Well: Depression May Stifle Shingles Vaccine Response

Depression may lower the effectiveness of the shingles vaccine, a new study found.

The research showed that adults with untreated depression who received the vaccine mounted a relatively weak immune response. But those who were taking antidepressants showed a normal response to the vaccine, even when symptoms of depression persist.

Shingles, an acute and painful rash, strikes a million Americans each year, mostly older adults. Health officials recommend that those over 60 get vaccinated against the condition, which is caused by reactivation of the same virus that causes chickenpox, varicella-zoster.

In the new study, published in the journal Clinical Infectious Diseases, researchers followed a group of 92 older men and women for two years. Forty of the subjects had a major depressive disorder; they were matched with 52 control subjects of similar age. The researchers measured their immune responses to the shingles vaccine and a placebo shot.

Compared with the control patients, those with depression were poorly protected by the vaccine. But the patients who were being treated for their depression showed a boost in immunity — what the researchers called a “normalization” of the immune response. It is unclear why that was the case.

The authors of the study speculated that treatment of older people with depression might increase the effectiveness of the flu shot and other vaccines as well.

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Stocks open higher following a two-day decline

Strong earnings results from big U.S. companies offered investors a whiff of hope Friday. Stocks rose after a two-day slump, but remained on track for their worst week this year.

Hewlett-Packard drove the Dow Jones industrial average higher a day posting fiscal first-quarter earnings that beat the forecasts of analysts and the company itself. The results came as relief after months of bad news for the computer maker. Its stock rose $1.36, or 8 percent, to $18.46.

American International Group Inc. helped boost the Standard & Poor's 500 index after saying its fourth-quarter operating results exceeded forecasts. The company's net loss was $4 billion, mainly because of claims related to Superstorm Sandy, in the first full quarter after it finished repaying its $182 billion government bailout. Its stock rose $1.39, or 4 percent, to $38.67.

The Dow Jones industrial average was up 42 points at 13,922 in the first 45 minutes of trading. The Standard & Poor's 500 index rose six to 1,508. The Nasdaq composite index rose 14 to 3,145.

All three indexes remain down for the week. The S&P 500 is on track for its first weekly loss of the year.

Stocks plunged Wednesday afternoon after minutes from the Federal Reserve's latest policy meeting spooked investors. The minutes revealed disagreement at the Fed about how long to keep buying bonds in an effort to boost the economy. The slide continued Thursday.

Many analysts believe that the Fed's bond-buying and resulting low interest rates have driven this year's stock rally, which has lifted indexes to their highest levels since the 2008 financial crisis.

Among the other corporate news moving markets:

— Abercrombie & Fitch sank after a key sales metric declined in the all-important holiday quarter. Its stock fell $2.27, or 5 percent, to $46.78.

— WebMD Health Corp. soared after the health website operator reported better-than-expected revenue and an optimistic outlook for 2013. The stock rose $3.85, or 24 percent, to $20.15.

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Bulgari shows off Liz Taylor's gems

It isn't easy sometimes to be an ordinary person in Los Angeles, so near to and yet so far from the city's glamorous events.

You hear about the grand Oscar parties, but you will never be invited. The award ceremony may be taking place minutes from where you live, but you watch it at home, on TV, in your sweat pants — and you might as well be in Dubuque.

Rodeo Drive too can make you feel like a scrap on the cutting room floor. As you stroll the wide and immaculate sidewalks of Beverly Hills' iconic shopping street, you pass by boutiques you'd feel self-conscious walking into. In the windows are baubles and trinkets you could never in three lifetimes afford.

Which is why it is rather nice to be invited to make a private appointment at the house of Bulgari, the fine Italian jeweler that opened its doors in 1884.

Elizabeth Taylor loved Bulgari jewels. Richard Burton, whose torrid affair with her began during the filming of "Cleopatra" in Rome, accompanied her often to the flagship shop on the Via Condotti. He liked to joke that the name Bulgari was all the Italian she knew.

So it is fitting that starting Oscar week, the jeweler is celebrating the Oscar-winning star with an exhibit of eight of her most treasured Bulgari pieces.

They are heavy on diamonds and emeralds — of rare size, gleam and value.

And Bulgari knows their value well.

After Taylor's death, it reacquired some of the gems at a Christie's auction. One piece, an emerald-and-diamond brooch that also can be worn as a pendant, sold for $6,578,500 — breaking records both for sales price of an emerald and for emerald price per carat ($280,000).

That brooch, whose centerpiece is an octagonal step-cut emerald weighing 23.44 carats, was Burton's engagement present to Taylor. He followed it upon their marriage (his second, her fifth) with a matching necklace whose 16 Colombian emeralds weigh in at 60.5 carats. Bulgari bought the necklace back too, for $6,130,500.

They are in the exhibit, along with Burton's engagement ring to Taylor and a delicate brooch — given to her by husband No. 4, Eddie Fisher — whose emerald and diamond flowers were set en tremblant so that they gently fluttered as Taylor moved.

The jewels are not for sale.

On Tuesday night, actress Julianne Moore wore the Burton necklace, with pendant attached, at a gala for Bulgari's top clients. At the dinner hour, guests were escorted along a lavender-colored carpet to a nearby rooftop that had been transformed into a Roman terrace.

Those honored guests, of course, got private viewings of Taylor's jewels.

But so did Amanda Perry, a healer from West Hollywood who arrived the next morning for one of the first appointments available to the public.

Someone had emailed news of the collection to the 35-year-old Taylor fan. She walked in off the street Tuesday, when the exhibit was open only to press — and Sabina Pelli, Bulgari's glamorous executive vice president, fresh from Rome, was taking sips of San Pellegrino brought to her on a silver tray between back-to-back interviews that started at 5 a.m.

The camera crews were long gone when Perry came back Wednesday. She had the exhibit, and handsome sales associate Timothy Morzenti of Milan, entirely to herself.

In a black suit, still wearing on his left hand the black glove he dons to handle fine jewels, Morzenti whisked Perry off via a private elevator to the exhibit on the second floor. The jewels stood in vitrines mounted high off the ground. Behind them were photos and a slide show of Taylor, bejeweled.

"Which piece would you like to see first?" Morzenti asked her as a security guard stood by. "I personally love the emerald ring."

Then he proceeded at leisure to explain Bulgari-signature sugar-loaf cuts and trombino ring settings, while tossing in occasional Taylor stories.

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Well: Getting Patients to Think About Costs

A colleague and I recently got into a heated discussion over health care spending. It wasn’t that he disagreed with me about the need to rein in costs; but he said he was frustrated every time he tried to do so.

Earlier that week, for example, he had tried to avoid ordering a costly M.R.I. scan for a patient who had been suffering from headaches. After a thorough examination, my colleague was convinced the headaches were the result of stress.

But the patient was not.

“She wouldn’t leave until she got that M.R.I.,” my colleague said. Even after he had explained his conclusions several times, proposed a return visit in a month to reassess the situation and ran so far overtime that his office nurse knocked on the door to make sure nothing had gone awry, the patient continued to insist on getting the expensive study.

When my colleague finally evoked cost – telling the woman that while an M.R.I. might ferret out rare causes, it didn’t make sense to spend the enormous fee on something of such marginal benefit – the woman became belligerent. “She yelled that this was her head we were talking about,” he recalled. “And expensive tests like this were the reason she had health insurance.”

Face flushed, he paused to take a deep breath. “Yeah, I may be all for controlling costs,” he finally said. “But are our patients?”

According to a new study in the journal Health Affairs, his concern about patients may not be far off the mark.

A growing number of initiatives aimed at controlling spiraling health care costs have been championed in recent years, aiming to replace the current model in which doctors are reimbursed for every office visit, test or procedure performed. These programs range from pay-for-performance, where doctors can earn more money by meeting predetermined quality “goals” like controlling patients’ blood sugar or high blood pressure, to accountable care organizations, where clinicians and hospitals in partnership are paid a lump sum to cover all care.

Their uninspired monikers aside, all of these plans share one defining feature: doctors are to be the key agents of change. Whether linked with quality measures, bundled payments or satisfaction scores, it is the doctors’ behavior and choice of treatments that result in savings, goes the thinking.

But as the new study reveals, doctors need to take into account more than just symptoms and diseases when deciding what to prescribe and offer. They must also consider their patients’ opinions and willingness to be cost conscious when it comes to their own care.

The researchers conducted more than 20 patient focus groups and asked the participants to imagine themselves with various symptoms and a choice of diagnostic and treatment options that varied only slightly in effectiveness but significantly in cost. They were asked, for example, to choose between an M.R.I. or a CT scan for a severe long-standing headache, with the M.R.I. being much more expensive but also more likely to catch some extremely rare problems.

When it came to their own treatment, “patients for the most part did not want cost to play any role in decision-making,” said Dr. Susan Dorr Goold, one of the study authors and a professor of internal medicine and health management and policy at the University of Michigan in Ann Arbor. Most did not want their doctors to take expenditures into account, and many made it clear that they would ask for the significantly more expensive medications, procedures or diagnostic studies, even if those options were only slightly better than the cheaper alternatives. “That puts doctors, whose primary responsibility is to their individual patients, in a very difficult position.”

A majority of the participants refused to consider the expenses borne by insurers or by society as a whole when making their choices. Some doubted that one individual’s efforts would have any real overall impact and so gave up considering cost-savings altogether. Others said they would go out of their way to choose the more expensive options, viewing such decisions as acts of defiance and a kind of well-deserved “payback” after years of paying insurance premiums.

Underlying all of these comments was the belief that cost was synonymous with quality. Even when the focus group leaders reminded participants that the differences between proposed options were nearly negligible, participants continued to choose the more expensive options as if it were beyond question that they must be more efficacious or foolproof.

The study’s findings are disheartening. But Dr. Goold and her co-investigators believe that public beliefs and attitudes about cost and quality can be changed. They cite the dramatic transformation in attitudes about end-of-life care as an example of how initiatives to improve understanding can lead people to make higher quality and more cost-effective decisions, like choosing hospices over hospitals.

“We need to begin to talk about these issues in a way that doesn’t turn it into a discussion pitting money against life, and we need to find ways of getting people to think about not spending money on things that offer marginal benefit” Dr. Goold said. “Because it’s going to be tough otherwise trying to implement any cost-saving measures, if patients don’t accept them.”

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Freddie Mac: 30-year mortgage rate rises slightly to 3.56%

The average interest rate for a 30-year fixed home loan was 3.56% early this week, according to the giant mortgage finance company Freddie Mac. The low rates are helping to spur more construction of new homes. (Katie Falkenberg / For The Times)

By E. Scott Reckard

February 21, 2013, 8:01 a.m.

Lenders were offering 30-year fixed mortgages at an average 3.56% this week, up slightly from last week, while the 15-year fixed loan held steady at 2.77%, according to Freddie Mac’s weekly survey.

Start rates on adjustable mortgages were flat to slightly higher, Freddie Mac said in the survey, released Thursday.

The 30-year rate, pegged at 3.53% for the three previous weeks, is now up about a quarter of a percentage point from its record lows late last year.  

QUIZ: How much do you know about mortgages?

The favorable rates have helped to drive housing demand, pushing prices higher. The online real-estate site Zillow Inc. said Thursday that nearly 2 million U.S. homeowners were freed from negative equity in 2012, meaning their mortgages were no longer larger than the value of their homes.

The low rates also are encouraging new-home construction, although new-home starts slipped slightly in January compared to December.

Freddie Mac asks lenders each week what terms they are offering borrowers on popular types of loans. In the latest survey, the borrowers would have paid an average 0.8% of the loan amount in upfront fees and discount points to the lenders.

US Total Construction Spending data by YCharts

ALSO:

Refinances surge thanks to help for underwater borrowers

Gary Winnick asking $225 million for 8.4-acre Bel-Air estate

Banks have provided $45.8 billion in aid under mortgage settlement

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Grapevine on Interstate 5 closed due to ice

By Hailey Branson-Potts

February 20, 2013, 7:19 a.m.

The California Highway Patrol shut down a stretch of Interstate 5 through the Grapevine early Wednesday because of ice.

The freeway was closed about 6:35 a.m. between Castaic and Grapevine Road, said CHP Officer Ed Jacobs. No motorists were stranded, he said.

“Until further notice, it’s Mother Nature’s call” on when to reopen the highway, Jacobs said.

Lingering rain, snow showers and gusty winds were expected to affect mountain regions until midday, according to the National Weather Service. Up to three inches of snow could fall Wednesday at elevations as low as 2,000 feet.

The additional precipitation could create hazardous icy roadways, the National Weather Service said. Snowfall, coupled with heavy winds, could reduce visibility to zero.

A stretch of California 58 in Kern County, which was shut down Tuesday night because of snow, remained closed, according to the California Highway Patrol.

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Autopsy confirms Mindy McCready's death as suicide

HEBER SPRINGS, Ark. (AP) — Authorities in Arkansas say preliminary autopsy results confirm country music singer Mindy McCready's death was a suicide.

The Cleburne County sheriff said in a statement Wednesday that preliminary autopsy results from Arkansas' state crime lab show McCready's death was a suicide from a single gunshot wound to the head.

Investigators have said McCready apparently shot and killed her late boyfriend's dog before she turned the gun on herself Sunday at her home in Heber Springs, Ark. Authorities found McCready's body and the dog on the front porch where her longtime boyfriend, musician David Wilson, died last month of a gunshot wound to the head.

Authorities are investigating Wilson's death as a suicide but haven't determined an official cause of death yet.

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Ask an Expert: Questions About Hearing Loss? A Help Desk

This week’s Ask the Expert features Neil J. DiSarno, who will answer questions about hearing loss. Dr. DiSarno is the chief staff officer for audiology at the American Speech-Language-Hearing Association. From 1998 to 2012 he was chairman of the department of communication sciences and disorders at Missouri State University. Following are the types of questions that Dr. DiSarno is prepared to answer.

Neil J. DiSarno of the American Speech-Language-Hearing Association.

¶My wife has told me she believes I’m not hearing as well as I used to. What sort of specialist should I see and what can I expect?

¶I’ve been told that I should consider using hearing aids. If I decide to, how much better am I likely to hear?

¶I’ve noticed that my 2-year-old granddaughter’s speech is not developing properly. Neither her mother or the pediatrician seem to be concerned, but I suspect there is a problem. What do you suggest?

¶I use hearing aids, but still have great difficulty hearing conversation in restaurants and in large group settings. Is this common and is there something more that I can do to improve my ability to function in those settings?

Please leave your questions in the comments section. Answers will be posted on Wednesday, Feb. 27. (Unfortunately, not all questions may be answered.)

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can connect with Michael Winerip on Facebook here. You can follow Booming via RSS here or visit nytimes.com/booming and reach us by e-mail at booming@nytimes.com.

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Stocks slip following homebuilding slowdown

Associated Press

February 20, 2013, 8:54 a.m.

Stock indexes are slipping in midday trading after the government reported that housing construction slowed down during the first month of the year.

The Dow Jones industrial average fell 33 points to 14,001 as of noon Eastern Wednesday.

The Standard & Poor's 500 index dropped seven points to 1,523. The Nasdaq composite fell 20 points to 3,193.

The Dow closed at its highest level of the year Tuesday, bringing it within one percent of 14,164, the record high reached more than five years ago.

GPS device maker Garmin plunged 9 percent after the company's results missed analysts' forecasts.

Boeing rose 1 percent. An investigation into the overheating of a battery that caused a Boeing 787 to make an emergency landing in Japan last month found that it was incorrectly wired.

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/* This extends our settings object with any user-defined settings passed to the function and returns the jQuery object shareTip
was called on */
return this.each(function() {
if (options) {
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/* Function that replaces the HTML in the shareTip with the template we defined at the top */
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var removeLinks = function (){
shareTip.innerHTML = templateHTML;
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/* This is the function that makes the links for the Tweet / Share functionality */

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Four dead, including suspect, in series of Orange County shootings

Orange County sheriff's officials said they don't know what prompted a series of shootings across multiple cities early Tuesday morning that left at least four people dead and others wounded.

Authorities believe the violence began in Ladera Ranch, south of Mission Viejo.

The first call came at 4:45 a.m. reporting a shooting on Red Leaf Lane, where deputies discovered a woman shot dead at the scene.

The suspect, described as a man in his 20s, fled the area in an SUV.

Sheriff's Department spokesman Jim Amormino said “multiple incidents” then occurred in Tustin and another at the Santa Ana border before the suspect apparently shot and killed himself in Orange.

“There’s a lot to sort out,” he said.

Tustin Police Lt. Paul Garaven said the suspect attempted to carjack multiple vehicles in Tustin, with  each shooting occurring a few minutes apart.

Police received a report about 5:30 a.m. of a carjacking near Red Hill Avenue and Nisson Road near the 5 Freeway in Tustin, Garaven said.

The carjacking suspect opened fire and wounded a bystander, he said.

Soon after that, another carjacking was reported near the 55 Freeway, Garaven said. The victim of that carjacking was killed, Garaven said. A body lay covered by a yellow tarp on Village Way near the McFadden Avenue freeway entrance.

Another shooting was reported on Edinger Avenue near the Micro Center in Tustin, Garaven said. Officers confirmed that another carjacking had taken place, he said.

One person was killed and another was taken to a hospital. Officers spotted the suspect in a stolen vehicle, followed him into the city of Orange and initiated a traffic stop near the intersection of East Katella Avenue and North Wanda Road, Garaven said.

The suspect then shot and killed himself, Garaven said. Garaven said there is “no threat to the community” because the suspect is deceased.

Bill Myers, who works at Allied Refrigeration at Edinger Avenue in Tustin, said he passed numerous police vehicles on his way to work early Tuesday.

The Micro Center, across the street from Allied Refrigeration, was roped off, and police were at the scene, Myers said.

Myers arrived at work at about 6:20 a.m. and said there was "a bunch of activity going on. It was pretty crazy."

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