The New Old Age Blog: The Reluctant Caregiver

Now and then, I refer to the people that caregivers tend to as “loved ones.” And whenever I do, a woman in Southern California tells me, I set her teeth on edge.

She visits her mother-in-law, runs errands, helps with the paperwork — all tasks she has shouldered with a grim sense of duty.  She doesn’t have much affection for this increasingly frail 90something or enjoy her company; her efforts bring no emotional reward. Her husband, an only child, feels nearly as detached. His mother wasn’t abusive, a completely different scenario, but they were never very close.

Ms. A., as I’ll call her because her mother-in-law reads The Times on her computer, feels miserable about this. “She says she appreciates us, she’s counting on us. She thanks us,” Ms. A. said of her non-loved one. “It makes me feel worse, because I feel guilty.”

She has performed many services for her mother-in-law, who lives in a retirement community, “but I really didn’t want to. I know how grudging it was.”

Call her the Reluctant Caregiver. She and her husband didn’t invite his parents to follow them to the small city where they settled to take jobs. The elders did anyway, and as long as they stayed healthy and active, both couples maintained their own lives. Now that her mother-in-law is widowed and needy, Ms. A feels trapped.

Ashamed, too. She knows lots of adult children work much harder at caregiving yet see it as a privilege. For her, it is mere drudgery. “I don’t feel there’s anybody I can say that to,” she told me — except a friend in Phoenix and, anonymously, to us.

The friend, therapist Randy Weiss, has served as both a reluctant caregiver to her mother, who died very recently at 86, and a willing caregiver to her childless aunt, living in an assisted living dementia unit at 82. Spending time with each of them made Ms. Weiss conscious of the distinction.

Her visits involved many of the same activities, “but it feels very different,” she said. “I feel the appreciation from my aunt, even if she’s much less able to verbalize it.” A cherished confidante since adolescence, her aunt breaks into smiles when Ms. Weiss arrives and exclaims over every small gift, even a doughnut. She worked in the music industry for decades and, despite her memory loss, happily sings along with the jazz CDs Ms. Weiss brings.

Because she had no such connection with her mother, whom Ms. Weiss described as distant and critical, “it’s harder to do what I have to do,” she said. (We spoke before her mother’s death.) “One is an obligation I fulfill out of duty. One is done with love.”

Unlike her friend Ms. A, “I don’t feel guilty that I don’t feel warmly towards my mother,” Ms. Weiss said. “I’ve made my peace.”

Let’s acknowledge that at times almost every caregiver knows exhaustion, anger and resentment.  But to me, reluctant caregivers probably deserve more credit than most. They are not getting any of the good stuff back, no warmth or laughter, little tenderness, sometimes not even gratitude.

Yet they are doing this tough work anyway, usually because no one else can or will. Maybe an early death or a divorce means that the person who would ordinarily have provided care can’t. Or maybe the reluctant caregiver is simply the one who can’t walk away.

“It’s important to acknowledge that every relationship doesn’t come from ‘The Cosby Show,’” said Barbara Moscowitz when I called to ask her about reluctance. Ms. Moscowitz, a senior geriatric social worker at Massachusetts General Hospital, has heard many such tales from caregivers in her clinical practice and support groups.

“We need to allow people to be reluctant,” she said. “It means they’re dutiful; they’re responsible. Those are admirable qualities.”

Yet, she recognizes, “they feel oppressed by the platitudes. ‘Your mother is so lucky to have you!’” Such praise just makes people like Ms. A. squirm.

Ms. Moscowitz also worries about reluctant caregivers, and urges them to find support groups where they can say the supposedly unsay-able, and to sign up early for community services — hotlines, senior centers, day programs, meals on wheels — that can help lighten the load.

“Caregiving only goes one way – it gets harder, more complex,” she said. “Support groups and community resources are like having a first aid kit. It’s going to feel like even more of a burden, and you need to be armed.”

I wonder, too, if reluctant caregivers have a romanticized view of what the task is like for everyone else. Elder care can be a wonderful experience, satisfying and meaningful, but guilt and resentment are also standard parts of the job description, at least occasionally.

For a reluctant caregiver, “the satisfaction is, you haven’t turned your back,” Ms. Moscowitz said. “You can take pride in that.”

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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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DealBook: Court Gives Investor an Edge in a Lawsuit Against Apple

7:47 p.m. | Updated

In the battle between Apple and the hedge fund manager David Einhorn, score a point for the billionaire who is taking up the mantle of shareholder advocate.

A federal judge said on Tuesday that he was leaning toward Mr. Einhorn’s contention that Apple had violated securities regulations by bundling several shareholder proposals into one matter.

A lawsuit by Mr. Einhorn’s Greenlight Capital, filed this month in Federal District Court in Manhattan, argues that Apple improperly grouped a vote to eliminate the company’s ability to issue preferred stock at will with other initiatives that Mr. Einhorn supports.

While the judge overseeing the case, Richard J. Sullivan, did not immediately grant Mr. Einhorn’s request for a halt to the vote, he said that the facts of the case favored the investor’s interpretation.

“I think success on the merits lies with Greenlight,” Judge Sullivan said at the end of a nearly two-hour hearing. Earlier in the hearing, he implied that he believed Securities and Exchange Commission rules prohibited the bundling of disparate shareholder initiatives.

Spokesmen for Greenlight and Apple declined to comment after the hearing.

Though a small point in the skirmish between Apple and Mr. Einhorn, the judge’s comments may provide some ballast to the hedge fund manager’s call to other investors. Mr. Einhorn’s bigger goal is to persuade Apple to return some of its $137 billion cash trove to shareholders.

He has asked Apple to issue preferred shares, which would pay out billions of dollars in dividends over time. His lawsuit revolves around the technology giant’s proposal to eliminate “blank check” preferred shares that the company can issue without a shareholder vote. He argues that the company improperly bundled the plan with two other corporate governance changes that he supports.

Apple has said that it will consider Mr. Einhorn’s request, but that it has no plans to amend the shareholder proposal.

Judge Sullivan is expected to decide within days whether to grant a preliminary injunction, given the Feb. 27 cutoff for voting on Apple’s shareholder proposals.

A lawyer for Mr. Einhorn, Mitchell P. Hurley of the firm Akin Gump, argued during Tuesday’s hearing that his client would suffer “irreparable harm” if the vote were allowed to proceed, because he would be forced to vote against two matters he would ordinarily support.

During questioning, however, Judge Sullivan expressed skepticism about the need to take immediate action.

A lawyer for Apple, George Riley of O’Melveny & Myers, said in court that if shareholders approved the disputed initiative, the company would wait for the judge to rule before adopting the new measures in its corporate charter.

Judge Sullivan also questioned why Mr. Einhorn had waited so long to act. He filed suit on Feb. 6, over a month after Apple first disclosed its shareholder proxy.

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Civilian deaths in war in Afghanistan drop for first time in 6 years

KABUL, Afghanistan -- Civilian deaths in the war in Afghanistan dropped in 2012 for the first time in six years, a sign of lessening hostilities, but insurgents dramatically expanded their campaign of assassinating government supporters, the United Nations said Tuesday.

The annual U.N. report on civilian casualties in Afghanistan documented a 12% decline in civilian deaths, largely due to fewer ground operations, new limits on airstrikes by U.S.-led coalition forces and fewer suicide bombings by insurgents. Coalition operations resulted in 39% fewer civilian deaths, the report said.

A harsh winter that limited combat operations and insurgent movements also contributed to the drop in casualties as the 11-year conflict shifts to a new phase in which foreign forces step back and Afghan soldiers and police, who possess less deadly weapons, are almost entirely in the lead.

In all, 2,754 civilians died in the war last year, bringing the death toll to 14,728 since 2007, when the U.N. began tracking civilian casualties.

But the report said that targeted killings -- attacks against government employees, tribal and religious leaders and Afghans involved in peace efforts -- resulted in more than twice as many deaths and injuries in 2012, in part because Taliban-led insurgents increased their use of homemade bombs that spread damage over a wider area.

U.N. officials said they were particularly disturbed by a seven-fold increase in casualties among government workers, including the murders of the two top officials in the women’s affairs department in Laghman province, east of Kabul.

"Steep increases in the deliberate targeting of civilians perceived to be supporting the government demonstrates another grave violation of international humanitarian law," Jan Kubis, the U.N. special envoy to Afghanistan, said in a statement. He said the Taliban leaders’ promises to protect civilians so far amounted to "only words."

Insurgents were responsible for 81% of civilian casualties last year, compared to 72% in 2011, the report said, with improvised bombs being the single deadliest weapon.

Civilian deaths and injuries from operations by U.S.-led international forces and Afghan soldiers and police fell by 46%, the U.N. said, due largely to new restrictions by coalition commanders on airstrikes on residential dwellings.

Still, a NATO airstrike last week in eastern Kunar province reportedly killed 10 civilians in addition to four Taliban commanders, provoking fresh ire from President Hamid Karzai. The Afghan leader on Monday ordered his country’s security forces "not to request foreign airstrikes on residential areas" – a move that could further reduce civilian deaths but also hinder Afghan forces that have no air power of their own.

Marine Gen. Joseph F. Dunford, the coalition commander, said this week that his forces would comply with Karzai's order and could continue to operate effectively. The order does not apply to unilateral NATO operations, but experts say that in practice it could give U.S. forces cover for stepping back even further from combat operations as the Obama administration seeks to withdraw half of the remaining 66,000 American troops from Afghanistan by next February.

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Watch a Robot Interview <em>Portlandia'</em>s Fred Armisen

Here at Wired we don’t fear losing our jobs to robots – in fact, we advocate for it.

So when Fred Armisen stopped by the Wired office after the SF Sketchfest tribute to his Peabody Award-winning show Portlandia, we decided to let our robot Rob-EE do the talking. Armisen and Rob-EE even had a heart-to-android-heart. Rob-EE also managed to get some dirt about Armisen’s thoughts on the end of 30 Rock, working on both Portlandia and Saturday Night Live, and the very-prescient subject of a robot’s right to comedy.

“Hopefully there will be a day when all comedy is all robots,” Armisen says. “There should be comedians who perform only for robots – I’m saying human comedians that only perform for robots.”

Find out what else happened when Rob-EE sat down with Armisen in the video above. Portlandia airs Fridays at 10 p.m./9 p.m. Central on IFC.

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National Briefing | South: Abortion Curbs Clear Senate in Arkansas

The State Senate voted 25 to 7 on Monday to ban most abortions 20 weeks into a pregnancy. The measure goes back to the House to consider an amendment that added exceptions for rape and incest. The legislation is based on the belief that fetuses can feel pain 20 weeks into a pregnancy, and is similar to bans in several other states. Opponents say it would require mothers to deliver babies with fatal conditions. Gov. Mike Beebe has said he has constitutional concerns about the proposal but has not said whether he will veto it.

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DealBook: Prosecutors, Shifting Strategy, Build New Wall Street Cases

Criticized for letting Wall Street off the hook after the financial crisis, the Justice Department is building a new model for prosecuting big banks.

In a recent round of actions that shook the financial industry, the government pushed for guilty pleas, rather than just the usual fines and reforms. Prosecutors now aim to apply the approach broadly to financial fraud cases, according to officials involved in the investigations.

Lawyers for several big banks, who spoke on the condition of anonymity, said they were already adjusting their defenses and urging banks to fire employees suspected of wrongdoing in the hope of appeasing authorities.

But critics question whether the new strategy amounts to a symbolic reprimand rather than a sweeping rebuke. So far, the Justice Department has extracted guilty pleas only from remote subsidiaries of big foreign banks, a move that has inflicted reputational damage but little else.

The new strategy first materialized in recent settlements with UBS and the Royal Bank of Scotland, which were accused of manipulating interest rates to bolster profit. As part of a broader deal, the banks’ Japanese subsidiaries pleaded guilty to felony wire fraud.

The settlements present a significant shift. Authorities have long avoided guilty pleas over fears they will destroy the banks and imperil the broader economy. By going after a subsidiary, prosecutors shield the parent company from losing its license, but still send a warning to the financial industry.

The Justice Department plans to continue the campaign as it pursues guilty pleas from other bank subsidiaries suspected of reporting false interest rates, according to the prosecutors and the lawyers who requested anonymity to discuss the cases. Authorities are scrutinizing Citigroup, whose Japanese unit is suspected of rate manipulation, and prosecutors recently accused one former trader there of colluding with other banks in a vast rate-rigging conspiracy.

Prosecutors want the rate-rigging investigation to serve as a template for other financial fraud cases. Two officials, who spoke on condition of anonymity, described a plan to eventually wring an admission of guilt from an entire bank.

“This Department of Justice will continue to hold financial institutions that break the law criminally responsible,” Lanny A. Breuer, the departing head of the agency’s criminal division, said in an interview.

The strategy will face significant roadblocks.

For one, banking regulators are likely to sound alarms about the economy. HSBC avoided charges in a money laundering case last year after concerns arose that an indictment could put the bank out of business. In the first interest rate-rigging case, prosecutors briefly considered criminal charges against an arm of Barclays, but they hesitated given the bank’s cooperation and its importance to the financial system, two people close to the case said.

The Justice Department will also face resistance from Wall Street. In meetings with authorities, banks are trying to distinguish their activities from the bad behavior at UBS and Barclays, according to the industry lawyers. One lawyer who represents Deutsche Bank acknowledged that Wall Street was girding for battle over the push for guilty pleas.

Some lawyers posit that the new approach amounts to a government shakedown, because institutions may plead guilty to dodge an indictment. “I think it’s a step in the wrong direction,” said James R. Copland, the director of the Center for Legal Policy at the Manhattan Institute.

Complicating matters, lawmakers and consumer advocates will continue to complain that banks get off too easily. In the rate manipulation cases, critics have clamored for more potent penalties, seeking convictions against parent companies.

The problems “should provide motivation to prosecutors, regulators and Congress to do more to ensure that this type of behavior is stopped, and that banks and their executives who manipulate markets are held accountable,” said Senator Carl Levin, Democrat of Michigan.

Critics point to the UBS case. Before UBS signed the deal, Japanese authorities assured the bank that a guilty plea would not cost the subsidiary its license, a person involved in the case said. While the case has weighed on the stock price, the subsidiary is operating normally and clients have stayed put, according to people with direct knowledge of the case.

Prosecutors defend their effort, saying it was born from painful experiences over the last decade.

After Arthur Andersen was convicted in 2002, the accounting firm went out of business, taking 28,000 jobs with it. The Supreme Court later overturned the case, prompting the government to alter its approach.

Prosecutors then turned to deferred-prosecution agreements, which suspend charges against corporations in exchange for certain concessions and a promise to behave. But the Justice Department took heat for prosecuting few top bank executives after the financial crisis. A recent “Frontline” documentary portrayed prosecutors as Wall Street apologists.

So the government is seeking a balanced approach, aiming to hold banks accountable without shutting them down. Prosecutors consulted federal policies that required them to weigh action with “collateral consequences” like job losses. Mr. Breuer also collected input from staff, including the head of his fraud unit, Denis J. McInerney, a former defense lawyer who represented Arthur Andersen.

Mr. Breuer eventually deployed a strategy built on guilty pleas for subsidiaries. He imported the model, in part, from his foreign bribery actions and pharmaceutical cases.

“Extracting a guilty plea from a wholly owned subsidiary finally enables the Justice Department to look tough on financial institutions while sparing them from the corporate death penalty,” said Evan T. Barr, a former federal prosecutor who now defends white-collar cases as a partner at Steptoe & Johnson.

As the Arthur Andersen cases fades from memory, some prosecutors say their new approach will lay the groundwork for parent companies to plead guilty.

But first, officials say, they are testing the strategy in the interest rate-rigging case. Authorities suspect that more than a dozen banks falsified reports to influence benchmark interest rates like the London interbank offered rate, or Libor, which underpins the costs for trillions of dollars in financial products like mortgages and credit cards.

Prosecutors focused on Japanese units because e-mail traffic exposed how traders there had routinely manipulated rates to increase profits, officials say. The units also have few ties to American arms of the banks, containing any threat to the economy.

After the Barclays case, authorities shifted to UBS, given the scope of the evidence and the bank’s past brushes with authorities, according to officials. The bank’s Japanese subsidiary was also a hub of rate-rigging activity. “The Justice Department had a clear view on the past of this institution,” said one executive who met with government officials.

Along with paying $1.5 billion in fines, the bank agreed to bolster its controls and have its Japanese unit plead guilty. It was the first big global bank subsidiary to plead guilty in more than two decades.

The Royal Bank of Scotland met a similar fate. The bank’s conduct was less severe than the actions of UBS, but it too had a rogue Japanese subsidiary. The bank announced a $612 million settlement with authorities this month, including a guilty plea in Japan.

Using the settlements as a template, prosecutors are building cases against other banks ensnared in the investigation, people involved in the case said, and guilty pleas are likely. Deutsche Bank is expected to settle with authorities by late 2013, the people said.

Citigroup and JPMorgan Chase, two American banks under scrutiny, pose a thornier challenge. So far, authorities have flexed their newfound muscle with foreign banks.

American regulators may warn that extending the campaign to Citigroup would threaten the company’s stock and prompt an exodus of clients. Japan’s regulators, some feeling upstaged by the recent actions, might raise similar concerns. Citigroup’s lawyers will also push back, people involved in the case said, citing the bank’s cooperation with investigators and emphasizing that wrongdoing never reached upper levels of management. The bank fired the trader recently charged by the Justice Department.

Authorities could counter that Citigroup’s Japanese unit is a repeat offender. It butted heads with Japanese regulators three times over the last decade.

“This is hard-nosed negotiation,” said Samuel W. Buell, a former prosecutor who is now a professor at Duke Law School. “It’s a game of chicken.”

Mark Scott contributed reporting from London and Hiroko Tabuchi from Tokyo.

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Mary Jo White could face conflicts of interest as SEC chairwoman

NEW YORK — As a lawyer in private practice, Mary Jo White worked for Wall Street all-stars: banking giant JPMorgan Chase & Co., auditor Deloitte & Touche, former Bank of America Corp. chief Ken Lewis.

White, President Obama's pick to lead the U.S. Securities and Exchange Commission, even did legal work for former Goldman Sachs Group Inc. director Rajat Gupta, the highest-profile catch in the federal government's crackdown on insider trading, according to disclosures White filed ahead of her U.S. Senate confirmation hearing.

If she wins approval to lead the country's top financial watchdog, government ethics rules could force White to sit out of some SEC decisions. Potential conflicts of interest — or the appearances of conflicts — could arise from her work at the high-powered New York law firm Debevoise & Plimpton, and that of her husband John White, a partner at the prestigious firm Cravath, Swaine & Moore.

Obama's appointment of White, a former U.S. attorney in Manhattan known for high-profile prosecutions of mobsters and terrorists, was seen as a signal the administration was getting tougher on Wall Street. Her confirmation hearing in the Senate has not yet been scheduled but is expected in the next several weeks.

"She would have quite a minefield to navigate," said Robert Kelner, an attorney who is an expert in government ethics rules at the law firm Covington & Burling in Washington. "But this is not unusual for a senior-level appointee coming out of a law firm."

White could have to abstain from votes on matters involving former clients at a time when the SEC has been struggling to regain investor confidence among regulators and financial markets.

Government ethics rules generally prevent commissioners from participating in matters in which they or their spouses have any financial stake, or have any interest that could raise questions about their impartiality, Kelner said.

These rules generally restrict commissioners from taking part in cases they worked on while in the private sector — whether to bring a securities fraud lawsuit against a former client, for example, Kelner said.

White could still be involved in other matters dealing with former clients, just as long as she hasn't previously worked on the other side of particular cases before the SEC, Kelner said.

What could also complicate White's tenure at the SEC is an ethics pledge Obama has required executive-branch appointees to sign since he took office.

Aiming to limit the effects of the "revolving door" between government officials and the private sectors they regulate, the ethics pledge precludes appointees from participating in any matter involving "specific parties that is directly and substantially related" to their "former employer or former clients." Kelner said the pledge generally would not apply to broad regulations or policies.

The White House could grant White a waiver from the ethics pledge.

White did not respond to an email request for comment. Nominees typically do not speak publicly ahead of their confirmation hearings.

White would take over the SEC at a time when the agency faces major regulatory issues, aside from enforcement issues. The five-member commission, under former Chairwoman Mary Schapiro, failed to pass a sweeping overhaul of money-market funds, which federal officials say remain a weak link in the financial system.

Also before the SEC are rules governing high-speed stock trading and how the increasingly fragmented stock market is structured. The agency still must mete out myriad regulations called for by the Dodd-Frank financial overhaul of 2010.

John Coffee, a securities law expert at Columbia University in New York, said White has no apparent conflicts involving the marquee regulatory matters facing the SEC.

"There is just a forest of bayonets waiting out there if she looked like she was protecting a former client from an enforcement action," Coffee said. "I think she's also too smart to put herself in that kind of position."

andrew.tangel@latimes.com

Times staff writer Jim Puzzanghera in Washington contributed to this report.

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Pondering the Point of Snow Bikes While Riding With Wolves

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Well: Health Effects of Smoking for Women

The title of a recent report on smoking and health might well have paraphrased the popular ad campaign for Virginia Slims, introduced in 1968 by Philip Morris and aimed at young professional women: “You’ve come a long way, baby.”

Today that slogan should include: “…toward a shorter life.” Ten years shorter, in fact.

The new report is one of two rather shocking analyses of the hazards of smoking and the benefits of quitting published last month in The New England Journal of Medicine. The data show that “women who smoke like men die like men who smoke,” Dr. Steven A. Schroeder, a professor of health and health care at the University of California, San Francisco, wrote in an accompanying editorial.

That was not always the case. Half a century ago, the risk of death from lung cancer among men who smoked was five times higher than that among women smokers. But by the first decade of this century, that risk had equalized: for both men and women who smoked, the risk of death from lung cancer was 25 times greater than for nonsmokers, Dr. Michael J. Thun of the American Cancer Society and his colleagues reported.

Today, women who smoke are even more likely than men who smoke to die of lung cancer. According to a second study in the same journal, women smokers face a 17.8 times greater risk of dying of lung cancer than women who do not smoke; men who smoke are at 14.6 times greater risk to die of lung cancer than men who don’t. Women who smoke now face a risk of death from lung cancer that is 50 percent higher than the estimates reported in the 1980s, according to Dr. Prabhat Jha of the Center for Global Health Research in Toronto and his colleagues.

After controlling for age, body weight, education level and alcohol use, the new analysis found something else: men and women who continue to smoke die on average 10 years sooner than those who never smoked.

Dramatic progress has been made in reducing the prevalence of smoking, which has fallen from 42 percent of adults in 1965 (the year after the first surgeon general’s report on smoking and health) to 19 percent in 2010. Yet smoking still results in nearly 200,000 deaths a year among people 35 to 69 years old in the United States. A quarter of all deaths in this age group would not occur if smokers had the same risk of death as nonsmokers.

The risks are even greater among men 55 to 74 and women 60 to 74. More than two-thirds of all deaths among current smokers in these age groups are related to smoking. Over all, the death rate from all causes combined in these age groups “is now at least three times as high among current smokers as among those who have never smoked,” Dr. Thun’s team found.

While lung cancer is the most infamous hazard linked to smoking, the habit also raises the risk of death from heart disease, stroke, pulmonary disease and other cancers, including breast cancer.

Furthermore, changes in how cigarettes are manufactured may have increased the dangers of smoking. The use of perforated filters, tobacco blends that are less irritating, and paper that is more porous made it easier to inhale smoke and encouraged deeper inhalation to achieve satisfying blood levels of nicotine.

The result of deeper inhalation, Dr. Thun’s report suggests, has been an increased risk of chronic obstructive pulmonary disease, or C.O.P.D., and a shift in the kind of lung cancer linked to smoking. Among nonsmokers, the risk of death from C.O.P.D. has declined by 45 percent in men and has remained stable in women, but the death rate has more than doubled among smokers.

But there is good news, too: it’s never too late to reap the benefits of quitting. The younger you are when you stop smoking, the greater your chances of living a long and healthy life, according to the findings of Dr. Jha’s international team.

The team analyzed smoking and smoking-cessation histories of 113,752 women and 88,496 men 25 and older and linked them to causes of deaths in these groups through 2006.

Those who quit smoking by age 34 lived 10 years longer on average than those who continued to smoke, giving them a life expectancy comparable to people who never smoked. Smokers who quit between ages 35 and 44 lived nine years longer, and those who quit between 45 and 54 lived six years longer. Even quitting smoking between ages 55 and 64 resulted in a four-year gain in life expectancy.

The researchers emphasized, however, that the numbers do not mean it is safe to smoke until age 40 and then stop. Former smokers who quit by 40 still experienced a 20 percent greater risk of death than nonsmokers. About one in six former smokers who died before the age of 80 would not have died if he or she had never smoked, they reported.

Dr. Schroeder believes we can do a lot better to reduce the prevalence of smoking with the tools currently in hand if government agencies, medical insurers and the public cooperate.

Unlike the races, ribbons and fund-raisers for breast cancer, “there’s no public face for lung cancer, even though it kills more women than breast cancer does,” Dr. Schroeder said in an interview. Lung cancer is stigmatized as a disease people bring on themselves, even though many older victims were hooked on nicotine in the 1940s and 1950s, when little was known about the hazards of smoking and doctors appeared in ads assuring the public it was safe to smoke.

Raising taxes on cigarettes can help. The states with the highest prevalence of smoking have the lowest tax rates on cigarettes, Dr. Schroeder said. Also helpful would be prohibiting smoking in more public places like parks and beaches. Some states have criminalized smoking in cars when children are present.

More “countermarketing” of cigarettes is needed, he said, including antismoking public service ads on television and dramatic health warnings on cigarette packs, as is now done in Australia. But two American courts have ruled that the proposed label warnings infringed on the tobacco industry’s right to free speech.

Health insurers, both private and government, could broaden their coverage of stop-smoking aids and better publicize telephone quit lines, and doctors “should do more to stimulate quit attempts,” Dr. Schroeder said.

As Nicola Roxon, a former Australian health minister, put it, “We are killing people by not acting.”

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Hollywood directs its star power toward a campaign closer to home

A stylish crowd waited beneath a flashing marquee outside the Fonda Theatre. "Appearing tonight!" the sign read. "Eric Garcetti 4 Mayor."

In a city where political campaigns are typically waged at neighborhood meetings, not Hollywood concert halls, last week's star-studded fundraiser for Garcetti highlighted the entertainment industry's outsized role in this year's mayoral race. Talk show host Jimmy Kimmel started the show with a stand-up routine and musician Moby got the crowd of several hundred dancing. Actress Amy Smart urged everyone to tweet about the campaign, and actor Will Ferrell beamed in via video to pledge that if Garcetti is elected, every resident in the city will receive free waffles.

Hollywood is taking to City Hall politics like never before, veterans say, with power players such as Steven Spielberg leading a major fundraising effort and celebrities such as Salma Hayek weighing in via YouTube. A Times analysis of city Ethics Commission records found that actors, producers, directors and others in the industry have donated more than $746,000 directly to candidates, with some $462,000 going to Garcetti and $226,000 to City Controller Wendy Greuel.

Several of Greuel's big-name celebrity supporters, including Tobey Maguire, Kate Hudson and Zooey Deschanel, recently hosted a fundraiser for her at an exclusive club on the Sunset Strip. She is getting extra help from Spielberg and his former partners at DreamWorks, Jeffrey Katzenberg and David Geffen, who have given at least $150,000 and are raising more for an independent group funding a TV ad blitz on her behalf.

The burst of support is coming from an industry often maligned for paying little attention to local politics.

While Mayor Antonio Villaraigosa is often photographed at red carpet events and former Mayor Tom Bradley was famously close to actor Gregory Peck, serious Hollywood money and star power has tended to remain tantalizingly out of reach for local politicians. "It's no secret that the entertainment industry has never really focused on the city that houses it," said Steve Soboroff, who ran for mayor and lost in 2001.

Political consultant Garry South, who has worked on mayoral and gubernatorial campaigns, recalled having to pay celebrities to appear at fundraisers in the past. Hollywood has long embraced candidates in presidential and congressional elections, South said, in part because they have more influence over causes favored by celebrities.

"The mayor of L.A. is not going to get us out of Afghanistan. The mayor of L.A. is not going to determine whether or not gay marriage is legal," South said. "The local issues are just not as sexy."

But this year, if you're a part of the Hollywood establishment, chances are you've gotten invitations to fundraisers for Greuel, Garcetti or both.

The difference this time is that both candidates have worked to cultivate deep Hollywood connections, observers say. Garcetti has represented Hollywood for 12 years, overseeing a development boom and presiding over ceremonies to add stars — Kimmel recently got one — on the Hollywood Walk of Fame. Greuel is a former executive at DreamWorks, where she worked with the moguls who founded the studio. She has also served for 10 years on the board of the California Film Commission.

City Councilwoman Jan Perry and entertainment attorney Kevin James have reaped far less financial support from the industry, records show, although each claims a share of celebrity endorsements. Dick Van Dyke sponsored a fundraiser for Perry and Oscar winner Dustin Lance Black has given to James.

Agent Feroz Taj, who attended Garcetti's Moby concert, said a flurry of activity around the race, involving friends and colleagues, piqued his interest. He said he's never been involved in a political campaign, but now when he receives invites to Greuel events, he says he is supporting Garcetti.

Industry insiders have been buzzing about a letter they say is being circulated by an advisor to Spielberg and Katzenberg, urging people to give $15,000 to an independent group supporting Greuel. The DreamWorks founders have made a difference for Greuel in previous elections. In 2002, financial support from the studio executives and their allies helped her squeak out a victory in one of the closest City Council races in history.

This time around, billionaire media mogul Haim Saban is getting involved, providing his Beverly Hills estate for a Greuel fundraiser featuring U.S. Sen. Barbara Boxer (D-Calif.). Greuel has also received contributions from Tom Hanks and actresses Mariska Hargitay and Eva Longoria, neither of whom have given to a local political campaign before, according to records.

Garcetti, on the other hand, has picked up contributions from former Disney Chief Executive Michael Eisner, as well as newcomers to local politics Jake Gyllenhaal and Hayek, who once traveled with Garcetti on a global warming awareness mission to the South Pole. The actress released a video endorsing Garcetti and thanking him for helping her find her wallet in the snow.

Campaign consultant Sean Clegg linked the industry's burgeoning interest in mayoral politics to President Obama's election, which he said had "a catalyzing effect on Hollywood." Indeed, many Greuel and Garcetti supporters were Obama backers. Hayek hosted a fundraiser for Obama and Longoria served as a co-chair of his reelection campaign.

Clegg is a consultant for Working Californians, an independent campaign committee that hopes to raise and spend at least $2 million supporting Greuel, with donations from Spielberg and others in Hollywood, as well as the union representing Department of Water and Power employees.

Generally, Clegg argued, Hollywood money is different than the special-interest funding campaigns collect. "Money is coming out of the entertainment industry more on belief and less on the transactional considerations," he said.

But Raphael Sonenshein, director of the Pat Brown Institute of Public Affairs at Cal State L.A., said Hollywood's new interest in local elections may be tied to growing concerns about film production being lured elsewhere by tax incentives.

Garcetti and Greuel have both pledged to reverse job losses tied to runaway television and film production, with Garcetti touting a recent proposal to eliminate roughly $231,000 in annual city fees charged for pilot episodes of new TV shows. The number of pilots shot locally has dropped 30% in recent years, but city budget analysts say the tax break would have a minimal effect because city fees represent only a small portion of production costs.

On the council, both candidates voted to eliminate filming fees at most city facilities. Greuel tells audiences she has an insider's perspective on the industry's needs and says she will create an "entertainment cabinet" to help it thrive. "I have sat with studio heads," she said in a recent interview. "They want a city . . . that is a champion for film industry jobs in Los Angeles."

Greuel may have Garcetti beat on experience in the studio front office, but he is the only candidate with his own page on IMDb.com — a closely watched industry website that tracks individuals' film and television credits.

The councilman, a member of the Screen Actors Guild, has made several television appearances, including one for the cable police drama "The Closer." He played the mayor of Los Angeles.

kate.linthicum@latimes.com

Times staff writer Maloy Moore contributed to this report.

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