and race with a group of teenage boys in Chicago, a moment aides point to as perhaps the first time he had spoken about these issues in such a personal, powerful way as president. A few months later, he publicly lamented the death of Trayvon Martin, a black Florida teenager, saying that “could have been me 35 years ago.”

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President Obama on Monday with Darinel Montero, a student at Bronx International High School who introduced him before remarks at Lehman College in the Bronx. Credit Stephen Crowley/The New York Times

That case, along with public ruptures of anger over police shootings in Ferguson and elsewhere, have pushed the issue of race and law enforcement onto the public agenda. Aides said they imagined that with his presidency in its final stages, Mr. Obama might be thinking more about what comes next and causes he can advance as a private citizen.

That is not to say that his public discussion of these issues has been universally welcomed. Some conservatives said he had made matters worse by seeming in their view to blame police officers in some of the disputed cases.

“President Obama, when he was elected, could have been a unifying leader,” Senator Ted Cruz of Texas, a Republican candidate for president, said at a forum last week. “He has made decisions that I think have inflamed racial tensions.”

On the other side of the ideological spectrum, some liberal African-American activists have complained that Mr. Obama has not done enough to help downtrodden communities. While he is speaking out more, these critics argue, he has hardly used the power of the presidency to make the sort of radical change they say is necessary.

The line Mr. Obama has tried to straddle has been a serrated one. He condemns police brutality as he defends most officers as honorable. He condemns “criminals and thugs” who looted in Baltimore while expressing empathy with those trapped in a cycle of poverty and hopelessness.

In the Bronx on Monday, Mr. Obama bemoaned the death of Brian Moore, a plainclothes New York police officer who had died earlier in the day after being shot in the head Saturday on a Queens street. Most police officers are “good and honest and fair and care deeply about their communities,” even as they put their lives on the line, Mr. Obama said.

“Which is why in addressing the issues in Baltimore or Ferguson or New York, the point I made was that if we’re just looking at policing, we’re looking at it too narrowly,” he added. “If we ask the police to simply contain and control problems that we ourselves have been unwilling to invest and solve, that’s not fair to the communities, it’s not fair to the police.”

Moreover, if society writes off some people, he said, “that’s not the kind of country I want to live in; that’s not what America is about.”

His message to young men like Malachi Hernandez, who attends Boston Latin Academy in Massachusetts, is not to give up.

“I want you to know you matter,” he said. “You matter to us.”

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