Different looks for Heat, Lakers at All-Star break

HOUSTON (AP) — If Kobe Bryant's season seems tough, imagine what Dwyane Wade went through five years ago.

"I came to All-Star weekend one year, I think we had won nine games. Seriously," Wade said Friday. "I was looking for my 10th win at the All-Star game."

Things sure have changed for his Miami Heat.

Back where they first teamed up as All-Stars in 2006, Wade, LeBron James and Chris Bosh return as NBA champions who will start together for the Eastern Conference on Sunday night.

Now the misery belongs to Bryant, Dwight Howard and the Los Angeles Lakers, whose season has been so disappointing that Bryant was asked Friday if the All-Star weekend was a "retreat" for him.

"I don't know if it's a retreat, it's just more of an opportunity to get some rest, regroup, put the first half of the season behind us and move on," he said.

As Wade knows, the All-Star break can be just that — a break — from a forgettable season.

He arrived for the 2008 All-Star game with a 9-43 record after the Heat lost on Valentine's Day to the Chicago Bulls, on their way to a 15-win debacle just two years after they won the NBA title.

"I put all that aside though, and I came and I enjoyed the weekend, and when I went back to Miami, it was like, 'Oh my God, we're back in it,'" Wade said. "But All-Star weekend, you just enjoy being an All-Star. You enjoy being around the guys. You can kind of forget about that a little bit, unless you have the cameras and the microphones in front of you asking you questions about it, but besides that you try to enjoy it."

This time, the Heat celebrated Valentine's Day in Oklahoma City with a 110-100 victory over the Thunder, the team they beat in five games last summer for the title. They have won seven in a row, James is playing arguably the best basketball of his career, and they can relax and reminisce as they return to Houston.

"It's really indescribable," Bosh said, "just to not only win a championship with great guys, be in a great locker room, and just to have fun doing it, but just to be an All-Star every year, play with great teammates, I mean to play in front of a lot people in arenas every night. I don't take those things for granted."

James, Wade and Bosh were in their third NBA seasons when they were chosen for the 2006 game, which turned out like so many Heat games these days. James was voted MVP after scoring 29 points and leading a huge East comeback that was wrapped up when Wade made the go-ahead basket with 16 seconds left.

Think about that: James was already the best player that night, and he was nowhere near the player he is today.

"I'm a better player. At that point in time, I wasn't a complete basketball player. I couldn't shoot as well as I can now, I never posted up back then," James said. "More games, more playoff games, more knowledge. You continue to learn each and every day, it makes you a better player. That's what you want, to become a better player. That's what I want. I want to be the greatest of all-time. I try to do whatever it takes to get me in that position.

"Seven years, I've tried to improve each and every year."

He's gotten to the point now where he ran off an NBA-record six straight games with at least 30 points and 60 percent shooting from the field, and seems to be distancing himself from anyone else that can take the MVP award he won last year for the third time in four years.

"He's doing well," Bosh said in a Texas-sized understatement. "That's the best way to put it."

Bosh was chosen as a starter Friday by Heat coach Erik Spoelstra, who will lead the East. He replaces Boston guard Rajon Rondo, who pulled out with a torn ACL.

Bryant and Howard are still here, away from a Los Angeles season that's been anything but a Hollywood story.

Considered a title contender after acquiring Howard and Steve Nash in the summer, the Lakers fell to 25-29 after they were blown out Wednesday by the rival Clippers, who opened a 13-game lead over them in the Pacific Division standings.

Smiling as he sat with his daughter, Natalia, Bryant laughed that he wished the All-Star break was a chance for the Lakers to "hit the reset button" on what he's said has been a most difficult season.

"Hopefully there's an easy button like in the commercial when we come back in the second half of the season and things are a little easier for us," he said.

Howard has battled injuries to his back and shoulder and has been nothing like the player who has been the NBA's dominant big man in recent years. He said at times he hasn't been having fun and has tried to ignore all the bad news around the team.

"You just try to stay away from the tube and do as much as I can to rehab my back and my shoulder and my mind, and really just get away from everything when I'm not playing basketball," he said.

If he's looking for a chance to enjoy himself this season, it may get no better than the next few days.

"It's a great weekend, it's an unbelievable weekend for the fans to be able to put all their favorite players together in one venue," James said. "We have a great time with it."

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Follow Brian Mahoney on Twitter: http://www.twitter.com/Briancmahoney

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Fat Dad: Baking for Love

Fat Dad

Dawn Lerman writes about growing up with a fat dad.

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

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

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

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

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

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

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

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

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

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

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

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Fat Dad’s ‘Closet’ Brownies

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

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

1. Preheat oven to 350 degrees.

2. Grease an 8-inch square baking dish.

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

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

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

Yield: 16 brownies

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

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U.S. Signals Support for Japan’s Yen Policy

MOSCOW — Ben S. Bernanke, the Federal Reserve chairman, strongly indicated on Friday that the United States did not intend to censure Japan for weakening its currency over the last several months, something that has aided Japanese exporters and angered its competitors.

Mr. Bernanke spoke in brief introductory remarks at a conference in Moscow of the Group of 20, a club of the world’s largest industrial and emerging economies.

At issue are stimulus programs backed by Prime Minister Shinzo Abe, who is also maintaining pressure on the Bank of Japan to keep interest rates near zero and flood the economy with money to support Japanese manufacturers. As a result, the yen has lost about 15 percent of its value against the dollar over the last three months, meaning products produced in Japan, like some Sony electronics or models of Toyota cars, are relatively cheaper.

Japan’s maneuver touched off fears that other countries and the European Union might follow suit in a so-called currency war, which has been the main topic of the Group of 20 meeting here, which runs through Saturday.

Initially, it seemed the world’s largest economies might agree on a firm statement at the end of the meeting to condemn a currency war, or competitive devaluations. This tactic is now widely seen as a beggar-thy-neighbor approach to creating growth that would ultimately harm a global recovery and is understood to be a cause of the lingering nature of the depression in the 1930s.

Mr. Bernanke, an advocate of the loose monetary policy in the United States known as quantitative easing, but also a student of the Great Depression, suggested a distinction should be drawn based on the intention of the monetary easing.

“The United States is using domestic policies to advance domestic agendas,” Mr. Bernanke said, speaking in a gilded and colonnaded chamber in the Kremlin to a round table of the world’s leading central bankers and finance ministers, in addition to President Vladimir V. Putin of Russia.

“We believe that by strengthening the U.S. economy, we are helping to strengthen the global economy as well,” Mr. Bernanke said. “We welcome similar approaches by other countries.” He said he endorsed an earlier statement at the meeting from Christine Lagarde, the director of the International Monetary Fund, who had said the risk of a currency war was “overblown.”

The global recovery has become unbalanced, Mr. Lagarde said in her statement to the group. Developed countries are swooning, while the emerging markets bounced back quickly, and yet such countries, including Russia, have been critical of the stimulus efforts of the developed nations. Japan’s devaluation of the yen is “sound policy,” she said.

“The international monetary system can function effectively if each country follows the right policies for their domestic economies,” she said, ultimately lifting the tide of the global marketplace, she said.

Ms. Lagarde did caution that too bald a ploy to prop up exports would not count as a justified weakening of a currency.

Because loose monetary policy encourages economic growth while also helping exports, critics of such tactics say these are distinctions without a difference.

Germany’s finance minister offered a contrarian view, saying that countries should not use easy money to avoid reducing their deficits over the long term, with measures like reducing government waste.

The Russian finance minister, Anton Siluanov, the host of the meeting, has also been pushing for a strong statement against competitive devaluations in the final communiqué from the forum, expected Saturday. Mr. Siluanov said in his opening remarks that a statement endorsing market mechanisms to set exchange rates would “find a place in the communiqué.”

That reiterated the position of a statement issued by the Group of 7 earlier this week. But it now seems a watered-down version is more likely.

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Benedict Says He Will Be ‘Hidden to the World’ in Retirement

VATICAN CITY — Saying he would soon be “hidden to the world,” Pope Benedict XVI took his leave of parish priests and clergy of the Diocese of Rome on Thursday as he offered personal, and incisive, recollections of the Second Vatican Council, the gathering of bishops 50 years ago that set the Roman Catholic Church’s course for the future.

Benedict, who announced his resignation on Monday in a move that stunned the Roman Catholic world, also indicated that he would not hold a public role once his resignation becomes official on Feb. 28. He is the first pope to step down in nearly 600 years.

“Though I am now retiring to a life of prayer, I will always be close to all of you and I am sure all of you will be close to me, even though I remain hidden to the world,” Benedict, 85 and increasingly frail, told the assembly of hundreds of priests, who had greeted him with a long standing ovation and some tears.

Priests in attendance said they felt they had witnessed a powerful moment in church history, one that also humanized a pope who has often seemed remote. “It moved me to see the pope smile,” said Don Mario Filippa, a priest in Rome. “He has found peace within himself.”

“It was a part of history,” said Father Martin Astudillo, 37, an Argentine priest who is studying in Rome. “This is a man of God who at the end of his public role transmits his vision of the church and relationship with the church,” he added. “We saw in a few words a real synthesis of his vision of the church and what he expects from whomever takes over.”

During the reflection — or “chat” in his words — on the Second Vatican Council, Benedict recalled the “incredible” expectations of the bishops going into the gathering.

“We were full of hope, enthusiasm and also of good will,” he said.

But while the council made landmark decisions that would propel the church into the future, much got lost in the media’s interpretation of what transpired, he said, which led to the “calamities” that have marred recent church history.

The media reduced the proceedings “into a political power struggle between different currents of the church,” and they chose sides that suited their individual vision of the world, the pope said.

These messages, not that of the council, entered into the public sphere and that led in the years to “so many calamities, so many problems, seminaries closed, convents that closed, the liturgy trivialized,” the pope said.

Benedict spoke of how the council had explored ideas of “continuity” between the Old and New Testaments, and of the relationship between the Catholic and Jewish faiths, an issue that was thorny during his tenure.

“Even if it’s clear that the church isn’t responsible for the Shoah, it’s for the most part Christians who did this crime,” Benedict said of the Holocaust, adding that this called for a need to “deepen and renovate the Christian conscience,” even if it’s true that “real believers only fought against” Nazi barbarism.

At a news briefing on Thursday, the Rev. Federico Lombardi, the Vatican spokesman, confirmed a report in the Turin newspaper La Stampa that the pope had accidentally hit his head during a trip to Mexico last March. The press corps traveling with the pope was not informed of the accident.

The Vatican newspaper L’Osservatore Romano has reported that the pope had decided to retire after returning from that trip. But Father Lombardi rejected La Stampa’s suggestion that the episode might have prompted the decision.

La Stampa reported that Benedict had gotten up in the middle of the night but could not find the light switch in the unfamiliar environment, and accidentally hit his head on a bathroom sink.

An unidentified prelate on the same trip said the pope came down to breakfast the next morning with blood in his hair, the paper said. There was also blood on the pillow, “and a few drops on the carpet,” the prelate told La Stampa. “But it was not a deep cut, nor was it worrisome,” and it was covered by the pope’s thick hair, the prelate said. The pope did not complain during the day’s events.

Later that night, the prelate said, he heard that the pope’s doctor had reacted by expressing concerns about so much travel, and that Benedict had responded that he too had concerns about traveling.

Father Lombardi said: “I don’t deny that this episode happened, but it didn’t impact on the rest of his trip, nor on his decision to resign. That isn’t linked to one single episode.”

Since Benedict announced the decision, saying he felt he did not have the strength to continue in his ministry, there has been much closer public scrutiny of his health.

On Tuesday, the Vatican confirmed for the first time that the pope had had a pacemaker since his time as a cardinal and had its batteries changed three months ago.

Once retired, Benedict will live in a convent inside Vatican City, and will be tended to by the nuns who currently look after him. Father Lombardi said Benedict’s longtime personal secretary, Archbishop Georg Gänswein, who was also named prefect of the papal household two months ago, would continue to work for him.

Father Lombardi said he saw no conflict of interest if Archbishop Gänswein served the current pope and his successor.

The prefect is responsible for logistical duties, and “in this sense it is not a profound problem, I think,” Father Lombardi said.

Rachel Donadio contributed reporting.

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Amputee Olympic star Pistorius charged in slaying

PRETORIA, South Africa (AP) — Oscar Pistorius, the double-amputee sprinter dubbed the Blade Runner, was charged Thursday in the Valentine's Day slaying of his girlfriend at his upscale home in South Africa, a shocking twist to one of the feel-good stories of last summer's Olympics.

Pistorius buried his face in the hood of his workout jacket as officers escorted him from a police station after his arrest in the shooting death of Reeva Steenkamp, a 30-year-old model who had spoken out on Twitter against rape and abuse of women.

Police said she was shot four times in the pre-dawn hours at Pistorius' villa in a gated community in the capital, Pretoria. Officers found a 9 mm pistol inside the home and arrested Pistorius on a murder charge.

What sparked the shooting remained unclear, but police said they had received calls in the past about domestic altercations at the home of the 26-year-old athlete, who has spoken publicly about his love of firearms.

A police spokeswoman, Brigadier Denise Beukes, said the incidents included "allegations of a domestic nature."

"I'm not going to elaborate on it, but there have been incidents," Beukes said. She said Pistorius was home at the time of Steenkamp's death and "there is no other suspect involved."

Pistorius made history in the London Games when he became the first double-amputee track athlete to compete in the Olympics. He didn't win a medal but did make the semifinals of the 400 meters and became an international star.

Thursday, companies quickly removed billboards and advertising featuring Pistorius, a national hero in South Africa who also inspired fans worldwide with the image of his high-tech carbon-fiber blades whipping through the air.

Kenny Oldwage, Pistorius' lawyer, told reporters the athlete was "emotional" after his arrest, "but he is keeping up." He said he planned to seek bail for Pistorius at a preliminary hearing Friday.

Pistorius has had troubles in the past in his personal life, which often featured fast cars, cage fighters and women.

In February 2009, he crashed a speedboat on South Africa's Vaal River, breaking his nose, jaw and several ribs and damaging an eye socket. He required 180 stitches to his face. Witnesses said he had been drinking, and officers found alcoholic beverages in the wreckage, though they did not do blood tests.

In November, Pistorius was involved in an altercation over a woman with a local coal mining millionaire, South African media reported. The two men involved the South African Police Service's elite Hawks investigative unit before settling the matter.

Pistorius' father, Henke Pistorius, said Thursday: "We all pray for guidance and strength for Oscar and the lady's parents."

A spokeswoman for Pistorius at Fast Track, an international sports marketing agency in London, said the athlete was assisting with the investigation and there would be no further comment "until matters become clearer."

The sprinter's former coach, Andrea Giannini, said he hoped the shooting was "just a tragic accident."

"No matter how bad the situation was, Oscar always stayed calm and positive," Giannini told The Associated Press in Italy. "Whenever he was tired or nervous, he was still extremely nice to people. I never saw him violent."

Firearms captivated Pistorius, the subject of an online Nike advertisement that featured him with the caption: "I am a bullet in the chamber." In November 2011, he posted a photograph on Twitter of himself at a shooting range, bragging about his score. "Had a 96% headshot over 300m from 50shots! Bam!" he wrote.

Linked to a number of women by the South African media, Pistorius and Steenkamp were first seen together publicly in November. She was named one of the world's 100 Sexiest Women for two years running by the men's magazine FHM.

The leggy blonde with a law degree also appeared in international and South African ads and was a celebrity contestant on "Tropika Island of Treasure," a South African reality show filmed in Jamaica.

While known for her bikini-clad, vamping photo spreads, she tweeted messages urging women to stand up against rape. Her tweets also focused on Pistorius, with one of her last messages noting her excitement over Valentine's Day.

"What do you have up your sleeve for your love tomorrow?" she wrote. "It should be a day of love for everyone."

Police have not publicly named Steenkamp as the victim, saying only that a 30-year-old woman was killed. Steenkamp's publicist, however, confirmed in a statement that the model had died.

"Everyone is simply devastated," the publicist, Sarit Tomlinson, said. "She was the kindest, sweetest human being; an angel on earth and will be sorely missed."

Police arrived at Pistorius' home after 3 a.m., and paramedics tried unsuccessfully to revive Steenkamp, police spokeswoman Lt. Col. Katlego Mogale said.

Officers later took Pistorius to a hospital so doctors could collect samples for DNA testing and check his blood alcohol content.

Pistorius had both legs amputated below the knee before his first birthday because of a congenital condition, and campaigned for years to be allowed to compete against able-bodied athletes.

He was initially banned because of his carbon fiber blades — which critics said gave him an unfair advantage — before being cleared by sport's highest court in 2008.

He was a last-minute selection to South Africa's Olympic team, competing in the 400 meters and the 4x400 relay. He later retained his Paralympic title in the 400 meters.

South Africa's Sports Confederation, its Olympic committee and the International Paralympic Committee all had no comment on the shooting.

Shock rippled across South Africa, a nation of 50 million where nearly 50 people are killed each day, one of the world's highest murder rates. U.N. statistics say South Africa also has the second highest rate of shooting deaths in the world, behind only Colombia.

"The question is: Why does this story make the news? Yes, because they are both celebrities, but this is happening on every single day in South Africa," said Adele Kirsten, a member of Gun Free South Africa.

"We have thousands of people killed annually by gun violence in our country. So the anger is about that it is preventable."

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Gerald Imray reported from Cape Town, South Africa. Associated Press writers Michelle Faul and Ed Brown in Johannesburg contributed to this report.

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Jon Gambrell can be reached at www.twitter.com/jongambrellAP.

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Doctor and Patient: Afraid to Speak Up to Medical Power

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Media Decoder Blog: CBS Reports Record Operating Income for 4th Quarter

The CBS Corporation set records in the fourth quarter for operating income and adjusted operating income, the company said Thursday, but the results were short of some analysts’ expectations, causing its share price to fall slightly in after-hours trading.

The adjusted net earnings of $414 million produced earnings per share of 64 cents, also a new quarterly record for CBS, though some analysts had forecast a price as high as 69 cents.

CBS, which reported full-year results for 2012 as well as for the quarter ending Dec. 31, also announced an additional stock buyback of $1 billion. That brings the total amount of stock CBS has committed to repurchasing for the current year to $2.2 billion.

Over all, CBS demonstrated improved results in most financial categories and divisions. Revenues for the quarter rose to $3.7 billion, up 2 percent from $3.61 billion for the comparable quarter in 2011.

The company reported net income of $393 million, or 60 cents a share, up 6.2 percent from $370 million, or 55 cents a share, in the fourth quarter of 2011.

CBS cited increases in advertising revenue in the quarter, partly driven by political commercials in an election year. The CBS broadcast network continues to be the most watched in television and will likely beat all its competitors in the significant ratings categories for the current season.

The company also saw increases from subscription fees, driven by improvement in its cable networks. Showtime, the pay-cable channel owned by CBS, has experienced growth in subscriptions, thanks in part to its award-winning drama “Homeland.” CBS has pressed for years for increased compensation from cable systems for the rights to carry CBS broadcast stations, and Thursday the company reported that retransmission fees were also up for the quarter, part of 9 percent growth overall in affiliate and subscription fees.

Adjusted operating income before depreciation and amortization increased 6 percent, to $866 million from $814 million the year before. Operating income increased 12 percent to $726 million, up from $647 million.

For the full year CBS also produced some encouraging results. The company reported revenues of $14.09 billion, up 3 percent from $13.64 billion in 2011. Adjusted income increased to $3.49 billion from $3.16 billion. Operating income of $2.98 billion was up from $2.62 billion in 2011. All represented new highs for CBS.

One more troubling area was publishing. CBS’s Simon & Schuster unit experienced a decrease in revenues, to $215 million from $229 million in 2011. CBS attributed the drop to decreasing print book sales that could not be offset by increasing e-book sales.

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IHT Special: Tunisia Sinks Back Into Turmoil

TUNIS — Following the murder of a leading opposition politician, Tunisians are asking whether the Arab Spring, which began in their country, has accomplished much of anything. They are disenchanted with the fits and starts of the transition from dictatorship to something else.

“Nobody likes the situation and this government has to change,” said Rabbeh Souly, 28, who sped up her steps on the pavement in central Tunis after witnessing a mugging. “They need to fix the things that concern people like unemployment and poverty. Before, at least things were calm and safe. I regret Ben Ali is gone.”

She was speaking of the longtime dictator Zine el-Abidine Ben Ali, who was ousted two years ago. His departure ushered in a transition coalition government led by the Islamists.

Now Tunisia is at a crossroads. Violence has been escalating for months and the general political atmosphere has been deteriorating. This was underscored by the murder of leftist opposition leader Chokri Belaid, who was shot in front of his house by unidentified assailants last week. The killing came as a shock to both ordinary people and to the political establishment.

Thousands of Tunisians took to the streets after Mr. Belaid’s death, vowing revenge in scenes reminiscent of the protests in 2011.

“With our souls, with our blood, we will avenge you Belaid,” they chanted in the rain on a march to the cemetery.

In the halls of government buildings, another drama played out. The prime minister, Hamadi Jebali, called for the government to resign in favor of a technocratic leadership. But his own Ennahda party disavowed his call.

Ennahda, a moderate Islamist party, has been the strongest political group following the departure of Mr. Ben Ali, winning elections in October 2011 handily because it was viewed as very different from the strongman and his cronies.

But after the assassination of Mr. Belaid, the party has been forced into retreat, while the secular leftist opposition has been given new momentum and unity.

“The country entered a new political cycle: It was in a difficult political transition that was marked by phases of instability and now we are seeing a radicalization of political actors,” said Vincent Geisser, a researcher at the French Institute for the Near East who is based in Beirut, speaking of Islamists and secularists. “There is a serious need for dialogue before there is another assassination.”

The challenges are real: The country is dealing with a weak economy that contracted by 1.8 percent in 2011 and grew by an estimated 2.7 percent last year — not enough to reduce unemployment, which is running at about 17 percent, up from 13 percent at the end of the old regime.

Political instability is also frightening away tourists. Tourism was a key source of jobs and income in the past.

The turmoil is hurting just about everyone.

“Political parties are fighting and the Tunisian people are paying for it,” said Mohamed Ben Amor, sweeping in front of a bodega after a protest on Avenue Bourguiba. “The country is deeply affected by the problems that are happening, so business has been really bad.”

Tunisians lay the blame at Ennahda’s door for failing to address the roots of popular discontent and maintain order in the country, while creating an atmosphere in which religious radicals get away with making violent threats against the secular opposition.

Violence has been escalating in Tunisia over the past two years. Extremists have attacked tombs they consider sacrilegious and a TV station they believe has violated their conservative religious beliefs. In Sidi Bouzid, a city in central Tunisia, the extremist Salafis vandalized a bar in September.

Rachid Ghannouchi, a founder and leader of the Islamist party, who was recently called an “assassin” by demonstrators, strongly denies that the party has promoted violence.

“Ennahda never resorted to violence, it’s not part of our ideology,” he said during an interview in one of the party’s offices in Tunis.

“We are in power, but we feel like we are in the opposition. We don’t have any political party that stands by our party,” he added.

Even so, many blame Ennahda for the political turmoil and worry about a takeover by the military.

“Most Tunisians are held hostage by this kind of radicalization of the political spectrum,” Mr. Geisser said. “This stubbornness to not listen to each other could lead to a takeover by the security apparatus.”

Fares Mabrouk, a co-founder of the Arabic Policy Institute, a research concern in Tunis, believes that the shorter the transition period, the more chances the country has to get back to a more stable political climate. The current government is only supposed to remain until a constitution is in place and new elections are held.

“There is today an opportunity to create a historical compromise that will be unique to Tunisia, and unique in the Arab world,” he said. “The murder of Chokri Belaid and the unification of the left will balance the forces.”

The constitution is not finished and there is no date set yet for elections. This fight over political legitimacy is hurting the country.

“We have two equal forces and it can lead to civil war,” Mr. Mabrouk said. “The first one has electoral legitimacy and the other has now a martyr that is giving them legitimacy. With the political future so unclear, no Tunisian or foreign businesses will invest.”

But for many Tunisians, the murder of Mr. Belaid was a call to even greater political activism.

“I am in a state of shock, but actually there are thousands of Chokri Belaids,” said Mounji Ayari, 43, who wept as he held a sign with a picture of Mr. Belaid that read “martyr” at the funeral. “He is someone who taught us rebellion. He may be dead but he will forever stay with us and we will make sure his ideals live on.”

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Barry Bonds seeks dismissal of felony conviction

SAN FRANCISCO (AP) — A lawyer for Barry Bonds urged a federal appeals court on Wednesday to toss out the slugger's obstruction of justice conviction, saying a rambling answer he gave while testifying before a grand jury was not a crime.

Appellate specialist Dennis Riordan argued that Bonds was not formally or specifically charged with the felony that he was convicted of committing. A federal jury in April 2011 found baseball's all-time home runs leader guilty of obstruction for saying he was a "celebrity child" when asked about injecting steroids.

Prosecutors asked Bonds during his December 2003 grand jury appearance whether Greg Anderson, his personal trainer, ever gave him "anything that required a syringe to inject yourself with?"

Bonds referred to his father, former major leaguer Bobby Bonds, when he responded "that's what keeps our friendship. You know, I am sorry, but that — you know, that — I was a celebrity child, not just in baseball by my own instincts. I became a celebrity child with a famous father. I just don't get into other people's business because of my father's situation, you see ..."

That particular exchange wasn't included in the indictment originally released in November 2007. The omission is "the dagger in the heart of this conviction," Riordan argued.

Further, Riordan said that Bonds ultimately answered the question when put to him again and denied receiving any substance to inject.

Judge Michael Daly Hawkins wondered aloud if Bonds' direct denial undercut the government's argument that Bonds intentionally misled the grand jury.

Assistant U.S. Attorney Merry Jean Chan countered that the denial was a lie because Bonds' former personal assistant, Cathy Hoskins, testified that she witnessed Anderson inject Bonds. Chan said Bonds' denial and his other rambling answers to the same question throughout his grand jury appearance added up to obstruction.

"He answered the question falsely each time," she said.

Bonds and his legal team are asking a three-judge panel of the U.S. 9th Circuit Court of Appeals to dismiss the lone felony conviction stemming from Bonds' 2½ hours of testimony in December 2003 before a grand jury investigating performance enhancing drug use and sales among elite athletes. Bonds, who was rejected by voters last month in his first year of eligibility for the Hall of Fame, wasn't required to attend Wednesday's highly technical hearing, though Riordan said his client expressed a desired to watch the proceedings in person.

Riordan said outside court that he advised Bonds to watch from afar rather than personally attending the 35-minute session San Francisco. A local television station was given permission to show the hearing live and streamed at least a couple of segments on the Internet.

"His presence would have been a distraction," Riordan said.

Legal experts who have followed the case closely since his grand jury appearance in December 2003 are divided over Bonds' chances before Daly Hawkins and Judges Mary Schroeder and Mary Murguia, each of whom was appointed by a different Democrat president and all of whom are based in Phoenix, home of San Francisco's division rival Diamondbacks and about a 20-minute drive from the Giants' Scottsdale spring training facility.

One set of analysts argue that appellate courts are reluctant to overturn jury verdicts absent an overwhelmingly obvious mistake. They say that U.S. District Judge Susan Illston, who ran the trial, is a respected jurist who has few of her cases overturned.

"There is a definite overriding respect of a jury's verdict," said Howard Wasserman, a Florida International University law professor. "Typically, it's pretty hard to get a jury's verdict reversed."

On the other hand, there are those lawyers who argue that Bonds stands a good chance to clear his name.

"The government's biggest hurdle is that testimony obstruction cases are usually based on blatant, undeniable lies to questions at the heart of an investigation," said William Keane, a San Francisco criminal defense attorney. "Here the prosecution limps in with only a single rambling, unresponsive, unimportant answer that is literally true."

Regardless of the outcome, University of New Hampshire law professor Michael McCann contends that the case was ultimately a loss of the U.S. Department of Justice. In a case that put a superstar athlete at the defendant's table, the jury deadlocked on three charges of making false statements

"The main thrust of the government's original case was that he lied when he denied taking steroids," said McCann, who also edits the popular Sports Law Blog. "That's not what he was convicted of. Obstruction was not the main charge."

If Bonds' conviction is upheld, he will have to serve 30 days house arrest.

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Phys Ed: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

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A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.

For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.

One group began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.

Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.

The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.

The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.

The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.

Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.

To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.

By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.

There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.

However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.

The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.

But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.

“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable” after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.

The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.

But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,” a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,” he says. But those working out only twice a week “weren’t far behind.”

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