Decision on gay conversion ban depends on other rulings

The fate of a new California law that would prohibit doctors and therapists from trying to change a minor's sexual orientation depends in part on rulings in other cases in which the government tried to restrict physicians' communications with their patients.

Will the law be viewed as similar to a federal policy that prevented doctors from recommending marijuana to their patients? If so, the law perishes. Or is California's ban on so-called conversion therapy akin to a regulation upheld by the Supreme Court that required doctors to tell patients about the possibly detrimental effects of abortion?

The dispute is before the U.S. 9th Circuit Court of Appeals, which is expected to decide within the next several days whether to put the law on hold before it takes effect Jan. 1. A ruling could take months.

The ban on trying to change a minor's sexual orientation, the first of its kind in the nation, has divided the lower courts. A federal judge in Sacramento appointed by President Obama found that the law did not violate free speech rights; her colleague, appointed by the first President Bush, concluded that it did.

Legal scholars also have conflicting assessments of whether the law will be overturned on 1st Amendment grounds.

UC Berkeley constitutional law scholar Jesse Choper said the law faces "a steep uphill battle" on free speech grounds.

"It is very hard to silence speech generally," Choper said.

But UC Irvine Law School Dean Erwin Chemerinsky said the law was constitutional because it banned an ineffective and harmful therapy.

Communications between professionals and their clients generally have less 1st Amendment protection than other forms of speech. A lawyer or doctor who negligently gives bad advice may be found liable for malpractice, and licensing requirements for professionals may be restrictive.

"The fact that it is speech doesn't immunize it from liability or punishment," Chemerinsky said.

California's law subjects doctors and therapists to discipline by their licensing boards for practicing the therapy known as "sexual orientation change efforts," or conversion therapy.

Treatments include psychoanalysis, behavioral therapy and religious and spiritual counseling. In the past, some licensed therapists have practiced aversion therapy, using nausea-inducing drugs to combat sexual impulses, and hormone treatments.

Therapists seeking to change a patient's orientation also have encouraged men to spend more time with heterosexuals, participate in sports and avoid members of the opposite sex, except for romantic contact.

One of the plaintiffs in the lawsuit now before the 9th Circuit is a 15-year-old boy who has been undergoing the therapy for 15 months.

Mathew Staver, the lead lawyer in that lawsuit, said the boy is receiving standard cognitive behavioral therapy. Shock treatment and aversion techniques are no longer used, he said.

"According to what I know, he has stopped experiencing same-sex attraction," said Staver, founder of Liberty Counsel, a nonprofit group that advocates for conservative Christian views.

Psychological efforts to change sexual orientation were once grounded in a 1952 classification of homosexuality as a mental disease in the Diagnostic and Statistical Manual of Mental Disorders.

But that classification was removed in 1973, and most psychological associations now recommend against the therapy, calling it ineffective and potentially harmful. A task force report by the American Psychological Assn. in 2009 said conversion therapy could trigger depression, suicide and substance abuse.

"Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality — in other words, they do not indicate either mental or developmental disorders," the report said.

It said that there was no study demonstrating that therapy affected sexual orientation of children and teenagers, and that the prospect of effecting an enduring change in a person's sexual orientation was "unlikely."

But the report also said research on the therapy was too sketchy to draw conclusions about safety and efficacy and noted that some people said they had benefited from the counseling.

Initially, the bill that created the law was opposed by the California Psychological Assn., California Assn. for Licensed Professional Clinic Counselors, California Psychiatric Assn. and California Assn. of Marriage and Family Therapists. After the bill was amended, the associations of psychologists and family therapists supported the bill and the others withdrew their opposition. Organizations with religious viewpoints continued to oppose it.

In one of two lawsuits filed to block the law, a group of therapists, minors and parents said the ban prevented even the mention of possible therapy to change an undesired sexual orientation. The state countered that the law banned only a therapy, not the discussion of ways to change sexual orientation or the ability to refer patients to out-of-state therapists who practice the methods.

U.S. District Judge Kimberly J. Mueller, ruling for the state, said the law prohibits a form of conduct — therapy that uses pain or discomfort to combat sexual arousal and efforts to alter thought patterns, including hypnosis.

"Plaintiffs in this case do not have a fundamental right to receive a therapy that California has deemed harmful and ineffective," Mueller wrote.

But in a similar lawsuit brought by two therapists and a man who underwent conversion therapy, U.S. District Judge William B. Shubb blocked the state from enforcing the law on the three plaintiffs.

"Protecting an individual's First Amendment rights outweighs the public's interest in rushing to enforce an unprecedented law," Shubb wrote.

maura.dolan@latimes.com

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Obama Walks a Fine Line With Egyptian President

Tara Todras-Whitehill for The New York Times

Egyptians opposed to President Mohamed Morsi prayed in Tahrir Square, Cairo, on Friday. More Photos »

CAIRO — Tanks and barbed wire had surrounded Egypt’s presidential palace and crowds of protesters were swarming around last week when President Obama placed a call to President Mohamed Morsi.

Mr. Morsi and his allies in the Muslim Brotherhood stood accused of  a sudden turn toward authoritarianism, as they fulminated about conspiracies, steamrollered over opponents, and sent their supporters into a confrontation with protesters the night before that call; the clash left seven people dead. But Mr. Obama did not reprimand Mr. Morsi, advisers to both leaders said.

Instead, a senior Obama administration official said, the American president sought to build on a growing rapport with his Egyptian counterpart, arguing to Mr. Morsi that it was in his own interest to offer his opposition compromises, in order to build trust in his government.

“These last two weeks have been concerning, of course, but we are still waiting to see,” said another senior administration official, speaking on the condition of anonymity to avoid aggravating relations with Egypt. “One thing we can say for Morsi is he was elected, so he has some legitimacy.” He noted that Mr. Morsi was elected with 51 percent of the vote.

As Egyptians vote Saturday on the draft constitution, the results may also render a verdict on Mr. Morsi’s ability to stabilize the country and the Obama administration’s bet that it can build a workable partnership with a government guided by the Brotherhood — a group the United States shunned for decades as a threat to Western values and interests.

White House officials say that as Egypt’s first democratically elected president, Mr. Morsi has a unique chance to build a credible democratic process with broad participation, which is the surest source of stability.

But critics of the Brotherhood have cited Mr. Morsi’s strong-arm push for the Islamist-backed charter as vindication of their argument that Islamist politics are fundamentally incompatible with tolerance, pluralism and the open debate essential to democracy. They say that his turn to authoritarianism has discredited the Obama administration’s two-year courtship of Egypt’s new Islamist leaders.

Some say they suspect the White House may envision the trade-off it offered to the ousted president, Hosni Mubarak: turning a blind eye to heavy-handed tactics so long as he continues to uphold the stability of American-backed regional order.

And by muting its criticism, the Obama administration shares some of the blame, said Michael Hanna, a researcher at the Century Foundation in New York and an Egyptian-American in Cairo for the vote. “Silence is acquiescence,” he said, adding about Mr. Morsi: “At some point if you are so heedless of the common good that you are ready to take the country to the brink and overlook bodies in the street, that is just not O.K.”

Mr. Obama’s advisers, though, say that in Egypt the dual goals of stability and democracy are aligned, because in the math of the revolution Egyptians will no longer accept the old autocracy.

As for Mr. Morsi, administration officials and other outside analysts argue that so far his missteps appear to be matters of tactics, not ideology, with only an indirect connection to his Islamist politics. “The problem with Morsi isn’t whether he is Islamist or not, it is whether he is authoritarian,” said a Western diplomat in Cairo, speaking on the condition of anonymity because of diplomatic protocol.

What is more, the leading opposition alternatives appeared no less authoritarian: Ahmed Shafik, who lost the presidential runoff, was a former Mubarak prime minister campaigning as a new strongman, and Hamdeen Sabahi, who narrowly missed the runoff, is a Nasserite who has talked of intervention by the military to unseat Mr. Morsi despite his election as president.

“The problem with ‘I told you so’ is the assumption that if things had turned out differently the outcome would be better, and I don’t see that,” the diplomat said, noting that the opposition to the draft constitution had hardly shown more respect than Mr. Morsi has for the norms of democracy or the rule of law. “There are no black hats and white hats here, there are no heroes and villains. Both sides are using underhanded tactics and both sides are using violence.”

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Principal Dawn Lafferty Hochsprung Was Loved By Kids: Friend

By Julia Haskins

12/14/2012 at 07:30 PM EST

Dawn Lafferty Hochsprung, the Sandy Hook Elementary School principal killed in Friday's mass shooting, will be remembered as a committed educator who was loved by her students.

The principal of the Newtown, Conn., school died trying to protect the students she cared for every day. The gunman, identified as 20-year-old Adam Lanza, started his rampage in the school's main office, where Hochsprung had reportedly come out of a meeting.

Hochsprung was killed in the shooting, the sound of which was reportedly broadcast over the school's PA system.

"She was really nice and very fun, but she was also very much a tough lady in the right sort of sense," Tom Prunty, a friend whose niece goes to Sandy Hook and was uninjured Friday, told CNN. "She was the kind of person you'd want to be educating your kids. And the kids loved her."

In all, the death toll in the tragedy has been put at 28 total: 20 children, six adults – including Hochsprung – the gunman and the gunman's mother, who was a kindergarten teacher, at a secondary location.

Safety In Mind

Hochsprung was committed to school safety, having recently installed a visual monitoring system on the campus. Visitors had to wait to be let in after the school doors locked at 9:30 a.m., and then sign in at the main office. In a letter to parents about the security system, Hochsprung said the lengthy process of the new system would take some getting used to, but that it was for the greater good of the school. And Hochsprung would have done anything to make Sandy Hook Elementary School a great place to be.

"I don't think you could find a more positive place to bring students to every day," she told the Newtown Bee when she was first hired.

Vito Kala, the owner and manager of The Villa, an Italian restaurant down the road from Sandy Hook Elementary School that was frequented by Hochsprung and other staff members, tells PEOPLE he had no doubt about Hochsprung's courage.

"It doesn't surprise me at all to hear the principal was a hero," he said. "That's [in line] with what I know. That is what she would have done, no question."

Danbury Deputy superintendent William Glass would agree. "She had a tremendous intellect and a wonderful way with children," Glass said of the always-smiling principal. "She was an amazing educator. She was everything you would want."

And a dad of triplets who attend the school says of Hochsprung: "Every year she'd do a sock-hop at the school, and she'd dress up in hoop skirts and bobby socks. She really got into it. She was so great with the kids. They loved her. It does not surprise me at all she'd do something heroic."

Hochsprung maintained an active Twitter account, where she updated followers with news about the school. Her last Tweet expressed her excitement about a school event. "Setting up for the Sandy Hook nonfiction book preview for staff... Common Core, here we come!"

Hochsprung, of Waterbury, Conn., came to Sandy Hook Elementary School in 2010 with 12 years of administrative experience. She received a bachelor's degree in special education from Central Connecticut State University in 1993, a master's in special education from Southern Connecticut State University in 1997, and a sixth-year degree in educational leadership from Southern in 1998, according to NewsTimes.

She had two daughters and three stepdaughters, according to CNN.

– With reporting from Sara Hammel

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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Glimpsing the hereafter, or just missing loved ones?

What do you wear to visit a psychic?

I pondered the question as I stood in the mirror, practicing my poker face.

Would she see through my Uggs to my mismatched socks? Will she know that I dug these jeans from the bottom of my hamper?

I'd made an appointment to meet with the psychic because I'd been worrying over a dream. It featured my late husband and my dead mother, who both passed many years ago and barely knew each other.

In the dream, they looked serene. Neither of them spoke. She was standing at the bottom of my stairs, he was outside on the porch.

I was overjoyed to see them together. Then I woke up and had to accept they are still dead. I pulled the covers over my head and stayed in bed.

I couldn't shake the memory of how happy I'd been, and wound up ruminating for months over what the dream might mean.

Was the visit just a friendly 'hello' from the people I missed most? Or was it some sort of omen that I'd be joining them soon?

I was surprised to discover I felt oddly OK with the thought of dying — but bothered by all that I'd leave undone.

I grappled with the practical issues the prospect presented: Should I increase my life insurance, use up my vacation days, teach my daughters to cook? I embarked on a flurry of medical visits.

The dream had stoked a longing I could not seem to quiet.

I wanted to know the unknowable. More than that, I wanted to summon my loved ones back.

::

I started my search for clarity the way searches always begin: I Googled "dream of dead mother and husband," and wound up looking for insight on "Your Online Spirituality Destination."

The website said my dream might simply have been "a way of resolving your sorrow psychologically while you slept." Then it confirmed my fears with this: "Some psychics who interpret dreams would say that such a dream could bode that you may die soon."

I can buy into the concept of psychics, but I have trouble with the specifics. I think some people may be blessed with celestial gifts. But I doubt they're the ones charging for mind-reading on websites like this.

I needed a psychic with references. A friend suggested Sabrina.

The blurb on her website sounded good, vaguely scientific: "Sabrina offers psychic readings through use of the tarot deck, clairvoyance and clairsentience."

The market for psychic readings is bigger than skeptics might think. Three-quarters of Americans believe in life after death, and almost half of those surveyed think it's possible to communicate with spirits or be visited by ghosts.

That's what draws us to reality shows like "Long Island Medium," where wisecracking star Theresa Caputo can't even get her teeth cleaned without picking up a message from a dead relative of some stranger in the waiting room.

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Rice Ends Bid to Succeed Clinton as Secretary of State

WASHINGTON — President Obama knew before he picked up the phone on Thursday afternoon what Susan E. Rice, his ambassador to the United Nations, was calling about: she wanted to take herself out of the running for secretary of state and spare him a fight.

By acceding to Ms. Rice’s request, which she had conveyed to White House aides the night before, Mr. Obama averted a bitter, potentially disruptive battle with Republicans in Congress at the start of his second term and at a time when his administration is struggling to reach a politically difficult deal on the federal budget.

In a statement, the president praised Ms. Rice and expressed some anger over the withering criticism directed at her by Republicans because of  comments she made in the aftermath of the lethal attack on the American mission in Benghazi, Libya.

“While I deeply regret the unfair and misleading attacks on Susan Rice in recent weeks,” he said, “her decision demonstrates the strength of her character, and an admirable commitment to rise above the politics of the moment to put our national interests first.”

By all accounts, Ms. Rice had been Mr. Obama’s first choice to succeed Hillary Rodham Clinton, though recently he seemed to be signaling that her nomination was far from a foregone conclusion. Her decision to withdraw, which senior officials insist Ms. Rice made without prodding from the White House, clears the way for Mr. Obama to nominate Senator John Kerry, Democrat of Massachusetts and chairman of the Senate Foreign Relations Committee, officials said.

Republicans say Mr. Kerry would sail through a confirmation process, while several senators had vowed to block Ms. Rice’s nomination, citing what they said were her misleading statements about the Sept. 11 attack that killed four Americans, including Ambassador J. Christopher Stevens.

By stepping aside, Ms. Rice will allow Mr. Obama to present a full slate of appointees to his national security team, as early as next week. Among the other candidates for key posts, officials said, is former Senator Chuck Hagel, a Nebraska Republican, for secretary of defense. Like Mr. Kerry, Mr. Hagel, a Vietnam veteran who opposed the Iraq war, would be supported by many of his former colleagues.

Their nominations would also remove a major source of tension between the White House and Congressional Republicans, who had expanded their attack on Ms. Rice from Benghazi to a broader indictment of her record as a policy maker on Africa, her role in securing American embassies in Kenya and Tanzania that came under terrorist attack, and even her personal finances.

Senator Lindsey Graham, a Republican from South Carolina and one of Ms. Rice’s fiercest critics, said Thursday that he respected her decision, but added in a statement that he planned “to continue working diligently to get to the bottom of what happened in Benghazi.”

In a letter she sent to Mr. Obama before her call, Ms. Rice attributed her decision to a recognition that “the confirmation process would be lengthy, disruptive and costly — to you and to our most pressing national and international priorities. The trade-off is simply not worth it to our country.”

Mr. Obama said he accepted her request with regret, describing her in a statement as “an extraordinarily capable, patriotic, and passionate public servant” with a “limitless capability to serve our country” — a line that one official said signaled that Ms. Rice, who will continue in her job at the United Nations, remains a candidate for other senior posts, including national security adviser.

Republicans are eager to see a new appointee, and should it be Mr. Kerry, his party’s 2004 presidential nominee, he would receive a far different reception.  “She made her own decision and I think it’s the right decision,” said Senator John Barrasso of Wyoming, a member of the Foreign Relations Committee. “I think she would have had a very hard time getting through.” Mr. Kerry, by contrast, is “immensely qualified and he would be easily confirmed,” he said.

For his part, Mr. Kerry heaped praise on Ms. Rice. In a statement, he said, “As someone who has weathered my share of political attacks and understands on a personal level just how difficult politics can be, I’ve felt for her throughout these last difficult weeks, but I also know that she will continue to serve with great passion and distinction.”

Jennifer Steinhauer contributed reporting.

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Angry Birds beats Samsung in viral marketing as mobile interest surged in 2012

This past year has shown us how effective leading smartphone and mobile app companies have become at leveraging viral videos. In Ad Age’s top-10 viral videos list for 2012, Samsung (005930) and Rovio each hog two spots. The Angry Birds Space video racked up 109 million views and the Angry Birds Star Wars hit the 41 million view mark. Meanwhile, Samsung managed to get 79 million views for its Galaxy S III video and 42 million views for the LeBron’s Day clip. It’s notable that Rovio’s Angry Birds clips were far cheaper to produce, with no major stars or lavish video production gimmickry.

The smartphone/mobile app industry thus held four of the top-10 viral video slots in 2012 — the rest of the list is a motley crew of names ranging from Invisible Children and Red Bull to Intel and M&M. It is telling that the smartphone/mobile app cluster is the only industry or cultural phenomenon that generated more than one spot on the list. Popular interest in mobile content continues surging.

It might also be a sign of the times that Apple (AAPL) did not hit the top-10. Samsung’s ultra-aggressive promotional efforts have started bearing fruit. What was once a boring, stale copycat brand in 2008 has suddenly started gripping the imaginations of consumers in a completely new way.

But perhaps even more interesting is that a mobile app company with less than 100 million euros in sales in 2011 managed to beat the mighty Samsung marketing machine in 2012. Rovio is in the vanguard of spreading mobile gaming into demographic niches that have never been all that interested in technology or gaming.

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L.A. Reid: I'm Leaving The X Factor

TV Watch

12/13/2012 at 07:10 PM EST

The latest season of The X Factor is down to the wire – but L.A. Reid is already looking ahead to next season. And he's not planning to come back.

"I have decided that I will not return to The X Factor next year," Reid, who is chairman and CEO of Epic Records, tells Access Hollywood. "I have a company to run that I've kind of neglected."

Of his decision to leave the singing competition, he says, "It saddens me a little bit, but only a little bit."

One of the things he's sure to miss is spending so much time with his pal and fellow judge Simon Cowell. "I love Simon. We have a great relationship," says Reid. "We have fun together, we talk, we laugh, we do bad things, we're friends."

Reid says being on the show, which also currently stars judges Britney Spears and Demi Lovato, was "a nice break" from his day job, "but now I've got to go back to work."

Reid has been a judge on the show for two seasons with Cowell. Nicole Scherzinger and Paula Abdul lasted only one season as judges before leaving.

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Study: People worldwide living longer, but sicker

LONDON (AP) — Nearly everywhere around the world, people are living longer and fewer children are dying. But increasingly, people are grappling with the diseases and disabilities of modern life, according to the most expansive global look so far at life expectancy and the biggest health threats.

The last comprehensive study was in 1990 and the top health problem then was the death of children under 5 — more than 10 million each year. Since then, campaigns to vaccinate kids against diseases like polio and measles have reduced the number of children dying to about 7 million.

Malnutrition was once the main health threat for children. Now, everywhere except Africa, they are much more likely to overeat than to starve.

With more children surviving, chronic illnesses and disabilities that strike later in life are taking a bigger toll, the research said. High blood pressure has become the leading health risk worldwide, followed by smoking and alcohol.

"The biggest contributor to the global health burden isn't premature (deaths), but chronic diseases, injuries, mental health conditions and all the bone and joint diseases," said one of the study leaders, Christopher Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.

In developed countries, such conditions now account for more than half of the health problems, fueled by an aging population. While life expectancy is climbing nearly everywhere, so too are the number of years people will live with things like vision or hearing loss and mental health issues like depression.

The research appears in seven papers published online Thursday by the journal Lancet. More than 480 researchers in 50 countries gathered data up to 2010 from surveys, censuses and past studies. They used statistical modeling to fill in the gaps for countries with little information. The series was mainly paid for by the Bill & Melinda Gates Foundation.

As in 1990, Japan topped the life expectancy list in 2010, with 79 for men and 86 for women. In the U.S. that year, life expectancy for men was 76 and for women, 81.

The research found wide variations in what's killing people around the world. Some of the most striking findings highlighted by the researchers: — Homicide is the No. 3 killer of men in Latin America; it ranks 20th worldwide. In the U.S., it is the 21st cause of death in men, and in Western Europe, 57th.

— While suicide ranks globally as the 21st leading killer, it is as high as the ninth top cause of death in women across Asia's "suicide belt," from India to China. Suicide ranks 14th in North America and 15th in Western Europe.

— In people aged 15-49, diabetes is a bigger killer in Africa than in Western Europe (8.8 deaths versus 1 death per 100,000).

— Central and Southeast Asia have the highest rates of fatal stroke in young adults at about 15 cases per 100,000 deaths. In North America, the rate is about 3 per 100,000.

Globally, heart disease and stroke remain the top killers. Reflecting an older population, lung cancer moved to the 5th cause of death globally, while other cancers including those of the liver, stomach and colon are also in the top 20. AIDS jumped from the 35th cause of death in 1990 to the sixth leading cause two decades later.

While chronic diseases are killing more people nearly everywhere, the overall trend is the opposite in Africa, where illnesses like AIDS, malaria and tuberculosis are still major threats. And experts warn again shifting too much of the focus away from those ailments.

"It's the nature of infectious disease epidemics that if you turn away from them, they will crop right back up," said Jennifer Cohn, a medical coordinator at Doctors Without Borders.

Still, she acknowledged the need to address the surge of other health problems across Africa. Cohn said the agency was considering ways to treat things like heart disease and diabetes. "The way we treat HIV could be a good model for chronic care," she said.

Others said more concrete information is needed before making any big changes to public health policies.

"We have to take this data with some grains of salt," said Sandy Cairncross, an epidemiologist at the London School of Hygiene and Tropical Medicine.

He said the information in some of the Lancet research was too thin and didn't fully consider all the relevant health risk factors.

"We're getting a better picture, but it's still incomplete," he said.

___

Online:

www.lancet.com

http://healthmetricsandevaluation.org

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Basking in a uniquely Korean 24-hour spa experience

Robert Kim took his family to Wi Spa last Friday night so his wife could revisit the public bath culture she grew up with in Korea. Besides, his two sons, the older one anyway, love the children's playroom, equipped with video games, foosball and a slide.

The Kims (the last name, he joked, of half the families in the cavernous jimjilbang) ran into another father he knew from the Korean-English dual language school their kids attend in Porter Ranch. (More on the jimjilbang later.) The children ran back and forth from the playroom to the floor mats where the men lounged, leaning against backrests.

"It's a nice little family outing," said Kim, a contractor. "We usually don't let them play video games except for weekends," Kim shrugged. "But my wife wanted to relax."

Wi is a 24-hour spa on the edge of K-town, modeled on a national culture that arose when most Koreans didn't have their own bathrooms. Several floors resemble a Western spa: marble counters, room dividers covered in tiny glass tile and a gym.

But the jimjilbang is uniquely Korean, a ballroom-size chamber with wide pillars where mother, father, grandparents and kids are sprawled out on vinyl mats, fooling with their laptops, watching television, reading and sleeping. Everyone dresses in yellow T-shirts and baggy khaki shorts, handed out at check-in as a hygiene measure. The scene looks like a reunion picnic, or summer camp, without the bunk inspections.

Some families even spend the night. Rest assured, no matter what time you arrive at Wi Spa, someone will be sleeping. On the mats in front of flat-screen TVs at 4 p.m.; on the wooden bench beside the baths at 6 p.m., and on white leather couches near midnight.

And no matter when you leave, someone will be applying makeup at the vanities, taking baths and using the hair dryers. As I packed up at 5:30 a.m. last week, a mother was smoothing lotion on her daughter in a scene out of a Renoir painting.

There are no rules but one: You must get naked. But only on the floors where the men and women part company to take the baths and undergo various scrubbing, massaging and skin-polishing regimens. In the women's section, the services are provided by no-nonsense Korean women dressed in matching black lace bras and briefs — I know how that sounds, but the uniform is serviceable, not alluring.

Radiant heat wafts up from the floors, creating a womb-like atmosphere. During my visit, a few young women hung onto their towels until the last second. But you really can't cling to your modesty when grandmothers, mothers and daughters of all sizes and descriptions have abandoned theirs.

No one cares what anyone else does, or who sees them do it. A 24-hour restaurant serves snacks, Korean food and, in a sop to vegans, avocado tacos. But one mother passed out persimmon slices from a plastic container she brought from home.

The jimjilbang is ringed by saunas of varying temperatures and (unproven) health benefits, the clay ball room, Himalayan salt room, jade room and ice room. The bulgama, encased in a clay oven that looks like a lopped-off beehive, was 226 degrees, hot enough to boil an egg. Manager Jonathan Seo said it was too hot for him, but typical of the Korean spas he used to visit with his family.

"Back in my country of origin, the public baths would be a bonding time for my dad and myself," Seo said.

Unlike in Western spas, no one cares about the kids experiencing extreme temperatures. A 10-year-old told me she braved the bulgama, and when I peeked in the ice room, one little boy was sitting on top of another.

I got caught up in the indulgent mood and watched several Korean soap operas. In one, two couples sought fake divorces so they could inherit money. The stock villain seemed to be the daughter-in-law.

Friday night was family night, and most of the spa guests were Korean Americans, but there was a sprinkling of Chinese and white locals, and some tourists from Atlanta. A downtown office employee stopped by on her way to a party in Santa Monica. "That way I'll arrive relaxed" and beat the traffic, she said. A few Hollywood filmmakers were also there, including one who asked me not to name her lest the place be deluged with industry types. She sometimes takes meetings in the jimjilbang.

Her son and other twenty-somethings bar-hop in K-town, get a late-night bite at the restaurant and lie down for a few hours before heading home, she told me. And indeed, about 1 a.m., the hipsters, including one in blond dreadlocks, arrived on schedule, although not noticeably inebriated.

Two young couples half-sat and half-lay on the little stage where Wi Spa from time to time has put on karaoke contests. Sean Fohle, a graduate student in economics at UCLA, had been there after a bachelor party brunch, arriving "fairly inebriated," he said. One of the guys cannonballed into the men's pool.

"There were some bad looks, but nobody said anything or kicked us out," said Fohle, a Palms resident.

For the bachelor party, Fohle had gone on the Internet and learned to make the traditional Korean "lamb's head" towel hat, which many of the Koreans in the jimjilbang were sporting.

At 1 a.m., bedtime was nowhere in sight for the Kim family. The dads and I had the kind of long, lazy conversation you can only have at 1 in the morning when you're so relaxed you're not embarrassed to sit on a mat in kids' clothing and talk to perfect strangers.

I retreated to the darkened room on the women's floor, passing three robed bodies in translucent face masks lying end to end, and a mother with her limbs entangled with her daughter's, all sound asleep.

gale.holland@latimes.com

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