'Blade Runner' Oscar Pistorius weeps as he faces murder charge









JOHANNESBURG, South Africa -- Olympic sprinter Oscar Pistorius, the double-amputee revered in South Africa for overcoming his disability to compete in the London Games last year, wept in court Friday as he faced a murder charge in connection with the fatal shooting of his girlfriend.

During the proceedings in Pretoria, Gerrie Nel, one of the National Prosecuting Authority’s most senior advocates, said he would argue the killing of model and law graduate Reeva Steenkamp was premeditated murder, the most serious category of offense under South African law.


Nel is known for prosecuting high-profile cases, including winning the conviction of former police chief and Interpol boss Jackie Selebi on corruption charges.


Pistorius, nicknamed the "Blade Runner" because of the carbon-fiber prosthetic legs he uses to compete, did not enter a formal plea and was remanded into custody at Brooklyn police station in Pretoria until Tuesday, when his bail application is to be heard.








Under South African law, a suspect charged with such a high-level offense would have to prove exceptional circumstances to be granted bail.


In a packed courtroom, members of Pistorius' family struggled to pass through a media scrum and to find seats. The hearing coincided with "Black Friday," a day when people were being urged to wear black to protest rapes and violence against women.


[Updated, 8:35 a.m. Feb. 15: The family and Pistorius' management company later issued a statement denying that the athlete had murdered his girlfriend, saying: "The alleged murder is disputed in the strongest possible terms."


Some details of Pistorius' argument and the state's case are expected Tuesday.]

The famed athlete's court appearance came as South African media reported that he shot Steenkamp, his girlfriend of several months, four times through a bathroom door.


Under South African law, a person who fatally shoots an intruder has to prove he or she had a reasonable fear that the intruder posed a real threat to his or her life.

South Africa has one of the highest rates of gun homicides in the world, with killings of women by intimate partners the leading cause of female homicide in the country. About 57% of female homicide victims were killed by their partners in 2009, according to a report last year by the Medical Research Council.


One-third of female homicides were committed by partners with a history of prior violence against their partners, according to the report.

Friends of Steenkamp and Pistorius mourned the incident on social media.

"Drained, confused, I just can't wrap my head around things," one of Pistorius’ close friends, Alex Pilakoutas, posted on Twitter.


Darren Fresco, who described himself as one of Steenkamp’s best friends said he was hoping to wake from a nightmare and hear her infectious laughter again.

"We were just goofing off the other day talking to each other in only the way that we could to each other. My heart is on the verge of exploding with the pain of such a sudden loss of one of my best friends," Fresco, who said he was one of the last people to exchange tweets with Steenkamp, posted on Facebook.

ALSO:

Oscar Pistorius remains in jail facing murder charge

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Iranian general reportedly assassinated while traveling from Syria


robyn.dixon@latimes.com





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Lebbeus Woods: The Architect Who Dared to Ask 'What If?'


He envisioned underground cities, floating buildings and an eternal space tomb for Albert Einstein worthy of the great physicist’s expansive intellect. With such grand designs, perhaps it’s not too surprising that the late Lebbeus Woods, one of the most influential conceptual architects ever to walk the earth, had only one of his wildly imaginative designs become a permanent structure.


Instead of working with construction and engineering firms, Woods dreamed up provocative creations that weren’t bound by the rules of society or even nature, according to Joseph Becker and Jennifer Dunlop Fletcher, co-curators of a new exhibit at the San Francisco Museum of Modern Art titled Lebbeus Woods, Architect.


“It was almost a badge of honor to never have anything built, because you were not a victim of the client,” Becker told Wired during a preview of the fascinating show, which opens Saturday and runs through June 2. While not a full retrospective of Woods’ career, the exhibit shows off three decades of his work in the form of drawings, paintings, models and sketchbooks filled with bold ideas, raw concepts and cryptic inscriptions. (See several examples of Woods’ work in the gallery above.)


As the curators discussed Woods’ work and his impact on the world of architecture, they talked of a brilliant mind consumed with disruption, with confronting the boring, repetitive spaces humans have become accustomed to living in by challenging the “omnipresence of the Cartesian grid.” Woods’ fantastic visions included buildings designed for seismic hot zones that might move in response to earthquakes, or a sprawling city that would exist underneath a divided Berlin, providing a sort of subterranean salon where individuals from the East and West might mingle, free from the conflicting ideologies of their governments.


“He was very focused, I think, in all of his work, in what he said was ‘architecture for its own sake,’” Becker said. “Not architecture for clients, not architecture that is diluted, and not architecture that really had to be held up against certain primary factors, including gravity or government.”


Woods found his place in the conceptual architecture movement that sprang from the 1960s and ’70s, when firms like Superstudio and Archigram presented a radical peek into a possible — if improbable — future. Casting a skeptical eye on the way humans lived in cities, these conceptual architects were more interested in raising questions than in crafting blueprints for buildings that would actually be built of concrete, steel and glass.


In fact, none of the nearly 200 fascinating drawings and other works on display in Lebbeus Woods, Architect were ever meant to be built, said Dunlop Fletcher. Instead of the archetypical architect’s detailed plans and models, carefully calibrated to produce a road map to a finished structure, Woods’ drawings are whimsical and thought-provoking, with radical new ideas being the intended result of his efforts. “There are going to be gaps in this, and you fill in the gaps with what you bring to it,” she said.


Woods’ ideas started in his sketchbooks, which he crammed with detailed drawings. “He was extremely gifted with the pen,” said Becker, adding that many of the pieces are notated in a strange hybrid language that could be part Latin, part invented. The curators likened it to a kind of code that connected the conceptual fragments that run through Woods’ highly theoretical work.


“It could mean something, it could be that he’s creating almost these fictional artifacts of these supporting elements to engage with the larger drawings that he would do later,” Becker said. “They’re almost Da Vinci-like in their illegibility.”


Other questions remain about just what, exactly, Woods was up to with when he took pencil to paper. Take, for instance, a piece called Aero-Livinglab, from his Centricity series from the late 1980s, in which the architect was “essentially creating a utopian city” with “its own set of rules,” according to Becker. The drawing depicts a floating room that resembles an insect as much as it does some sort of alien zeppelin. Just what would the purpose of such a construction be?


“It could be an inhabitable space,” Becker said. “It could be small, it could be large. Often these things don’t have clear scale, but we do know that the point of Centricity was to invite a question of ‘what if?’”


An obituary on the Architectural Record website dubbed Woods “the last of the great paper architects” and said he “achieved cult-idol status among architects for his post-apocalyptic landscapes of dense lines and plunging perspectives. Deconstructivist in the most literal of ways, they were never formalist exercises. Instead, they conveyed the architect’s deep reservations as to the nature of contemporary society, and particularly its penchant for violence. He eschewed practice, claiming an interest in architectural ideas rather than the quotidian challenges of commercial building.”


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Quirky comedy film “Prince Avalanche” charms Berlin






BERLIN (Reuters) – Cinema has a new odd couple in “Prince Avalanche“, a low-budget film set in the remote, fire-ravaged forests of Texas and starring Paul Rudd and Emile Hirsch as an unlikely pair of workers painting markings on a seemingly endless road.


The tedium of their work allows space for them to argue, bicker, compete and bond in David Gordon Green‘s oddball remake of a 2011 Icelandic movie called “Either Way”.






In competition at the Berlin film festival, where it premieres on Wednesday, “Prince Avalanche” has received mostly warm reviews, with the Hollywood Reporter calling it an “odd little gem of a movie”.


Green, best known for stoner comedy “Pineapple Express”, took an unusual approach to making the film: he decided to adapt an Icelandic picture even before he had seen it.


“I watched the film for the first time really with the intension of remaking it, which is really strange,” he told reporters in Berlin.


He set the action in the late 1980s rather than today, because it allowed him to cut his characters off completely from an outside world with no Skype, mobile phones or iPads – generally a time when “things were more pleasant.”


LOVE-HATE RELATIONSHIP WITH NATURE


For Hirsch, there were parallels with his most famous role to date in Sean Penn‘s 2007 “Into the Wild” in which he plays Christopher McCandless, who turns his back on society and wanders into the Alaskan wilderness.


In “Prince Avalanche” his character Lance is just the opposite – a young drifter who hates being away from the buzz of the city and the company of his girlfriends.


“I love shooting in nature, that’s for sure, but I think because I’m so identified with the part in ‘Into the Wild’ I like the idea of playing a character that didn’t really like nature and hated to be alone from the beginning,” he said.


“I certainly love nature and I love being in the wilderness, but I was raised in Sante Fe, New Mexico but also in Los Angeles, California.”


Green rushed to shoot the movie, which took just 16 days to film, in order to capture the devastation caused by a 2011 wildfire at Bastrop State Park.


He kept his crew to a minimum – no more than 10 people on set at any time – and allowed the actors to improvise.


The barren landscape, which was quickly recovering its color and vitality, was captured by Green’s regular director of photography Tim Orr.


Rudd, best known for comic roles and most recently starring in “This is 40″, plays Alvin, the boyfriend of Lance’s older sister who is introverted, serious and constantly seeking to better himself, including learning German using a language tape.


By contrast, Lance hates sleeping in tents, hunting for food and painting roads, and can’t wait for the weekend when he can get back to civilization.


Gradually the two misfits begin to get along, helped by Alvin’s personal crisis and a crate of hooch left by a mysterious old truck driver played by the late character actor Lance LeGault, to whom the movie is dedicated.


(Reporting by Mike Collett-White, editing by Paul Casciato)


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Fat Dad: Baking for Love

Fat Dad

Dawn Lerman writes about growing up with a fat dad.

My grandmother Beauty always told me that the way to a man’s heart was through his stomach, and by the look of pure delight on my dad’s face when he ate a piece of warm, homemade chocolate cake, or bit into a just-baked crispy cookie, I grew to believe this was true. I had no doubt that when the time came, and I liked a boy, that a batch of my gooey, rich, chocolatey brownies would cast him under a magic spell, and we would live happily ever.

But when Hank Thomas walked into Miss Seawall’s ninth grade algebra class on a rainy, September day and smiled at me with his amazing grin, long brown hair, big green eyes and Jimi Hendrix T-shirt, I was completely unprepared for the avalanche of emotions that invaded every fiber of my being. Shivers, a pounding heart, and heat overcame me when he asked if I knew the value of 1,000 to the 25th power. The only answer I could think of, as I fumbled over my words, was “love me, love me,” but I managed to blurt out “1E+75.” I wanted to come across as smart and aloof, but every time he looked at me, I started stuttering and sweating as my face turned bright red. No one had ever looked at me like that: as if he knew me, as if he knew how lost I was and how badly I needed to be loved.

Hank, who was a year older than me, was very popular and accomplished. Unlike other boys who were popular for their looks or athletic skills, Hank was smart and talented. He played piano and guitar, and composed the most beautiful classical and rock concertos that left both teachers and students in awe.

Unlike Hank, I had not quite come into my own yet. I was shy, had raggedy messy hair that I tied back into braids, and my clothes were far from stylish. My mother and sister had been on the road touring for the past year with the Broadway show “Annie.” My sister had been cast as a principal orphan, and I stayed home with my dad to attend high school. My dad was always busy with work and martini dinners that lasted late into the night. I spent most of my evenings at home alone baking and making care packages for my sister instead of coercing my parents to buy me the latest selection of Gloria Vanderbilt jeans — the rich colored bluejeans with the swan stitched on the back pocket that you had to lie on your bed to zip up. It was the icon of cool for the popular and pretty girls. I was neither, but Hank picked me to be his math partner anyway.

With every equation we solved, my love for Hank became more desperate. After several months of exchanging smiles, I decided to make Hank a batch of my chocolate brownies for Valentine’s Day — the brownies that my dad said were like his own personal nirvana. My dad named them “closet” brownies, because when I was a little girl and used to make them for the family, he said that as soon as he smelled them coming out of the oven, he could imagine dashing away with them into the closet and devouring the whole batch.

After debating for hours if I should make the brownies with walnuts or chips, or fill the centers with peanut butter or caramel, I got to work. I had made brownies hundreds of times before, but this time felt different. With each ingredient I carefully stirred into the bowl, my heart began beating harder. I felt like I was going to burst from excitement. Surely, after Hank tasted these, he would love me as much as I loved him. I was not just making him brownies. I was showing him who I was, and what mattered to me. After the brownies cooled, I sprinkled them with a touch of powdered sugar and wrapped them with foil and red tissue paper. The next day I placed them in Hank’s locker, with a note saying, “Call me.”

After seven excruciating days with no call, some smiles and the usual small talk in math class, I conjured up the nerve to ask Hank if he liked my brownies.

“The brownies were from you?” he asked. “They were delicious.”

Then Hank invited me to a party at his house the following weekend. Without hesitation, I responded that I would love to come. I pleaded with my friend Sarah to accompany me.

As the day grew closer, I made my grandmother Beauty’s homemade fudge — the chocolate fudge she made for Papa the night before he proposed to her. Stirring the milk, butter and sugar together eased my nerves. I had never been to a high school party before, and I didn’t know what to expect. Sarah advised me to ditch the braids as she styled my hair, used a violet eyeliner and lent me her favorite V-neck sweater and a pair of her best Gloria Vanderbilt jeans.

When we walked in the door, fudge in hand, Hank was nowhere to be found. Thinking I had made a mistake for coming and getting ready to leave, I felt a hand on my back. It was Hank’s. He hugged me and told me he was glad I finally arrived. When Hank put his arm around me, nothing else existed. With a little help from Cupid or the magic of Beauty’s recipes, I found love.


Fat Dad’s ‘Closet’ Brownies

These brownies are more like fudge than cake and contain a fraction of the flour found in traditional brownie recipes. My father called them “closet” brownies, because when he smelled them coming out of the oven he could imagine hiding in the closet to eat the whole batch. I baked them in the ninth grade for a boy that I had a crush on, and they were more effective than Cupid’s arrow at winning his heart.

6 tablespoons unsalted butter, plus extra for greasing the pan
8 ounces bittersweet chocolate, chopped, or semisweet chocolate chips
3/4 cup brown sugar
2 eggs at room temperature, beaten
1 teaspoon vanilla extract
1/4 cup flour
1/2 cup chopped walnuts (optional)
Fresh berries or powdered sugar for garnish (optional)

1. Preheat oven to 350 degrees.

2. Grease an 8-inch square baking dish.

3. In a double boiler, melt chocolate. Then add butter, melt and stir to blend. Remove from heat and pour into a mixing bowl. Stir in sugar, eggs and vanilla and mix well.

4. Add flour. Mix well until very smooth. Add chopped walnuts if desired. Pour batter into greased baking pan.

5. Bake for 35 minutes, or until set and barely firm in the middle. Allow to cool on a rack before removing from pan. Optional: garnish with powdered sugar, or berries, or both.

Yield: 16 brownies


Dawn Lerman is a New York-based health and nutrition consultant and founder of Magnificent Mommies, which provides school lectures, cooking classes and workshops. Her series on growing up with a fat father appears occasionally on Well.

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Supreme Court to Hear Monsanto Seed Patent Case


Aaron P. Bernstein for The New York Times


Vernon Hugh Bowman, an Indiana farmer, is challenging Monsanto, the world's largest seed company, over genetically modified crops.







With his mere 300 acres of soybeans, corn and wheat, Vernon Hugh Bowman said, “I’m not even big enough to be called a farmer.”




Yet the 75-year-old farmer from southwestern Indiana will face off Tuesday against the world’s largest seed company, Monsanto, in a Supreme Court case that could have a huge impact on the future of genetically modified crops, and also affect other fields from medical research to software.


At stake in Mr. Bowman’s case is whether patents on seeds — or other things that can self-replicate — extend beyond the first generation of the products.


It is one of two cases before the Supreme Court related to the patenting of living organisms, a practice that has helped give rise to the biotechnology industry but which critics have long considered immoral. The other case, involving a breast cancer risk test from Myriad Genetics, will determine whether human genes can be patented. It is scheduled to be heard April 15.


Monsanto says that a victory for Mr. Bowman would allow farmers to essentially save seeds from one year’s crop to plant the next year, eviscerating patent protection. In Mr. Bowman’s part of Indiana, it says, a single acre of soybeans can produce enough seeds to plant 26 acres the next year.


Such a ruling would “devastate innovation in biotechnology,” the company wrote in its brief. “Investors are unlikely to make such investments if they cannot prevent purchasers of living organisms containing their invention from using them to produce unlimited copies.”


The decision might also apply to live vaccines, cell lines and DNA used for research or medical treatment, and some types of nanotechnology.


Many organizations have filed briefs in support of Monsanto’s position — universities worried about incentives for research, makers of laboratory instruments and some big farmer groups like the American Soybean Association, which say seed patents have spurred crop improvements. The Justice Department is also supporting Monsanto’s argument.


BSA/The Software Alliance, which represents companies like Apple and Microsoft, said in a brief that a decision against Monsanto might “facilitate software piracy on a broad scale” because software can be easily replicated. But it also said that a decision that goes too far the other way could make nuisance software patent infringement lawsuits too easy to file.


Some critics of biotechnology say that a victory for Mr. Bowman could weaken what they see as a stranglehold that Monsanto and some other big biotech companies have over farmers, which they say has led to rising seed prices and the lack of high-yielding varieties that are not genetically engineered.


Patents have “given seed companies enormous power, and it’s come at the detriment of farmers,” said Bill Freese, science policy analyst for the Center for Food Safety, which was an author of a brief on the side of Mr. Bowman. “Seed-saving would act as a much needed restraint on skyrocketing biotech seed prices.”


Farmers who plant seeds with Monsanto’s technology must sign an agreement not to save the seeds, which means they must buy new seeds every year.


Monsanto has a reputation for vigorously protecting its intellectual property.


The Center for Food Safety, which has tracked the cases, said Monsanto had filed more than 140 patent infringement lawsuits involving 410 farmers and 56 small farm businesses, and had so far received $23.67 million in recorded judgments. The center says there are many other cases in which farmers settled out of court or before a suit was filed.


Monsanto says it must stop infringers to be fair to the large majority of farmers who do pay to use its technology.


But Monsanto typically exercises no control over soybeans or corn once farmers sell their harvested crops to grain elevators, which in turn sell them for animal feed, food processing or industrial use.


Mr. Bowman said that for his main soybean crop, he honored Monsanto’s agreement, buying new seeds each year containing the Roundup Ready gene, which makes the plants immune to the herbicide Roundup. That technology is hugely popular, used in more than 90 percent of the nation’s soybeans, because it allows farmers to spray fields to kill weeds without hurting the crop.


This article has been revised to reflect the following correction:

Correction: February 15, 2013

An earlier version of the home page summary for this article incorrectly described the crops produced from Monsanto seeds as pesticide-resistant. They are resistant to the herbicide Roundup, not a pesticide.



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Former Bell official says he voted for pay raise out of fear









One of the former Bell city leaders accused of plundering the town's treasury by taking oversized salaries testified Thursday that the fat paychecks and other extraordinary benefits that came with the job were all but forced on him.


George Cole, a former steelworker, returned to the witness stand for a second day and testified that he voted for a 12% annual pay raise for a City Council board in 2008 only because he feared retribution from then-City Manager Robert Rizzo.


"He had shown himself to be very vindictive if you crossed him at that time," Cole said. "I was worried that if I didn't vote for this, if I voted against it, he would do whatever he could to destroy the work that was important to me and the community. I knew that was his character."





Cole said it was the most difficult decision he ever made while on the council but was in the best interest of Bell — a city, he said, where he had devoted decades to advocating for new schools and programs for at-risk youths and senior citizens.


Cole, along with Luis Artiga, Victor Bello, Oscar Hernandez, Teresa Jacobo and George Mirabal, is accused of drawing an inflated salary from boards and authorities that rarely met and did little work.


The pay increases for the authorities were placed on the consent calendar — a place for routine and non-controversial items that are voted on without discussion. Cole defended the practice and said the agendas, minutes and staff reports were always available to the public at City Hall and at the library.


"I never tried to hide what we were doing," Cole said.


He also testified that the minutes did not reflect work done for those authorities.


Cole justified his vote for previous City Council pay raises to allow for a more diverse pool of council candidates who could use the money. And when he voted for a council salary increase in 2005, Cole noted that Bell was in a "very strong financial position."


The 63-year-old also told jurors that when he discovered $15,500 had been deposited into a 401(k)-style account for him, he complained. Cole said Rizzo refused to remove the money.


Initially, Cole said, Rizzo was a first-rate city administrator, making improvements such as repairing and keeping streets clean and erecting a protective fence around the city's largest park.


"From the time he started, he was able to accomplish things other managers previous to him said couldn't be done or were unable to do," Cole said.


Cole said the two would sometimes meet for breakfast to discuss city matters. "It was business," he said. "It wasn't two chums getting together."


But when Cole decided to give up his salary during his last year in office, he said it fractured his relationship with Rizzo. When he learned about Rizzo's near-$800,000 salary from a story published in The Times in 2010, he said he felt sick.


"I just felt like the dumbest person in the world that this guy had just pulled one of the biggest cons I've ever seen on, not just me, but on the city of Bell," Cole testified.


Rizzo faces 69 felony corruption charges. He and his former assistant, Angela Spaccia, are expected to go on trial later this year.


Cole's top annual salary was $67,000, his attorney said. At the time, he was earning nearly $95,000 a year as chief executive of the Steelworkers Old Timers Foundation.


In 2004, the city paid the state pension system $36,648 to buy Cole an additional five years of service time. Cole was one of 11 Bell administrators for whom the city bought service time.


CalPERS — the state's largest public pension program — has disallowed the service time the city bought, saying the buy-ins were not council-approved and that a municipality cannot pay for them.


Cole also was among the 40 or so Bell employees who were scheduled to receive additional payments through Bell's own supplemental retirement plan, established in 2003. In combination with the CalPERS pension, the payout was among the best retirement plans for non-safety employees in the state. The council never approved the plan.


jeff.gottlieb@latimes.com


corina.knoll@latimes.com





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Never Tell Me the Odds: A Look at <cite>Star Wars</cite> Tabletop Gaming's Past and Present

Before J.J. Abrams was a twinkle in George Lucas' eye, Star Wars fans had another outlet for the continued adventures of their favorite characters: the tabletop. Whether playing with board games, miniatures, or pen-and-paper role-playing games, Star Wars has been a setting of choice for three decades and counting.


Throughout this gallery, you'll find both hidden gems from Star Wars' past as well as recent hits, proving that the franchise is anything but running out of steam. In fact, when put into the hands of creative game designers, Star Wars has continuously led to some truly engaging experiences.


Above:



As if the combination of Star Wars and Angry Birds was not enough to drive fans wild, Hasbro rolled the combo into its own Jenga game. Rather than plucking pieces with a steady hand, you'll be flinging those iconic birds to knock out as many Jenga blocks as possible. The destruction doesn't end there, though. An entire line of Star Wars Angry Birds games was launched last year, with six other titles featuring everything from Jabba's Palace to the ice planet Hoth.


Image courtesy of Hasbro

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Ryan O’Neal wins appeals ruling in defamation case






LOS ANGELES (AP) — Ryan O’Neal may have enough evidence to show that he was defamed by a man who claimed the actor stole a valuable portrait of the late Farrah Fawcett, an appeals court ruled Thursday.


A divided panel of the 2nd District Court of Appeal ruled that O’Neal’s case against Craig Nevius, a former Fawcett associate, should be allowed to proceed and that the actor may be able to win some damages. One justice disagreed and wrote that the case should be dismissed.






O’Neal sued in July 2011, claiming he was defamed by Nevius‘ comments that the actor had stolen a Fawcett portrait created by Andy Warhol. The painting is the subject of a separate lawsuit between O’Neal and the University of Texas, which claims Fawcett left the artwork to the school after her 2009 death.


Nevius’s attorney, Lincoln Bandlow, said he would appeal the ruling to the California Supreme Court. He had appealed a lower court’s ruling allowing the case to go forward.


O’Neal’s suit seeks more than $ 1 million in damages. He claimed in the case that Warhol gave him the portrait and he intends to bequeath it to his only son from his longtime relationship with Fawcett, Redmond O’Neal.


Nevius’ comments that O’Neal stole the artwork were made in interviews with Star magazine and “Good Morning America,” and he cooperated with UT investigators searching for the portrait.


Although Nevius initially denied he accused O’Neal of stealing the painting, he acknowledged in a later court filing that he made the claim to university investigators.


“The inferences reasonably drawn from the evidence here would support a jury’s finding that Nevius harbored strong ill-feelings toward O’Neal,” the justices siding with O’Neal wrote. The dissent argues that Nevius’ comments were constitutionally-protected speech and the case should have been dismissed.


O’Neal’s fight with UT over the portrait returns to court on Feb. 27.


The actor and Nevius have battled in court for years.


Nevius collaborated on a documentary of Fawcett’s fight with cancer but sued the actor claiming he interfered in the project and removed him from it shortly before Fawcett’s death. The case was dismissed before trial.


___


Anthony McCartney can be reached at http://twitter.com/mccartneyAP


Entertainment News Headlines – Yahoo! News





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Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

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DealBook: Confidence on Upswing, Mergers Make Comeback

The mega-merger is back.

For the corporate takeover business, the last half-decade was a fallow period. Wall Street deal makers and chief executives, brought low by the global financial crisis, lacked the confidence to strike the audacious multibillion-dollar acquisitions that had defined previous market booms.

Cycles, however, turn, and in the opening weeks of 2013, merger activity has suddenly roared back to life. On Thursday, Berkshire Hathaway, the conglomerate run by Warren E. Buffett, said it had teamed up with Brazilian investors to buy the ketchup maker H. J. Heinz for about $23 billion. And American Airlines and US Airways agreed to merge in a deal valued at $11 billion.

Those transactions come a week after a planned $24 billion buyout of the computer company Dell by its founder, Michael S. Dell, and private equity backers. And Liberty Global, the company controlled by the billionaire media magnate John C. Malone, struck a $16 billion deal to buy the British cable business Virgin Media.

“Since the crisis, one by one, the stars came into alignment, and it was only a matter of time before you had a week like we just had,” said James B. Lee Jr., the vice chairman of JPMorgan Chase.

Still, bankers and lawyers remain circumspect, warning that it is still too early to declare a mergers-and-acquisitions boom like those during the junk bond craze of 1989, the dot-com bubble of 1999 and the leveraged buyout bonanza of 2007. They also say that it is important to pay heed to the excesses that developed during these moments of merger mania, which all ended badly.

A confluence of factors has driven the recent deals. Most visibly, the stock market has been on a tear, with the Standard & Poor’s 500-stock index this week briefly hitting its highest levels since November 2007. Higher share prices have buoyed the confidence of chief executives, who now, instead of retrenching, are looking for ways to expand their businesses.

A number of clouds that hovered over the markets last year have also been removed, eliminating the uncertainty that hampered deal making. Mergers and acquisitions activity in 2012 remained tepid as companies took a wait-and-see approach over the outcome of the presidential election and negotiations over the fiscal cliff. The problems in Europe, which began in earnest in 2011, shut down a lot of potential transactions, but the region has since stabilized.

“When we talk to our corporate clients as well as the bankers, we keep hearing them talk about increased confidence,” said John A. Bick, a partner at the law firm Davis Polk & Wardwell, who advised Heinz on its acquisition by Mr. Buffett and his partners.

Mr. Bick said that mega-mergers had a psychological component, meaning that once transactions start happening, chief executives do not want to be left behind. “In the same way that success breeds success, deals breed more deals,” he said.

A central reason for the return of big transactions is the mountain of cash on corporate balance sheets. After the financial crisis, companies hunkered down, laying off employees and cutting costs. As a result, they generated savings. Today, corporations in the S.& P. 500 are sitting on more than $1 trillion in cash. With interest rates near zero, that money is earning very little in bank accounts, so executives are looking to put it to work by acquiring businesses.

The private equity deal-making machine is also revving up again. The world’s largest buyout firms have hundreds of billions of dollars of “dry powder” — money allotted to deals in Wall Street parlance — and they are on the hunt. The proposed leveraged buyout of Dell, led by Mr. Dell and the investment firm Silver Lake Partners, was the largest private equity transaction since July 2007, when the Blackstone Group acquired the hotel chain Hilton Worldwide for $26 billion just as the credit markets were seizing up.

But perhaps the single biggest factor driving the return of corporate takeovers is the banking system’s renewed health. Corporations often rely on bank loans for financing acquisitions, and the ability of private equity firms to strike multibillion-dollar transactions depends on the willingness of banks to lend them money.

For years, banks, saddled by the toxic mortgage assets weighing on their balance sheets, turned off the lending spigot. But with the housing crisis in the rearview mirror and economic conditions slowly improving, banks are again lining up to provide corporate loans at record-low interest rates to finance acquisitions.

The banks, of course, are major beneficiaries of megadeals, earning big fees from both advising on the transactions and lending money to finance them. Mergers and acquisitions in the United States total $158.7 billion so far this year, according to Thomson Reuters data, more than double the amount in the same period last year. JPMorgan, for example, has benefited from the surge, advising on four big deals in recent weeks, including the Dell bid and Comcast’s $16.7 billion offer for the rest of NBCUniversal that it did not already own.

Mr. Buffett, in a television interview last month, declared that the banks had repaired their businesses and no longer posed a threat to the economy. “The capital ratios are huge, the excesses on the asset aside have been largely cleared out,” said Mr. Buffett, whose acquisition of Heinz will be his second-largest acquisition, behind his $35.9 billion purchase of a majority stake in the railroad company Burlington Northern Santa Fe in 2009.

While Wall Street has an air of giddiness over the year’s start, most deal makers temper their comments about the current environment with warnings about undisciplined behavior like overpaying for deals and borrowing too much to pay for them.

Though private equity firms were battered by the financial crisis, they made it through the downturn on relatively solid ground. Many of their megadeals, like Hilton, looked destined for bankruptcy after the markets collapsed, but they have since recovered. The deals have benefited from an improving economy, as well as robust lending markets that allowed companies to push back the large amounts of debt that were to have come due in the next few years.

But there are still plenty of cautionary tales about the consequences of overpriced, overleveraged takeovers. Consider Energy Future Holdings, the biggest private equity deal in history. Struck at the peak of the merger boom in October 2007, the company has suffered from low natural gas prices and too much debt, and could be forced to restructure this year. Its owners, a group led by Kohlberg Kravis Roberts and TPG, are likely to lose billions.

Even Mr. Buffett made a mistake on Energy Future Holdings, having invested $2 billion in the company’s bonds. He admitted to shareholders last year that the investment was a blunder and would most likely be wiped out.

“In tennis parlance,” Mr. Buffett wrote, “this was a major unforced error.”

Michael J. de la Merced contributed reporting.

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