Dial back esophageal cancer screening: internists

NEW YORK (Reuters Health) – A group of U.S. internal medicine doctors today recommended limiting esophageal cancer screening to people with chronic heartburn who have additional, more severe symptoms.

Known as upper endoscopy, the screening procedure is often used to diagnose and manage gastroesophageal reflux disease (GERD) – which can be tied to a higher risk of esophageal cancer.

But some of that use may be unnecessary, the American College of Physicians (ACP) said – adding costs and putting patients at risk of side effects without evidence of a clear benefit.

“Not every patient with GERD who comes in should be getting this procedure done,” said Dr. Amir Qaseem, ACP’s director of clinical policy, who co-wrote the guidelines.

“It’s a low-risk procedure, but every procedure carries risk of complications,” he told Reuters Health.

During an upper endoscopy, a doctor inserts a flexible tube with a camera, called an endoscope, into the mouth and down the throat. Some patients receive anesthesia beforehand.

Earlier this year, a Reuters Health report suggested another type of screening, transnasal esophagoscopy, is becoming increasingly popular despite a lack of evidence it lowers the risk of dying from esophageal cancer (see Reuters Health story of April 20, 2012: http://reut.rs/I3mkij).

One in 125 men and one in 400 women in the United States will get esophageal cancer in their lifetime, according to the American Cancer Society, and most people who are diagnosed with the disease die within five years.

But there’s no evidence that traditional upper endoscopy lowers those risks either, according to the ACP’s Clinical Guidelines Committee.

The group laid out recommendations for use of the procedure in people with GERD on Monday in the Annals of Internal Medicine.

Most people with GERD, including patients with heartburn and regurgitation, should start treatment with acid-suppressing drugs and only undergo endoscopy if medication doesn’t help them, the committee said. People with more severe symptoms, such as bleeding and frequent vomiting, can go straight to endoscopy to rule out more serious conditions – but screening shouldn’t be regularly repeated if the initial test is negative.

In the case of Barrett’s esophagus, in which the esophageal lining is damaged by stomach acid, patients with no signs of cancer shouldn’t be screened more than once every three years, according to the guidelines.

UNNECESSARY COSTS, RISKS

Even among most people with Barrett’s, the risk of cancer is quite low, according to Dr. Lauren Gerson, a gastroenterologist at Stanford University in California who wasn’t involved in the new study.

“Use of upper endoscopy beyond the indications listed here is likely to generate unnecessary costs and expose patients to risks without improving clinical outcomes,” the committee wrote.

In particular, the ACP does not recommend routine screening for women or adults younger than 50, because their risk of esophageal cancer is much lower than that of older men.

An upper endoscopy costs more than $ 800. Rare side effects include esophageal perforation, pneumonia and breathing problems. False positives could also lead to more unnecessary tests and procedures with their own set of side effects, Qaseem said.

Although the new guidelines are directed at physicians, Qaseem said it’s also important for patients to understand the benefits and limitations of esophageal cancer screening. And people shouldn’t be afraid to ask their doctors why they’re ordering an endoscopy and whether it’s really necessary, he said.

Most cases of GERD, Qaseem added, will not be dangerous and can get better with lifestyle changes, such as weight loss.

“There is evidence that losing weight is effective, not eating late at night is effective, and so-forth,” Gerson told Reuters Health.

“That’s the first recommendation to patients, to try to make lifestyle changes to reduce their GERD symptoms and try to get off medications, if possible.”

SOURCE: http://bit.ly/R1w1Xu Annals of Internal Medicine, online December 3, 2012.

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The 10 Best Tweets on the Pope Joining Twitter

Today, Pope Benedict XVI signed up for an instant means to spread his holy message to followers worldwide—but is he really ready for them to talk back?

Within hours of launching the Twitter account @pontifex, the pope had more than 140,000 followers, thousands of mentions, and zero tweets. The pope will not begin tweeting until Dec. 12, the Vatican said in a written statement Monday. The account, which will tweet in eight languages, will respond to the hashtag #askpontifex to answer questions of faith (most likely not to include queries on pop culture, fashion, or what you should have for lunch).

This isn’t the 85-year-old’s first Twitter rodeo. He caused a stir—and drew in 50,000 new followers—when he sent his first tweet from the Vatican Twitter account last summer. His personal account offers a way to increase awareness of the church’s message and reach out to a more digital subset of the 1.2 billion Catholic followers worldwide.

Here are some of the top tweets about His Holiness’s Twitter debut:

Businessweek.com — Top News

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Official: Syria moving chemical weapons components

WASHINGTON (AP) — U.S. and allied intelligence have detected Syrian movement of chemical weapons components in recent days, a senior U.S. defense official said Monday, as the Obama administration strongly warned the Assad regime against using them.

A senior defense official said intelligence officials have detected activity around more than one of Syria‘s chemical weapons sites in the last week. The defense official spoke on condition of anonymity because he was not authorized to speak publicly about intelligence matters.

Secretary of State Hillary Rodham Clinton, in Prague for meetings with Czech officials, reiterated President Barack Obama‘s declaration that Syrian action on chemical weapons was a “red line” for the United States that would prompt action.

“We have made our views very clear: This is a red line for the United States,” Clinton told reporters. “I’m not going to telegraph in any specifics what we would do in the event of credible evidence that the Assad regime has resorted to using chemical weapons against their own people. But suffice it to say, we are certainly planning to take action if that eventuality were to occur.”

Syria said Monday it would not use chemical weapons against its own people. The Ministry of Foreign Affairs said Syria “would not use chemical weapons — if there are any — against its own people under any circumstances.”

Syria has been careful never to confirm that it has any chemical weapons.

The use of chemical weapons would be a major escalation in Assad’s crackdown on his foes and would draw international condemnation. In addition to causing mass deaths and horrific injuries to survivors, the regime’s willingness to use them would alarm much of the region, particularly neighboring states, including Israel.

At the White House, press secretary Jay Carney said, “We are concerned that in an increasingly beleaguered regime, having found its escalation of violence through conventional means inadequate, might be considering the use of chemical weapons against the Syrian people. And as the president has said, any use or proliferation of chemical weapons by the Syrian regime would cross a red line for the United States. “

Administration officials would not detail what that response might be.

Although Syria is one of only seven nations that have not signed the Chemical Weapons Treaty, it is a party to the 1925 Geneva Protocol that bans the use of chemical weapons in war. That treaty was signed in the aftermath of World War I, when the effects of the use of mustard gas and other chemical agents outraged much of the world.

Clinton didn’t address the issue of the fresh activity at Syrian chemical weapons depots, but insisted that Washington would address any threat that arises.

An administration official said the trigger for U.S. action of some kind is the use of chemical weapons or movement with the intent to use or provide them to a terrorist group like Hezbollah. The U.S. is trying to determine whether the recent movement detected in Syria falls into any of those categories, the official said. The administration official was speaking on condition of anonymity this person was not authorized to speak publicly about the issue.

The senior defense official said the U.S. does not believe that any Syrian action beyond the movement of components is imminent.

An Israeli official said if there is real movement on chemical weapons, it would require a response. He didn’t say what that might be and spoke on condition of anonymity pending a formal government response to the reports of the latest activities.

Israeli officials have repeatedly expressed concerns that Syrian chemical weapons could slip into the hands of Hezbollah or other anti-Israel groups, or even be fired toward Israel in an act of desperation by Syria.

Syria is believed to have several hundred ballistic surface-to-surface missiles capable of carrying chemical warheads.

Its arsenal is a particular threat to the American allies, Turkey and Israel, and Obama singled out the threat posed by the unconventional weapons earlier this year as a potential cause for deeper U.S. involvement in Syria’s civil war. Up to now, the United States has opposed military intervention or providing arms support to Syria’s rebels for fear of further militarizing a conflict that activists say has killed more than 40,000 people since March 2011.

Clinton said that while the actions of President Bashar Assad‘s government have been deplorable, chemical weapons would bring them to a new level.

“We once again issue a very strong warning to the Assad regime that their behavior is reprehensible, their actions against their own people have been tragic,” she said. “But there is no doubt that there’s a line between even the horrors that they’ve already inflicted on the Syrian people and moving to what would be an internationally condemned step of utilizing their chemical weapons.”

Activity has been detected before at Syrian weapons sites, believed to number several dozen.

Defense Secretary Leon Panetta said in late September the intelligence suggested the Syrian government had moved some of its chemical weapons in order to protect them. He said the U.S. believed that the main sites remained secure.

Asked Monday if they were still considered secure, Pentagon press secretary George Little declined to comment about any intelligence related to the weapons.

Senior lawmakers were notified last week that U.S. intelligence agencies had detected activity related to Syria’s chemical and biological weapons, said a U.S. intelligence official, speaking on condition of anonymity to discuss the closed-door meetings. All congressional committees with an interest in Syria, from the intelligence to the armed services committees, are now being kept informed.

“I can’t comment on these reports but I have been very concerned for some time now about Syria’s stockpiles of chemical weapons and its stocks of advanced conventional weapons like shoulder-launched anti-aircraft missiles,” said House intelligence committee Chairman Mike Rogers, R-Mich. “We are not doing enough to prepare for the collapse of the Assad regime, and the dangerous vacuum it will create. Use of chemical weapons by the Assad regime would be an extremely serious escalation that would demand decisive action from the rest of the world,” he added.

Syria is believed to have one of the world’s largest chemical weapons programs, and the Assad regime has said it might use the weapons against external threats, though not against Syrians. The U.S. and Jordan share the same concern about Syria’s chemical and biological weapons — that they could fall into the wrong hands should the regime in Syria collapse and lose control of them.

___

Klapper reported from Prague. Associated Press writers Josef Federman in Jerusalem, Albert Aji in Damascus and Matthew Lee, Kimberly Dozier, and Julie Pace in Washington contributed to this report.

Europe News Headlines – Yahoo! News

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Angry Birds Star Wars updated with 20 additional levels, Princess Leia cameo

Rovio on Thursday updated its immensely popular Angry Birds Star Wars game to include 20 additional levels. The latest game in the bird-slinging franchise was released earlier this month and was an instant hit, topping the iTunes App Store in less than three hours. In the most recent update, gamers must help the birds escape from the AT-ATs and Pigtroopers on the remote ice world of Hoth. Luckily, the rebel birds have a secret weapon — Princess Leia.

“It is a dark time for the Rebellion,” Rovio wrote on its website. ”Evading the dreaded Imperial Starfleet, a group of freedom fighters has established a new secret base on the remote ice world of Hoth. Unfortunately the evil Lord Vader discovers their hideout, and the desperate Rebel birds must escape the AT-ATs and Pigtroopers hot on their trail. But the Rebels have an ace up their sleeve with the debut of PRINCESS LEIA and her attractive new power!”

Angry Birds Star Wars is available for Android, iOS, Macs and PCs. The Hoth trailer follows below.

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Clint Eastwood’s daughter named Miss Golden Globe

LOS ANGELES (TheWrap.com) – Hooray for nepotism.

One of Clint Eastwood‘s daughters, Francesca Eastwood, has been named Miss Golden Globe for this January’s awards show. She joins a long list of celebrity offspring including Rumer Willis (Demi Moore and Bruce’s little girl) and Lorraine Nicholson (the apple of Jack’s eye) in receiving the honor. Other past Miss Gold Globes include Melanie Griffith (daughter of Peter Griffith and Tippi Hedren) and Laura Dern (daughter of Bruce Dern and Diane Ladd).

Francesca Eastwood is the daughter of Eastwood and actress Frances Fisher. She is the second Eastwood to become a Miss Golden Globe – her half sister Kathryn Eastwood, daughter of Clint Eastwood and Jacelyn Reeves, received the title in 2005.

“I have watched the Golden Globes ceremonies since I was a little girl, and it means so much to me to be a part of one of Hollywood’s most illustrious events,” Francesca Eastwood said in a statement.

The 19-year-old actress has appeared in her father’s movies, including “True Crime,” and can currently be seen on the E! reality show “Mrs. Eastwood and Company,” which shows her living a life of Carmel-by-the-Sea opulence along with her famous family and the South African band Overtone.

The duties of a Miss Golden Globe are somewhat nebulous, but they involve assisting with the highly rated awards show, cooking up a cure for world hunger and working on a vaccine for avian flu (OK, some of that may not be true).

Movies News Headlines – Yahoo! News

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Belcher Didn’t Have ‘Long Concussion History,’ Team Says

The death of Kansas City Chiefs linebacker Jovan Belcher, the latest in a string of tragic NFL suicides, has left the player’s teammates, coaches, family and friends wondering what could have led a man described as generous and caring to murder his girlfriend — the mother of his 3-month-old daughter — and then kill himself.

Kansas City police say Belcher, 25, shot and killed his girlfriend Saturday morning before going to the team stadium and and committing suicide by shooting himself in the head as he was talking to coaches.

“When the officers arrived, when they were pulling up, they actually observed a black male who had a gun to his head and he was talking to a couple of coaches out in the parking lot,” Kansas City Police spokesman Darin Snapp told ABC News Radio. “As officers pulled up, and began to park, that’s when they heard the gunshot and it appears the individual took his own life.”

It’s not yet clear what prompted Belcher’s actions, but his suicide follows those of former NFL players Junior Seau, 43, and Dave Duerson, 50, both of whom died of self-inflicted gunshot wounds to the chest in the last two years.

The suicides of Seau, Duerson and a number of other NFL players have been blamed on concussions racked up from playing the violent sport, and a condition called chronic traumatic encephalopathy, or CTE, but that may not be the case for Belcher.

Kansas City Chiefs Player Jovan Belcher’s Murder-Suicide Watch Video

Did Brain Injury Lead to NFL Star’s Suicide? Watch Video

Chiefs chairman Clark Hunt said today that Belcher was “a player who had not had a long concussion history,” even though he was a three-time all-America wrestler and a star on the football team at his West Babylon, N.Y., high school.

Seau’s and Duerson’s brains are both being studied at Boston University’s Center for the Study of Traumatic Encephalopathy, where researchers have already learned that Duerson had CTE, which may have led to his suicide.

CTE is a progressive, degenerative disease found in people who have had brain trauma from repeated blows to the head, according to the Center. It includes brain tissue degeneration and a buildup of an abnormal protein called tao, resulting in symptoms including confusion, aggression, and depression. Ultimately, CTE results in dementia.

In 2006, former Pittsburgh Steelers player Terry Long killed himself by drinking antifreeze, and former Philadelphia Eagles player Andre Waters shot himself in the head. Both of them suffered from CTE.

Researchers at Boston University found evidence of CTE in 12 of the 13 professional football players’ brains they received between 2008 and 2010, according to the university. CTE can also be found in hockey players, wrestlers, and boxers.

“Football is entertainment in which the audience is expected to delight in gladiatorial action that a growing portion of the audience knows may cause the players degenerative brain disease,” ABC News’ George Will wrote in a Washington Post column published Aug. 3 just before he appeared on “This Week with George Stephanopoulos.”

Will cited Seau and Duerson in his column, both of whom committed suicide after 2010, adding that 62-year-old former NFL safety Ray Easterling committed suicide in April 2012. Esterling’s autopsy revealed that he had dementia and depression brought on by CTE.

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MoD extends maintenance contracts

2 December 2012 Last updated at 08:47 ET

Five contracts to maintain naval support ships have been extended by the Ministry of Defence.

It says the extensions, which are worth a total of about £349m, are likely to safeguard about 800 jobs.

The GMB trade union welcomed the news, saying “shipyard workers are just as important as the armed forces”.

The contracts, given to five British companies, cover the maintenance of the 13-strong Royal Fleet Auxiliary (RFA) flotilla of naval support vessels.

The RFA provides support such as fuel and munitions to the Royal Navy at sea.

It is made up of fuel tankers, a medical facility and landing ships.

The contracts were originally allocated in 2008 for an initial period of five years.

Following a review which the MoD says was to ensure value for money, they have now been extended for a further five years.

The companies involved include Cammell A&P Group Ltd – a ship repair facility in Falmouth – and Lloyds Register, which is based in Bristol.

The three others are Cammell Laird Ship Repairers and Shipbuilders Ltd, based in Birkenhead, Southampton-based Trimline Ltd and Hempel UK Ltd, which is in Cwmbran, south Wales.

Defence minister Philip Dunne said the RFA ships were “crucial to the work of the Royal Navy”, adding that “without them it simply could not operate”.

“These substantial contracts will not only safeguard hundreds of UK jobs but will ensure that these ships can continue in their roles for years to come,” he said.

Meanwhile, David Hulse, of the GMB trade union, said: “This is welcome news in these bleak times.

“GMB maintains that the shipyard workers are just as important as the armed forces to our nation’s defences, which is why it is crucial that the MoD plan procurement to ensure capacity and skills.”

BBC News – Business

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Egypt’s anti-Morsi rebellion of judges is complete

CAIRO (AP) — Egypt‘s rebellion of the judges against President Mohammed Morsi became complete on Sunday with the country’s highest court declaring an open-ended strike on the day it was supposed to rule on the legitimacy of two key assemblies controlled by allies of the Islamist leader.

The strike by the Supreme Constitutional Court and opposition plans to march on the presidential palace on Tuesday take the country’s latest political crisis to a level not seen in the nearly two years of turmoil since Hosni Mubarak‘s ouster in a popular uprising.

Judges from the country’s highest appeals court and its sister lower court were already on an indefinite strike, joining colleagues from other tribunals who suspended work last week to protest what they saw as Morsi‘s assault on the judiciary.

The last time Egypt had an all-out strike by the judiciary was in 1919, when judges joined an uprising against British colonial rule.

The standoff began when Morsi issued decrees on Nov. 22 giving him near-absolute powers that granted himself and the Islamist-dominated assembly drafting the new constitution immunity from the courts.

The constitutional panel then raced in a marathon session last week to vote on the charter’s 236 clauses without the participation of liberal and Christian members. The fast-track hearing pre-empted a decision from the Supreme Constitutional Court that was widely expected to dissolve the constituent assembly.

The judges on Sunday postponed their ruling on that case just before they went on strike.

Without a functioning justice system, Egypt will be plunged even deeper into turmoil. It has already seen a dramatic surge in crime after the uprising, while state authority is being challenged in many aspects of life and the courts are burdened by a massive backlog of cases.

“The country cannot function for long like this, something has to give,” said Negad Borai, a private law firm director and a rights activist. ‘We are in a country without courts of law and a president with all the powers in his hands. This is a clear-cut dictatorial climate,” he said.

Mohamed Abdel-Aziz, a rights lawyer, said the strike by the judges will impact everything from divorce and theft to financial disputes that, in some cases, could involve foreign investors.

“Ordinary citizens affected by the strike will become curious about the details of the current political crisis and could possibly make a choice to join the protests,” he said.

The Judges Club, a union with 9,500 members, said late Sunday that judges would not, as customary, oversee the national referendum Morsi called for Dec. 15 on the draft constitution hammered out and hurriedly voted on last week.

The absence of their oversight would raise more questions about the validity of the vote. If the draft is passed in the referendum, parliamentary elections are to follow two months later and they too may not have judicial supervision.

The judges say they will remain on strike until Morsi rescinds his decrees, which the Egyptian leader said were temporary and needed to protect the nation’s path to democratic rule.

For now, however, Morsi has to contend with the fury of the judiciary.

The constitutional court called Sunday “the Egyptian judiciary’s blackest day on record.”

It described the scene outside the Nile-side court complex, where thousands of Islamist demonstrators gathered since the early morning hours carrying banners denouncing the tribunal and some of its judges.

A statement by the court, which swore Morsi into office on June 30, said its judges approached the complex but turned back when they saw the protesters blocking entrances and climbing over its fences. They feared for their safety, it added.

“The judges of the Supreme Constitutional Court were left with no choice but to announce to the glorious people of Egypt that they cannot carry out their sacred mission in this charged atmosphere,” said the statement, which was carried by state news agency MENA.

Supporters of Morsi, who hails from the Islamic fundamentalist Muslim Brotherhood, claim that the court’s judges remain loyal to Mubarak, who appointed them, and accuse them of trying to derail Egypt’s transition to democratic rule.

In addition to the high court’s expected ruling Sunday on the legitimacy of the constitution-drafting panel, it was also expected to rule on another body dominated by Morsi supporters, parliament’s upper chamber.

Though Morsi’s Nov. 22 decrees provide immunity to both bodies against the courts, a ruling that declares the two illegitimate would have vast symbolic significance, casting doubt on the standing of both.

The Brotherhood’s political arm, the Freedom and Justice party, sought to justify the action of its supporters outside the court as a peaceful protest. It reiterated its charge that some members of the judiciary were part and parcel of Mubarak’s autocratic policies.

“The wrong practices by a minority of judges and their preoccupation with politics … will not take away the respect people have for the judiciary,” it said.

Its explanation, however, failed to calm the anger felt by many activists and politicians.

“President Morsi must take responsibility before the entire world for terrorizing the judiciary,” veteran rights campaigner and opposition leader Abdel-Halim Kandil wrote in his Twitter account about the events outside the constitutional court.

Liberal activist and former lawmaker Amr Hamzawy warned what is ahead may be worse.

“The president and his group (the Muslim Brotherhood) are leading Egypt into a period of darkness par excellence,” he said. “He made a dictatorial decision to hold a referendum on an illegal constitution that divides society, then a siege of the judiciary to terrorize it.”

Egypt has been rocked by several bouts of unrest, some violent, since Mubarak was forced to step down in the face of a popular uprising. But the current one is probably the worst.

Morsi’s decrees gave him powers that none of his four predecessors since the ouster of the monarchy 60 years ago ever had. Opposition leaders countered that he turned himself into a new “pharaoh” and a dictator even worse than his immediate predecessor Mubarak.

Then, following his order, the constituent assembly rushed a vote on the draft constitution in an all-night session.

The draft has a new article that seeks to define what the “principles” of Islamic law are by pointing to theological doctrines and their rules. Another new article states that Egypt’s most respected Islamic institution, Al-Azhar, must be consulted on any matters related to Shariah law, a measure critics fear could lead to oversight of legislation by clerics.

Rights groups have pointed out that virtually the only references to women relate to the home and family, that the new charter uses overly broad language with respect to the state protecting “ethics and morals” and fails to outlaw gender discrimination.

At times the process appeared slap-dash, with fixes to missing phrasing and even several entirely new articles proposed, written and voted on in the hours just before sunrise.

The decrees and the vote on the constitution draft galvanized the fractured, mostly secular opposition, with senior leaders setting aside differences and egos to form a united front in the face of Morsi, whose offer on Saturday for a national dialogue is yet to find takers.

The opposition brought out at least 200,000 protesters to Cairo’s Tahrir Square on Tuesday and a comparable number Friday to press demands that the decrees be rescinded. The Islamists responded Saturday with massive rallies in Cairo and across much of Egypt.

The opposition is raising the stakes with plans to march on Morsi’ palace on Tuesday, a move last seen on Feb. 11, 2011 when tens of thousands of protesters marched from Tahrir Square to Mubarak’s palace in the Heliopolis district to force him out. Mubarak stepped down that day, but Morsi is highly unlikely to follow suit on Tuesday.

Middle East News Headlines – Yahoo! News

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The 20 Most-Shared Ads of 2012

1. Kony 2012 (Invisible Children)

Most Americans had never heard of Joseph Kony, the head of the Lord’s Resistance Army in Uganda, before. This March video from advocacy group Invisible Children changed that.

Click here to view this gallery.

[More from Mashable: The 12 Most Memorable Marketing Campaigns of 2012]

Is Kony 2012 an ad? If so, it was the most-viral ad of the year. If not, it was just an extremely effective advocacy video and a Belgian video for cable network TNT was actually the most-viral ad of 2012.

Unruly, which keeps tabs on viral video activity, thinks Kony is, so it tops this year’s list. Indeed, Kony’s numbers are pretty staggering — 10 million shares and 94 million views on YouTube make it the Gangnam Style of charity videos. Not bad for a 30-minute film that doesn’t have a cat in sight and doesn’t introduce a new dance move.

[More from Mashable: 14 Bizarrely Awesome Rap Cover Videos]

Speaking of which, there are two tributes to Carly Rae Jepsen‘s “Call Me Maybe” on this list. There are also a few examples of borrowed equity, including Hobbit director Peter Jackson (for Air New Zealand), OK Go (Chevrolet), James Bond (Coke Zero) and various European soccer stars for Nike. There are also viral ad stalwarts Ken Block and GoPro. As usual, though, there are a lot of surprises. Who would have guessed, for instance, that a public service announcement for Melbourne Metro (as in Melbourne, Australia), would rack up 30 million views in less than a month?

This story originally published on Mashable here.

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“Walking Dead” midseason finale preview: attack of the bloodthirsty killers, aka our heroes

LOS ANGELES (TheWrap.com) – (Spoiler warning: Don’t read this if you don’t want to know what happened this season on “The Walking Dead” or in the comics. We’re also giving some general details about Sunday’s midseason finale.)

As eventful as this season of “The Walking Dead” has been, they’re just getting to the best stuff.

Showrunner Glen Mazzara tells TheWrap that Sunday’s midseason finale will include several intense faceoffs, including one between Michonne and The Governor’s zombified daughter, Penny. It will also introduce Tyreese (“The Wire” star Chad Coleman), one of the most beloved characters in the Robert Kirkman comics that inspired the series. And Daryl will try desperately to reunite with his brother Merle, who has moved to Woodbury and become one of The Governor’s chief lieutenants.

The episode also features an attack on Woodbury by some “bloodthirsty killers” – also known as Rick, Daryl, and the other survivors we’ve been rooting for throughout the show.

Mazzara also talked with us about the season so far, including a horrific encounter between Maggie and the Governor, and how much we should empathize with zombies.

TheWrap: What can you say about the midseason finale?

Mazzara: It all comes to a head. We’ve spent this season introducing all these new characters into the world, introducing the governor and re-introducing Merle and Michonne, and getting these two groups face to face.

The Governor does despicable things, but in his mind, he’s the good guy.

I think you’ll see that in this midseason finale. The Governor is able to say that they’re attacked by bloodthirsty killers. He can certainly make the case that Rick and his group are killers. And if you look at it objectively, they are. They took over the prison, most of those prisoners are now dead, and the people of Woodbury are just peace-loving survivors. The Governor is definitely able to pain Rick as a villain. And in doing that, he can hopefully mobilize the people of Woodbury to war.

He’s spared the people of Woodbury from seeing some ugly stuff. Is he doing it for a noble reason – to preserve their innocence – or is it so he can exploit them?

I think it’s so he can better exploit them. He feels that the people of Woodbury are sheep. He’s not interested in what they think. He just wants them to speak well of him. They are there to be ruled and he’s there to rule by any means necessary.

I feel like Glen and Maggie are our audience surrogates at this point, our pals, and they were both horribly abused. You’ve gotten a lot of feedback from fans relieved that The Governor stopped short of raping Maggie in the last episode.

He’s killed National Guardsmen. Think of all the stuff that he’s done. And the line he’s crossed and the act from which he cannot be redeemed is that he made our beloved Maggie take off her shirt and bra.

It’s very interesting, and I don’t think that would be the case if people did not care about that character as much as they do.

Why did he stop short of raping Maggie?

He didn’t rape Maggie because she wouldn’t have been broken by it. She says ‘Do what you’re gonna do, and then go to hell.’ So then to do that would have been torture for torture’s sake. It wouldn’t have gotten him the information he wanted. So he thinks about that and thinks, this isn’t going to achieve my agenda. He moves on. He brings her in, topless, implying that she was raped, to Glen, and he puts the gun to Glen’s head. … And she gives up that information.

One change you made is that in the comics, Michonne is horribly raped and tortured by the governor.

She still may be. But I think it’s important to say that this is a character who is willing to do whatever he wants or thinks it takes to achieve his goals. … We know he’s capable of rape. We know he’s capable of murder. He knows where the prison is, and he is coming for them. He collects heads. He’s the most dangerous character in this world and he is furious.

Also last episode, we saw an effort to see how much human memory remains with walkers when they transform. How much should we empathize with walkers?

I think the show has always been in a sense compassionate to zombies. The first zombie that we met was bicycle girl and Rick says ‘I’m sorry this happened to you.’ … So I do think there’s something in the DNA of this TV show in which the frightening creatures – our worst fears, walking the earth – are also individuals and people. In a way, they’re the damned. They’ve lost their souls. They’re like a ghost that doesn’t realize that they’ve passed on and can’t make it to the light. They’re dead but they’re not dead and it’s a type of curse. It comes out of a long history of horror movie. There is some type of compassion even though there can’t be.

Does it seem like people who care about the zombies are suckers?

That’s the question. What is the right way within this world? You have people who retain their humanity, like Dale, end up eaten. People who lose their humanity, like Shane, end up dead too. So in a way it’s irrelevant. It’s like a state of war in which anyone can be killed at any time. But there’s a random quality to life and death and that’s what makes it so frightening. No matter what you do, you can still suffer a horrific fate. Who would ever assume that Carol would still be alive at this point? And she is.

She’s a survivor, but she’s not Michonne. And Carol is just as likely to live or die as Michonne.

TV News Headlines – Yahoo! News

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