Phys Ed: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

Fitness Tracker

Marathon, half-marathon, 10k and 5K training plans to get you race ready.

A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.

For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.

One group began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.

Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.

The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.

The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.

The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.

Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.

To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.

By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.

There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.

However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.

The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.

But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.

“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable” after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.

The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.

But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,” a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,” he says. But those working out only twice a week “weren’t far behind.”

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Carnival cancels more cruises, estimates loss from Triumph mishap




























































































Tugboats are towing the Carnival Triumph cruise ship to Mobile, Ala. Passengers were reporting long lines and miserable conditions.
































































The engine fire that disabled a Carnival cruise ship in the Gulf of Mexico will certainly cost the cruise line money but it is unclear if it will tarnish its reputation in the long run.


The fire broke out Sunday, leaving the Carnival Triumph without propulsion and power for some bathrooms, elevators and kitchens. The ship, carrying more than 3,000 passengers and 1,000 crew members, is being towed by three tug boats to Mobile, Ala.


Carnival has announced it will reimburse passengers for the cruise fare, transportation costs and other expenses and has also canceled 14 future sailings of the Triumph through April.



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  • Carnival Corp., the parent company of Carnival Cruise Lines, estimated Wednesday that the cancellations and Triumph's repair costs will result in an $0.08 to $0.10 earnings per share drop in the first half of the year.


    Carnival Corp.'s shares are already taking a hit.


    CCL Chart


    The incident is only the latest mishap for Carnival in the past few years. In 2010, an engine fire also cut power to the Carnival Splendor during a cruise to the Mexican Riviera.


    Carnival Corp. is also the parent company of an Italian cruise line that operated the Costa Concordia, which wrecked in the Italian coast last year, drowning 32 passengers and crew.


    On the Carnival Triumph, passengers who have contacted family and friends via emails and texts say they were standing in long lines for food and to use toilets. Some slept on the deck to get relief from the heat in the cabins. Others used plastic bags when bathrooms were disabled.


    On social media, reaction on the Carnival Triumph news was mixed.



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    Stewart Chiron, a cruise expert who writes for the cruiseguy.com website, said he doesn't expect the latest incident to hurt Carnival's reputation or future cruise sales.


    "It's a crummy situation but I personally think Carnival is doing a good job handling it,” he said.


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    Guantanamo witness testifies on courtroom eavesdropping allegations









    FT. MEADE, Md. -- Top officials at the terror detainee prison at the U.S. Naval Base on Guantanamo Bay, Cuba, began testifying in a pretrial hearing Tuesday about courtroom security and allegations that the CIA or other U.S. intelligence officials are secretly listening to private conversations between defense lawyers and five accused Sept. 11 plotters.

    First to the witness stand -- in fact the first substantial witness to testify in the military tribunal case that is the only prosecution in the 2001 terror attacks -- was Maurice Elkins, an Army veteran who is the director of technology for the new courtroom built next to the prison compound that houses 166 detainees.


    In a crisp gray suit, Elkins testified that it would be almost impossible for any outside intelligence officials, known by the ambiguous acronym OCA for Original Classification Authority, to tap into the private defense conversations, and less likely they could record them.





    But, he conceded, “I do not know what the OCA’s capability is.”


    Yet while acknowledging that outside intelligence officials are indeed monitoring the proceedings should any classified information be inadvertently disclosed, Elkins added, “No entity in the U.S. government has ever asked me for recordings.”


    Though Elkins was a defense witness, his testimony largely mirrored the government’s position that confidential defense conversations are not being picked up by the CIA or other intelligence agencies.


    However, under questioning from David Nevin, an attorney for alleged Sept. 11 mastermind Khalid Shaikh Mohammed,  Judge James L. Pohl, an Army colonel, acknowledged that intelligence authorities could be listening in and recording.


    When Nevin asked if it was possible the OCA was recording everything they were picking up, the judge stepped in and answered the questions. “Anything is possible,” he said. “Most witnesses would agree that anything in life is possible.”


    Elkins put it this way:  "I wouldn't know OCA if I walked next to OCA on the street or played basketball with OCA.” He added,  “You’re asking me to assume they are recording, and I can’t answer that.”


    The defense, however, filed an emergency motion to address the matter, claiming that covert intelligence officials are listening in on their private courtroom discussion, as well as to visits the lawyers have with their clients in the prison.


    Also scheduled to testify Tuesday are Navy Capt. Thomas Welsh, the staff judge advocate at the prison, and Army Col. John Bogdan, the compound commander.


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    NBC stumbles in deep midwinter freeze, ratings low


    NEW YORK (AP) — NBC, after being heartened by some long-sought success this past fall, has fallen into a deep midwinter freeze.


    The network has badly stumbled recently, hitting its three lowest viewership levels for a traditional television season in the past four weeks, the Nielsen ratings company said. The only exception came the week NBC televised the Pro Bowl.


    NBC expected some tough times with the end of the pro football season and its popular Sunday night game. Two other popular shows, the reality singing competition "The Voice" and the sci-fi drama "Revolution," are on hiatus, which network entertainment President Robert Greenblatt noted a month ago in a bid to lower expectations.


    "No one is more aware of what January through March will bring than us," he said.


    Yet the depth of NBC's recent troubles has to be disheartening. NBC was feeling good about the musical drama "Smash," yet the 4.5 million people who watched its second-season premiere last week represented its smallest audience. The medical drama "Do No Harm" was cancelled after two weeks when it reached a paltry 2.2 million people last week in the time slot NBC once dominated with "ER."


    The detective series "Deception," with Victor Garber, seems headed for a short life after reaching 3.1 million people last Monday. The comedy "1600 Penn," about a family living in the White House, had only 2.6 million people on Thursday, Nielsen said.


    The audiences for all four of those series put together roughly equaled the number of people who saw "The Walking Dead," about a sheriff's deputy fighting zombie-like people, on AMC on Sunday night, Nielsen said.


    Thirty-three other broadcast programs had bigger audiences than NBC's most-watched show last week, "Dateline NBC." The network has turned over its Friday night schedule to the news division with "Dateline" and Brian Williams' newsmagazine, "Rock Center."


    CBS, led by the Grammy Awards, thoroughly dominated prime time on broadcast TV last week. Its average audience was twice that of second-place Fox. Seventeen of the 20 top broadcast programs last week were on CBS, with the exceptions being two episodes of "American Idol" on Fox and ABC's "Modern Family."


    CBS averaged 13.2 million viewers for the week (8.0 rating, 13 share). A ratings point represents 1,147,000 households, or 1 percent of the nation's estimated 114.7 million TV homes. The share is the percentage of in-use televisions tuned to a given show.


    Fox was second with 6.5 million (3.8, 6), ABC had 6.3 million (4.1, 7), NBC had 4.3 million (2.8, 5), the CW had 1.6 million (1.0, 2) and ION Television had 1.2 million (0.8, 1).


    Among the Spanish-language networks, Univision led with a 3.7 million prime-time average (1.9, 3). Telemundo had 1.3 million (0.7, 1), UniMas had 960,000 (0.5, 1), Estrella had 230,000 (0.1, 0) and Azteca 130,000 (also 0.1, 0).


    NBC's "Nightly News" topped the evening newscasts with an average of 9.6 million viewers (6.4, 12). ABC's "World News" was second with 8.6 million (5.8, 11) and the "CBS Evening News" had 7.5 million viewers (5.0, 9). It was the biggest audience for CBS' evening newscast since January 2009.


    For the week of Feb. 4-10, the top 10 shows, their networks and viewerships: "Grammy Awards," CBS, 28.38 million; "NCIS," CBS, 21.79 million; "The Big Bang Theory," CBS, 18.98 million; "NCIS: Los Angeles," CBS, 16.67 million; "Person of Interest," CBS, 14.88 million; "American Idol" (Wednesday), Fox, 14.27 million; "Two and a Half Men," CBS, 14.12 million; "American Idol" (Thursday), Fox, 13.28 million; "Criminal Minds," CBS, 11.98 million; "2 Broke Girls," CBS, 11.37 million.


    ___


    ABC is owned by The Walt Disney Co. CBS is owned by CBS Corp. CW is a joint venture of Warner Bros. Entertainment and CBS Corp. Fox and My Network TV are units of News Corp. NBC and Telemundo are owned by Comcast Corp. ION Television is owned by ION Media Networks. TeleFutura is a division of Univision. Azteca America is a wholly owned subsidiary of TV Azteca S.A. de C.V.


    ___


    Online:


    http://www.nielsen.com


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    Well: Straining to Hear and Fend Off Dementia

    At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

    A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

    Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.


    Katherine Bouton speaks about her own experience with hearing loss.


    A transcript of this interview can be found here.


    Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

    In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

    “Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

    In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

    In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

    Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

    What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

    The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

    Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

    A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

    A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

    Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

    In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

    Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

    Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

    “Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

    “If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

    Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.



    Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.


    This post has been revised to reflect the following correction:

    Correction: February 12, 2013

    An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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    California tomato farmer gets 6 years in prison for price-fixing









    A man who built one of California’s most successful tomato-farming companies was sentenced to six years in prison for scheming to inflate tomato prices and deceiving consumers about his products' quality.


    Frederick Scott Salyer, former owner of SK Foods, was accused of bribing buyers with companies such as Kraft Foods and Frito Lay to pay inflated prices for his tomato products, prices that were then passed along to consumers.


    He also instructed employees to write false reports about the tomatoes’ quality, lying about mold content and whether the product qualified as organic, federal prosecutors said.





    “Scott Salyer used bribery and fraud to deceive his customers about SK Foods’ products in order to maximize his profits,” said Benjamin B. Wagner, the U.S. attorney in Sacramento. “He turned his company into a machine of corruption and economic crime.”


    U.S. District Judge Lawrence K. Karlton imposed the sentence Tuesday at a hearing in Sacramento.


    Salyer, 57, pleaded guilty in March 2012 to racketeering and price-fixing charges. He had been free on $6 million bond, living under house arrest at his Pebble Beach home.


    Ten other people have been convicted of charges related to the scheme, prosecutors said.


    “This case is a prime example where public trust was breached by corporate greed,” said Herbert M. Brown, special agent in charge of the FBI’s Sacramento office.  “Salyer's business practices knowingly defrauded consumers for financial gain and he attempted to use the cloak of an agribusiness giant to insulate himself.”


    Salyer’s attorneys had asked for a sentence of no more than four years in prison, saying he had already paid dearly for his crimes.


    “Mr. Salyer has suffered in other ways. He has lost his business and his home, suffered personal financial ruin and lost all standing in the community and the business world,” defense attorney Elliot R. Peters said in a sentencing brief.


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    Report: U.S. recovered $4.2 billion from healthcare fraud in 2012























































































    Federal officials report $4.2 billion in healthcare fraud recoveries


    Federal officials say they recovered nearly $8 for every dollar spent on healthcare fraud investigations in 2012.
    (Scott Eells / Bloomberg)





































































    Federal officials said they recovered a record-high $4.2 billion related to healthcare fraud and abuse in fiscal year 2012.


    U.S. Atty. Eric Holder and Health and Human Services Secretary Kathleen Sebelius said the federal government recovered $7.90 for every dollar spent on healthcare-related fraud and abuse investigations.


    The total of $4.2 billion in taxpayer dollars recovered for fiscal year 2012 was up slightly from $4.1 billion a year earlier, officials said. It's estimated that Medicare loses about $60 billion annually to fraud and improper payments.





    "We are gaining the upper hand in our fight against healthcare fraud," Sebelius said.


    The Obama administration has tried to crack down on Medicare fraud by boosting investigations in certain "hot spots" such as Miami and Los Angeles and using technology to detect schemes sooner.


    Last year, Medicare said it began screening all 1.5-million providers enrolled in the government healthcare program to identify ineligible and potentially fraudulent providers or suppliers. As a result, officials said nearly 150,000 ineligible providers were booted from Medicare.


    Still, some members of Congress have complained that the Obama administration has been too slow to deploy technology widely used by the credit-card industry to weed out fraud and abuse.


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    Follow Chad Terhune on Twitter
































































































































































































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    Grammy audience down, still 2nd highest since 1993


    NEW YORK (AP) — While the Grammy Awards couldn't come close to the freakishly high ratings generated in 2012 because of Whitney Houston's death and Adele's smashing success, this year's show had the second-largest audience for the program since 1993.


    The Nielsen company said Monday that music's annual awards show was seen by 28.4 million people Sunday night on CBS.


    The Grammys this year were packed with high-powered musical moments and, in its awards, celebrated the industry's diversity rather than overwhelmingly honoring one artist. It also had a few water-cooler moments: Which boyfriend was Taylor Swift specifically dissing in her latest performance of "We Are Never Ever Getting Back Together"? Was Chris Brown flaunting his revived relationship with Rihanna?


    The music academy's decision to turn the televised Grammys into more of a showcase than an awards show appears to be bearing fruit, too. The show's audience was nearly 2 million higher than the 26.7 million who watched in 2011. From 2005 to 2009, the Grammy Awards audience fluctuated from 17 million to 20 million viewers.


    Last year, 39.9 million people tuned in to see how the industry would react to Houston's death just before the awards and celebrate the coronation of its hottest star, Adele, who won six Grammys.


    This year's show featured the musical return of Justin Timberlake, collaborations honoring Bob Marley and Levon Helm, and performances by the majority of stars up for major awards.


    The Grammys far outpaced the Emmys, which had 13.3 million viewers last September for its more traditional awards show, and the Golden Globes, which had 19.7 million viewers in January. The upcoming Oscars usually get more than 30 million viewers.


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    Well: Price for a New Hip? Good Luck Getting a Reliable Estimate

    Jaime Rosenthal, a senior at Washington University in St. Louis, called more than 100 hospitals in every state last summer, seeking prices for a hip replacement for a 62-year-old grandmother who was uninsured but had the means to pay herself.

    The quotes she received might surprise even hardened health care economists: only about half of the hospitals, including top-ranked orthopedic centers and community hospitals, could provide any sort of price estimate, despite repeated calls. Those that could gave quotes that varied by a factor of more than 10, from $11,100 to $125,798.

    Ms. Rosenthal’s grandmother was fictitious, created for a summer research project on health care costs. But the findings, which form the basis of a paper released on Monday by JAMA Internal Medicine, are likely to fan the debate on the unsustainable growth of American health care costs and an opaque medical system in which prices are often hidden from consumers.

    “Transparency is all the rage these days in government and business, but there has been little push for pricing transparency in health care, and there’s virtually no information,” said Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa, who wrote the paper with Ms. Rosenthal. He added: “I can get the price for a car, for a can of oil, for a gallon of milk. But health care? That’s not so easy.”

    President Obama’s Affordable Care Act focused primarily on providing insurance to Americans who did not have it. But the high price of care remains an elephant in the room. Although many experts have said that Americans must become more discerning consumers to help rein in costs, the study illustrates how hard that can be.

    “We’ve been trying to help patients get good value, but it is really hard to get price commitments from hospitals — we see this all the time,” said Jeff Rice, the chief executive of Healthcare Blue Book, a company that collects data on medical procedures, doctors visits and tests. “And even if they say $20,000, it often turns out $40,000 or 60,000.”

    There are many caveats to the study. Most patients — or insurers — never pay the full sticker price of surgery, because insurance companies bargain with hospitals and doctors for discounted rates. When Ms. Rosenthal balked at initial high estimates, some hospitals produced lower rates for a person without insurance.

    But in other ways the telephone quotations underestimated prices, because they did not include the fees for outpatient rehabilitation, for example.

    In an accompanying commentary, Andrew Steinmetz and Ezekiel J. Emanuel of the University of Pennsylvania acknowledged that there was “no justification” for the inability to provide estimates or for the wide range of prices. But they said that more rigorous data on quality — like infection rates and unexpected deaths — were required to know when high prices were worth it.

    “Without quality data to accompany price data, physicians, consumers and other health care decision makers have no idea if a lower price represents shoddy quality of if it constitutes good value,” they wrote.

    But, broadly, researchers emphasized that studies had found little consistent correlation between higher prices and better quality in American health care. Dr. Cram said there was no data that “Mercedes” hip implants were better than cheaper options, for example.

    Jamie Court, the president of the California-based Consumer Watchdog, said: “If one hospital can put in a hip for $12,000, then every hospital should be able to do it. When there’s 100 percent variation in sticker price, then there is no real price. It’s about profit.”

    Dr. Cram said the study did contain some good news: some of the country’s top-ranked hospitals came up with “bargain basement prices” in response to repeated calls. “If you’re a good consumer and shop around, you can get a good price — you don’t have to pay $120,000 for a Honda,” he said.

    But that shopping can be arduous in a market not set up to respond to consumers. To get a total price, Ms. Rosenthal often had to call the hospital to get its estimate for on-site care, and a separate quote from doctors. And many were simply perplexed when she asked for a price upfront, Ms. Rosenthal said, adding, “The people who answered didn’t know what to do with the question.”

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    American-US Airways merger talks reportedly close to completion









    Merger talks between the parent company of American Airlines and US Airways continued Monday, with sources suggesting an announcement could be made later this week.


    The union of Fort Worth-based American and Phoenix-based US Airways would create the nation's largest airline, with a mainline fleet of nearly 1,000 planes.


    The boards of the two airlines are expected to meet in the next few days to vote on the proposed merger, sources have told Reuters News.





    According to the sources, US Airways Chief Executive Doug Parker would become CEO, while AMR Corp.' chief Tom Horton would serve as non-executive chairman of the board until next year.


    In 2011, American Airlines became the latest of several major carriers in the last decade to file for bankruptcy. US Airways, a smaller but more profitable carrier, has publicly advocated a merger with American to better compete against larger carriers such as Delta and United.


    Sources have told Reuters and other news outlets that a merger between the two is in the works, pending negotiations to appoint a new board and management. Also delaying a final decision has been a decision on how to split the value of the new carrier among creditors and shareholders of the existing airlines.


    Analysts have estimated that the two companies could generate up to $1 billion in savings and added revenue by combining forces.


    "In our view, we have held that an eventual merger between American and US Airways was in the best long-term interest of both carriers," Jeff Kauffman, an analyst at Sterne Agee, said in a report Monday.


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