TIME Cancer

It’s Unlikely Tobacco Company Will Pay $23.6 Billion

Based on the industry's track record, the second-largest tobacco company probably won't pay the billions in damages it owes to a Florida widow

Big Tobacco took a hit on Friday when a court ordered the second-largest tobacco company in the U.S. to pay damages to a Florida widow who had sued them for her husband’s smoking-related death. However, it’s unlikely that the company will pay full price for its negligence.

Although the verdict will likely stand, tobacco company R.J. Reynolds says it plans to appeal the $23.6 billion that the jury determined it owed widow Cynthia Robinson. Based on the industry’s track record, that will likely result in them paying far less.

Robinson’s husband, Michael Johnson, began chain-smoking when he was 13-years-old and died at the young age of 36 in 1996. A decade after her husband’s untimely death, Robinson took the cigarette-makers to court, saying they were not forthcoming about the extremely harmful effects of their product, suing them for not informing the public that smoking was addictive. And almost another decade later, she proved her case.

Unsurprisingly, R.J. Reynolds, whose holding company Reynolds American Inc. recently announced a $27 billion deal to buy out rival Lorillard, contested the verdict. “Regardless of the rhetoric surrounding this case, the damages awarded are grossly excessive and impermissible under state and constitutional law,” said Jeff Raborn, vice president and assistant general counsel for R.J. Reynolds Tobacco Company in a statement sent to TIME. “We will file post-trial motions with the trial court promptly, requesting that the verdict in the case be set aside. We are confident that the law will be followed and the punitive damages verdict will not be allowed to stand.”

Raborn is probably right.

“It is quite likely, bordering on certainty, that the amount of punitive damages will be reduced, though it is unclear how much,” says John Banzhaf, a law professor at George Washington University known for his successful litigations against the tobacco industry. There’s not a lot of dispute among the legal community that the verdict will be reduced–probably substantially. Prior verdicts against Big Tobacco demanding billions in court have been reduced to millions–something the industry, which spends about $23 million on cigarette marketing each day, can pay off rather comfortably. In 2009, Phillip Morris failed to overturn a $79.5 million punitive-damages ruling in the U.S. Supreme Court, and business continued as usual.

“This doesn’t set a legal precedent, but the result of this verdict has people asking how much money will it take to deter tobacco companies? Previous verdicts against tobacco companies have been treated as just the cost of doing business,” says Richard Daynard, a law professor at Northeastern University who specializes in tobacco control. So far, no verdict has changed the economic fundamentals of the industry. But this time, the industry might being feeling less confident.

“I think this is the first time in many years that tobacco companies are going to have to start thinking about really doing something different,” says Daynard. After all, it’s likely we will see many more cases like Robinson’s land similar verdicts in Florida, and it’s possible that similar lawsuits will start to pop up nationwide.

Robinson’s case is one of thousands of lawsuits referred to as an “Engle progeny,” which was developed after a $145 billion verdict in favor of a class action lawsuit led by Dr. Howard A. Engle, a Miami Beach pediatrician. The award was voided in appeals court, under the finding that individual smokers could not make up a class. Though the tobacco industry did not have to pay the award, which was the largest punitive damages payment decided by a jury, the decision opened the floodgates for individual cases to head to Florida court with the support of the Engle case, which proved that the tobacco industry knew cigarettes were addictive, and failed to warn the public.

“The [Robinson] case indicates that juries, when a case is properly presented, are willing to sock it to tobacco companies,” says Banzhaf. “They are angry as hell at these tobacco companies, and when an attorney presents a strong case, they are willing to hit them, and hit them hard.”

Banzhaf says the case will likely motivate attorneys in other states that are less gung-ho to take on Big Tobacco. Lawyers in states like New York, California, and Washington with good tobacco control track records, he said, are likely “salivating” at the future possibilities.

Banzhaf believes that the public is finally grasping the health implications of smoking and is now willing to punish those that profit from it. The numbers seem to support this claim: smoking rates are down 2.8% since 2005 according to CDC data, and smokers can be charged up to 50% more under Obamacare. “Clearly the public is angry. But the courts have to allow damages that are substantially higher than ordinary damages,” says Banzhaf.”Hitting them with $16 million is pocket change.”

It will be no surprise if the final bill for R.J. Reynolds is significantly lower than what the Florida jury determined to be sufficient, but it’s encouraging for the pending cases. “About 70% of Engle cases that have gone to verdict have gone in favor of the plaintiff,” says Daynard. “There are thousands more of these cases pending. Any of them could produce a jury verdict like this because it’s the same misbehavior.”

Unfortunately, the tobacco industry can also produce the same appeals solution they’ve achieved successfully in the past.

TIME Health Care

Johns Hopkins to Pay $190 Million to Victims of Secretly Recorded Exams

A sign stands in front of part of the Johns Hopkins Hospital complex on July 8, 2014, in Baltimore.
A sign stands in front of part of the Johns Hopkins Hospital complex on July 8, 2014, in Baltimore. Patrick Semansky—AP

A male gynecologist secretly filmed and took pictures during exams with female patients

Johns Hopkins Hospital announced on Monday that it reached a $190 million settlement with patients whose exams were secretly recorded by a gynecologist.

The class-action lawsuit involved more than 8,000 former patients of Dr. Nikita Levy, the Associated Press reports, and the deal marks one of the largest involving sexual misconduct by a doctor. Most of the discovered videos and photographs—about 1,200 videos and 140 photos—did not include the women’s faces and were taken with a pen-like camera he wore around his neck.

The case never led to criminal charges but essentially argued that Johns Hopkins should have been aware of what the doctor was doing. Levy committed suicide 10 days after he was fired in February 2013, which occurred after an employee came forward with suspicions.

Johns Hopkins released a statement in October on the discovery of Levy’s “misconduct and breach of trust,” writing: “We have redoubled our efforts to ensure that all of us in the Johns Hopkins community understand our responsibility, and we want to encourage you to speak up if you have any concerns about patient care or privacy.”

In a statement sent to reporters, Jonathan Schochor, the lawsuit’s lead attorney, said: “When learning of Dr. Levy’s behavior, our clients were extremely distraught. They felt a great breach of faith and trust. They felt betrayed. Now, with this proposed settlement, we can begin the process of healing our community.”

The settlement still needs final approval by a judge, the AP reports.

“We assure you that one individual does not define Johns Hopkins,” the hospital system said on Monday, acknowledging the settlement. “Johns Hopkins is defined by the tens of thousands of employees who come to work determined to provide world-class care for our patients and their families.”

TIME Diet/Nutrition

Eat Umami, Eat Less

Calories count when it comes to weight, but taste may play a role as well.

If you’re feeling unsatisfied after a meal, perhaps wasn’t flavorful enough. A new study suggests that the taste umami may actually make you feel more full and satisfied.

Umami, a hard-to-describe flavor that tilts toward the savory, is considered the “fifth taste” after salty, sweet, sour and bitter. Long used in Japanese cooking, umami is actually glutamate, once it’s broken down by cooking a steak, for example, or by fermenting things like cheese and soy. For a quick dash of umami, cooks have turned to monosodium glutamate (MSG), a flavor enhancer that’s added to soups and other foods. Now a new study published in The American Journal of Clinical Nutrition, suggests that MSG can make food more appetizing and therefore help diners feel more full.

The researchers asked 27 participants to eat the same breakfast, then some ate a high-protein soup with an MSG-enzyme combination while other had soup without the pairing. Everyone then sat down for an identical lunch, and the scientists tracked how much the volunteers ate as well as asked them questions about their appetite and how full they felt. The diners who ate the MSG-laced soup consumed less of their lunch, but still say they felt satisfied, suggesting that umami may have a role in regulating eating.

It’s not the first taste linked to appetite — peppers and spicy foods, for example, have been associated with eating less. It’s not exactly clear how the flavors affect appetite — they may work in different ways — but the growing research suggests that how much you eat may be affected by which taste buds the food activates.

TIME Stress

Burnout in the Hospital: Why Doctors Are Set Up for Stress

Every job can lead to burnout, but what happens when it strikes doctors, who make decisions that can affect their patients' lives?

Some experts call physician burn out “inevitable,” given the high-pressure environment in which they must make potentially life-saving, and almost always life-altering, choices on a constant basis. Research shows that up to 40% of U.S. doctors experience emotional, physical, and psychological burnout from their jobs, and the consequences are no different for them than they are for people in other occupations — substance abuse and cutting corners.

In the premiere issue of the journal Burnout Research, which is dedicated to research on the topic, Anthony Montgomery, an associate professor in the Psychology of Work and Organizations in the University of Macedonia in Greece, focused on physician burnout, and argues that the way doctors are trained may set them up for a career of frustrations and high-stress situations. And the consequences may be hurting the care they provide patients.

He says that while doctors interact with people on a daily basis, their training and their worth as physicians are focused almost entirely on their technical capabilities, leaving them with few tools for understanding and navigating social interactions and for collaborating as part of a larger team or organization.

Montgomery argues that most medical students are chosen because of their high test scores, so medical school becomes like an extension of school. They then become residents, thrown into a more social environment in which they are expected to interact with patients, hospital staff and colleagues in ways they may not have expected to or been prepared to do. It’s assumed they have the leadership skills and the proper emotional capacity to guide patients through extremely stressful and often traumatic experiences, but not having the tools to manage these situations can be stressful on the doctors themselves. While burnout among physicians is widespread, some studies have shown surgeons and OBGYNs can be at a particularly high risk.

“The irony is that doctors are the one group of people we don’t want to be stressed, yet we are increasing the possibility for them to make mistakes,” says Montgomery. “Doctors understand that their job is to be the best doctor they can, but [they do] not necessarily [understand] their part in helping the hospital as a whole better serve the community.” In his practice, for example, Montgomery says that his colleagues admitted to learning skills like communication and teamwork on the job, after they left medical school.

And that’s not just a problem for the medical community. The more doctors feel stressed about their jobs, the more they feel burned out and defeated by the health care system, leading to less motivation to improve conditions, both for themselves and for patients. A 2012 study published in Archives of Internal Medicine reported that nearly 1 in 2 U.S. physicians report at least one symptom of burnout, like losing enthusiasm for their work, or growing cynical. Forty percent of doctors reported being unsatisfied with their work-life balance and that they did not have time to devote to their families or their personal lives. And in a 2013 study published in JAMA, the consequences of that burnout started to emerge — only 36% of 2,556 surveyed physicians believed doctors had a major responsibility in reducing health care costs, despite the fact that they prescribe the drugs, tests and procedures that can escalate costs. Other studies also link burnout to poorer quality care and increased rates of medical errors.

What can be done to alleviate some of the pressure on physicians? Montgomery cites revisiting the way doctors are educated in order to arm them with stronger social and leadership skills, as well as some untraditional strategies, including teaching mindfulness. Improving the doctor-patient relationship may also help, so physicians and patients collaborate in their care rather than perpetuate a hierarchical system which neither doctor nor patient finds satisfying. He writes: “The uncomfortable truth is that we may need to reimagine healthcare in a way that views some errors as unavoidable, demystifies the physicians as superheroes, engages real patient participation and steers healthcare professionals away from cultures of self-preservation.” In other words, making health care more satisfying for physicians and patients may be a group effort, and that’s something that doctors aren’t quite used to yet.

 

TIME LGBT

Obama Signs Executive Order on LGBT Job Discrimination

Protects employees of federal contractors from discrimination based on sexual orientation and gender identity

+ READ ARTICLE

President Obama signed an executive order Monday protecting lesbian, gay, bisexual and transgender people working for government contractors from discrimination.

The order protects any employee for a federal contractor from discrimination based on their sexual orientation and/or gender identification. It covers about 28 million workers, making up one-fifth of the U.S. workforce, and includes no exemption for religious organizations.

“It doesn’t make much sense, but today in America millions of our fellow citizens wake up and go to work with the awareness that they could lose their job, not because of anything they do or fail to do but because of who they are,” the president told supporters at the White House, CBS News reports. “America’s federal contracts should not subsidize discrimination against the American people.”

Many U.S. companies already offer protections for LGBT employees, according to data highlighted by the Obama Administration. Some 91% of Fortune 500 companies already prohibit discrimination based on sexual orientation and 61% prohibit discrimination based on gender identity.

The five top federal contractors–which get about a quarter of all federal contracting dollars–already prohibit discrimination based on sexual orientation and gender identity.

Still, although many companies were already in support of protections, Obama’s order makes it official, and without exceptions.

TIME movies

Here’s What the X-Wing Starfighter Looks Like in Star Wars: Episode VII

Director JJ Abrams also offers fans the chance to win a preview screening of the sequel

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Eight weeks ago, Star Wars: Episode VII director J.J. Abrams announced that by donating to the “Star Wars: Force for Change” initiative, you, yes you, could be in the upcoming reboot of the iconic sci-fi franchise.

Now, in an online video in which he is shown standing next to the movie’s iteration of an X-Wing Starfighter, Abrams has kicked the fundraiser—for UNICEF—up a notch .

Fans who donate to the initiative–which has donations from 119 countries already–could win a chance to have an early and private screening of Star Wars: Episode VII in their hometown with 20 of their closest friends and family.

Already, the campaign, which is organized by the Omaze fundraising site, is offering fans the opportunity to fly to London with a friend for a behind-the-scenes look at the set, a chance to meet cast members, and most importantly, be transformed into a Star Wars character and be a part of an actual scene in the movie.

According to The Hollywood Reporter, the campaign raised over $1 million in the first 24 hours of its launch. Disney has also donated $1 million to the cause, which will benefit UNICEF’s Innovation Labs and fund projects throughout the developing world.

You can still donate to the cause, and enter to win a chance to be in the movie or attend a preview screening, here. There’s only four days left though, so hurry.

TIME

Chikungunya in Florida Man Is First Case Acquired in the U.S.

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WS photography—Getty Images/Flickr RF

The Centers for Disease Control and Prevention (CDC) says that the first case of the mosquito-borne virus chikungunya infection picked up in the U.S. occurred in a Florida man who had not recently traveled abroad.

This year, 243 people in the U.S. became infected, but this is the first case of a disease believed to originate from a mosquito in the U.S.

Chikungunya is a disease caused by a virus that leads to fever, joint pain, headaches, swelling and rash. The infection is usually not fatal, but the pain can be debilitating.

“The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens,” Roger Nasci, chief of CDC’s Arboviral Diseases Branch said in a statement.

The CDC is teaming up with the Florida Department of Health to confirm how the Florida man became infected and is monitoring the area for additional cases. The CDC believes that chikungunya in the U.S. will follow a similar pattern to that of the dengue virus, in which imported cases cause some local transmission, but did not cause a widespread outbreak. Public health officials are investigating how the mosquitoes were infected with the virus, including whether the insects acquired the virus by biting infected individuals. Since 2006, there have been an average of 28 cases a year of chikungunya infection; none of those cases have prompted an outbreak, however. Countries in Africa, Asia, Europe, India, the Middle East, and the French side of the Caribbean island of St. Martin have experienced outbreaks in the past and 23 countries have experienced local transmission of the virus in recent years.

The best way to stay protected from the virus is to keep mosquitoes at bay by wearing repellants and creating a physical barrier from being bitten, with long sleeves and pants when possible. Health officials also recommend getting rid of any standing water outside the home, where mosquitoes generally breed.

TIME

Alcohol Plus Energy Drinks Makes You Want to Drink More, Study Says

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New study finds people drinking alcohol with energy drinks have a greater desire to drink Chris Stein—Getty Images

A small study shows people drinking vodka Red Bulls want to drink more

A recent Australian study found that when people drink alcohol with energy drinks they have a stronger desire to keep drinking compared to people who just drank a vodka soda.

The study, published in the journal Alcoholism: Clinical & Experimental Research, assigned 75 participants between the ages 18 and 30 to either just drink alcohol, or drink an alcohol and energy drink combination. The people in the energy drink group received a 60 ml of vodka and a Red Bull energy drink. The other group drank a vodka soda. All the drinks had some fruity beverage added to them so they didn’t taste terrible. The participants then filled out questionnaires about their drinking experience before and after.

The alcohol-energy drink imbibers had a stronger desire to continue drinking compared to the group just drinking alcohol. The researchers note that although the participants in the study drank the same amount, there are some pretty significant implications if there happens to be something about drinking alcohol with energy drinks that makes people want to keep boozing. As people get more tipsy, it can become harder to cut themselves off.

The study is small and preliminary, but there’s a growing interest in how energy drinks and alcohol interact in the body. The energy drink industry is continuing to grow, starting as a $3.8 billion business globally in 1999 to $27.5 billion in 2013, according to market research firm Euromonitor. Knowing the spectrum of their effects is important for safe socializing.

TIME Heart Disease

A Common Cholesterol Drug’s Safety Is In Question

New studies suggest Niacin doesn't help, but harms users

Two new studies suggest significant dangers from the common cholesterol drug niacin, and some doctors say the risks are not worth it.

One of the studies published in New England Journal of Medicine looked at extended-release niacin, and the other study looked at the combination of extended-release niacin and another drug, laropiprant, that makes it more effective. Neither found significant benefits, and both found high risk for adverse side effects in the gastrointestinal and musculoskeletal systems like bleeding, diarrhea and even gout. The niacin-laropiprant study found a 9% increase in death risk.

In a corresponding editorial, “Niacin and HDL Cholesterol — Time to Face Facts,” Dr. Donald Lloyd-Jones of Northwestern University in Chicago writes, “on the basis of the weight of available evidence showing net clinical harm, niacin must be considered to have an unacceptable toxicity profile for the majority of patients, and it should not be used routinely.” He notes that niacin may still have a role for patients at a very high risk for cardiovascular disease who do not tolerate statins.

It’s been thought in the past that niacin, a type of B vitamin, are a viable alternative or complement to statins. But the NEJM studies show that not only does niacin not work as well as statins, but it has some serious side effects. The researchers found that people taking niacin had about the same rates of disease as people on placebos, suggesting that the drug is not as effective as it’s thought to be.

Though many people will likely remain on niacin, members of the medical community caution people on the drugs, warning they should talk to their doctors about whether or not they should continue.

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