Major Retailers Start Selling Financial Products, Challenging Banks





On a recent shopping trip to Costco, Lilly Neubauer picked up paper towels, lentils, carrots — and a home mortgage.




While Ms. Neubauer, 27, said she was surprised to find the warehouse club selling financial products, she and her husband saved about $200 a month by refinancing there this year. She also bought home insurance from Costco, she said, again because it was cheaper there.


“It opened us up to the fact that Costco is more than toilet paper,” said Ms. Neubauer, who lives in Dallas.


As the nation’s largest banks stay stingy with credit and a growing portion of the population has no bank at all, major retailers are stepping into the void. Customers can now withdraw cash at an A.T.M. with a prepaid card from Walmart, take out a loan at Home Depot for a kitchen renovation or kick-start a new venture with a small-business loan from Sam’s Club. This year, Walmart even started to test selling a life insurance policy.


Consumer advocates are torn about the growth of this shadow banking industry. Financial products are making it into the hands of people who otherwise might not qualify for them, but these products are not always subject to the same regulations as bank products are. And to turn a profit, retailers generally have to charge more to people with poor credit or none at all.


“These products can come with high fees and few real protections,” said Norma P. Garcia, a senior lawyer with Consumers Union.


For the retailers, banking products are not huge profit centers but a business strategy, meant to put money into customers’ hands and get them buying more.


“You’ve got to remember, Walmart is intended to be a one-stop shop,” said Charles M. Holley Jr., the company’s chief financial officer.


Retailers were once interested in actually becoming banks. Sears, in the 1980s, tried a “socks and stocks” strategy that included acquiring the Dean Witter brokerage firm. And Wal-Mart Stores sought a banking charter for almost a decade before finally abandoning the quest in 2007.


While supermarket chains have leased space to bank branches for years, they are now offering their own products or teaming with small financial firms to do an end run around big banks. While the banks are likely to bristle at such competition, supporters of the retailers say the stores are stepping into areas that banks have abandoned.


“The banks kind of dropped the ball, and in my mind, and in the consumers’ mind, they left it open for different approaches,” said Robert L. Phillips, a professor at Columbia Business School.


Part of the lure is the so-called underbanked population — people who use few, if any, bank services. The Federal Deposit Insurance Corporation estimates that roughly 10 million households in the United States do not use a bank, up from nine million three years ago. And the agency says 24 million more households have a bank account but still use nonbank financial services, like prepaid cards.


Mr. Holley said that 20 to 25 percent of Walmart customers were unbanked.


“The more kinds of services we can offer our core customer like that, the better for them,” he said.


Last month, Walmart unveiled a prepaid card with American Express. The card operates much like a debit card except that it is not attached to a bank account. It comes with free customer-service telephone support, and fees are relatively low, but the account is not backed by the F.D.I.C.


Frustrated with the fees charged by her bank, Nancy Fry, a real estate broker in Logan, Utah, bought a prepaid card from Walmart this year. But this was even worse, she said — she was charged $3 every time she loaded money onto the card. “I really don’t have very much money and can’t afford these fees,” she said.


Consumer advocates complain that prepaid cards are loosely regulated and can cannibalize the money put on them. Consumer lawyers have pushed for greater disclosure of fees and more stringent regulation of the card providers. The government is expected to issue new rules this year.  


Walmart began to test selling a one-year MetLife life insurance policy this year, and customers can wire money or pay bills at any Walmart store.


Costco is also courting customers who are fed up with their banks. “A lot of members think their bank fees are too high, or the trust level has gone down over the years, or they’re having issues with debit and credit cards,” said Jay Smith, Costco’s director of business and financial services.


Costco sells auto and homeowners’ insurance, offers credit card processing for small businesses and began making mortgages in late 2010. It does not make money on the mortgages, which are offered by small lenders, Mr. Smith said. The idea is to get people to renew their store memberships, where Costco makes a large chunk of its profit.


Home Depot, whose customers are mainly homeowners, is trying to increase sales by extending credit to people who would otherwise have trouble getting it. Last year, the company began offering loans of up to $40,000, and this year it extended its no-interest credit card payment terms. “We have the ability to get credit to consumers in this tight credit market, and we wanted people to take advantage of that in a market where people don’t have access to home-equity lines of credit like they used to,” said Dwaine Kimmet, Home Depot’s treasurer and vice president for financial services.


Mr. Kimmet said the loans were especially useful for people who needed emergency items, like a water heater, though shoppers use them for other home décor projects as well.


They are also helpful for Home Depot, whose sales growth has been squeezed by the housing crisis.


Mr. Kimmet said the store loans, unlike home-equity lines of credit, did not require collateral, meaning Home Depot could not seize someone’s house for a failure to pay.


The interest rate on Home Depot’s credit card is higher than that on a typical credit card — 18 percent to 27 percent, depending on credit score, compared with an average of 14.59 percent, according to Bankrate. But Mr. Kimmet said the retailer offered cards to people with credit scores as low as 600, below what many lenders accept.


Other retailers are also trying to make it easier for people to qualify for financial products. Office Depot and Sam’s Club offer loans backed by the government’s Small Business Administration, and both involve quick, one-page initial applications. More than 1,000 Sam’s Club members have used the program since its introduction two years ago, the company said.  


When Kent Prater was about to open a restaurant in Lumberton, N.C., he searched online for loans backed by the Small Business Administration and found that Sam’s Club sold them. He applied online for a $25,000 loan and was approved for a $10,000 loan, with an interest rate of about 10 percent. With a bank, “I think it would probably be a little bit more difficult, because of the environment — the economy and the regulatory environment,” said Mr. Prater, who opened Thai Chili last month.


Paco Underhill, who researches shopper behavior as founder and chief executive of Envirosell, said retailers offering financial products was only the beginning.


“The banks are going to scream bloody murder when retailers try to obtain banking charters,” he said. “But it’s not hard for a retail organization to look across the landscape and say, ‘Who are my customers, and what else could I be selling them?’ ”


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Mike D'Antoni plans to coach Lakers on Sunday













Mike D'Antoni


Mike D'Antoni won NBA coach of the year in his first full season as head coach of the Phoenix Suns.
(Jeff Gross / Getty Images)

































































Just finished interviewing new Lakers Coach Mike D’Antoni by telephone, and how’s that for a fine start in town — he's talking to Page 2.

It’s going to take a little while to transcribe tape and write a column, but here’s how we began Tuesday morning.

"Got bad news for you, Mike. You’re losing 73% to 11% to Phil Jackson in a poll of who people would like to see coaching the Lakers."





D’Antoni laughs. "I’ve got some really close friends who are Laker fans and they were disappointed I got the job."

Reminded that the fans in Staples Center have been chanting, "We want Phil," D’Antoni says, "They can’t chant, 'We want Mike,' because they got him."

D’Antoni is still recovering from reconstructive surgery on his right knee. He’s getting around now with one crutch or a cane.

He will fly to Los Angeles on Wednesday, meet his team Thursday and says he’s probably aiming to make his Lakers coaching debut Sunday.

"When I feel better I’ll start coaching, and I think miraculously I’ll start feeling better when Steve [Nash] is feeling better," he says. "I’ve already tried coaching without him and that didn’t work out too well, so I’m thinking I’ll be smart this time."

If the tape recorder batteries hold up, more to come soon.

ALSO:

Phil Jackson gets call from Lakers and it's not what he expected

Lakers players surprised but enthused by hiring of Mike D'Antoni

It's unanimous: Lakers' selection of Mike D'Antoni over Phil Jackson is wrong






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Human Brain Is Wired for Harmony



By Elizabeth Norton, ScienceNOW


Stop that noise! Many creatures, such as human babies, chimpanzees, and chicks, react negatively to dissonance—harsh, unstable, grating sounds. Since the days of the ancient Greeks, scientists have wondered why the ear prefers harmony. Now, scientists suggest that the reason may go deeper than an aversion to the way clashing notes abrade auditory nerves; instead, it may lie in the very structure of the ear and brain, which are designed to respond to the elegantly spaced structure of a harmonious sound.


“Over the past century, researchers have tried to relate the perception of dissonance to the underlying acoustics of the signals,” says psychoacoustician Marion Cousineau of the University of Montreal in Canada. In a musical chord, for example, several notes combine to produce a sound wave containing all of the individual frequencies of each tone. Specifically, the wave contains the base, or “fundamental,” frequency for each note plus multiples of that frequency known as harmonics. Upon reaching the ear, these frequencies are carried by the auditory nerve to the brain. If the chord is harmonic, or “consonant,” the notes are spaced neatly enough so that the individual fibers of the auditory nerve carry specific frequencies to the brain. By perceiving both the parts and the harmonious whole, the brain responds to what scientists call harmonicity.


In a dissonant chord, however, some of the notes and their harmonics are so close together that two notes will stimulate the same set of auditory nerve fibers. This clash gives the sound a rough quality known as beating, in which the almost-equal frequencies interfere to create a warbling sound. Most researchers thought that phenomenon accounted for the unpleasantness of a dissonance.



But Cousineau and her colleagues suspected that beating might not be the whole story. In a previous paper, cognitive neuroscientist Josh McDermott of New York University in New York City isolated the acoustic factors of harmonicity and beating, and then tested subjects on their preferences. Subjects that were attracted to harmonicity, he found, were drawn to consonant sounds more consistently than they disliked beating.


To put the beating hypothesis to an even more rigorous test, Cousineau and McDermott teamed up to study a group of subjects with a condition called amusia, an inherited inability to distinguish pitch, recognize melody, or sing in tune. Amusics also can’t distinguish consonance from dissonance. The investigators reasoned that if beating really does explain why people don’t like dissonance, and the amusics are unmoved by dissonance, then they presumably wouldn’t respond to the beating either.


In the new study, reported online today in the Proceedings of the National Academy of Sciences, participants with and without amusia listened through headphones to a range of sounds, both sung and electronically generated. The stimuli included harmonic sounds and inharmonic sounds (produced by shifting some frequencies of a previously harmonic sound), and sounds with beating and without. (To hear samples, click on the audio clips above. The “beating” tone must be heard through headphones.) As expected, amusic subjects could not distinguish consonance from dissonance. Surprisingly, though, they disliked the beating sound just as much as did control subjects without amusia.


“Beating is the textbook explanation for why people don’t like dissonance, so our study is the first real evidence that goes against this assumption,” Cousineau says. “It suggests that consonance rests on the perception of harmonicity, and that, when questioning the innate nature of these preferences, one should study harmonicity and not beating.”


As far as dislike of dissonance, “the results rule out the idea that beating matters very much,” agrees Laurent Demany, a psychophysicist at the University of Bordeaux in France. He says the study of amusic subjects was a spectacular idea. “Sensitivity to harmonicity is important in everyday life, not just in music,” he notes. For example, the ability to detect harmonic components of sound allows people to identify different vowel sounds, and to concentrate on one conversation in a noisy crowd. Because amusics don’t have problems with these tasks, even though they can’t distinguish consonance, further investigation of subjects with the condition should provide valuable information of the role of harmonicity in communication and perception, Demany says.


This story provided by ScienceNOW, the daily online news service of the journal Science.


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Jason Biggs defends tweeting ways
















NEW YORK (AP) — Jason Biggs is brushing off criticism he received during the recent election season for vulgar tweets that referenced the wives of both Republican Mitt Romney and his running mate in the presidential race, Paul Ryan.


The “American Pie” star took heat for off-color comments posted to his Twitter feed at the time of the Republican National Convention in August. The outpouring of criticism from parents groups, pundits and others led Nickelodeon to issue an apology for the actor’s comments on the social media website. Biggs is providing one of the voices in the cable TV station’s new animated series “Teenage Mutant Ninja Turtles.”













“I made a political tweet, so I got a little bit of heat from the right,” he said.


With elections over, Biggs says he’s moving on.


He appeared Monday night in New York at the annual 24 Hour Plays event, which was sponsored by luxury pen-maker Montblanc to benefit the Urban Arts Partnership. The benefit draws more than two dozen actors who write, rehearse, and perform one of six plays that they began working on the night before.


Biggs’ tweets have also poked fun at the Kardashians, Amanda Bynes, Lindsay Lohan and the ABC show “The Bachelorette.”


“I’m more afraid of the Kardashians, than I am of the Republicans,” he said.


He said he sees Twitter as an extension of the darker side of his humor.


As a three-time performer in 24 Hour Plays benefit, Biggs says he’s grown to feel more comfortable with the process.


“It’s a little easier. But it’s still nerve-racking, man.”


Entertainment News Headlines – Yahoo! News



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Q & A: Weighing the Evidence





Q. My husband weighs twice as much as I do, yet we take the same dose of over-the-counter medications, as recommended on the packaging. Shouldn’t weight be a factor?




A. There is little information about using weight as a factor in adjusting doses of either prescription or over-the-counter medications, said Dr. Steven A. Kaplan, director of the Iris Cantor Men’s Health Center at NewYork-Presbyterian/Weill Cornell hospital.


“We are beginning to study different responses by weight,” he said, but he and other researchers have reached no conclusions on recommendations for therapy.


“In my own field, urology,” he added, “my opinion is that it is more likely for the recommended dose to be ineffective in a larger person rather than to be toxic in a thinner adult.”


Some prescription drugs, like chemotherapy agents, already have their dosages adjusted for weight because of their highly toxic nature. As for over-the-counter drugs, recommended doses generally tend to be weighted in favor of safety rather than efficacy, Dr. Kaplan said.


He and other doctors emphasized the importance of following package directions. For example, acetaminophen (like Tylenol) can present a life-threatening risk if the liver cannot process a high dose. If you find that the recommended dose does not work for you, Dr. Kaplan said, speak to your doctor.


C. CLAIBORNE RAY


Readers may submit questions by mail to Question, Science Times, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.



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Wall Street Moves Higher


Wall Street stocks fell at the start of trading Tuesday, but later managed small gains, after international lenders clashed over help for Greece and investor concern grew over how a lack of agreement in Congress could hurt the nation’s economy.


Equities have been pressured in recent sessions by worries over a series of stringent budget cuts and tax increases that are scheduled to take effect in the new year. Market participants are concerned that if no deal is reached to modify the changes, the economy could fall back into recession.


In afternoon trading, the Standard & Poor’s 500-stock index added 0.2 percent to about 1,383 points, the Dow Jones industrial average rose 0.2 percent to about 12,842, and the Nasdaq composite index was 0.2 percent lower.


Concerns over the fiscal discussions contributed to the S.&P. 500’s losses last week, the worst week for the index since June. On Monday, the index ended up only by 0.1 percent, off its highs of the session.


“Stocks will be stuck where they are until we get some kind of resolution on this, and if we don’t get something done, people will be even more disenchanted with equities than they are now,” said Art Hogan, managing director of Lazard Capital Markets in New York.


American lawmakers return to the Capitol Tuesday with a seven-week deadline to reach agreement over the budget and taxes, and while most analysts expect some kind of deal will be forged, concerns remained. Barclays on Tuesday cut its year-end target for the S.&P. 500 to 1,325 points from 1,395, saying there was “little basis to believe a grand compromise is in the offing.”


Home Depot, the home improvement retailer, rose 4 percent after it reported earnings that beat expectations and raised its outlook.


“Home Depot has two things going for it — an improvement in the housing sector and the rebuilding efforts after Hurricane Sandy,” Mr. Hogan said. “That’s a backdrop where the company is very well positioned.”


The euro started weaker after euro zone finance ministers said Greece should be given until 2022 to meet a goal for reducing its debt mountain to a more manageable level, but Christine Lagarde, chief of the International Monetary Fund, insisted the existing target of 2020 should stay.


Behind the differences was a debate over whether euro zone governments should write off some of their Greek debt holdings to help Athens, an idea that Germany opposes.


European stocks closed higher. The DAX in Germany added less than a point, and the CAC 40 in France gained 0.6 percent. The FTSE 100 in Britain added 0.3 percent.


The S.&P. 500 was still up about 10 percent for 2012, despite losses in recent weeks. The Nasdaq has fallen for five straight weeks.


Stocks closed little changed Monday, with investors limiting bets ahead of the negotiations in Washington. Volume was light, with the bond market and government offices closed for Veterans Day.


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Why Lakers' hiring of Mike D'Antoni is bad, in 7 seconds or less








The new Lakers coach famously wants his players to shoot in seven seconds or less. I’m not going to require that long to list the reasons that hiring Mike D'Antoni was yet another Buss blunder.

He's never taken a team to an NBA Finals. He has a losing record in the playoffs. He doesn't coach defense. His sprinting offense will be tested on a team led by aging guys who no longer sprint.

And, oh yeah, he's not Phil Jackson.






I'll repeat what I wrote on Friday, only now with a greater and sadder emphasis: The only way the panicky firing of Mike Brown makes even an ounce of sense is if he was immediately replaced by Jackson.

Turns out, not only did Jim Buss not have a deal in place with Jackson when he fired Brown -- an inconceivable truth -- but he also wasn't prepared to make a deal. Buss apparently walked away from Jackson partially because the coach asked for an ownership piece of the team. Magic Johnson wins five championship rings and gets a piece of the Lakers, but Jackson's five championship rings gets him the door? This couldn’t be because Jim Buss never really liked Jackson, could it?

If you insist on applauding the Buss family for great ownership in moving so fast on firing Brown, then you must rip them for not having his logical replacement already in place, and you must be sickened that they didn’t realize the only man for that job, at this time, at any cost, was Jackson.

Mike D'Antoni is a great guy and a charismatic presence. If they add some younger and quicker pieces, the Lakers could eventually be wildly fun. But he has even less credibility with players than Mike Brown. He is exactly as one-dimensonal as Mike Brown. And his postseason basketball success makes Mike Brown look like, well, Jackson.

If you want to hire D'Antoni, you give Brown more than five games to get this roster figured out, because the transition time for D'Antoni is going to be long and the rewards are going to be questionable. If you want to hire D'Antoni, you make darn sure this season is trashed first, because there are no guarantees that his system can get any team past the second round.

Once it became obvious that Buss wouldn't give in to Jackson's incredible demands -- do you really blame Jackson for his asking price? -- then they should have just handed the team to Bernie Bickerstaff and taken their time in a national search. Instead, they settled on a guy who is recovering from knee-replacement surgery and can't even join the team immediately, they settled on him in about two days, and they relied on his best reference being a point guard with a fractured leg.

What about interviewing Brian Shaw? How about Nate McMillan? If Jackson is not an option, don't you at least look at Jerry Sloan?

D'Antoni coached in New York, so he can handle the heat here. The problem is, he went 121-167 there and could not even weasel a winning record out of a roster that, at one point, included Carmelo Anthony, Amare Stoudemire and Jeremy Lin.

D'Antoni coached basketball's most exciting team in Phoenix, so he knows entertainment. The problem: Those Phoenix teams had flexible fliers like Leandro Barbosa, Shawn Marion, a younger Steve Nash and a healthier Stoudemire. All that, and they still lost in the Western Conference finals in consecutive seasons.

His teams famously don't guard anybody. His offense is famously based on youth and quickness. His is a game of glitter but, so far, no NBA gold. How long is Dwight Howard sticking around if he doesn't think this guy can make the Lakers a winner?

On Friday night, in the wake of the Brown firing, everyone from the fans to Kobe Bryant were begging for Phil Jackson. Come this morning, they should be begging for an explanation.

One could list the reasons that the Mike Brown fire/Mike D'Antoni hire is just the latest in a series of moves that, despite their glittering roster, illustrate a huge vacancy in the Lakers' top-level leadership. But it's going to take a lot more than seven seconds.

Bill.plaschke@latimes.com

Twitter.com/billplaschke






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Introducing Wired's 'Top 3': May the Best Gadgets Win











Apple iPad. Microsoft Surface. Google Nexus 10. Samsung Galaxy Tab 2 10.1. Amazon Kindle Fire HD. Samsung Galaxy Note 16GB (Wi-Fi) 10.1, White. Samsung Galaxy Tab 2 7.0 (Wi-Fi) 8GB. LG G-Slate V909 32GB Wi-Fi & 4G Unlocked 8.9-inch. Sony Tablet S. Pioneer 11.6-inch Atom DreamBook ePad tablet. Asus Transformer Pad Infinity TF700 (gray, 32GB).


Gadget fatigue: It’s what happens when you start thinking about what tablet or smartphone or laptop or TV you want to buy. Too many choices. Too many variables. Too many upgrades.


Exactly how much stuff is coming out? Consider Motorola’s cellphone lineup. Its popular Razr series released six models over the last year — the Droid Razr, the Droid Razr Maxx, the Droid Razr HD, the Droid Razr Maxx HD, the Droid Razr M and the Razr I. Motorola, owned by Android mobile OS maker Google, also makes a number of other phones, such as the Atrix HD and Electrify.


Wired is here to help. We’ve reorganized our gadget reviews to highlight three clear winners in each of the most important consumer electronics categories. It’s called Wired’s Top 3, and it means what it says. Every day, you’ll find the three most successful gadgets, as judged by Wired reviewers, among hundreds of available mobile phones, tablets, e-readers, TVs and more.


Each category comes with in-depth buying advice. And we’ll be updating these lists and guides as soon as new products arrive, so you don’t have to slog through endless SKUs to find the stuff you need to look at before you make a purchase.


Think of it as noise-canceling tech for gadget news and reviews.


Don’t agree with our choices? Tell us so in the comments, and make your own suggestions for new (and old) products we should throw into the cage to face off with our current Top 3.






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Elmo puppeteer accused of underage relationship
















NEW YORK (AP) — The puppeteer who performs as Elmo on “Sesame Street” is taking a leave of absence from the popular kids’ show in the wake of allegations that he had a relationship with a 16-year-old boy.


Sesame Workshop said puppeteer Kevin Clash denies the charges, which were first made in June by the alleged partner, who by then was 23.













“We took the allegation very seriously and took immediate action,” Sesame Workshop said in a statement issued Monday. “We met with the accuser twice and had repeated communications with him. We met with Kevin, who denied the accusation.”


The organization described the relationship as personal and “unrelated to the workplace.” Its investigation found the allegation of underage conduct to be unsubstantiated. But it said Clash exercised “poor judgment” and was disciplined for violating company policy regarding Internet usage. It offered no details.


“I had a relationship with (the accuser),” Clash told TMZ. “It was between two consenting adults and I am deeply saddened that he is trying to make it into something it was not.”


At his request, Clash has been granted a leave of absence in order to “protect his reputation,” Sesame Workshop said.


No further explanation was provided, nor was the duration of his leave specified.


“Elmo is bigger than any one person and will continue to be an integral part of ‘Sesame Street’ to engage, educate and inspire children around the world, as it has for 40 years,” Sesame Workshop said in its statement.


“Sesame Street” is currently in production, but other puppeteers are prepared to fill in for Clash during his absence, according to a person close to the show who spoke on condition of anonymity because that person was not authorized to publicly discuss details about the show’s production.


“Elmo will still be a part of the shows being produced,” that person said.


The 52-year-old Clash, the divorced father of a grown daughter, has been a puppeteer for “Sesame Street” since 1984. It was then that he was handed the fuzzy red puppet named Elmo and asked to come up with a voice for him. Clash transformed the character, which had been a marginal member of the Muppets troupe for a number of years, into a major star rivaling Big Bird as the face of “Sesame Street.”


In 2006, Clash published an autobiography, “My Life as a Furry Red Monster,” and was the subject of the 2011 documentary “Being Elmo: A Puppeteer’s Journey.”


Entertainment News Headlines – Yahoo! News



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The New Old Age Blog: What Chemo Can't Do

Let’s start with a simple medical fact: Chemotherapy doesn’t cure people who have very advanced Stage 4 lung or colon cancer.

Chemo can be quite effective at earlier stages. Even in late-stage disease, it may relieve symptoms for a while; it might help someone with tumors in his lungs breathe more easily, for example. Chemo can extend life for weeks or months.

It can also make the recipient feel nauseated, wiped out and generally lousy, and require him to spend more time in clinics and hospitals than a dying person might choose to. But it can’t banish cancer. Many aspects of medical prognosis and treatment are uncertain. Not this one.

Such patients’ doctors have almost certainly told them their cancer is incurable. Those who opted for chemotherapy anyway had to sign consent forms spelling out the potential side effects. Yet Dr. Jane Weeks, a research oncologist at Dana-Farber Cancer Institute in Boston, knew from previous studies that cancer patients can develop unrealistic ideas about their odds of survival.

So as she and her co-authors began analyzing results from the first representative national study of patients with advanced cancer, all undergoing chemotherapy, to see what they thought about its effects, Dr. Weeks expected many — perhaps a third of them — to get it wrong.

She was staggered to see how mistaken she was.

Nearly 1,200 patients or their surrogates were interviewed within months of a diagnosis of Stage 4 colon or lung cancer. They answered a number of questions during these telephone interviews, but the key one was: “After talking with your doctors, how likely did you think it was that chemotherapy would cure your cancer?” The only correct answer: “Not at all likely.”

But a great majority chose one of the other responses indicating some likelihood of cure or else said they didn’t know. The study, just published in The New England Journal of Medicine, found that 69 percent of lung cancer patients and 81 percent of those with colon cancer misunderstood the purpose of the very treatment they’d been undergoing.

The misperception was significantly higher among African-Americans, Asians and Hispanics than among whites — but not because of education levels, the usual variable in studies of health knowledge. “It suggests that this reflects cultural differences,” Dr. Weeks said.

Strangely, the patients who responded inaccurately also were more likely to highly rate their communications with doctors. Those who grasped that chemo wasn’t curative were, in effect, penalizing the doctors who helped them reach that understanding.

In a way, Dr. Weeks said, this makes sense. It reflects what researchers call optimism bias — or what Dr. Douglas White, a University of Pittsburgh bioethicist, has called “the powerful desire not to be dead.”

These were not very elderly people.  The bulk were ages 55 to 69. Only about a quarter of colon cancer patients and about a third of those with lung cancer were over age 70.

“It’s completely understandable that patients want to believe the chemo will cure them,” Dr. Weeks said. “And it’s understandable that physicians hesitate to take away that false hope.”

But this confusion can have unhappy consequences. For patients to make truly informed decisions, “they need to understand the outcomes,” Dr. Weeks said. “If they’re missing this critical fact, that can’t happen.”

People often hit rough times during weeks of chemotherapy. Common side effects include nausea and vomiting, diarrhea and fatigue; there are many trips to hospitals for IV drugs, X-rays and blood tests. “They’ll soldier on if they think it will cure them,” Dr. Weeks said. “Any of us would.”

But if these patients might respond differently if they understand that chemo is meant to make them feel better but may have the opposite effect, or that it may buy them another 10 to 12 weeks (a reasonable average for lung cancer) or maybe a year (for colon cancer) but won’t prevent their deaths.

Moreover, “if patients think chemo has a chance of curing them, they’ll be less likely to have end-of-life discussions early on,” Dr. Weeks said. “And they pay a price for that later” — if they enter hospice care much too late or die in hospitals instead of at home, as many prefer.

Possibly, at the time of the initial discussions, these patients recognized that chemo didn’t equal cure, she hypothesized. Then, they and their doctors began to focus on doing something, and they stopped seeing their cancer as incurable.

But realism — as palliative care doctors know — doesn’t have to mean despair. “A really good physician can communicate effectively and still maintain patient trust and confidence,” Dr. Weeks said.

“We have the tools to help patients make these difficult decisions,” two Johns Hopkins physicians, Dr. Thomas J. Smith and Dr. Dan Longo, wrote in an editorial published with the study. “We just need the gumption and incentives to use them.”


Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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