Hollywood directs its star power toward a campaign closer to home

A stylish crowd waited beneath a flashing marquee outside the Fonda Theatre. "Appearing tonight!" the sign read. "Eric Garcetti 4 Mayor."

In a city where political campaigns are typically waged at neighborhood meetings, not Hollywood concert halls, last week's star-studded fundraiser for Garcetti highlighted the entertainment industry's outsized role in this year's mayoral race. Talk show host Jimmy Kimmel started the show with a stand-up routine and musician Moby got the crowd of several hundred dancing. Actress Amy Smart urged everyone to tweet about the campaign, and actor Will Ferrell beamed in via video to pledge that if Garcetti is elected, every resident in the city will receive free waffles.

Hollywood is taking to City Hall politics like never before, veterans say, with power players such as Steven Spielberg leading a major fundraising effort and celebrities such as Salma Hayek weighing in via YouTube. A Times analysis of city Ethics Commission records found that actors, producers, directors and others in the industry have donated more than $746,000 directly to candidates, with some $462,000 going to Garcetti and $226,000 to City Controller Wendy Greuel.

Several of Greuel's big-name celebrity supporters, including Tobey Maguire, Kate Hudson and Zooey Deschanel, recently hosted a fundraiser for her at an exclusive club on the Sunset Strip. She is getting extra help from Spielberg and his former partners at DreamWorks, Jeffrey Katzenberg and David Geffen, who have given at least $150,000 and are raising more for an independent group funding a TV ad blitz on her behalf.

The burst of support is coming from an industry often maligned for paying little attention to local politics.

While Mayor Antonio Villaraigosa is often photographed at red carpet events and former Mayor Tom Bradley was famously close to actor Gregory Peck, serious Hollywood money and star power has tended to remain tantalizingly out of reach for local politicians. "It's no secret that the entertainment industry has never really focused on the city that houses it," said Steve Soboroff, who ran for mayor and lost in 2001.

Political consultant Garry South, who has worked on mayoral and gubernatorial campaigns, recalled having to pay celebrities to appear at fundraisers in the past. Hollywood has long embraced candidates in presidential and congressional elections, South said, in part because they have more influence over causes favored by celebrities.

"The mayor of L.A. is not going to get us out of Afghanistan. The mayor of L.A. is not going to determine whether or not gay marriage is legal," South said. "The local issues are just not as sexy."

But this year, if you're a part of the Hollywood establishment, chances are you've gotten invitations to fundraisers for Greuel, Garcetti or both.

The difference this time is that both candidates have worked to cultivate deep Hollywood connections, observers say. Garcetti has represented Hollywood for 12 years, overseeing a development boom and presiding over ceremonies to add stars — Kimmel recently got one — on the Hollywood Walk of Fame. Greuel is a former executive at DreamWorks, where she worked with the moguls who founded the studio. She has also served for 10 years on the board of the California Film Commission.

City Councilwoman Jan Perry and entertainment attorney Kevin James have reaped far less financial support from the industry, records show, although each claims a share of celebrity endorsements. Dick Van Dyke sponsored a fundraiser for Perry and Oscar winner Dustin Lance Black has given to James.

Agent Feroz Taj, who attended Garcetti's Moby concert, said a flurry of activity around the race, involving friends and colleagues, piqued his interest. He said he's never been involved in a political campaign, but now when he receives invites to Greuel events, he says he is supporting Garcetti.

Industry insiders have been buzzing about a letter they say is being circulated by an advisor to Spielberg and Katzenberg, urging people to give $15,000 to an independent group supporting Greuel. The DreamWorks founders have made a difference for Greuel in previous elections. In 2002, financial support from the studio executives and their allies helped her squeak out a victory in one of the closest City Council races in history.

This time around, billionaire media mogul Haim Saban is getting involved, providing his Beverly Hills estate for a Greuel fundraiser featuring U.S. Sen. Barbara Boxer (D-Calif.). Greuel has also received contributions from Tom Hanks and actresses Mariska Hargitay and Eva Longoria, neither of whom have given to a local political campaign before, according to records.

Garcetti, on the other hand, has picked up contributions from former Disney Chief Executive Michael Eisner, as well as newcomers to local politics Jake Gyllenhaal and Hayek, who once traveled with Garcetti on a global warming awareness mission to the South Pole. The actress released a video endorsing Garcetti and thanking him for helping her find her wallet in the snow.

Campaign consultant Sean Clegg linked the industry's burgeoning interest in mayoral politics to President Obama's election, which he said had "a catalyzing effect on Hollywood." Indeed, many Greuel and Garcetti supporters were Obama backers. Hayek hosted a fundraiser for Obama and Longoria served as a co-chair of his reelection campaign.

Clegg is a consultant for Working Californians, an independent campaign committee that hopes to raise and spend at least $2 million supporting Greuel, with donations from Spielberg and others in Hollywood, as well as the union representing Department of Water and Power employees.

Generally, Clegg argued, Hollywood money is different than the special-interest funding campaigns collect. "Money is coming out of the entertainment industry more on belief and less on the transactional considerations," he said.

But Raphael Sonenshein, director of the Pat Brown Institute of Public Affairs at Cal State L.A., said Hollywood's new interest in local elections may be tied to growing concerns about film production being lured elsewhere by tax incentives.

Garcetti and Greuel have both pledged to reverse job losses tied to runaway television and film production, with Garcetti touting a recent proposal to eliminate roughly $231,000 in annual city fees charged for pilot episodes of new TV shows. The number of pilots shot locally has dropped 30% in recent years, but city budget analysts say the tax break would have a minimal effect because city fees represent only a small portion of production costs.

On the council, both candidates voted to eliminate filming fees at most city facilities. Greuel tells audiences she has an insider's perspective on the industry's needs and says she will create an "entertainment cabinet" to help it thrive. "I have sat with studio heads," she said in a recent interview. "They want a city . . . that is a champion for film industry jobs in Los Angeles."

Greuel may have Garcetti beat on experience in the studio front office, but he is the only candidate with his own page on IMDb.com — a closely watched industry website that tracks individuals' film and television credits.

The councilman, a member of the Screen Actors Guild, has made several television appearances, including one for the cable police drama "The Closer." He played the mayor of Los Angeles.

kate.linthicum@latimes.com

Times staff writer Maloy Moore contributed to this report.

Read More..

TV show with Pistorius' dead girlfriend airs

JOHANNESBURG (AP) — Reeva Steenkamp's last wish for her family before she was shot dead at boyfriend Oscar Pistorius' home was for them to watch her in a reality TV show that went on air in South Africa on Saturday night, two days after her killing.

Sharon Steenkamp, Reeva's cousin, told The Associated Press that the model and law graduate was "proud of being in the show" and reminded them in their last conversation to make sure that they watched it.

The South African Broadcasting Corp. aired the "Tropika Island of Treasure" program, showing the late Steenkamp — the victim of a Valentine's Day shooting at the home of Pistorius, the Olympic star and double-amputee athlete. She is laughing and smiling, and blowing a kiss toward the camera in Jamaica when it was filmed last year.

South Africans also saw her swimming in the ocean and watching people jump off a cliff and into the sea, shaking her head as they leaped.

SABC said it was dedicated to Steenkamp and displayed the words "Reeva Steenkamp 19 August 1983 - 14 February 2013" between images of a rose and a candle in a short tribute before the show aired. She was also seen blowing the kiss as she sat on a Jamaican beach and her name again appeared on screen with the years of her birth and death.

The country was rocked Thursday when news broke of Steenkamp's shooting death at the upscale house of the star athlete. Pistorius was arrested and charged with her murder and remains in custody in a police station. His family has strongly denied prosecutors' claims that he murdered her.

Steenkamp's family said earlier Saturday that it had not been contacted by either the SABC — South Africa's national broadcaster — or the show's producers for permission to air it, but were not opposed to it because Reeva wanted everyone to see it.

"Her last words to us personally were that she wants us to watch it," Sharon Steenkamp said, hours before the program was shown.

SABC aired the reality show on its main channel, which prominently featured Steenkamp.

The show's executive producer, Samantha Moon, said going ahead with the show "is what she would have wanted."

Steenkamp, a 29-year-old blonde model who graduated from law school, died after suffering four gunshot wounds, police said. Officers recovered a 9-mm pistol from Pistorius' house and quickly charged the Olympian with murder for Steenkamp's killing.

Pistorius will appear in court Tuesday for a bail hearing, something police have said they oppose. Prosecutors also say they will pursue upgraded charges of premeditated murder against him, which means the disabled icon and double-amputee runner could face a life sentence.

Steenkamp was known in South Africa for appearing in commercials and as a bikini-clad model in men's magazines.

Pistorius and Steenkamp met Nov. 4 at the Kyalami race track, which sits between Pretoria and Johannesburg and has been used for Grand Prix and Formula 1 races, said Justin Divaris, a mutual friend.

Divaris said his own girlfriend was a close friend to Steenkamp. Pistorius and Steenkamp immediately hit it off and decided in the spur of the moment to attend a sports award ceremony together the same night, Divaris said. At the time, Pistorius had been dating another woman and his personal life was constant fodder for gossip pages.

Later, however, problems may have started, as police have said there were previous domestic altercations at Pretorius' home in a gated community near South Africa's capital, Pretoria.

A Steenkamp family spokesman said late Friday that relatives still faced a long struggle to come to terms with her killing.

"I can't see the family getting over this shortly," said Reeva's uncle, Mike Steenkamp. "It's going to be a long, long-term reconciliation with a lot of things and issues."

Family members plan for a memorial service Tuesday for the model in Port Elizabeth, her hometown on South Africa's southern coast. Pistorius has a court appearance scheduled in Pretoria on the same day for his lawyers to argue that he can be released on bail.

Portions released earlier Saturday of the reality show, sponsored by a milk fruit drink, feature Steenkamp laughing and smiling on the beaches of Jamaica. Another portion shows her swimming with two dolphins, which tap her on the cheek with their snouts.

"I think the way that you go out, not just your journey in life, but the way that you go out and the way you make your exit is so important," Steenkamp says in the video. "You either made an impact in a positive or a negative way, but just maintain integrity and maintain class and just remain true to yourself.

"I'm going to miss you all so much and I love you very, very much."

___

Associated Press writer Jon Gambrell contributed to this report.

___

Gerald Imray can be reached at http://twitter.com/GeraldImrayAP

Read More..

A secret agent reveals her secrets of success

The prospect of a business book written by a former CIA officer fills one with dread at the inevitable 007 anecdotes and labored corporate parallels.

But "Work Like a Spy: Business Tips From a Former CIA Officer," published by Portfolio, turns out to be rather different. There are no gadgets, few cloaks and fewer daggers: Instead it is a bracingly realistic book about people at work. It is short. It is sharp. Better still, it is sensible.

It is also about spying, though only enough to lend a sprinkle of glamour and danger. The book jacket photo shows author J.C. Carleson, an undercover agent for eight years, looking like a real-life Carrie from "Homeland" — without the blond hair and the bipolar disorder.

Yet her stories from the field are as much blunder as conspiracy. The book opens with the heroine as a young case officer in an armed convoy in Iraq. It is 2003 and she is going to inspect a plant that the U.S. is convinced makes biological weapons. They disarm the guards and terrify everyone — only to discover it is a salt factory.

"Salt. (Insert your own expletive of choice here.) Salt!" she writes.

Carleson assures us that not all CIA work is suitable for general adoption: The threatening, lying, trapping, cheating, misleading and detaining that go with the territory should not be tried in the office.

But the spy can teach the general manager about human nature. Spies are simply better at observing people because they have spent more time practicing and because the stakes are too high to screw it up.

By comparison, the rest of us are pretty hopeless, only we don't know it. Reluctantly, I have started to reappraise my own view of myself as a brilliant judge of character and admit that such a belief is a liability.

I've just tried the following exercise: Pick a stranger and try to guess their education, profession, religion, income bracket, marital status and hobbies. Disaster: I was wrong on every score.

Because we cling to this idea that our gut instincts are reliable, we make a lot of avoidable mistakes. We make bad hiring decisions. We talk vaguely about wanting passion and creativity rather than setting to work corroborating resumes and seeking out references. Employers should make a short, precise list of the traits a job requires and hire to fill it. It is all obvious. Yet it takes a spy to point it out.

Less obvious but no less valuable is her tip for job candidates: Get the interviewer to do most of the talking and then hang on their every word. Since hardly anyone can resist talking about themselves to a rapt audience, a job offer is almost bound to follow.

To the public speaker and the salesman, Carleson has further good advice: Never rely on a script and never learn what you are going to say by heart. When you do this you use a different tone of voice, go on to autopilot and all trust is lost in an instant. Carleson is right. I have done this, but never again.

I also liked the observation about newly minted CIA officers (for which read new Harvard MBAs and so on) who emerge from the yearlong training process all swagger and irritating charm. This doesn't wash in the agency, any more than it does elsewhere. More seasoned colleagues slap them down. "Don't try to case officer me," they say.

Not everything from the book can be copied. The CIA keeps its best staff by doing sensible things such as moving people around, giving them interesting work and letting lone wolves be lone wolves.

Yet the perks of being an undercover agent also involve wearing disguises, learning how to crash cars and jump out of aircraft — all of which are big pluses, but not terribly transferable.

The main lesson from "Work Like a Spy" is that we are much more likely to get what we want if we watch other people carefully. It helps to identify the other person's weaknesses, and for this there are some common denominators: "… ego, money, ego, ego … ego, ego, ego."

Lucy Kellaway is a columnist for the Financial Times of London, in which this review first appeared.

Read More..

Deasy wants 30% of teacher evaluations based on test scores

L.A. schools Supt. John Deasy announced Friday that as much as 30% of a teacher's evaluation will be based on student test scores, setting off more contention in the nation's second-largest school system in the weeks before a critical Board of Education election.

Leaders of the teachers union have insisted that there should be no fixed percentage or expectation for how much standardized tests should count — and that test results should serve almost entirely as just one measure to improve instruction. Deasy, in contrast, has insisted that test scores should play a significant role in a teacher's evaluation and that poor scores could contribute directly to dismissal.

In a Friday memo explaining the evaluation process, Deasy set 30% as the goal and the maximum for how much test scores and other data should count.

In an interview, he emphasized that the underlying thrust is to develop an evaluation that improves the teaching corps and that data is part of the effort.

"The public has been demanding a better evaluation system for at least a decade. And teachers have repeatedly said to me what they need is a balanced way forward to help them get better and help them be accountable," Deasy said. "We do this for students every day. Now it's time to do this for teachers."

Deasy also reiterated that test scores would not be a "primary or controlling" factor in an evaluation, in keeping with the language of an agreement reached in December between L.A. Unified and its teachers union. Classroom observations and other factors also are part of the evaluation process.

But United Teachers Los Angeles President Warren Fletcher expressed immediate concern about Deasy's move. During negotiations, he said, the superintendent had proposed allotting 30% to test scores but the union rejected the plan. Deasy then pulled the idea off the table, which allowed the two sides to come to an agreement, Fletcher said. Teachers approved the pact last month.

"To see this percentage now being floated again is unacceptable," the union said in a statement.

Fletcher described the pact as allowing flexibility for principals, in collaboration with teachers, first to set individual goals and then to look at various measures to determine student achievement and overall teacher performance.

"The superintendent doesn't get to sign binding agreements and then pretend they're not binding," Fletcher said.

When Deasy settled on 30%, his decision was in line with research findings of the Bill & Melinda Gates Foundation, which has examined teacher quality issues across the country. Some experts have challenged that work.

The test score component would include a rating for the school based on an analysis of all students' standardized test scores. Those "value-added" formulas, known within L.A. Unified as Academic Growth Over Time, can be used to rate a school or a teacher's effectiveness by comparing students' test scores with past performance. The method takes into account such factors as family income and ethnicity.

After an aggressive push by the Obama administration, individual value-added ratings for teachers have been added to reviews in many districts. They make up 40% of evaluations in Washington, D.C., 35% in Tennessee and 30% in Chicago.

But Los Angeles will use a different approach. The district will rely on raw test scores. A teacher's evaluation also may incorporate pass rates on the high school exit exam and graduation, attendance and suspension data.

Deasy's action was met Friday with reactions ranging from guarded to enthusiastic approval within a coalition of outside groups that have pushed for a new evaluation system. This coalition also has sought to counter union influence.

Elise Buik, chief executive of the United Way of Greater Los Angeles, said weighing test scores 30% "is a reasonable number that everyone can be happy with."

The union and the district were under pressure to include student test data in evaluations after L.A. County Superior Court Judge James C. Chalfant ruled last year that the system was violating state law by not using test scores in teacher performance reviews.

A lawsuit to enforce the law was brought by parents in Los Angeles, with support from the Sacramento-based EdVoice advocacy organization.

If the "actual progress" of students is taken into account under Deasy's plan, "it's a historic day for LAUSD," said Bill Lucia, the group's chief executive.

All of this is playing out against the backdrop of the upcoming March 5 election. The campaign for three school board seats has turned substantially into a contest between candidates who strongly back Deasy's policies and those more sympathetic toward the teachers union. Deasy supporters praise the superintendent for measures they say will improve the quality of teaching. The union has faulted Deasy for limiting job protections and said he has imposed unwise or unproven reforms.

In the upcoming election, the union and pro-Deasy forces are matched head to head in District 4, with several employee unions behind incumbent Steve Zimmer and a coalition of donors behind challenger Kate Anderson.

Anderson had high praise for Deasy's directive, saying it struck the right balance and that teachers and students would benefit.

Zimmer said that although he understands that principals need guidance, "I worry about anything that would cause resistance or delay in going forward. I hope this use of a percentage won't disrupt what had been a collaborative process."

howard.blume@latimes.com

Read More..

Judge sets May trial date for Kardashian divorce

LOS ANGELES (AP) — Kim Kardashian has a due date for her baby and now a trial date for her divorce from NBA player Kris Humphries.

A judge on Friday set a May 6 trial for the reality TV star who wants to end her marriage before July, when her child with Kanye West is due.

Kardashian filed for divorce on Oct. 31, 2011, after she and Humphries had been married just 72 days. Their lavish, star-studded nuptials were recorded and broadcast by E! Entertainment Television.

The trial is expected to last three to five days and could reveal details about Kardashian's reality show empire, which includes "Keeping Up With the Kardashians" and several spinoffs.

Two judges determined Friday that Humphries' lawyers had adequate time to prepare for the trial.

Humphries wants the marriage annulled based on his claim that Kardashian only married him for the sake of her show.

She denies that allegation and says the case should be resolved through what would be her second divorce.

Humphries' attorney Marshall Waller asked for a delay until basketball season is over.

But Superior Court Judge Scott Gordon refused, saying firefighters, police officers, truck drivers and others have to miss work for trials, and Humphries must do the same if necessary.

Waller filed paperwork Thursday to withdraw from the case but didn't mention that development in court and refused to answer any questions about the document on Friday.

Waller said he was still hoping to obtain and review 13,000 hours of footage from Kardashian's reality shows to try to prove the fraud claim but noted he does not yet have an agreement to receive the footage.

Kardashian's lawyer said her client was ready for trial.

"Let's get this case dispensed with," attorney Laura Wasser said.

Humphries has provided a deposition in the case, as have West and Kardashian family matriarch Kris Jenner.

___

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

Read More..

L.A.'s 'Urban Outlaw' selling his custom Porsche 911 accessories

Magnus Walker steps between the scarred carcasses of Porsche 911s lining his garage wall. He pauses and points to a gaping hole where the car's front hood should be.

"Cars in here have to die," he says, "so others can live."

With a chest-length beard and finger-thick dreadlocks, the 45-year-old English immigrant doesn't look like a prototypical buttoned-down Porsche collector. But for more than a decade, Walker has worked in downtown L.A.'s arts district, transforming scrap heaps into one-off custom 911s, earning him the nickname "Urban Outlaw."

"I don't build white glove, Pebble Beach show cars," he says. "I'm building cars for myself."

What once was an expensive obsession may now become a lucrative profession. Already a successful businessman, Walker has started a new company to sell merchandise and the accessories that have become his signature 911 modifications to a cult of followers.

Each of his 911s still has Porsche's trademark large oval headlights, low front hood and sloping teardrop roofline that give the car its legendary silhouette. But Walker's custom touches — drilled-out door handles, trunk lids with horizontal slats cut into the metal — give them a hot rod edge.

His handiwork is on display across the street from the "chop shop" in a showroom-like garage filled with classic Porsche advertisements, rows of vintage license plates and oil-smeared car parts. About a dozen candy-colored 911s from 1964 through 1973 sit parked and ready for the road.

Look closely. No two cars are the same.

There's a 1966 Irish green 911 with wooden interior accents and black vinyl interior. A few steps away is a 1965 silver 911 with a houndstooth interior and Porsche black side stripe. Front and center is a 1972 911 STR decked out in white with red and blue accents and gold wheels.

"I've got to make the next car better than the last one," he said. "I don't chase originality, but if I stumble upon it, I don't turn away."

Walker has never wanted to build 911s to sell them. He's received requests, but he prefers to build them the way he sees fit, in his own time. He sells them when he feels like it, and they fetch $40,000 to $130,000, depending on the rarity of the car.

Some, he can't imagine ever selling.

His innovation has won the admiration of Porsche executives, several of whom visited his shop in November during the Los Angeles Auto Show. Walker now has an open invitation to tour the company's factory in Stuttgart, Germany.

It's high praise from the company, which is known for its strict adherence to the 911's timeless styling. The two-door, rear-engine car is renowned for its simplicity. Its shape has remained virtually unchanged since the first model rolled off assembly lines more than half a century ago.

"We can't go as far as to say we endorse his work. That's pretty hard for a company like ours to say," said Nick Twork, a Porsche spokesman. "But his cars have a unique style, and we have taken notice."

Walker's real skill with modifying 911s doesn't have anything to do with shoehorning in a new engine or gaudy paint jobs. Rather, it's something known as "backdating" to Porsche connoisseurs.

As Porsche's popularity increased after the first 911 in 1964, so did the company's car production. Many of the hand-made or accessory detailing began to disappear.

So Walker applies subtle changes to the cars, such as swapping out a glue-on plastic rearview mirror with a chrome one, or taking out dashboard gauges and recalibrating them.

"You can only look at a stock car so many times," said Manny Alban, president of Porsche Club of America. "What he does is very tasteful. As long as he doesn't stick a Chevy V-8 in the back, we'll be OK with it."

Walker lightens the cars, lowers them closer to the ground and installs a stiffer suspension for aggressive handling — basically building a street version of a 911 race car.

Read More..

Stevie Wonder not happy with Lil Wayne's lyrics

ATLANTA (AP) — Stevie Wonder is not happy with Lil Wayne's vulgar lyrics that reference Emmett Till, a black teen who was killed in 1955 for allegedly whistling at a white woman.

The R&B legend says the rapper's disturbing verse should not have made it beyond the recording studio for the world to hear.

"You can't equate that to Emmett Till," Wonder said. "You just cannot do that. ... I think you got to have someone around you that — even if they are the same age or older — is wiser to say, 'Yo, that's not happening. Don't do that.'"

Wonder, who says he is a fan and friend of Lil Wayne, made the comments when asked what he thought of Lil Wayne's controversial lyrics in an interview Thursday.

On a remix to Future's song "Karate Chop," Lil Wayne compared a rough sex act to the tortuous death of 14-year-old Till in Mississippi, an incident that ultimately helped change the national conversation on race. Following a crude reference to rough sex, Lil Wayne indicates that he wanted to do as much damage as had been done to Till.

Till's family has asked the rapper for an apology, and Epic Records, Future's label, said the official song will not feature the vulgar words and is employing "great efforts" to pull it down.

Wonder, 62, hopes the 30-year-old Grammy winner understands the perspective of the Till family and chooses his words wisely in the future.

"Sometimes people have to put themselves in the place of people who they are talking about," Wonder said. "Imagine if that happened to your mother, brother, daughter or your son. How would you feel? Have some discernment before we say certain things. That goes for me or any other (song)writer."

___

Follow Jonathan Landrum Jr. on Twitter at http://twitter.com/MrLandrum31

Read More..

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.

Read More..

Stocks inch higher as finance ministers meet for G20

Stocks edged higher in early trading on Wall Street, putting the S&P 500 in line for a seventh straight week of gains.

The Standard & Poor's 500 rose one point to 1,522 as of 10:23 a.m. EST. For the week, the index is four points higher. It has risen every week so far this year.

The Dow Jones industrial average rose 26 to 13,978. The Nasdaq composite advanced 6 to 3,204.

Burger King gained 46 cents to $16.98. The company's fourth-quarter earnings nearly doubled after it revamped its menu.

A stock market rally that started in January has slowed in February. Investors piled into stocks at the beginning of the year after lawmakers reached a last-minute deal to avoid the “fiscal cliff” of sweeping tax hikes and spending cuts. The gains continued as investors were encouraged by signs that the housing and jobs markets are recovering.

Herbalife surged $3.51, or 9 percent, to $41.78 after the billionaire investor Carl Icahn disclosed that he had accumulated a 13 percent stake in the company. The stock of the supplement company slumped last year after Pershing Square Capital Management's William Ackman described it as a massive pyramid scheme and placed bets that it would fall.

The yield on the 10-year Treasury note, which moves inversely to its price, has risen since the beginning of the year as investors put more cash into stocks. The yield rose 1 basis point Friday to 2.01 percent. It started the year at 1.70 percent.

Read More..

Oscar Pistorius arrested in slaying of model Reeva Steenkamp

Paralympian Oscar Pistorius charged with murder

By Houston Mitchell

February 14, 2013, 6:35 a.m.

South African police Thursday arrested double amputee Olympic runner Oscar Pistorius and said he would be charged with murder after his girlfriend, Reeva Steenkamp, was shot and killed at his home earlier in the morning.

Police spokesperson Brigadier Denise Beukes said that Pistorius was at his home after the death of the victim and that "there is no other suspect involved."

"There are witnesses and they have been interviewed this morning. We are talking about neighbors and people that heard things earlier in the evening and when the shooting took place," Beukes said.

Pistorius' court hearing was originally scheduled for Thursday afternoon but has been postponed until Friday to give forensic investigators time to carry out their work.

The athlete's father, Henke Pistorius, told South Africa's SABC radio news that he didn't know the facts. "If anyone makes a statement, it will have to be Oscar. He's sad at the moment."

Media in South Africa are reporting that Steenkamp was surprising Pistorius for Valentine's Day when he mistook her for a burglar and shot her. Steenkamp was shot in the arm and head and a 9-mm pistol was recovered at the scene.

"We have also taken cognizance of the media reports during the morning of an alleged break-in or that the young lady was mistaken to be a burglar," Beukes said. "Obviously our forensic investigation is still ongoing and we're not sure where this report came from.... Our detectives have been on the scene, our forensic investigators have been on the scene and the investigation is ongoing."

South African police said that there had been "previous incidents" of a domestic nature reported at Pistorius' home.

Pistorius, 26, was born without the fibula bone in both legs. He was known as the "Blade Runner" for his use of carbon fiber prosthetic blades. He was the first double amputee to run in the Olympics and reached the 400 meter semifinals in London 2012.

ALSO:

LeBron James' blistering streak an NBA best

O.J. Simpson holds Super Bowl party in his prison cell

Advisor says Vince Young took out loan for a $300,00 birthday party

Read More..