Bosnian Roma family plays itself in stark film

BERLIN (Reuters) – When Bosnian director Danis Tanovic learned about a Roma family refused emergency medical care because they could not pay for it, he not only decided to turn their story into a film but managed to convince the couple to play themselves.

The result is “An Episode in the Life of an Iron Picker”, a simple, powerful tale of one man’s struggle to provide for his partner and two daughters and of a society where money is apparently more important than human life.

The fact that Nazif Mujic and his partner Senada Alimanovic are Roma adds an extra dimension of injustice and alienation, but Tanovic’s tale is more universal.

“This story happens all around Europe to Roma people,” the award-winning director told Reuters in Berlin, where his movie is in competition at the film festival.

“In my country it happens to other people too. It is probably the poorest country in Europe. So this is an unfortunate reality of many, many people who live there … It really made me angry so I just went there and did this film.”

Tanovic first read about the case of the couple and their two children in a local newspaper in 2011.

He went to visit them in their run-down home in the village of Poljice, and after several days they finally agreed to appear as themselves in a kind of docu-drama.

Mujic had no regular job, but helped strip down cars to make a few Bosnian marks from a scrap dealer. Alimanovic was pregnant with their third child when she fell ill and miscarried.

The family was told she must have emergency surgery, but when doctors discovered they had no insurance they were sent away despite Mujic’s desperate and humiliating pleas.

Told it would cost 980 marks (around 500 euros) to pay for an operation, Mujic knew he could never raise the money, and so went back to the hospital and to charities, begging for help.

“BETTER IN THE WAR”

In the end the only way to succeed was to break the law.

“I really tried and struggled to get some help for Senada from all the different state institutions, but none of them would help, so it is tough,” Mujic said in Berlin, speaking through a translator.

“My biggest ambition is to have a job and be able to support the family, but unfortunately I don’t have any illusions or hopes that I will be able to get work anyway.”

Tanovic, best known for his 2001 Academy Award-winning debut feature “No Man’s Land”, said Bosnians too often turned their backs on the poor, despite many cases he knew where people risked lives to help a stranger during the 1992-95 war.

“I wish I lived in a country that took better care of their people but it is not the case,” he said.

“So when you open Bosnian newspapers … every day you see people asking for help, people begging for money to help operate somebody or something. It is terrible.”

At one point in the unscripted film, which cost just 30,000 euros ($ 40,000) to make, Mujic tells a charity worker that life was better during the war, and Tanovic said that to some extent he agreed.

“A lot of people actually lived better in the war, because in war you don’t see rich people driving cars around, you don’t see politicians having fun … All you see is people trying to survive and you are surviving too, so you are happy when you have one meal.”

(Reporting by Mike Collett-White, editing by Paul Casciato)

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Well: 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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American, US Airways announce merger

CEOs Doug Parker and Tom Horton speak to the "CBS This Morning" co-hosts about the merger of American Airlines and US Airways in their first network morning interview.

AMR Corp., parent of American Airlines, and US Airways Group will merge, the companies said Thursday.

If the $11 billion merger is approved by regulators and a bankruptcy judge, it will create the world's largest airline, unseating Chicago-based United Continental Airlines. The combination is expected to be completed in the third quarter of this year.

Chicago, where the two companies have little overlap, would remain a major hub for the airline.

American Airlines is the No. 2 carrier in the region, with about 27 percent of the market, 500 flights per day and 9,300 Chicago-based employees. O'Hare is American's second-largest hub, after Dallas-Fort Worth, which will be the headquarters for the merged airline.

By contrast, US Airways flights account for just 2 percent of the airline seats flying out of Chicago's airports, and the carrier has 170 employees in Chicago.
 
The combined airline will keep the American Airlines name but will be run by US Airways CEO Doug Parker, while American's CEO, Tom Horton, becomes nonexecutive chairman. The terms of the merger wwere unanimously approved Wednesday by the boards of directors of both companies.

American said the combined airline would have a strong financial foundation and robust global network, with more than 6,700 daily flights to 336 destinations in 56 countries. It also pointed to an enhanced Oneworld Alliance, of which American Airlines is a founding member.

"Our combined network will provide a significantly more attractive offering to customers, ensuring that we are always able to take them where they want to travel, when they want to go," Parker said in a statement.

However, consumer groups have been critical of the rumored merger.

"From a consumer standpoint -- individual traveler or corporate travel department -- there are few benefits to offset the negative impacts of this proposed merger that include reduced competition, higher fares and fees and diminished service to small and mid-size communities," said Business Travel Coalition Chairman Kevin Mitchell.

Charlie Leocha, director of the Consumer Travel Alliance, said the merger offered "no discernible consumer benefits."

"Antitrust regulations were created to protect consumers, not to facilitate industry consolidation," he said. "The claim that this merger will provide more destinations is hollow. Whatever new cities are added by a future [American Airlines-US Airways] network are subtracted from the current airline alliance network that US Airways enjoys with United. The net effect is that, overall, consumers are left with nothing new and no improvement to the status quo."

In Chicago, travelers would be largely shielded from those downsides, experts have said. The region's plethora of flights from O'Hare International Airport and Midway, as well as the presence of many discount airlines, should be enough to hold fares largely in check on most routes after the merger.

Customers can continue to book travel and track and manage flights and frequent flyer activity through AA.com or USAirways.com, and will continue to as usual in the AAdvantage and Dividend Miles frequent flyer programs. At first, there are no changes to the frequent flyer programs of either airline as a result of the merger agreement.

The merger is supported by American Airlines' unions.

"The new American Airlines will return to a position of industry preeminence," said Dennis Tajer, spokesman for the Allied Pilots Association, the American Airlines pilot union.

Horton will be board chairman through the first annual meeting of shareholders. After that, Parker will take over as chairman. The board will initially be made up of 12 members, three American Airlines representatives, including Tom Horton, four US Airways representatives, including Doug Parker, and five AMR creditor representatives.

Under the terms of the merger agreement, US Airways stockholders will receive one share of common stock of the combined airline for each share of US Airways common stock then held. American Airlines stakeholders, including labor unions, would own 72 percent of the merged airline, while US Airways stakeholders would own the rest.

gkarp@tribune.com

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Obama challenges GOP to do more than just cut deficit

WASHINGTON -- President Barack Obama used his State of the Union address on Tuesday night to try to push past the fiscal battles that plagued his first term - and still threaten his second - as he laid out an agenda he hopes will shape his legacy.

Obama's overarching message was that other things matter beside the Republicans' seemingly all-consuming drive for deficit cutting, embodied in a looming showdown just three weeks away over automatic across-the-board spending cuts.

Those other things, he told Congress, include some traditionally liberal causes, like raising the federal minimum wage and pursuing climate initiatives, and some that have gained bipartisan support, such as immigration reform and curbing gun violence.

"Most of us agree that a plan to reduce the deficit must be part of our agenda," Obama said. "But let's be clear: deficit reduction alone is not an economic plan."

But with Washington so deeply divided, Obama's speech appeared unlikely to go far in helping the Democratic president and his Republican opponents find common ground to ease the ideological gridlock. He offered no tangible new concessions of his own.

Still, Obama's sense of urgency and frustration was almost palpable. He alternately scolded and cajoled lawmakers while expanding on his vision for a more activist government so loathed by conservatives, the same theme he struck in his second inauguration address on January 21.

"The American people don't expect government to solve every problem. They don't expect those of us in this chamber to agree on every issue. But they do expect us to put the nation's interests before party," he said, pressing Republicans to resolve budget and fiscal differences without drama.

Obama - whose first-term promise to become a transformational, post-partisan president failed to materialize in part because of struggles over the deficit - knows the clock is ticking.

The consensus among Washington insiders is that he has a limited window, possibly as little as a year and a half, to take advantage of the Republicans' post-election disarray and push through his congressional priorities before being reduced to lame-duck status.

SETTING PRIORITIES

Just three weeks after staking out a decidedly liberal philosophy at his inauguration, Obama used his State of the Union address to start fleshing out and prioritizing his goals for the rest of his presidency.

He made clear that job creation and bolstering the middle class would top the list, but he also gave due attention to immigration reform and gun control, which have moved to the forefront at the start of his second term.

Obama's renewed emphasis on pocketbook issues that dominated the 2012 campaign appears to reflect the view that advancing other legacy-shaping initiatives could hinge on how he fares with unfinished economic business from his first four years.

Many of the economic plans he presented in his State of the Union address were familiar to listeners as proposals that Republicans have blocked before, including new investment in modernizing infrastructure, boosting manufacturing, creating construction jobs and helping to ease homeowners' mortgage woes.

There is ample reason to doubt that these ideas - even in repackaged form - will gain much traction in a still-divided Congress where Republicans control the House of Representatives and will oppose almost any new spending Obama proposes.

But the biggest red flags for Republicans may be Obama's call for a hike in the federal minimum wage to $9 an hour, a traditional liberal idea, and his demand that Congress pursue a "market-based solution" to climate change - with a warning that if lawmakers do not act soon, "I will."

Obama's call for a nationwide program to expand pre-school education for the low-income families - another progressive cause - is also expected to run into Republican opposition.

There is little doubt the president is aware that many of these proposals, especially those with spending attached, may be dead-on-arrival in Congress.

But he may be counting on being able to accuse Republicans of obstructionism in the 2014 midterm elections - as he did with some success in the 2012 campaign - as his Democrats seek to win back the House.

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Phys Ed: 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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Downtown condo market seeing rebound

Downtown Chicago's condo market is on the rebound after many moribund years, as sales volume and pricing improve in a market constrained by a lack of inventory.

It's a rare piece of good news for downtown condo owners as well as for developers pondering projects and trying to line up financing.

With a steady stream of apartment projects delivering in the next two years, the lack of new condo construction could signal opportunities for companies interested in pursuing smaller projects in key neighborhoods because the demand is there. Until those projects materialize, condo owners looking to sell face a better market than they have in several years.

Sales of existing downtown condos rose 31.2 percent last year, to 4,675 units sold, while the median sales price of $300,000 was a gain of about 2.6 percent from 2011, according to data from Appraisal Research Counselors.

Another piece of good news for current condo owners: Of the 65 downtown buildings studied by the firm, the average sales price per square foot of units sold during the second half of last year rose while the number of distressed condo sales in those buildings saw a substantial drop. Distressed sales, which accounted for  28 percent of sales since 2010, fell to 17 percent of sales during the second half of 2012.

In addition, only 1,104 newly constructed condo units remain unsold downtown.

"When we see more transactions occurring, that's a really good indication of demand," said Gail Lissner, a vice president at the firm. "The look of the condo market has changed in terms of unsold inventory."

Lissner's remarks came Tuesday during a lunchtime briefing on the local housing market.

Most of the unsold inventory, more than 500 units, is in the South Loop and the bulk of it is in the newly named and repositioned 500-unit South Loop Luxury by Related.

The three buildings, once called One Museum Park West, 1600 Museum Park and Museum Park Place 2 were taken over by New York-based Related Cos. in July have been renamed the Grant, Adler Place and Harbor View, respectively.

Since December, 40 units there are under contract, according to Related Midwest, which officially launched sales in the project Tuesday.

Other new projects reporting positive sales trends are Park Monroe Phase II, a 48-unit adaptive reuse project with 16 sales and CA3, a 40-unit building with 18 sales.

"These are all great indicators of strong sales," Lissner said. "Price stabilization has occurred in the market. You don't hear people talking about bottoming out. That was so yesterday."

mepodmolik@tribune.com | Twitter @mepodmolik

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Bears terminate contract of wide receiver Johnny Knox

Johnny Knox’s football career could be over.

The injured wide receiver, who continues to recover from spinal fusion surgery, had his contract terminated by the Chicago Bears on Tuesday morning. Knox, a 26-year-old vested veteran, spent the entire 2012 season on the physically unable to perform list after sustaining a devastating blow from Seahawks defensive end Anthony Hargrove in 2011.

Knox collected his $1.26 million salary while sitting out this past season. His contract originally was supposed to expire after the ’12 campaign. But according to rules of the collective bargaining agreement, when a player in the last year of his contract is on the PUP list that entire season, his contract can be rolled over to the next season, at the team’s discretion.

Multiple sources indicated the structural damage Knox suffered would make it difficult for him to return to football again. The initial outlook was four to six months of recovery just to perform normal activities, and even longer before Knox could return to football.

That optimism changed when the structural damage was discovered during surgery. Knox's back was unstable and there were more torn ligaments than anticipated. The nerve damage couldn't be assessed until after the surgery, and Knox had to wear a back brace for a while after the procedure.

In an interview with the Tribune, Hargrove expressed remorse for his hit on Knox.

"You never want to hit somebody like that," Hargrove said. "You never want to put somebody in that position, to jeopardize their health."

Knox, a former fifth-round draft pick from Abilene Christian in Texas, started 27 of 45 games played in three seasons (2009-11) with the Bears. He had 133 receptions for 2,214 yards and 12 touchdowns and his 16.6 yards per reception was seventh best in the NFL during that time.

Knox also compiled 1,506 yards on 55 kickoff returns (27.4 yards per return) with one touchdown, earning a Pro Bowl nod as a returner in 2009.

His speed was an asset that helped the Bears stretch the field. New coach Marc Trestman seems destined to add more help at receiver to take some of the load off Brandon Marshall, with Knox out of the mix and Devin Hester's offensive status uncertain.

vxmcclure@tribune.com

Twitter@vxmcclure23

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CNN slots Jake Tapper Show, cuts length of Wolf Blitzer’s “Situation Room”

LOS ANGELES (TheWrap.com) – CNN slotted new anchor Jake Tapper‘s upcoming show for 4 p.m. on weekdays, cutting Wolf Blitzer‘s “The Situation Room” back one hour, a CNN spokeswoman told TheWrap.

Tapper, lured away from ABC News in December, was CNN boss Jeff Zucker‘s first major hire since taking charge of the network. Now, with his own show coming in March, Blitzer’s program will but cut from three hours to two as it moves to the 5 p.m. to 7 p.m. time slot.

A CNN spokeswoman told TheWrap Tapper‘s show has no specific starting date yet because it is still in development.

Last month, Turner Broadcasting posted LinkedIn job openings for a senior producer at a new daily program called “Tapper.”

And on Monday, CNN named Federico Quadrani, MSNBC’s executive producer of “Jansing and Company,” as the show’s new executive producer.

Choosing Quadrani – who served as an Emmy-winning producer for NBC’s “Today” show from 2003 to 2009 – is one of Zucker’s higher profile hires as the former “Today” producer attempts to replicate his morning show success at CNN.

After taking charge of the show in 1992, Zucker led “Today” to its ratings highs before Katie Couric‘s departure for CBS. The subsequent exit of Meredith Vieira, who replaced Couric, made it vulnerable to rival “Good Morning America.”

Late last month, CNN announced that it had bought “20/20″ anchor and former “GMA” host Chris Cuomo to lead a new morning show with Erin Burnett.

TV News Headlines – Yahoo! News

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Personal Health: 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. (Hazelden also published his book.)

“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 at “Effective Addiction Treatment.”

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Maker's Mark lowering proof to meet demand

Makers Mark lowers alcohol proof to meet demand. (WPIX - New York)

Maker's Mark announced it is reducing the amount of alcohol in the spirit to keep pace with rapidly increasing consumer demand.

In an email to its fans, representatives of the brand said the entire bourbon category is "exploding" and demand for Maker's Mark is growing even faster. Some customers have even reported empty shelves in their local stores, it said.

After looking at "all possible solutions," the total alcohol by volume of Maker's Mark is being reduced by 3 percent. Representatives said the change will allow it to maintain the same taste while making sure there's "enough Maker's Mark to go around." It's working to expand its distillery and production capacity, too.

Maker's Mark, made by Deerfield-based Beam Inc., said it's done extensive testing to ensure the same taste. It says bourbon drinkers couldn't tell the difference. It also underscored the fact that nothing else in the production process has changed.

"In other words, we've made sure we didn't screw up your whisky," the note said.

Rob Samuels, chief operating officer and grandson of Maker's Mark Founder Bill Samuels, Sr., said this is a permanent decision that won’t be reversed when demand for bourbon slows down. Samuels said that bourbon has gone from the slowest growing spirits category to the fastest over the last 18 months, driven by growth overseas and demand from younger drinkers. An average bottle of Maker’s Mark takes six and half years to produce from start to finish, and since the company doesn’t buy or trade whiskey, it’s been impossible to keep up. 

The first bottle of Maker's Mark, with its signature red wax closure, was produced in 1958.

Beam is the country's second-largest spirits company by volume. It also makes Jim Beam, Sauza tequila and Pinnacle vodka. It's still dwarfed by industry-leading Diageo, the London-based maker of Smirnoff, Tanqueray, Captain Morgan and Johnnie Walker.

It's a tough time to take a risk with one of its oldest and most popular brands. Beam has promised that 25 percent of sales will come from new products, a difficult goal to attain but a critical one for investor confidence.The move met some backlash on social media sites, where some said they would boycott the bourbon if the company went ahead with its plans.

Many also complained that they'd rather see an increase in its price than a decrease in the alcohol. But observers say that by raising the price, Beam would have hurt itself by positioning Maker's Mark to compete against its own higher end brands like Basil Hayden's.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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