Illinois corporate tax credits swelled to $161 million 2011

When lawmakers raised taxes on Illinois residents and businesses, they also increased corporate income tax breaks for a select group of companies.

In 2011, businesses were eligible to claim about $161 million in tax credits — double from the prior year — mostly because of the increase to 5 percent from 3 percent in the state's personal income tax rate, which is a factor in determining the value of the incentives. The boost marked the largest increase in the Economic Development for a Growing Economy tax credit program, the state's main economic development program, since its creation in 1999.

Deere & Co., Boeing Co. and Caterpillar Inc., whose leader severely criticized lawmakers for tax hikes, were among dozens of companies that received more robust tax breaks. Some companies' deals also allowed them to be in line to receive tax incentives even while laying off workers or lowering wages.

The EDGE program allows a business to claim a credit against its corporate income tax liability if it agrees to create and/or retain jobs and make an investment in the state of at least $1 million, for companies with fewer than 100 workers, and at least $5 million for larger companies.

Once accepted into the program, which typically lasts 10 years, a company applies on an annual basis for a tax credit certificate, similar to a voucher, which it can claim when it files its taxes.

Marcelyn Love, a spokeswoman with the Department of Commerce and Economic Opportunity, which administers the program, said that under the tax credit program companies make investments and employ workers, practices that otherwise would not have occurred without the credits.

"Both the private investment and the increased employment significantly increase tax revenue collection for the state in excess of the credits given," Love said in an email. Far from adding to the tax burden, she added, these incentives actually generate revenue for the state. "Further, most of these tax credits pay for themselves within two years."

The certificates are the only way to gauge the potential cost and scope of the program, because tax filings are not public. The Tribune obtained the 2011 certificates data, the latest year available, under the state's Freedom of Information Act. Companies have as many as five years to redeem a certificate.

After a deal is finalized, a company has two years to meet its side of the bargain and begin applying for certificates. Thus, the increase in the total value of 2011 tax breaks is also the result of companies receiving certificates for the first time. For example, Ford Motor Co. began applying for its certificates in 2010 from a 2007 deal.

During Gov. Pat Quinn's administration, companies have received increasingly larger deals. Many have been for retaining jobs, according to a Tribune analysis. In 2011, Sears Holdings Corp. was offered a tax credit package worth $150 million over 10 years to keep its headquarters in the state and retain at least 4,250 full-time jobs. The company, which after the deal was announced revealed that it was closing 125 stores nationwide, has yet to apply for a certificate. Five of those stores were in Illinois. State officials have said that during a recession, when few jobs are created, it's important to focus on retaining workers.

Chris Brathwaite, a Sears spokesman, said the company's employment level at its headquarters is higher than the more than 6,000 jobs it had when the deal was approved, but he declined to provide figures.

In general, the value of a certificate equals the number of jobs created and/or retained, multiplied by wages tied to those jobs and the state's personal income tax rate.

That means companies that didn't add one worker and kept wages at the 2010 rate received a 67 percent boost to their 2011 corporate income tax break. Just like individuals, corporations also registered a tax rate increase in 2011. Lawmakers set the new corporate income tax rate at 7 percent, up from 4.8 percent. The increases in breaks partially offset that hike.

The formula under which companies become eligible to receive tax breaks was aimed at encouraging job creation and increasing employee wages. Still, the 2011 data revealed that some companies made deals to allow job cuts and still qualify for incentives, a practice known as "normal attrition."

A case in point is Motorola Mobility. For the past two years, Motorola Mobility has qualified for certificates worth a total of $22.6 million while slowly chipping away at its workforce. Late last year, the smartphone-maker, which was acquired by Google Inc. in May, announced it was laying off 20 percent of its global workforce. Locally, the company cut hundreds of workers, bringing its Illinois head count to about 2,300, a figure that would make it ineligible for a 2013 certificate unless it boosts its workforce before the end of the year.

The Department of Commerce and Economic Opportunity said the EDGE program played a crucial role in keeping Motorola Mobility in Illinois after it was acquired by Google. Its presence, the agency said, is drawing more technology investment and jobs to the state.

A state lawmaker wants the state to end the wiggle room practice, cap at $100 million the annual amount of tax breaks awarded and remove the investment bar so more small and medium-size businesses can qualify for breaks.

"Large multinationals are getting all the breaks," said Rep. Jack Franks, D-Marengo, adding that his focus is to modernize the program and increase accountability.

Franks' House Bill 1336 would also limit the length of the tax breaks to five years and require that companies pay workers at least the median salary of their occupation as determined by federal data. The bill also eliminates the provision requiring companies to make a capital investment in the state of at least $1 million or $5 million, depending on their size. And it creates a nine-member board to oversee the deals, with members appointed by the governor and approved by the state Senate.

Franks said that the Department of Commerce and Economic Opportunity shouldn't promote the program while also negotiating deals with companies, because it creates a conflict of interest.

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Exhausted passengers describe woes on disabled cruise ship

MOBILE, Alabama—

Thousands of relieved passengers poured ashore from a stinking cruise ship on Friday after five days adrift in the Gulf of Mexico with overflowing toilets and stench filled cabins.

Exhausted passengers lined the ship's decks, waving towels and flashlights, cheering and singing "Sweet Home Alabama" as tug-boats pulled the stricken Carnival Triumph into the port of Mobile, Alabama.

Some travelers kissed the ground when they walked off, others disembarked wearing the ship's white bath robes, part souvenir and part protection against a chilly night.

With only one working elevator, it took several hours to get the more than 4,200 people off the ship, Carnival said. Passengers were greeted dockside with warm food, blankets and cell phones to call family and friends.

About 100 buses waited to carry passengers on a seven-hour bus ride to Galveston, Texas, while others buses departed for shorter rides to New Orleans, as well as hotels in Mobile, before eventually flying home.

The end of the saga, documented live on U.S. cable news stations, was another public relations disaster for cruise giant Carnival Corp. Last year, its Costa Concordia luxury liner grounded off the coast of Italy, killing 32 people.

Carnival officials said the Triumph, which entered service in 1999, would be towed to a Mobile repair facility for damage assessment.

The 893-foot vessel was returning to Galveston from Cozumel, Mexico on the third day of a four-day cruise when an engine-room fire knocked out power and plumbing across most of the ship on Sunday.

Passengers described a gut-wrenching stench on parts of the ship and complained to relatives and media by cellphone that toilets and drainpipes overflowed, soaking many cabins and interior passages in raw sewage.

"The stench was awful," said Robin Chandler, a 50-year-old from Dallas who spent her birthday on the ship. "A lot of people were crying and freaking out."

Jacob Combs, an Austin, Texas-based sales executive with a healthcare and hospice company, praised the ship's crew.

"Just imagine the filth," said Combs, 30. "People were doing crazy things and going to the bathroom in sinks and showers. It was inhuman. The stewards would go in and clean it all up. They were constantly cleaning," he said.

Debbie Moyes, 32, of Phoenix told the Los Angeles Times she was awakened Sunday by a fellow passenger banging on her door, warning people to escape.

"That was one of the only points in my life I thought I might die," the mother of four said as she stood in the parking lot.

Soon after, she said some passengers panicked.

"People were hoarding food -- boxes and boxes of cereal, grabbing cake with both hands," she said.

APOLOGY FROM CARNIVAL

Facing criticism over the company's response, Carnival Cruise Lines Chief Executive Gerry Cahill boarded the ship to personally apologize to passengers.

"I know the conditions on board were very poor," he told reporters, sounding shaken in a brief media appearance before he boarded the ship. "I know it was difficult. I want to apologize for subjecting our guests to that," he said.

"We pride ourselves with providing our guests with a great vacation experience and clearly we failed in this particular case," Cahill added.

Operated by Carnival Cruise Lines, the flagship brand of Carnival Corp, the ship left Galveston a week ago carrying 3,143 passengers and 1,086 crew. It was supposed to return on Monday.

Some passengers said conditions deteriorated rapidly on the Triumph earlier in the week, saying people were getting sick and passengers had been told to use plastic "biohazard" bags as makeshift toilets.

"It wasn't a vacation anymore it was like survival mode. Eat what you can. Snack when you can. It was awful," said passenger Tammy Garcia.

Smoke from the engine fire was so thick that passengers on the lower decks in the rear of the ship had to be permanently evacuated and slept the rest of the voyage on the decks under sheets, passengers said.

COMPENSATION OFFER

Some passengers said they tried to pass the time playing cards and organizing Bible study groups and scavenger hunts for the children on board the ship.

Cahill has issued several apologies and Carnival, the world's largest cruise company, said passengers will be reimbursed in full plus transportation expenses, a future cruise credit equal to the amount paid for this voyage, plus a payment of $500 a person to help compensate them.

Chandler, the passenger, scoffed at the compensation offer. "There are lost wages, I've got a baby sitter at home and I had to take off work," she said.

Some passengers said conditions improved on Thursday after a generator was delivered to the ship, providing power for a grill to cook hot food. Passengers said toilets began flushing again on Thursday and the ship served steaks and lobster - a relief after a steady diet of cold sandwiches of cucumber and cheese.

Carnival Corp Chairman and CEO Micky Arison was criticized in January last year for failing to travel to Italy and take personal charge of the Costa Concordia crisis. The tragedy unleashed numerous lawsuits against his company.

He has not publicly commented on the Triumph incident.

"I think they really are trying to do the right thing, but I don't think they have been able to communicate it effectively," said Marcia Horowitz, an executive who handles crisis management at Rubenstein Associates, a New York-based PR firm.

Carnival Corp shares closed down 11 cents at $37.35 in trading on Thursday on the New York Stock Exchange.

The Triumph is a Bahamian-flagged vessel and the Bahamas Maritime Authority will be the primary agency investigating the cause of its engine room fire.

Earlier this month, Carnival repaired an electrical problem on one of the Triumph's alternators. The company said there was no evidence of any connection between the repair and the fire.

For all the passengers' grievances, they will likely find it difficult to sue the cruise operator for any damages, legal analysts said. Over the years, the cruise industry has put in place a legal structure that shields operators from big-money lawsuits.

Reuters and Molly Hennessy-Fiske, Los Angeles Times

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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, chocolaty 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 lay 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 homemade 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 for Hank 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 l 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.

---

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

---

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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Push for online sales tax picks up in Congress

U.S. states could collect millions of dollars in online sales taxes, with members of both parties in Congress sponsoring legislation Thursday that would resolve states' decades-long struggle to tax businesses beyond their borders.

"Small businesses and states alike are suffering from the inability to collect due -- not new -- taxes from purchases made online," said Rep. Steve Womack, R-Ark., adding the legislation is a "bipartisan, bicameral, common-sense solution that promotes states' rights and levels the playing field for our Main Street businesses."

Legislation on the Amazon tax, named for the colossal Internet retailer, has languished for years.

In 1992 the Supreme Court decided the patchwork of state tax laws made it too difficult for online retailers to collect and remit sales taxes. So states can tax Internet only sales made by companies with a physical presence in the states. That means online retailers such as Amazon.com Inc. collect sales tax in some states and not in others.

The bills introduced on Thursday reconcile differences in legislation that the House of Representatives and Senate considered last year. The nearly identical details in the bills and strong bipartisan support mean the final bill could be sent to President Barack Obama this year.

Members of Congress recently assured state lawmakers they would pass a law in 2013.

In the last decade, Internet sales have gone from 1.6 percent of all U.S. retail sales to more than 5 percent, according to Commerce Department data, a proportion that will likely grow as shoppers make more purchases on handheld devices. In the third quarter of 2012,  "e-commerce" sales were $57 billion, the department said.

Large Internet retailers are worried the tax could drive up the cost of doing business. They would also have to create new systems and software to collect the surcharges, adding to their costs. Amazon said in July it prefers having the tax issue resolved at the federal level.

When the 2007-09 recession caused states' revenues to collapse, Republican and Democratic governors backed the tax as a financial solution that would not require federal aid.

A leader in the Republican party, Virginia Gov. Bob McDonnell went so far as to figure online tax revenue into his recent plan for overhauling the state's transportation funding.

"The revenue states are losing out on is legally owed, but because of a pre-Internet Supreme Court ruling, states aren't able to collect it," Sen. Deb Peters, R-S.D., said in a statement.

States and cities say they can recoup billions of dollars with the tax. Fitch Ratings estimates put the states' loss at $11 billion.

Some states are considering their own legislation. Florida is debating a bill that advocates say could bring the state more than $400 million.

Small retailers, meanwhile, have said the sales tax will will allow them to compete with massive online retailers.

"While store owners collect and remit state and local sales taxes their digital competitors are off the hook -- and benefiting because of it," said David French, the National Retail Federation's senior vice president for government relations, in a statement.

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'Blade Runner' Olympian charged with girlfriend's murder

JOHANNESBURG -- South African "Blade Runner" Oscar Pistorius, a double amputee who became one of the biggest names in world athletics, was charged on Thursday with shooting dead his girlfriend at his upscale home in Pretoria.

Police said they opened a murder case after a 30-year-old woman was found dead at the Paralympic and Olympic star's house in the Silverlakes gated complex on the capital's outskirts.

Pistorius, 26, and his girlfriend, model Reeva Steenkamp, had been the only people in the house at the time of the shooting, police brigadier Denise Beukes, told reporters, adding witnesses had been interviewed about the early morning incident.

"We are talking about neighbors and people that heard things earlier in the evening and when the shooting took place," Beukes said outside the heavily guarded residential complex. Earlier, police said a 9mm pistol had been found at the scene.

Beukes said police were aware of previous incidents at the Pistorius house. "I can confirm that there has previously been incidents at the home of Mr Oscar Pistorious, of allegations of domestic nature," she said.

Pistorius, who uses carbon fiber prosthetic blades to run, is due to appear in a Pretoria court on Friday.

"He is doing well but very emotional," his lawyer Kenny Oldwage told SABC TV, but gave no further comment.

A sports icon for triumphing over disabilities to compete with able-bodied athletes at the Olympics, his sponsorship deals, including one with sports apparel group Nike, are thought to be worth $2 million a year.

South Africa's M-Net cable TV channel said it was pulling adverts featuring Pistorius off air immediately.

"WE ARE ALL DEVASTATED"

Steenkamp's colleagues in the modeling world were distraught. "We are all devastated. Her family is in shock," her agent, Sarita Tomlinson, tearfully told Reuters. "They did have a good relationship. Nobody actually knows what happened."

Pistorius, who was born without a fibula in both legs, was the first double amputee to run in the Olympics and reached the 400-metre semi-finals in London 2012.

In last year's Paralympics he suffered his first loss over 200 meters in nine years. After the race he questioned the legitimacy of Brazilian winner Alan Oliveira's prosthetic blades, though he was quick to express regret for the comments.

South Africa has some of the world's highest rates of violent crime, and many home owners have weapons to defend themselves against intruders, although Pistorius' complex is surrounded by a three-meter high wall and electric fence.

In 2004, Springbok rugby player Rudi Visagie shot dead his 19-year-old daughter after he mistakenly thought she was a robber trying to steal his car in the middle of the night.

Before the murder charge was announced, Johannesburg's Talk Radio 702 said the athlete may have mistaken Steenkamp for a burglar.

Recent media interviews with Pistorius revealed he kept an assortment of weapons in his home.

"Cricket and baseball bats lay behind the door, a pistol by his bed and a machine gun by a window," Britain's Daily Mail wrote in a profile published last year.

Pistorius was arrested in 2009 for assault after slamming a door on a woman and spent a night in police custody. Family and friends said it was just an accident and charges were dropped.

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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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