‘Bloodless’ Lung Transplants for Jehovah’s Witnesses


Eric Kayne for The New York Times


SHARING HOME AND FAITH A Houston couple hosted Gene and Rebecca Tomczak, center, in October so she could get care nearby.







HOUSTON — Last April, after being told that only a transplant could save her from a fatal lung condition, Rebecca S. Tomczak began calling some of the top-ranked hospitals in the country.




She started with Emory University Hospital in Atlanta, just hours from her home near Augusta, Ga. Then she tried Duke and the University of Arkansas and Johns Hopkins. Each advised Ms. Tomczak, then 69, to look somewhere else.


The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.


Given the complexities of lung transplantation, in which transfusions are routine, some doctors felt the procedure posed unacceptable dangers. Others could not get past the ethics of it all. With more than 1,600 desperately ill people waiting for a donated lung, was it appropriate to give one to a woman who might needlessly sacrifice her life and the organ along with it?


By the time Ms. Tomczak found Dr. Scott A. Scheinin at The Methodist Hospital in Houston last spring, he had long since made peace with such quandaries. Like a number of physicians, he had become persuaded by a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases.


By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it. The way he saw it, patients declined lifesaving therapies all the time, for all manner of reasons, and it was not his place to deny care just because those reasons were sometimes religious or unconventional.


“At the end of the day,” he had resolved, “if you agree to take care of these patients, you agree to do it on their terms.”


Ms. Tomczak’s case — the 11th so-called bloodless lung transplant attempted at Methodist over three years — would become the latest test of an innovative approach that was developed to accommodate the unique beliefs of the world’s eight million Jehovah’s Witnesses but may soon become standard practice for all surgical patients.


Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.


Ms. Tomczak had dismissed the prospect of a transplant for most of the two years she had struggled with sarcoidosis, a progressive condition of unknown cause that leads to scarring in the lungs. The illness forced her to quit a part-time job with Nielsen, the market research firm.


Then in April, on a trip to the South Carolina coast, she found that she was too breathless to join her frolicking grandchildren on the beach. Tethered to an oxygen tank, she watched from the boardwalk, growing sad and angry and then determined to reclaim her health.


“I wanted to be around and be a part of their lives,” Ms. Tomczak recalled, dabbing at tears.


She knew there was danger in refusing to take blood. But she thought the greater peril would come from offending God.


“I know,” she said, “that if I did anything that violates Jehovah’s law, I would not make it into the new system, where he’s going to make earth into a paradise. I know there are risks. But I think I am covered.”


Cutting Risks, and Costs


The approach Dr. Scheinin would use — originally called “bloodless medicine” but later re-branded as “patient blood management” — has been around for decades. His mentor at Methodist, Dr. Denton A. Cooley, the renowned cardiac pioneer, performed heart surgery on hundreds of Witnesses starting in the late 1950s. The first bloodless lung transplant, at Johns Hopkins, was in 1996.


But nearly 17 years later, the degree of difficulty for such procedures remains so high that Dr. Scheinin and his team are among the very few willing to attempt them.


In 2009, after analyzing Methodist’s own data, Dr. Scheinin became convinced that if he selected patients carefully, he could perform lung transplants without transfusions. Hospital administrators resisted at first, knowing that even small numbers of deaths could bring scrutiny from federal regulators.


“My job is to push risk away,” said Dr. A. Osama Gaber, the hospital’s director of transplantation, “so I wasn’t really excited about it. But the numbers were very convincing.”


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Herbalife is global giant with business model in question









Stock spotlight is a new weekly feature that will profile a notable, public company.


The company: Herbalife Ltd.


Headquarters: Los Angeles





Ticker: HLF


Employees: 6,200 employees and 3.2 million independent distributors worldwide


Revenue: $4.1 billion in 2012


Net Income: $477 million in 2012


Stock Price: $36.79 at Friday's close


52-week range: $24.24 to $73


Annual dividend: $1.20 a share annually, a current yield of about 3%


P/E Ratio: $7.87, based on 2013 estimated earnings


The business: The company sells weight-loss, nutrition, hair- and skin-care products in more than 80 countries, utilizing independent distributors who profit from their own sales and sales from others they recruit into the business. Its top-selling product is cookies and cream flavor Formula 1, a high-protein, meal-replacement shake mix. Herbalife does very little mainstream advertising and does not sell products in retail stores. Instead it relies on a network of independent distributors who recruit customers, counsel them about nutrition and fitness and sell them products. The company recently agreed to a $44-million, 10-year deal to sponsor the Los Angeles Galaxy professional soccer team, one of many professional sports clubs it supports around the world.


The latest: Wall Street veterans say they've never seen a fight like this. Noted hedge fund managers Bill Ackman and Carl Icahn have engaged in a heated debate about Herbalife's business model, with billions of dollars at stake. Ackman has taken a $1-billion "short position" against the company's shares, meaning he'll profit if the stock price drops. In a slick, multimedia pitch on Wall Street, Ackman contended that the company is a well-disguised pyramid scheme. He said the vast majority of the company's independent distributors make little money or lose money, while a fortunate few get rich off commissions they receive for recruiting others into the business. Ackman said he expects Herbalife's shares to hit zero. Icahn said he has purchased nearly 13% of the company's shares and planned to talk to executives about strategies to increase its profitability, including taking it private. Herbalife acknowledged discussions with Icahn but did not elaborate. The company insists its business model is completely legal. Herbalife said it sells products that help people live healthy lives while giving entrepreneurs an opportunity to build their own businesses.


Accomplishments: The company reported record sales and profit in 2012 and said it expects things to improve in 2013. It has mountains of available cash, pays a decent dividend and repurchased 15 million — or more than 10% — of its shares in little more than a year.


Challenges: Herbalife shares have been extremely volatile in the last nine months, plunging more than 40% in the days after Ackman's attack, and falling 20% in a single day in May after hedge fund manager David Einhorn questioned the company's business model. Herbalife has acknowledged it is under review by the Securities and Exchange Commission. The Federal Trade Commission released dozens of complaints it has received about Herbalife in recent years. Neither agency has confirmed an investigation.


Analyst opinions: Seven analysts have the stock as a buy or strong buy, while four have it as hold. The average one-year target price is about $58 a share.


Voices: "Our belief remains steadfast that Herbalife operates a perfectly legal multilevel marketing model that has proven particularly efficacious in the weight-loss category.... Herbalife's sustained growth and 30-plus year history in a highly regulated industry indicate a legitimate business [because] pyramid schemes are unsustainable." — Scott Van Winkle, analyst, Canaccord Genuity;


"Buckle up, it's going to be bumpy.... We are maintaining our overweight, but recognize that the stock is not for the faint of heart. We expect Mr. Ackman to continue to make noise on his short thesis, however, and for the potential for an FTC investigation to be an overhang on the stock for the indefinite future." — Brian Wang, analyst, Barclays Capital;


"It is clear that over time Herbalife is answering the questions that need to be answered and providing greater clarity around their business model — one that we see as simple but effective. We think it logical that, as these questions are finally answered to the investment community's satisfaction, the shares will trade, finally to the premium valuation we believe it deserves. The scarlet letter it wears today in the minds of the short seller community will be removed." — Timothy Ramey, analyst, D.A. Davidson & Co.


stuart.pfeifer@latimes.com





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Athletes cash in on California's workers' comp









SACRAMENTO — In his seven-year career with the Denver Broncos, running back Terrell Davis, a former Super Bowl Most Valuable Player, dazzled fans with his speed and elusiveness.


At the end of his rookie year in 1995, he signed a $6.8-million, five-year contract. Off the field he endorsed Campbell's soup. And when he hung up his cleats, he reported for the National Football League Network and appeared in movies and TV shows.


So it may surprise Californians to find out that in 2011, Davis got a $199,000 injury settlement from a California workers' compensation court for injuries related to football. This came despite the fact Davis was employed by a Colorado team and played just nine times in California during an 88-game career, according to the NFL.





Davis was compensated for the lifelong effects of multiple injuries to the head, arms, trunk, legs and general body, according to California workers' compensation records.


He is not alone.


Over the last three decades, California's workers' compensation system has awarded millions of dollars in benefits for job-related injuries to thousands of professional athletes. The vast majority worked for out-of-state teams; some played as little as one game in the Golden State.


All states allow professional athletes to claim workers' compensation payments for specific job-related injuries — such as a busted knee, torn tendon or ruptured spinal disc — that happened within their borders. But California is one of the few that provides additional payments for the cumulative effect of injuries that occur over years of playing.


A growing roster of athletes are using this provision in California law to claim benefits. Since the early 1980s, an estimated $747 million has been paid out to about 4,500 players, according to an August study commissioned by major professional sports leagues. California taxpayers are not on the hook for these payments. Workers' compensation is an employer-funded program.


Now a major battle is brewing in Sacramento to make out-of-state players ineligible for these benefits, which are paid by the leagues and their insurers. They have hired consultants and lobbyists and expect to unveil legislation next week that would halt the practice.


"The system is completely out of whack right now," said Jeff Gewirtz, vice president of the Brooklyn Nets — formerly the New Jersey Nets — of the National Basketball Assn.


Major retired stars who scored six-figure California workers' compensation benefits include Moses Malone, a three-time NBA most valuable player with the Houston Rockets, Philadelphia 76ers and other teams. He was awarded $155,000. Pro Football Hall of Fame wide receiver Michael Irvin, formerly with the Dallas Cowboys, received $249,000. The benefits usually are calculated as lump-sum payments but sometimes are accompanied by open-ended agreements to provide lifetime medical services.


Players, their lawyers and their unions plan to mount a political offensive to protect these payouts.


Although the monster salaries of players such as Los Angeles Lakers guard Kobe Bryant and Denver Broncos quarterback Peyton Manning make headlines, few players bring in that kind of money. Most have very short careers. And some, particularly football players, end up with costly, debilitating injuries that haunt them for a lifetime but aren't sufficiently covered by league disability benefits.


Retired pros increasingly are turning to California, not only because of its cumulative benefits but also because there's a longer window to file a claim. The statute of limitations in some states expires in as little as a year or two.


"California is a last resort for a lot of these guys because they've already been cut off in the other states," said Mel Owens, a former Los Angeles Rams linebacker-turned-workers' compensation lawyer who has represented a number of ex-players.


To understand how it works, consider the career of Ernie Conwell. A former tight end for the St. Louis Rams and New Orleans Saints, he was paid $1.6 million for his last season in 2006.


Conwell said that during his 11-year career, he underwent about 18 surgeries, including 11 knee operations. Now 40, he works for the NFL players union and lives in Nashville.


Hobbled by injuries, he filed for workers' compensation in Louisiana and got $181,000 in benefits to cover his last, career-ending knee surgery in 2006, according to the Saints. The team said it also provided $195,000 in injury-related benefits as part of a collective-bargaining agreement with the players union.


But such workers' compensation benefits paid by Louisiana cover only specific injuries. So, to deal with what he expects to be the costs of ongoing health problems that he said affect his arms, legs, muscles, bones and head, Conwell filed for compensation in California and won.


Even though he played only about 20 times in the state over his professional career, he received a $160,000 award from a California workers' compensation judge plus future medical benefits, according to his lawyer. The Saints are appealing the judgment.





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Dozens of stars rehearse day before Oscar ceremony


LOS ANGELES (AP) — Some dressed down in jeans and hoodies. Others looked camera-ready in suits or chic dresses and spiky stilettos.


But no matter how they looked, all of the stars who rehearsed Saturday for the 85th Academy Awards seemed excited about being a part of the big show.


They paraded through the Dolby Theatre in 15-minute increments: Meryl Streep. Ben Affleck. Reese Witherspoon. Richard Gere. Jennifer Aniston. John Travolta. Nicole Kidman. Jack Nicholson. And dozens more.


Each practiced their lines in front of an audience of show workers and awarded prop Oscars to rehearsal actors. They also scanned the theater from the stage, searching for their show-night seats.


"Oh, wow. That's a very dramatic picture of me," best-actress nominee Jessica Chastain said after spotting her seat-saving placard. "I'm looking at everyone's headshots. It's kind of incredible."


Affleck confessed his excitement from the stage as he looked out at all the famous faces expected Sunday.


"This is like the most memorable aspect of the Oscars," the "Argo" director said. "You see all these place cards (at rehearsal), then you come back and they're all here!"


Affleck also chatted backstage with the college film students who won a contest to serve as trophy carriers during the ceremony.


"I love that," he said. "It's super cool."


Travolta spent time with the students, too.


"I was there when that idea was born and I said it was the best idea they could possibly come up with," he told the aspiring filmmakers backstage. "And here you are!"


Travolta plans to bring his 13-year-old daughter, Ella Bleu, to the ceremony.


Kidman made rehearsals a family affair. Husband Keith Urban and their eldest daughter, Sunday, watched from the audience as Kidman ran through her lines.


She looked impeccable in a wine-colored dress and tall metallic shoes, but other stars were decidedly more casual. Kristen Stewart arrived in jeans, sneakers and a backward ball cap. (She also limped on an injured right foot.) Renee Zellweger also opted for comfort in jeans and running shoes.


The cast of "Chicago," including Gere, Zellweger, Queen Latifah and Catherine Zeta-Jones, injected their rehearsal with silliness. Latifah purposely over-enunciated her lines, and when a pair of rehearsal actors claimed an Oscar onstage and gave an acceptance speech, Zeta-Jones started to play them off with an imaginary violin.


"Get outta here!" Gere said with a smile.


Octavia Spencer, who won the supporting actress Oscar last year for her performance in "The Help," also had a little fun.


"I'm going to do a soft-shoe," she said, shuffling off stage.


Streep and Jane Fonda were each wowed by the set design. Fonda snapped a photo with her iPhone, and Streep marveled at how far the walk to the microphone was.


"All the way to here?!" she asked. "Oh my God."


Halle Berry literally stumbled during her first rehearsal, her pointy heel catching on part of the stage. She insisted on trying again.


"Woo hoo," she said. "Made it."


___


AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .


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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain


Matt Rainwaters for Texas Monthly


The Sherman grave of Andre Thomas’s victims.







SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.






The Texas Tribune

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.




For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org






Matt Rainwaters for Texas Monthly

Laura Boren






He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.


He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.


In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.


Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.


“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”


Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.


At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.


Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.


He was on a mission from God, he said, to free their hearts of demons.


Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.


“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.


From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.


bgrissom@texastribune.org



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Jason Bateman gives Ernest Borgnine's estate a new identity

Markus Canter and Cristie St. James, who share the title luxury properties director at Prudential in Beverly Hills, like Jason Bateman's real estate sense. The actor got privacy, potential and a knoll location for $3 million.









Actor Jason Bateman and his wife, actress Amanda Anka, are dropping anchor in the Beverly Crest area with the purchase of the estate of Ernest Borgnine for $3 million.


The gated country English compound sits on a half-acre knoll. The 6,148-square-foot home features a formal entry hall, a grand staircase, a paneled library, an office, a den, six bedrooms and seven bathrooms. There is a guesthouse and a swimming pool.


Bateman, 44, stars in the comic film "Identity Thief," released this month. He is known to generations of TV viewers for his roles in "Arrested Development" (2003-present) and "Valerie," later retitled "The Hogan Family" (1986-91). Anka, 44, has appeared in "Bones" (2008), "Notes From the Underbelly" (2007) and "Beverly Hills, 90210" (1996).








Borgnine, who died last year at 95, is remembered for his Oscar-winning performance in "Marty" (1955) and his work in the title role as commander of a madcap crew in the sitcom "McHale's Navy" (1962-65). Until 2011 he was the voice of Mermaidman on "SpongeBob SquarePants."


The estate came on the market in October for the first time in 60 years priced at $3.395 million.


Billy Rose, Paul Lester and Aileen Comora of the Agency in Beverly Hills were the listing agents. Richard Ehrlich of Westside Estate Agency represented the buyers.


Where pair spent days of their lives


Soap star Peter Reckell and his wife, singer Kelly Moneymaker, have sold their custom-built, eco-friendly home in Brentwood for $3.35 million.


Before building the 3,345-square-foot house, the couple had the existing home on the site torn down, crated and shipped to Mexico for reuse by Habitat for Humanity. Then they designed and built a three-bedroom, four-bathroom contemporary that uses solar power.


Green elements include a photovoltaic system with battery backup, skylights, recycled glass terrazzo floors with radiant heating, recycled denim and organic cotton insulation, bamboo cabinets and doors, a roof garden and a water reclamation system.


A temperature-controlled wine cave and a recording studio are among other features.


Along with an indoor/outdoor koi pond, a meditation fountain and a solar infinity pool, outdoor amenities include a 16th century East Indian temple that was turned into a pavilion.


"This is my sanctuary," Reckell said. It frames views of the Santa Monica Mountains Conservancy.


Reckell, 57, played Bo Brady on "Days of Our Lives" from 1983 through last year. The show began in 1965. He also appeared in "Knots Landing" (1988-89). He is an avid environmentalist and bikes to work.


Moneymaker, 42, is a former member of the music group Exposé. She was inspired to build an environmentally friendly home because the carpet and other elements in the old house bothered her allergies and affected her voice.


Public records show they bought the property in 2003 for $1.14 million.


Daniel Banchik of Prudential's West Hollywood office was the listing agent. Scott Segall of John Aaroe Group represented the buyer.


Another rock owner for home


Hard Rock Cafe co-founder Peter Morton has made his mark on L.A.'s real estate scene of late, buying the old Elvis Presley estate in Beverly Hills at year-end for $9.8 million.


But flying under the radar was his bigger off-market purchase midyear for a property in Bel-Air at $25 million, public records show. Area real estate agents not involved in the transaction say Morton plans to take down the existing home and build another on the site. The estate had belonged to Joseph Farrell, who founded National Research Group Inc. in 1978 and brought market testing to Hollywood. Farrell died in December 2011.





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Gunfire and deadly crash rattle the Las Vegas Strip









LAS VEGAS — A spectacular predawn crash on the Strip — triggered when bullets fired from a black Range Rover peppered a Maserati — hit this resort city right between the eyes. In the end, three people were dead and a major intersection under lockdown during a three-state manhunt for the shooters, leaving even casino veterans used to the extraordinary scratching their heads.


The mayhem was sparked, witnesses told police, by a quarrel early Thursday at a hotel valet stand.


The two vehicles left the Aria resort hotel and were heading north on Las Vegas Boulevard at 4:20 a.m., an hour when the casino marquees shine brightly but the gambling thoroughfare is largely empty. At Harmon Avenue, occupants inside the Range Rover opened fire on the Maserati, police said.





The silver-gray sports car, which was struck several times, sped into the intersection at Flamingo Road, ramming a Yellow cab. The taxi exploded, killing the driver and a passenger. Four other vehicles in the intersection were also involved in the crash and explosion, but officers offered no details.


"Omg Omg Omg that car just blew up!" one witness tweeted shortly after the crash, posting a photo of the wreckage. "God Bless their Souls! Omg!"


The driver of the Maserati died later at a hospital, police said. A passenger in the vehicle received minor injuries and was being interviewed by investigators. At least three others were also injured.


Police in Nevada, California, Arizona and Utah were on alert for the distinctive black Range Rover SUV, described as having dark-tinted windows, black rims and out-of-state paper dealer plates.


"We are going to pursue these individuals and prosecute them," Clark County Sheriff Doug Gillespie said at an afternoon news conference. "This act was totally unacceptable. It's not just tragic but unnecessary — the level of violence we see here in Las Vegas and across America."


Authorities had not publicly identified the dead. But a Las Vegas television station late Thursday identified the taxi driver as Michael Boldon, 62, who the station said had recently moved here from Michigan to care for his 93-year-old mother.


The victim's son, who drives a limousine, told Fox News 5 that he last talked with his father after 3 a.m., and later called his cellphone shortly after the crash to warn him to avoid the Strip. But there was no answer.


The station also identified the driver of the Maserati as Ken Cherry, a rap artist from Oakland who also is known as "Kenny Clutch." The station quoted family members identifying Cherry as the driver. An Internet video of a Cherry song called "Stay Schemin" shows two men in a vehicle on the Strip.


Police had more questions than answers.


"It began with a dispute at a nearby hotel and spilled onto the streets," said Capt. Chris Jones of the Las Vegas Police Robbery and Homicide Division.


The morning's events threw the Strip into disarray all day. The gambling boulevard's busiest and best-known intersection was cordoned off by yellow police tape until nightfall, keeping traffic and curious pedestrians away from the carnage. Even skywalks were blocked off.


While slot machines beeped and card games continued inside casinos around the accident scene — including the Bellagio, Caesars Palace and Paris Las Vegas — hotel bell captains were fielding questions from tourists who had awakened to news of the crash and the Strip shutdown. The alleys and side streets between nearby hotels were clogged with pedestrians who inched along on narrow sidewalks, past delivery doors, many making their own paths between the landscaped bushes and palm trees.


Even casino industry workers were thrown into turmoil. Hotel maids and dealers who finished their midnight shifts after dawn were left without bus service home. "I'm stranded," said Tiruselam Kefyalew, 25, a maid. "What a day to leave my cellphone at home."


Limousine drivers who normally prowl the city's gambling core improvised detours. Some said the police blockade would cost them $500 or more in lost business and tips.


"Most people understand, but you have your complainers," said Jim DeSanto, a limo driver who waited for fares outside Bally's casino. "Those people will complain, even when everything is perfect."


Well after noon, guests peered out nearby hotel windows and others leaned into the street to glimpse the crime scene.


"Hey, honey, it must have happened right here," one man told his wife as they left Caesars around noon. The tourist, who would only say that he had arrived from Tampa, Fla., the previous evening, had looked out his hotel window at 4:30 to see a vehicle in flames.





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Adele, 'Les Miserables' cast sing on Oscar stage


LOS ANGELES (AP) — It was an extra starry, musical day at the Dolby Theatre.


Adele took the stage first Friday, followed by the cast of "Les Miserables," singing together of the first time.


Oscar nominees Hugh Jackman and Anne Hathaway, along with co-stars Russell Crowe, Amanda Seyfried, Helena Bonham-Carter, Sasha Baron-Cohen, Eddie Redmayne, Aaron Tveit and Samantha Barks rehearsed their performances on the Oscar stage. They were backed by members of the musical's stage productions from London and Broadway.


"Les Miserables" director Tom Hooper sat in the front row of the theater as his cast sang.


Moments earlier, Adele dazzled the tiny audience of show workers with her performance of the James Bond theme "Skyfall."


"I need a lot more reverb on me," she said after her first run. "You might need to get a new reverb machine."


The 24-year-old multiple Grammy winner arrived wearing a black tunic, black leggings and flats, with no makeup and her hair in a ponytail.


"I'm going to have very high heels on the night, guys," she announced from the microphone, sipping tea between verses.


"Do you need the dresses?" she asked, and a team of stylists brought out the gowns Adele is considering for her Oscar performance.


The dress producers favored? "It's very heavy — I mean I struggle to stand in it," Adele said. "Come and feel how heavy it is, so you don't think I'm a wimp!"


She performed her Oscar-nominated song five times before leaving the theater. "It's been good, yeah?" she asked producer Neil Meron, who nodded in approval.


Just after Adele wrapped, the star-studded "Les Miserables" cast took the stage. Hathaway chatted with Bonham-Carter as Jackman sang a capella. Then Hathaway checked her microphone with a quick verse.


"Ooh, that was flat," she said.


The entire cast assembled for a final run-through when Jackman spontaneously began singing "My Bonny Lies over the Ocean."


"My bonny lies over my daddy," the ensemble responded, breaking into laughter.


Other stars rehearsing Friday included Jennifer Hudson, who is set to perform a song from "Dreamgirls" at Sunday's ceremony.


___


AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .


___


Online:


www.oscar.com


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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do


U.S. Air Force/Master Sgt. Steve Horton


Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.





The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.


“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.


That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.


But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.


“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”


Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.


Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.


Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.


The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.


The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.


That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.


The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.


After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.


But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.


The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.


The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.


She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.


“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.


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Herbalife cozies up with UCLA








Herbalife International says it's all about helping people "pursue healthy, active lives." UCLA's Geffen School of Medicine likes to think of itself as being in the forefront of medical research and modern healthcare.


But the curious relationship between these two supposed champions of healthful living should turn your stomach.


Herbalife is the Los Angeles nutritional supplement firm that has become the centerpiece of a ferocious Wall Street tug of war. The major player is hedge fund manager Bill Ackman, who contends that Herbalife is a scam to sell overpriced products by fooling people into becoming Herbalife "distributors" by implying the business will make them rich. He says he's shorted $1 billion in Herbalife shares as a bet that the company is destined to collapse. On the other side are investors who either believe Herbalife will stay a highflier, or who just want to squeeze Ackman dry. (He's not a popular chap.)






One of Ackman's accusations against the company is that it exaggerates the scientific research behind its powders and pills. That's where UCLA comes in, because Herbalife has exploited its "strong affiliation" with the medical school to give its products scientific credibility.


Those words were uttered by Herbalife CEO Michael Johnson during a 2007 conference call. In fact, Johnson seldom lets an investor event pass without mentioning UCLA, specifically the Mark Hughes Cellular and Molecular Nutrition Lab at the medical school's Center for Human Nutrition. Herbalife says it has contributed $1.5 million in cash, equipment and software to the lab since 2002. (The lab is named after Herbalife's founder, who died in 2000 after a four-day drinking binge — not the greatest advertisement for healthful, active living.)


That's not much of an investment for a company that collected $2 billion in profits over the same period. But Johnson sometimes refers to the lab as if it's an Herbalife facility. "Our product development stems out of our own research and development labs," he told an investor conference in 2008. "It comes from UCLA where we have the Mark Hughes Cellular Lab there."


Nor does Johnson shrink from the admission of what he hopes to gain from the UCLA connection. In 2007, explaining how he inculcates Herbalife's distributors with respect for the firm's protein powders and other supplements, he said: "We bring these great minds from UCLA to join us, to give them confidence in these products."


That brings us to Herbalife's prime UCLA trophies, David Heber and Louis Ignarro.


Heber is director of the Center for Human Nutrition and a professor at the medical school. He's a well-known obesity specialist with hundreds of scientific articles and four popular diet books to his name. He's also chairman of Herbalife's "Nutrition Advisory Board," a collection of credentialed experts who supposedly meet once a year and sometimes make appearances at Herbalife events. Ignarro and two other UCLA medical school faculty members, dermatologist Jenny Kim and psychiatrist and aging specialist Gary Small, are also on the board. (None replied to my requests for comment.)


The board members traditionally have been paid as much as $60,000 annually, plus a per diem of up to $3,000 for event appearances. (This year, the company said it cut them back to $20,000 a year and $1,500 per diem).


Heber has a special deal, however. A firm he's "affiliated with" collects an annual payment of $300,000 from Herbalife, according to Herbalife disclosures. He also received Herbalife stock grants in 2005, 2010, 2011 and 2012. Herbalife refuses to say how much those grants were worth, and Heber refused to talk with me.


What was he paid for? According to a company spokesman, "for the use and promotion of the nutritional philosophies, theories and concepts contained in his bestselling books," as well as to lend luster to the company's products. In a 2009 promotional video, Johnson introduced Heber as a UCLA faculty member and as "a good friend, a pal and a mentor of Herbalife in all things nutrition." Together they bemoaned the nutritional catastrophe of fast-food burger and fries and offered up an Herbalife protein shake as though it's the only sensible alternative.


Ignarro is an even bigger catch. A professor at the medical school's department of pharmacology, he shared the 1998 Nobel Prize in physiology or medicine for work on the role of nitric oxide in cardiac health. Herbalife soon put him on its payroll. Since 2003, according to corporate disclosures, it has paid a consulting firm connected to Ignarro a total of $17.8 million.


The money principally covers royalties on the sale of an Herbalife product called Niteworks, the label of which carries Ignarro's signature and explicit endorsement. Niteworks, which Herbalife says is "based on" Ignarro's research, chiefly comprises the amino acids L-argenine and L-citrulline, which supposedly generate nitric oxide in the body. There's no evidence that the formulation has ever been subjected to clinical trials to determine its safety and efficacy for humans, and under a 1994 law it doesn't have to be — as a nutritional supplement, it's exempt from Food and Drug Administration oversight of the sort applied to pharmaceuticals.


Ignarro's connection with Herbalife hasn't been free of embarrassment: In 2003 and 2004 he co-wrote two academic articles about the positive affect of nitric oxide on mice, without disclosing his role with the marketing of Niteworks or his connection to Herbalife. The journal that published both papers had to run corrections making the appropriate disclosures. He later apologized, saying that his Italian co-authors "inadvertently failed" to make the disclosures and asserting that he did not act improperly. He didn't respond to my request for an interview.


Herbalife relentlessly promotes its Ignarro connection. At distributor events he's treated like a rock star, telling packed, cheering audiences how great Niteworks is — "It's magical in that it works!" He can be seen in an Herbalife video talking about this "refreshing lemon-flavored product" that "enhances the body's natural nitric oxide production while you sleep." If you look fast, you'll see a disclaimer flash on the screen warning that these statements "have not been evaluated by the Food and Drug Administration" and that Niteworks "is not intended to diagnose, treat, cure or prevent any disease."


That's a clue to how Heber and Ignarro can make grandiose claims for Herbalife products with impunity: That same 1994 law allows nutritional supplement marketers like Herbalife to say almost anything about their nostrums, as long as they flash that pro-forma disclaimer.


It's hard to blame Herbalife for seeking credibility by throwing money at college professors; marketing 101 tells us that even an implicit university endorsement can sprinkle pixie dust over the meanest product. Throw in a Nobel Prize, and you're golden. Nor is Herbalife the only firm to dig its talons into the medical school's Center for Human Nutrition. In one of his books Heber mentions that the center's donors have included Lynda and Stewart Resnick, whose Roll Global markets Fiji Water, Pom Wonderful pomegranate juice and Wonderful Pistachios.


So you may not be surprised to learn that in 2008 Heber was appointed to the firm's Pistachio Health Scientific Advisory Board. Or that he was co-author of a 2012 scientific paper finding that pistachios are a more healthful snack than pretzels. Or that when Pom got in trouble with the Federal Trade Commission for making inflated health claims for its pomegranate juice, he was a leading expert witness for the defense. (The FTC found the firm's ads deceptive anyway.)


Heber, Ignarro and their colleagues certainly have some sound medical and nutritional ideas to offer, but they've made it impossible to know where the sensible ideas end and the shilling for Herbalife begins. Herbalife maintains that it employs its UCLA cadre "as individuals, not in their capacities as UCLA employees or representatives." But that's baloney of an especially non-nutritious variety: Most of them are on the Herbalife payroll because of their UCLA connection.


That's a serious issue for the medical school. At what point does it lose its reputation as a source of objective scientific knowledge, and become instead an arm of Herbalife's (or the Resnicks') P.R. machine? At what point does it begin to look like a university for sale?


When torrents of cash fall upon people like Heber and Ignarro — especially when the payments promote interests fundamentally in conflict with their responsibilities for thorough, objective research — it's proper to ask whether the recipients should be viewed primarily as university professors with an income source on the side, or as agents of industry exploiting their academic titles for show.


The University of California has a "conflict-of-commitment" policy governing the outside activities of its faculty members, but it may be too tolerant. The policy frowns on outside salaried work without written permission, but it provides a yawning loophole for arrangements like consultantships. Faculty are required to maintain "appropriate standards of scholarly inquiry" and to practice "intellectual honesty."


The policy is silent on how those standards might be affected by outside income of $300,000 a year, much less $17.8 million over a decade.


UCLA plainly hasn't done enough to make sure that its faculty aren't trading on its name in ways that devalue that name. But Herbalife may not be gaining as much as it thinks, either. Examine this relationship closely enough, and when you ask yourself whose claims for the healthfulness of these products you should believe, Herbalife's or the professors', you may find that the only safe answer is: nobody's.


Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.






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