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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Airbus and Boeing on Different Paths on Battery

When it comes to the volatile new lithium-ion battery technology, Boeing and Airbus are heading in different directions.

Faced with the potential of a lengthy investigation into what caused batteries on two Boeing 787 jets to ignite or emit smoke last month, Airbus said Friday that it had dropped plans to use the technology on its forthcoming wide-body jet, the A350-XWB, to avoid possible delays in producing the planes. But Boeing, which has much more at stake, said later in the day that it would stick with the batteries and that it was working with regulators to reduce risks even if the cause of the hazards is not clearly found.

All 50 of the 787s delivered so far were grounded in mid-January. And even though the problems have embarrassed Boeing and could cost it hundreds of millions of dollars, the company said Friday, “There’s nothing we’ve learned in the investigations that would lead us to a different decision regarding lithium-ion batteries.”

To some extent, Boeing’s bravado reflects a sense among battery experts that they have narrowed down the ways that the batteries, made by a Japanese company, GS Yuasa, could fail. That then increases the chances that a handful of changes may eventually provide enough assurance that the batteries would be safe to use.

Airbus was planning on a more limited use of the lithium-ion batteries than Boeing, and by switching to the more traditional nickel-cadmium batteries, the company can make the necessary changes as it is building the planes. Boeing, on the other hand, has a strong motivation to stick with the lithium-ion batteries in hopes that a solution will emerge.

Under flight safety regulations, industry and government officials said, Boeing might not have to go through as extensive — and time-consuming — an approval process if it redesigned the lithium-ion batteries as it would if it switched to the conventional batteries.

Even though the behavior of the more traditional batteries is better understood, they have not yet been certified for use in the 787s, and the batteries and related parts of the plane’s electrical system would have to be created and tested from scratch. Under the safety directive grounding the planes, Boeing might have a more straightforward path to get them flying again if it could persuade the Federal Aviation Administration that redesigning the lithium-ion batteries would work.

Federal and industry officials said Boeing would probably have to spread the eight cells in the batteries farther apart — or increase the insulation between them — to keep a failure in one cell from cascading to the others in the “thermal runaway” that led to the smoke and fire. Battery experts are also looking into whether vibrations in flight could have added to the risks of unwanted contact between the cells. And Boeing would undoubtedly have to wall off the battery within a sturdier metal container and make it easier to vent any hazardous materials outside the plane.

Aviation experts said the examination of such changes reflected what could end up being a difficult calculation for safety regulators: Will there be a way to assure the safety of the batteries if they cannot tell for certain what set off the problems on the two planes?

Until now, most of the public statements by regulators have focused on the need to pin down the cause of the battery problems. But investigators, now weeks into their work, have only been able to find limited clues in the charred remains of the two batteries.

As a result, government and outside experts, working closely with Boeing engineers, have been studying the research on lithium-ion batteries carried out since Boeing won approval for its batteries in 2007 and, in essence, trying to come up with a safer design.

Government and industry officials said Friday that it was still too early to know if Boeing could devise enough changes to satisfy regulators and the flying public.

Airbus said it started informing airline customers on Thursday that it would not move ahead with an original plan to use the lithium-ion batteries on its A350s.

“Airbus considers this to be the most appropriate way forward in the interest of program execution and reliability,” said Marcella Muratore, an Airbus spokeswoman.

This article has been revised to reflect the following correction:

Correction: February 15, 2013

An earlier version of this article mischaracterized incidents in January involving lithium-ion batteries in Boeing 787 Dreamliners. In one case a battery caught fire, and in another a battery emitted smoke; both batteries did not catch fire.

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French Forces Needed Longer in Mali, U.S. Official Says

WASHINGTON — French military forces will probably be needed to carry out operations against militants in Mali even after a United Nations peacekeeping force is organized to secure the country, a senior State Department official told Congress on Thursday.

“There’s going to be an ongoing need for a counterterrorism operation in northern Mali, and that probably will always reside in the hands of the French and not in the hands of the United Nations,” Johnnie Carson, the top State Department official on Africa issues, told the House Foreign Affairs Committee.

Mr. Carson’s comments reflected extensive consultations between France and the United States regarding the military operation in Mali and suggested that there would be a longer-term role for French forces in the country. French officials declined to comment on Thursday night.

France rushed 4,000 troops to Mali in January, but French officials have made it clear they would like to hand over responsibility for the bulk of the mission to West African and Malian forces when the terrorist threat is reduced. Eventually these units are to be supplanted by a United Nations peacekeeping force made up of African troops.

In a brief interview after the hearing, Mr. Carson sketched out his vision of how the military operation might evolve, including a likely role for French counterterrorism forces in tracking down militants in the rugged northern part of Mali.

“It would be very separate and very different,” he said, making the point that while French forces might be in Mali at the same time as peacekeepers they would operate under a separate chain of command. “A bilateral agreement between the Malian government and French government would be able to do that.”

Edward R. Royce, the California Republican who is chairman of the panel, expressed concern that the mission might be handed over to the United Nations prematurely.

“We do not want to do that hastily,” Mr. Carson responded. “We think that over time the U.N. does have peacekeeping norms and standards that would be applicable and useful in Mali.”

The United States is barred by law from providing direct support to the Malian military after the coup there last year. But it has been providing intelligence, refueling French aircraft, flying equipment and troops to the region, and helping to train West African troops.

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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 and its share price fell in after-hours trading.

The adjusted net earnings of $414 million produced earnings of 64 cents a share, also a quarterly record for CBS, though some analysts had forecast income 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 most likely beat all its competitors in the significant ratings categories for the current season.

The company also had 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 revenue 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 troubling area was publishing. Revenue decreased at CBS’s Simon & Schuster unit, 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.

CBS reported its financial results after the stock market closed. In after-hours trading, its stock fell 44 cents, to $42.50.

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In Japan, the Fax Machine Is Anything but a Relic

Kosuke Okahara for The New York Times

Yuichiro Sugahara, whose company delivers bento lunchboxes, mostly through fax orders.

TOKYO — Japan is renowned for its robots and bullet trains, and has some of the world’s fastest broadband networks. But it also remains firmly wedded to a pre-Internet technology — the fax machine — that in most other developed nations has joined answering machines, eight-tracks and cassette tapes in the dustbin of outmoded technologies.

Last year alone, Japanese households bought 1.7 million of the old-style fax machines, which print documents on slick, glossy paper spooled in the back. In the United States, the device has become such an artifact that the Smithsonian is adding two machines to its collection, technology historians said.

“The fax was such a success here that it has proven hard to replace,” said Kenichi Shibata, a manager at NTT Communications, which led development of the technology in the 1970s. “It has grown unusually deep roots into Japanese society.”

The Japanese government’s Cabinet Office says that almost 100 percent of business offices and 45 percent of private homes had a fax machine as of 2011.

Yuichiro Sugahara learned the hard way about his country’s deep attachment to the fax machine, which the nation popularized in the 1980s. A decade ago, he tried to modernize his family-run company, which delivers traditional bento lunchboxes, by taking orders online. Sales quickly plummeted.

Today, his company, Tamagoya, is thriving with the hiss and beep of thousands of orders pouring in every morning, most by fax, many with minutely detailed handwritten requests like “go light on the batter in the fried chicken” or “add an extra hard-boiled egg.”

“There is still something in Japanese culture that demands the warm, personal feelings that you get with a handwritten fax,” said Mr. Sugahara, 43.

Japan’s reluctance to give up its fax machines offers a revealing glimpse into an aging nation that can often seem quietly determined to stick to its tried-and-true ways, even if the rest of the world seems to be passing it rapidly by. The fax addiction helps explain why Japan, which once revolutionized consumer electronics with its hand-held calculators, Walkmans and, yes, fax machines, has become a latecomer in the digital age, and has allowed itself to fall behind nimbler competitors like South Korea and China.

“Japan has this Galápagos effect of holding on to some things they’re comfortable with,” said Jonathan Coopersmith, a technology historian who is writing a book on the machine’s rise and fall. “Elsewhere, the fax has gone the way of the dodo.”

In Japan, with the exception of the savviest Internet start-ups or internationally minded manufacturers, the fax remains an essential tool for doing business. Experts say government offices prefer faxes because they generate paperwork onto which bureaucrats can affix their stamps of approval, called hanko. Many companies say they still rely on faxes to create a paper trail of orders and shipments not left by ephemeral e-mail. Banks rely on faxes because, they say, customers are worried about the safety of their personal information on the Internet.

Even Japan’s largest yakuza crime syndicate, the Kobe-based Yamaguchi-gumi, has used faxes to send notifications of expulsion to members, the police say.

After the deadly earthquake and tsunami in northeastern Japan in 2011, there was a small boom in fax sales to replace machines that had been washed away. One of the hottest sellers is a model that is powered by batteries so it will keep working during power failures caused by natural disasters.

At Tamagoya, Mr. Sugahara has turned his company’s reliance on the fax and standard telephones into an art form. Every morning, orders for about 62,000 lunches pour in, about half by fax. Most of those lunches are cooked and put onto trucks even before the last order is taken. A small army of 100 fax and telephone operators carefully coordinate deliveries, and fewer than 60 lunches — or 0.1 percent — are wasted.

Hisako Ueno contributed reporting.

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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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