Transcripts For WMPT The NewsHour With Jim Lehrer 20091120

captioning sponsored by macneil/lehrer productions >> lehrer: good evening. i'm jim lehrer. on the newshour this friday, the lead story-- new guidelines for cervical cancer screening. betty ann bowser begins. then, after the other news of the day, margaret warner puts the recommendations in context; spencer michels details the budget crunch and cuts at california's universities. >> i'm to the going to be able to go to school next year. >> lehrer: mark shields and michael gerson, filling in for david brooks, offer their analysis; and jeffrey brown examines an oprah ending and beginning. >> i love this show. this show has been my life. and i love it enough to know when it's time to say good-bye. major funding for the newshour with jim lehrer is provided by: >> what the world needs now is energy. the energy to get the economy humming again. the energy to tackle challenges like climate change. what if that energy came from an energy company? every day, chevron invests $62 million in people, in ideas-- seeking, teaching, building. fueling growth around the world to move us all ahead. this is the power of human energy. chevron. >> we are intel, sponsors of tomorrow. wells fargo advisors. together, we'll go far. >> and by bnsf railway. and monsanto. and by toyota. grant thornton. >> and by the bill and melinda gates foundation. dedicated to the idea that all people deserve the chance to live a healthy productive life. and with the ongoing support of these institutions and foundations. and... this program was made possible by the corporation for public broadcasting. and by contributions to your pbs station from viewers like you. thank you. >> lehrer: medical experts recommended new guidelines today on testing for cervical cancer. it was the second major change>f this week involving cancer screening in women. newshour health correspondent betty ann bowser has our lead story report. >> reporter: for years, american women have been advised to have routine pap smears to screen for cervical cell abnormalities and for h.p.v., the human papilloma virus. it causes cervical cancer and will be responsible for more than 11,000 cases and 4,000 deaths in the u.s. this year alone. but today, the american college of obstetricians and gynecologists offered new guidelines. they recommend that: women wait until they are 21 years old before having their first pap smear test, whether or not they are sexually active; that women aged 21 to 29 get tested every 2 years, instead of annually; and that those 30 and older with three consecutive normal pap results should get screened every three years. women between 65 and 70 can quit having the tests entirely, if they've had 3 or more consecutive negative tests and 10 years with no abnormal results. in effect, dr. deborah smith says, there was too much risk for too little gain in the old guidelines. she's a fellow at the american college of obstetricians and gynecologists, and a practicing gynecologist herself. >> over the past 10-15 years, there's been more aggressive treatment of pre-cancerous lesions, or lesions that would not develop into cancer. lesions that are changes in the pap smear, but don't actually progress to developing cervical cancer. and what we've found out is that, when young women are subjected to the treatment, it actually damaged the cervix. >> reporter: the reaction today among doctors and patients we talked to was mixed. >> so, i wanted to talk to you a little bit about the new pap smear screening recommendation. >> reporter: dr. nancy gaba is an obstetrician and gynecologist in washington, d.c. she already advises patients in their 30's to get a pap smear every three years as long as they've had a normal pap and negative hpv test. >> cervical cancer, and it's precursors, are actually a very slowly progressive disease. so by spreading out the intervals between screenings, you're not really compromising the patient's care, because it's very unlikely there would be anything significantly different from one year to the next, or even two years. >> reporter: despite the change to their routine, several patients said it makes sense. >> i feel very comfortable with my physician, and if she recommends that, because of my age and my medical history, that i only need a pap smear every three years, then i'm comfortable with that. >> reporter: this is the second time this week that a panel of experts has made major recommendations about women's health screening for cancer. on tuesday, a government appointed task force advised women under 50 to scale back on routine mammograms. >> i think we would be late in diagnosing cervical cancer in a number of patients that might have had it diagnosed sooner. >> reporter: and dr. richard beckerman, who has been treating washington, says he understands the science behind the new screening guidelines, but he worries it will drive patients away. >> when you're looking at women under 50 a lot use me as their primary care physician so i'm the only one who is doing their breast, pelvis examinations, sometimes checking their lab work, listening to the heart and lungs, checking their blood pressure. i think we're going to lose a lot of women, to follow up if they were otherwise coming in on a regular basis. >> reporter: 26-year-old ellen rockower has her concerns. >> you know if you catch it early on things are gonna be ok, if you don't catch it, leads to more problems, so if there's not enough screening that might just make for more problems. >> reporter: the american college of obstetricians and gynecologists said today there's more to routine exams than just a pap smear, and it urged women to continue getting regular checkups. >> lehrer: we'll have more on cancer screening later in the program. in other news today, senate democrats won over a key moderate as they try to bring health care reform to the floor. senator ben nelson of nebraska said he would vote to begin debate on the bill. it's estimated to cost $848 billion over 10 years. majority whip dick durbin would not say yet if he has the 60 votes to overcome republican opposition and bring up the bill. >> i have only been asked 30 or 40 times, do you have the 60 votes. we're not assuming a thing. we're working hard to bring all democrats together for the 60 votes necessary to proceed to this historic debate. it would be a real break if one republican would join us and say yes, this is an issue worth debating. >> lehrer: republican >> lehrer: republican jon kyl charged the democratic bill is too expensive, and cuts medicare and expands government too much. he said senate majority leader reid is pushing something the public does not want. >> in view of that, it would be our hope that our more moderate colleagues on the democratic side would respect the wishes of their constituents, rather than do the bidding of harry reid. because at the end of the day, this health care legislation will impact every american in extraordinary ways. and we believe in very negative ways. >> lehrer: the vote on allowing senate debate to begin on the bill is tentatively set for tomorrow night. the senate ethics committee has admonished senator roland burris for "misleading" statements. the illinois democrat fills the seat once held by president obama. but he has given changing versions of his contacts with the man who appointed him. governor rod blagojevich was later ousted over allegations he tried to sell the seat. the u.s. and 5 other nations urged iran today to reconsider a u.n. proposal on its nuclear program. the iranian regime balked this week at shipping much of its uranium abroad for additional processing. in berlin, germany, the head of the u.n. nuclear agency, mohamed el baradei, said he still sees room for a deal. >> i would hope definitely that we will get an agreement before the end of the year. and that is what i think, you know, a number of partners have indicated that, you know, they would like to give iran an opportunity to engage at the end of the year. i would hate to see that we are moving back to sanctions >> lehrer: in washington, a state department spokesman said the u.s. has not given up hopes of an agreement. in afghanistan, a suicide bomber killed 16 people, and wounded at least 23 more. the attacker blew himself up on a motorcycle in the western city of farah. it happened 50 yards from the provincial governor's compound. separately, a lawmaker with close ties to president karzai escaped being killed when his convoy was bombed. officials in pakistan reported a missile strike by an unmanned u.s. drone killed eight militants. the target was a taliban compound in the northwest. the strike came as pakistani prime minister gilani met with visiting cia director leon panetta. gilani warned an influx of u.s. troops in afghanistan could push more insurgents across the border to pakistan. the worst flooding in memory engulfed parts of britain today. the heaviest rain ever recorded in northern england fell on the lake district, especially around the town of cockermouth. we have a report from jane deith of independent television news. >> it was a worst-case scenario, this was beyond what anyone here could believe. hundreds of people lifted off the roofs of their homes. down below the water rose to eight feet. it was surging through streets and houses at 20 knots making it too dangerous for boats to get to people. over near the coast policeman bill barker was working on a bridge over the river when the bridge buckled and he was swept away. it came after a desperate and frightening night here. area helicopters were working in the pitch-black and 90 mile an hour winds while life boats and mountain rescue teams reached people where they could. even now 24 hours after the maina, the river is still absolutely tearing through the town. and you can imagine how frightening it would have been when it poured over that wall and went into people's houses at chest height. it is easy to understand why many of them had to be rescued from their roofs by those sea king helicopters. the government has promised cambria it will help pay for the cleanup. >> above a certain threshold we pick up 90% of the cost of that. so it depensd, it's early days yet because we're to the going to know exactly how much the cost will be. until the floodwaters recede and people can really assess the damage. but we've activated it today in recognition of the seriousness of this emergency. >> reporter: and this emergency isn't over. the ref was still trying to reach people who were trapped this afternoon. and hanging over everyone is the awful thought that the area could have to go through all of this again. more heavy rain is forecast tonight. >> lehrer: there was also wide crystal burman ucla student "i'm >> lehrer: there was also widespread flooding in scotland and ireland. on wall street today, the dow jones industrial average lost 14 points to close at 10,318. the nasdaq fell more than 10 points to close at 2146. for the week, the dow gained half a percent. the nasdaq fell one percent. and still to come on the newshour tonight: college cutbacks; shields and gerson; and oprah says goodbye. that follows context for the new recommendations on cervical cancer screening. margaret warner is in charge. >> warner: science and medicine have long grappled with the trade-offs involved in cancer screening. what's not clear is whether today's new pap smear guidelines, coupled with another panel's recommendations earlier this week to scale back mammograms for women under 50, mark an important milestone in that debate. we explore that now with: dr. douglas kamerow of georgetown university. he's a former assistant surgeon general and chief scientist at rti international, a research institution. and dr. julie gralow of the american society of clinical oncology, and she is the director of breast oncology at the seattle cancer care alliance. o wellcome to you both. doctor, the fact that we've had these two new sets of guidelines in the same week, is in just a coincidence or is there some new thinking going on more broadly about how to at least weigh the trade-offs in cancer screening? >> well, the answer to your question is it's a coincidence. two different organizations. they have nothing to do with each other. they came out with these at that time. but you're right. it raises the point, what is a good screening test and who gets it and when do you get it. >> okay. how would you define that? and is there -- is there a consensus emerging that maybe, this seems to fly in the face of everything we've been told about the value of preventive screening, preventive care, early. how do you jibe those two? >> well, it's nice to think that all prevention is good. but the answer is it isn't. you need to have a prove entest. and you need to have a disease that is amenable to screening. both these cases, breast cancer and cervical cancer we have a test that is pretty good at being screamed, usually a long asymptomatic. especially in cervical cancer. but you have to have an accurate screening test. >> doctor, what is your thought about the sort of broader message from these two new guidelines this week? >> i think an important message is that we need to be talking to our individual patients about the risks and benefits to be gained and to be lost with all of these procedures. i think these are two very different cases, cervical cancer, picked up by a pap smer is found as usually a very preinvasive phase that will take many years to evolve into a dangerous invasive cancer. and these guidelines today don't really surprise us. we have a lot of new information that has come into play since some of the older guidelines reflecting annual screening pap smears were made. >> but you feel it is different with breast cancer. >> breast cancer we've got good, solid randomized trials of mammography or not that show that we save lives. most breast cancers picked up on mammograms are already invasive. meaning they can spread throughout the body and they can lead to death. we don't have as long a preclinical phase as we do in cervical cancer where we can watch it for a while or we can have a few years. most breast cancers picked up even biannual screening mammography have already moved to the invasive, the risky, life threatening phase. >> so doctor, why would this panel conclude that for women under 50 routine exams are not indicated? >> well, i think you heard when you last talked about this with the co-chair of the panel, i'm not on this panel, that they probably didn't word their recommendations as well as they could have. and they didn't say not to screen under 50. what they said is what the doctor said, is that for the best evidence, for women 50 and over is to get routine mammograms, pretty much everybody. but for people younger than that, women younger than that, they need to talk to their doctors and discuss it so they can understand what the benefits are and what the risks are. >> i guess what i'm asking here though is there a conflict between an approach that says the statistics show that only one case in 1900 in a woman under 50 actually turns into a fatal form of cancer. so therefore cost benefit, risk benefit analysis suggestions don't do that routinely. and over 50 it is 1 in 1300. that approach versus what many americans and many human beings feel which is we should go to every step we can to save every, any life we can. >> well, i think that first of all it's not a decade kind of thing. that was done for convenience and it's arbitrary. the risk is a continuum. and i think everyone agrees on what the science says which is as you get older as a woman, you are more likely to have breast cancer. and your breasts are easier to examine so the mammography is better as you get older. but that said, if you could have any chance in one in a million you wouldn't do it, right. so if at's not something you do in one in a million, where do you draw the line, that is just the question, is it one in 14,000, 6,000, 200, where do you draw the line. >> doctor? >> i think we're all trying to practice evidence-based medicine here. but what we where seeing is that depending on your perspective, you view the evidence, the science differently. if you take a public health policy standpoint where you are looking at how many exams do we need and how many biopsies do we need to do to find a case of breast cancer, you would weigh out like the u.s. preventive services task force. if you are a clinician in the trenchs who struggles with identifying women 40 to 50 and knowing who really is at increased risk, then you are probably going to lean toward doing the screening regularly and all women because we don't know how to really assess risk in that group very well. >> what does the furor over this, doctor, say about the prospect of reshaping our health care delivery system so it is, quote, more evidence-based. >> as the doctor says, it depends on which end you look at the evidence from. >> that's right. it is going to be an interesting challenge as we try to rationalize our health system which right now is a crazy quilt system where people get what they get. we've got no budgets. and you just get what you get. what is going to happen when we try to make it a little clearer what makes sense and what doesn't make sense. it's going to be a challenge to do that. and this to some extent may give us a picture of what happens. because we're used to, in this country, of getting1x everything we can afford. and some time that is probably going to have to stop. these may not be the perspect examples of that. but they do make people think about what is worth it, what is not worth it. what makes a difference not just in terms of money but in terms of health and outcomes. and inconvenience and side effects. >> doctor, to what degree do recommendations like this drive insurance company coverage decisions? now i should point out to our viewers that i think in every state but utah it's actually the law requires coverage 6 mammograms for women over 40. so that particular case probably is not, it's to the going to be effective. but in general, the recommendations like this ultimately drive insurance company decisions. >> it would be a tragedy if in the end either insurance companies or government legislation were what decided what is a very important discussion and decision between a physician and a patient. although you are correct that virtually all of the u.s. states require coverage for screening mammography beginning at age 40, that doesn't mean that that is what will be recommended. and so we have to be careful that we, this could be a very healthy dialogue. we have to be careful that we don't turn patients off, that we don't give a message that mammograms and cervical cancer, oh we're not even sure if they work or not, you know, the screening for cervical cancer, so i just won't get it at all. i do like the comment made earlier that the gynecologists are the ones doing a lot of the primary care for our younger women. and if they get the message, you only need your pap smear once a year, that doesn't mean you don't need a lot of your other health screens on an annual basis. and so that would be a poor message to come out of all of this as well. >> final response for you, is there a danger that that is the message some women will take away from this? >> i think that that is a concern. but the important thing is that women or men talk to their doctors about what is important for them and useful for them and will make a difference to them to keep them healthy and improve their health. >> but to a lot of women or men going for that test is short of a shortcut. you think of it as a shortcut. >> but as the doctor says it is not the linchpin. you should be seeing your doctor regular, primary care doctor regularly to get health maintains kinds of things not tied to a specific test. >> doctor, thank you both. >> lehrer: next tonight, tuition hikes and protests at california's public universities. newshour correspondent spencer michels has our report. >> reporter: it was shades of days past at the university of california at berkeley today-- students occupying a building and barricading themselves inside. >> this is not your '60s berkeley sit-in. >> reporter: this time, they weren't protesting war, but a massive tuition hike approved yesterday. >> can't take it no more! >> reporter: similar protests erupted yesterday as hundreds of students marched at the campus of ucla in los angeles. but student outrage was not enough to dissuade the board of regents that governs the 10 schools under the university of california umbrella. faced with declining state support and an unbalanced state budget, the members voted to raise undergraduate tuition by $2,500 to more than $10,000 per year across the u.c. system. it now costs three times as much as it did 10 years ago to attend university of california schools, and that's not including housing, board and books. as a result, many of the more than 200,000 students in the system say they may be priced out of an education. >> my sister is starting college next year. we can't afford it. >> reporter: so what do you do? i'll just have to take out a >> i'll just have to take out a huge loan and be paying it off the rest of my life. >> reporter: the anger played out in different ways as the regents convened thursday. some students peacefully occupied a building on the ucla campus. others faced off with police outside the board meeting and briefly tried to enter the meeting hall. board members and staff were caught inside for hours as the protests continued. the university system president, mark yudof, emerged later under guard. the tuition hike is part of california's larger budget drama. the state is $6.3 billion in the red this year, and faces shortfalls of $20 billion a year over each of the next five years. that's forced the university system to absorb major funding cuts and to put a partial freeze on hiring, as some professors are being lured by rival universities. we caught up with president yudof today in the san francisco bay area. >> well, i think it does hurt, but we have few choices. we have half as much money to spend per student from the state as we did 1990.-- $16,000 in 1990, less than $8,000 today. library hours shorter. we've laid off thousands, probably lay off more. we have furloughs, fee increases. >> reporter: some students and faculty are saying salaries for administrators are too high. >> those are just words, and they're not accurate. we're not overpaid. it's flat out not true. if you make less that $70,000 per year, under our proposal, you don't pay one dime in tuition, what we call fees, not a dime. and if you're up to $120,000, you get substantial break. >> reporter: but that argument has failed to stop ongoing marches. in late september, a 10,000- strong rally took place at berkeley, the system's crown jewel. >> we need to make a statement about valuing education. we also need to be in solidarity together. >> reporter: on a campus known for its history of protest, faculty and students alike staged a sit-in to protest spending cuts and fee increases. among the speakers was french professor ann smock. >> the value of it as a public institution is definitely threatened dramatically now, largely because of the fee hikes >> reporter: the systemic problems threaten the university's global reputation, says smock. it's a reputation enhanced over the years by a raft of nobel prizes and other accolades. president yudof insists they will endeavor to maintain quality amid the budget crunch /many of businesses. our research business is growing astronomically. we're doing well. our hospitals are full. we have a core problem-- who pays the english department? we have to have it. who's going to pay sociology, humanities? that's where we're running into trouble. >> reporter: the grim budget forecast probably mean more tough times ahead for the university system, and for the students being asked to pay even more. >> lehrer: now, the analysis of shields and gerson. that's syndicated columnist mark shields and "washington post" columnist michael gerson. david brooks is off tonight. mark, are there going to be 60 votes tomorrow night for the health-care bill to go to the floor of the senate? >>. >> lehrer: did i say house. >> the senate will not consider it unless there are 60 votes. so there will be 60 votes. >> lehrer: do you agree. >> absolutely. i talked to republicans on the hill today. they actually -- fully expect that democrats will vote to consider health care even if they are not sure what the details are going to be. >> lehrer: why will the republicans not vote to consider it at all? >> well, i think that there is a party line discipline on this issue. i think they believe that the approach is fundamentally flawed, not just at the margins. so there is very little --. >> lehrer: why debate it. >> exactly. >> lehrer: yeah. what other major obstacles going to be to get from past tomorrow night to actually to get to enact something by the senate first and then beyond? >> well, certainly, jim, the there are significant differences but i don't think life or death differences between what passed the house, what passed the senate it will come down to financing, to the exact form of the public option, a public plan that is available to provide insurance with the private insurance companies. but i think that quite honestly that senator read has maneuvered this quite well and i think that he has disciplined democratic majority behind him. they do fervently want to get republican support. senator snow, they really, that has been -- important, that sense of bipartisanship. but that may not be. i think the will is there and i think the imperative is there to pass it. >> lehrer: do you see 60 votes. in other words, it will still take 60 votes to enact something on the senate. do you see 60 votes. >> starting the debate is an easy part. ending it with cloture at the end is the hard part and you need 60 votes to do that, that is absolutely true. and there are a number of obstacles and they get progressively higher. because the house could make votes that were largely symbolic on abortion or other issues because they knew it wasn't going to be in the final bill. the senate doesn't really have that option in a certain way. it becomes more real in this. abortion is going to be an interesting thing to watch. because somehow senator barbara boxer and ben nelson who has 100% pro-life record has to agree on something. that will be interesting to watch. financing is going to be interesting because there is a lot of new taxes in here that come from medicare payroll taxes, okay. the difficulty there is a lot of people who want to do medicare reform eventually would like to use that money to do medicare reform. not to spend it on the broader health-care plan. so it's actually undermining future reform on these issues. and a lot of the cost that is projected by the cbo here is really, i think, based on tricks. i mean the real costs don't start until five years into this budget window which makes a lot of the discussion about cost really underestimating the cost when it is fully phased in. >> lehrer: do you see obstacles similarly? >> i don't. i mean i do dissent with michael on the house. the house would not have passed the bill without the stupak amendment. >> lehrer: that is the abortion. >> that's right, one out of four democrats in the house is pro-life so they could not have passed it because they wouldn't get any republican votes. they had to pass it with democrats. >> lehrer: that amendment prohibits the use of federal money to fund an abortion. >> except in the case of rape, incest or the life of the mother. and that takes the high language which has been approved annually every year by the congress since 1976. and incorporates it in. that's -- the question becomes whether public money can be used in any form and the stupak amendment, forbids any public money being used, and whether it is actually to purchase abortion coverage you will need probably a separate rider under the plan. that's going to be --. >> lehrer: so there is still a long way to go on that. >> there, is there. but nancy pelosi who is pro-choice persuaded the pro-choice caucus to go along. and we'll find out. harry reid is doing a modified pro-choice pro-life, mostly pro-life, we'll see how effective he can be in uniting his caucus. >> lehrer: michael, the discussion that we, that marg res -- margaret just ran on the testing, particularly -- exclusive in this case of women's health issues, how does that, does that, do you think that is going to play in, either directly or indirectly into the health care debate? >> it was a total coincidence but i think it does have a consequence when it comes to the health care debate. the reality is we've got a system that in many ways is inefficient and chaotic, health-care system that, you know, doesn't spend money correctly. but when government comes in and rationalizes that system and says these are best interests, okay, it raises questions about the role of government in a variety of decisions. you know, in a new system where the government takes a more central role, would these kind of best practice decisions, you know, have a broader influence? will they be effected by the cost control, you know, imperative that government will face? so you know, raises these questions. at an awkward time. >> lehrer: as one of the doctors told margaret, she didn't want the government making these decisions about the test. >> the republicans were given a gift, an opening. this commission which was totally apolitical, appointed by president bush 25 years, its membership. >> lehrer: the mammogram committee. >> they come up with their plan. and with no sense of timing as to what is going on in the country. and the republicans on the hill who don't have a plan of their own say hey, this is a great opening. what we will do is say this is -- let's be very blunt about it. one out of eight american women gets breast cancer. everybody knows or is related to somebody who has suffered from breast cancer. and the one sense of control control that women have had is regular early mammograms and self-detection. and both of which are sort of undermined and sabotaged by this report. and so no wonder it created an understandable stir and anxiety in the country and especially among women. >> lehrer: speaking about, this is a segue, michael, speaking of anxiety, what do you make of the anxiety within the congress, even among some democrats, about secretary, treasury secretary quitener and what is going on in the economy and in the financial system. an a little bit toward the whole obama administration about this. >> well, it does reveal that there is a certain disconnect between the major issues if in a lot of congressional districts including democratic congressional districts. they're not really talking about climate change very much. they are talking some about health care. but they are mainly talking about jobs. unemployment is the main political problem in america. and the members of the house democrats are going to go into 2010. and they need a real message on this. so there was a minirevolt including among the black caucus in the congress that says look, you guys aren't messaging correctly or sufficiently on the jobs issue. you are talking about things that aren't as directly relevant to my constituents. >> lehrer: do you read it the same way. >> i don't think it's limited to democratic districts. i think the --. >> lehrer: everybody. >> i think it's everybody, universal. and it's not only jobs and unemployment which is an overriding concern. we have double-digit unemployment. >> there a total disconnect between the prosperity and plushness of wall street and the pain of main street. and so the people --. >> lehrer: that is what they brought out with quitener. >> exactly. >> lehrer: they are more than just up set, they are angry. >> they are angry and they look at the government economic policies and they say what got us to this point of chaos and crisis, it was the big banks and wall street. who are the beneficiaries of the economic policy. the big banks and wall street. and who is paying for it? the people in the country who are unemployed. that is the anger. and i think that the sense that secretary quitener has not been as forceful enough in regulation or any of that. i think that is part of it. and the other thing is, jim, there is always a sense of a punching bag in any administration. nobody wants to take on the president. it was done rumsfeld that they took on. and i want to say, got to get ready of the president i take on rumsfeld. quitener is plague the rumsfeld role right now. >> lehrer: what about afghanistan. the president's upcoming decision on that. is he going to make it soon do you think? is it time, has the time come to kind of get it over with. >> he would say it would be within, you know, basically i guess we're talking about days now. and i think --. >> pirro: does that become a problem for him, just the timing of it regardless of -- >> he has gotten some criticism from sources that don't expect to criticize the president in recent past. but no, i think it is necessary for him when he makes the decision that it better be clear, it bet heer be forceful, it better be precis9é the measures of success better be there, the objectives, the timetable, exactly what we are there for, what we are trying to achieve. i think and there has to be a pay for it we are now looking at $1 trillion that we have spent just on the battlefield in iraq and afghanistan. none of it funded. >> how do you read this decision-making. >> well, it's been next week, the decision is supposed to be next week for months now. keeps being put off and off. and the process itself which was supposed to be a model of deliberation, they invited cameras into the meetings to show, we're deliberating on this, has become pretty much a mess. very dysfunctional process. >> lehrer: a lot of leaking going on. >> a lot of leaking of whole classified documents to discredit one side or discredit the other side which is a real disservice to the president. but it reveals a growing gap between military and civilian. it shows fights in afghanistan between our ambassador and the head of the mcchrystal. and ikenberry, our ambassador there, which i think is a very bad sign. and so i think it's revealing tensions in a very dysfunctional process. he has to make a decision soon. >> i'm confident he will make a decision. i mean this is not the first administration to leak. the leaker in washington always leaks, to get either himself elevated or his position heard and everybody in washington said nobody believes in official spokesman. everybody believes in unidentified source. so i think that is what we have got going on right now. >> lehrer: same thing as before? >> i don't think so. these are very, very serious leaks. among, in a national security team that's very divided. designed to discredit other members of that team and determine the outcome. that's different than just self-serving leaks. that's very serious. >> it is a debate which we aren't used to. >> lehrer: thank you both very much. thank you again. good to see you, michael. >> thank you, mark. now, oprah makes a move. jeffrey brown tells the story. >> these years with you our viewers, have enriched my life beyond measure. >> reporter: it was a pure "oprah" moment this afternoon, as oprah winfrey announced that her phenomenally popular and successful daytime talk show will end in two years, after 25 seasons, and that she'll concentrate on creating a new cable channel to be called-- and this, too, is pure "oprah"-- the "oprah winfrey network" or "o.w.n". >> so why walk away and make next season the last? here's the real reason. i love this show, this show has been my life, and i love it enough to know when to say good-bye. 25 years feels right in my bones and right in my spirit. >> welcome to the very first national oprah winfrey show. >> reporter: with some seven million daily viewers, winfrey's show is the highest rated talk show in american television history, as well as the longest running on daytime tv. she's known for celebrity interviews, from michael jackson in 1993... to sarah palin just this week; for some wacky moments that enter popular cultural legend... and for regularly making her own story the focus of the program, as in 1988 when she wheeled in a wagon loaded with fat to showcase her 67-pound weight loss. but her program is only part of the multibillion dollar "oprah" media empire. among other things, she's also a successful tv producer, the force behind dr. phil, rachael ray, and others; a magazine publisher-- in 2004, she launched "o, the oprah magazine," which features her on the cover every week; and a movie producer of films including "precious", which is just opening nationwide today. oprah the entertainer, worth some $2.7 billion, also notably got herself involved in politics and, by all accounts, showed some of her larger influence when she publicly supported president obama in last year's campaign. this afternoon, some faithful viewers watched her announcement at a northern virginia spa. >> wow. i can't even remember not watching oprah. i remember going home from high school to watch her. she wasn't stuffy real, more relatable to me as someone in high school than phil donahue, who was the only person on at that time. she has it there in the studio, but it also comes across the camera, and it takes talent to do that. >> reporter: oprha's move to cable, a joint venture with discovery communications, will shake up the world of commercial tv, and represents a gamble that her audience will follow. >> lehrer: finally tonight, help for family members caring for troops critically injured in war. that's the subject of tonight's edition of the pbs program "now." in this excerpt, correspondent maria hinojosa highlights one family's struggle. >> good job. head up, shoulders back. >> ed had been taking care of his son eric for four years now. eric was among the first wave of veterans to come back from iran with a traumatic brain injury, or tbi. he had been blown up by a homemade bomb. eric's father says the va hospital system wasn't prepared to treat the thousands of soldiers returning with these kinds of injuries. after eric got home, he spent three months in a va trauma hospital in richmond, virginia. >> and in that three months he just went downhill. he lost weight. he got ill. he just essentially got to the point in my opinion that he gave up. he gave up. >> reporter: for eric's family, the final straw came when ed found his son in a hallway at the va facility during what was being called therapy. >> they called it hallway therapy there. it's good for him to be watching things going on around. but eric was slumped over in his chair drooling. call it what you will. it wasn't therapy. >> reporter: ed and his wife beth were shocked to find that the va has no long-term care and rehabilitation facilities for the increasing number of vets with brain injuries. they brought eric home and both quit their jobs to be able to work with him full-time. they fought successfully to place their son in a private facility in chicago. eric arrived unable to move his limbs. >> we're going to walk over to the chair. >> reporter: but his family says that over the next seven months there was a remarkable transformation, with assistance, he even learned to walk again. >> brigadier-general lori sutton is in charge of creating programs that help families impacted by tbi. >> there are estimates that it could cost billions, not millions but billions of dollars to treat all of the service members who are coming home with traumatic brain injury. >> reporter: is that feasible? >> as far as i'm concerned, as a nation when we send our treasure, our sons and daughters to war, we owe them and their families whatever it takes to help them recover, to rehabilitation -- rehabilitate, to reintegrate, to live lives of purpose, passion and meaning. >> reporter: general sutton has created a training program for family caregivers to learn the often complicated tasks involved with caring for a tbi patient but will they get paid for this work? earlier this year democratic senator daniel acaca introduced a bill to help caregivers like bill ed and beth. it would allow each severely wounded veteran of the fight fing the war in iraq and afghanistan to designate that caregiver. that person would get medical training, health insurance and a city pend of about $10 an hour as long as the va determines their care is medically necessary. advocates say it's money that would otherwise be spent on nursing home staff. >> lehrer: yesterday, the senate gave a hand to people like the edmundsons. it unanimously passed a $4 billion measure to provide benefits to families who care for severely injured veterans from the iraq and afghan wars. the house has passed similar legislation. next, the two bills go to a conference committee. >> lehrer: we had a guest coming up for jeff's story about oprah. we had some tech difficulties but our audio connection is now back and we go back to jeffrey brown. >> joining me for more is the media crit ignore -- critic for st. petersburg times in florida. sorry about the technical difficulties first, i'm glad we have you now. so tell us, what is known about oprah, why she is ending her program and heading for cable tv? >> sure. oprah -- oprah's contract for her syndicated tv show was about to run out at the end the 2011. she had to make a decision about whether she was going to keep doing the show. and instead of keeping doing the show, she has decided to stop. now we're assuming that she's going to take a show to a cable channel that she is developing with the discovery communications group called the oprah winfrey network. but she has not announced that she is going to do a show for them. but the rumors in hollywoodland and tvland are that she have do some kind of different show. not like the show she is doing now for that cable channel. >> reporter: before we get to this future cable network, first i mean we see why viewers care about this. but explain why this matters in the world of media business. why is she such a force and how does this reverberate? >> obviously oprah is a cultural icon. and more than that she is an icon in the tv business. she leaves the highest rated syndicated tv show right now and that business has been in decline. oprah herself even though she is still the highest rated has seen her ratings go down by half in recent years. and there was a sense that she would not earn the kind of money from the show that she had been earning. she might have to take up to a 50% cut in revenues because tv stations are hurting right now. the recession hit them hard. they are not getting the kind of advertising revenue they are used to. they can't pay the big money they used to pay to have the oprah winfrey show. so her moving to cable was a sense that with her vote, she is voting for the future of her brand and the future of her celebrity with cable television as opposed to broadcast. and that's very significant. >> and what does she leave behind? i mean who is hurt in the network world. she's got one network, abc where most of her shows air. she's got another one, i think cbs that syndicates her show. and she's got all these programs that she leads into that care about having her, right? >> exactly. you've named all the big people who are going to be hurt by her depar ture. cbs television bought the syndicator that handles the oprah winfrey network some time ago. they are going to lose a lot of money. abc stations across the country mostly handle her show. so they are used to this huge audience being fed into their 5 p.m. local newscasts. so all of those stations are going to be looking at what can we do now to replace oprah winfrey. here in tampa an nbc affiliate airs her show and they have had the top 5 p.m. newscast for some years now. that whole balance of power is going to shift. and we'll be seeing those kinds of things in markets all across the country once she leaves on september 9th, 2011. >> reporter: i mentioned the 7 million viewers a day. you said that's down from the past. but that's still a pretty big number. who are those people and how does that compare to the rest of the field in daytime or for that matter, the nighttime talk shows. >> well, i think there is a sense that oprah has been the ultimate voice for women on television, certainly in the last ten years if not longer. and so there is a sense that she speaks directly to the women of america. and i think those are the people that are most attracted to her show. now once she leaves who will take over that voice? a lot of people are looking to ellen degeneres who seems to be the second most popular woman on daytime popular. bonie hunt also hosts a show. and there is also a sense that oprah has created a lot of smaller successors. she created dr. phil, rachel ray, she helped develop the doctor oz show that just debuted this year in syndication. so some those people are likely to pick up her audience as well. and there may be some new hosts. maria osmond was trying to develop a syndicated tv show. if i was a syndicator i might take another look at her now that oprah is going to be away from the field. >> so eric, finally this move to cable, i mean it's a gamble even for oprah, right? what are the pitfalls of making a shift like this for her and in this balance you are talking about between networks and cable. >> well, cable is essentially a niche medium it is garnered, it's focused on attracting a small sliver of audience. so the danger for oprah is that she no longer has the cultural significance and the fame that she once had. when you are a broadcaster, you reach everybody. when you are in cable, you reach a smaller sliver of people. now there are big fans and intensely engaged with your brand and that ishat she will gainment but she may lose the ability to take, make a best selling book the way she used to be able to. or start a huge nationwide buying trend the way she used to be able to. that is going to be her test. can she still get people across the country to react to her brand in the way that she used to when she would hold up a book and say buy this, or find a trend of society and say this is worth taking a look at. >> all right, but she is big enough that the whole industry has to watch, right? >> oh, most definitely. and i have a feeling that, you know, even what she does on cable, that will be a small part of her brand. she still has a magazine. she is still on satellite radio. she still has a web presence. and i have a feeling all of those things are going to get tweaked once she moves and starts her own cable channel. >> eric, thanks for joining us. >> thank you. >> lehrer: again, the major developments of the day: medical experts recommended new guidelines on testing for cervical cancer. it followed new recommendations early this week for mammograms; and senate democrats won over a key moderate as they try to bring health care reform to the floor. on newshour.pbs.org, two online- only features tonight: a reporter's podcast on the european union's new president; and an "art beat" conversation with documentary filmmaker frederick wiseman about his new project on the paris opera ballet. and again to our honor roll of american service personnel killed in the iraq and afghanistan conflicts. we add them as their deaths are made official and photographs become available. here, in silence, are nine more. >> lehrer: "washington week" can be seen later this evening on most pbs stations. we'll see you online, and again here monday evening. have a nice weekend. i'm jim lehrer. thank you and good night. major funding for the newshour with jim lehrer is provided by: >> this is the engine that connects abundant grain from the american heartland to haran's best selling whole wheat, while keeping 60 billion pounds of carbon out of the atmosphere every year.a bnsf, the engine that connects us. monsanto. producing more. conserving more. improving farmers' lives. that's sustainable agriculture. more at producemoreconservemore.com. intel. supporting coverage of innovation and the economy. monsanto. and by the alfred p. sloan foundation. supporting science, technology, and improved economic performance and financial literacy in the 21st century. and with the ongoing support of these institutions and foundations. and... this program was made possible by the corporation for public broadcasting. and by 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