Prescription deaths: Lawmaker wants cases reported to Medical Board

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The chairman of a state Senate committee that oversees the Medical Board said Monday he would introduce a bill requiring coroners to report all prescription drug deaths to the agency — a move aimed at helping authorities identify doctors whose prescribing practices may be harming patients.

Sen. Curren D. Price Jr., responding to a Times' report that authorities have failed to recognize how often people overdose on medications prescribed by their doctors, said the medical board needed coroners reports to improve oversight of potentially dangerous practices.

“There appears to be a disconnect between coroners and the Medical Board,” Price (D-Los Angeles), said in an interview. “Hopefully legislation will tighten that up and provide the kind of accountability we all expect.”

FULL COVERAGE: Legal drugs, deadly outcomes

The Times investigation published Sunday found that in nearly half of the accidental deaths from prescription drugs in four Southern California counties, the deceased had a doctor's prescription for at least one drug that caused or contributed to the death.

The investigation identified 3,733 deaths that involved prescription drugs in Los Angeles, Orange, San Diego and Ventura counties from 2006 through 2011. In 1,762 of those cases — 47% — drugs for which the deceased had a prescription were the sole cause or a contributing cause of death.

The Times found that prescription drug deaths often involved multiple drugs, sometimes prescribed by more than one doctor. In some cases, the deceased also mixed prescribed drugs with illegal drugs, alcohol or both.

The paper identified 71 Southern California physicians who prescribed drugs to three or more patients who later fatally overdosed. The doctors were primarily pain specialists, general practitioners and psychiatrists.

Price said that although there may be legitimate reasons for a doctor's prescriptions being linked to a death, “it’s cause for some further review.”

“I think a red flag goes up any time you have one [doctor] involved in several deaths,” he said. “And I think an investigation is not only warranted but called upon by the public.”

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'Skyfall' brings record Bond debut of $88.4M

LOS ANGELES (AP) — James Bond is cashing in at the box office.

"Skyfall," the 23rd film featuring the British super-spy, pulled in a franchise-record $88.4 million in its U.S. debut, bringing its worldwide total to more than $500 million since it began rolling out overseas in late October.

The top 20 movies at U.S. and Canadian theaters Friday through Sunday, followed by distribution studio, gross, number of theater locations, average receipts per location, total gross and number of weeks in release, as compiled Monday by Hollywood.com are:

1. "Skyfall," Sony, $88,364,714, 3,505 locations, $25,211 average, $90,564,714, one week.

2. "Wreck-It Ralph," Disney, $33,012,796, 3,752 locations, $8,799 average, $93,647,405, two weeks.

3. "Flight," Paramount, $14,785,097, 2,047 locations, $7,223 average, $47,455,396, two weeks.

4. "Argo," Warner Bros., $6,617,229, 2,763 locations, $2,395 average, $85,583,187, five weeks.

5. "Taken 2," Fox, $4,012,829, 2,487 locations, $1,614 average, $131,300,000, six weeks.

6. "Cloud Atlas," Warner Bros., $2,658,250, 2,023 locations, $1,314 average, $22,844,956, three weeks.

7. "The Man With the Iron Fists," Universal, $2,592,705, 1,872 locations, $1,385 average, $12,821,030, two weeks.

8. "Pitch Perfect," Universal, $2,573,350, 1,391 locations, $1,850 average, $59,099,993, seven weeks.

9. "Here Comes the Boom," Sony, $2,522,790, 2,044 locations, $1,234 average, $39,033,885, five weeks.

10. "Hotel Transylvania," Sony, $2,400,226, 2,566 locations, $935 average, $140,954,208, seven weeks.

11. "Paranormal Activity 4," Paramount, $1,980,033, 2,348 locations, $843 average, $52,600,612, four weeks.

12. "Sinister," Summit, $1,524,448, 1,554 locations, $981 average, $46,578,686, five weeks.

13. "Silent Hill: Revelation," Open Road Films, $1,300,137, 1,902 locations, $684 average, $16,383,406, three weeks.

14. "The Perks of Being a Wallflower," Summit, $1,132,924, 607 locations, $1,866 average, $14,614,770, eight weeks.

15. "Lincoln," Disney, $944,308, 11 locations, $85,846 average, $944,308, one week.

16. "Alex Cross," Summit, $911,973, 1,090 locations, $837 average, $24,603,042, four weeks.

17. "Fun Size," Paramount, $757,223, 1,301 locations, $582 average, $8,800,336, three weeks.

18. "Looper," Sony, $582,150, 491 locations, $1,186 average, $64,669,383, seven weeks.

19. "The Sessions," Fox, $545,550, 128 locations, $4,262 average, $1,655,222, four weeks.

20. "Seven Psychopaths," CBS Films, $404,812, 356 locations, $1,137 average, $14,098,469, five weeks.

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Universal and Focus are owned by NBC Universal, a unit of Comcast Corp.; Sony, Columbia, Sony Screen Gems and Sony Pictures Classics are units of Sony Corp.; Paramount is owned by Viacom Inc.; Disney, Pixar and Marvel are owned by The Walt Disney Co.; Miramax is owned by Filmyard Holdings LLC; 20th Century Fox and Fox Searchlight are owned by News Corp.; Warner Bros. and New Line are units of Time Warner Inc.; MGM is owned by a group of former creditors including Highland Capital, Anchorage Advisors and Carl Icahn; Lionsgate is owned by Lions Gate Entertainment Corp.; IFC is owned by AMC Networks Inc.; Rogue is owned by Relativity Media LLC.

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Alzheimer’s Precursors Founds at Earlier Age

Scientists studying Alzheimer’s disease are increasingly finding clues that the brain begins to deteriorate years before a person shows symptoms of dementia.

Now, research on a large extended family of 5,000 people in Colombia with a genetically driven form of Alzheimer’s has found evidence that the precursors of the disease begin even earlier than previously thought, and that this early brain deterioration occurs in more ways than has been documented before.

The studies, published this month in the journal Lancet Neurology, found that the brains of people destined to develop Alzheimer’s clearly show changes at least 20 years before they have any cognitive impairment. In the Colombian family, researchers saw these changes in people ages 18 to 26; on average, members of this family develop symptoms of mild cognitive impairment at 45 and of dementia at 53.

These brain changes occur earlier than the first signs of plaques made from a protein called beta amyloid or a-beta, a hallmark of Alzheimer’s. Researchers detected higher-than-normal levels of amyloid in the spinal fluid of these young adults. They found suggestions that memory-encoding parts of the brain were already working harder than in normal brains. And they identified indications that brain areas known to be affected by Alzheimer’s may be smaller than in those who do not have the Alzheimer’s gene.

“This is one of the most important pieces of direct evidence that individual persons have the disease and all the pathology many years before,” said Dr. Kaj Blennow, a professor in clinical neurochemistry at the University of Gothenburg in Sweden, who was not involved in the research.

Dr. Nick Fox, a neurologist at University College London, who was also not part of the research, said the findings suggested that “some of the things that we thought were more downstream may not be quite so downstream; they may be happening earlier.”

That, in turn, said Dr. Fox, who wrote a commentary about the findings in Lancet Neurology, could have implications for when and how to treat people, because “there may be targets to attack, whether it’s high levels of a-beta or whatever, when people are still functioning very well.”

The Colombian family suffers from a rare form of Alzheimer’s that is caused by a genetic mutation; it strikes about a third of its members in midlife. Because the family is so large and researchers can identify who will get the disease, studying the family provides an unusual opportunity to learn about Alzheimer’s causes and pathology.

Researchers, led by Dr. Eric Reiman of the Banner Alzheimer’s Institute in Phoenix, and in Colombia by Dr. Francisco Lopera, a neurologist at the University of Antioquia, recently received a grant from the National Institutes of Health to conduct a clinical trial to test a drug on family members before they develop symptoms, to see if early brain changes can be halted or slowed.

The studies in Lancet Neurology used several tests, including spinal taps, brain imaging and functional M.R.I.

“The prevailing theory has been that development of Alzheimer’s disease begins with the progressive accumulation of amyloid in the brain,” Dr. Reiman said. “This study suggests there are changes that are occurring before amyloid deposition.”

One possibility is that brain areas are already impaired. Another possibility, experts said, is that these brain differences may go back to the young developing brain.

“It is a genetic disease, and it’s not hard to imagine that your gene results in some differences in the way your brain is formed,” said Dr. Adam Fleisher, director of brain imaging at the Banner Institute and an author of the studies.

In one of the Lancet Neurology studies, researchers examined 44 relatives between ages 18 to 26. Twenty had the mutation that causes Alzheimer’s. The cerebrospinal fluid of those with the mutation contained more amyloid than that of relatives without it. This was striking because researchers know that when people develop amyloid plaques — whether they have early-onset or late-onset Alzheimer’s — amyloid levels in their spinal fluid are lower than normal. That is believed to be because the fluid form of amyloid gets absorbed into the plaque form, Dr. Reiman said.

So, the high level of amyloid fluid in the Colombian family supports a hypothesis about a difference between the beginning phases of genetic early-onset Alzheimer’s and the more common late-onset Alzheimer’s. The difference may be that early-onset Alzheimer’s involves an overproduction of amyloid, while late onset involves a problem clearing amyloid from the brain.

In another result, when the subjects performed a task matching names with faces, those with the mutation had greater activity in the hippocampus and parahippocampus, areas involved in memory. Dr. Reiman suggested this could mean that the pre-Alzheimer’s brain has to expend more effort to encode memories than a normal brain.

Researchers also found that the mutation carriers had less gray matter in areas that tend to shrink when people develop dementia. Dr. Fox emphasized that seeing less gray matter so early was so novel that it should be treated cautiously unless other studies find a similar result.

In the second study, brain imaging was used to look for amyloid plaques in 50 people ages 20 to 56: 11 with dementia, 19 mutation carriers without symptoms and 20 normal family members. Plaques occurred at an average age of 28, more than 15 years before cognitive impairment would be expected and two decades before dementia.

The study also found that amyloid plaques increased steadily until about age 37, after which the brain did not seem to gain many more plaques. Dr. Blennow said that while researchers know that amyloid plaques plateau when people already have dementia, they did not know that the plateau appears to occur years before.

The researchers are currently analyzing data from family members ages 7 to 17 to see if some of the brain changes occur at an even younger age.

“Some people think that that may be scary, that you can see it so many years before,” Dr. Reiman said. “But it seems to me that that provides potential opportunities for the development of future therapies.”

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Group mobilizing young people to push for national debt plan

WASHINGTON — Kicking the can down the road on the skyrocketing national debt could hurt young people more than anybody. And now they are organizing to fight back.

A new group, the Can Kicks Back, aims to give Americans 18 to 32 years old a voice in the debate over tax hikes and budget cuts that loom next year if Congress and President Obama cannot agree on a deficit-reduction plan.

"Young people are struggling in this economy, and our goal is to demonstrate how the growing national debt is impacting that problem," said Ryan Schoenike, a co-founder of the group.

Part of that effort will be sending a giant mascot character in the shape of a can to college campuses to generate support, and then to Congress to highlight the concerns of young people. The group is focusing on how the debt affects the ability of people to get a job, pay for their education and raise a family, Schoenike said.

To drive home the point, the group is highlighting the share of the national debt being shouldered by every American.

Although the U.S. national debt officially is about $16.25 trillion, the Can Kicks Back is using a much higher figure — $71 trillion — which includes unfunded liabilities such as Social Security, Medicare and government pensions.

Each person's share of that larger figure is $227,000 and rising, the group said.

The group's advisory board includes Erskine Bowles and Alan Simpson, the former co-chairs of the National Commission on Fiscal Responsibility and Reform that developed a sweeping deficit-reduction plan.

The Can Kicks Back is working with the Campaign to Fix the Debt, an organization founded by Bowles and Simpson that also includes leading corporate chief executives.

The group is trying to build off the engagement of many young people in the presidential election and wants to launch chapters on at least 500 college campuses by the end of the 2013 spring semester.

The group's goal is to pressure Congress and the White House to agree to "a bold, balanced and bipartisan 'grand bargain' on fiscal issues" by the Fourth of July. To do that, the group wants young people to commit to making a 30-second phone call each week to a member of Congress pushing for a deficit-reduction deal.

"It's a simple act, sort of 30 seconds to save your future," Schoenike said. The group wants those calls to add up to a "million millennial minutes."

"There's such a disconnect between what we see in the real world and what happens in Washington," said Nick Troiano, the group's other co-founder.

Comments last week by Obama and House Speaker John A. Boehner (R-Ohio) about their willingness to compromise on tax rates and revenues are a good sign for a possible compromise, but young people can add to the pressure to make a deal, Troiano said.

jim.puzzanghera@latimes.com

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Members of Congress demand fuller explanation of Petraeus affair

WASHINGTON— The woman whose complaints sparked an FBI investigation that led to CIA Director David H. Petraeus' resignation was identified Sunday as an unpaid social liaison to MacDill Air Force Base near Tampa, Fla., where Petraeus formerly was stationed.

Military sources identified her as Jill Kelley, who had complained about harassing emails that investigators traced to Paula Broadwell, a married Army reservist who was Petraeus' biographer, according to military sources.

U.S. officials say the FBI's investigation of Broadwell's emails led them to discover explicit messages between her and Petraeus suggesting they were carrying on an extramarital affair.

Also Sunday, members of Congress demanded a fuller explanation of how and when law enforcement agents learned that Petraeus was having the affair.

Petraeus told National Intelligence Director James R. Clapper about the situation Tuesday, election day, and Clapper urged Petraeus to resign. The White House first learned of the affair Wednesday, officials said, and President Obama accepted Petraeus' resignation Friday. Key members of Congress found out only hours before the public did.

Kelley, 37, was described as a close friend of Petraeus. Officials have said that Broadwell, 40, considered the woman she emailed a rival for the retired Army general's affections.

Broadwell, who has two children, could not be reached for comment.

Kelley and her husband, Scott, issued a statement to the Associated Press on Sunday evening: "We and our family have been friends with Gen. Petraeus and his family for over five years. We respect his and his family's privacy and want the same for us and our three children."

Petraeus, one of the most influential military minds of his generation, took the CIA job last year after retiring as a four-star general and having been the top U.S. ground commander in both the Iraq and Afghanistan wars.

Broadwell met Petraeus when he gave a 2006 speech at Harvard University, where she was studying for a master's degree. She decided to make Petraeus' leadership style a doctoral dissertation topic and, later, to write his biography.

She received special access to Petraeus when he was in charge of U.S. Central Command in Tampa from 2008 to 2010, according to a U.S. officer who served under him.

"She was always in Tampa, sometimes for weeks at a time, and it was always explained that she was writing a book about him," said the officer, speaking anonymously to discuss an ongoing investigation.

When Petraeus took command in Afghanistan, Broadwell started showing up there periodically too, according to several U.S. officers who served in Kabul. She often stayed for several weeks or more at Petraeus' headquarters in downtown Kabul, where she received a room at the special quarters reserved for visiting dignitaries.

"She stayed in the distinguished visitor residences on base, much like the other traveling gang of think-tankers," said an official who served in Kabul at the time. "She did travel with him a bit too."

When the biography, "All In: The Education of General David Petraeus," came out in January, the publisher's promotional materials said that Broadwell was "afforded extensive access by Gen. Petraeus, his mentors, his subordinates and his longtime friends," and that she "embedded with the general, his headquarters staff and his soldiers on the front lines of fighting."

Petraeus' resignation sent shock waves through Congress that continued on the Sunday talk shows.

Senate Intelligence Committee Chairwoman Dianne Feinstein (D-Calif.) said that when Petraeus told her Friday he was quitting over an affair, it was "like a lightning bolt."

Appearing on "Fox News Sunday," Feinstein said she wanted to know why the bureau didn't notify the intelligence committees sooner. The incident "could have had an effect on national security," Feinstein said. "We should have been told."

Feinstein backed away from her earlier statement that Obama should not have accepted Petraeus' resignation. "When you realize additional complications ... I think he did the right thing," she said. "I think the president really had no choice but to accept that resignation."

Rep. Mike Rogers (R-Mich.), chairman of the House Intelligence Committee, had questions about how the matter was handled and about the former CIA director's conduct, a senior committee aide said.

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10 things you need to know today: November 11, 2012

Emails from Petraeus‘ mistress triggered investigation, the BBC’s chief resigns, and more in our roundup of the stories that are making news and driving opinion

1. BIOGRAPHER’S EMAILS LED FBI TO PETRAEUS AFFAIR
Paula Broadwell, the woman with whom CIA Director David Petraeus had an extramarital affair, leading to his sudden resignation on Friday, had allegedly sent harassing emails to a woman in Florida, leading the FBI to investigate the claim — and eventually uncovering the affair. Broadwell, who was Petraeus‘ official biographer, reportedly sent emails to the Florida woman inquiring about the nature of her relationship with Petraeus, prompting the unidentified woman to lodge a complaint with the FBI. The FBI began its investigation in the spring, and interviewed Petraeus in the past two weeks. During the interview, Petraeus admitted to the affair with Broadwell, who is also married. [Wall Street Journal]
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2. BBC CHIEF RESIGNS OVER GROWING SCANDAL
BBC’s director general George Entwistle resigned his post Saturday night amid growing criticism as the broadcaster deals with an alleged sex abuse scandal that implicated longtime BBC host Jimmy Savile. Savile, who died last year, was suspected of sexually abusing hundreds of young people over the decades, sometimes on BBC premises. Entwistle had most recently come under fire for allowing a false report on the BBC program Newsnight to air on Nov. 2. During the broadcast, a former Conservative Party politician was wrongly implicated in a pedophile scandal involving a children’s home in Wales. Entwistle said the report reflected “unacceptable journalistic standards” and never should have been broadcast. [New York Times]
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SEE ALSO: 10 things you need to know today: November 2, 2012

3. ISRAEL FIRES WARNING SHOT AT SYRIA
Israel fired a warning shot into Syria on Sunday after a stray mortar from Syria hit a military post in the Golan Heights. No injuries or damage were reported in Israel. Israel captured the Golan from Syria in the 1967 Mideast war and subsequently annexed it. The incident was the first time Israel has been drawn into the fighting in the neighboring country. Meanwhile, the Syrian opposition, holding critical meetings in Qatar agreed Saturday to a new coalition to oppose President Bashar al-Assad. One Islamist opposition delegate said a new leader and deputy would be chosen on Sunday evening. [Associated Press, BBC]
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4. REP. ALLEN WEST WON’T CONCEDE
Rep. Allen West (R-Fla.) was defeated by Democratic opponent Patrick Murphy, according to Florida’s vote count on Saturday, but the incumbent refuses to concede. The state issued complete but unofficial results showing Murphy with a lead of 2,442 votes, or 50.4 percent. That’s beyond the half-percent margin needed to trigger an automatic recount. West’s campaign alleges that in St. Lucie County, the only one of the three counties in the district that Murphy won, votes may have been counted twice and have asked to review sign-in books from the polls. West’s only path forward is through the courts. Under state law, he still could contest the election if misconduct or fraud might have changed its result. [Politico]
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SEE ALSO: The woman who named her newborn twins Barack and Mitt

5. IRAQ CANCELS ARMS DEAL WITH RUSSIA
Iraq’s Prime Minister Nouri al-Maliki, has canceled a recently signed $ 4.2 billion arms deal with Russia after suspicions of corruption surfaced. The prime minister’s adviser Ali al-Moussawi did not give any details or context. “We informed Russia about our decision, but we hope to sign a new weapons deal between Iraq and Russia,” al-Moussawi said. [CNN]
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6. BOEHNER TELLS HOUSE GOP TO FALL IN LINE
After the Republican Party’s electoral battering last week, House Speaker John Boehner insisted to House Republicans in a conference call that while they “would continue to staunchly oppose tax rate increases as Congress grapples with the impending fiscal battle, they had to avoid the nasty showdowns that marked so much of the last two years,” writes The New York Times. Many members offered subdued words of support, in contrast to a similar call last year when Boehner tried to persuade members to compromise with Democrats on a deal to extend temporary payroll tax cuts, “only to have them loudly revolt.” Both Boehner and President Obama seem to be keeping open the avenue of negotiation to address the looming fiscal cliff set to hit Jan. 1. [New York Times]
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SEE ALSO: The highest skyscraper climb with a bionic leg

7. APPLE AND HTC SETTLE PATENT DISPUTES
Apple and Taiwanese phonemaker HTC have settled all their outstanding disputes over patents, ending a fight that began in March 2010. The two companies signed a 10-year license agreement that will extend to current and future patents held by one another. HTC’s have been in decline since the second half of 2011, despite having become a major global phone company by aligning itself with Google’s Android platform. [BBC]
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8. STRONG EARTHQUAKE HITS MYANMAR
After a 6.-magnitude earthquake hit northern Myanmar on Sunday, at least 12 people were feared dead. The U.S. Geological Survey said the quake hit near the city of Mandalay, at a depth of just 6.2 miles. The shallow quake was felt in Bangkok, the capital of neighboring Thailand, and several aftershocks followed. [Voice of America]
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SEE ALSO: 10 things you need to know today: November 3, 2012

9. CHINA TO LAUNCH NEXT MANNED CRAFT IN JUNE
A spokesperson for the Chinese space program announced Saturday that China’s next space mission will launch in June 2013. The operation is the second manned mission for the country, which completed its first manned mission — Shenzhou-9 — in June of this year. “They will stay in space for 15 days, operating both automated and manual space dockings with the target orbiter Tiangong-1, conducting scientific experiments in the lab module and giving science lectures to spectators on the Earth,” Niu Hongguang of the Chinese space program said. [Forbes]
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10. JUSTIN BIEBER AND SELENA GOMEZ SPLIT
Singer Justin Bieber, 18, and girlfriend, singer-actor Selena Gomez, 20, have gone their separate ways, a source confirms to the Associated Press. The split happened last week, and the two young stars cite distance and their busy schedules as contributing factors. The two had been dating for a year. [Associated Press] 

SEE ALSO: 10 things you need to know today: October 31, 2012

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Hathaway says 'Les Mis' made her feel deprived

NEW YORK (AP) — Anne Hathaway credits her new husband Adam Schulman for helping her get through the grueling filming of the screen adaptation of "Les Miserables."

In "Les Mis," the 30-year-old actress plays Fantine, a struggling, sickly mother forced into prostitution in 1800s Paris.

Hathaway lost 25 pounds and cut her hair for the role. She tells the December issue of Vogue, the part left her in a "state of deprivation, physical and emotional." She felt easily overwhelmed and says Shulman was understanding and supportive.

The couple wed in September in Big Sur, Calif. Hathaway wore a custom gown by Valentino whom she collaborated with on the design. Working with the designer is a memory she says she will "treasure forever."

The December issue of Vogue hits stores Nov. 20.

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Well: Quitting Smoking for Good

Few smokers would claim that it’s easy to quit. The addiction to nicotine is strong and repeatedly reinforced by circumstances that prompt smokers to light up.

Yet the millions who have successfully quit are proof that a smoke-free life is achievable, even by those who have been regular, even heavy, smokers for decades.

Today, 19 percent of American adults smoke, down from more than 42 percent half a century ago, when Luther Terry, the United States surgeon general, formed a committee to produce the first official report on the health effects of smoking. Ever-increasing restrictions on where people can smoke have helped to swell the ranks of former smokers.

Now, however, as we approach the American Cancer Society’s 37th Great American Smokeout on Thursday, the decline in adult smoking has stalled despite the economic downturn and the soaring price of cigarettes.

Currently, 45 million Americans are regular smokers who, if they remain smokers, can on average expect to live 10 fewer years. Half will die of a tobacco-related disease, and many others will suffer for years with smoking-caused illness. Smoking adds $96 billion to the annual cost of medical care in this country, Dr. Nancy A. Rigotti wrote in The Journal of the American Medical Association last month. Even as some adult smokers quit, their ranks are being swelled by the 800,000 teenagers who become regular smokers each year and by young adults who, through advertising and giveaways, are now the prime targets of the tobacco industry.

People ages 18 to 25 now have the nation’s highest smoking rate: 40 percent. I had to hold my breath the other day as dozens of 20-somethings streamed out of art gallery openings and lighted up. Do they not know how easy it is to get hooked on nicotine and how challenging it can be to escape this addiction?

Challenging, yes, but by no means impossible. on the Web you can download a “Guide to Quitting Smoking,” with detailed descriptions of all the tools and tips to help you become an ex-smoker once and for all.

Or consult the new book by Dr. Richard Brunswick, a retired family physician in Northampton, Mass., who says he’s helped hundreds of people escape the clutches of nicotine and smoking. (The printable parts of the book’s provocative title are “Can’t Quit? You Can Stop Smoking.”)

“There is no magic pill or formula for beating back nicotine addiction,” Dr. Brunswick said. “However, with a better understanding of why you smoke and the different tools you can use to control the urge to light up, you can stop being a slave to your cigarettes.”

Addiction and Withdrawal

Nicotine beats a direct path to the brain, where it provides both relaxation and a small energy boost. But few smokers realize that the stress and lethargy they are trying to relieve are a result of nicotine withdrawal, not some underlying distress. Break the addiction, and the ill feelings are likely to dissipate.

Physical withdrawal from nicotine is short-lived. Four days without it and the worst is over, with remaining symptoms gone within a month, Dr. Brunswick said. But emotional and circumstantial tugs to smoke can last much longer.

Depending on when and why you smoke, cues can include needing a break from work, having to focus on a challenging task, drinking coffee or alcohol, being with other people who smoke or in places you associate with smoking, finishing a meal or sexual activity, and feeling depressed or upset.

To break such links, you must first identify them and then replace them with other activities, like taking a walk, chewing sugar-free gum or taking deep breaths. These can help you control cravings until the urge passes.

If you’ve failed at quitting before, try to identify what went wrong and do things differently this time, Dr. Brunswick suggests. Most smokers need several attempts before they can become permanent ex-smokers.

Perhaps most important is to be sure you are serious about quitting; if not, wait until you are. Motivation is half the battle. Also, should you slip and have a cigarette after days or weeks of not smoking, don’t assume you’ve failed and give up. Just go right back to not smoking.

Aids for Quitting

Many if not most smokers need two kinds of assistance to become lasting ex-smokers: psychological support and medicinal aids. Only about 4 percent to 7 percent of people are able to quit smoking on any given attempt without help, the cancer society says.

All 50 states and the District of Columbia have free telephone-based support programs that connect would-be quitters to trained counselors. Together, you can plan a stop-smoking method that suits your smoking pattern and helps you avoid common pitfalls.

Online support groups and Nicotine Anonymous can help as well. To find a group, ask a local hospital or call the cancer society at (800) 227-2345. Consider telling relatives and friends about your intention to quit, and plan to spend time in smoke-free settings.

More than a dozen treatments can help you break the physical addiction to tobacco. Most popular is nicotine replacement therapy, sold both with and without a prescription. The Food and Drug Administration has approved five types: nicotine patches of varying strengths, gums, sprays, inhalers and lozenges that can curb withdrawal symptoms and help you gradually reduce your dependence on nicotine.

Two prescription drugs are also effective: an extended-release form of the antidepressant bupropion (Zyban or Wellbutrin), which reduces nicotine cravings, and varenicline (Chantix), which blocks nicotine receptors in the brain, reducing both the pleasurable effects of smoking and the symptoms of nicotine withdrawal. Combining a nicotine replacement with one of these drugs is often more effective than either approach alone.

Other suggested techniques, like hypnosis and acupuncture, have helped some people quit but lack strong proof of their effectiveness. Tobacco lozenges and pouches and nicotine lollipops and lip balms lack evidence as quitting aids, and no clinical trials have been published showing that electronic cigarettes can help people quit.

The cancer society suggests picking a “quit day”; ridding your home, car and workplace of smoking paraphernalia; choosing a stop-smoking plan, and stocking up on whatever aids you may need.

On the chosen day, keep active; drink lots of water and juices; use a nicotine replacement; change your routine if possible; and avoid alcohol, situations you associate with smoking and people who are smoking.

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Flights for Thanksgiving may be best holiday-season deal

If your grim financial situation means you have to choose between flying for either Thanksgiving or the December holidays, you may get a better deal flying for Turkey Day.

The national average price for a round-trip domestic flight for Thanksgiving is $420, about the same as a year ago, according to airline ticket data analyzed by the travel booking website Priceline.com. But the national average airfare for the span that includes Christmas and New Year's Eve is up 3%, to $444.

If you had booked Thanksgiving reservations in early October, you would have paid an average airfare of $393, while the average December holiday airfare, if booked at that time, was $430, according to Priceline.

But if you waited to book your Thanksgiving flight, you are not alone.

As of Oct. 26, 78% of Americans who say they plan to travel for Thanksgiving had yet to make reservations, according to the travel website Hotwire.

Travel experts say such procrastinators may regret waiting so long.

On the busiest travel days around Thanksgiving, the average flight will be 90% full, according to Airlines for America, the trade group for the nation's largest airlines.

In contrast, the average flight throughout 2011 was 82% full. Empty airline seats are increasingly hard to find as airlines have merged, cut less-profitable routes and consolidated flights on popular routes.

"Flight reductions have reduced the number of available seats and that, coupled with holiday travel demand, is enabling fares to creep upward," said Brian Ek, a travel expert for Priceline. "The good news is that Thanksgiving airfares are back to running about flat with last year so, if you can only travel for one end-of-year holiday, that's probably the one to pick."

U.S. satisfaction falls for airlines, rises for car rental firms

American travelers are increasingly dissatisfied with the nation's airlines, but they seem pretty happy with the country's car rental companies.

For the first nine months of this year, the U.S. Bureau of Transportation Statistics received 12,145 consumer complaints about airline services, up 33.5% compared with the first nine months of 2011.

Based on complaints filed to the bureau in September alone, the biggest sources of aggravation for fliers were flight delays, cancellations, problems with baggage, ticketing and reservations and, of course, customer service.

United Airlines had the most complaints in September with 211, followed by American Airlines with 162.

Meanwhile, customer satisfaction with rental car companies has increased for the third consecutive year, according to a study released last week by J.D. Power & Associates. In fact, the satisfaction level — reaching 769 on a 1,000-point scale — is the highest in seven years.

The greatest improvement in the satisfaction rating came from the shuttle van or bus service that car rental companies use to transport customers and the daily rates and fees, according to the study.

Another big factor in raising customer satisfaction: a warm smile. The study found that car rental customers give an average rating of 795 when they are greeted at the counter with a smile, while customers who don't get a smile give an average rating of 647.

Ryanair CEO opposes seat belt use

Seat belts on airplanes are useless.

That was the latest rant by Michael O'Leary, the chief executive for Ryanair, the ultra low-cost airline based in Ireland.

O'Leary, who opposes seat belts because he is pushing for standing-room sections of his planes, called aviation authorities who disagree with him "plonkers."

"Seat belts don't matter," O'Leary told the Telegraph. "If there ever was a crash on an aircraft, God forbid, a seat belt won't save you."

hugo.martin@latimes.com

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Advice to California's GOP: Leave — or better yet, change

Memo to the California GOP:

Rough couple of weeks, huh?

First you found out that the number of registered Republicans in California has dipped below 30%, which means we are fast approaching the day when the entire state membership can fit into two golf carts.

To make matters worse, of the 1 million people who used a new online voter registration system this election cycle, only 20% registered as Republicans. And 60% of those who registered were under 35, which means your future's not looking great.

Then the dominoes really started to fall.

Gov. Brown's Proposition 30, the first general, statewide tax hike in two decades, passed so easily that the ghost of Howard Jarvis threw himself in front of a truck.

Proposition 32, an all-out attempt to defang public employee unions, got pummeled despite an infusion of last-minute anti-labor cash from Arizona.

What could be worse? I'll tell you what. In the state Legislature, Democrats won supermajorities in both houses. Do you know what that means? It's like handing your teenager a credit card, a checkbook and the car keys so he can drive to an all-night orgy.

Meanwhile, on the national front, two states said yes to recreational marijuana and three states said yes to same-sex marriage. And Mitt Romney proved that when your only loyal supporters are aging white men who still drive Buicks and watch "Matlock" reruns — in a country with an ever more diverse population — you're cooked.

It was a wipeout, a blitz, a disaster.

So now what?

Glad you asked, because as it happens, I've got some advice for the leaders and members of the California's shrinking Grand Old Party.

Your first option is to cut and run. Frankly, I regularly hear from Republicans who so despise California and everything it stands for, I'm surprised they keep subjecting themselves to so much misery. Wouldn't it be better to sell everything, pack up the station wagon and move to Georgia or Kentucky? They think, act and vote red in those states, and they probably hate California at least as much as you do.

But here's another option. You could sit tight here in the Golden State, wait for the Democrats to screw things up in Sacramento even more than they already have, and then raise your hand when the situation cries out for the voice of fiscal prudence.

The first thing you're going to have to do, though, is remake the GOP. And by that I mean that you have to get rid of the Neanderthals who dominate the party. Then you need to start grooming and promoting some common-sense fiscal moderates, provided you can locate any.

What do I mean by that?

If someone believes Barack Obama is a socialist, Communist, Marxist, Muslim, radical, black liberation theologian, non-citizen, illegitimate president or Manchurian Candidate, forget about him. He may have a shot at a career in talk radio, but he's not going to make it in California politics.

And you're not going to breathe new life into the GOP with someone who believes the answer to the state's problems is to deport a couple million Latinos, unless they're working in the garden at extremely low rates.

You should also nix anyone who believes that gay people have chosen a "lifestyle" in the way they might choose toothpaste or a pair of shoes, and can be "converted" with enough hard work and Bible study.

I know, I know. We're really thinning the field here. And I'm not even done.

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