Most Americans Face Lower Tax Burden Than in the 80s




What Is Fair?:
Taxes are still a hot topic after the presidential election. But as a country that spends more than it collects in taxes, are we asking the right taxpayers to pay the right amounts?







BELLEVILLE, Ill. — Alan Hicks divides long days between the insurance business he started in the late 1970s and the barbecue restaurant he opened with his sons three years ago. He earned more than $250,000 last year and said taxes took more than 40 percent. What’s worse, in his view, is that others — the wealthy, hiding in loopholes; the poor, living on government benefits — are not paying their fair share.








Kirsten Luce for The New York Times

"I don't have the answer of where to pull back. I want the state parks to stay open. I want, I want, I want. I want Big Bird, I think it's beautiful. What don't I want? I don't know," said Anita Thole, a safety supervisor for a utility contractor.






“It feels like the harder we work, the more they take from us,” said Mr. Hicks, 55, as he waited for a meat truck one recent afternoon. “And it seems like there’s an awful lot of people in the United States who don’t pay any taxes.”


These are common sentiments in the eastern suburbs of St. Louis, a region of fading factory towns fringed by new subdivisions. Here, as across the country, people like Mr. Hicks are pained by the conviction that they are paying ever more to finance the expansion of government.


But in fact, most Americans in 2010 paid far less in total taxes — federal, state and local — than they would have paid 30 years ago. According to an analysis by The New York Times, the combination of all income taxes, sales taxes and property taxes took a smaller share of their income than it took from households with the same inflation-adjusted income in 1980.


Households earning more than $200,000 benefited from the largest percentage declines in total taxation as a share of income. Middle-income households benefited, too. More than 85 percent of households with earnings above $25,000 paid less in total taxes than comparable households in 1980.


Lower-income households, however, saved little or nothing. Many pay no federal income taxes, but they do pay a range of other levies, like federal payroll taxes, state sales taxes and local property taxes. Only about half of taxpaying households with incomes below $25,000 paid less in 2010.


The uneven decline is a result of two trends. Congress cut federal taxation at every income level over the last 30 years. State and local taxes, meanwhile, increased for most Americans. Those taxes generally take a larger share of income from those who make less, so the increases offset more and more of the federal savings at lower levels of income.


In a half-dozen states, including Connecticut, Florida and New Jersey, the increases were large enough to offset the federal savings for most households, not just the poorer ones.


Now an era of tax cuts may be reaching its end. The federal government depends increasingly on borrowed money to pay its bills, and many state and local governments are similarly confronting the reality that they are spending more money than they collect. In Washington, debates about tax cuts have yielded to debates about who should pay more.


President Obama campaigned for re-election on a promise to take a larger share of taxable income above roughly $250,000 a year. The White House is now negotiating with Congressional Republicans, who instead want to raise some money by reducing tax deductions. Federal spending cuts also are at issue.


If a deal is not struck by year’s end, a wide range of federal tax cuts passed since 2000 will expire and taxes will rise for roughly 90 percent of Americans, according to the independent Tax Policy Center. For lower-income households, taxation would spike well above 1980 levels. Upper-income households would lose some but not all of the benefits of tax cuts over the last three decades.


Public debate over taxes has typically focused on the federal income tax, but that now accounts for less than a third of the total tax revenues collected by federal, state and local governments. To analyze the total burden, The Times created a model, in consultation with experts, which estimated total tax bills for each taxpayer in each year from 1980, when the election of President Ronald Reagan opened an era of tax cutting, up to 2010, the most recent year for which relevant data is available.


The analysis shows that the overall burden of taxation declined as a share of income in the 1980s, rose to a new peak in the 1990s and fell again in the 2000s. Tax rates at most income levels were lower in 2010 than at any point during the 1980s.


Governments still collected the same share of total income in 2010 as in 1980 — 31 cents from every dollar — because people with higher incomes pay taxes at higher rates, and household incomes rose over the last three decades, particularly at the top.


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Powerball's $580-million-plus jackpot inspires wishes, dreamers









Don't bother telling Wednesday night's Powerball winners -- if there are any -- that a lottery is just a tax on those who flunked math. With a winning ticket in hand, or even just the dream of one, who cares if the odds against them exceeded 175 million to 1? 


Last-minute ticket-buying pushed the jackpot to nearly $580 million, which is how much a single winner would get if he or she took the money in annual payments over 30 years.  


The winning numbers: 5-16-22-23-29, and the Powerball:  06





Officials couldn't say immediately after the 8 p.m. drawing whether there were any winning tickets. But beforehand, officials had said there was a 75% chance that someone would win Wednesday night. 


No one had won since Oct. 6, causing the jackpot to roll over 16 times. It  grows at least $10 million every time no one wins, lottery officials said. 


To play Powerball, one must pick five unique numbers from 1 through 59, and a Powerball number from 1 through 35. The odds of winning are 1 in 175,223,510. 


Powerball tickets aren't sold in California, but some feverish residents reportedly drove or flew to one of 42 participating states  to buy a chance at a fortune. The District of Columbia and the U.S. Virgin Islands also participate. 


Maybe the next time the jackpot soars, out-of-state travel won't be necessary. On Thursday, the California State Lottery Commission is expected to adopt regulations to join the Powerball lottery. If so, California retailers could start selling the $2 tickets in April.


[Updated, 9:53 p.m., Nov. 28: An earlier version of this post said the jackpot would exceed $550 million.  Late Wednesday, the Associated Press reported, Powerball officials said it would be nearly $580 million.]


 ALSO:


Zig Ziglar dies at 86; motivational speaker inspired millions


Nanny, in hospital, pleads not guilty to murder of 2 children


Texas moves to seize polygamist Warren Jeffs' ranch compound 







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A Google-a-Day Puzzle for Nov. 29











Our good friends at Google run a daily puzzle challenge and asked us to help get them out to the geeky masses. Each day’s puzzle will task your googling skills a little more, leading you to Google mastery. Each morning at 12:01 a.m. Eastern time you’ll see a new puzzle posted here.


SPOILER WARNING:
We leave the comments on so people can work together to find the answer. As such, if you want to figure it out all by yourself, DON’T READ THE COMMENTS!


Also, with the knowledge that because others may publish their answers before you do, if you want to be able to search for information without accidentally seeing the answer somewhere, you can use the Google-a-Day site’s search tool, which will automatically filter out published answers, to give you a spoiler-free experience.


And now, without further ado, we give you…


TODAY’S PUZZLE:



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Ken is a husband and father from the San Francisco Bay Area, where he works as a civil engineer. He also wrote the NYT bestselling book "Geek Dad: Awesomely Geeky Projects for Dads and Kids to Share."

Read more by Ken Denmead

Follow @fitzwillie and @wiredgeekdad on Twitter.



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Cate Blanchett in negotiations for evil stepmother in Disney’s Cinderella film












LOS ANGELES (TheWrap.com) – Cate Blanchett is in negotiations to play the evil stepmother in Disney‘s re-imagining of the classic fairytale Cinderella, the “Untitled Cinderella Story,” an individual with knowledge of the situation told TheWrap.


Blanchett would be the first to be cast in the live-action film. It is being directed by Mark Romanek for the studio based on a script by Chris Weitz.












The film is being produced by Simon Kinberg, who is best-known for the “X-Men” series.


The feature was first set up at Disney in May 2010 based on a pitch by Aline Brosh McKenna (“Devil Wear Prada.”), who wrote the initial draft.


Disney set the project up in the wake of its success with “Alice in Wonderland,” an adaptation of the Lewis C. Carroll book that starred Johnny Depp.


Disney representatives could not be reached for comment.


Blanchett can next be seen on screen in “The Hobbit: An Unexpected Journey” on December 14. She was recently confirmed for George Clooney’s upcoming film “The Monuments Men.” She will also be seen in “The Hobbit: The Desolation of Smaug” and “The Hobbit: There and Back Again.”


Cinderella has been adapted for the big screen dozens of times. In Andy Tennant’s 1998 version “Ever After: A Cinderella Story,” Angelica Houston played the evil stepmother. In the TV movie “Cinderella” in 1997, the role was played by Bernadette Peters. Sigourney Weaver voiced the character in “Happily N’Ever After” in 2006. Disney‘s 1950 version featured Eleanor Audley in the voice role of Lady Tremaine, the wicked stepmother.


Movies News Headlines – Yahoo! News


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Phys Ed: Keeping Your Eye on the Ball

Recently, researchers in England set out to determine whether weekend golfers could improve their game through one of two approaches. Some were coached on individual swing technique, while others were instructed to gaze fixedly at the ball before putting. The researchers hoped to learn not only whether looking at the ball affects performance, but also whether where we look changes how we think and feel while in action.

Phys Ed

Gretchen Reynolds on the science of fitness.

Back in elementary school gym class, virtually all of us were taught to keep our eyes on the ball during sports. But a growing body of research suggests that, as adults, most of us have forgotten how to do this. When scientists in recent years have attached sophisticated, miniature gaze-tracking devices to the heads of golfers, soccer players, basketball free throw shooters, tennis players and even competitive sharpshooters, they have found that a majority are not actually looking where they believe they are looking or for as long as they think.

It has been less clear, though, whether a slightly wandering gaze really matters that much to those of us who are decidedly recreational athletes.

Which is in part why the British researchers had half of their group of 40 duffers practice putting technique, while the other half received instruction in a gaze-focusing technique known as “Quiet Eye” training.

Quiet Eye training, as the name suggests, is an attempt to get people to stop flicking their focus around so much. But “Quiet Eye training is not just about looking at the ball,” says Mark Wilson, who led the study, published in Psychophysiology, and is a senior lecturer in human movement science at the University of Exeter in England. “It is about looking at the ball for long enough to process aiming information.” It involves reminding players to first briefly sight toward the exact spot where they wish to send the ball, and then settle their eyes onto the ball and hold them there.

This tight focus on the ball, Dr. Wilson says, blunts distracting mental chatter and allows the brain “to process the aiming information you just gathered” and direct the body in the proper motions to get the ball where you wish it to go.

A quiet, focused eye, in other words, seems to encourage a quiet, focused mind, which then makes for more accurate putting.

And in fact, after Dr. Wilson had his golfing volunteers practice for hours on either specific aspects of stroke technique or on focusing their gaze and not worrying about technique, those who had worked on their gaze were more accurate than those who had fine-tuned their technique. Those trained to focus also had lower heart rates and less muscle twitchiness, indicating less performance anxiety.

Similar results have been reported among soccer penalty kickers, who, like golfers, need to precisely place a ball but have the added distraction of a peripatetic, obstructive goalie. Many players tend to glance at the goalie as they prepare to shoot. Their eyes are not quiet, and their aim is affected.

But in a study published last year in the journal Cognitive Processing, collegiate players who were instructed to look briefly toward one of the upper, far corners of the goal and then immediately back to the ball, ignoring the goalie, significantly improved their shooting accuracy and reduced by 50 percent the number of times the goalie blocked their try, compared to teammates who didn’t quiet their gaze.

It did not seem to matter, says Greg Wood, also of the University of Exeter, who led the study, that kickers were glancing briefly toward where they planned to shoot, potentially telegraphing their intentions to the goalie. “An accurate shot kicked with typical speed will reach the goal in approximately 400 milliseconds, leaving the goalie with insufficient processing and response time,” he says. Players needn’t disguise intent if their aim is true.

Of course, merely keeping your eye on the ball won’t induce it to roll or rise to the desired location if you employ miserable technique. No amount of laser-eyed focus will get one of my putts to land. But what is interesting about Quiet Eye-style training, Dr. Wilson says, is that it can allow recreational and novice athletes with rudimentary skills to progress rapidly.

Specifically, Dr. Wilson says, after having extensively studied just how the best golfers look, he now teaches novice golfers at his lab to “keep their gaze on the back of the ball, which is the contact point for the putter, for a brief period before starting the putting action” — long enough to, for instance, “say ‘back of the cup’ to themselves,” he says. The golfers are told to hold that position throughout the putting stroke and, he says, “importantly, after contact for a split second. I often ask golfers to rate the quality of their contact on the ball from 1 to 10, before they look up to see where the ball went.”

Inexperienced putters who followed these instructions improved much more rapidly, he says, than those who merely practiced putts repeatedly.

“It seems so obvious,” Dr. Wilson says. “It is almost too simple. People assume that they are doing all of this already. ‘You mean I should look at the ball?’ Duh!”

But, he concludes, “the fact is that many people do not look at the right place at the right time.”

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The Next War: In Federal Budget Cutting, F-35 Fighter Jet Is at Risk


Luke Sharrett for The New York Times


Vice Adm. David Venlet was named to lead the Joint Strike Fighter program in 2010 after problems had left it behind schedule and over budget.







LEXINGTON PARK, Md. — The Marine version of the F-35 Joint Strike Fighter, already more than a decade in the making, was facing a crucial question: Could the jet, which can soar well past the speed of sound, land at sea like a helicopter?






Luke Sharrett for The New York Times

An F-35B, the Marine Corps version of the Joint Strike Fighter.






On an October day last year, with Lt. Col. Fred Schenk at the controls, the plane glided toward a ship off the Atlantic coast and then, its engine rotating straight down, descended gently to the deck at seven feet a second.


There were cheers from the ship’s crew members, who “were all shaking my hands and smiling,” Colonel Schenk recalled.


The smooth landing helped save that model and breathed new life into the huge F-35 program, the most expensive weapons system in military history. But while Pentagon officials now say that the program is making progress, it begins its 12th year in development years behind schedule, troubled with technological flaws and facing concerns about its relatively short flight range as possible threats grow from Asia.


With a record price tag — potentially in the hundreds of billions of dollars — the jet is likely to become a target for budget cutters. Reining in military spending is on the table as President Obama and Republican leaders in Congress look for ways to avert a fiscal crisis. But no matter what kind of deal is reached in the next few weeks, military analysts expect the Pentagon budget to decline in the next decade as the war in Afghanistan ends and the military is required to do its part to reduce the federal debt.


Behind the scenes, the Pentagon and the F-35’s main contractor, Lockheed Martin, are engaged in a conflict of their own over the costs. The relationship “is the worst I’ve ever seen, and I’ve been in some bad ones,” Maj. Gen. Christopher Bogdan of the Air Force, a top program official, said in September. “I guarantee you: we will not succeed on this if we do not get past that.”


In a battle that is being fought on other military programs as well, the Pentagon has been pushing Lockheed to cut costs much faster while the company is fighting to hold onto a profit. “Lockheed has seemed to be focused on short-term business goals,” Frank Kendall, the Pentagon’s top weapons buyer, said this month. “And we’d like to see them focus more on execution of the program and successful delivery of the product.”


The F-35 was conceived as the Pentagon’s silver bullet in the sky — a state-of-the art aircraft that could be adapted to three branches of the military, with advances that would easily overcome the defenses of most foes. The radar-evading jets would not only dodge sophisticated antiaircraft missiles, but they would also give pilots a better picture of enemy threats while enabling allies, who want the planes, too, to fight more closely with American forces.


But the ambitious aircraft instead illustrates how the Pentagon can let huge and complex programs veer out of control and then have a hard time reining them in. The program nearly doubled in cost as Lockheed and the military’s own bureaucracy failed to deliver on the most basic promise of a three-in-one jet that would save taxpayers money and be served up speedily.


Lockheed has delivered 41 planes so far for testing and initial training, and Pentagon leaders are slowing purchases of the F-35 to fix the latest technical problems and reduce the immediate costs. A helmet for pilots that projects targeting data onto its visor is too jittery to count on. The tail-hook on the Navy jet has had trouble catching the arresting cable, meaning that version cannot yet land on carriers. And writing and testing the millions of lines of software needed by the jets is so daunting that General Bogdan said, “It scares the heck out of me.”


With all the delays — full production is not expected until 2019 — the military has spent billions to extend the lives of older fighters and buy more of them to fill the gap. At the same time, the cost to build each F-35 has risen to an average of $137 million from $69 million in 2001.


The jets would cost taxpayers $396 billion, including research and development, if the Pentagon sticks to its plan to build 2,443 by the late 2030s. That would be nearly four times as much as any other weapons system and two-thirds of the $589 billion the United States has spent on the war in Afghanistan. The military is also desperately trying to figure out how to reduce the long-term costs of operating the planes, now projected at $1.1 trillion.


“The plane is unaffordable,” said Winslow T. Wheeler, an analyst at the Project on Government Oversight, a nonprofit group in Washington.


Todd Harrison, an analyst at the Center for Strategic and Budgetary Assessments, a research group in Washington, said Pentagon officials had little choice but to push ahead, especially after already spending $65 billion on the fighter. “It is simultaneously too big to fail and too big to succeed,” he said. “The bottom line here is that they’ve crammed too much into the program. They were asking one fighter to do three different jobs, and they basically ended up with three different fighters.”


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Regents OK raise for new UC Berkeley chief









Despite strong opposition from Gov. Jerry Brown, the UC Board of Regents on Tuesday gave the incoming chancellor of UC Berkeley a $50,000 — or 11.4% — pay raise over the current campus head. The extra money will come from private donations, not state funds, the regents said.


Nicholas B. Dirks will be paid $486,000, which officials said is $14,000 less than his current salary as a high-ranking administrator at Columbia University.


Brown, who is a regent, described Dirks as an excellent choice but said he would not vote for the salary given the austerities that the state and the 10-campus UC system still face. The university must look for more efficient ways to teach and operate and "the leaders have to demonstrate that they are also sacrificing," Brown said.





The $50,000 increase, even though it won't come from public coffers, "does not fit within the spirit of servant leadership that I think will be required over the next few years," the governor said.


Brown also cited voters' recent approval of his Proposition 30 tax increase, which spared UC from deep budget cuts. During the campaign for the measure, the governor said, he promised voters that he would "use their funds judiciously and with prudence."


Brown, who rarely attended regents meetings before the election, has since become a dramatic presence and voice against UC status quo. Since last summer, he has criticized raises for Cal State executives and suggested that all public colleges promote less expensive insiders instead of shopping for high-priced "hired guns" from across the country.


Besides noting that Dirks will take a pay cut from being Columbia's executive vice president and dean of its arts and sciences faculty, UC leaders said his UC Berkeley salary will be much lower than that of leaders at many other prestigious public and private universities.


"I try to get the very best person I can in this job to navigate the university through some very complicated times," UC system President Mark G. Yudof said.


Yudof said he and Brown do not see "exactly eye to eye" on Dirks' pay, but Yudof said he and the governor agree on nearly all other issues, including efforts to keep tuition from rising.


The regents first debated the issue privately Tuesday in a telephone conference call linking those in Oakland, Sacramento and Los Angeles. After the call went public, three regents voted against the pay increase — Brown, Lt. Gov. Gavin Newsom and Charlene Zettel — and 11 others voted for it. All 14 voted to appoint Dirks.


State Sen. Leland Yee (D-San Francisco), a frequent UC critic, issued a statement suggesting that Dirks follow the example of Timothy P. White, who recently asked for a 10% pay cut from the salary paid his Cal State predecessor. Yee said he would reintroduce legislation to limit executive pay raises in public higher education.


When he starts at the 36,000-student UC Berkeley on June 1, Dirks will receive free campus housing, along with $121,700 in relocation fees paid out in installments over four years and other benefits.


An anthropologist and historian who is an expert on India and its British colonial era, he will succeed Robert J. Birgeneau, who has been Berkeley chancellor for eight years. Dirks' wife, Columbia history professor Janaki Bakhle, is expected to receive a faculty job at UC Berkeley, but officials said her hiring and any possible salary must be reviewed by faculty panels.


After his confirmation, Dirks, who is the son of a former UC Santa Cruz administrator, said he was grateful to lead "one of the greatest universities in the world" and said he would work to boost student financial aid and encourage interdisciplinary research and studies.


He thanked Brown and California voters for passing Proposition 30, which raises the state sales tax a quarter-cent over four years and the income tax on high earners over seven years. Dirks, 61, promised that he would carefully "steward the tax dollars that are being paid by the citizens of this great state."


The regents unanimously approved an annual $245,600 salary and housing for Jane Close Conoley, who will become acting chancellor at UC Riverside next month until a permanent one is hired. That salary is below the $325,000 pay of the current Riverside campus chief, White, who is leaving to become chancellor of the Cal State system. Conoley is now dean of UC Santa Barbara's Gervitz Graduate School of Education.


larry.gordon@latimes.com





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A Google-a-Day Puzzle for Nov. 28











Our good friends at Google run a daily puzzle challenge and asked us to help get them out to the geeky masses. Each day’s puzzle will task your googling skills a little more, leading you to Google mastery. Each morning at 12:01 a.m. Eastern time you’ll see a new puzzle posted here.


SPOILER WARNING:
We leave the comments on so people can work together to find the answer. As such, if you want to figure it out all by yourself, DON’T READ THE COMMENTS!


Also, with the knowledge that because others may publish their answers before you do, if you want to be able to search for information without accidentally seeing the answer somewhere, you can use the Google-a-Day site’s search tool, which will automatically filter out published answers, to give you a spoiler-free experience.


And now, without further ado, we give you…


TODAY’S PUZZLE:



Note: Ad-blocking software may prevent display of the puzzle widget.




Ken is a husband and father from the San Francisco Bay Area, where he works as a civil engineer. He also wrote the NYT bestselling book "Geek Dad: Awesomely Geeky Projects for Dads and Kids to Share."

Read more by Ken Denmead

Follow @fitzwillie and @wiredgeekdad on Twitter.



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Robbie Williams aims to seal solo legacy with tour












LONDON (Reuters) – Still famous as the in-again/out-again member of chart-topping boyband Take That, British singer Robbie Williams says it is time to get serious as a solo artist and prove his place at the top of the pop pile.


Williams told reporters on Monday he planned a 15-date European stadium tour kicking off in Manchester on June 19, 2013 and concluding in Tallinn, Estonia on August 20.












“I’m buzzing. I’m ready to go. I haven’t done a tour of this size since 2006,” he said in London.


“I think it’s legacy time, because I’m venturing into getting my handicap down at golf and all that business.


“I’m nearly 40, that’s what I’m trying to say. I want to go and seal my place in pop history and go off and deliver a tour of great magnitude while I still can.”


The 38-year-old in fact enjoyed major success after leaving Take That in 1995, producing a string of hit albums and singles including “Angels” and “Millennium” and signing a contract with EMI in 2002 reportedly worth tens of millions.


But by the time his 2006 album “Rudebox” came out followed by “Reality Killed the Video Star” in 2009, he was seen as a dwindling force in British pop who had failed to break the key U.S. market.


Williams rejoined Take That in 2010 and they recorded the hit album “Progress” before touring together in 2011, and the singer said the experience had helped give him confidence to tour large venues again as a solo artist.


“I just ran out of ideas and ran out of a bit of creativity and ran out of energy and did the textbook ‘burnt out’,” he said of the late 2000s.


“But I’ve been working really hard and I needed to do something else, and fortunately it came in the shape of my old band. A lot of demons were vanquished from the past. A lot of wrongs were put to rights.


“That tour last summer was just absolutely incredible. It kick-started my professional career.”


Earlier this month, Williams returned to the top of the album charts with “Take the Crown”.


Asked whether he would consider rejoining Take That again, he replied: “I haven’t officially left … What I do know is that … if we all remain healthy then I will definitely be a part of Take That at some point. It’s joyful being around them.”


Williams conceded it may be too early to talk about his legacy at 38, but added he wanted to “put my stamp down.


“The fact that 40 is looming plays on my mind more than it does on anybody else’s mind. Pop stars cease to be pop stars at 40 and start being old people singing, don’t they?


“There is a forum for a male solo star to get up there in stadiums and own the place and I want that to be me, so I’ve kind of been lethargic for the last couple of albums.”


Williams recently became a father, and said his daughter would accompany him on tour. Olly Murs, who rose to fame on “The X Factor” reality TV show, will support Williams on his tour.


(Reporting by Mike Collett-White, editing by Paul Casciato)


Music News Headlines – Yahoo! News


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Personal Health: Aiding the Doctor Who Feels Cancer's Toll

The woman was terminally ill with advanced cancer, and the oncologist who had been treating her for three years thought the next step might be to deliver chemotherapy directly to her brain. It was a risky treatment that he knew would not, could not, help her.

When Dr. Diane E. Meier asked what he thought the futile therapy would accomplish, the oncologist replied, “I don’t want Judy to think I’m abandoning her.”

In a recent interview, Dr. Meier said, “Most physicians have no other strategies, no other arrows in their quiver beyond administering tests and treatments.”

“To avoid feeling that they’ve abandoned their patients, doctors throw procedures at them,” she said.

Dr. Meier, a renowned expert on palliative care at Mount Sinai Medical Center in New York, was the keynote speaker this month at the Buddhist Contemplative Care Symposium, organized by the New York Zen Center for Contemplative Care and the Garrison Institute. She described contemplative care as “the discipline of being present, of listening before acting.”

“Counter to how the American medical system is structured, which pays for what gets done,” she said, “its approach is, ‘Don’t just do something, stand there.’ ”

But the idea is not to do just that. Rather, she said, the goal is to “restore the patient to the center of the enterprise.”

Under the Affordable Care Act, she said, unnecessary procedures may decline as more doctors are reimbursed for doing what is best for their patients over time, not just for administering tests and treatments. But more could be done if physicians were able to step away from the misperception that everything that can be done should be done.

Dr. Meier’s question prompted Judy’s oncologist to realize that what his patient needed most at the end of her life was not more chemotherapy, but for him to sit down with her, to promise to do his best to keep her comfortable and to be there for the rest of her days.

Occupational Distress

Patients and families may not realize it, but doctors who care for people with incurable illness, and especially the terminally ill, often suffer with their patients. Unable to cope with their own feelings of frustration, failure and helplessness, doctors may react with anger, abruptness and avoidance.

Visits may be reduced to a quick review of the medical chart, and phone calls may not be returned. Even though their doctors are still there, incurably ill patients may feel neglected and depressed, which can exacerbate illness and pain and even hasten death. Dr. Michael K. Kearney, a palliative care physician at Santa Barbara Cottage Hospital, told the Contemplative Care conference that doctors, especially those who care for terminally ill patients, are subject to two serious forms of occupational stress: burnout and compassion fatigue.

He described burnout as “the end stage of stresses between the individual and the work environment” that can result in emotional and physical exhaustion, a sense of detachment and a feeling of never being able to achieve one’s professional goals.

He likened compassion fatigue to “secondary post-traumatic stress disorder, or vicarious traumatization — trauma suffered when someone close to you is suffering.”

A doctor with compassion fatigue may avoid thoughts and feelings associated with a patient’s misery, become irritable and easily angered, and face physical and emotional distress when reminded of work with the dying. Compassion fatigue can lead to burnout.

In one study of 18 oncologists, published in 2008 in The Journal of Palliative Medicine, those who saw their role as both biomedical and psychosocial found end-of-life care very satisfying. But those “who described a primarily biomedical role reported a more distant relationship with the patient, a sense of failure at not being able to alter the course of the disease and an absence of collegial support,” the authors noted.

Healing the Healer

For doctors at risk of becoming overwhelmed by the stresses of their jobs, Dr. Kearney recommends adopting the time-honored Buddhist practice of “mindfulness meditation,” which involves cultivating mental techniques for stress reduction that are native to all of us but practiced by too few. He likened meditation to “learning to breathe underwater, or finding sources of renewal within work itself.”

To achieve it, a person sits quietly, paying attention to one’s breathing and whenever a distracting thought intrudes, turning one’s attention back to the sensation of breathing. This can help calm the mind and prepare it for a clearer perspective.

Dr. Kearney said this practice could help doctors “really pay attention and be tuned into their patients and what the patients are experiencing.”

“Patients, in turn,” he said, “experience a doctor who’s not just focused on a medical agenda but who really listens to them.”

He said mindfulness meditation helps doctors become more self-aware, empathetic and patient-focused, and to make fewer medical errors. It enables doctors to notice what is going on within themselves and to consider rational options instead of just reacting.

“It’s like pressing an internal pause button,” Dr. Kearney said. “The doctor is able to recognize he’s being stressed, and it prevents him from invoking the survival defense mechanisms of fight (‘Let’s do another course of chemotherapy’), flight (‘There’s nothing more I can do for you — I’ll go get the chaplain’) and freeze (the doctor goes blank and does nothing).” Such reactions can be highly distressing to a dying patient.

When a patient asks for the impossible, like “Promise me I’m not going to die,” the mindful doctor is more likely to step back and say, “I can promise you I’ll do everything I can to help you. I’m going to continue to care for you and support you as best as I can. I’ll be back to see you later today and again tomorrow,” Dr. Kearney said.

Although Dr. Kearney does mindfulness meditation for 30 minutes every morning, he said as little as 8 to 10 minutes a day has been shown helpful to practicing physicians.

In addition, doctors can factor moments of meditation into the course of the workday — say, while washing their hands, having a snack or coffee or pausing before entering the next patient room to focus on breathing.

To deal with the emotional flood that can come after a traumatic event, he suggested taking a brief timeout or calling on a friend or colleague to go for a walk.

This is the second of two columns about communication and cancer. Read the first: “When Treating Cancer Is Not an Option”

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