South L.A. frustrated by delays in building new King hospital

Earlier this year, Joane Austin rushed her elderly mother to the emergency room for fear she was having a heart attack.

Austin normally would have made the short trip to Martin Luther King Jr./Drew Medical Center, the landmark hospital in South Los Angeles. But King/Drew has been closed for five years, so Austin drove several miles to the emergency room at Centinela Hospital Medical Center in Inglewood.

"I prayed all the lights would stay green," she said. "It was scary."

Once they arrived, doctors determined that Austin's mother needed emergency surgery to remove scar tissue around her intestines.

For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years.

But the opening has been repeatedly delayed, and the community is still waiting. Originally, officials hoped to have the new facility ready by 2010. Then it was pushed to 2012. Now, officials say they plan to have construction completed next year and the hospital opening its doors in 2014.

Without a nearby hospital, patients have had to travel to such places as Bellflower, Inglewood and Long Beach for emergency room and inpatient care.

Several local hospitals — California Hospital Medical Center, L.A. County/USC Medical Center and Harbor-UCLA Medical Center — received an influx of former King patients after the closure. The closest hospital, St. Francis Medical Center in Lynwood, reported an increase of 20% to 30% in emergency room visits since King/Drew closed, though other factors also may have contributed to the rise.

Getting to other hospitals has presented a challenge for many in the low-income neighborhood, said William Hobson, president and chief executive of the Watts Healthcare Corp. "Just the fact that it is a long way away may discourage them from going," he said.

The closure of King/Drew, which was born out of the Watts riots and opened in 1972, created a healthcare gap in a community where rates of chronic disease are high and vast swaths of the population lack insurance, said David Carlisle, president of the adjacent Charles R. Drew University of Medicine and Science. South Los Angeles has a shortage of doctors, inpatient beds and outpatient services, according to both experts and research.

Despite King/Drew's many medical lapses, which earned it the nickname "Killer King," many in the community remained fiercely loyal to the hospital and the services it provided.

Studies examining the impact of King/Drew's closure found that it led to delays in care for elderly blacks and Latinos and a dramatic increase in patient admissions at other trauma centers. Physicians throughout the county also reported more overcrowding in other emergency rooms and said they saw sicker patients who didn't know where to go or couldn't afford transportation elsewhere.

"It is fearful to think about how many lives may have been saved had this thing been opened by now," said Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils. "It shouldn't take five years to build a facility."

Patrick Wooten, 49, went to St. Francis when he had a dislocated kneecap a few years ago. Wooten, who is uninsured, said he received good care at the private hospital but then got a $3,200 bill. Wooten said he is frustrated that the new King hospital still hasn't opened and won't until 2014. "What you do until then, God only knows," he said. "Hopefully we can wait it out."

Last year, Sandira Gonzalez, 29, took her 5-year-old son to the Martin Luther King urgent care center when he had a fever. But when the center closed for the night, her son had to be taken by ambulance to Harbor-UCLA near Torrance, where he was treated for an infection.

Community members and advocates said they are disappointed by the long wait, caused by a combination of bureaucratic delays and the complexity of the project. But when it does open, they said, they are hopeful that it will be a better, and safer, hospital.

The county is building the hospital and will help support it financially but will not be responsible for day-to-day operations. Instead, an independent, nonprofit organization will run the facility, to be known as Martin Luther King Jr. Community Hospital, and the University of California will help staff it and ensure the quality of patient care. Construction is progressing, but the grand opening may still be nearly two years away.

"It will be a significantly different kind of institution, with the right kind of accountability," said Robert K. Ross, president and chief executive of the California Endowment. "Now we just need the institution to open up on budget and on time."

Los Angeles County Supervisor Mark Ridley-Thomas said it takes time to create a state-of-the-art hospital — and a whole medical complex — that could become a model for others around the nation. "A lot of eyes are on this," he said. "We want to do this well and we want to do it right.... Nothing else is acceptable."

The nonprofit's board recognizes how critical the facility is to the area, said board President Manny Abascal. "Every day this hospital is not open, people are suffering," he said. At the same time, he added, the board is committed to ensuring that the new hospital is a high-quality institution. "If you open it … and there are some of the same problems you had before, then it's going to be devastating," he said.

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Glen Campbell considering more live shows in 2013

NASHVILLE, Tenn. (AP) — Glen Campbell may be wrapping up a goodbye tour but that doesn't mean he's done with the stage.

Campbell is considering scheduling more shows next year after playing more than 120 dates in 2012.

The 76-year-old singer has Alzheimer's disease and has begun to lose his memory. He put out his final studio album, "Ghost on the Canvas," in 2011 and embarked on the tour with family members and close friends serving in his band and staffing the tour.

Campbell's longtime manager Stan Schneider said in a phone interview from Napa, Calif., where the tour wrapped for the year Friday night, that recent West Coast shows have been some of the singer's strongest. Campbell will break for the holidays and if he still feels strong he'll begin scheduling more shows.

___

Online:

http://glencampbellmusic.com

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Doctors Who Work for Hospitals Face a New Bottom Line

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.

Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.

In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.

In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.

Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.

Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed.

Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know for sure. “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the F.T.C.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.”

A Drive to Consolidate

An array of new economic realities, from reduced Medicare reimbursements to higher technology costs, is driving consolidation in health care and transforming the practice of medicine in Boise and other communities large and small. In one manifestation of the trend, hospitals, private equity firms and even health insurance companies are acquiring physician practices at a rapid rate.

Today, about 39 percent of doctors nationwide are independent, down from 57 percent in 2000, according to estimates by Accenture, a consulting firm.

Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law.

“If you’re going to be paid for value, for performance, you’ve got to perform together,” said Dr. Ricardo Martinez, chief medical officer for North Highland, an Atlanta-based consultant that works with hospitals.

The recent trend is reminiscent of the consolidation that swept the industry in the 1990s in response to the creation of health maintenance organizations, or H.M.O.’s — but there is one major difference. Then, hospitals had difficulty managing the practices, contending that doctors did not work as hard when they were employees as they had as private operators. Now, hospitals are writing contracts more in their own favor.

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Cut Medicare and Social Security? What's the rush?

The question that normally comes to mind when someone claims to know the future is why he's out hustling rubes for pennies with his purported clairvoyance, instead of using it to make a fortune and retiring to the South Seas.

Of course, the answer is that nobody ever does know the future. And that leads to the question of why so much of the "fiscal cliff" debate in Washington is based on supposedly perfect knowledge of conditions that are 20, or even 70, years away.

We're talking about projections of the cost of "entitlements" — a noxious way of referring to Medicare and Social Security, excellent programs that most workers have paid for during their careers and that have kept millions of Americans healthy and out of poverty.

The customary talking point by the anti-deficit lobby is that the rising cost of these programs will eat us alive. That future, the argument continues, is coming at us like an onrushing train, so to avoid having to cut benefits when it arrives, we best cut benefits now.

The element of haste is a crucial element in this debate. That's because as real estate brokers and late-night TV hucksters know, pressure to Act Now! is what leads their marks to overlook that the basic premise is bogus.

Consider the prevailing assumptions about the future of Social Security and Medicare. One is that Social Security's trust fund will run dry in 2033, at which point the money coming in from payroll taxes will be enough to cover only about 75% of currently scheduled benefits. Will this happen? It might, but it might not:

The program's trustees, who are the source of the projection, don't bet the farm on it. They also project that under certain conditions of economic and employment growth — all of them perfectly plausible — it might never run dry. You don't hear much about that projection because it doesn't fit into the narrative that Social Security is "going broke."

Healthcare costs, with Medicare and Mediaid as big components, have been projected to rise to as much as 40% of gross domestic product by 2082 if not restrained. That's a fearsome prospect, but it's based on a long-outdated forecast by the Congressional Budget Office, which doesn't use the same methodology anymore. It was highly implausible, if not impossible, in the first place.

That CBO projection, like others employed by the anti-"entitlement" lobby to push for gutting the program, relied on projecting past experience into the future without adjusting for changes in behavior or policy.

This is a common fallacy well understood by pollsters. They know that if you ask people what the future will look like, they'll describe something that looks like today, except more so. If street crime is in the news, for example, they'll posit a future in which every community looks like Deadwood.

Investment experts try to moderate this tendency by reminding clients that trees don't grow to the stratosphere. To put it another way, just because your son is 4 feet tall at age 6 doesn't mean he'll be 12 feet tall at age 18. And just because the average American born today will live to the age of 78 doesn't mean that a baby born in 2032 will live to 100.

These questionable forecasts result in the nauseating spectacle of corporate CEOs such as Lloyd Blankfein of Goldman Sachs lecturing Americans that the retirement benefits and elder healthcare coverage they've paid for during their working lives are things we "can't afford."

Blankfein didn't worry about what the country could afford when Goldman pocketed $12.9 billion in taxpayer funds to cover its losses in the collapse of insurance giant AIG. But there he was on CBS on Nov. 19, saying, "You...have to do something to lower people's expectations — the entitlements and what people think that they're going to get, because they're not going to get it."

Blankfein proceeded to lecture his interviewer that Social Security "wasn't devised to be a system that supported you for a 30-year retirement after a 25-year career." This is fair enough, one supposes, though it's a mystery where Blankfein gets the idea that the average retiree today has spent only 25 years in the workplace, rather than 45, and lives to the age of 95. Does Goldman Sachs do all its math this way?

The Social Security projection is probably the most misused and misunderstood statistic in the fiscal-cliff debate. The trustees warn every year that its forecast is "inherently uncertain." They warn that it's a melange of projections of at least 17 factors, including fertility and mortality rates, economic growth, unemployment, wages and life expectancy, many of which are interrelated.

No one — no business, no government agency — makes plans today based on a vision of the world 20 years from now. IBM doesn't do it. Google doesn't do it. The Department of Defense doesn't do it. You and I don't do it. Not even life insurance companies, which might be said to live in the future, do it.

The reason smart people and companies don't make bets on the distant future is precisely because it's unknowable. Try the following thought experiment: Instead of looking ahead 20 years, look back 20 years, and try to list all the events that have had immense, material effects on today's economy, but were unimaginable in 1992.

Here's my list: 9/11. The Afghan war. The Iraq war. The housing bubble. The crash of 2000. The crash of 2008. The crash of Lehman Bros. The iPod. The iPhone. The iPad. The founding of Google. Hurricane Andrew, Hurricane Katrina, Superstorm Sandy. Obamacare.

What are the chances that another such list will make the U.S. economy in 2033 look utterly different from what we imagine in 2012? I'd say 100%.

Forecasting healthcare costs may be even more of a mug's game. In a 2008 paper, economists Glenn Follette and Louise Sheiner of the Federal Reserve observed that the CBO unwisely projected healthcare costs into the future by assuming that the trends of the past simply would continue.

But the trends of the past had included an unprecedented expansion of public and private insurance coverage, which cut average out-of-pocket spending from 51% of total healthcare outlays in 1960 to 13% in 2005. That created an explosion in demand.

Could the trend continue? Plainly not. The Fed economists also noted that any trend pointing toward healthcare consuming 40% of GDP would have such destructive effect on the rest of the economy that personal behavior or political action would change it before reaching that point. The CBO now acknowledges that.

Healthcare reform has made such projections even more uncertain today, in part because the reform act includes numerous cost-limiting initiatives, the success of which can only be guessed at. That's an argument against taking such radical steps as raising the Medicare eligibility age, as some fiscal-cliff pundits advocate.

Leaving aside that doing so would drive up costsfor employers, states and Medicare participants themselves by more than it would save the federal government (the Kaiser Family Foundation crunched the numbers), it's far too early to know if it's even necessary.

One might argue that the uncertainty of economic forecasts means there's no point in economic planning at all. But there are good reasons for looking ahead, just not good reasons for thinking your vision of the future is 20/20.

And there's a big difference between making a congressional budget and making fundamental changes in programs as complex as Social Security and Medicare. The life span of a congressional budget is two years, max, because no Congress can bind its successors. But changes in Social Security and Medicare are forever. So when you hear that we have to do it now, stat! or we're doomed, take it for the snake oil that it is.

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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The lure of fishing endures even when they're not biting

PERSPECTIVE

Gale Holland, Los Angeles Times

November 30, 2012

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he's a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America's battlefields and an "honest conversation about the country's history."

___

Online:

http://www.traceadkins.com

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Recipes for Health: Asian Chopped Salad With Seasoned Tofu ‘Fingers’ — Recipes for Health

Andrew Scrivani for The New York Times

I like to serve the baked seasoned tofu “fingers” warm on top of the salad. They are delicious cold, too; it is worth making up a separate batch for the refrigerator. If you have an assortment of vegetables leftover from Thanksgiving dinner, throw them in!

For the Tofu:

1/4 cup soy sauce

2 tablespoons mirin (sweet Japanese rice wine)

1 tablespoon rice vinegar

1 tablespoon minced or grated fresh ginger

1/2 teaspoon sugar

1 tablespoon Asian sesame oil

1 pound firm tofu

For the salad:

1 romaine heart, chopped

5 cups mixed chopped or diced vegetables such as:

Green or red cabbage

Celery (from the inner heart)

Red pepper

Radishes, sliced or chopped

1/4 cup dry roasted peanuts, coarsely chopped

1/4 cup chopped cilantro (more to taste)

1 serrano pepper, seeded and minced (optional)

For the dressing:

2 tablespoons fresh lime juice

1/4 cup tofu marinade, above

2 tablespoons canola or peanut oil

1/3 cup low-fat buttermilk or plain nonfat yogurt

1. Marinate the tofu: combine the soy sauce, mirin, rice vinegar, ginger and sugar in a 2-quart bowl. Whisk in the sesame oil and combine well. Drain the tofu and pat dry with paper towels. Slice into 1/3-inch thick slabs and cut the slabs in half lengthwise to get “fingers” approximately 1/3 inch thick by 3/4 inch wide. Blot each finger with paper towels. Add to the bowl with the marinade and gently toss to coat. Cover and refrigerate for 15 minutes to an hour, or for up to a day.

2. Meanwhile, heat the oven to 375 degrees and line a baking sheet with parchment. Lift the tofu out of the marinade and arrange the pieces on the parchment-covered baking sheet. Bake for 7 to 10 minutes, until the edges are just beginning to color and the marinade sets on the surface of the tofu. Remove from the heat.

3. In a large bowl, combine all of the salad ingredients. Whisk together the dressing ingredients and toss with the salad. If desired, transfer to a platter. Garnish with the tofu strips and serve.

Yield: Serves 4

Advance preparation: The chopped vegetables can be prepared up to a day ahead and refrigerated in a well covered container. The tofu marinade will keep for two days in the refrigerator. The baked seasoned tofu will keep for several days in the refrigerator.

Nutritional information per serving: 317 calories; 20 grams fat; 2 grams saturated fat; 8 grams polyunsaturated fat; 9 grams monounsaturated fat; 1 milligram cholesterol; 19 grams carbohydrates; 5 grams dietary fiber; 470 milligrams sodium (does not include salt to taste); 16 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Electricity rates to rise for Southern California Edison customers

SACRAMENTO — Almost 5 million Southern California Edison Co. customers in hundreds of cities and communities across the southern, central and coastal parts of the state will be hit with higher electric bills early next year and bigger hikes in each of the following two years.

The decision, which Edison says will add an average of $7 a month to residential bills for the first year, covers Edison's costs to provide service, which amounts to about half a ratepayer's bill. Other costs for buying fuel and contracting for power deliveries fluctuate and are passed directly to consumers.

The California Public Utilities Commission unanimously approved new rates, retroactive to the beginning of this year, on Thursday as part of an every-three-years process of reviewing finances at the heavily regulated utility.

The 5% increase for 2012 — providing the Rosemead company with $5.7 billion in revenue — is less than the 16.6% the company had sought. Rates, however, are estimated to rise an additional 6.3% for 2013 and 5.9% in 2014 under the PUC order.

"This decision ensures that SCE is able to invest in smart energy systems, renewables and safety and reliability, while its ratepayers are protected," PUC Commissioner Timothy Alan Simon said.

Edison provides electricity to 13 million people, including most of Los Angeles and Orange counties as well as much of Central California and the Inland Empire. Not included are residents of Los Angeles who get their power from the municipally owned Department of Water and Power.

Edison, the decision notes, has faced "two significant challenges to operations" in the last year: a December 2011 wind storm that damaged the grid, and the extended shutdown of two nuclear power reactors at the San Onofre Nuclear Generating Station in San Diego County.

Edison in a statement called the commission's action "constructive" because the decision helps it finance needed upgrades in its system.

Consumer groups said they were pleased that commissioners granted Edison, a unit of Edison International, less than what the company sought from the PUC.

"We definitely got a substantial amount shaved off, but it's still more than we think Edison really needs," said Mindy Spatt, a spokeswoman for the Utility Reform Network, which advocates for ratepayers at the state's three big investor-owned electric companies.

Business groups also complained that the jump in Edison's already steep electric rates could make it harder for them to keep operating profitably.

"California manufacturers already pay 50% higher electricity rates than the national average," said Gino Di Caro, a spokesman for the California Manufacturers & Technology Assn. "Obviously, energy costs are one of the primary budgetary items for any manufacturing operation, and this is all the more reason for California to find ways to offset these costs."

marc.lifsher@latimes.com

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Powerball's $580-million jackpot inspires wishes, dreamers

Don't bother telling Wednesday night's Powerball winners  that a lottery is just a tax on those who flunked math. With a winning ticket in hand, or even just the dream of one, who cares if the odds against them exceeded 175 million to 1? 

Last-minute ticket-buying pushed the jackpot to nearly $580 million, which is how much a single winner would get if he or she took the money in annual payments over 30 years.  

The winning numbers: 5-16-22-23-29, and the Powerball:  06. 

Hours after the 8 p.m. drawing, officials said winning tickets had been sold in Arizona and Missouri.

No one had won since Oct. 6, causing the jackpot to roll over 16 times. It  grows at least $10 million every time no one wins, lottery officials said. 

To play Powerball, one must pick five unique numbers from 1 through 59, and a Powerball number from 1 through 35. The odds of winning are 1 in 175,223,510. 

Powerball tickets aren't sold in California, but some feverish residents reportedly drove or flew to one of 42 participating states  to buy a chance at a fortune. The District of Columbia and the U.S. Virgin Islands also participate. 

Maybe the next time the jackpot soars, out-of-state travel won't be necessary. On Thursday, the California State Lottery Commission is expected to adopt regulations to join the Powerball lottery. If so, California retailers could start selling the $2 tickets in April.

[Updated, 10:45 p.m., Nov. 28: An earlier version of this post said the jackpot would exceed $550 million.  Late Wednesday, the Associated Press reported, Powerball officials said it would be nearly $580 million. And early Thursday EST, lottery officials said winning tickets had been sold in Arizona and Missouri.]

 ALSO:

Zig Ziglar dies at 86; motivational speaker inspired millions

Nanny, in hospital, pleads not guilty to murder of 2 children

Texas moves to seize polygamist Warren Jeffs' ranch compound 

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'That 70s Show' star arrested in North Carolina

STATESVILLE, N.C. (AP) — "That '70s Show" star Lisa Robin Kelly is free on bond after being arrested for assault.

Police in the Charlotte, N.C., suburb of Mooresville arrested the 42-year-old Kelly and 61-year-old husband Robert Joseph Gilliam after responding to a disturbance at their home Monday. Both are free on bond.

Gilliam is charged with misdemeanor assault on a female. Kelly is charged with misdemeanor assault. They were taken to the Iredell County Detention Center and released on $500 bond apiece. They have a court date of Jan. 25. It's not known if either has an attorney.

Kelly portrayed Laurie Forman, sister of Topher Grace's lead character Eric, on the FOX series, which ended in 2006. She also appeared on the TV shows "Murphy Brown" and "Married . . . With Children."

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Cost of Brand-Name Prescription Medicines Soaring

The price of brand-name prescription medicines is rising far faster than the inflation rate, while the price of generic drugs has plummeted, creating the largest gap so far between the two, according to a report published Wednesday by the pharmacy benefits manager Express Scripts.

The report tracked an index of commonly used drugs and found that the price of brand-name medicines increased more than 13 percent from September 2011 to this September, which it said was more than six times the overall price inflation of consumer goods. Generic drug prices dipped by nearly 22 percent.

The drop in the price of generics “represents low-hanging fruit for the country to save money on health care,” said Dr. Steve Miller, the chief medical officer of Express Scripts, which manages the drug benefits for employers and insurers and also runs a mail-order pharmacy.

The report was based on a random sample of six million Express Scripts members with prescription drug coverage.

The Pharmaceutical Research and Manufacturers of America, the trade group representing brand-name manufacturers, criticized the report, saying it was skewed by a handful of high-priced specialty drugs that are used by a small number of patients and overlooked the crucial role of major drug makers.

“Without the development of new medicines by innovator companies, there would be neither the new treatments essential to progress against diseases nor generic copies,” Josephine Martin, executive vice president of the group, said in a statement.

The report cited the growth of specialty drugs, which treat diseases like cancer and multiple sclerosis, as a major reason for the increase in spending on branded drugs. Spending on specialty medicines increased nearly 23 percent during the first three quarters of 2012, compared with the same period in 2011. All but one of the new medicines approved in the third quarter of this year were specialty drugs, the report found, and many of them were approved to treat advanced cancers only when other drugs had failed.

Stephen W. Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota, said the potential benefits of many new drugs did not always match the lofty price tags. “Increasingly it’s going to be difficult for drug-benefit programs to make decisions about coverage and payment and which drugs to include,” said Mr. Schondelmeyer, who conducts a similar price report for AARP. He also helps manage the drug benefit program for the University of Minnesota.

“We’re going to be faced with the issue that any drug at any price will not be sustainable.”

Spending on traditional medicines — which treat common ailments like high cholesterol and blood pressure — actually declined by 0.6 percent during the period, the report found. That decline was mainly because of the patent expiration of several blockbuster drugs, like Lipitor and Plavix, which opened the market for generic competitors. But even as the entry of generic alternatives pushed down spending, drug companies continued to raise prices on their branded products, in part to squeeze as much revenue as possible out of an ever-shrinking portfolio, Dr. Miller said.

Drug makers are also being pushed by from companies like Express Scripts and health insurers, which are increasingly looking for ways to cut costs, said C. Anthony Butler, a pharmaceuticals analyst at Barclays. “I think they’re pricing where they can but what they keep telling me is they’re under significant pressure” to keep prices low, he said.

Express Scripts earns higher profits from greater use of generic medicines than brand name drugs sold through their mail-order pharmacy, Mr. Butler said. “There’s no question that they would love for everybody to be on a generic,” he said.

Dr. Miller acknowledged that was true but said that ultimately, everyone wins. “When we save people money, that’s when we make money,” he said. “We don’t shy away from that.”

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Union walkout cripples ports of Los Angeles and Long Beach

A small union of maritime clerks managed to shut down most of the nation's busiest seaport complex Wednesday, raising concerns about harm to the fragile economy.

Although late November is a relatively slow time for cargo movement at the ports of Los Angeles and Long Beach, a prolonged closure could prove costly for retailers and manufacturers who rely on the ports to get their goods as well as truckers and other businesses that depend on the docks for work.

"You are stranding goods at ports that handle 40% of the nation's import trade," said Jock O'Connell, an international trade economist who works as an advisor to Beacon Economics.

"The danger here is that this could call into question the reliability of the San Pedro Harbor ports," O'Connell said. "The Wal-Marts and the Home Depots may be forced to think twice about relying on these ports as their primary gateway."

Showing an influence that extended far beyond its numbers, the 800-member International Longshore and Warehouse Union Local 63's Office Clerical Unit established picket lines at seven of the eight terminals at the Port of Los Angeles, which is the largest container port in the U.S.

The union, whose members handle most of the paperwork for ships entering and leaving the ports, also struck three of the six terminals at the neighboring Port of Long Beach, which ranks second only to Los Angeles in the amount of container cargo it moves.

The union's picket lines had at least the tacit approval of the larger, 50,000-member ILWU of dockworkers, clerks and other workers who handle all of the cargo on the west coasts of the U.S. and Canada and in Hawaii.

About 10,000 of those dockworkers are employed at the Los Angeles and Long Beach ports, and they refused to cross the lightly manned picket lines. That left the normally bustling harbor eerily quiet for a Wednesday afternoon.

On Tuesday, with the walkout confined to the APM Terminals at the Port of Los Angeles, an arbitrator ruled that the picket lines were invalid because the union was not bargaining in good faith. The arbitrator ordered union members to return to work Tuesday night, but they refused. Union members have been working without a contract since June 30, 2010.

At the entrance to Long Beach's Total Terminals International, six members of the clerical workers union held signs that said, "On Strike ... For hours, wages & working conditions." Workers on that picket line and six others said they were under strict orders not to talk to the news media.

Officially, the union fell back on a statement released Tuesday evening and had no further comment Wednesday.

In that statement, logistics clerk Trinie Thompson said the workers were "drawing the line against corporate greed and outsourcing that's destroying the good-paying jobs that support working families in our community." The union's primary concern is that its jobs could be transferred to nonunion labor in countries with lower wages.

But the 14 employers involved in the contract negotiations — some of the largest ocean shipping lines and terminal operators in the world — said they hadn't outsourced any jobs. The management group said it had offered "absolute job security" and generous wage and pension increases.

The employers have accused the union of engaging in the practice of "feather bedding," requiring employers to call in temporary employees and hire new permanent employees even when there is no work to perform.

On Wednesday, the management group said the union's conduct "shows an irresponsible willingness to jeopardize port operations and thousands of jobs in the Los Angeles area." If a strike drags on, "the negative effects on jobs and the economy will be felt nationwide," the employers said.

The dispute was raising concerns far beyond the harbor area.

"A work stoppage at America's two busiest ports just as the holiday shopping season begins is a recipe for disaster," said Sandy Kennedy, president of the Retail Industry Leaders Assn., a trade group. "If the strike isn't resolved quickly, the effects on retailers, their customers and the economy will be enormous."

A 10-day lockout in 2002 at all West Coast ports left ships piling up offshore, unable to unload cargo. The cost of the dispute was estimated as high as $15 billion.

California Sens. Barbara Boxer and Dianne Feinstein issued a statement urging a quick resolution of the dispute "so we can protect the economy of the Los Angeles region, the West Coast and our nation, which will be adversely affected by the closures at these ports."

Rep. Janice Hahn (D-San Pedro) said she was backing the port workers.

"I stand in solidarity with the hard-working clerical workers, most of whom are women, of the ILWU Local 63's Office Clerical Unit, who are striking today to prevent their jobs from being sent overseas," Hahn said in a statement. "These workers have been bargaining in good faith for over two years, and I urge a fair resolution that keeps these good-paying jobs" at the ports of Los Angeles and Long Beach.

ron.white@latimes.com

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Man who set his two children ablaze pleads guilty

When asked how he pleaded to the murder of his 11-year-old daughter, Ashley, the father — his once full cheeks sunken and his skin now a pasty white against the dark green of the suicide prevention frock — was silent for a few seconds, his eyes wandering blankly as if in a daze.

He then croaked something barely audible. An interpreter repeated it loud and clear: "Guilty."

As he admitted also murdering his 10-year-old son, Alexander, Dae Kwon Yun dropped his head to his chest. Even as his attorney discussed his multiple suicide attempts in jail and as the judge spoke of the horrific crime he had committed when he doused an SUV in gasoline and set it on fire with his two children inside, the 61-year-old father refused to look up.

"It's beyond my imagination how someone can blow up their children," Superior Court Judge Stephen Marcus said, sentencing Yun on Tuesday to two consecutive life terms without the possibility of parole. "From my vantage point there is no justification."

Yun's attorneys said that although it may not be justification, there was a complex backdrop to the murder-suicide attempt six years ago — culture, mental illness, a life in shambles after his business crumbled and his marriage fell apart. He was the oldest son in a family of nine children, saddled with expectations and responsibilities, unable to admit failure, show weakness or ask for help.

"His mental state has been fragile before Day One. That's why we had a Day One," said his attorney, Casey Lilienfeld, calling the life sentence a "just" outcome.

In exchange for Yun's guilty plea, prosecutors said Tuesday that they would no longer seek the death penalty.

"This was a horrific crime with horrific results," Deputy Dist. Atty. Habib Balian said outside court. "The sentence will assure justice will be served."

A probation officer who evaluated the case wrote that for Yun, capital punishment would have been a reprieve.

"It is the belief of this officer that the death penalty would allow the defendant to avoid the punishment which is appropriate for his crimes," the officer wrote in a 2008 report made public Tuesday. "It is therefore believed the best interest of the community will be served by a sentence to state prison for as long a period of time as his natural life provides."

The Toyota Sequoia parked in a deserted alley in downtown Los Angeles erupted in flames on a Sunday afternoon in April 2006, a few weeks after the businessman shut down his T-shirt manufacturing business and his wife of 13 years filed for divorce. Shortly before the blaze, witnesses saw Yun shouting at his daughter before shoving her into the back seat of his car.

After the vehicle went up in flames — with all three inside — Yun rolled out of the SUV onto the ground with his legs aflame, a witness recalled at a preliminary hearing. Yun yelled for help, but never once gestured toward his children inside the burning vehicle, the witness said.

The children's deaths horrified Los Angeles' Korean community, a shock that was multiplied when within days of the attack, two other Korean men committed murder-suicides, one in Echo Park and another in Fontana.

According to the probation report, Yun, while he was being treated for his burns, told detectives that he had contemplated killing himself and his children for months because he was angry with his wife.

His wife and the children's mother, Sun Ok Ma, testified that he had repeatedly beaten her and threatened to kill her and burn down their home, leading to their separation and divorce. He pleaded guilty in 2004 to beating Ma, and was sentenced to two years' probation.

Deputy Dist. Atty. Bobby Grace, another prosecutor on the case, said Tuesday that the attack was "definitely premeditated," noting that Yun purchased the gasoline, picked an isolated location and parked the car up against a loading dock, making it difficult for the doors to open.

Prosecutors told the judge that Ma had been informed of the plea and sentencing, but said she did not want to make a statement.

Yun's attorneys asked that their client receive mental health treatment in prison and be kept in protective custody, saying he was suicidal and would be a target for violence from other inmates.

The man has shown "tremendous remorse" for his crime, attorney Christopher Apostal said. Yun has attempted suicide at least three times since his arrest, his attorneys said, and has been placed on the highest level of suicide watch with around-the-clock monitoring.

The judge said he would make the recommendations but declined the attorneys' request that Yun be housed in Southern California to accommodate visits from his family. Marcus said the decision was up to the state Department of Corrections and Rehabilitation, and that the man should not receive "special treatment."

victoria.kim@latimes.com

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Nintendo: more than 400,000 Wii Us sold in US

NEW YORK (AP) — Nintendo says it has sold more than 400,000 of its new video game console, the Wii U, in its first week on sale in the U.S.

The Wii U launched on Nov. 18 in the U.S. at a starting price of $ 300. Nintendo says the sales figure, based on internal estimates, is through Nov. 24.

Six years ago, Nintendo Co. sold 475,000 of the original Wii in that console’s first seven days in stores. The original Wii remains available, and Nintendo says it sold more than 300,000 of them last week, along with roughly 250,000 handheld Nintendo 3DS units and about 275,000 of the Nintendo DS.

Wedbush analyst Michael Pachter estimates that Nintendo will ship 1 million to 1.5 million Wii Us in the U.S. through the end of January.

Gaming News Headlines – Yahoo! News

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'Dancing With the Stars: All Stars' champ crowned

LOS ANGELES (AP) — She was dissed on "The Bachelor" and came in third place during her first stint on "Dancing With the Stars," but Melissa Rycroft is now a winner.

The reality TV star and her professional dance partner, Tony Dovolani, were named the champions Tuesday on ABC's "Dancing With the Stars: All Stars."

The pair beat out fellow finalists (and former champs) actress Kelly Monaco and Olympian Shawn Johnson to claim the sparkly mirror-ball trophy.

Fellow contestants on the show's first "all-star" season hoisted the new winners into the air as confetti rained down inside the "Dancing With the Stars" ballroom.

On the eve of the final competition, Rycroft said she felt confident and excited.

"I want to feel like a champion," she said.

Tuesday's two-hour season finale featured performances by the three finalists and each of the returning cast members: actors Pamela Anderson, Sabrina Bryan, Kirstie Alley and Gilles Marini; singers Joey Fatone and Drew Lachey; race car driver Helio Castroneves; reality TV star Bristol Palin; Olympic skater Apolo Anton Ohno; and football star Emmitt Smith.

Six of those contestants — Johnson, Monaco, Lachey, Ohno, Smith and Castroneves — were previous "Dancing" winners.

Rycroft and Dovolani came into the final contest with a pair of perfect scores. Those points were combined with viewer votes and a last set of judges' scores for an "instant dance" for which they had less than an hour to prepare.

Rycroft was a contestant on "The Bachelor" in 2009 and first appeared on "Dancing With the Stars" that same year. The 29-year-old also starred in a reality series earlier this year, "Melissa & Tye," about her marriage to Tye Strickland and their move to Hollywood so she could pursue an entertainment career.

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Online:

http://beta.abc.go.com/shows/dancing-with-the-stars/index

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Recipes for Health: Spinach and Turkey Salad — Recipes for Health

Andrew Scrivani for The New York Times

Turkey or chicken transforms this classic spinach salad (minus the bacon) into a light main dish, welcome after Thanksgiving and before the rest of the holiday season feasting begins.

2 cups (12 ounces) shredded cooked turkey, chicken breast or chicken breast tenders

1 6-ounce bag baby spinach

6 white or cremini mushrooms, thinly sliced

1 cup cooked wild rice

2 tablespoons chopped walnuts

1 to 2 hard boiled eggs (to taste), finely chopped (optional)

2 tablespoons chopped chives

1 to 2 tablespoons chopped fresh herbs such as parsley, tarragon or marjoram

For the dressing:

2 tablespoons fresh lemon juice

1 tablespoon red wine vinegar, tarragon vinegar or sherry vinegar

1 teaspoon Dijon mustard

Salt and freshly ground pepper

1 small garlic clove, pureed

1/3 cup extra virgin olive oil

2 tablespoons plain low-fat yogurt

1. Combine all of the salad ingredients in a large salad bowl. Whisk together the lemon juice, vinegar, Dijon mustard, salt, pepper, garlic, olive oil and yogurt. Toss with the salad just before serving.

Yield: Serves 4 as a main dish

Advance preparation: The salad can be assembled and the dressing mixed several hours before serving. Refrigerate and toss together when ready to serve.

Variation: Add 1 ripe but firm persimmon, peeled, cored and sliced, to the mixture.

Nutritional information per serving: 375 calories; 25 grams fat; 4 grams saturated fat; 5 grams polyunsaturated fat; 15 grams monounsaturated fat; 53 milligrams cholesterol; 14 grams carbohydrates; 2 grams dietary fiber; 119 milligrams sodium (does not include salt to taste); 26 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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UCLA Medical Center gets failing grade on patient safety

A national report card on patient safety gave a failing grade to Ronald Reagan UCLA Medical Center, one of the country's most prestigious hospitals and one of only 25 nationwide to receive such low marks.

In a report issued Wednesday, the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, gave a letter grade of F to UCLA Medical Center for performing poorly on several measures tied to preventing medical errors, patient infections and deaths.

Leapfrog withheld a failing grade for UCLA in June when it released its first-ever hospital safety scores to give low-performing hospitals time to show improvement.

Officials at UCLA disputed the failing grade and they said one patient death in 2010 unfairly lowered its grade from a C to an F under Leapfrog's methodology.

"UCLA is not an F hospital in quality and safety," said Tom Rosenthal, chief medical officer at Ronald Reagan UCLA Medical Center. "It is not a fair scoring system and it does a disservice to the public."

This debate over UCLA's score comes amid a proliferation of healthcare ratings by outside organizations trying to provide more information to consumers and employers. These scores are also taking on greater importance as some insurers and employers use them as one factor in determining whether a hospital or doctor should be included in a provider network.

Given those stakes, the California Hospital Assn. has called on Leapfrog and other rating organizations to offer more details on how their scores are tabulated and to focus on reliable measures that can assess patient care. Some highly regarded hospitals across the country, such as UCLA, fare well in one ranking and then poorly in the next.

Leapfrog gave an F to one other area hospital, Western Medical Center Anaheim. The hospital said it disagreed with Leapfrog's rating methods and added that it "continuously adds new systems to enhance our patient care."

Cedars-Sinai Medical Center received an A in Leapfrog's June report, but its grade dropped to a C on this latest review, which included more recent data from last year. Thirty Kaiser Permanente hospitals received an A and one got a B from Leapfrog.

Experts urge consumers to use these score cards as one tool in evaluating a hospital and to discuss any specific concerns with their doctor and other medical providers.

Leapfrog estimates that 180,000 Americans die annually from hospital accidents, errors and infections, and it says hospitals need to do more to protect patients from harm. Its hospital safety score is derived from 26 measures of publicly reported data.

Rosenthal said UCLA scores well on healthcare quality and patient outcomes on numerous measures tracked by the federal government and other rating organizations, suggesting that Leapfrog's methods are potentially flawed.

He said a liver transplant patient died during surgery in 2010 from an air embolism, one of several preventable medical errors that Leapfrog and other groups regularly track. Rosenthal said the patient's death was a regrettable mistake, but that error hasn't occurred since then.

Leah Binder, Leapfrog's president and chief executive, said her group's scoring methods are statistically valid and devised by a panel of leading experts in patient safety. She said UCLA scored poorly in several areas of patient care, such as foreign objects left in a patient during surgery and pressure ulcers.

"It isn't just one incident that gave them a score so far below the national average," Binder said. "We see it all the time that a hospital might have a stellar reputation, but behind the scenes they aren't safe for many of their patients."

On pressure ulcers, Rosenthal said, UCLA looked worse than its actual performance because of over-reporting in the hospital billing data that was reviewed by Leapfrog.

Overall, Leapfrog gave an A or B to 1,468 hospitals, or 56% of the 2,618 reviewed nationwide. The group issued a C to 1,004 hospitals, or 38%. At the bottom, 146 hospitals, or 6%, were labeled D or F.

Leapfrog reviewed 246 hospitals in California. The ratings are available online at http://www.hospitalsafetyscore.org.

chad.terhune@latimes.com

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Egypt president meets judges, fails to 'contain crisis'

CAIRO — President Mohamed Morsi suggested Monday that he would scale back broad powers he assumed last week but failed to appease Egypt's judiciary, which would still lack oversight of some institutions including the Islamist-led assembly drafting a new constitution.

Morsi and senior judges met for nearly five hours to discuss differences resulting from the president's declaration that his office was free from judicial review. Morsi told judges that the decree was meant to be temporary, and mainly aimed at shielding the long-troubled constitutional assembly from any judicial attempt to disband it.

Presidential spokesman Yasser Ali said after the meeting that Morsi's decree was not designed to "infringe" on the judiciary, suggesting not all of the president's actions would be immune from court review. The Supreme Judicial Council on Saturday condemned Morsi's expanded powers as an "unprecedented attack" on the courts. And Monday's talks did not seem to soften the sentiment of some council members.

"Our meeting with the president has failed to contain the crisis," Abdelrahman Bahloul, a member of the judicial council, told the newspaper Al Masry al Youm. "The statement issued by the presidency is frail and does not represent the members of the council."

The Judges Club, a separate legal organization, also was not satisfied that Morsi had scaled back enough of his authority. It called on its members to continue a partial strike in Alexandria and other cities. Ziad Akl, a political analyst, said Morsi's negotiations with the judges were a move to show the public he's not a dictator, "but, in reality, his declaration has not changed."

The talks in the presidential palace did not stop anti-Morsi demonstrations in Tahrir Square on Monday. But in a sign tensions may be easing, the Muslim Brotherhood, which Morsi helped lead until his inauguration in June, announced it was canceling a scheduled demonstration Tuesday to avoid bloodshed and possible clashes with Morsi opponents.

The consequences of the nation's restiveness played out as Morsi and the judges met Monday, with mourners turning out to bury two boys from opposite political sides who were killed in recent clashes: a 16-year-old antigovernment protester reportedly shot with a rubber bullet near Tahrir Square and a 15-year-old struck by a stone when a crowd attacked an office of the Brotherhood's Freedom and Justice Party in the Nile Delta.

"The presidency mourns two of the nation's finest young men," Morsi said in a statement.

But the images of two funerals made it clear that Morsi and the Brotherhood, although still Egypt's dominant political forces, miscalculated the depth of public anger that has bristled since last year's overthrow of longtime autocrat Hosni Mubarak and subsequent government setbacks, including judicial action disbanding the Islamist-led parliament.

Last month, Morsi, who for months has held wide executive and legislative powers, attempted to fire Prosecutor-General Abdel Meguid Mahmoud, only to retreat after a backlash from judges. His most recent decree to hold his office above judicial oversight struck many as another ill-conceived bid to consolidate his authority and advance an Islamist agenda.

Morsi contended that his intent was to prevent Mubarak-era judges from disrupting the country's political transition. Many Egyptians, including opposition figures, are suspicious of the courts, Mahmoud in particular. But Morsi's unilateral decree echoed the strongman tactics of his predecessor.

One of the president's biggest challenges is to protect the assembly drafting the constitution, which will open the way for new parliamentary elections. In June, the Supreme Constitutional Court, made up mostly of Mubarak-appointed judges, dissolved parliament. The court has since been deciding the fate of the Islamist-led assembly, which Morsi feared would also be disbanded.

Activists, liberals, women and non-Muslims have boycotted the assembly, saying that it is too focused on sharia, or Islamic law, which could limit civil rights. Protesters in Tahrir Square said they will continue their demonstrations until Morsi retracts more of his power.

Jaber Nassar, a legal expert quoted on state TV, said Morsi's meeting with the judges showed that he remains adamant on keeping broad authority. He called Morsi's announcement Monday "simply a political statement meant to curb protests against" his decree.

jeffrey.fleishman@latimes.com

Abdellatif is a special correspondent.

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Berry's ex says he was threatened before fight

LOS ANGELES (AP) — Halle Berry's ex-boyfriend claims the actress's fiance threatened to kill him during a Thanksgiving confrontation that left him with a broken rib, bruised face and under arrest.

Gabriel Aubry's claims are included in court filings that led a judge Monday to grant a restraining order against actor Olivier Martinez, who is engaged to the Oscar-winning actress.

Aubry, 37, was arrested on suspicion of misdemeanor battery after his confrontation with Martinez on Thursday, but he states in the civil court filings that he was not the aggressor and that he was threatened and attacked without provocation. Martinez told police that Aubry had attacked first, the filings state.

A representative for Martinez could not be immediately reached for comment.

Aubry's filing claims Martinez threatened him the day before the fight at an event at his daughter's school that he and the actors attended. Aubry, a model, has a 4-year-old daughter with Berry and the former couple have been engaged in a lengthy custody battle.

The proceedings have been confidential, but Aubry states a major aspect of the case was Berry's wish to move to Paris and take her daughter with her. The request was denied Nov. 9, Berry's court filings state, and Aubry shares joint custody of the young girl.

Aubry claims Martinez told him, "You cost us $3 million," while he was punched and kicked him in the driveway of Berry's home. Aubry had gone to the home to allow his daughter to spend Thanksgiving with her mother, the filings state. Aubry claims Martinez threatened to kill him if Aubry didn't move to Paris.

Berry was not in the driveway during the confrontation and neither was their daughter, the documents state.

Photos of Aubry's face with cuts and a black eye were included in his court filing.

A judge set a hearing for Dec. 17 to consider whether a three-year restraining order should be granted. Aubry has a Dec. 13 court date for the possible battery case, which has not yet been filed by prosecutors.

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

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Books: Woe Is Syphilis, and Other Afflictions of Famous Writers

The old Irishman was a swollen, wheezing mess, blood pressure wildly out of control, kidneys failing, heart fibrillating. “What we have here,” said his new Spanish doctor, “is an antique cardiorenal sclerotic of advanced years.”

In fact, what the doctor had there was William Butler Yeats: the poet had a long list of chronic medical problems and experienced one of his regular cardiac crises while wintering in Spain. He still had three poetically productive years ahead of him before he died of heart failure in 1939, at age 73.

What makes antique case histories like Yeats’s so compelling to research, so interesting to read? Admittedly, they have educational value — medicine moves forward by looking back — but their major attraction is undoubtedly the operatic vigor of their emotional punch. As we contemplate the poor health of historic notables, we can sigh gustily at the immense suffering our ancestors considered routine, wince at the lunatic treatments they so innocently underwent, and marvel over and over again that the body, the brain and the mind can take such divergent paths.

These pleasures are present in abundance in the newest addition to the genre of medical biography, “Shakespeare’s Tremor and Orwell’s Cough.” Dr. John J. Ross, a Harvard physician, writes that he stumbled into the field by accident while trying to enliven a lecture on syphilis with a few literary references. The discovery that Shakespeare was apparently obsessed with syphilis (and suspiciously familiar with its symptoms) hooked Dr. Ross.

The resulting collection of 10 medico-literary biographical sketches ranges from the tubercular Brontës, whose every moist cough is familiar to their fans, to figures like Nathaniel Hawthorne, whose medical stories are considerably less familiar.

Dr. Ross’s discussion of Shakespeare is unique in the collection for its paucity of relevant data: so few details are known of the playwright’s life, let alone his health, that all commentary is necessarily supposition. Dr. Ross is not the first to note that references to syphilis are “more abundant, intrusive and clinically exact” in Shakespeare’s works than those of his contemporaries. This observation, along with the apparent deterioration of Shakespeare’s handwriting in his last years, leads to the hypothesis that Shakespeare had syphilis repeatedly as a young man, and wound up suffering more from treatment than disease.

The Elizabethans dosed syphilis with a combination of hot baths (treating the disease by raising body temperature endured into the 20th century), cathartics and lavish quantities of mercury. The drooling that accompanies mercury poisoning was considered a sign of excellent therapeutic progress, Dr. Ross writes: “Savvy physicians adjusted the mercury dose to produce three pints of saliva a day for two weeks.”

And so, when Shakespeare signed his will a month before he died with a shaky hand, was his tremor not possibly a sign of residual nerve damage from the mercury doses of his sybaritic youth? No amount of scholarship is likely to confirm this theory, but details of the argument are gripping and instructive nonetheless.

The story of the blind poet John Milton runs for a while along similar lines. Much is known about the long deterioration of Milton’s vision and other particulars of his delicate health, but Dr. Ross observes that many of his problems seem to have cleared up once he actually became blind. Was he vigorously medicating himself with lead-based nostrums in hopes of forestalling what Dr. Ross argues was probably progressive retinal detachment, then recovering from lead poisoning once his vision was irretrievably gone? Another intriguing if unanswerable question.

Just as the competing injuries of disease and treatment battered the luminaries of English and American literature, so did pervasive mental illness.

Jonathan Swift was a classic obsessive-compulsive long before he succumbed to frontotemporal dementia (Pick’s disease). Poor Hawthorne, so forceful on the page, was in person a tortured shrinking violet, the embodiment of social phobia and depression. Emily Brontë’s behavior was strongly suggestive of Asperger syndrome; Herman Melville was clearly bipolar; Ezra Pound was just nuts.

Yet they all wrote on, despite continual psychic and physical torments. Perhaps the thickest medical chart of all belongs to Jack London, who survived several dramatic episodes of scurvy while prospecting in the Klondike (he was treated with raw potatoes, a can of tomatoes and a single lemon), then accumulated a long list of other medical problems before killing himself (inadvertently, Dr. Ross argues) with an overdose of morphine from his personal and very capacious medicine chest.

Dr. Ross has not written a perfect book. The fictionalized scenes he creates between some of his subjects and their medical providers should all have been excised by a kindly editorial hand, which might also have addressed more than a few grammatical errors. Frequent leaps from descriptive to didactic mode as Dr. Ross updates the reader on various medical conditions can be jarring, like PowerPoint slides suddenly deployed in a poetry reading. True literary scholars might dismiss the book as lit crit lite, a hodgepodge of known facts culled from the usual secondary sources.

But all these caveats fade into the background when Dr. Ross hits his narrative stride, as he does in chapter after chapter. Then the stories of the wounded storytellers unfold smoothly on the page, as mesmerizing as any they themselves might have told, those squinting, wheezing, arthritic, infected, demented, defective yet superlative examples of the human condition.

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Cyber Monday shoppers look for online deals, many while at work

Retail reporter Shan Li and consumer columnist David Lazarus talk with Trae Bodge, senior editor at Retailmenot.com Insider about Cyber Monday.

Consumers hopped online for some more Internet shopping on Cyber Monday after last week's post-Thanksgiving Black Friday frenzy came to a close.

Many started early this year: Online spending on Black Friday topped $1 billion for the first time as some shoppers turned to their computers instead of braving the crowds in person.

Cyber Monday is "the Super Bowl of online shopping," said Jonathan Johnson, president of bargain site Overstock.com.

As of late afternoon, the site's traffic was up compared with last year's Cyber Monday, he said, but it was too early to predict how the entire day's sales would shake out. In the last few years, he said, Cyber Monday shoppers with high-speed Web access have started browsing Overstock at home after a day at the office.

"It used to be during the work hours that people shopped the most," Johnson said. "Now, it's a big hump in the middle of the day during work hours, then slows down during the commute home, and the biggest hump is at night."

This Cyber Monday, up to 129 million consumers were expected to hit Web merchants to take advantage of discounts, promotions and free shipping, according to the National Retail Federation.

Some of them, just returning to work after Thanksgiving, indulged right at their desks.

"People at work already take care of personal business like online banking. During the holidays they shop and buy gifts," said Andrew Lipsman, vice president of industry analysis at research firm ComScore Inc. "People can also shop without family members looking over their shoulder and kids snooping around to see what they're getting."

Nancy Lu, 28, of Los Angeles' Koreatown planned to surreptitiously browse the websites of favorite stores such as Macy's and J. Crew in the hopes of scoring some bargains for herself and her family. The personal assistant said she was hoping to get holiday shopping done early this year.

"I'm usually the person at the malls two days before Christmas trying to find something for everyone," she said. "If I find really good deals on Monday then I can relax later on."

For the last two years, Cyber Monday has been the year's biggest online spending day, Lipsman said. That's up from 12th place in 2006. Last year, Cyber Monday sales totaled $1.3 billion, and ComScore predicted they could reach $1.5 billion this year.

More consumers are using laptops, smartphones and tablet computers to do their shopping this holiday season.

On Black Friday, 57.3 million Americans visited an online retail site, up 18% from a year earlier, ComScore said. The National Retail Federation said that for the first time ever, more than half of shoppers over the long Thanksgiving weekend said they checked out stores online.

Cyber Monday, its name coined in 2005, quickly gained traction as shoppers took advantage of work computers with faster Internet connections, Lipsman said. Now, he said, at-work transactions account for about half the dollars spent at online retailers that day.

Nearly half of workers plan to do some of their shopping online while at the office this holiday season, according to a survey from CareerBuilder. More women than men said they had shopped at work in the past: 43% compared with 36%.

The retailer with the most-visited site on Black Friday was e-commerce giant Amazon.com Inc., followed by Wal-Mart Stores Inc., Best Buy Co., Target Corp. and Apple Inc., ComScore said. Amazon is the nation's largest online-only retailer.

Nearly all merchants with a Web presence are participating in the flurry of promotions and discounts surrounding Cyber Monday, said Trae Bodge, a shopping expert at deals site RetailMeNot.

She said some people admit to devoting three or more hours to shopping while at work.

That's good news for retailers, many of which will continue to roll out deals online this week.

shan.li@latimes.com

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Survey finds lots of unused vacation time

As an information technology supervisor at Pitzer College in Claremont, Dennis Crowley had so much work to do last year that he finished 2011 without using nearly five days of paid vacation.

"And to be frank, I was too busy to even realize I was losing time," he said.

Crowley's situation is not unusual. A survey by Harris Interactive Inc. found that by the end of 2012, Americans will leave an average of 9.2 days of vacation unused, up from the average of 6.2 days in 2011.

Nearly 90% of those questioned said they would take more leisure trips on their vacation if they had the time and money to do so, according to the survey of more than 2,000 U.S. adults that was commissioned by travel website Hotwire.

Hotwire has a selfish reason for pointing out the survey results: The travel website says vacationers can save lots of money by traveling between Thanksgiving and Christmas. During the holiday gap, hotel rates drop 33% in Boston, 28% in San Francisco and 26% in Seattle, compared with the peak summer travel season, according to the website.

Crowley has learned his lesson. He said he is keeping closer tabs on his vacation time this year. But instead of using his accrued vacation time to travel, he said is spending more time with his children.

Airline food getting more healthful

On the nation's airlines, the days of free lunch are long over. That also goes for breakfast, dinner and snacks. Once complimentary, most airline food now comes with a price tag.

But there is some good news about what you get to eat on commercial airlines: It is getting more healthful.

That's the assessment of Charles Platkin, a professor of nutrition at the City University of New York's Hunter College who has tested and ranked airline foods off and on since 2000. With few exceptions, Platkin said most airlines now offer at least one healthful meal alternative on their menu.

"It's actually moving in a good direction," he said. "It's been an ebb and flow, but the overall trend is positive."

Platkin gave the top ranking this year to Virgin America, noting that the airline based in California offers low-calorie options such as roasted pear and arugula salad, a "protein plate" with hummus and whole wheat pita bread, plus oatmeal for breakfast. He gave the airline 41/4 stars out of a maximum of five stars.

At the bottom of the list was Allegiant Air, with a rating of only one and a half stars. Platkin said the Las Vegas airline "made it clear that their foods were not healthy. It shows."

The airline's snacks include M&Ms, Oreo Brownies and Pringles chips.

Air Canada and Alaska Airlines came in second and third, respectively, in Platkin's ranking. The other big airlines — including United, American, Delta and US Airways — ranked in the middle of the list.

Platkin does not eat the food on every airline. "I don't have that kind of time," he said. "I have classes to teach."

Instead, he collects and reviews lists of food items, including the ingredients and calorie numbers, from the airlines.

TSA defends stopping traveler over watch

A traveler was stopped by federal security officers at the Oakland International Airport this month because of an unusual wristwatch he was wearing.

When word got out about the incident, critics of the Transportation Security Administration blasted the agency, saying it was another example of the TSA overreacting.

In hopes of stifling the uproar, the TSA released a photo of the watch last week. This is no ordinary timepiece. It includes a toggle switch, wires and what look like tiny fuses attached to the wristband.

A TSA explosives detection team determined that the watch was not an explosive device. Still, the Alameda County sheriff's deputies, who were called by the TSA to investigate, arrested the watch owner, Geoffrey McGann, a teacher and artist from Rancho Palos Verdes. He was jailed on suspicion of possession of components to make a destructive device, according to news reports.

The Alameda County district attorney's office declined last week to file charges against McGann.

McGann's attorney accused the TSA of being "hyper-vigilant."

The TSA responded in its blog last week, saying, "Terrorists take everyday items and attempt to manipulate them to make improvised explosive devices. Our officers are trained to look for anomalies such as this one."

hugo.martin@latimes.com

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