Well: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

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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Health insurer WellPoint picks Joseph Swedish as its new CEO

INDIANAPOLIS — Health insurance giant WellPoint Inc., parent of Anthem Blue Cross, is picking a veteran hospital executive who has never run a public company to become its next chief executive.

The Indianapolis insurer says Trinity Health CEO Joseph Swedish will take over March 25, replacing interim CEO John Cannon.

WellPoint, the nation's second-largest health insurance company, has been searching for a new leader since Angela Braly resigned in August amid investor frustration over disappointing financial results.

The company runs Blue Cross Blue Shield plans in 14 states, including Anthem — the largest for-profit insurer in California. It also runs CareMore clinics in California and other states.

Swedish, 61, has been CEO at Trinity Health in Livonia, Mich., since December 2004. Under his leadership, revenue at the nonprofit Catholic healthcare system increased from $5.7 billion in 2005 to $8.9 billion in 2012, and total assets increased from $7.5 billion to $11.7 billion. The organization's community benefit ministry, which includes care for the poor and community heath activity, increased from $265 million in 2005 to $615 million in 2012.

Swedish's resume includes work with HCA, the nation's largest hospital chain. He also has served as a director for another insurer, Coventry Health Care.

In his new job, Swedish's tasks will include helping WellPoint prepare for coverage expansions that start next year under the federal healthcare overhaul.

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Ex-Bell officials defend themselves as honorable public servants

Less than three years ago, they were handcuffed and taken away in a case alleged to be so extensive that the district attorney called it "corruption on steroids."

But on Monday, two of the six former Bell council members accused of misappropriating money from the small, mostly immigrant town took to the witness stand and defended themselves as honorable public servants who earned their near-$100,000 salaries by working long hours behind the scenes.

During her three days on the stand, Teresa Jacobo said she responded to constituents who called her cell and home phone at all hours. She put in time at the city's food bank, organized breast cancer awareness marches, sometimes paid for hotel rooms for the homeless and was a staunch advocate for education.

"I was working very hard to improve the lives of the citizens of Bell," she said. "I was bringing in programs and working with them to build leadership and good families, strong families."

Jacobo, 60, said she didn't question the appropriateness of her salary, which made her one of the highest-paid part-time council members in the state.

Former Councilman George Mirabal said he too worked a long, irregular schedule when it came to city affairs.

"I keep hearing time frames over and over again, but there's no clock when you're working on the council," he said Monday. "You're working on the circumstances that are facing you. If a family calls … you don't say, '4 o'clock, work's over.' "

Mirabal, 65, said he often reached out to low-income residents who didn't make it to council meetings, attended workshops to learn how to improve civic affairs and once even made a trip to a San Diego high school to research opening a similar tech charter school in Bell.

"Do you believe you gave everything you could to the citizens of Bell?" asked his attorney, Alex Kessel.

"I'd give more," Mirabal replied.

Both Mirabal and Jacobo testified that not only did they perceive their salaries to be reasonable, but they believed them to be lawful because they were drawn up by the city manager and voted on in open session with the city attorney present.

Mirabal, who once served as Bell's city clerk, even went so far as to say that he was still a firm supporter of the city charter that passed in 2005, viewing it as Bell's "constitution." In a taped interview with authorities, one of Mirabal's council colleagues — Victor Bello — said the city manager told him the charter cleared the way for higher council salaries.

Prosecutors have depicted the defendants as salary gluttons who put their city on a path toward bankruptcy. Mirabal and Jacobo, along with Bello, Luis Artiga, George Cole and Oscar Hernandez, are accused of drawing those paychecks from boards that seldom met and did little work. All face potential prison terms if convicted.

Prosecutors have cited the city's Solid Waste and Recycling Authority as a phantom committee, created only as a device for increasing the council's pay. But defense attorneys said the authority had a very real function, even in a city that contracted with an outside trash company.

Jacobo testified that she understood the introduction of that authority to be merely a legal process and that its purpose was to discuss how Bell might start its own city-run trash service.

A former contract manager for Consolidated Disposal Service testified that Bell officials had been unhappy with the response time to bulky item pickups, terminating their contract about 2005, but that it took about six years to finalize because of an agreement that automatically renewed every year.

Deputy Dist. Atty. Edward Miller questioned Mirabal about the day shortly after his 2010 arrest that he voluntarily told prosecutors that no work was done on authorities outside of meetings.

Mirabal said that if he had made such a statement, it was incorrect. He said he couldn't remember what was said back then and "might have heed and hawed."

"So it's easy to remember now?" Miller asked.

"Yes, actually."

"More than two years after charges have been filed, it's easier for you to remember now that you did work outside of the meetings for the Public Finance Authority?"

"Yes, sir."

Miller later asked Mirabal to explain a paragraph included on City Council agendas that began with the phrase, "City Council members are like you."

After some clarification of the question, Mirabal answered: "That everybody is equal and that if they look into themselves, they would see us."

corina.knoll@latimes.com

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Young Afghan musicians in NY for date at Carnegie

SCARSDALE, N.Y. (AP) — For these young people from Afghanistan, it's the perfect trip to America. They get to scarf down New York pizza, go ice skating — and take the stage at Carnegie Hall.

The Afghan Youth Orchestra, many of whose members are not far removed from eking out a living on the streets of Kabul, is on the New York leg of a U.S. tour that melds Western classics with traditional Afghan music.

About 50 players held a joint rehearsal Monday with 25 members of the Scarsdale High School orchestra, which meant that young musicians from a war-torn country where music was banned for several years by the Taliban were playing alongside those from one of New York's toniest suburbs.

"This is all providing a model for the future of Afghanistan," said William Harvey, the Afghan orchestra's American conductor and arranger. "The recomposed music, taking the best from both worlds, and the cooperation between the Afghan kids and the Scarsdale kids, shows what has to happen for Afghanistan."

Among the pieces rehearsed in advance of Tuesday night's Carnegie program were adaptations of Vivaldi's "Four Seasons" and Ravel's "Bolero," both incorporating Afghan instruments and rhythms.

A handful of people in the Scarsdale auditorium got to hear familiar melodies perked up with such instruments as the sitar, dilruba and ghichak. Some of the Afghan musicians were barefoot.

"I love the 'Bolero,'" said Milad Yousofi, 18, a pianist from Kabul who, like the rest of the orchestra, attends the Afghanistan National Institute of Music, which was founded just three years ago.

Yousofi is hoping the orchestra's U.S. visit — it played in Washington last week and is headed for Boston — will help him find a way to continue his musical education in America.

"I'm very excited and amazed that we are going to Carnegie Hall," he said. "New York is my dream city. I want to come here as soon as possible. But then I want to go back to Afghanistan and teach."

Hojat Hameed, 21, a violinist who also plays electric guitar in a rock band, said he became interested in music when he heard a Celine Dion recording.

"That made me want to become a musician," he said. "I could feel I wanted to come home to music."

Some of the Afghans may have been saved from desperate lives by the music school.

"One of my violinists used to sell chewing gum on the street," said Harvey, who spoke to the musicians in English and Dari, one of Afghanistan's two main languages. "She had to. The Taliban had beaten her father paralyzed and he couldn't work."

"The return of music to Afghanistan is a victory of the human spirit," Harvey said.

Ahmad Sarmast, who founded the school, said hearing the orchestra play was "a touching experience."

"The Taliban deprived children of their music," he said. "It was like a genocide of music. Now this is an incredible way of showing pride in our people, our youth, our school, our country."

He said the school, which is funded by the World Bank and others, is free and provides enough of a stipend to keep the musicians off the streets. And it accepts boys and girls, another reversal of Taliban orders.

Amedee Williams, who heads the Scarsdale music program, said he heard last year that the Afghan school was trying to raise funds for a tour. He contacted the school and suggested their orchestra members could save on New York hotels by staying with Scarsdale families. That turned out not to be necessary, but it forged a partnership that resulted in the Scarsdale orchestra joining the Afghans at Carnegie Hall.

Before the joint orchestra rehearsed on Sunday, he said, all the youngsters had pizza. Afterward, they went ice skating, which was a new activity for the Afghans "and some of the Scarsdale kids," Williams said.

"There was a lot of hand-holding, supporting each other," he said. "It was good to see."

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Report Faults Priorities in Breast Cancer Research

Too little of the money the federal government spends on breast cancer research goes toward finding environmental causes of the disease and ways to prevent it, according to a new report from a group of scientists, government officials and patient advocates established by Congress to examine the research.

The report, “Breast Cancer and the Environment — Prioritizing Prevention,” published on Tuesday, focuses on environmental factors, which it defines broadly to include behaviors, like alcohol intake and exercise; exposures to chemicals like pesticides, industrial pollutants, consumer products and drugs; radiation; and social and socioeconomic factors.

The 270-page report notes that scientists have long known that genetic and environmental factors contribute individually and also interact with one another to affect breast cancer risk. Studies of women who have moved from Japan to the United States, for instance, show that their breast cancer risk increases to match that of American women. Their genetics have not changed, so something in the environment must be having an effect. But what? Not much is known about exactly what the environmental factors are or how they affect the breast.

“We know things like radiation might cause breast cancer, but we don’t know much that we can say specifically causes breast cancer in terms of chemicals,” said Michael Gould, a professor of oncology at the University of Wisconsin, Madison, and a co-chairman of the 23-member committee that prepared the report.

At the two federal agencies that spend the most on breast cancer, only about 10 percent of the research in recent years involved environment and prevention. From 2008 to 2010, the National Institutes of Health spent $357 million on environmental and prevention-related research in breast cancer, about 16 percent of all the financing for the disease. From 2006 to 2010, the Department of Defense spent $52.2 million on prevention-oriented research, about 8.6 percent of the money devoted to breast cancer. Those proportions were too low, the group said, though it declined to say what the level should be.

“We’re hedging on that on purpose,” Dr. Gould said. “It wasn’t the role of the committee to suggest how much.”

He added, “We’re saying: ‘We’re not getting the job done. We don’t have the money to get the job done.’ The government will have to figure out what we need.”

Jeanne Rizzo, another member of the committee and a member of the Breast Cancer Fund, an advocacy group, said there was an urgent need to study and regulate chemical exposures and inform the public about potential risks. “We’re extending life with breast cancer, making it a chronic disease, but we’re not preventing it,” she said.

“We have to look at early life exposures, in utero, childhood, puberty, pregnancy and lactation,” Ms. Rizzo said. “Those are the periods when you get set up for breast cancer. How does a pregnant woman protect her child? How do we create policy so that she doesn’t have to be a toxicologist when she goes shopping?”

Michele Forman, a co-chairwoman of the committee and an epidemiologist and professor of nutritional sciences at the University of Texas, Austin, said the group found that breast cancer research at various government agencies was not well coordinated and that it was difficult to determine whether there was duplication of efforts.

She said that it was essential to study how environmental exposures at different times of life affected breast-cancer risk, and that certain animals were good models for human breast cancer and should be used more.

The report is the result of the Breast Cancer and Environmental Research Act, which was passed in 2008 and required the secretary of health and human services to create a committee to study breast cancer research. A third of the members were scientists, a third were from government and a third were from advocacy groups. The advocates, Dr. Forman said, brought a sense of urgency to the group

“People who are not survivors need to have that urgency there,” she said.

Pointing to the vaccine now being offered to girls to prevent cervical cancer, Dr. Forman said, “I look forward to the day when we have an early preventive strategy for breast cancer.”

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Domino's hopes customers flock to 'pizza theater'

A pair of mustachioed pizza makers in blue aprons — visible from behind a glass display at a new Domino's store in Seattle — tossed dough into the air as a handful of corporate executives looked on.

Domino's calls the concept "pizza theater" because customers now can come in and watch their orders being made.

The new look is part of a four-year effort to freshen the pizza chain's image and boost its growing ranks of carryout customers.

The open-kitchen format includes seating for a dozen or so people, a chalkboard where customers can leave comments, and a refrigerated section for grab-and-go items such as salads and milk.

"This is the way we always made our pizzas. A lot of people just had no idea," said Domino's Chief Executive Patrick Doyle, who was in Seattle last week to see the new store. "It was sort of one of those lightning-bolt moments where we said, 'Gee, maybe we should show them.' "

Founded in 1960, Domino's long has been known for inexpensive pizza delivered to your doorstep. Its 30-minute guarantee helped make it the world's largest pizza-delivery company in the 1980s (though it later had to drop the pledge amid charges that it led to reckless driving).

Today, the Ann Arbor, Mich., company holds a 22% share of the U.S. pizza-delivery market and ranks No. 2 overall among U.S. pizza chains.

More than two-thirds of U.S. consumers buy carryout pizza at least once a month, making carryout the most popular pizza format, according to research firm Technomic Inc. Nearly half of all pizza orders are for carryout, while a third are for delivery and a fifth are for eat-in.

Experts say that if a Domino's store is nearby, many consumers prefer to pick up their orders and save a few dollars that otherwise would go to a delivery fee and tip.

Domino's jumped on the trend last year when it began offering a weekday pickup promotion of a large three-topping pizza for $7.99. It also redesigned its logo, dropping the word "pizza" to reflect a larger menu, including sandwiches, pasta and chocolate "lava" cakes.

Doyle said the plan is to redo the greater Seattle area's 74 franchised locations by midyear, which would make Seattle the first market to be completely overhauled.

Doyle said Domino's also is setting out to hire 800 new full-time and part-time employees in that area — something he attributed to new store openings, as well as solid sales growth.

Domino's has about 4,500 U.S. franchised stores, as well as 390 company-owned stores. Its U.S. sales at stores open at least a year rose 3.3% in the third quarter, and its stock has been trading at the upper end of a 52-week range of $28.17 to $47.91. Its shares rose 8 cents Monday to $46.81.

Pizza Hut is the largest U.S. pizza chain, with an 18% market share, followed by Domino's, at 11%, and Papa John's, at 7%, according to Technomic.

In late 2009, Domino's rolled out a new recipe promising a garlic-seasoned crust, bolder tomato sauce and tastier cheese. The new store format builds on that push to be more transparent, Doyle said.

"Consumers want to see what they're eating," he said. "We've always been known as delivery experts, but a third or more of our orders now are for carryout. We're proud of these pizzas, and we want people to see it."

Seattle resident James Johnson, 28, a longtime Domino's customer, said he welcomes the changes. Johnson stopped by the revamped Domino's on his way home from work last week to pick up dinner.

"You can watch the pizza being made from beginning to end," he said. "It's kind of cool to see, depending on whether you're engaged and not on your cellphone."

Martinez writes for the Seattle Times.

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Locals believe bobcat trappers are crossing the line in Joshua Tree

JOSHUA TREE — Annica Kreuter's backyard on the edge of Joshua Tree National Park has been a perfect place to chronicle the adventures of eight bobcats.

Over the last decade she has watched a young bobcat chased up a tree by a coyote; an alpha male surveying the landscape from the hood of her car; a kitten sauntering into the yard as she gardens; a matron sniffing the back of Kreuter's neck as she napped on a hammock.

Lately, seven of the eight have vanished. "At sunrise, I hear the one that is still here crying for his family," Kreuter said.

She and others in this high desert community of about 8,000 say bobcats have been disappearing lately, killed for the value of their pelts by trappers who often trespass on private property. The trappers come armed with wire cages, squirt bottles of potent scent and bobcat lures: battery-powered vibrating pet toys festooned with feathers to resemble dying birds.

Hunting and trapping bobcats is legal during hunting season outside of the national park boundaries. But to the locals, that makes little difference. "The very idea of trapping in a place where bobcats are so well-known they have nicknames — Big Gray, Leroy, Tomboy — is disturbing and heartbreaking," Kreuter said.

As one of the top predators of a 720,000-acre park visited by 1.4 million people each year, the bobcat's presence — or absence — has a cascade of consequences, making it a governing force of the ecosystem and the local ecotourism economy. An adult bobcat stands about 15 inches high and can cover 25 to 30 miles of territory in a day. Using razor-sharp claws and powerful legs, it preys on rabbits and makes a significant contribution to rodent control.

Critics believe the trappers are after bobcats that routinely crisscross the invisible park boundary lines.

"This is really, really bad," said astronomer and conservationist Tom O'Key, who was the first to discover a trap. "These guys are carpetbaggers coming onto private land to slaughter bobcats with no regard for a tight-knit community that cares deeply about the national park and its wildlife."

O'Key alerted the community after finding a trap chained to a jojoba bush and camouflaged with broken branches and leaves on his property north of the park. He notified the San Bernardino County Sheriff's Department and the Hi-Desert Star newspaper.

Bobcats are being targeted for the value of their pelts in top-dollar markets such as China, Russia and Greece. A premium pelt of heavily spotted white belly fur can earn a trapper more than $600, according to Nathan Brock, who skinned 10 bobcats that he captured in the Joshua Tree area during the hunting season that ended Jan. 31.

Brock, 38, an active-duty Marine stationed at nearby Twentynine Palms Marine Corps Base, acknowledged that one of his traps was set on private property and not on federal Bureau of Land Management grounds, where trapping is legal. The region is a patchwork of private property and BLM land.

"I feel horrible about that," Brock said. "It's my fault for not making sure."

The manufacturer of Brock's trap, Mercer Lawing of Barstow, said critics miss the point. "We love those animals more than the people who are complaining about us trapping them do," Lawing said. "Nathan and I harvest adult male cats and turn loose adult females and kittens."

The national park has taken a neutral position on the issue, given that its jurisdictional reach extends only as far as its boundaries.

However, park biologist Michael Vamstad said, "Residents have every right to be upset. The fact that there is no limit on bobcats that can be legally taken during hunting season doesn't jibe along the edges of a national park. It's a relic regulation."

Conservationists are calling for a "no-trapping" buffer zone in the area because bobcats travel along a web of interconnected wildlife corridors stretching from the national park to the Marine base about 10 miles to the north.

"The law has to change if it's legal for a handful of people to line the boundary of a national park with traps to catch bobcats, then send their pelts to China for profit," said Brendan Cummings, public lands director for the Center for Biological Diversity. "We are not going to let this happen again."

Equally pointed words came from Nancy Karl, executive director of the Mojave Desert Land Trust, a nonprofit dedicated to preserving safe passage for wildlife between protected areas. "We are watching and paying close attention — and we are going to change things," Karl said. "Those trappers would be best advised to move it."

louis.sahagun@latimes.com

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Producers: 'Chicago' cast to join Oscar performers

LOS ANGELES (AP) — Academy Awards producers Craig Zadan and Neil Meron have run out of rehearsal space. Dressing rooms, too.

The award-winning production duo is planning the most performance-filled Oscar show ever. They promise a "wow moment" in each of its 13 acts, so the show demands a more dynamic stage and more dressing rooms and rehearsal time than previous Oscar productions.

"I don't think any Oscars have been as performance-based," Meron said.

It's no surprise, given the pair's hit-filled history: They produced 2003's best picture, "Chicago," and count TV's "Smash" and the recent Broadway revival of "How to Succeed in Business Without Really Trying" among their credits.

Running out of space for their Oscar production's A-list roster of performers — including Barbra Streisand, Adele and Norah Jones — is what Zadan calls a "great problem."

"When you do an Oscar show, you don't have a dressing room problem. The presenters don't get dressing rooms. And how many people perform on the Oscars, like one or two?" he said. "We have a staggering amount of performers, and each of them needs a dressing room... We're measuring the magnitude of how big the show is by the fact that we don't have (enough) dressing rooms."

Just added to the list of stars who may need spots? The cast of "Chicago."

The producers announced Monday that Renee Zellweger, Catherine Zeta-Jones, Queen Latifah and Richard Gere will reunite on the stage where "Chicago" won its Oscar 10 years ago.

"In a night of celebration of the music of the movies, we find it very appropriate," Meron said.

So will the musical cast sing?

"We can't talk about what they're going to do!" Zadan said.

Here's what they will talk about:

— Expect a dynamic, screen-filled set to accommodate the movie-focused numbers: "We're using a lot of cutting-edge technology with new LED screens of different sizes, shapes and configurations... It's kind of thrilling what we're doing with screens," Zadan said. "There will be, too, the regular screen that you have to use each year... but then we have all kinds of other screens that we're using in the show that are completely unique and different and allow us to do stuff with cinema, so it's not a concert thing where somebody comes out and sings a song. It's all integrated into movies."

— Look for a lot of host Seth MacFarlane: "He's going to be very present as a host, as a host should," Meron said.

— And expect to hear him show off his chops: "Seth will sing. He's got a great voice," Zadan said.

"Seth really does understand and have great reverence for the music of the movies," Meron added. "He loves it."

— And about those "wow moments?" Among them will be a celebration of the James Bond film franchise, a tribute to movie musicals, Streisand, Adele, a "special appearance" by Daniel Radcliffe, Charlize Theron, Channing Tatum and Joseph Gordon-Levitt, and maybe something from the cast of "Chicago."

"We think seeing the cast of 'The Avengers' is pretty wow," Meron said.

Better book them a dressing room.

___

Contact Sandy Cohen at www.twitter.com/APSandy.

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Well: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found here.

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Dozens of airline fees rose or changed in 2012, study finds

Airline travel fees — including charges to check a bag and to board early — have become so prevalent that travelers almost need an advanced degree in mathematics to calculate overall trip costs.

Last year at least 36 airline fees increased, and 16 others were redefined, bundled or unbundled with other services, according to a recent study by the consumer travel website Travelnerd.

One bright spot in the Travelnerd study of 14 U.S. airlines is that most fee increases were only $5 to $10 each.

In one case an airline had a big fee reduction. The study found that United Airlines reduced its fee for checking an overweight bag to $100 from $200 for bags 50 to 70 pounds and to $200 from $400 for bags 71 to 100 pounds.

"Travelers really have to be extra cautious when booking a flight," said Alicia Jao, vice president of travel media at Travelnerd, who predicts travelers will see even more fees in 2013. "U.S. carriers are becoming creative at charging consumers extra fees."

But some airlines seem to charge fees arbitrarily, said Perach Mazol, a Los Angeles resident who recently flew to Florida with friends from Romania to take a cruise.

On her flight from L.A. to Fort Lauderdale, Fla., on Spirit Airlines, she said the Florida airline did not charge for the carry-on bags she and her friends were carrying, but the carrier asked for $50 each to carry the same bags on the flight back. (Spirit is one of only two airlines in the U.S. that charge passengers for carry-on luggage.)

"I don't understand why they charged us on one flight and they don't on the other," Mazol said. "It's confusing."

A spokeswoman for Spirit said the airline tries to enforce its policies consistently.

"Maybe she got lucky one way and didn't have to pay," Spirit spokeswoman Misty Pinson said.

United offering satellite-based Wi-Fi

United Airlines was one of the last major airlines to offer onboard wireless Internet. But the Chicago carrier is trying to make up for its tardiness.

United offers Wi-Fi in about 3% of its fleet of about 700 planes, one of the lowest rates of any major carrier in the nation, according to a recent study.

But United recently became the first U.S.-based international carrier to offer satellite-based Wi-Fi Internet for passengers traveling on long-haul overseas flights.

The carrier has installed satellite-based Wi-Fi on nearly a dozen planes, with plans to expand the service to more than 300 planes, or about 43% of the fleet, by the end of the year.

"With this new service, we continue to build the airline that customers want to fly," said Jim Compton, vice chairman and chief revenue officer at United.

Satellite-based Wi-Fi is typically as fast as ground-based Wi-Fi, experts say, but the advantage is that it can give passengers Internet access when flying over areas where cellular towers don't exist — such as the Pacific or Atlantic oceans.

But, of course, there is a price to pay for the service.

United is charging $3.99 to $14.99 for standard speed, depending on the duration of the flight, and $5.99 to $19.99 for faster speeds.

United is not the only airline to offer satellite-based Wi-Fi. Southwest Airlines, the nation's largest domestic carrier, offers it through Westlake Village-based Row 44.

Delta to raise fee to access lounges

Airline fees are rising not only for onboard services but for amenities at the airport too.

Delta Air Lines, which has invested more than $20 million in its airport lounges over the last two years, announced that it would raise the cost for annual membership to access its lounges across the country by $50, starting March 1.

The increase means that an annual membership will range from $350 to $450, depending on membership level. (The more miles passengers fly on Delta the less they pay for membership.)

Among the investments Delta has made is the addition of a new luxury bar that opened recently at Delta's lounge at Los Angeles International Airport. Instead of helping themselves at a self-serve bar, members can now belly up to a fully stocked bar and order a drink from a bartender.

hugo.martin@latimes.com

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