Quest to Eliminate Diagnostic Lapses





SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.




At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.


Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice.


The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.


To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.


Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?


The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.


And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.


In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.


Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.


Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.


Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.


When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.


Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”


He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”


Clinical Precision


Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.


One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.


There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.


“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.


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Better Economy and Storm Delays Lift U.S. Auto Sales


DETROIT (AP) — Superstorm Sandy gave an extra boost to already strong U.S. auto sales last month, although carmakers warned that uncertainty over the "fiscal cliff" could undo some of those gains.


Most major companies, from Toyota to Chrysler, posted impressive increases from a year earlier. Only General Motors was left struggling to explain its 3-percent sales gain and large inventory of unsold trucks.


Americans were already willing to buy a new car or truck last month because they're more confident in the economy. Home values are rising, hiring is up and auto financing is readily available. Also, the average age of a vehicle on U.S. roads is approaching a record 11 years, so many people are looking to replace older cars.


Sandy just boosted that demand. The storm added 20,000 to 30,000 sales industry wide in November, mostly from people who planned to buy cars during the October storm but had to delay their purchases, Ford estimated. People who need to replace storm-damaged vehicles are expected to drive sales for several more months. GM estimates that 50,000 to 100,000 vehicles will eventually need to be replaced.


November sales, when calculated on an annual basis, are likely to be 15 million or more, the highest rate since March of 2008, according to LMC Automotive, a Detroit-area consulting firm. That's higher than the 14.3 million annual rate so far this year, even though November is normally a lackluster month due to cold weather and holiday anticipation. Both GM and Chrysler predicted November sales would run at an annual rate of 15.3 million.


If sales end up at 15 million for the year, it would be a vast improvement over the 10.4 million during the recession in 2009. Sales would still fall short of the recent peak of around 17 million in 2005.


But the ongoing "fiscal cliff" negotiations between Congress and the White House could still derail the industry's recovery. The term refers to sharp government spending cuts and tax increases scheduled to start Jan. 1 unless an agreement is reached to cut the budget deficit. Economists say that those measures, if implemented, could push the U.S. economy back into a recession.


"Exactly how much growth we can expect next year will depend in part on how Congress and the president resolve the fiscal cliff issue," said Kurt McNeil, GM's U.S. sales chief. "Markets and consumers hate uncertainty."


McNeil and other GM executives tried to explain the automaker's disappointing performance. GM's biggest brand, Chevrolet, reported flat sales over last year despite new products like the Spark minicar. Silverado pickup sales fell 10 percent.


GM's sales have been trailing the industry all year. They were up 4 percent through October, compared to the industry-wide increase of 14 percent.


GM said its competitors resorted to higher than usual incentives last month to get rid of 2012 model-year trucks. GM, which had more 2013 trucks on its lots, was only offering an average of $500 per truck, or a third of what others were offering. GM has been trying to hold the line on costly incentives, which can hurt resale value and brand image.


"We want to be known for great products, not great incentives," McNeil said.


But some analysts think GM will be forced to offer more deals in December to clear out higher-than-forecast inventory.


Asian brands also got a boost from some unusually big discounts, said Jesse Toprak, senior analyst for automotive pricing site TrueCar.com. TrueCar estimated that Hyundai and Kia, which were admonished by the U.S. government in late October for overstating gas mileage, increased incentive spending by nearly 30 percent. Nissan spending was up 45 percent to $4,273 per vehicle, by far the highest incentives in the industry.


Toyota said its 17-percent sales increase was partly due to post-Sandy demand. Honda was up 39 percent thanks to strong sales of the new Accord sedan and clearance deals on the outgoing Civic, which was replaced by a new 2013 Civic at the end of the month.


Luxury cars saw their usual yearend surge as holiday commercials started crowding the airwaves. Porsche's sales rose 71 percent to 3,865, a record month for the automaker. Infiniti, Acura, BMW and Lexus all reported big gains.


Edmunds.com analyst Jessica Caldwell said luxury brands have historically targeted their customers at this time of year because of holiday bonuses. That's no longer a driving factor, she said, but it's still a good time of year for people to buy 2012 model-year luxury vehicles because dealers are trying to clear them out.


Other automakers reporting sales Monday:


— Chrysler's sales were up 14 percent. Ram pickups were up 23 percent, while sales of the Fiat 500 minicar more than doubled.


— Hyundai's sales rose 8 percent, led by the Sonata midsize car and the Elantra compact. TrueCar said Hyundai increased incentives by 30 percent it was admonished by the U.S. government in late October for overstating gas mileage.


— Volkswagen's sales rose 29 percent on the strength of the Passat sedan, which was up 75 percent.


— Nissan's sales climbed 13 percent as sales of its new Pathfinder SUV more than tripled over last year.


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Tunnel Collapses Outside Tokyo, Trapping Motorists


Kyodo News, via Associated Press


A surveillance camera within the Sasago tunnel showed rescue workers at the scene of a collapse on Sunday.







TOKYO — At least seven people were feared dead after a highway tunnel collapsed on Sunday in eastern Japan, trapping them in their vehicles and starting a fire that filled the passage with thick, black smoke.








Franck Robichon/European Pressphoto Agency

Fire fighters and rescue personnel gathered at the entrance to the Sasago tunnel, west of Tokyo.






Three vehicles appeared to have been crushed under concrete that fell from the ceiling of the three-mile Sasago Tunnel near the city of Otsuki in Yamanashi Prefecture, about 50 miles west of Tokyo, the national disaster management agency said. Officials from the agency and the police said it remained unclear why a section of the tunnel — 150 to 200 feet of eight-inch-thick concrete that weighed about 180 tons — suddenly fell.


A vehicle carrying six people caught fire, whose heavy smoke initially prevented firefighters from entering the tunnel. But even after putting out the blaze, rescuers had to temporarily suspend efforts to reach the vehicles inside because of the danger of a further collapse, officials said.


Rescue efforts resumed later in the day, though progress was slow.


A 28-year-old woman managed to escape from the vehicle that caught fire, officials said. She told firefighters that five other people remained inside. It was unclear how many people were in the other trapped vehicles besides the drivers.


One of the other vehicles appeared to be a truck belonging to a food wholesaler, officials said. The truck’s driver called his company right after the accident to ask for help, they said, but officials were later unable to reach him on his cellphone.


The operator of the highway, the Central Nippon Expressway, held a news conference to apologize for the accident. The police said they had opened an investigation into the cause of the collapse and about whether professional negligence by the operator was a factor.


The accident closed a section of the Chuo Expressway, which connects Tokyo to western Japan. Such long tunnels — usually lined with smooth, white concrete — are common on highways in the mountainous island nation.


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Apple to sell new iPads, iPhone 5 in China in Dec.












CUPERTINO, Calif. (AP) — Apple Inc. on Friday said its latest iPad models will go on sale in China on Dec. 7, followed by the iPhone 5 a week later.


China is one of Apple‘s largest and fastest-growing markets. Analyst Brian White at Topeka Capital Markets said iPhone 5 is launching roughly when he expected it, but he hadn’t expected the iPad mini and the fourth-generation, full-size iPad to go on sale in China this year.












“Our conversations during our meetings and casual consumer interactions during our China trips tell us that the iPad Mini will take off like wildfire in China,” White wrote in a research report Friday morning. “The smaller form factor and lower price point, we believe Apple will be able to sell the iPad mini in meaningful volumes.”


White said uptake of the iPhone 4S was relatively slow in China, because the signature new feature, voice-recognition-powered virtual assistant Siri, did not understand Mandarin Chinese. With this year’s software update, Siri now does understand the language, which should encourage upgrades, he said.


Gadgets News Headlines – Yahoo! News


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KC fans observe moment for violence victims

KANSAS CITY, Mo. (AP) — Before the Kansas City Chiefs kicked off their game Sunday, fans at Arrowhead Stadium observed a moment of silence for the victims of domestic violence and their families.

Not mentioned was Jovan Belcher, the Chiefs linebacker who killed his girlfriend and then himself a day earlier, across the parking lot from the stadium.

Barely more than 24 hours later, fans grilled, played catch and enjoyed beverages on an unseasonably warm and sunny day.

The festive atmosphere masked some of the pain Chiefs fans felt after hearing that Belcher had killed 22-year-old Kasandra M. Perkins, then drove to the team practice facility and turned the gun on himself. The couple had an infant daughter.

Coach Romeo Crennel and general manager Scott Pioli had tried to stop Belcher, and watched powerless as he shot himself in the head after thanking both of them for giving him a chance in the NFL.

"To have to witness that, I don't think you would wish that on your worst enemy," Chiefs fan Ty Rowton said. "That memory will never, ever leave them."

Missing from the sky above Arrowhead Stadium was the small plane that had carried a banner during previous home games calling for Pioli's firing. Fans, many of whom had been wearing black Chiefs apparel in recent games to protest the team's performance, turned out in red again.

"Now everybody's just in shock," Rowton said.

Arrowhead was less than half full, and quieter than usual, though the fans made some noise when Peyton Hillis scored a touchdown. The big running back took the ball over to the sideline, where he handed it to Crennel and gave the coach a big hug.

Chiefs fan Ben Cunningham, a 32-year-old who has missed only one home game in 23 years, said he feels sorry for the families and friends who now must endure the aftermath of Saturday's shootings, but not for Belcher.

"I don't have much sympathy for him," Cunningham said. "He caused a lot of heartbreak for a lot of people."

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Opinion: A Health Insurance Detective Story





I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?




After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?


The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.


Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.


But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?


A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.


Here’s a snapshot of my surreal experience:


NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.


Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”


I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.


NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.


NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.


My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.


NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.


Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.


But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.


NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.


CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.


NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.


Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.



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John McAfee Plays Hide-and-Seek in Belize


Photo Illustration by The New York Times


John McAfee, right, a pioneer in computer security who lives in Belize, is a “person of interest” in the murder of his neighbor. More Photos »





DANIEL GUERRERO promised during his campaign for mayor here to clean up San Pedro, the only town on this island, a 20-minute puddle jump from the mainland. But if he ever runs for re-election, don’t expect him to mention that vow.


“I meant clean up the trash, the traffic, that sort of thing,” he says. “I didn’t mean this.”


“This” is a full-blown international media frenzy and the kind of mess that no politician could have seen coming. It started on Nov. 11, the morning that Gregory Faull, a 52-year-old American, was found dead, lying face up in a pool of blood in his home. He had been shot in the head. His laptop and iPhone were missing. A 9-millimeter shell was found nearby.


What happened next turned this from a local crime story to worldwide news: The police announced that a “person of interest” in the investigation was a neighbor, John McAfee, a Silicon Valley legend who years ago earned millions from the computer virus-fighting software company that still bears his name.


A priapic 67-year-old, with an improbable mop of blond-highlighted hair and a rotating group of young girlfriends, Mr. McAfee quickly melted into the island’s lush green forest. Then, for Belizean authorities, the real embarrassment began.


Asserting his innocence, Mr. McAfee became a multiplatform cyberdissident, with a Twitter account, and a blog at whoismcafee.com with audio links, a comments section, photographs and a stream of invective against the government and the police of Belize. He has done interviews on podcasts, like the “Joe Rogan Experience,” and offered a $25,000 reward for information leading to the arrest of “the person or persons” who killed Mr. Faull. He has turned lamming it into a kind of high-tech performance art.


“I am asking all people of conscience to read this blog, especially the links in the ‘Background’ section,’ and see the ugly truth unfolding here,” he posted on Nov. 18. “Speak out. Write your congressmen. Write the prime minister. Do what you can.”


Before he went underground, Mr. McAfee led a noisy, opulent and increasingly stressful life here. He was known for the retinue of prostitutes who he says moved in and out of his house, and for employing armed guards, some of whom stood watch on the beach abutting his house. He also kept a pack of untethered dogs on his property who barked at and sometimes bit passers-by.


Two days before the murder, someone had poisoned a handful of those dogs. As it happens, Mr. Faull had complained about the animals, as well as the guards and the constant late-night inflow and outflow of taxis on the dirt path that runs behind his and Mr. McAfee’s homes — a path so tiny that it’s supposed to be off-limits to cars.


Mr. Faull had shown up at the town council office a few weeks ago with a letter decrying the din and the dogs, as well as Mr. McAfee’s guns and behavior. Nothing came of it.


“We were planning to meet with John McAfee and hand him the letter,” Mr. Guerrero said. “But it never happened. We were busy doing other work.”


In hindsight, that looks like a blunder. Mr. McAfee has since said on his blog that he had no choice but to flee because police and politicians in Belize are corrupt and eager to kill him. As proof, he has written at length about a late April raid that the country’s Gang Suppression Unit conducted at a property of his on the mainland, in a district called Orange Walk.


Some McAfee watchers have a different theory — namely, that he grew paranoid and perhaps psychotic after months of experimenting with and consuming MDPV, a psychoactive drug. These experiments were described in detail by Mr. McAfee himself, under the pseudonym “Stuffmonger” in a forum on Bluelight, a Web site popular with drug hobbyists.


So, here’s one hypothesis: Rich man doses himself to madness while seeking sexual bliss through pharmacology. Then shoots neighbor in a rage. Case closed, right? Ah, but those Bluelight posts were a ruse, Mr. McAfee would later blog, just one of the many pranks he has perpetrated over the years — part of a bet with a friend to see if he could create Bluelight’s largest-ever thread.


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Police: Chiefs' Belcher accused in murder-suicide

KANSAS CITY, Mo. (AP) — Kansas City Chiefs linebacker Jovan Belcher fatally shot his girlfriend Saturday, then drove to Arrowhead Stadium and committed suicide in front of his coach and general manager.

Authorities did not release a possible motive for the murder-suicide, though police said that Belcher and his girlfriend had been arguing recently. The two of them have an infant child.

Belcher thanked general manager Scott Pioli and coach Romeo Crennel before shooting himself in the parking lot of the team's practice facility, police spokesman Darin Snapp said. Police had locked it down by mid-morning and reporters were confined to the street just outside the gates.

The Chiefs were scheduled to play the Carolina Panthers on Sunday at Arrowhead Stadium. The Panthers were advised by the league to travel to Kansas City as planned, though no official announcement on the game itself had been made.

Belcher was a 25-year-old native of West Babylon, N.Y., on Long Island, who played college ball at Maine. He signed with the Chiefs an undrafted free agent, made the team and stayed with it for four years, moving into the starting lineup. He'd played in all 11 games this season.

"The entire Chiefs family is deeply saddened by today's events, and our collective hearts are heavy with sympathy, thoughts and prayers for the families and friends affected by this unthinkable tragedy," Chiefs chairman Clark Hunt said in a statement.

"We sincerely appreciate the expressions of sympathy and support we have received from so many in the Kansas City and NFL communities, and ask for continued prayers for the loved ones of those impacted," Hunt said. "We will continue to fully cooperate with the authorities and work to ensure that the appropriate counseling resources are available to all members of the organization."

Authorities reported receiving a call Saturday morning from a woman who said her daughter had been shot multiple times at a residence about five miles away from the Arrowhead complex. The call actually came from Belcher's mother, who referred to the victim as her daughter, leading to some initial confusion, police said.

Police then received a phone call from the Chiefs' training facility.

"The description matched the suspect description from that other address. We kind of knew what we were dealing with," Snapp said. The player was "holding a gun to his head" as he stood in front of the front doors of the practice facility.

"And there were Pioli and Crennel and another coach or employee was standing outside and appeared to be talking to him. It appeared they were talking to the suspect," Snapp said. "The suspect began to walk in the opposite direction of the coaches and the officers and that's when they heard the gunshot. It appears he took his own life."

The coaches told police they never felt in any danger, Snapp said.

"They said the player was actually thanking them for everything they'd done for him," he said. "They were just talking to him and he was thanking them and everything. That's when he walked away and shot himself."

Snapp described the girlfriend as in her early 20s and that she and the player had a child together. He said Belcher's mother told police they had recently been arguing.

Belcher is the latest among several players and NFL retirees to die from self-inflicted gunshot wounds in the past couple of years. The death of the beloved star Junior Seau, who shot himself in the chest in at his California home in May, sent shockwaves around the league.

Kansas City Mayor Sly James said that he spoke to Pioli after the incident, and while he refused to discuss the GM's emotional state, the mayor said Pioli was "extremely concerned that fans of this team are not disappointed and not left in the cold."

"I think they think there's an obligation to the people of this city, the fans of the team and the fans of the other team to play the game," James said.

The season has been a massive disappointment for the Chiefs, who were expected to contend for the AFC West title. They're just 1-10 and mired in an eight-game losing streak marked by injuries, poor play and fan upheaval, with calls for Pioli and Crennel to be fired.

The Twitter account for a fan group known as "Save Our Chiefs" recently surpassed 80,000 followers, about 17,000 more than the announced crowd at a recent game.

"The Oakland Raiders are empathizing with the Chiefs organization," the Chiefs' AFC West rivals said in a statement. "Our hearts are wounded by such an unimaginable tragedy in our NFL family."

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Associated Press Writer Heather Hollingsworth contributed to this report.

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Online: http://pro32.ap.org and http://twitter.com/AP_NFL

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Saints' Vilma, Smith attend Williams hearing

WASHINGTON (AP) — Saints defensive end Will Smith says he's glad he got a chance to hear former defensive coordinator Gregg Williams testify at an appeals hearing in the bounties case.

Smith and New Orleans linebacker Jonathan Vilma attended Friday's session, where Williams was cross-examined by the players' lawyers for about four hours.

Smith described the hearing as "peaceful" and "not awkward."

Smith and Vilma — along with two former Saints, free-agent defensive lineman Anthony Hargrove and Cleveland Browns linebacker Scott Fujita — were suspended by the NFL for the Saints' cash-for-hits program that the league says Williams ran from 2009 to 2011.

Smith, suspended four games, and Vilma, suspended for the entire current season, have been playing while their appeals are pending.

Smith declined to discuss any details of Friday's hearing.

"We got to hear what Gregg had to say," Smith said. "We wanted to make sure we were there just to hear him out.".

Right from the start, the NFL said Williams was in charge of a pay-for-pain bounty system with the New Orleans Saints.

The former defensive coordinator — who told the league about others' involvement — was being cross-examined Friday by lawyers for players appealing their suspensions in the case.

"We know what we did and know what we didn't do," Smith said.

The hearing is part of the latest round of player appeals overseen by former NFL Commissioner Paul Tagliabue. Former Saints assistant coach Mike Cerullo faced questions Thursday, when lawyers for the league and for players spent more than nine hours in a Washington office building.

Tagliabue and various lawyers declined to comment Thursday or Friday.

Vilma and Smith traveled to Washington after playing in New Orleans' 23-13 loss at Atlanta on Thursday night.

Neither player was required to attend Friday, but Smith said this week that "part of the things that we wanted all along was to face our accusers."

The NFL has described Vilma and Smith as ringleaders of a performance pool designed to knock targeted opponents out of games. The league has sworn statements from Williams and Cerullo saying Vilma offered $10,000 to anyone who knocked quarterback Brett Favre out of the NFC championship game at the end of the 2009 season.

NFL Commissioner Roger Goodell issued the initial suspensions, which also included a full-season ban for Saints head coach Sean Payton.

Lawsuits brought by Vilma and the NFL Players Association to challenge Goodell's handling of the case, including his decision in October to appoint Tagliabue as the arbitrator for the appeals, are pending in federal court in New Orleans.

On Thursday, U.S. District Judge Ginger Berrigan gave the parties until Monday to answer questions about whether the NFL's collective bargaining agreement prevents a commissioner from handing out discipline for legal contact, and whether the CBA's passages about detrimental conduct are "ambiguous, hence unenforceable."

In March, the NFL announced that its investigation showed the Saints put together a bounty pool of up to $50,000 to reward game-ending injuries inflicted on opponents. "Knockouts" were worth $1,500 and "cart-offs" $1,000 — with payments doubled or tripled for the playoffs, the league said.

According to the league, the pay-for-pain program was administered by Williams, with Payton's knowledge. At the time, Williams apologized for his role, saying: "It was a terrible mistake, and we knew it was wrong while we were doing it."

Later that month, Payton became the first head coach suspended by the league for any reason — banned for all of this season without pay — and Williams was suspended indefinitely.

Williams was known for his aggressive, physical defenses as a coordinator for Tennessee, Washington, Jacksonville and New Orleans, and during his time as head coach of Buffalo. In January, he was hired by St. Louis to lead their defense.

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Connect with Howard Fendrich on Twitter at http://twitter.com/HowardFendrich

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Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Hacking Report Criticizes Murdoch Newspaper and British Press Standards





LONDON — The leader of a major inquiry into the standards of British newspapers triggered by the phone hacking scandal offered an excoriating critique of the press as a whole on Thursday, saying it displayed “significant and reckless disregard for accuracy,” and urged the press to form an independent regulator to be underpinned by law.







Dan Kitwood/Getty Images

Lord Justice Sir Brian Leveson on Thursday with his inquiry on press standards.






The report singled out Rupert Murdoch’s defunct tabloid The News of the World for sharp criticism.


“Too many stories in too many newspapers were the subject of complaints from too many people with too little in the way of titles taking responsibility, or considering the consequences for the individuals involved,” the head of the inquiry, Lord Justice Sir Brian Leveson, said in a 46-page summary of the findings in his long-awaited, 1,987-page report published in four volumes.


“The ball moves back into the politicians’ court,” Sir Brian said, referring to what form new and tighter regulations should take. “They must now decide who guards the guardians.”


The report was published after some 337 witnesses testified in person in 9 months of hearings that sought to unravel the close ties between politicians, the press and the police, reaching into what were depicted as an opaque web of links and cross-links within the British elite as well as a catalog of murky and sometimes unlawful practices within the newspaper industry.


“This inquiry has been the most concentrated look at the press this country has ever seen,” Sir Brian said after the report was made public.


But in a first reaction, Prime Minister David Cameron resisted the report’s recommendation that a new form of press regulation should be underpinned by laws, telling lawmakers that they “should be wary” of “crossing the Rubicon” by enacting legislation with the potential to limit free speech and free expression.


Mr. Cameron’s remarks drew immediate criticism from the leader of the Labour opposition, Ed Miliband, who said Sir Brian’s proposals should be accepted in their entirety.


Mr. Cameron ordered the Leveson Inquiry in July, 2011, as the phone hacking scandal at The News of the World blossomed into broad public revulsion with reports that the newspaper had ordered the interception of voice mail messages left on the cellphone of Milly Dowler, a British teenager who was abducted in 2002 and later found murdered. Sir Brian said there had been a “failure of management and compliance” at the 168-year-old News of the World, which Mr. Murdoch closed in July, 2011, accusing it of a “general lack of respect for individual privacy and dignity.”


“It was said that The News of the World had lost its way in relation to phone hacking,” the summary said. “Its casual attitude to privacy and the lip service it paid to consent demonstrated a far more general loss of direction.”


Speaking after the report was published, Sir Brian said that while the British press held a “privileged and powerful place in our society,” its “responsibilities have simply been ignored.”


“A free press in a democracy holds power to account. But, with a few honorable exceptions, the U.K. press has not performed that vital role in the case of its own power.”


“The press needs to establish a new regulatory body which is truly independent of industry leaders and of government and politicians,” he said. “Guaranteed independence, long-term stability and genuine benefits for the industry cannot be realized without legislation,” he said, adding: “This is not and cannot reasonably or fairly be characterized as statutory regulation of the press.”


In the body of the exhaustive report, reprising at length the testimony of many of the witnesses who spoke at the hearings, the document discusses press culture and ethics; explores the press’s attitude toward the subjects of its stories; and discusses the cozy relationship between the press and the police, and the press and politicians.


John F. Burns, Sandy Lark Turner and Sandy Macaskill contributed reporting.



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