WASHINGTON (Reuters) - House Speaker John Boehner said on Friday congressional leaders and President Barack Obama must try to move on from Republicans' failed tax plan and work together to avert the looming U.S. "fiscal cliff."

Boehner, the top Republican in Congress, was unrepentant at a Capitol Hill news conference the day after the stunning failure of his "Plan B" option, a development that raised doubts about his own leadership and left negotiations in disarray.

The failure cast fresh uncertainty over talks to avoid roughly $600 billion in across-the-board tax hikes and automatic government spending cuts due to begin in January that could push the U.S. economy back into recession in 2013. This combination of tax hikes and spending cuts is known as the "fiscal cliff."

It was "not the outcome I wanted," Boehner said after he was unable to muster enough Republican support in the House for a plan that would have limited income-tax increases to only the wealthiest sliver of the population - those earning $1 million and more.

Boehner, Obama's chief negotiating partner in talks seeking a bipartisan "fiscal cliff" solution, said he was not concerned that Thursday's withdrawn vote threatened his position as House speaker. He did not outline a clear path forward on negotiations.

The speaker failed to control unruly conservative fellow House Republicans who adamantly oppose raising taxes on anyone. They delivered a stinging rebuke to Boehner by refusing to back his "Plan B" approach.

Boehner said a divided Washington must come together to revamp the massive U.S. tax code in a way that helps spur economic growth. "How we get there, God only knows," he said.

Stocks dropped sharply at the open of trading, one day after Boehner's bill was put on the shelf.

Investors have been increasingly optimistic that a deal would be worked out before the end of the year, but this has changed that equation. Major indexes lost more than 1 percent, though stocks are still higher for the week, suggesting investors still hold out hope that an agreement will be brokered in Washington.

'SEE YOU LATER'

Boehner had hoped to use the Plan B option to pressure Obama in "fiscal cliff" talks. But late on Thursday he abruptly pulled the legislation. House members, heading to their home states for the holidays, were instructed to be available on 48 hours notice if necessary.

"They went from Plan B to plan see-you-later," Obama adviser David Axelrod said on MSNBC on Friday morning.

Obama said he still plans to work with Congress and was hopeful for a bipartisan solution, his press secretary said in a statement late on Thursday. The House is controlled by Republicans and the Senate by Obama's fellow Democrats.

The crumbling of Boehner's plan highlights his struggle to lead some House Republicans who flatly reject any deal that would increase taxes on anyone.

Republican Representative Tim Huelskamp criticized Boehner's handling of the negotiations, saying the speaker had "caved" to Obama opening the door to tax hikes. Huelskamp, a dissident first-term congressman, said he was not willing to compromise on taxes even if they are coupled with cuts to government spending sought by conservatives.

Conservatives "are so frustrated that the leader in the House right now, the speaker, has been talking about tax increases. That's all he's been talking about," Huelskamp said on MSNBC on Friday morning.

"There's been very little outreach by this leadership team to conservatives. ... Do not ask for tax increases. We're not going to give them," Huelskamp said, added: "We can still get this done."

Obama and his fellow Democrats in Congress are insisting that the wealthiest Americans pay more in taxes in order to help reduce high federal budget deficits and avoid deep spending cuts.

SENATE LEGISLATION

Democrats are now stepping up efforts to gather some Republican votes for a Democratic bill passed by the Senate months ago that would extend the expiring tax cuts to all but the wealthiest Americans.

"What we'll have to do is figure out where that line is that gives us those 218 votes" needed to garner a majority of the House behind legislation, Republican Representative Michael Burgess said on CNBC on Friday.

Senate Republican Leader Mitch McConnell, who has experience helping to forge deals when House Republicans are in disarray, is likely to play a larger role now in attempting to rescue the situation along with other Senate Republicans, who have been more receptive to compromising.

Wall Street and numerous chief executives have expressed frustration with Washington and the wrangling over a deal that has persisted for weeks with little progress.

Aetna Inc Chief Executive Officer Mark Bertolini said he feels negotiations seem like they are falling apart, calling the back-and-forth among politicians "pitiful and embarrassing" in the Wall Street Journal on Friday.

"The worst-case scenario is increasingly becoming a probable scenario," BlackRock Inc Chief Executive Officer Laurence Fink told the newspaper.

Sean West, a Eurasia Group analyst, told Reuters: "Boehner didn't have a ton of good moves, and has even fewer now." He said he thought Boehner was "either headed back to the White House for a big deal or he's accepting whatever bipartisan fallback is crafted by Senate leaders. Hard to see him coming back with another partisan gambit."

(Additional reporting by Richard Cowan and Susan Heavey; Editing by Fred Barbash and Will Dunham)

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According to legend, the ancient Mayans' long-count calendar ends at midnight Thursday, ushering in the end of the world.

Didn't happen.

"This is not the end of the world. This is the beginning of the new world," Star Johnsen-Moser, an American seer, said at a gathering of hundreds of spiritualists at a convention center in the Yucatan city of Merida, an hour and a half from the Mayan ruins at Chichen Itza.

"It is most important that we hold a positive, beautiful reality for ourselves and our planet. ... Fear is out of place."

As the appointed time came and went in several parts of the world, there was no sign of the apocalypse.

Indeed, the social network Imgur posted photos of clocks turning midnight in the Asia-Pacific region with messages such as: "The world has not ended. Sincerely, New Zealand."

In Merida, the celebration of the cosmic dawn opened inauspiciously, with a fumbling of the sacred fire meant to honor the calendar's conclusion.

Gabriel Lemus, the white-haired guardian of the flame, burned his finger on the kindling and later had to scoop up a burning log that fell from the ceremonial brazier onto the stage.

Still, Lemus was convinced that it was a good start, as he was joined by about 1,000 other shamans, seers, stargazers, crystal enthusiasts, yogis, sufis and swamis.

"It is a cosmic dawn," Lemus declared. "We will recover the ability to communicate telepathically and levitate objects ... like our ancestors did."

Celebrants later held their arms in the air in a salute to the Thursday morning sun.

"The galactic bridge has been established," intoned spiritual leader Alberto Arribalzaga. "At this moment, spirals of light are entering the center of your head ... generating powerful vortexes that cover the planet."

Despite all the ritual and banter, few here actually believed the world would end Friday; the summit was scheduled to run through Sunday. Instead, participants said they were here to celebrate the birth of a new age.

A Mexican Indian seer who calls himself Ac Tah, and who has traveled around Mexico erecting small pyramids he calls "neurological circuits," said he holds high hopes for Friday.

"We are preparing ourselves to receive a huge magnetic field straight from the center of the galaxy," he said.

Terry Kvasnik, 32, a stunt man from Manchester, England, said his motto for the day was "be in love, don't be in fear." As to which ceremony he would attend on Friday, he said with a smile, "I'm going to be in the happiest place I can."

At dozens of booths set up in the convention hall, visitors could have their auras photographed with "Chi" light, get a shamanic cleansing or buy sandals, herbs and whole-grain baked goods. Cleansing usually involves having copal incense waved around one's body.

Visitors could also learn the art of "healing drumming" with a Mexican Otomi Indian master, Dabadi Thaayroyadi, who said his slender hand-held drums are made with prayers embedded inside. The drums emit "an intelligent energy" that can heal emotional, physical and social ailments, he said.

During the opening ceremony, participants chanted mantras to the blazing Yucatan sun, which quickly burned the fair-skinned crowd.

Violeta Simarro, a secretary from Perpignan, France, taking shelter under an awning, noted that the new age won't necessarily be easy.

"It will be a little difficult at first, because the world will need a complete 'nettoyage' (cleansing), because there are so many bad things," she said.

Not all seers endorsed the celebration. Mexico's self-styled "brujo mayor," or chief soothsayer, Antonio Vazquez Alba, warned followers to stay away from gatherings on Friday. "We have to beware of mass psychosis" that could lead to stampedes or "mass suicides, of the kind we've seen before," he said.

"If you get 1,000 people in one spot and somebody yells 'Fire!' watch out," Vazquez Alba said. "The best thing is to stay at home, at work, in school, and at some point do a relaxation exercise."

Others saw the gathering as a model for the coming age.

Participants from Asian, North American, South American and European shamanistic traditions mingled amiably with the Mexican hosts.

"This is the beginning of a change in priorities and perceptions. We are all one," said Esther Romo, a Mexico City businesswoman who works in art promotion and galleries. "No limits, no boundaries, no nationalities, just fusion."

Gabriel Romero, a Los-Angeles based practitioner of crystal skull channeling, was so sure it wasn't the end of the world that he planned a welcome ceremony for the new age at dawn on Saturday, when he would erect a stele, a stone monument used by the Mayans to commemorate important dates or events.

The Maya, who invented an amazingly accurate calendar almost 2,000 years ago, measured time in 394-year periods known as baktuns. Some anthropologists believe the 13th baktun ends Dec. 21. Still, archaeologists have uncovered Mayan glyphs that refer to dates far, far in the future, long beyond Dec. 21.

Yucatan Gov. Rolando Zapata, whose state is home to Mexico's largest Mayan population and has benefited from a boom in tourism, said he, too, felt the good vibes.

"We believe that the beginning of a new baktun means the beginning of a new era, and we're receiving it with great optimism," Zapata said.

He said thousands of tourists and spiritualists are expected for Friday's once-in-5,125-years event. "All the flights to the city are completely full," Zapata said.

The Yucatan state government has even invited a scientist to speak about the Large Hadron Collider in Switzerland, to debunk the idea it could produce world-ending rogue particles, a concept popularized by author Steve Alten in his recent book "Phobos, Mayan Fear."

Alten suggests the rogue particles "tiny black holes" could unleash earthquakes that might cause a huge tsunami, but acknowledges that linking such events to Dec. 21 "is author's license."

"It's science fiction theory, I'm a science fiction writer," he told The Associated Press.

The European Organization for Nuclear Research, however, has listed a number of odd subatomic phenomena "magnetic monopoles," ''vacuum bubbles" and "strangelets" that could play a role in the next apocalypse scare.

All of it amused Deyanira de Alvarez, a tourist from Mexico City, as she snapped a photo of the countdown clock mounted in the Merida international airport showing just over two days left to "the galactic alignment."

"My grandmother says that people have been talking about (the world ending) ever since she was a little girl," De Alvarez said. "And look, grandma is still here."

Turkish officials said the 400-kilogram , made mainly in Turkey but with an optical imager provided by South Korea, was safely in orbit at nearly 700 kilometers in altitude and had sent signals to a ground station in northern Norway.

The satellite was launched aboard a Chinese Long March 2D vehicle operated from the Jiuquan Satellite Launch Center in Gansu Province. It was the 19th launch of a Chinese Long March rocket, all variants included, for 2012 a year Chinese launch service officials had forecast would be particularly active for the rocket line.

Gokturk-2 is Turkey's second Earth observation satellite, following the smallin 2011 aboard a Russian-Ukrainian Dnepr rocket. []

Rasat has a ground resolution of about 7.5 meters, meaning it can detect objects of that diameter and larger. Gokturk-2 has a 2.5-meter resolution and includes 15 gigabytes of image storage capacity.

Turkish Science, Industry and Technology Minister Nihat Ergun said before the launch that Gokturk-2 should be seen as an investment in high technology, and a signal of Turkey's determination to have its own, restrictions-free use of Earth observation imagery.

Turkey's defense forces have purchased anotherfrom Telespazio of Rome and Thales Alenia Space of France and Italy. This 1,000-kilogram spacecraft will be similar to the two French Pleiades satellites now in orbit, with a 70-centimeter ground resolution in black and white and 2.8 meters in color.

The satellite's development has taken longer than expected, and it is not expected to be launched before late 2014. Telespazio's contract, valued at 250 million euros ($325 million) when signed in 2009, includes establishing a satellite integration and test facility in Turkey as well as a Gokturk ground station.

Thales Alenia Space and Telespazio are thus doing for Turkey what rival Astrium Satellites of Europe is doing for Kazakhstan in providing a satellite, a training regime and an initial satellite test facility to a nation that has made clear it ultimately wants to be able to build satellites of its own.

The Turkish Scientific and Technological Research Council and Turkish Aerospace Industries built Gokturk-2. Ergun said the entire Gokturk-2 project is valued at 140 million Turkish Lira ($79 million).

This story was provided by, dedicated to covering all aspects of the space industry.

* Families welcome new police inquiry into soccer tragedy

* Police to probe "truly shocking" new evidence

LONDON, Dec 19 (Reuters) - The deaths of 96 soccer fans in the 1989 Hillsborough stadium disaster will be reinvestigated after Britain's High Court quashed the original inquest verdicts on Wednesday due to a "profound and almost palpable" sense of injustice.

The government also set up a new police investigation into Britain's worst sporting disaster, in a victory for victims' families who never accepted the official version of events and have campaigned for more than 20 years for "Justice for the 96".

Home Secretary (interior minister) Theresa May said an independent panel's report into Hillsborough had uncovered "truly shocking" evidence that must be investigated.

The Liverpool supporters died after a crush in an enclosed, overcrowded terrace at the stadium in the northern city of Sheffield on April 15, 1989 during an FA Cup semi-final against Nottingham Forest.

An independent inquiry set up by the last government concluded in September that police tried to deflect the blame on to fans to cover up their own incompetence. It suggested 41 lives could have been saved if the emergency response had been quicker.

The original inquests found the deaths were "accidental". However, the government's chief legal advisor, Attorney General Dominic Grieve, applied to the court to quash those verdicts after the Hillsborough panel published its damning report.

Overturning the verdicts, Lord Chief Justice Lord Judge, the country's most senior legal authority, said there had been a "profound and palpable belief that justice has not been done and that it cannot be done without and until the full truth is revealed".

"We must record our admiration and respect for their determined search for the truth about the circumstances of the disaster ... which - despite disappointments and setbacks - has continued for nearly quarter of a century," he said, according to the Press Association.

INQUESTS 'UNSOUND'

Grieve welcomed the ruling and said the original inquests had been "fundamentally unsound".

"I hope and trust that new inquests will provide a better understanding of how each of their loved ones died, and bring closer the justice for which they have fought so hard," he said.

The independent panel, set up in 2010 by the last Labour government to examine all the public paperwork relating to the tragedy. It found that senior police edited their officers' statements from the day to try to limit the damage to their reputation.

Prime Minister David Cameron said in September that evidence suggesting police tried to defect the blame for the disaster onto Liverpool fans to cover up their own flawed response amounted to a "double injustice".

The tragedy shocked the world and led to a new era of modern stadiums across Britain. Banks of terracing and metal fences around pitches disappeared, replaced by seating and better security.

The new police investigation will be led by Jon Stoddart, a former chief constable of Durham police, northeast England.

"The findings of the Hillsborough Independent Panel were truly shocking, but while the families have now been given the truth, they have not yet received justice," May said.

Campaigner Trevor Hicks, who lost two teenage daughters at Hillsborough, told the BBC the developments were a "huge step for the families".

"Justice is on its way - I think a lot of us are going to have a much happier Christmas," he said.

Lilly said Wednesday that it will launch another late-stage study of the drug, solanezumab, no later than next year's third quarter. The company's stock slipped in midday trading.

The Indianapolis drugmaker said in August that the intravenous treatment failed to slow memory decline in two late-stage studies of about 1,000 patients each. But scientists saw a statistically significant slowing when they combined trial data. Pooled results found 34 percent less mental decline in mild Alzheimer's patients compared with those on a fake treatment for 18 months.

Researchers also saw a statistically significant result when they examined a subgroup of patients with mild cases of Alzheimer's disease.

Lilly will attempt to confirm that benefit in the new trial before it seeks U.S. regulatory approval, something analysts widely expected the drugmaker to do after it announced the initial results.

The additional study could help Lilly build a better case with U.S. regulators. But it will likely take a few years to learn the results. Researchers will have to measure over time a patient's rate of cognitive decline, which involves the ability remember things.

Citi analyst Andrew Baum said in a research note the study will likely be completed by the second half of 2015. He expects the drug, if approved, to launch in 2017.

Eli Lilly and Co.'s share price fell $1.60, or 3.2 percent, to close at $49. It's still up 16 percent since the company announced the initial results in August. Baum said Wednesday's news helped shake out some of the "false hope" for a near-term approval of the drug that had inflated the stock price.

Drugmakers have tried and failed for years to develop successful treatments for Alzheimer's, and patients and doctors are anxious for something that can slow its progression.

Solanezumab was one of three potential Alzheimer's drugs in late-stage testing. Bapineuzumab, being developed by Pfizer Inc. and Johnson & Johnson's Janssen Alzheimer Immunotherapy unit, gave disappointing results in two studies last summer.

A pivotal study of the third Gammagard, by Baxter International Inc. will wrap up at the end of this year. Results are expected in the first or second quarter next year.

Solanezumab binds to beta-amyloid protein, which scientists believe is a key component to sticky plaque that basically gums up the brain of a patient with Alzheimer's disease. The drug is designed to help the body remove the protein from the brain before it can form that plaque.

Current treatments like Pfizer Inc.'s Aricept try to control symptoms of the disease. Analysts have said a treatment that does more than manage symptoms such as memory loss, confusion and agitation could be worth billions of dollars in annual sales. But drugmakers first have to spend a massive amount on testing and clinical development to produce such a drug.

"When you go for the blockbuster, you have to pay for the blockbuster, either in money or time," WBB Securities analyst Steve Brozak said regarding Lilly's announcement.

More than 35 million people worldwide have dementia, a term for brain disorders that affect memory, judgment and other mental functions. Alzheimer's is the most common type. Many Alzheimer's patients typically live four to eight years after diagnosis, as the disease gradually erodes their memory and ability to think or perform simple tasks.

In the United States, 5.4 million people have Alzheimer's, which is the country's sixth-leading cause of death. The number of Alzheimer's patients in the U.S. is expected to jump to 16 million by 2050, and costs for care are expected to skyrocket.

___

AP Chief Medical Writer Marilynn Marchione in Milwaukee contributed to this report.

"For many women with PCOS, (the risks) will be small," said Dr. Christopher McCartney, an associate professor at the University of Virginia School of Medicine in Charlottesville, who was not involved in the new work. "For some women, they might be high enough to say we really shouldn't use the Pill, such as for women over 35 who smoke."

The three to five percent of women in the U.S. with PCOS have a hormone imbalance, which can lead to irregular periods, extra hair growth and higher risks for being overweight and developing hypertension and diabetes.

They are often treated with oral contraceptives, many of whose labels already include warnings about blood clots. A blood clot, also called venous thromboembolism, can be deadly if it spreads to the lungs, although none of the cases of blood clots in the study were fatal.

Because women with PCOS already tend to have more heart disease risk factors, researchers wanted to see if the Pill adds any additional risk.

They used medical and pharmacy information from a large health insurance database, including 43,500 women with PCOS.

On average, over the course of a particular year, about 24 out of every 10,000 women with PCOS taking the Pill were diagnosed with a blood clot, compared to about 11 out of every 10,000 women without the disorder using the contraceptive.

"Am I particularly surprised by the findings? No," said Dr. Shahla Nader-Eftekhari, a professor at the University of Texas Medical School at Houston, who treats women with PCOS but was not involved in the current study.

OBESITY PLAYING A ROLE?

The study, published in the Canadian Medical Association Journal, could not say for sure why women with PCOS are more likely to have a blood clot.

McCartney said he suspects that obesity has something to do with it.

At the beginning of the study in 2001 the percent of women with and without PCOS who were obese was the same - about 13 percent - but by the end of the study in 2009, 33 percent of women with PCOS and 21 percent of women without the disorder were obese.

"I really think that could be something that's contributing to the risk," McCartney told Reuters Health.

"Weight not only contributes to the risks associated with the Pill, it also contributes to some of the symptoms of PCOS and some of the metabolic problems associated with PCOS," he added.

McCartney pointed out that the risk of developing a blood clot, even among women with PCOS, is still considered small, and shouldn't necessarily discourage women from taking the Pill.

Steven Bird, the lead author of the study and an epidemiologist with the U.S. Food and Drug Administration, said that the importance of the findings is to raise awareness among women and their doctors that there is an increased risk for them if they take the Pill.

"Although the risk is small, prescribers should consider the increased risk for blood clots in women with PCOS who are prescribed contraceptive therapy," Bird told Reuters Health by email.

McCartney agreed, and added that it's also a good reminder for doctors of women with PCOS to discuss the importance of maintaining a healthy weight.

SOURCE: http://bit.ly/VgvaOa Canadian Medical Association Journal, online December 3, 2012.

"There are a number of indications that the economy is getting weaker and not only in the indebted southern European countries, but across the euro zone," Liikanen was quoted as saying in an excerpt released on Saturday.

"Economic developments are causing us concern," he said, adding that no-one is immune to the effects of the debt crisis. "Not even the German economy."

Liikanen did not say what action should be taken to deal with the slowdown, and a Reuters poll this week found economists are evenly split on what else - if anything - the ECB will do.

Thirty-nine economists said the ECB would hold its main refinancing rate at its current record low of 0.75 percent through the first quarter of next year, while 38 believed it would cut the rate to 0.5 percent.

The ECB on December 6 predicted the euro zone economy would shrink again in 2013. Its projections for economic performance ranged from a 0.9 percent drop to a meager 0.3 percent rise next year, suggesting contraction is far more likely than not.

It had previously penciled in a range of -0.4 percent to +1.4 percent for the euro area economy.

On Dec 7. the central banks of Germany and Austria forecast barely any economic growth in 2013, with the Bundesbank flagging risks of a recession in the euro zone's biggest economy as the debt crisis hits the bloc's core.

(Reporting By Erik Kirschbaum; Editing by Hugh Lawson)

In the past, pharmaceutical companies could launch a high-priced drug with little push back. But now, there is more pressure from insurers as well as doctors to justify using drugs that provide only incremental benefits. Products that offer clear-cut advances in treatment, however, still command premium prices.

The pressure on costs is likely to accelerate. The U.S. Affordable Care Act includes several provisions aimed at improving the value of healthcare, including paying hospitals for the quality of care rather than the quantity.

"It's a sign of the times," said Mark Mynhier, partner, healthcare industries advisory at PricewaterhouseCoopers PwC. "We are in fact in a significantly financially challenging environment."

Four-fifths of U.S. health insurers recently polled by PwC now require evidence of cost savings or a clear clinical benefit to include new products on their lists of covered drugs.

Doctors at New York's Memorial Sloan-Kettering Cancer Center decided in November not to use Zaltrap, a new $11,000 a month colon cancer drug, because it has a "modest" impact on survival, works no better than Avastin, a similar but cheaper competitor, and has worse side effects.

Sanofi SA, according to the hospital, responded by offering the drug to all health providers at a 50 percent discount to its wholesale price.

The Manhattan cancer center still does not include Zaltrap on its list of available drugs. Sanofi and Regeneron, which helped develop and also sells the drug, both declined to comment.

"In order to warrant the price, you are going to have to have better overall survival," said Rhonda Greenapple, chief executive at Reimbursement Intelligence, a consulting firm specializing in medical reimbursement.

Linking value to patient outcomes - mainly a drug's impact on survival - is particularly important in oncology, where treatment costs can total tens of thousands of dollars a year.

"In cases where there are co-pays, they really do effect the consumer," Mynhier said. "Patients are saying 'I can't afford to pay 10 or 20 percent of a $100,000 therapy.'"

WellPoint Inc, the second-largest U.S. health insurer by market value, said it is increasing the amount it pays for less expensive generic cancer drugs as an incentive for doctors to use them.

PROFIT OPPORTUNITY FOR DOCTORS

Infused cancer medications are first purchased by doctors, who then bill insurers for reimbursement. That is different from pills and other oral drugs for which doctors typically write a prescription filled at a pharmacy.

The offer of a 50-percent discount to Zaltrap's list price is a potential windfall for doctors. Patients, health insurers, the government or anyone else who pays healthcare bills would not see a benefit.

"At the very least it is an incentive for doctors to use the drug," said Dr Leonard Saltz, chief of Memorial Sloan-Kettering's gastrointestinal oncology service. "And I find that concerning."

He noted that rebates and discounts for cancer drugs are not uncommon, but said this is the first time he is aware of a verbal across-the-board offer for a half-price discount.

The average U.S. oncologist, according to the Journal of Oncology Practice, generated revenue of nearly $5 million last year, of which drug costs accounted for nearly $3 million.

To combat the temptation of wider profit margins, health plans in recent years began reimbursing doctors for cancer drugs based on average sales prices, rather than wholesale prices. But for a new drug such as Zaltrap, reimbursement is based on the full list price until a sales track record is established.

WellPoint said it is raising reimbursements to independent oncologist on a range of generic chemotherapy drugs by as much as 140 percent.

"These drugs are the backbone of many therapies recommended by the National Comprehensive Cancer Network (NCCN) ... and typically much less expensive than their brand counterparts," said Jennifer Malin, WellPoint's medical director oncology.

She said the goal is to shift the system away from what has been a largely drug-revenue based practice model, to one where oncologists are paid for providing good patient-centered care.

"The payers are looking at the quality data and demanding incremental value over existing products," said Dan Mendelson, chief executive officer of consulting firm Avalere Health.

"COKE DIDN'T WORK, SO LET'S TRY PEPSI"

Zaltrap was approved in August by the Food and Drug Administration after a study found it improved survival, in combination with chemotherapy, by 1.4 months in colon cancer patients who had stopped responding to chemo.

That is the same benefit seen with Avastin, sold by Roche Holding AG for around $5,000 a month, or about half the price of Zaltrap.

NCCN guidelines say either one or the other drug should be used, not both, but Dr Saltz said most Zaltrap use is likely in patients who were already treated with Avastin - a practice that insurers will eventually stop.

"It's like saying Coke didn't work so let's try Pepsi," he said.

As scientists unravel the biological underpinnings of cancer cells, new targeted therapies are being developed, but the process is expensive.

Dr. Saltz said the solution might just be to walk away from drugs with small, incremental benefits.

"We simply can't afford to pay these very, very large amounts for drugs that offer most people very small benefit," Dr Saltz said. "We haven't figured out how to rein it in."

(Reporting By Deena Beasley in Los Angeles. Editing by Andre Grenon)

Patterson's protagonist, homicide detective and forensic psychologist Alex Cross, has already been adapted onto the big screen by actor Morgan Freeman in 1997's "Kiss the Girls" and the 2001 thriller "Along Came a Spider".

For the latest film, out in U.S. theaters on Friday, Patterson picked writer-director-actor Tyler Perry to play the lead in an adaptation of "Cross," the 12th book in the series, where the detective pursues vicious serial killer, The Butcher, played by Matthew Fox.

Patterson sat down with Reuters to talk about the new film, the casting of Perry in the lead role, and why he continues to adapt his work on the big and small screens.

Q: Your Alex Cross book series is very successful, with the 20th installment due out next February. Why do readers like him?

A: "He's unusual as these kind of characters go because he's very compassionate. He's a family person. The standard of these movies is the lone wolf cop/detective/private eye who lives a cynical life, goes home, smokes, drinks himself to sleep, has women trouble, etc. This is a different character. He's an African-American guy who is well-educated and is very family oriented. He's raising his kids and doing a good job. The grandmother is involved in the household."

Q: Did you have a lot of influence over the film version of "Alex Cross"?

A: "On this one, a lot. I had cast approval, director approval. I own 40 percent of the movie. But I'm easy. I'm the best partner you could ever want. I'm tough in the sense that I know what works and what doesn't. I have this gut about what people want to read about, what they want to see on the screen. And I have the luxury of being able to do whatever I want to do."

Q: Tyler Perry tends to direct, write, produce and act in his own projects. Were you nervous that he might not be able to relinquish control and be simply a work-for-hire?

A: "We went to Atlanta to meet him and he said, 'James, I wouldn't attempt this if I wasn't sure I could pull it off. I have too much to lose and I wouldn't try this, but I'm sure I can do it. And I'm going to submit to another director.' And he did. There was no ego. He was all business. And I think he pulled it off. People are going to go, 'Wow.'"

Q: What do you think of the finished product?

A: "The movie has the suspense you would expect, but what separates it (from others in that genre) is, it's emotional. I think it would have been nice to have a couple million more (dollars) to make the movie. I think the opening could have been better, an opening scene that really established the killer and the girl he had taken - a strong dialogue scene that would have had context for the chase."

Q: You have a number of books adapted to film, as well as TV movies and television series. Is that important to you?

A: "My thing with movies is very simple. I don't need the money, but I like to do anything that I can look at and go, 'That's good.'"

Q: Have you been able to say that with the bulk of the adaptations?

A: "I look at the 'Women's Murder Club' TV series (that ran from 2007-2008) and go, 'That was bad.' Other than (star) Angie Harmon, the casting was shaky in terms of chemistry."

Q: Yet you continue to try....

A: "Because I'm a movie freak! I see everything. 'The Master', 'Taken 2', 'Hotel Transylvania'. I see anything, any day of the week. My father grew up in the poorhouse ... (and) my mother cleaned the poorhouse. So growing up, for my one sister and I, going to movies on Saturday, that was it. And it was double features. I remember how exciting it was. That was the big thing for the week."

Q: You also write children's and young adult books like "Middle School" and "Maximum Ride." Is that an important audience for you to reach?

A: "It's not the school's job to get the kids reading. It's the parents' job, but parents won't do it. They just won't bite the bullet and say 'you gotta read.' So that's what got me into it. If we don't get kids reading, our country is going to be in a worse mess than it is."

(Reporting By Zorianna Kit; Editing by Piya Sinha-Roy and Maureen Bavdek)