The New Old Age Blog: Is the Pope Frail?

White-haired at 85, Pope Benedict XVI looks a bit hunched in photos. He has had a pacemaker for years, the Vatican recently confirmed for the first time — an indicator of long-standing heart problems. His older brother has said that age is taking its toll.

Observers have noticed the pope’s reduced energy. The Times has reported that he was ferried to the altar at St. Peter’s for Midnight Mass Christmas Eve on a “wheeled platform,” then appeared to doze off during the service.

Visiting Mexico last year, he awoke at night and couldn’t locate a light switch in his room, then fell — such a familiar scenario for caregivers of old people — and bloodied his head when he hit the bathroom sink.

Beyond these few facts, we know very little about the health problems that have led Benedict to announce his retirement after his final audience on Wednesday. We don’t even really know if his flagging stamina — “the certainty that my strengths, due to an advanced age, are no longer suited to an adequate exercise” of leading the church, as he put it — was the true reason behind his resignation. But people have been describing him as tired and increasingly frail.

In geriatrics, “frailty” has a specific meaning: It’s a syndrome, a collection of physiological symptoms that drain people’s reserves, leaving them less able to withstand stressors — like a long trek through St. Peter’s Basilica or around a foreign country.

Geriatricians diagnose frailty when a patient meets three of five criteria: Unintentional weight loss of more than 10 pounds in the past year. Weakness, as measured by a test of handgrip strength. Self-reported exhaustion. Slowness, calculated by how long it takes to walk 15 feet. Low physical activity.

“You feel a sense of vulnerability,” said Linda Fried, dean of the Mailman School of Public Health at Columbia University and a leading frailty researcher for 20 years. With significantly lower energy, “It’s harder to push the envelope.”

Frailty’s prevalence increases with age, “from a tiny proportion of people in their 60s, about three percent, to up to a quarter or a third of people 85 and older,” Dr. Fried said. Doctors have learned to pay attention because of the unhappy consequences. “It’s strongly associated with higher mortality, as well as loss of mobility, falls and other kinds of disability,” she said.

Is Benedict frail? Certainly he is reporting that he is exhausted, but does he fit the other criteria? “The pope has probably never done a grip strength test,” said Ken Covinsky, a geriatrician at the University of California, San Francisco.

But the odds are high that he has health problems, even if they’re unacknowledged by Vatican spokesmen. In the United States, at least, nearly half of those over 65 have two or more chronic diseases, like diabetes, hypertension and emphysema. “It would be a rare 85-year-old with only one thing wrong with him,” Dr. Covinsky said.

And frailty is one of those conditions that indicate all is not well.

People often recognize frailty, even without data on walking speed. “I’ve tested it out myself over the years” when speaking to groups, Dr. Fried reported. “I ask people what they’re seeing, and there’s great consistency between the things they picture and what science has measured.”

Frail elders, people tell her, are thin (although overweight people can also be frail), weak, slow, fragile-looking. “The term people use is, they look like they could be knocked over by a feather,” she said.

So if observers in Vatican City say Benedict looks frail, well, maybe he is.

But I’m pursuing this subject not to ask experts to diagnose the pope from afar, but to point out that paying attention to frailty makes sense for the rest of us and our elders. It’s one of the conditions people can do something about.

In frailty’s early stages, “there’s great potential to reverse it or slow it,” Dr. Fried said. The key is exercise. “You have to walk and move, maintain strength and muscle mass,” she said. “We don’t have a drug to prescribe, but even if we did, there’s no question in my mind that exercise will always be the foundation.”

The pope has said that he plans to move into the Mater Ecclesiae convent within the Vatican once it’s renovated for him. We have to assume the nuns, and perhaps a couple of physical therapists, will provide excellent care there.

“Often, people with frailty can live a pretty good life with good home care and social support, and almost every country does better at that than the United States,” Dr. Covinsky said. Our lack of a workable, affordable system of long-term care for the elderly and disabled poses a national crisis.

This is where being a former pope — something that is so rare that it shocked the world — may be a good way to live out one’s days.

“In the U.S., he could get M.R.I.’s and all kinds of expensive tests,” Dr. Covinsky noted. “But Medicare won’t pay for a home health aide four hours a day.” Luckily, the Vatican probably will provide it.

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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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Deficit hawks' 'generational theft' argument is a sham

Here's a phrase you can expect to be hearing a lot in the national debate over fiscal policy, as we move past the "sequester," which is the crisis du jour, and toward the budget cliff/government shutdown deadline looming at the end of March:

"Generational theft."

The core idea the term expresses is that we're spending so much more on our seniors than our children that future generations are being cheated. An important corollary is that the government debt we incur today will come slamming down upon the shoulders of our children and grandchildren.

The generational theft trope has already been receiving a vigorous workout in the press. Earlier this month, the Washington Post gave great play to a study by the Urban Institute stating that the federal government spends $7 on the elderly for every dollar it spends on kids. As we shall see, this is true as far as it goes, but it doesn't go nearly far enough to render an accurate picture of government spending.

The National Journal, another influential publication in Washington, picked up the theme last week by observing that because the sequester exempts Social Security and Medicare from budget cuts, the automatic spending reductions it mandates will fall disproportionately on education and other such boons to the young. This will "deepen the budget's generational imbalance."

This is also a bedrock argument of the anti-deficit organizations, such as Fix the Debt, associated with hedge fund billionaire Peter G. Peterson. For decades he has pursued a wearisome and spectacularly self-interested campaign to cut Social Security and Medicare benefits for the working class so taxes won't go up too much on the wealthy.

One of those organizations, called "The Can Kicks Back," promotes a "Millennial-driven campaign to fix the national debt." But backstopping its twenty- and thirty-something leaders is an advisory board comprising such Peterson frontmen as Morgan Stanley board member Erskine Bowles and former Sen. Alan Simpson (R-Wyo.). These guys are "millennials" only if we're talking about the last millennium before this one.

So here's the truth about the "generational theft" theme: It's wrong on the numbers and wrong on the implications.

Let's start with that 7-to-1 spending ratio on seniors versus children. Among the flaws in the calculation is that the vast majority of government dollars spent on children comes from state and local governments, which pay most of the cost of education. On a per capita basis, state and local spending on kids swamps the federal government's spending 8 to 1.

Moreover, there are twice as many children 18 and under as seniors 65 and over (this 2008 figure also comes from the Urban Institute report). Put the numbers together and you discover that spending by governments at all levels in 2008 came to about $1 trillion on seniors and $936 billion on children. In other words, very close to 1 to 1.

The notion underlying the comparison of spending on seniors and children is that "if you save a dollar on Social Security it would be transferred automatically to children," observes Theodore R. Marmor, an emeritus professor of public policy at Yale and a long-term student of social welfare programs. He traces this notion to deficit hawks and dismisses it as "not naive, but cynical."

That's because most of the spending on seniors is in Social Security and Medicare, and therefore has been largely paid for by those very beneficiaries over the course of their working lives.

Payroll taxes have more than covered what today's average retiree will receive back from Social Security. They won't cover the average payout on Medicare, but that's an artifact of uncontrolled healthcare costs, not of the structure of Medicare itself. Changing the terms of that program, say by raising the eligibility age (currently 65) won't save money and may actually raise costs.

In other ways, treating Social Security and Medicare spending on the one hand and spending on kids on the other as though they're opposite sides of a zero-sum game is just an act of ideological legerdemain aimed at undermining those programs.

If America wants to spend more on children, it's plenty rich enough to do so without eating away at the income of their grandparents. The money can come from the defense budget, farm supports or dozens of other places, even higher income taxes.

Let's not forget, too, that the people who will really suffer from gutting Social Security won't be today's seniors, who will escape the worst of the cutbacks — they'll be today's young people, for whom Social Security would become much less supportive when they retire.

What about the debt load we're supposedly imposing on future generations? This is another transparently Petersonian feat of sleight of hand, based on the assertion that while it's we who incur the debt, it's our children who will have to pay if off.

All the hand-wringing over today's borrowing conveniently assumes that the debt buys nothing, which makes it easier for debt hawks to pretend that it's only an expense and not an investment.

But money borrowed for the stimulus has bought jobs and unemployment benefits, which have helped sustain families through the Great Recession. (At least a few of those families have children, wouldn't you guess?)

In a larger sense, money borrowed by every generation is typically invested in programs and infrastructure — highway, schools, research and conservation, for example — that will add to future generations' wealth.

It's the persistence of the "generational theft" claim, which bubbles up every few years, that exposes its ideological roots.

It's a fundamental piece of a decades-long campaign to distract Americans into thinking that the threat to their way of life comes from a war of old against young, rather than an intra-generational class war in which the vast majority of economic gains from improvements in worker's productivity has flowed to the wealthy, not to the workers.

The economist Dean Baker observes, for example, if the federal hourly minimum wage had merely kept up with productivity growth after 1969 rather than stagnating (and getting eaten away by inflation) it would be more than $16.54, and we wouldn't be arguing about whether the country can "afford" an increase to $9.

The "generational theft" argument is a sham. It's an attempt to get around the fact, so distasteful to the enemies of government social programs, that Social Security and Medicare are hugely popular. As Marmor observes, if you can't put across the case that these programs are undesirable, "you have to make them look uncontrollable, ungovernable, and therefore unaffordable."

The argument has been tried out on several generations in the past, and they've seen through it. Today's generation should see through it too.

Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.

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Mike Piazza softens stance on Dodgers' Vin Scully

PHOENIX—

— Calling Vin Scully "a class act" and saying he had "the utmost respect" for him, Mike Piazza on Monday defended what he wrote in his recently released autobiography about the Hall of Fame broadcaster.

In his book, "Long Shot," Piazza described Scully as instrumental in turning the fans of Los Angeles against him during the contract stalemate that led to his trade to the Florida Marlins in 1998. Piazza wrote that Scully "was crushing me" on the air, a charge Scully vehemently denied.

"I can't say that I have regrets," Piazza said. "I was just trying to explain the situation."

The former All-Star catcher was at the Dodgers' spring-training facility with Italy's World Baseball Classic team, for which he is a coach. Scully was also at the complex, to call the Dodgers' 7-6 victory over the Chicago Cubs.

"I'd love to see him," Piazza said.

The two didn't meet.

"I always liked him," Scully said. "I admired him. I think either he made a mistake or got some bad advice. I still think of him as a great player and I hope he gets into the Hall of Fame. I really do. Whatever disappointment I feel, I'll put aside."

Scully declined to comment further on Piazza or his book.

Piazza complimented Scully as he tried to defend what he wrote.

"Vin is a class act; he's an icon," Piazza said. "To this day, I have the utmost respect for him. But the problem is, you have to go back in time and understand that at that point in time in my career with the Dodgers was a very tumultuous time. I was more or less telling my version of the story, at least what I was experiencing. And I said at the end of the book, it's not coming from a place of malice or anger. I think anybody who remembers that time knows it was a very tumultuous time."

Piazza said his intent wasn't to blame Scully.

"I don't think anybody who read the passage from start to finish felt that way," Piazza said. "Anybody who reads it knows it wasn't me blaming. That was definitely not the only factor. There were other factors. The team made the mistake, I made the mistake, of speaking publicly."

Piazza acknowledged that he never heard Scully's broadcasts and that his impressions of them were based on what he heard from others.

"My perception was that he was given the Dodgers' versions of the negotiations, which, I feel, wasn't 100% accurate," Piazza said.

In his book, Piazza also took issue with how Scully asked him about his contract demands during a spring-training interview. Piazza said Monday that he was "taken aback" by the line of questioning because he previously hadn't talked publicly about the negotiations.

To reach the practice fields at Camelback Ranch on Monday, Piazza had to pass through a gantlet of Dodgers fans. Piazza said he wasn't nervous.

"I did a book signing a couple of weeks ago in Pasadena and the fans were really nice," he said.

Piazza denied that he hadn't returned to Dodger Stadium in recent years out of fear of being booed, as Tom Lasorda told The Times last month.

Piazza said he always associated the Dodgers with the O'Malley family, which sold the team to News Corp. in 1998.

"Since then, obviously, they've taken on a different identity," Piazza said.

Piazza was noncommittal about visiting the ballpark in the future. "We'll see," he said. "I'll never say never."

Wouldn't it be harder to return now that his portrayal of Scully has upset fans?

"I don't know," he said. "I can't answer that."

Piazza also spoke about falling short of being elected to the Hall of Fame in his first year of eligibility.

"I definitely couldn't lie and say I wasn't a little disappointed," he said.

He is hopeful he will one day be inducted. "I trust the process," he said.

Piazza wouldn't say whether he thought Barry Bonds and Roger Clemens deserved to be in the Hall of Fame. Both players, who have been linked to performance-enhancing drugs, also were denied election.

Piazza has denied using performance-enhancing drugs and has never faced detailed allegations that he did. Asked if he was upset that the indiscretions of others might have altered others' perceptions of him, he replied, "Unfortunately, that's the way life is sometimes. I can't control and worry about what people think."

dylan.hernandez@latimes.com

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Singer Morrissey says no to Kimmel, 'Duck Dynasty'

LOS ANGELES (AP) — The TV series "Duck Dynasty" is coming between Morrissey and Jimmy Kimmel.

The singer and animal rights activist says he canceled his appearance Tuesday on ABC's "Jimmy Kimmel Live" because "Duck Dynasty" cast members will be on the talk show.

Morrissey says he can't perform on a show with what he called people who "amount to animal serial killers."

A&E's "Duck Dynasty" reality show follows a Louisiana family with a business selling duck calls and decoys.

A&E did not immediately respond to requests for comment from it and the Robertson family.

A person familiar with the Kimmel show's plans confirmed that Morrissey was to appear. The person lacked authority to discuss the matter publicly and spoke on condition of anonymity.

The person says Morrissey's performance will be rescheduled.

ABC says the Churchill band will perform Tuesday on Kimmel's show but declined comment on the switch.

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Reach AP Television Writer Lynn Elber at http://www.twitter.com/lynnelber .

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Horse Meat in European Beef Raises Questions on U.S. Exposure

The alarm in Europe over the discovery of horse meat in beef products escalated again Monday, when the Swedish furniture giant Ikea withdrew an estimated 1,670 pounds of meatballs from sale in 14 European countries.

Ikea acted after authorities in the Czech Republic detected horse meat in its meatballs. The company said it had made the decision even though its tests two weeks ago did not detect horse DNA.

Horse meat mixed with beef was first found last month in Ireland, then Britain, and has now expanded steadily across the Continent. The situation in Europe has created unease among American consumers over whether horse meat might also find its way into the food supply in the United States. Here are answers to commonly asked questions on the subject.

Has horse meat been found in any meatballs sold in Ikea stores in the United States?

Ikea says there is no horse meat in the meatballs it sells in the United States. The company issued a statement on Monday saying meatballs sold in its 38 stores in the United States were bought from an American supplier and contained beef and pork from animals raised in the United States and Canada.

“We do not tolerate any other ingredients than the ones stipulated in our recipes or specifications, secured through set standards, certifications and product analysis by accredited laboratories,” Ikea said in its statement.

Mona Liss, a spokeswoman for Ikea, said by e-mail that all of the businesses that supply meat to its meatball maker  issue letters guaranteeing that they will not misbrand or adulterate their products. “Additionally, as an abundance of caution, we are in the process of DNA-testing our meatballs,” Ms. Liss wrote. “Results should be concluded in 30 days.”

Does the United States import any beef from countries where horse meat has been found?

No. According to the Department of Agriculture, the United States imports no beef from any of the European countries involved in the scandal. Brian K. Mabry, a spokesman for the department’s Food Safety and Inspection Service, said: “Following a decision by Congress in November 2011 to lift the ban on horse slaughter, two establishments, one located in New Mexico and one in Missouri, have applied for a grant of inspection exclusively for equine slaughter. The Food Safety and Inspection Service (F.S.I.S.) is currently reviewing those applications.”

Has horse meat been found in ground meat products sold in the United States?

No. Meat products sold in the United States must pass Department of Agriculture inspections, whether produced domestically or imported. No government financing has been available for inspection of horse meat for human consumption in the United States since 2005, when the Humane Society of the United States got a rider forbidding financing for inspection of horse meat inserted in the annual appropriations bill for the Agriculture Department. Without inspection, such plants may not operate legally.

The rider was attached to every subsequent agriculture appropriations bill until 2011, when it was left out of an omnibus spending bill signed by President Obama on Nov. 18. The U.S.D.A.  has not committed any money for the inspection of horse meat.

“We’re real close to getting some processing plants up and running, but there are no inspectors because the U.S.D.A. is working on protocols,” said Dave Duquette, a horse trader in Oregon and president of United Horsemen, a small group that works to retrain and rehabilitate unwanted horses and advocates the slaughter of horses for meat. “We believe very strongly that the U.S.D.A. is going to bring inspectors online directly.”

Are horses slaughtered for meat for human consumption in the United States?

Not currently, although live horses from the United States are exported to slaughterhouses in Canada and Mexico. The lack of inspection effectively ended the slaughter of horse meat for human consumption in the United States; 2007 was the last year horses were slaughtered in the United States. At the time financing of inspections was banned, a Belgian company operated three horse meat processing plants — in Fort Worth and Kaufman, Tex., and DeKalb, Ill. — but exported the meat it produced in them.

Since 2011, efforts have been made to re-establish the processing of horse meat for human consumption in the United States. A small plant in Roswell, N.M., which used to process beef cattle into meat has been retooled to slaughter 20 to 25 horses a day. But legal challenges have prevented it from opening, Mr. Duquette said. Gov. Susana Martinez of New Mexico opposes opening the plant and has asked the U.S.D.A. to block it.

Last month, the two houses of the Oklahoma Legislature passed separate bills to override a law against the slaughter of horses for meat but kept the law’s ban on consumption of such meat by state residents. California, Illinois, New Jersey, Tennessee and Texas prohibit horse slaughter for human consumption.

Is there a market for horse meat in the United States?

Mr. Duquette said horse meat was popular among several growing demographic groups in the United States, including Tongans, Mongolians and various Hispanic populations. He said he knew of at least 10 restaurants that wanted to buy horse meat. “People are very polarized on this issue,” he said. Wayne Pacelle, chief executive of the Humane Society of the United States, disagreed, saying demand in the United States was limited. Italy is the largest consumer of horse meat, he said, followed by France and Belgium.

Is horse meat safe to eat?

That is a matter of much debate between proponents and opponents of horse meat consumption. Mr. Duquette said that horse meat, some derived from American animals processed abroad, was eaten widely around the world without health problems. “It’s high in protein, low in fat and has a whole lot of omega 3s,” he said.

The Humane Society says that because horse meat is not consumed in the United States, the animals’ flesh is likely to contain residues of many drugs that are unsafe for humans to eat. The organization’s list of drugs given to horses runs to 29 pages.

“We’ve been warning the Europeans about this for years,” Mr. Pacelle said. “You have all these food safety standards in Europe — they do not import chicken carcasses from the U.S. because they are bathed in chlorine, and won’t take pork because of the use of ractopamine in our industry — but you’ve thrown out the book when it comes to importing horse meat from North America.”

The society has filed petitions with the Department of Agriculture and Food and Drug Administration, arguing that they should test horse meat before allowing it to be marketed in the United States for humans to eat.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

An earlier version of this article misstated how many pounds of meatballs Ikea was withdrawing from sale in 14 European countries. It is 1,670 pounds, not 1.67 billion pounds.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

An earlier version of this article misstated the last year that horses were slaughtered in the United States. It is 2007, not 2006.

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Coordinated healthcare could save California $110 billion, group says

California could cut $110 billion in healthcare spending over the next decade, saving the average household $800 a year, by quickly moving away from conventional fee-for-service medicine and embracing more coordinated care, a new report says.

These findings released Tuesday come from the Berkeley Forum, a new group of healthcare executives, state officials and academics that studied California's healthcare market for the last year in hopes of finding ways to make care better and more affordable. The main recommendations are not entirely new, and these shifts are already underway in response to the federal healthcare law and pressure from employers to tame runaway medical costs.

But the group's report does quantify how much work remains to be done and the potential savings if major changes are made in how doctors and hospitals are paid. Health-policy experts at UC Berkeley convened this group, which included high-ranking executives from Kaiser Permanente, Anthem Blue Cross, Cedars-Sinai Medical Center and other industry players.

"This could be a game changer in the state," said Stephen Shortell, dean of the School of Public Health at UC Berkeley and a coauthor of the report. "These are the CEOs of big insurers, big health systems and large medical groups saying it's time for a change, and these are the people who can get things done."

The Berkeley Forum calls for a major shift toward "global budgets," in which physicians and hospitals provide care under preset amounts that are adjusted to reflect the health of their patients. These payments would also be tied to providers' performance on several quality measures.

This is similar to the "capitated" payments managed-care companies and HMOs have used for years in California. HMOs already cover 44% of California's population, which is about double the nationwide rate.

Despite that high penetration, the report's authors found that 78% of the state's healthcare costs, or about $245 billion annually, are still paid through fee-for-service arrangements, which can encourage medical providers to perform unnecessary tests and procedures. The report calls for reducing the share of fee-for-service payments to 50% by 2022.

The Berkeley Forum also says California should double the share of the state's population receiving integrated care from medical providers to 60% within the next decade. The most visible example of integrated care in California is Kaiser Permanente, the Oakland nonprofit that coordinates care across its hospitals and physician groups.

Other health insurers, hospitals and doctors are collaborating in similar ways through accountable-care organizations, medical homes and other initiatives that have strong backing from Medicare. Shortell acknowledged that there are "legitimate concerns" about this integration leading to higher prices as hospitals, clinics and physician groups rapidly consolidate.

The $110 billion in healthcare savings targeted by the group would amount to 2.5% of overall spending of $4.4 trillion over 10 years in California, according to the report. Those savings would mean an extra $800 annually for every California household.

Overall, the report found that 53% of the state's healthcare dollars are spent on just 5% of the population, illustrating the high cost of treating certain chronically ill patients.

Pam Kehaly, president of Anthem Blue Cross in California, said this industrywide collaboration "puts us on a path to improving the ailing California healthcare system."

chad.terhune@latimes.com

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Oscars 2013: An 'Argo' night at Academy Awards

For the second straight year, the movie business fell for itself.

"Argo" — in which a Hollywood producer and makeup artist help engineer the rescue of six Americans from Iran — won the top prize at the 85th Academy Awards, one year after the silent film story "The Artist" took the best picture Oscar.

"I never thought I'd be back here. And I am," producer-director Ben Affleck said in accepting the best picture trophy Sunday night, 15 years after he won an original screenplay Oscar for "Good Will Hunting" and then saw his career fall into a tailspin that included "Gigli" and "Daredevil."

FULL COVERAGE: Oscars 2013 | Winners

"It doesn't matter how you get knocked down in life. That's going to happen," said Affleck, who wasn't nominated for directing "Argo," one of nine films in the best picture race. "All that matters is that you've got to get up."

"Argo," which became the first movie to win best picture without its director being nominated since 1989's "Driving Miss Daisy," collected two other Academy Awards, for editing and adapted screenplay. But it was not the evening's most recognized film: That honor went to Ang Lee's "Life of Pi," which won four Oscars — for directing, visual effects, cinematography and score.

"Thank you, movie god," said Lee, whose movie came into the evening with 11 nominations, one behind Steven Spielberg's "Lincoln." The film about the 16th president helped Daniel Day-Lewis make movie history, as he became the only man to ever win three lead actor statuettes. "Lincoln" won one other prize, for production design.

The song-and-dance heavy ceremony, hosted by Seth MacFarlane, hewed closely to a traditional awards show script, but there were several surprises. First Lady Michelle Obama, who joined the ABC telecast from the White House, announced "Argo" as the best picture. And the ceremony featured only the sixth tie in Oscar history and the first since 1994, with the sound editing award split between "Zero Dark Thirty" and "Skyfall." For the first time in Oscar history, six best picture nominees were $100-million blockbusters.

The ceremony was billed as a tribute to music in film, and boasted a number of extravagant musical numbers — including a medley of songs from movie musicals and an appearance by Barbra Streisand, who sang "The Way We Were." The telecast also paid homage to the long running James Bond series, with Adele singing the theme from "Skyfall" and Dame Shirley Bassey performing the theme from 1964's "Goldfinger."

Oscars 2013: Nominee list | Red carpet | Highlights

Jennifer Lawrence, 22, nabbed the lead actress prize for her role as an emotionally unstable widow in "Silver Linings Playbook" — and promptly tripped over her long dress walking up the stairs to accept her statuette. The crowd quickly gave her a standing ovation. "You guys are just standing up because you feel bad that I fell and that's embarrassing," Lawrence said to the applauding crowd at the Dolby Theatre.

The evening's very first award — for supporting actor — was a shocker, with long shot Christoph Waltz winning for his role as bounty hunter Dr. King Schultz in Quentin Tarantino's "Django Unchained" over favored contenders Robert De Niro ("Silver Linings Playbook") and Tommy Lee Jones ("Lincoln"). Waltz, who won the same award three years ago for Tarantino's "Inglourious Basterds," dedicated his prize to his writer-director, who also won the Oscar for original screenplay. "We participated in a hero's journey — the hero being Quentin," Waltz said.

Tarantino pulled off a mild surprise with the screenplay triumph for his slave-revenge tale. He dedicated his award to his eclectic cast of actors. "I actually think if people know my movies 30-50 years from now it's because of the characters I create," Tarantino said.

Anne Hathaway's supporting actress win for her emotionally raw portrayal of a doomed seamstress in "Les Misérables" was hardly as startling. The 30-year-old had been the odds-on favorite to win since the film first screened for members of the Motion Picture Academy in late November. "It came true," she stage-whispered as she picked up her trophy for her performance, the centerpiece of which is the lament "I Dreamed a Dream."

Oscars 2013: Backstage | Quotes | Best & Worst moments

Some of the evening's wins were bittersweet.

The animated feature Oscar was shared by "Brave" directors Mark Andrews and Brenda Chapman, an unusual pairing given that Chapman was fired from the Pixar Animation Studios film and replaced by Andrews in the middle of production. "Making these are a struggle — it's a battle, it's a war," Andrews said backstage. "I was very happy it was him who took my place," Chapman said.

Rhythm & Hues Studios, the company behind "Life of Pi's" visual effects win, recently filed for bankruptcy and laid off hundreds of its employees. As Oscar winner Bill Westenhofer addressed the situation in his acceptance speech, he ran over time and the theme from "Jaws" began to play him off the stage. His microphone was cut off just as he said the words "I urge you all…"

William Goldenberg was a double nominee in the film editing category — he worked on both "Argo" and "Zero Dark Thirty" — and won the prize for Affleck's CIA drama.

"Working at my father's deli, I had to do a million things at one time," Goldenberg said backstage about the best training for his job. "It really does prepare you for the multitasking it takes to be in an editing room."

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‘Bloodless’ Lung Transplants for Jehovah’s Witnesses

Eric Kayne for The New York Times

SHARING HOME AND FAITH A Houston couple hosted Gene and Rebecca Tomczak, center, in October so she could get care nearby.

HOUSTON — Last April, after being told that only a transplant could save her from a fatal lung condition, Rebecca S. Tomczak began calling some of the top-ranked hospitals in the country.

She started with Emory University Hospital in Atlanta, just hours from her home near Augusta, Ga. Then she tried Duke and the University of Arkansas and Johns Hopkins. Each advised Ms. Tomczak, then 69, to look somewhere else.

The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.

Given the complexities of lung transplantation, in which transfusions are routine, some doctors felt the procedure posed unacceptable dangers. Others could not get past the ethics of it all. With more than 1,600 desperately ill people waiting for a donated lung, was it appropriate to give one to a woman who might needlessly sacrifice her life and the organ along with it?

By the time Ms. Tomczak found Dr. Scott A. Scheinin at The Methodist Hospital in Houston last spring, he had long since made peace with such quandaries. Like a number of physicians, he had become persuaded by a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases.

By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it. The way he saw it, patients declined lifesaving therapies all the time, for all manner of reasons, and it was not his place to deny care just because those reasons were sometimes religious or unconventional.

“At the end of the day,” he had resolved, “if you agree to take care of these patients, you agree to do it on their terms.”

Ms. Tomczak’s case — the 11th so-called bloodless lung transplant attempted at Methodist over three years — would become the latest test of an innovative approach that was developed to accommodate the unique beliefs of the world’s eight million Jehovah’s Witnesses but may soon become standard practice for all surgical patients.

Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.

Ms. Tomczak had dismissed the prospect of a transplant for most of the two years she had struggled with sarcoidosis, a progressive condition of unknown cause that leads to scarring in the lungs. The illness forced her to quit a part-time job with Nielsen, the market research firm.

Then in April, on a trip to the South Carolina coast, she found that she was too breathless to join her frolicking grandchildren on the beach. Tethered to an oxygen tank, she watched from the boardwalk, growing sad and angry and then determined to reclaim her health.

“I wanted to be around and be a part of their lives,” Ms. Tomczak recalled, dabbing at tears.

She knew there was danger in refusing to take blood. But she thought the greater peril would come from offending God.

“I know,” she said, “that if I did anything that violates Jehovah’s law, I would not make it into the new system, where he’s going to make earth into a paradise. I know there are risks. But I think I am covered.”

Cutting Risks, and Costs

The approach Dr. Scheinin would use — originally called “bloodless medicine” but later re-branded as “patient blood management” — has been around for decades. His mentor at Methodist, Dr. Denton A. Cooley, the renowned cardiac pioneer, performed heart surgery on hundreds of Witnesses starting in the late 1950s. The first bloodless lung transplant, at Johns Hopkins, was in 1996.

But nearly 17 years later, the degree of difficulty for such procedures remains so high that Dr. Scheinin and his team are among the very few willing to attempt them.

In 2009, after analyzing Methodist’s own data, Dr. Scheinin became convinced that if he selected patients carefully, he could perform lung transplants without transfusions. Hospital administrators resisted at first, knowing that even small numbers of deaths could bring scrutiny from federal regulators.

“My job is to push risk away,” said Dr. A. Osama Gaber, the hospital’s director of transplantation, “so I wasn’t really excited about it. But the numbers were very convincing.”

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Herbalife is global giant with business model in question

Stock spotlight is a new weekly feature that will profile a notable, public company.

The company: Herbalife Ltd.

Headquarters: Los Angeles

Ticker: HLF

Employees: 6,200 employees and 3.2 million independent distributors worldwide

Revenue: $4.1 billion in 2012

Net Income: $477 million in 2012

Stock Price: $36.79 at Friday's close

52-week range: $24.24 to $73

Annual dividend: $1.20 a share annually, a current yield of about 3%

P/E Ratio: $7.87, based on 2013 estimated earnings

The business: The company sells weight-loss, nutrition, hair- and skin-care products in more than 80 countries, utilizing independent distributors who profit from their own sales and sales from others they recruit into the business. Its top-selling product is cookies and cream flavor Formula 1, a high-protein, meal-replacement shake mix. Herbalife does very little mainstream advertising and does not sell products in retail stores. Instead it relies on a network of independent distributors who recruit customers, counsel them about nutrition and fitness and sell them products. The company recently agreed to a $44-million, 10-year deal to sponsor the Los Angeles Galaxy professional soccer team, one of many professional sports clubs it supports around the world.

The latest: Wall Street veterans say they've never seen a fight like this. Noted hedge fund managers Bill Ackman and Carl Icahn have engaged in a heated debate about Herbalife's business model, with billions of dollars at stake. Ackman has taken a $1-billion "short position" against the company's shares, meaning he'll profit if the stock price drops. In a slick, multimedia pitch on Wall Street, Ackman contended that the company is a well-disguised pyramid scheme. He said the vast majority of the company's independent distributors make little money or lose money, while a fortunate few get rich off commissions they receive for recruiting others into the business. Ackman said he expects Herbalife's shares to hit zero. Icahn said he has purchased nearly 13% of the company's shares and planned to talk to executives about strategies to increase its profitability, including taking it private. Herbalife acknowledged discussions with Icahn but did not elaborate. The company insists its business model is completely legal. Herbalife said it sells products that help people live healthy lives while giving entrepreneurs an opportunity to build their own businesses.

Accomplishments: The company reported record sales and profit in 2012 and said it expects things to improve in 2013. It has mountains of available cash, pays a decent dividend and repurchased 15 million — or more than 10% — of its shares in little more than a year.

Challenges: Herbalife shares have been extremely volatile in the last nine months, plunging more than 40% in the days after Ackman's attack, and falling 20% in a single day in May after hedge fund manager David Einhorn questioned the company's business model. Herbalife has acknowledged it is under review by the Securities and Exchange Commission. The Federal Trade Commission released dozens of complaints it has received about Herbalife in recent years. Neither agency has confirmed an investigation.

Analyst opinions: Seven analysts have the stock as a buy or strong buy, while four have it as hold. The average one-year target price is about $58 a share.

Voices: "Our belief remains steadfast that Herbalife operates a perfectly legal multilevel marketing model that has proven particularly efficacious in the weight-loss category.... Herbalife's sustained growth and 30-plus year history in a highly regulated industry indicate a legitimate business [because] pyramid schemes are unsustainable." — Scott Van Winkle, analyst, Canaccord Genuity;

"Buckle up, it's going to be bumpy.... We are maintaining our overweight, but recognize that the stock is not for the faint of heart. We expect Mr. Ackman to continue to make noise on his short thesis, however, and for the potential for an FTC investigation to be an overhang on the stock for the indefinite future." — Brian Wang, analyst, Barclays Capital;

"It is clear that over time Herbalife is answering the questions that need to be answered and providing greater clarity around their business model — one that we see as simple but effective. We think it logical that, as these questions are finally answered to the investment community's satisfaction, the shares will trade, finally to the premium valuation we believe it deserves. The scarlet letter it wears today in the minds of the short seller community will be removed." — Timothy Ramey, analyst, D.A. Davidson & Co.

stuart.pfeifer@latimes.com

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Paroled sex offenders disarming tracking devices

SACRAMENTO — Thousands of paroled child molesters, rapists and other high-risk sex offenders in California are removing or disarming their court-ordered GPS tracking devices — and some have been charged with new crimes including sexual battery, kidnapping and attempted manslaughter.

The offenders have discovered that they can disable the monitors, often with little risk of serving time for it, a Times investigation has found. The jails are too full to hold them.

"It's a huge problem," said Fresno parole agent Matt Hill. "If the public knew, they'd be shocked."

More than 3,400 arrest warrants for GPS tamperers have been issued since October 2011, when the state began referring parole violators to county jails instead of returning them to its packed prisons. Warrants increased 28% in 2012 compared to the 12 months before the change in custody began. Nearly all of the warrants were for sex offenders, who are the vast majority of convicts with monitors, and many were for repeat violations.

The custody shift is part of Gov. Jerry Brown and the legislature's "realignment" program, to comply with court orders to reduce overcrowding in state prisons. But many counties have been under their own court orders to ease crowding in their jails.

Some have freed parole violators within days, or even hours, of arrest rather than keep them in custody. Some have refused to accept them at all.

Before prison realignment took effect, sex offenders who breached parole remained behind bars, awaiting hearings that could send them back to prison for up to a year. Now, the maximum penalty is 180 days in jail, but many never serve that time.

With so little deterrent, parolees "certainly are feeling more bold," said Jack Wallace, an executive at the California Sex Offender Management Board.

Rithy Mam, a convicted child stalker, was arrested three times in two months after skipping parole and was freed almost immediately each time. After his third release, his GPS alarm went off and he vanished, law enforcement records show.

The next day, he turned up in a Stockton living room where a 15-year-old girl was asleep on the couch, police said. The girl told police she awoke to find the stranger staring at her and that he asked "Wanna date?" before leaving the home.

Police say Mam went back twice more that week and menaced the girl and her 13-year-old sister, getting in by giving candy to a toddler, before authorities recaptured him in a local park. He is in custody on new charges of child molestation.

Californians voted in 2006 to require that high-risk sex offenders be tracked for life with GPS monitors strapped to their bodies.

The devices are programmed to record offenders' movements and are intended, at least in part, to deter them from committing crimes. The devices, attached to rubber ankle straps embedded with fiber-optic cable, transmit signals monitored by a private contractor.

They are easy to cut off, but an alarm is triggered when that happens, as it is when they are interfered with in other ways or go dead, or when an offender enters a forbidden area such as a school zone or playground. The monitoring company alerts parole agents by text message or email.

Arrest warrants for GPS tamperers are automatically published online. The Times reviewed that data as well as thousands of jail logs, court documents and criminal histories provided by confidential sources. The records show that the way authorities handle violators can vary significantly by county.

San Bernardino County releases more inmates early from its cramped jails than any other county in California, according to state reports. But sex offenders who violate parole there generally serve their terms. A spokeswoman said the county closely reviews criminal histories, and those with past sex offenses are ineligible for early release.

By contrast, parole violators in San Joaquin County are often set free within a day of arrest.

A review of the county's jail logs shows that nine of the 15 sex offenders arrested for violating parole in December and January were let out within 24 hours, including seven who immediately tampered with their trackers and disappeared. One of the nine, a convicted rapist named Robert Stone, was arrested two weeks later on kidnapping charges and returned to jail, where he remains.

Raoul Leyva, a sex offender with a history of beating women, was arrested in April for fleeing parole and ordered to remain jailed for 100 days. He was out in 16 days and soon bolted again, after allowing the battery on his device to go dead, according to the documents reviewed by The Times.

Less than two weeks later, a drug dealer led police to a Stockton apartment where Leyva's girlfriend, 20-year-old Brandy Arreola, had lain for days on the floor, severely beaten and in a coma. Now brain damaged and confined to a wheelchair, Arreola spends her time watching cartoons.

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