England Develops a Voracious Appetite for a New Diet

LONDON — Visitors to England right now, be warned. The big topic on people’s minds — from cabdrivers to corporate executives — is not Kate Middleton’s increasingly visible baby bump (though the craze does involve the size of one’s waistline), but rather a best-selling diet book that has sent the British into a fasting frenzy.

“The Fast Diet,” published in mid-January in Britain, could do the same in the United States if Americans eat it up. The United States edition arrived last week.

The book has held the No. 1 slot on Amazon’s British site nearly every day since its publication in January, according to Rebecca Nicolson, a founder of Short Books, the independent publishing company behind the sensation. “It is selling,” she said, “like hot cakes,” which coincidentally are something one can actually eat on this revolutionary diet.

With an alluring cover line that reads, “Lose Weight, Stay Healthy, Live Longer,” the premise of this latest weight-loss regimen — or “slimming” as the British call “dieting” — is intermittent fasting, or what has become known here as the 5:2 diet: five days of eating and drinking whatever you want, dispersed with two days of fasting.

A typical fasting day consists of two meals of roughly 250 to 300 calories each, depending on the person’s sex (500 calories for women, 600 for men). Think two eggs and a slice of ham for breakfast, and a plate of steamed fish and vegetables for dinner.

It is not much sustenance, but the secret to weight loss, according to the book, is that even after just a few hours of fasting, the body begins to turn off the fat-storing mechanisms and turn on the fat-burning systems.

“I’ve always been into self-experimentation,” said Dr. Michael Mosley, one of the book’s two authors and a well-known medical journalist on the BBC who is often called the Sanjay Gupta of Britain.

He researched the science of the diet and its health benefits by putting himself through intermittent fasting and filming it for a BBC documentary last August called “Eat, Fast and Live Longer.” (The broadcast gained high ratings, three million viewers, despite running during the London Olympics. PBS plans to air it in April.)

“This started because I was not feeling well last year,” Dr. Mosley said recently over a cup of tea and half a cookie (it was not one of his fasting days). “It turns out I was suffering from high blood sugar, high cholesterol and had a kind of visceral fat inside my gut.”

Though hardly obese at the time, at 5 feet 11 inches and 187 pounds, Dr. Mosley, 55, had a body mass index and body fat percentage that were a few points higher than the recommended amount for men. “Given that my father had died at age 73 of complications from diabetes, and I was now looking prediabetic, I knew something had to change,” he added.

The result was a documentary, almost the opposite of “Super Size Me,” in which Dr. Mosley not only fasted, but also interviewed scientific researchers, mostly in the United States, about the positive results of various forms of intermittent fasting, tested primarily on rats but in some cases human volunteers. The prominent benefits, he discovered, were weight loss, a lower risk of cancer and heart disease, and increased energy.

“The body goes into a repair-and-recover mode when it no longer has the work of storing the food being consumed,” he said.

Though Dr. Mosley quickly gave up on the most extreme forms of fasting (he ate little more than one cup of low-calorie soup every 24 hours for four consecutive days in his first trial), he finally settled on the 5:2 ratio as a more sustainable, less painful option that could realistically be followed without annihilating his social life or work.

“Our earliest antecedents,” Dr. Mosley argued, “lived a feast-or-famine existence, gorging themselves after a big hunt and then not eating until they scored the next one.” Similarly, he explained, temporary fasting is a ritual of religions like Islam and Judaism — as demonstrated by Ramadan and Yom Kippur. “We shouldn’t have a fear of hunger if it is just temporary,” he said.

What Dr. Mosley found most astounding, however, were his personal results. Not only did he lose 20 pounds (he currently weighs 168 pounds) in nine weeks, but his glucose and cholesterol levels went down, as did his body fat. “What’s more, I have a whole new level of energy,” he said.

The documentary became an instant hit, which in turn led Mimi Spencer, a food and fashion writer, to propose that they collaborate on a book. “I could see this was not a faddish diet but one that was sustainable with long-term health results, beyond the obvious weight-loss benefit,” said Ms. Spencer, 45, who has lost 20 pounds on the diet within four months and lowered her B.M.I. by 2 points.

The result is a 200-page paperback: the first half written by Dr. Mosley outlining the scientific findings of intermittent fasting; the second by Ms. Spencer, with encouraging text on how to get through the first days of fasting, from keeping busy so you don’t hear your rumbling belly, to waiting 15 minutes for your meal or snack.

She also provides fasting recipes with tantalizing photos like feta niçoise salad and Mexican pizza, and a calorie counter at the back. (Who knew a quarter of a cup of balsamic vinegar added up to a whopping 209 calories?)

In London, the diet has taken off with the help of well-known British celebrity chefs and food writers like Hugh Fearnley-Whittingstall, who raved about it in The Guardian after his sixth day of fasting, having already lost eight pounds. (“I feel lean and sharper,” he wrote, “and find the whole thing rather exhilarating.”)

The diet is also particularly popular among men, according to Dr. Mosley, who has heard from many of his converts via e-mail and Twitter, where he has around 24,000 followers. “They find it easy to work into their schedules because dieting for a day here and there doesn’t feel torturous,” he said, adding that couples also particularly like doing it together.

But not everyone is singing the diet’s praises. The National Health System, Britain’s publicly funded medical establishment, put out a statement on its Web site shortly after the book came out: “Despite its increasing popularity, there is a great deal of uncertainty about I.F. (intermittent fasting) with significant gaps in the evidence.”

The health agency also listed some side effects, including bad breath, anxiety, dehydration and irritability. Yet people in London do not seem too concerned. A slew of fasting diet books have come out in recent weeks, notably the “The 5:2 Diet Book” and “The Feast and Fast Diet.”

There is also a crop of new cookbooks featuring fasting-friendly recipes. Let’s just say, the British are hungry for them.

This article has been revised to reflect the following correction:

Correction: March 2, 2013

A previous version of this article referred incorrectly to the national health care body in Britain. It is the National Health Service, not the National Health System.

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'Like finding lost Rembrandts'

Peter Mullin cracks open the door of a 1935 Voisin Type C25 Aerodyne at the back of the auto museum bearing his name. He points out the intricate details of a vibrant Art Deco interior, restored to its original luster.

A small ashtray hangs on the inside of each door — made from etched Lalique crystal.

Light streams into the car through three small glass windows in the fully retractable roof. A bold black and white patterned fabric covers the doors, seats and roof, sourced from the same French textile mill that wove the original fabric more than seven decades ago.

"You can see why this one is kind of the favorite," Mullin says of the C25 with a smile.

Once relegated to the scrap heap of automotive history, the Voisin brand has undergone a renaissance within the classic car world. The cars, which cost as much as a Bugatti in the 1920s and 30s, are worth millions of dollars today. They were the creation of Gabriel Voisin, a colorful yet fastidious French architect and engineer who made a fortune selling airplanes during World War I.

Mullin's navy blue and grey C25 won Best of Show at the 2011 Pebble Beach Concours d'Elegance, arguably the most prestigious prize in the classic car world. Another Voisin, a 1934 C15 ETS Saliot-bodied Roadster, won Best of Show in 2002.

When Pebble Beach Concours hosted Voisin as the featured marque in 2006, it provoked a frenzied reaction among collectors.

"It was like finding the lost Rembrandts," said Richard Adatto, an expert in classic French cars and a member of the classic car show's selection committee.

Prior to 2006, he said, no Voisin had sold for more than $1 million. After that, prices nearly doubled. Peter Mullin's C25 could be worth as much as $5 million today, said David Gooding, president and founder of the Gooding & Co. auction company. Most experts estimate there are 250 to 300 known Voisin automobiles, though they are starting to turn up as barn finds throughout Europe.

Fortunately for Mullin, he got into the brand early.

"I fell in love with the Art Deco nature of Voisin a number of years ago," Mullin said. "One by one, they found their way into the collection."

In addition to his prize-winner, Mullin owns 15 other exceptionally rare and valuable Voisin models on display at the Mullin Automotive Museum in Oxnard until the end of April. The museum is also home to dozens of gleaming prewar cars from other French marques like Bugatti, Delahaye and the odd Talbot-Lago.

Mullin, the man, owns nearly everything in the building. But the Voisin cars have become his favorite, not just for their intricate details, but because they embody the values of the man behind their nameplate.

Gabriel Voisin was a colorful figure who made a name for himself in the early 1900s as an aviation pioneer. Despite being in their mid-20s, Voisin and his younger brother Charles started the world's first aircraft company. Their early planes set several European flight records.

Gabriel Voisin kept the company open after his brother was killed in a 1912 car crash, and sold several thousand fighter planes to the French military and its allies for use in World War I.

After the war ended, a glut of planes and little demand for new ones pushed Voisin to build a machine with a more benevolent purpose. He spent roughly the next 20 years building some of the most elaborate and expensive cars of the era. The rigors of aviation engineering and attention to detail carried into Voisin's forward-thinking automobiles.

"Everything was designed all the way out," Adatto said. "Even the taillights were handmade."

Many of Voisin's cars have struts connecting the front wheel fender to the grille — like the wing struts common on aircraft from the era. The cars were largely built from lightweight materials such as aluminum or magnesium. Most cars from that time — and even today — were built from heavier steel.

Inside, the dashboard of many Voisin vehicles had gauges to show oil pressure and temperature in an era when most cars didn't even have a fuel gauge, Adatto said. A complex engine design used sleeve valves rather than the standard overhead poppet valves found on engines today.

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Bell jurors ordered to begin anew after panelist is dismissed

After nearly five days of deliberations, jurors in the Bell corruption trial were ordered Thursday to begin anew after a member of the panel was dismissed for misconduct and replaced by an alternate.

The original juror, a white-haired woman identified only as Juror No. 3, told Los Angeles County Superior Court Judge Kathleen Kennedy she had gone onto a legal website to look up jury instructions and then asked her daughter to help find a definition for the word "coercion."

Although all but one defense attorney requested that the woman stay, Kennedy said the juror needed to be removed. "She has spoken about the deliberations with her daughter, she has conducted research on the Internet, and I've repeatedly, repeatedly throughout this trial — probably hundreds of times — cautioned the jury not to do that," the judge said.

The removal came after jurors notified the judge that they were deadlocked and that continued deliberations seemed fruitless.

It was unclear how to interpret the day's events, whether the dismissed juror had been a lone holdout or an indication of a fractured jury.

The juror started to tell the judge which way she was leaning in the case, saying she had gone online "looking to see at what point can I get the harassment to stop.... How long do I have to stay in there and deliberate with them when I have made my decision that I didn't think there was —"

Kennedy cut her off before she could finish.

The woman clasped her hands over her mouth and said, "I'm sorry."

Two defense attorneys thought she was leaning toward acquittal and wanted her to stay. "I would have preferred the deadlock to a guilty verdict," said Alex Kessel, the attorney for George Mirabal, one of six former council members charged with misappropriation of public funds.

The council members are charged with inflating their salaries in what prosecutors contend was a far-reaching web of corruption in which fat paychecks were placed ahead of the needs of the city's largely immigrant, working-poor constituents.

When attorneys and defendants were summoned to the courtroom Thursday morning, they were initially told that the jury appeared to be deadlocked.

"Your honor, we have reached a point where as a jury we have fundamental disagreements and cannot reach a unanimous verdict in this case," read a note signed by two jurors, including the foreman, that was given to Kennedy.

A note from another juror alerted the judge that Juror No. 3 had consulted an outside attorney. That did not appear to be the case, but her other actions were revealed under questioning from the judge.

The same juror made a tearful request Monday to be removed from the panel because she felt others were picking on her. Kennedy told the woman that although discussions can get heated, it was important to continue deliberating.

On Thursday, however, the juror again broke into tears and said she had spoken with her daughter about "the abuse I have suffered." She said her daughter told her, "Mom, they're trying to find the weak link."

The woman said she had turned to the Internet to better understand the rules about jury deliberations and came across the word "coercion." After her daughter helped her look up the word's definition, she wrote it down on a piece of paper and brought it with her to court. When the judge asked to see the paper she went into the jury room to retrieve it.

The woman later left the courtroom in tears.

With an alternate in place, Kennedy told the panel to act as if the earlier deliberations had not taken place. The alternate had sat in the jury box during the four-week trial but did not take part in deliberations.

Former council members Luis Artiga, Victor Bello, George Cole, Oscar Hernandez, Teresa Jacobo and Mirabal are accused of drawing annual salaries of as much as $100,000 a year by serving on boards that did little work and seldom met, part of a scandal that drew national attention to the small city in 2010.

Prosecutors said that Bell's charter follows state law regarding council members' compensation. In a city the size of Bell, council members should be paid no more than $8,076 a year.

The trial began in late January, and the case went to the jury last Friday.

As the jury resumed deliberations in downtown Los Angeles, the verdict was clearly in on the streets of Bell.

One resident unfurled old protest banners and signs from the days when the pay scandal was first exposed and then called former members of an activist group that had led the charge for reform in the city.

"We're holding our breaths and waiting," Denise Rodarte, a member of the grassroots group Bell Assn. to Stop the Abuse, said in regard to a verdict.

"It's cut and dry: Local elected officials were supposed to make a certain amount of money, and they made a lot more."

corina.knoll@latimes.com

jeff.gottlieb@latimes.com

Times staff writer Ruben Vives contributed to this report.

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The New Old Age Blog: Why Can’t I Live With People Like Me?

“Aging in place” is the mantra of long-term care. Whether looking at reams of survey data, talking to friends or wishing on a star, who among us wouldn’t rather spend the final years — golden or less so — at home, surrounded by our cherished possessions, in our own bed, no cranky old coot as a roommate, no institutional smells or sounds, no lukewarm meals on a schedule of someone else’s making?

That works best, experts tell us, in dense cities, where we can hail a cab at curbside, call the superintendent when something breaks and have our food delivered from Fresh Direct or countless takeout restaurants. We’d have neighbors in the apartment above us, below us, just on the other side of the wall. Hearing their toilets flush and their children ride tricycles on uncarpeted floors is a small inconvenience compared to the security of knowing they are so close by in an emergency.

Urban planners, mindful that most Americans live in sprawling, car-reliant suburbs, are designing more elder-friendly, walkable communities, far from “real” cities. Houses and apartments are built around village greens, with pockets of commerce instead of distant strip malls. Some have community centers for congregate meals and activities; others share gardens, where people can get their hands in the warm spring dirt long after they can push a lawn mower.

All of this is a step in the right direction, despite the Potemkin-village look of so many of them. But it doesn’t take into account those who are too infirm to stay at home, even in cities or more manageable suburban environments. Some are alone, others with a loving spouse who by comparison is “well” but may not be for long, given the rigors of care-taking. It doesn’t take into account people who can’t afford a home health aide, who don’t qualify for a visiting nurse, who have no adult children to help them or whose children live far away.

But by now, aging in place, unrealistic for some, scary or unsafe for others and potentially very isolating, has become so entrenched as the right way to live out one’s life that not being able to pull it off seems a failure, yet another defeat at a time when defeats are all too plentiful. Are we making people feel guilty if they can’t stay at home, or don’t want to? Are we discouraging an array of other solutions by investing so much, program-wise and emotionally, in this sine qua non?

Regular readers of The New Old Age know that I am single, childless and terrified of falling off a ladder while replacing a light bulb, breaking a hip and lying on the floor, unattended, until my dog wails so loudly a neighbor comes by to complain. A MedicAlert pendant is not something that appeals to me at 65, but even if I give in to that, say at 75, I’m not sure my life will be richer for digging my heels in and insisting home is where I should be.

So I spend a lot of time thinking about the alternatives. I know enough to distinguish between naturally-occurring-retirement communities, or NORCs (some of which work better than others); age-restricted housing complexes (with no services); assisted living (which works fine when you don’t really need it and not so fine when you do); and continuing care retirement communities (which require big upfront payments and extensive due diligence to be sure the place doesn’t go belly up after you get there).

What I find so unappealing about all these choices is that each means growing old among people with whom I share no history. In these congregate settings, for the most part, people are guaranteed only two things in common: age and infirmity. Which brings us to what is known in the trade as “affinity” or “niche” communities,” long studied by Andrew J. Carle at the College of Health and Human Services at George Mason University in Fairfax, Va.

Mr. Carle, who trains future administrators of senior housing complexes, was a media darling a few years back, before the recession, with the first baby boomers approaching 65 and niche communities that included services for the elderly — not merely warm-weather developments adjacent to golf courses — expected to explode. In newspaper interviews as recently as 2011, Mr. Carle said there were “about 100 of them in existence or on the drawing board,” not counting the large number of military old-age communities.

Mr. Carle still believes that better economic times, when they come, will reinvigorate this sector of senior housing, after the failure of some in the planning stages and others in operation. In an e-mail exchange, Mr. Carle said there were now about 70 in operation, with perhaps 50 of those that he has defined as University Based Retirement Communities, adjacent to campuses and popular with alumni, as well as non-alumni, who enjoy proximity to the intellectual and athletic activities. Among the most popular are those near Dartmouth, Oberlin, the University of Alabama, Penn State, Notre Dame, Stanford and Cornell.

At the height of the “affinity” boom, L.G.B.T.-assisted living communities and nursing homes were all the rage, seen as a solution to the shoddy treatment that those of different sexual orientations in the pre-Stonewall generation experienced in generic facilities. A few failed, most never got built and, by all accounts, the only one to survive is the pricy Rainbow Vision community in Sante Fe, N.M.

A handful of nudist elder communities, and ones for old hippies, also fell by the wayside, perhaps too free-spirited for the task. According to Mr. Carle, despite the odds, at least one group of RV enthusiasts has added an assisted-living component to what began as collections of transient elderly, looking only for a parking spot and necessary water and power hook-ups for their trailers. Native Americans have made a go of an assisted-living community in Montana, and Asians have done the same in Northern California.

But professional affinity communities, which I find most appealing, are few and far between.

The storied Motion Picture & Television Country House and Hospital, a sliding-scale institution in the San Fernando Valley since 1940, survived near-closure in 2009 as a result of litigation, activism by the Screen Actors Guild and the local chapter of the Teamsters, and news media pressure. Among film legends who died there — along with cameramen, back-lot security guards and extras — were Mary Astor, Joel McCrea, Yvonne De Carlo and Stepin Fetchit.

New York State’s volunteer firefighters are all welcome to a refurbished facility in the Catskill region that offers far more in the way of care and activities, including a state-of-the-art gym, than when I visited there five years ago. At that time, the residents amused themselves by activating the fire alarm to summon the local hook and ladder company, which didn’t mind a bit.

Then there is Nalcrest, the retirement home for unionized letter carriers. Even as post offices nationwide are preparing to eliminate Saturday service, and snail mail becomes an artifact, the National Association of Letter Carriers holds monthly fees around the $500 mark, is located in central Florida so its members no longer have to brave rain and sleet to complete their appointed rounds, and bans dogs, the bane of their existence.

So why not aged journalists? We surely have war stories to embroider as we rock on the porch. Perhaps a mimeograph machine to produce an old-fashioned, dead-tree newspaper, which some of us will miss once it has given way to Web sites like this one. Pneumatic tubes, one colleague suggested, to whisk our belongings upstairs when we can no longer carry them. Other colleagues wondered about welcoming both editors and reporters. How can these two groups, which some consider natural adversaries, complain about each others’ tin ears or missed deadlines if we’re not segregated?

I disagree. The joy of this profession is its collaboration. We did the impossible day after day when young. We belong together when old.

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SpaceX launches to space station, but experiences problem in orbit

On an overcast morning, SpaceX's Falcon 9 rocket launched from Space Launch Complex 40 at Cape Canaveral Air Force Station and sped through the clouds Friday on its way to the International Space Station.

However, about 12 minutes into the NASA resupply mission, after the rocket had lifted its Dragon capsule packed with more than 1,200 pounds of cargo into orbit, there was an anomaly in the spacecraft.

"It appears that although it reached Earth orbit, Dragon is experiencing some type of problem right now," John Insprucker, Falcon 9 product director, told viewers on SpaceX's live webcast. "We'll have to learn the nature of what happened."

PHOTOS: A 'new era': Private-sector space mission

The live webcast was then shut down.

Elon Musk, SpaceX founder and chief executive, took to Twitter to describe the problem: "Issue with Dragon thruster pods. System inhibiting three of four from initializing. About to command inhibit override."

The company later issued a statement about the thrusters, which are crucial to the spacecraft successfully reaching the space station:

"One thruster pod is running. Two are preferred to take the next step which is to deploy the solar arrays. We are working to bring up the other two in order to plan the next series of burns to get to station."

The Hawthorne company's craft blasted off at 7:10 a.m. PST. The plan was that Dragon would reach and attach to the space station on Saturday, but it's unclear how the thruster issue will affect that.

There is a news conference slated for later in the day, when more information may be available.

SpaceX, formally known as Space Exploration Technologies Corp., has already performed successful NASA resupply missions to the space station. There was one official mission in October, and a demonstration mission took place in May.

Both of those missions also had problems.

In May, a problem with the Dragon's onboard sensors pushed back its capture by the station by about two hours later than planned.

In October, one of the nine engines on the massive Falcon 9 rocket experienced a problem and shut down shortly after launch. Because of the glitch, a satellite that the rocket was carrying didn't reach proper orbit, but the NASA resupply mission went on as planned and the Dragon capsule connected with the space station.

ALSO:

Southland aerospace firms brace for defense cuts

United Airlines pulls Boeing 787 out of service until June 5

United Arab Emirates reaches deal to buy unarmed Predator drones

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DNA science points to better treatment for acne

Ancient Egyptians were vexed by it, using sulfur to dry it out. Shakespeare wrote of its "bubukles, and whelks, and knobs, and flames o' fire."

Today, acne plagues us still. Doctors can cure some cancers and transplant vital organs like hearts, but they still have trouble getting rid of the pimples and splotches that plague 85% of us at some time in our lives — usually, when we're teenagers and particularly sensitive about they way we look.

But new research hints that there's hope for zapping zits in the future, thanks to advances in genetic research.

Using state-of-the-art DNA sequencing techniques to evaluate the bacteria lurking in the pores of 101 study volunteers' noses, scientists discovered a particular strain of Propionibacterium acnes bacteria that may be able to defend against other versions of P. acnes that pack a bigger breakout-causing punch.

As best as dermatologists can tell, zits occur when bacteria that reside in human skin, including P. acnes, feed on oils in the pores and prompt an immune response that results in red, sometimes pus-filled bumps. But the study subjects who had the newly discovered bacterial strain weren't suffering from whiteheads or blackheads, according to a report published Thursday in the Journal of Investigative Dermatology.

Someday, the realization that "not all P. acnes are created equal" might help dermatologists devise treatments that more precisely target bad strains while allowing beneficial ones to thrive, said Dr. Noah Craft, a dermatologist at the Los Angeles Biomedical Research Institute who conducted the study with colleagues from UCLA and Washington University in St. Louis.

Doctors might prescribe probiotic creams that deliver "good" P. acnes to the face the same way a daily serving of yogurt helps restore healthy bacteria in the digestive tract.

"There are healthy strains that we need on our skin," Craft said. "The idea that you'd use a nuclear bomb to kill everything — what we're currently doing with antibiotics and other treatments — just doesn't make sense."

The research is part of a broad effort backed by the National Institutes of Health to characterize the so-called human microbiome: the trillions of microbes that live in and on our bodies and evolve along with us, sometimes causing illness and often promoting good health.

Most of the microbiome attention so far has gone to studying species in the gut, said study leader Huiying Li, an assistant professor of molecular and medical pharmacology at UCLA's Geffen School of Medicine. But the NIH's Human Microbiome Project, which funds her research, also looks at microbial communities in the nasal passages, the mouth, the urogenital tract and the skin.

Li said she became interested in studying acne because the skin microbiome seemed particularly understudied.

The research team recruited 101 patients in their teens and 20s from dermatology clinics in Southern California. Among them, 49 had acne and 52 had "normal skin" and were not experiencing breakouts but had come to the clinics for other problems.

Doctors used adhesive pore strips to remove skin bacteria from patients' noses. The researchers then collected the waxy plugs — a combination of bacteria, oils, dead skin cells and other stuff — and used DNA to figure out which bacteria were present.

They found that the P. acnes species accounted for about 90% of the bacteria in pores, in both healthy patients and acne sufferers. Digging a little deeper into the DNA, they found that two particular strains appeared in about 20% of acne sufferers, while a third strain was found only in acne-free patients.

"Dogs are dogs, but a Chihuahua isn't a Great Dane," Craft said. "People with acne had pit bulls on their skin. Healthy people had poodles."

The team then sequenced the complete genomes — about 2.6 million base pairs apiece — of 66 of the P. acnes specimens to explore in more depth how the good and bad strains differed.

The two notable bad strains had genes, probably picked up from other bacteria or viruses, that are thought to change the shape of a microbe to make it more virulent. The researchers hypothesized that the foreign DNA, perhaps by sticking more effectively to human host tissues, may help trigger an inflammatory response in the skin: acne.

The good strain, on the other hand, contained an element known to work like an immune system in bacteria, Li said. Perhaps it allows this P. acne to fight off intruders and prevent pimples from forming.

Li said the researchers did not know why some people had the bad P. acnes strains and others did not, and whether genetics or environment played a bigger role.

Dr. Vincent Young, who conducts microbiome research at the University of Michigan Medical School but wasn't involved in the acne project, said advances in sequencing technology and analysis made the new study possible. In the past, he said, scientists wouldn't have tried to sequence dozens of genomes in a single species.

"They'd say, why waste the money?" he said. "Now you can do this in a couple of days."

Li and Craft — neither of whom suffered bad acne as teens — plan to keep up the work.

More research is needed to come up with super-targeted anti-microbial therapies, or to develop a probiotic cream for acne sufferers.

Craft continues collecting samples from patients' pores. He hopes to study whether twins share the same microbial profiles, how acne severity is reflected in bacteria populations, and how things change in a single patient over the course of a treatment regimen.

One of the study volunteers, 19-year-old UC Santa Cruz student Brandon Pritzker, said he would have loved to have treated his acne without affecting the rest of his body. When he took Accutane, he suffered back pain and mood shifts.

Now off the drug, Pritzker said he is at peace with his pimples. "I still have breakouts, but I figure I'm 19, that's the way it's going to be," he said.

But, he added, "it hindered my confidence at the time. Kids with clear skin are probably a little happier."

eryn.brown@latimes.com

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The New Old Age Blog: For the Elderly, Medical Procedures to Avoid

The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, kicked off last spring. It is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.

It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”

The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.

Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents.

The winners — or perhaps, losers?

Both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed on one major “don’t.” Topping both lists was an admonition against feeding tubes for people with advanced dementia.

“This is not news; the data’s been out for at least 15 years,” said Sei Lee, a geriatrician at the University of California, San Francisco, and a member of the working group that narrowed more than 100 recommendations down to five. Feeding tubes don’t prevent aspiration pneumonia or prolong dementia patients’ lives, the research shows, but they do exacerbate bedsores and cause such distress that people often try to pull them out and wind up in restraints. The doctors recommended hand-feeding dementia patients instead.

The geriatricians’ list goes on to warn against the routine prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. Though drugs like Haldol, Risperdal and Zyprexa remain widely used, “all of these have been shown to increase the risk of stroke and cardiovascular death,” Dr. Lee said. They should be last resorts, after behavioral interventions.

The other questionable tests and treatments:

No. 3: Prescribing medications to achieve “tight glycemic control” (defined as below 7.5 on the A1c test) in elderly diabetics, who need to control their blood sugar, but not as strictly as younger patients.

No. 4: Turning to sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta — “they don’t magically disappear from your body when you wake up in the morning,” Dr. Lee said. They continue to slow reaction times, resulting in falls and auto accidents. Other sleep therapies are preferable.

No. 5: Prescribing antibiotics when tests indicate a urinary tract infection, but the patient has no discomfort or other symptoms. Many older people have bacteria in their bladders but don’t suffer ill effects; repeated use of antibiotics just causes drug resistance, leaving them vulnerable to more dangerous infections. “Treat the patient, not the lab test,” Dr. Lee said.

The palliative care doctors’ Five Things list cautions against delaying palliative care, which can relieve pain and control symptoms even as patients pursue treatments for their diseases.

It also urges discussion about deactivating implantable cardioverter-defibrillators, or ICDs, in patients with irreversible diseases. “Being shocked is like being kicked in the chest by a mule,” said Eric Widera, a palliative care specialist at the San Francisco V.A. Medical Center who served on the American Academy of Hospice and Palliative Medicine working group. “As someone gets close to the end of life, these ICDs can’t prolong life and they cause a lot of pain.”

Turning the devices off — an option many patients don’t realize they have — requires simple computer reprogramming or a magnet, not the surgery that installed them in the first place.

The palliative care doctors also pointed out that patients suffering pain as cancer spreads to their bones get as much relief, the evidence shows, from a single dose of radiation than from 10 daily doses that require travel to hospitals or treatment centers.

Finally, their list warned that topical gels widely used by hospice staffs to control nausea do not work because they aren’t absorbed through the skin. “We have lots of other ways to give anti-nausea drugs,” Dr. Widera said.

You can read all the Five Things lists (more are coming later this year), and the Consumer Reports publications that do a good job of translating them, on the Choosing Wisely Web site.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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After 2 days of big gains, stocks turn mixed

The stock market on Thursday plodded rather than soared, flicking between small ups and downs after two days of triple-digit gains.

Big-name companies reported higher quarterly earnings, and the government reported that the jobless claims are falling and that the economy did better last year than first expected. But Washington's budget battle cast a pall over the market, with spending cuts set to automatically kick in Friday and no sign that the two political parties might work out their differences beforehand.

The Dow Jones industrial average darted between small gains and losses in early trading. At midday, it was up 12 at 14,087. That tamped down some of the buzz from the last two days about when it might top its record high. The Dow hit its highest point, 14,164.53, in October 2007, before the effects of the financial crisis had manifested themselves.

The Standard & Poor's 500 was up two at 1,518. The Nasdaq composite edged up eight to 3,171.

The economic data, while enough to edge the market higher for parts of the morning, painted a picture of investors' low expectations more than one of robust growth.

The government said the U.S. economy grew at an annual rate of 0.1 percent in the last three months of 2012. That's hardly ideal, but it's better than the previous estimate. Originally, the government thought the economy had shrunk 0.1 percent in the period.

The number of Americans seeking unemployment aid also fell last week, which economists described as mildly encouraging.

“We still have work to do, still a lot of headwinds to face,” said Steve Sachs, head of capital markets at ProShares in Bethesda, Md. “But long story short, we're in a better position now than we were three years ago.”

The past two days have been good for the stock market. The Dow gained a combined 291 points after reports showed that Americans are more confident and are buying more homes. Investors were also relieved by Federal Reserve Chairman Ben Bernanke's avowal that the Fed will keep trying to prop up the economy with bond purchases and other programs, although that also does signify that the Fed thinks the economy is doing poorly.

In Washington, lawmakers were preparing for another fiscal cliff. Automatic government budget cuts are set to take effect Friday, slashing spending in the defense industry and elsewhere. The cuts are happening because Democrats and Republicans haven't been able to compromise over the budget, and Thursday gave no indication that they will do so any time soon. Congressional leaders weren't scheduled to meet with President Barack Obama on the matter until Friday, after the cuts have already kicked in.

The yield on the 10-year Treasury note edged down to 1.89 percent from 1.90 percent late Wednesday.

Among companies making big moves:

—Groupon, the coupons website, plunged 21 percent after reporting late Wednesday that its quarterly loss had expanded. The stock fell $1.26 to $4.72.

—J.C. Penney fell 19 percent. Investors were unnerved by the quarterly loss the department store reported late Wednesday, which was larger than they were expecting. The stock dropped $4.10 to $17.06.

—A number of retailers and restaurants reported results Thursday morning. Wendy's, Domino's and the clothing chain Chico's were all up after reporting higher profit and revenue.

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Race for L.A. city controller heats up

A previously low-profile race for Los Angeles city controller has begun to heat up as opponents of City Councilman Dennis Zine accuse him of "double dipping" the city's payroll and question why he is considering lucrative tax breaks for a Warner Center developer.

Zine, who for 12 years has represented a district in the southeast San Fernando Valley, is the better known of the major candidates competing to replace outgoing Controller Wendy Greuel.

The others are Cary Brazeman, a marketing executive, and lawyer Ron Galperin. Zine has raised $766,000 for his campaign, more than double that of Galperin, the next-highest fundraiser, and has the backing of several of the city's powerful labor unions.

He also has been endorsed by Mayor Antonio Villaraigosa and several of his council colleagues. Galperin is backed by the Service Employees International Union, one the city's largest labor groups, and Brazeman is supported by retired Rep. Diane Watson and several neighborhood council representatives.

With the primary ballot less than a week away, Brazeman and Galperin have turned up the heat on Zine, hoping to push the race beyond the March 5 vote. If no one wins more than 50% of the ballots cast, the top two vote-getters will face a runoff in the May general election.

In a recent debate, Zine's opponents criticized him for receiving a $100,000 annual pension for his 33 years with the Los Angeles Police Department and a nearly $180,000 council salary. Brazeman and Galperin called it an example of "double dipping" that should be eliminated.

That brought a forceful response from Zine, who shot back that he gives a big portion of his police pension check to charities.

"I am so tired of hearing 'double dipping,' " he said. "I worked 33 years on the streets of Los Angeles. I have given over $300,000 to nonprofits that need it.... That's what's happened with that pension."

In the same debate, Brazeman accused Zine of cozying up to a Warner Center developer by pushing for tax breaks on a project that already has been approved. The nearly 30-acre Village at Westfield Topanga project would add 1 million square feet of new shops, restaurants, office space and a hotel to a faded commercial district on Topanga Canyon Boulevard.

"The councilman proposed to give developers at Warner Center tens of millions of dollars in tax breaks even though it's a highly successful project," he said. "He wants to give it away."

City records show that less than a month after the development was approved in February 2012, Zine asked the council for a study looking at possible "economic development incentives" that could be given to Westfield in return for speeding up street and landscaping enhancements to the project's exterior.

The motion's language notes that similar tax breaks have been awarded to large projects in the Hollywood and downtown areas, and that "similar public investment in the Valley has been lacking." Westfield is paying for the $200,000 study.

Zine defended his decision before the debate audience, saying if the study finds that the city will not benefit, no tax breaks will be awarded. "If there's nothing there, then they get nothing," Zine said.

The controller serves as a public watchdog over the city's $7.3-billion annual operation, auditing the general fund, 500 special fund accounts and the performance of city departments. Those audits often produce recommendations for reducing waste, fraud and abuse.

But the mayor and the council are not obligated to adopt those recommendations, and as a result the job is part accountant, part scolder in chief. All the candidates say they will use their elective position not only to perform audits but also to turn them into action.

Their challenge during the campaign has been explaining how they will do that.

Zine, 65, says his City Hall experience has taught him how to get things done by working with his colleagues. He won't be afraid to publicly criticize department managers, he said, but thinks collaboration works better than being combative.

"You can rant and rave and people won't work with you," he said. "Or you can sit down and talk it out, and you can accomplish things."

Galperin, 49, considers himself a policy wonk who relishes digging into the details to come up with ways to become more efficient with limited dollars and to find ways to raise revenue using the city's sprawling assets. For instance, the city owns two asphalt plants that could expand production and sell some of its material to raise money to fix potholes, he said.

He's served on two city commissions, including one that found millions of dollars in savings by detailing ways to be more efficient. Zine is positioning himself as a "tough guy for tough times," but the controller should be more than that, Galperin said.

"What we really need is some thoughtfulness and some smarts and some effectiveness," he said. "Just getting up there and saying we need to be tough is not going to accomplish what needs to be done."

Brazeman, 46, started his own marketing and public relations firm in West Los Angeles a decade ago and became active in city politics over his discontent with a development project near his home. He has pushed the council to change several initiatives over the last five years, including changes to the financing of the Farmers Field stadium proposal that will save taxpayer dollars, he said.

As controller, he would pick and choose his battles, and, Brazeman said, be "the right combination of constructive, abrasive and assertive."

catherine.saillant@latimes.com

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Van Cliburn, American classical pianist, dies

FORT WORTH, Texas (AP) — Van Cliburn, the internationally celebrated pianist whose triumph at a 1958 Moscow competition helped thaw the Cold War and launched a spectacular career that made him the rare classical musician to enjoy rock-star status, died Wednesday after a fight with bone cancer. He was 78.

Cliburn died at his home in Fort Worth surrounded by loved ones, said his publicist and longtime friend Mary Lou Falcone.

"Van Cliburn was an international legend for over five decades, a great humanitarian and a brilliant musician whose light will continue to shine through his extraordinary legacy," Falcone said in a statement. "He will be missed by all who knew and admired him, and by countless people he never met."

Cliburn made what would be his last public appearance in September at the 50th anniversary of the prestigious piano competition named for him. Speaking to the audience in Fort Worth, he saluted the many past contestants, the orchestra and the city. "Never forget: I love you all from the bottom of my heart, forever," he said to a roaring standing ovation.

Cliburn skyrocketed to fame when he won the first International Tchaikovsky Competition in Moscow at age 23 in 1958, six months after the Soviets' launch of Sputnik embarrassed the U.S. and propelled the world into the space age. He triumphantly returned to a New York City ticker tape parade — the first ever for a classical musician — and a Time magazine cover proclaimed him "The Texan Who Conquered Russia."

But the win also proved the power of the arts, bringing unity in the midst of strong rivalry. Despite the tension between the nations, Cliburn became a hero to music-loving Soviets who clamored to see him perform and Premier Nikita Khrushchev reportedly gave the go-ahead for the judges to honor a foreigner: "Is Cliburn the best? Then give him first prize."

In the years that followed, Cliburn's popularity soared, and the young man from the small east Texas town of Kilgore sold out concerts, caused riots when spotted in public and even prompted an Elvis Presley fan club to change its name to his. His recording of the Tchaikovsky Piano Concerto No. 1 with Russian conductor Kirill Kondrashin became the first classical album to reach platinum status.

Time magazine's 1958 cover story quoted a friend as saying Cliburn could become "the first man in history to be a Horowitz, Liberace and Presley all rolled into one."

Cliburn performed for royalty, heads of state in Europe, Asia and South America, and for every U.S. president since Harry Truman.

"Since we know that classical music is timeless and everlasting, it is precisely the eternal verities inherent in classical music that remain a spiritual beacon for people all over the world," Cliburn once said.

But he also used his skill and fame to help other young musicians through the Van Cliburn International Music Competition.

Created by a group of Fort Worth teachers and citizens in 1962, the competition, held every four years, remains a pre-eminent showcase for the world's top pianists. An amateur contest was added in 1999.

"It is a forum for young artists to celebrate the great works of the piano literature and an opportunity to expose their talents to a wide-ranging international audience," Cliburn said during the 10th competition in 1997. The 14th competition is to be held in May and June.

President George W. Bush presented Cliburn with the Presidential Medal of Freedom — the nation's highest civilian honor — in 2003. In 2004, he received the Order of Friendship of the Russian Federation from Russian President Vladimir Putin.

"I still have lots of friends in Russia," Cliburn said at the time. "It's always a great pleasure to talk to older people in Russia, to hear their anecdotes."

After the death of his father in 1974, Cliburn announced he would soon retire to spend more time with his ailing mother. He stopped touring in 1978.

He told The New York Times in 2008 that among other things, touring robbed him of the chance to enjoy opera and other musical performances. "I said to myself, 'Life is too short.' I was missing so much," he said. After winning the competition, he added, "it was thrilling to be wanted. But it was pressure too."

Cliburn emerged from his sabbatical in 1987, when he played at a state dinner at the White House during the historic visit to Washington of Soviet leader Mikhail Gorbachev. Gorbachev leapt from his seat to give the pianist a bear-hug and kisses on the cheeks.

The 13th Cliburn competition, held in 2009, made history when a blind pianist from Japan, Nobuyuki Tsujii, and a teenager from China, Haochen Zhang, both won gold medals. They were the first winners from any Asian country, and Tsujii was the first blind pianist to win. And it was only the second time there were dual first place winners.

Cliburn was born Harvey Lavan Cliburn Jr. on July 12, 1934, in Shreveport, La., the son of oilman Harvey Cliburn Sr. and Rildia Bee O'Bryan Cliburn. At age 3, he began studying piano with his mother, herself an accomplished pianist who had studied with a pupil of the great 19th century Hungarian pianist Franz Liszt.

The family moved back to Kilgore, Texas, within a few years of his birth.

Cliburn won his first Texas competition when he was 12, and two years later he played in Carnegie Hall as the winner of the National Music Festival Award.

At 17, Cliburn attended the Juilliard School in New York, where fellow students marveled at his marathon practice sessions that stretched until 3 a.m. He studied under the famed Russian-born pianist Rosina Lhevinne.

Between 1952 and 1958, he won all but one competition he entered, including the G.B. Dealey Award from the Dallas Symphony, the Kosciusko Foundation Chopin Scholarship and the prestigious Leventritt. By age 20, he had played with the New York Philharmonic and the symphonies of most major cities.

Cliburn's career seemed ready to take off until his name came up for the draft. Cliburn had to cancel all shows but was eventually excused from duty due to chronic nosebleeds.

Over the next few years, Cliburn's international popularity continued as he recorded pieces ranging from Mozart to a concerto by American Edward McDowell. Still, having been trained by arguably the best Russian teachers in the world, Cliburn's heart was Russian, with the Tchaikovsky and Rachmaninoff concertos.

After 1990, Cliburn toured Japan numerous times and performed throughout the United States. He was in the midst of a 16-city U.S. tour in 1994 when his mother died at age 97.

Cliburn made his home in Fort Worth, where in 1998 he appeared at the opening of the Nancy Lee and Perry R. Bass Performance Hall, both in recital and as soloist with the Fort Worth Symphony Orchestra. He endowed scholarships at many schools, including Juilliard, which gave him an honorary doctorate, and the Moscow and Leningrad Conservatories.

In December 2001, Cliburn was presented with the prestigious Kennedy Center Honors Medallion at the televised tribute held in Washington.

Until only recently, Cliburn practiced daily and performed limited engagements.

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Online:

Van Cliburn Foundation: http://www.cliburn.org

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