Starz will face new, challenging world as public company

Pay-TV channel Starz is trying to chart a new orbit.

Early next year, its parent company, Liberty Media, plans to spin off the premium network and its sister channel Encore into a new, stand-alone, publicly traded company.

Such a move would normally be cause for celebration. But for Starz, the separation comes amid uncertainty.

Its track record producing original shows has been mixed. The market is getting increasingly crowded not only from Starz's traditional competitors, HBO and Showtime, but also from new rivals including Netflix, Amazon and Redbox. And, starting in 2017, the network will lose one of its key suppliers of movies — Walt Disney Studios — to Netflix.

"It's an interesting time for Starz," said Matthew Harrigan, a media analyst with Wunderlich Securities. "Losing those Disney movies makes life a little more difficult, and it becomes even more important for them to create successful original programming."

STORY: On Location

Liberty Media is spinning off Starz in part to make it more attractive to potential buyers. Companies mentioned by analysts as possible suitors include Comcast Corp., parent of Universal Pictures. Other deep-pocketed prospective buyers could be News Corp., Walt Disney Co. and Viacom Inc. HBO and Showtime probably would face anti-trust issues if either of them made a run at Starz.

The shift also raises the stakes for Starz and its chief executive, Chris Albrecht, who has been given the task of building an original programming pipeline. Albrecht, who joined Starz nearly three years ago, has the experience. As the former head of HBO, he was a key architect of that network's success by helping nurture such culture-defining hits as "Sex and the City" and "The Sopranos."

Achieving those heights again, this time at Starz, has proved more elusive. Starz made a splash with its gladiator series "Spartacus," but another high-profile drama, "Boss," about a corrupt Chicago mayor played by Kelsey Grammer ("Frasier"), failed to deliver ratings to match its critical acclaim. "Boss" was canceled after two seasons. Last year's "Camelot," about a young King Arthur, started strong but then fell on its sword.

Starz, which has 20.8 million subscribers in the U.S., has spent the last few years playing catch-up. The network began developing original dramas much later than industry leaders HBO and Showtime, and also lags behind basic cable channels FX, AMC and USA Network.

At the same time, the availability of movies through other venues has increased dramatically, and film fans can just as easily get their fix by buying or renting DVDs — online or at supermarket kiosks — or through Internet streaming services. That makes the need for strong original content even greater.

Starz executives declined to comment for this story, citing the "quiet period" mandated by regulators before the public stock offering.

Hollywood movie studios have a strong incentive to protect the premium channels, which have long served as their unofficial ATMs. The channels, including HBO, Starz and Showtime, spit out hundreds of millions of dollars each year to movie studios in exchange for the first-run TV rights to recent releases. The fees — which can approach $30 million for a single blockbuster film — have helped studios turn deficits into profits for many movies.

The parent companies of HBO (Time Warner), Showtime (CBS Corp.) and Starz (Liberty Media), also have long collected hundreds of millions of dollars each year in profit from the channels in distribution fees from cable and satellite operators. According to consulting firm SNL Kagan, Starz and sister channel Encore this year will generate revenue of $1.34 billion and $414 million in cash flow, a metric similar to operating income.

Just a few years ago, Starz trailed HBO as the No. 2 movie channel in terms of distribution. But it has since been surpassed by Showtime. The CBS Corp. network has staged a string of hits including "Weeds," the serial killer drama "Dexter," the pill-popping dark comedy "Nurse Jackie" and its latest hit, the terrorist thriller "Homeland," which this fall won the Emmy for TV's best drama.

According to SNL Kagan, Showtime has 21 million subscribers and 2012 revenue of $1.6 billion. Cash flow for Showtime and its sister channels TMC and Flix should approach $690 million combined for this year. Showtime's programming expenses are slightly less because it ended its relationships with movie studios several years ago.

"Showtime has been doing something similar [to Starz] with their strategy, but they have programming that people are talking about," said BTIG analyst Richard Greenfield said. "The question is how does Starz stack up?"

Its shows have largely failed to attract the buzz that can drive subscriptions and ratings. "Spartacus" was Starz's most popular show, averaging more than 5 million viewers an episode during the third season when viewing on all platforms was counted. "Magic City," the channel's stylistic drama about Miami gangsters in the 1950s, averaged 3.1 million viewers an episode when it debuted this year, while "Boss" collared just 2.2 million an episode.

Starz is betting heavily on its lineup for next two years, which includes the second season of "Magic City" and the new prospects "Da Vinci's Demons," a drama about Leonardo's early days from David S. Goyer, a co-writer of the "Dark Knight Rises" film trilogy, and "Black Sails," a swashbuckling adventure from "Transformers" and "Pirates of the Caribbean" filmmaker Michael Bay.

The company this year is spending about $692 million on programming, with four-fifths of that amount earmarked for buying products from Disney and Sony Pictures Entertainment, according to SNL Kagan, which said Starz spends less than $100 million annually creating original series.

"They still need the movies to fill their schedule, but at the same time Starz needs some unique programs to define the channel," said Deana Myers, an SNL Kagan television analyst. "It's not an easy market to get into because a lot of other networks are doing original productions."

Although Starz will continue to receive the Disney movies for three years, the eventual loss puts pressure on the company to keep Sony as a supplier beyond 2016, when the parties' current arrangement ends. The loss of Disney movies and the coming end of the Sony contract could also complicate the picture as Starz tries to attract a new owner.

Potential suitor Viacom already has a presence in the premium channel business. The parent of Paramount Pictures teamed in 2009 with two other studios, Lions Gate Entertainment Corp. and Metro-Goldwyn-Mayer Studios Inc., to launch the movie service Epix. The upstart has struggled to make distribution deals with leading cable and satellite TV systems. That could make a merger between Epix and Starz enticing. Given that Epix is not nearly as powerful as HBO and Showtime, such a deal may also be able to pass regulatory muster.

meg.james@latimes.com

joe.flint@latimes.com

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Toyota to pay big to settle suits

Toyota Motor Corp., moving to put years of legal problems behind it, has agreed to pay more than $1 billion to settle dozens of lawsuits relating to sudden acceleration.

The proposed deal, filed Wednesday in federal court, would be among the largest ever paid out by an automaker. It applies to numerous suits claiming economic damages caused by safety defects in the automaker's vehicles, but does not cover dozens of personal injury and wrongful-death suits that are still pending around the nation.

The suits were filed over the last three years by Toyota and Lexus owners who claimed that the value of their vehicles had been hurt by the potential for defects, including floor mats that could cause the vehicles to surge out of control.

ROAD TO RECALL: Read The Times' award winning coverage

In addition, Toyota said it is close to settling suits filed by the Orange County district attorney and a coalition of state attorneys general who had accused the automaker of deceptive business practices. The costs of those agreements would be included in a $1.1-billion charge the Japanese automaker said it will take against earnings to cover the actions.

"We concluded that turning the page on this legacy legal issue through the positive steps we are taking is in the best interests of the company, our employees, our dealers and, most of all, our customers," Christopher Reynolds, Toyota's chief counsel in the U.S., said in a statement.

Toyota's lengthy history of sudden acceleration was the subject of a series of Los Angeles Times articles in 2009, after a horrific crash outside San Diego that took the life of an off-duty California Highway Patrol officer and his family.

Under terms of the agreement, which has not yet been approved in court, Toyota would install brake override systems in numerous models and provide cash payments from a $250-million fund to owners whose vehicles cannot be modified to incorporate that safety measure.

In addition, the automaker plans to offer extended repair coverage on throttle systems in 16 million vehicles and offer cash payments from a separate $250-million fund to Toyota and Lexus owners who sold their vehicles or turned them in at the end of a lease in 2009 or 2010. The total value of the settlement could reach $1.4 billion, according to Steve Berman, the lead plaintiff attorney in the case.

The lawsuits, filed over the last several years, had been seeking class certification.

News of the agreement comes scarcely a week after Toyota agreed to pay a record $17.35-million fine to the National Highway Traffic Safety Administration for failing to report a potential floor mat defect in a Lexus SUV. Those come on top of almost $50 million in fines paid by Toyota for other violations related to sudden acceleration since 2010.

The massive settlement does not, however, put Toyota's legal woes to rest. The automaker still faces numerous injury and wrongful death claims around the country, including a group of cases that have been consolidated in federal court in Santa Ana, and other cases awaiting trial in Los Angeles County.

The first of the federal cases, involving a Utah man who was killed in a Camry that slammed into a wall in 2010, is slated for trial in mid-February.

The California cases are set to begin in April, among them a suit involving a 66-year-old Upland woman who was killed after her vehicle allegedly reached 100 miles per hour and slammed into a tree.

Edgar Heiskell III, a West Virginia attorney who has a dozen pending suits against Toyota, said he is preparing to go to trial this summer in a case that involved a Flint, Mich., woman who was killed when her 2005 Camry suddenly accelerated near her home.

"We are proceeding with absolute confidence that we can get our cases heard on the merits and that we expect to prove defects in Toyota's electronic control system," he said.

Toyota spokesman Mike Michels said the settlement would have no bearing on the personal injury cases.

"All carmakers face these kinds of suits," he said. "We'll defend those as we normally would."

The giant automaker's sudden acceleration problems first gained widespread attention after the August 2009 crash of a Lexus ES outside San Diego.

That accident set off a string of recalls, an unprecedented decision to temporarily stop sales of all Toyota vehicles and a string of investigations, including a highly unusual apology by Toyota President Akio Toyoda before a congressional committee. Eventually Toyota recalled more than 10 million vehicles worldwide and has since spent huge sums — estimated at more than $2 billion, not including Wednesday's proposed settlement — to repair both its automobiles and public image.

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Analysis: Amazon’s Christmas faux pas shows risks in the cloud

(Reuters) – A Christmas Eve glitch traced to Amazon.com Inc that shuttered Netflix for users from Canada to South America highlights the risks that companies take when they move their datacenter operations to the cloud.

While the high-profile failure – at least the third this year – may cause some Amazon Web Services customers to consider alternatives, it is unlikely to severely hurt a fast-growing business for the cloud-computing pioneer that got into the sector in 2006 and has historically experienced few outages.

“The benefits still outweigh the risks,” said Global Equities Research analyst Trip Chowdhry.

“When it comes to the cloud, Amazon has got it right.”

The latest service failure comes at a critical time for Amazon, which is betting that AWS can become a significant profit generator even if the economy continues to stagnate. Moreover, it is increasingly targeting larger corporate clients that have traditionally shied away from moving critical applications onto AWS.

AWS, which Amazon started more than six years ago, provides data storage, computing power and other technology services from remote locations that group thousands of servers across areas than can span whole football fields. Their early investment made it a pioneer in what is now known as cloud computing.

Executives said last month at an Amazon conference in Las Vegas they could envision the division, which lists Pinterest, Shazam and Spotify among its fast-growing clients, becoming its biggest business, outpacing even its online retail juggernaut. Evercore analyst Ken Sena expects AWS revenue to jump 45 percent a year, from about $ 2 billion this year to $ 20 billion in 2018.

The service has boomed because it is cheap, relatively easy to use, and can be shut off, scaled back or ramped up quickly depending on companies’ needs. As the longest-running player in the game, Amazon now boasts the widest array of datacenter products and services, plus a broader stable of clients than rivals like Google Inc, Rackspace Inc and Salesforce.com Inc.

Outages such as the one that took down Netflix and other websites on the eve of one of the biggest U.S. holidays are part and parcel of the nascent business, analysts say. Moreover, outages have been a problem long before the age of cloud computing, with glitches within corporate datacenters and telecommunications hubs triggering myriad service disruptions.

COMING SOON: POST-MORTEM

Amazon’s latest service failure comes months after two high-profile outages that hit Netflix and other popular websites such as photo-sharing service Instagram and Pinterest. Industry executives, however, say its downtimes tend to attract more attention because of its outsized market footprint.

Netflix – which CEO Reed Hastings said relies on AWS for 95 percent of its datacenter needs – would not comment on whether they were pondering alternatives. Analysts say the video streaming giant is unlikely to try a large-scale switch, partly because all cloud providers experience outages.

“Despite a steady stream of these service outages, the demand for cloud services offered by AWS, Google, etc. continues to escalate because these services are still reliable enough to satisfy customer expectations,” said Jeff Kaplan, managing director of consultancy ThinkStrategies Inc.

“They offer cost-savings and elasticities that are too attractive for companies to ignore.”

But “Netflix and other organizations which rely on AWS will have to reexamine how they configure their services and allocate their service requirements across multiple providers to mitigate over-dependency and risks.”

AWS spokeswoman Rena Lunak said the outage was traced to a problem affecting customers at its oldest data center, run out of northern Virginia, which was linked also to the June failure.

The latest glitch involved a service known as Elastic Load Balancing, which automatically allocates incoming Web traffic across multiple servers in order to boost the performance of a website. She declined to provide further details about the outage, saying the company would be publishing a full post-mortem within days.

AWS has traditionally been used by start-up tech companies and smaller businesses that anticipate rapid growth in online traffic but are unwilling or unable to shell out on IT equipment and management upfront.

The company has more recently started winning more and more business from larger corporations. It has also set up a unit that caters to government agencies.

Regardless, Amazon’s clientele would do well not to put all their eggs in one basket, analysts say.

“Service outages do occur, but they are not common enough to cause users of these services to abandon today’s Cloud service providers at significant rates. In fact, every major Cloud service provider has experienced outages,” Kaplan said.

“Therefore, organizations that rely on these services are putting backup and recovery systems and protocols in place to mitigate the risks of future outages.”

(Additional reporting; editing by Edwin Chan and Richard Chang)

Tech News Headlines – Yahoo! News

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Patrick Dempsey brews up coffee shop purchase

LOS ANGELES (AP) — Patrick Dempsey says he wants to rescue a coffee house chain and more than 500 jobs.

The "Grey's Anatomy" star said Wednesday he's leading a group attempting to buy Tully's Coffee. The Seattle-based company filed for Chapter 11 bankruptcy protection in October.

Dempsey said he's excited about the chance to help hundreds of workers and give back to Seattle.

The actor has a strong TV tie to the city: He plays Dr. Derek Shepherd on "Grey's Anatomy," the ABC drama set at fictional Seattle Grace Hospital.

Tully's has 47 company-run stores in Washington and California, as well as five franchised stores and 58 licensed locations in the U.S.

Any sale would have to be approved by a judge. A bankruptcy court hearing is set for Jan. 11 in Seattle.

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Elwood V. Jensen, Pioneer in Breast Cancer Treatment, Dies at 92

Elwood V. Jensen, a medical researcher whose studies of steroid hormones led to new treatments for breast cancer that have been credited with saving or extending hundreds of thousands of lives, died on Dec. 16 in Cincinnati. He was 92.

The cause was complications of pneumonia, his son, Thomas Jensen, said.

In 2004 Dr. Jensen received the Albert Lasker Basic Medical Research Award, one of the most respected science prizes in the world.

When Dr. Jensen started his research at the University of Chicago in the 1950s, steroid hormones, which alter the functioning of cells, were thought to interact with cells through a series of chemical reactions involving enzymes.

However, Dr. Jensen used radioactive tracers to show that steroid hormones actually affect cells by binding to a specific receptor protein inside them. He first focused on the steroid hormone estrogen.

By 1968, Dr. Jensen had developed a test for the presence of estrogen receptors in breast cancer cells. He later concluded that such receptors were present in about a third of those cells.

Breast cancers that are estrogen positive, meaning they have receptors for the hormone, can be treated with medications like Tamoxifen or with other methods of inhibiting estrogen in a patient’s system, like removal of the ovaries. Women with receptor-rich breast cancers often go into remission when estrogen is blocked or removed.

By the mid-1980s, a test developed by Dr. Jensen and a colleague at the University of Chicago, Dr. Geoffrey Greene, could be used to determine the extent of estrogen receptors in breast and other cancers. That test became a standard part of care for breast cancer patients.

Scientists like Dr. Pierre Chambon and Dr. Ronald M. Evans, who shared the 2004 Lasker prize with Dr. Jensen, went on to show that many types of receptors exist. The receptors are crucial components of the cell’s control system and transmit signals in an array of vital functions, from the development of organs in the womb to the control of fat cells and the regulation of cholesterol.

Dr. Jensen’s work also led to the development of drugs that can enhance or inhibit the effects of hormones. Such drugs are used to treat prostate and other cancers.

Elwood Vernon Jensen was born in Fargo, N.D., on Jan. 13, 1920, to Eli and Vera Morris Jensen. He majored in chemistry at what was then Wittenberg College in Springfield, Ohio, and had begun graduate training in organic chemistry at the University of Chicago when World War II began.

Dr. Jensen wanted to join the Army Air Forces, but his poor vision kept him from becoming a pilot. During the war he synthesized poison gases at the University of Chicago, exposure to which twice put him in the hospital. His work on toxic chemicals, he said, inspired him to pursue biology and medicine.

Dr. Jensen studied steroid hormone chemistry at the Swiss Federal Institute of Technology on a Guggenheim Fellowship after the war. While there, he climbed the Matterhorn, one of the highest peaks in the Alps, even though he had no mountaineering experience. He often equated his successful research to the novel approach taken by Edward Whymper, the first mountaineer to reach the Matterhorn’s summit. Mr. Whymper went against conventional wisdom and scaled the mountain’s Swiss face, after twice failing to reach the summit on the Italian side.

Dr. Jensen joined the University of Chicago as an assistant professor of surgery in 1947, working closely with the Nobel laureate Charles Huggins. He became an original member of the research team at the Ben May Laboratory for Cancer Research (now the Ben May Department for Cancer Research) in 1951, and became the director after Dr. Huggins stepped down.

He came to work at the University of Cincinnati in 2002, and continued to do research there until last year.

His first wife, the former Mary Collette, died in 1982. In addition to his son, Dr. Jensen is survived by his second wife, the former Hiltrud Herborg; a daughter, Karen C. Jensen; a sister, Margaret Brennan; two grandchildren; and three great-grandchildren.

Dr. Jensen’s wife was found to have breast cancer in 2005. She had the tumor removed, he said in an interview, but tested positive for the estrogen receptor and was successfully treated with a medication that prevents estrogen synthesis.

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Toyota to pay big to settle suits

Toyota Motor Corp., moving to put years of legal problems behind it, has agreed to pay more than $1 billion to settle dozens of lawsuits relating to sudden acceleration.

The proposed deal, filed Wednesday in federal court, would be among the largest ever paid out by an automaker. It applies to numerous suits claiming economic damages caused by safety defects in the automaker's vehicles, but does not cover dozens of personal injury and wrongful-death suits that are still pending around the nation.

The suits were filed over the last three years by Toyota and Lexus owners who claimed that the value of their vehicles had been hurt by the potential for defects, including floor mats that could cause the vehicles to surge out of control.

ROAD TO RECALL: Read The Times' award winning coverage

In addition, Toyota said it is close to settling suits filed by the Orange County district attorney and a coalition of state attorneys general who had accused the automaker of deceptive business practices. The costs of those agreements would be included in a $1.1-billion charge the Japanese automaker said it will take against earnings to cover the actions.

"We concluded that turning the page on this legacy legal issue through the positive steps we are taking is in the best interests of the company, our employees, our dealers and, most of all, our customers," Christopher Reynolds, Toyota's chief counsel in the U.S., said in a statement.

Toyota's lengthy history of sudden acceleration was the subject of a series of Los Angeles Times articles in 2009, after a horrific crash outside San Diego that took the life of an off-duty California Highway Patrol officer and his family.

Under terms of the agreement, which has not yet been approved in court, Toyota would install brake override systems in numerous models and provide cash payments from a $250-million fund to owners whose vehicles cannot be modified to incorporate that safety measure.

In addition, the automaker plans to offer extended repair coverage on throttle systems in 16 million vehicles and offer cash payments from a separate $250-million fund to Toyota and Lexus owners who sold their vehicles or turned them in at the end of a lease in 2009 or 2010. The total value of the settlement could reach $1.4 billion, according to Steve Berman, the lead plaintiff attorney in the case.

The lawsuits, filed over the last several years, had been seeking class certification.

News of the agreement comes scarcely a week after Toyota agreed to pay a record $17.35-million fine to the National Highway Traffic Safety Administration for failing to report a potential floor mat defect in a Lexus SUV. Those come on top of almost $50 million in fines paid by Toyota for other violations related to sudden acceleration since 2010.

The massive settlement does not, however, put Toyota's legal woes to rest. The automaker still faces numerous injury and wrongful death claims around the country, including a group of cases that have been consolidated in federal court in Santa Ana, and other cases awaiting trial in Los Angeles County.

The first of the federal cases, involving a Utah man who was killed in a Camry that slammed into a wall in 2010, is slated for trial in mid-February.

The California cases are set to begin in April, among them a suit involving a 66-year-old Upland woman who was killed after her vehicle allegedly reached 100 miles per hour and slammed into a tree.

Edgar Heiskell III, a West Virginia attorney who has a dozen pending suits against Toyota, said he is preparing to go to trial this summer in a case that involved a Flint, Mich., woman who was killed when her 2005 Camry suddenly accelerated near her home.

"We are proceeding with absolute confidence that we can get our cases heard on the merits and that we expect to prove defects in Toyota's electronic control system," he said.

Toyota spokesman Mike Michels said the settlement would have no bearing on the personal injury cases.

"All carmakers face these kinds of suits," he said. "We'll defend those as we normally would."

The giant automaker's sudden acceleration problems first gained widespread attention after the August 2009 crash of a Lexus ES outside San Diego.

That accident set off a string of recalls, an unprecedented decision to temporarily stop sales of all Toyota vehicles and a string of investigations, including a highly unusual apology by Toyota President Akio Toyoda before a congressional committee. Eventually Toyota recalled more than 10 million vehicles worldwide and has since spent huge sums — estimated at more than $2 billion, not including Wednesday's proposed settlement — to repair both its automobiles and public image.

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Lakers snap Christmas Day streak with win over Knicks

Lakers 100, Knicks 94 (final)

The Lakers closed out the New York Knicks on Christmas Day to win their fifth in a row, avenging a Dec. 13 loss in New York, the low point of the season during a four-game losing streak. 

The Lakers haven't dropped a game since.

With the Lakers up by three points, Pau Gasol found a lane to the basket from the high post and flushed down a dunk to seal the victory with 11.6 seconds left.  Steve Nash, in his second game back from a leg injury, scored 16 points and dished 11 assists.

The Lakers shot 48.1% from the field but it was their defense that was instrumental in the victory, holding New York to only 16 points in the fourth quarter.

The Knicks shot 42.7% from the field despite 34 from Carmelo Anthony (13-23 shooting), who exploded in the third quarter to give the Knicks a nine-point lead.  The Lakers never led by more than five points.

Kobe Bryant also scored 34 points on 14-for-24 shooting.  Metta World Peace fouled out after scoring 20.  For the second consecutive game, Pau Gasol had six assists.

Knicks center Tyson Chandler also fouled out, finishing with six points and nine rebounds.  J.R. Smith helped carry the offensive load for New York with 25 points.

The Lakers will play on Wednesday night against the Nuggets in Denver.

Knicks 78, Lakers 77 (end of third quarter)

The Lakers survived a 17-point quarter from Carmelo Anthony to close to within one point after three quarters.

Falling behind by as many as nine points after halftime, the Lakers had a chance to go up by a point but Kobe Bryant missed a pair of free throws with 2.6 seconds left in the quarter.

Anthony climbed to 27 points for the game on 11-for-20 shooting while his Knicks shot 43.8% through three.  J.R. Smith contributed 20 points off the bench.

The Lakers were led by Bryant's 26 points on 11-for-18 shooting, while getting 18 points from Metta World Peace and 14 from Steve Nash.

Some of New York's lead was earned from behind the three-point line with eight makes in 22 tries.  The Lakers shot 48.3% from the field but only five of 18 (27.8%) from three-point range.

World Peace started the second half in place of Darius Morris but Anthony had the hot hand.

Lakers 51, Knicks 49 (halftime)

For the second consecutive quarter, the Lakers closed well against the Knicks. After New York's reserves had helped push the Knicks to a six-point advantage, the Lakers rallied to take a two-point lead at halftime.

Carmelo Anthony and Metta World Peace battled through a very physical period, challenging each other in the post. Anthony finished the half with 10 points while World Peace had a game-high 16 points after coming off the Lakers' bench.

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Jessica Simpson's Christmas gift: She's pregnant

NEW YORK (AP) — Jessica Simpson's daughter has the news all spelled out: "Big Sis."

Simpson on Tuesday tweeted a photo of her baby daughter Maxwell playing in the sand, the words "Big Sis" spelled out.

The 32-year-old old singer and personality has been rumored to be expecting again. The tweet appears to confirm the rumors.

"Merry Christmas from my family to yours" is the picture's caption. Simpson used a tweet on Halloween in 2011 to announce she was pregnant with Maxwell. She is engaged to Eric Johnson and gave birth to Maxwell in May.

One possible complication regarding her pregnancy: She is a spokeswoman for Weight Watchers.

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Op-Ed Contributor: Our Failed Approach to Schizophrenia

TOO many pendulums have swung in the wrong directions in the United States. I am not referring only to the bizarre all-or-nothing rhetoric around gun control, but to the swing in mental health care over the past 50 years: too little institutionalizing of teenagers and young adults (particularly men, generally more prone to violence) who have had a recent onset of schizophrenia; too little education about the public health impact of untreated mental illness; too few psychiatrists to talk about and treat severe mental disorders — even though the medications available in the past 15 to 20 years can be remarkably effective.

Instead we have too much concern about privacy, labeling and stereotyping, about the civil liberties of people who have horrifically distorted thinking. In our concern for the rights of people with mental illness, we have come to neglect the rights of ordinary Americans to be safe from the fear of being shot — at home and at schools, in movie theaters, houses of worship and shopping malls.

“Psychosis” — a loss of touch with reality — is an umbrella term, not unlike “fever.” As with fevers, there are many causes, from drugs and alcohol to head injuries and dementias. The most common source of severe psychosis in young adults is schizophrenia, a badly named disorder that, in the original Greek, means “split mind.” In fact, schizophrenia has nothing to do with multiple personality, a disorder that is usually caused by major repeated traumas in childhood. Schizophrenia is a physiological disorder caused by changes in the prefrontal cortex, an area of the brain that is essential for language, abstract thinking and appropriate social behavior. This highly evolved brain area is weakened by stress, as often occurs in adolescence.

Psychiatrists and neurobiologists have observed biochemical changes and alterations in brain connections in patients with schizophrenia. For example, miscommunications between the prefrontal cortex and the language area in the temporal cortex may result in auditory hallucinations, as well as disorganized thoughts. When the voices become commands, all bets are off. The commands might insist, for example, that a person jump out of a window, even if he has no intention of dying, or grab a set of guns and kill people, without any sense that he is wreaking havoc. Additional symptoms include other distorted thinking, like the notion that something — even a spaceship, or a comic book character — is controlling one’s thoughts and actions.

Schizophrenia generally rears its head between the ages of 15 and 24, with a slightly later age for females. Early signs may include being a quirky loner — often mistaken for Asperger’s syndrome — but acute signs and symptoms do not appear until adolescence or young adulthood.

People with schizophrenia are unaware of how strange their thinking is and do not seek out treatment. At Virginia Tech, where Seung-Hui Cho killed 32 people in a rampage shooting in 2007, professors knew something was terribly wrong, but he was not hospitalized for long enough to get well. The parents and community-college classmates of Jared L. Loughner, who killed 6 people and shot and injured 13 others (including a member of Congress) in 2011, did not know where to turn. We may never know with certainty what demons tormented Adam Lanza, who slaughtered 26 people at an elementary school in Newtown, Conn., on Dec. 14, though his acts strongly suggest undiagnosed schizophrenia.

I write this despite the so-called Goldwater Rule, an ethical standard the American Psychiatric Association adopted in the 1970s that directs psychiatrists not to comment on someone’s mental state if they have not examined him and gotten permission to discuss his case. It has had a chilling effect. After mass murders, our airwaves are filled with unfounded speculations about video games, our culture of hedonism and our loss of religious faith, while psychiatrists, the ones who know the most about severe mental illness, are largely marginalized.

Severely ill people like Mr. Lanza fall through the cracks, in part because school counselors are more familiar with anxiety and depression than with psychosis. Hospitalizations for acute onset of schizophrenia have been shortened to the point of absurdity. Insurance companies and families try to get patients out of hospitals as quickly as possible because of the prohibitively high cost of care.

As documented by writers like the law professor Elyn R. Saks, author of the memoir “The Center Cannot Hold: My Journey Through Madness,” medication and treatment work. The vast majority of people with schizophrenia, treated or untreated, are not violent, though they are more likely than others to commit violent crimes. When treated with medication after a rampage, many perpetrators who have shown signs of schizophrenia — including John Lennon’s killer and Ronald Reagan’s would-be assassin — have recognized the heinousness of their actions and expressed deep remorse.

It takes a village to stop a rampage. We need reasonable controls on semiautomatic weapons; criminal penalties for those who sell weapons to people with clear signs of psychosis; greater insurance coverage and capacity at private and public hospitals for lengthier care for patients with schizophrenia; intense public education about how to deal with schizophrenia; greater willingness to seek involuntary commitment of those who pose a threat to themselves or others; and greater incentives for psychiatrists (and other mental health professionals) to treat the disorder, rather than less dangerous conditions.

Too many people with acute schizophrenia have gone untreated. There have been too many Glocks, too many kids and adults cut down in their prime. Enough already.

Paul Steinberg is a psychiatrist in private practice.

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How will going off the 'fiscal cliff' affect the U.S.?

You've heard the predictions for what happens if the country goes over the "fiscal cliff": The economy will shrink, nervous consumers will stop spending, and the stock market will plunge.

But those doomsday predictions are overblown, some professional investors say.

Even if Congress and the White House can't reach a deal, the higher taxes and lower government spending that would follow would kick in only gradually. A recession is not guaranteed.

What's much more important to the stock market, the experts say, are economic fundamentals.

"History has shown that the economy is going to do what the economy is going to do," said Scott Carmack, co-portfolio manager at Leader Capital in Portland, Ore. "And politics don't create some sort of disaster."

Regardless of what happens, the "fiscal cliff" — sweeping tax increases and government spending cuts set to take effect Jan. 1 — is going to dominate the headlines and the market for the next week.

What's going to happen in the stock market between now and the budget deadline of Dec. 31?

The market hates uncertainty. If there's no deal, expect stocks to fall.

"We always knew we were going to get some volatility here," Carmack said. "Depending on leaders in Washington to come to some kind of agreement is like pulling teeth."

Besides, there are other incentives for people to pull money out of the market. Some professional investors are selling to lock in gains for the year. Others are selling because investments could be taxed at higher rates next year.

"It's been a pretty good year in the market," said Peter Tuz, co-manager of the Chase Growth and Chase Mid Cap Growth mutual funds in Charlottesville, Va. The Standard & Poor's 500 index is up more than 13% in 2012.

"People might look at that uncertainty and say, 'I'm happy with that, and now I'll take some money aside, and sell,'" he said.

What about after Jan. 1?

Deal or no deal, many investors don't expect the effects of the fiscal impasse to linger in the stock market for too long.

One big reason is that everyone has seen it coming for months.

"We're not overly concerned," said David Hefty, chief executive of Hefty Wealth Partners in Auburn, Ind. "The thing to keep in mind is that what hurts investors, what hurts the market, are things that are unexpected."

He added: "Everybody has 2008 burned into their minds. They think the 'fiscal cliff' will be the next 2008 event. A 2008 event is when nobody sees it coming, and everyone is blindsided. Nobody's going to be blindsided by this."

Hefty said he'd watch whether the Federal Reserve continues its policy of pumping money into the economy, and fundamentals such as housing and unemployment, to decide how to invest in 2013.

"We're looking at two key things that matter the most," he said. "The 'fiscal cliff' isn't one of them."

Donald Quigley, co-manager of the Artio Total Return Bond mutual fund, is more wary of the political effects than the economic effects. If Republicans and Democrats can't reach a compromise, he said, the world could take that as a sign that the United States government is dysfunctional.

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