Antismoking Outlays Drop Despite Tobacco Revenue

Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.

Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.

States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.

The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.

“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.

Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.

Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.

The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.

The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.

Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.

“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”

Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.

The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.

An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.

Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.

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Clock running out for owners of prime parcels near McCormick Place

The development team behind a long-stalled plan to build hotels and restaurants just north of McCormick Place suffered a serious setback in federal bankruptcy court on Wednesday afternoon.

Judge Jack Schmetterer granted a motion by lender CenterPoint Properties Trust to reject the latest development plan of property owner Olde Prairie Block Owner LLC, which is led by developers Pamela Gleichman, Karl Norberg and Gunnar Falk.

Schmetterer said Olde Prairie failed to show its plans were financially plausible, noting its pledges from investors were highly conditional.

"It's a maybe situation," he said. He gave them 10 days to produce a more solid plan.

"I urge them to take their best shot, because it is the last one they will get," he said. The next hearing is Dec. 17.

Gleichman said she is confident she can get more iron-clad commitments from her team's investment partners within that time frame.

If Schmetterer dismisses the bankruptcy case at the next hearing, it would open the door for a foreclosure auction of the property. This would make it possible for the Metropolitan Pier and Exposition Authority, the state-city agency that owns McCormick Place, or other parties, to bid for the properties located on the north side of Cermak Road, across the street from the authority's administrative offices and the West Building of McCormick Place.

McCormick Place officials are aiming to vastly expand the amenities surrounding the convention complex to include more hotels, restaurants, entertainment venues and an arena that could host large-scale corporate assemblies and potentially collegiate sports such as DePaul Blue Demons basketball.

DePaul University, which would like to bring its men's basketball back to the city from its current home at the Allstate Arena in Rosemont, is weighing a number of sites. McCormick Place and United Center officials have acknowledged talks with the university.

Opposition to an arena on the Olde Prairie blocks surfaced this week, with the Prairie District Neighborhood Alliance writing a letter stating an arena would be out of character in the historic residential area and would create traffic problems. Ald. Robert Fioretti, whose 2nd ward includes McCormick Place, has expressed opposition to an arena on that site as well.

kbergen@tribune.com | Twitter @kathy_bergen

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Suburban teachers end strike with tentative 3-year deal

Teachers in Community Unit District 300 reached a deal with the school board late Tuesday to end a one-day walkout in the large, far northwest suburban school district.

Talks had broken down late Monday, prompting the district's more than 1,200 teachers to go on strike Tuesday and leaving more than 20,000 students out of class.

School board member Joe Stevens announced after 9 p.m. Tuesday that, following talks that resumed at 2 p.m., the two sides has struck a three-year deal. No other details were immediately provided, but a union official called the agreement "fair to the teachers and responsible to the taxpayers."

Stevens said no further details would be released until the deal is ratified by the union and the school board. A board vote isn't expected until Dec. 18 at the earliest.

Just hours earlier, a union official had reported little progress at the resumed talks.

District 300, based in Carpentersville, was the latest among at least six Chicago-area school systems — including Chicago Public Schools — whose teachers have gone on strike this school year. Many of the same issues — class size, pay and benefits, equity of compensation compared to similar districts — have been repeated, as school boards seek new ways to control spending amid new mandates from Springfield and more modest tax receipts than before the economic downturn.

Tuesday, much of the public back-and-forth between the union and district officials was over class size. Currently, elementary classes are capped at 33 to 37 students, according to district figures, but some high school classes top 40 students, teachers said.

“You can't teach equitably that way,” Tom Domenz, an art teacher at Jacobs High in Algonquin, said from the picket line Tuesday. “Classes are all over the board. It's not fair to the kids. Parents are paying the same taxes and (students) are not getting the same attention.”

Steve Pittner, a seventh-grade social studies teacher at Algonquin Middle School, said there has been “tremendous support” from parents and teachers. Students also were seen joining the picket line.

“They got to do something about the class size,” Pittner said while picketing at Algonquin Road and Main Street. “(Large classes) are not creating a culture of learning that's conducive for our students. This is the worst I've seen it. As far as class size goes, this is bad.”

But district officials said they offered a deal to teachers on Monday in which class sizes would be capped next year at 27 students in kindergarten through second grade and 30 students in grades three to five. The plan would also add 60 new teachers throughout the district.

Williamson, however, said those class sizes aren’t low enough to satisfy teachers. He also said teachers want an increase in their base salary.

The district counters that the union returned with new salary demands after the school board made its offer to lower class sizes. The district say it has offered teachers raises of 3 percent this year, 2 percent next year and 3 percent in the following — figures that include both base pay and “step increase,” additional raises that teachers in most Chicago-area districts receive each year for adding another year of seniority.

Union officials have also argued that teachers are underpaid compared to other suburban districts, according to a statement on the teachers union website.

Of the teachers strikes that have occurred so far this year in the Chicago area, Evergreen Park District 124’s was the longest, lasting 10 days.

Chicago Public School teachers were off the job for seven days, and Lake Forest High School teachers for five days. Strikes in Crystal Lake-based Prairie Grove District 46 and Highland Park-based North Shore District 112 also each lasted for one day before deals were reached.

chicagobreaking@tribune.com

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Software guru McAfee says to seek asylum in Guatemala

GUATEMALA CITY (Reuters) – U.S. anti-virus software guru John McAfee, who is on the run from police in Belize seeking to question him in a murder probe, has crossed into Guatemala and said on Tuesday he will seek political asylum there.

McAfee has been in hiding for three weeks since police in Belize said they wanted to question him as “a person of interest” about the murder of fellow American Gregory Faull, with whom McAfee had quarreled.

McAfee smuggled himself and his girlfriend, Samantha, across the porous land border that Belize shares with Guatemala. He stayed at a hotel in a national park before heading for Guatemala City on Monday evening.

“I have no plans much for the future now. The reason I chose Guatemala is two-fold,” McAfee told Reuters by telephone from Guatemala’s Supreme Court, flanked by his lawyer, former attorney general and lawyer Telesforo Guerra.

“It is a country bordering Belize, it is a country that understands the corruption within Belize and most importantly, the former attorney general of the country is Samantha’s uncle and I knew that he would assist us with legal proceedings.”

McAfee has denied involvement in the murder and told Reuters on Monday he would not turn himself in. He posted repeatedly on his blog www.whoismcafee.com while on the run, describing how he would constantly change his disguise to elude capture.

On Tuesday, he appeared with his hair and goatee died black, and wearing a dark suit and tie – a far cry from the surfer-style blonde hair highlights, shorts and tribal-tattooed bare shoulders he sported in Belize.

“(Guerra) is now attempting to get political asylum for myself and for Sam. I don’t think there will be much of a problem. From here I can speak freely and safely,” McAfee said.

TECH GENIUS, “BONKERS”

McAfee says he believes authorities in Belize would kill him if he turned himself in for questioning. Belize’s prime minister has denied the claim and called the 67-year-old paranoid and “bonkers.”

On the Caribbean island of Ambergris Caye, where McAfee has lived for about four years, residents say he is eccentric, impulsive, erratic and at times unstable, with a penchant for guns and young women.

He would often be seen with armed bodyguards, pistols tucked into his belt, and McAfee’s neighbor had complained about the loud barking of dogs that guarded his exclusive beachside compound.

His run-in with authorities in Belize is a world away from a successful life in the United States, where he started McAfee Associates in 1989 and made millions of dollars developing the Internet anti-virus software that carries his name.

There was already a case against McAfee in Belize for possession of illegal firearms, and police had previously raided his property on suspicion he was running a lab to make illegal synthetic narcotics.

McAfee says he has been persecuted for refusing to donate money to politicians, that he loves Belize, and considers it his home.

Guatemala is a canny choice to seek refuge. It has long been embroiled in a territorial dispute with Belize. Guatemala claims the southern half of Belize and all of its islands, or cayes, rightfully belong to it. There is no extradition treaty between the two countries.

A Guatemalan government source said there was “no reason” to detain McAfee because there was no legal case against him pending in the country.

Harold Caballeros, Guatemala’s foreign minister, said his government was unaware of any arrest warrant and would study McAfee’s asylum request once presented, saying its success would “depend on the arguments.”

Guerra told Reuters McAfee would return to Belize once his situation in Guatemala was made legal, citing the fact he had crossed into the country illegally to avoid capture by police in Belize.

“He can go to the United States, there is no problem with that,” he added. “We have asked the U.S. embassy for support with our (asylum) request.”

He said the asylum request would be formally presented on Wednesday.

The U.S. Embassy in Guatemala City said in a statement McAfee would have to work within the country’s legal framework, but declined to elaborate. “The embassy does not comment on the actions of American citizens, due to privacy considerations.”

(Reporting by Simon Gardner and Gabriel Stargardter; Editing by Kieran Murray and Eric Walsh)

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“Family Guy” executive producer lands animated cop series with Fox

LOS ANGELES (TheWrap.com) – Despite – or perhaps because of – a robust cartoon slate that includes “The Simpsons,” “American Dad” and “Family Guy,” Fox apparently feels that it’s just not animated enough.

The network has given a 13-episode order to a new animated series, “Murder Police,” from “Family Guy” executive producer David Goodman and Jason Ruiz, Fox said Tuesday.

The series, which will be produced by Bento Box Animation (“Bob’s Burgers,” “Brickleberry”) via 20th Century Fox Television, centers around a dedicated, but inept detective and his colleagues – some perverted, some corrupt, some just plain lazy – in a twisted city precinct. Goodman and Ruiz created and wrote the series, with Goodman as executive producer and Ruiz as co-executive producer.

In addition to “Family Guy,” Goodman executive-produced Fox’s short-lived animated series “Allen Gregory,” which failed to receive a pickup after airing a handful of episodes last year.

Ruiz is one of the writers discovered through the network’s Fox Inkubation program. He will also voice the program, along with “MADtv” alum Will Sasso, Chi McBride, Horatio Sanz of “Saturday Night Live,” and other voice actors.

“David and Jason came to us with a really fresh take on law enforcement that we’ve never seen before,” said Kevin Reilly, Chairman of Entertainment, Fox Broadcasting Company. “With ‘Murder Police,’ these guys are taking a staple genre of television – the cop show – and turning it on its head by pushing the warped comedic boundaries that only animation can offer. It’s the kind of show our Animation Domination fans will absolutely love, and I can’t wait to introduce it next season.”

“Murder Police” will premiere during the 2013-2014 season.

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The New Old Age Blog: For the Old, Less Sense of Whom to Trust

There’s a reason so many older people fall for financial scams, new research suggests. They don’t respond as readily to visual cues that suggest a person might be untrustworthy, and their brains don’t send out as many warning signals that ignite a danger ahead gut response.

The research, published Monday in the Proceedings of the National Academy of Sciences, is the first to show that older adults’ vulnerability to fraud may be rooted in age-related neurological changes.

Specifically, researchers from the University of California, Los Angeles, found that an area in the brain known as the anterior insula was muted when older people looked at photographs of suspicious-looking individuals. This part of the brain activates gut-level feelings that help individuals interpret the reliability of other people and assess potential risks and rewards associated with social interactions.

In one part of the U.C.L.A. study, both younger and older adults were asked to evaluate the trustworthiness of people portrayed in 60 photographs while undergoing brain scans. When the younger adults (21 altogether, from 23 to 46 years of age) labeled a person “not trustworthy,” their anterior insulas lit up. But this wasn’t true for older adults (23 altogether, age 55 to 80).

“The warning signals that convey a sense of potential danger to younger adults just don’t seem to be there for older adults,” said Shelley Taylor, the lead researcher and a psychology professor at U.C.L.A.

In another part of the study, researchers asked 119 older adults (55 to 84 years old) and 24 younger adults (age 20 to 42) to rate people in photographs as trustworthy, neutral or untrustworthy. Signs they were potentially untrustworthy included people with insincere smiles, averted gazes and postures that “leaned away” rather than toward the camera, among others, Dr. Taylor said.

Older adults were equally adept at identifying people judged to be trustworthy or neutral, but much more likely to miss signs of those who may be untrustworthy and view suspicious-looking people as approachable, the study found.

“We believe what’s going on is that older adults have a bias toward positive emotional experience and this keeps them from recognizing negative cues,” Dr. Taylor said.

This so-called “positivity effect” has been documented through research by Laura Carstensen, a professor of psychology and public policy at Stanford University, and it explains why older adults are, on the whole, happier than younger adults.

Asked to comment about the new study, Ms. Carstensen said in an e-mail that it was “very well done,” and observed that for older adults, “there are likely many benefits of looking on the bright side. However, there are likely some contexts where looking away from the negative and focusing on the positive is not good,” including financial scams and fraud.

Alexander Todorov, a professor of psychology at Princeton University, called the findings “interesting,” but warned that “there is an implicit assumption that these trustworthiness evaluations based on facial appearance are accurate. This is far from clear.”

Dr. Taylor became acutely aware of financial fraud practiced on the elderly almost 20 years ago when her elderly father handed $17,000 to two men who approached him on the street and walked with him to his bank.

“I got descriptions of the two men from someone who lived nearby — one had few teeth, both were dressed in a slovenly manner, and they’d been seen sleeping in doorways and were using the drug rehab center nearby,” the professor explained in an e-mail.

In other words, they would have been viewed skeptically by most people, but weren’t seen in that light by Dr. Taylor’s father.

Statistics show that financial exploitation of the elderly is on the rise. According to a study published last year by the MetLife Mature Market Institute and the National Committee for the Prevention of Elder Abuse, elder financial abuse — everything from fraudulent sweepstakes to bank accounts emptied out by guardians — totaled $2.9 billion in 2010, a 12 percent increase from only two years before.

Earlier this year, the Government Accountability Office weighed in on the issue, noting the inadequacy of existing safeguards and calling for a new national strategy to address the problem.

On Tuesday my colleague Paula Span wrote about a just-published consumer guide, “Protect Your Pocketbook,” intended for older adults and families who wanted to understand what put them at risk, how to prevent fraud, and where to turn for help.

As for Dr. Taylor, she advises that seniors never agree on the spot to a phone offer or a pitch from a door-to-door salesman. “Either hang up or wait and get someone else involved in your life to evaluate what’s being presented,” she said.

With financial fraud, almost half the time seniors end up being taken in by a caretaker or someone posing as a friend. “Make absolutely sure that you’ve carefully checked out the people taking care of an older relative,” or any “surprising new friend” that you’ve never heard of before that’s now on the scene, she tells family members.

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South Loop residents oppose DePaul arena

The prospect of a DePaul University men's basketball arena being constructed on land just north of McCormick Place is drawing strong opposition from the Prairie District Neighborhood Alliance, a South Loop residents' organization, according to a letter released Tuesday.
 
A survey of 700 neighbors of the site, conducted by the community group, found more than 70 percent oppose construction of a Blue Demons arena there, Tina Feldstein, president of the organization, stated in the letter.
 
An arena would not fit within the residential and historic character of the area and could put two landmark structures, the Harriet F. Rees House and the American Book Co. building, at risk, the letter stated. It would also add to traffic congestion and potential rowdiness in an area already overburdened when conventions are in progress at McCormick Place or major events, including Chicago Bears games, are taking place at Soldier Field, Feldstein said in an interview.
 
"We're not against vibrant development, which hotel and retail would bring," Feldstein said. And the group would support an arena at an alternate site on the Near South Side, she said.
 
The letter was written in support of an alternate plan for the so-called "Olde Prairie" blocks, which is being put forward in bankruptcy court by developers Pam Gleichman, Karl Norberg and Gunnar Falk. Their plan calls for hotel and retail development on property directly north of the McCormick Place administrative offices and West Building on Cermak Road.
 
If they lose control of the property, it is expected to go up for auction, making it possible for the Metropolitan Pier and Exposition Authority, the state-city agency that owns McCormick Place, or other parties to make a run at it.
 
DePaul is weighing several sites, including property near McCormick Place and the United Center on the Near West Side. As well, the Allstate Arena in Rosemont is fighting to retain the team.
 
The neighborhood's opposition adds to resistance by Ald. Robert Fioretti, whose 2nd Ward includes McCormick Place.
 "That is not a place to put an arena -- far away from the school," he said. "I think there are traffic issues related, and it would be a bad deal for taxpayers in these economic times."

Fioretti noted such a project likely would require public subsidy.
 
The Olde Prairie blocks have not been officially designated as a potential site for a DePaul arena, but Fioretti said it is his understanding that they are being seriously considered.
 
Jim Reilly, chief executive officer of the exposition authority, known as McPier, has publicly acknowledged that there have been talks with DePaul. A spokeswoman on Tuesday said it would be premature to comment further at this point.

A DePaul spokesperson could not be reached for immediate comment.
 
Chicago Mayor Rahm Emanuel has said he would like DePaul to bring men's basketball back to the city. A spokesman declined comment beyond that.
 kbergen@tribune.com | Twitter @kathy_bergen

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District 300 teachers set to walk out this morning

(Tribune illustration / March 5, 2012)

Staff report

6:45 a.m. CST, December 4, 2012

Teachers in Carpentersville School District 300 went out on strike this morning after failing to reach an agreement on a new contract.

Negotiators for the teachers union and the school district met for nearly nine hours Monday but failed to reach an agreement, according to a statement posted by the school district.

Union officials have argued that teachers are underpaid compared to other suburban districts, yet administrators have portrayed them as “greedy and unreasonable,” according to a statement on the teachers union website.

The district in the far northwest suburbs has more than 20,000 students in grades kindergarten through 12 and employs about 1,200 teachers.

Several suburban teachers unions have staged walkouts since Chicago Public Schools teachers went on strike this fall. Most of the strikes lasted between one day and about a week.

chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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Kutcher’s Steve Jobs, Gordon-Levitt among Sundance premieres

NEW YORK (Reuters) – Ashton Kutcher‘s turn as Apple co-founder Steve Jobs and actor Joseph Gordon-Levitt‘s directorial debut about a modern day Don Juan are leading a slew of star-studded premieres unveiled Monday for the 2013 Sundance Film Festival.

Kutcher stars in “Jobs,” a biographical look at the career rise of Jobs from wayward hippie to charismatic inventor and entrepreneur, which Sundance said Monday will officially close the indie film festival backed by Robert Redford that runs January 17 to January 27.

The premiere lineup also features Gordon-Levitt directing, writing and starring in “Don Jon’s Addiction,” about a self-centered porn-addict attempting to reform his ways opposite Scarlett Johansson, Julianne Moore and Tony Danza.

Behind-the-scenes tales of pornography will also be explored in British director Michael Winterbottom‘s “The Look of Love,” starring Steve Coogan and based on British adult magazine publisher and entrepreneur Paul Raymond.

“Lovelace,” starring Amanda Seyfried and James Franco, tells the story of porn star Linda Lovelace famed for the film “Deep Throat.”

Sundance, the top U.S. film festival for independent cinema held in Park City, Utah, unveiled the premieres section – which typically feature more established directors – after it announced its competition films last week.

Adding to the premieres list is “Before Midnight,” director Richard Linklater’s third film collaborating with Ethan Hawke and Julie Delpy after “Before Sunrise” and “Before Sunset,” in which the audience encounters their characters nine years later in Greece.

New Zealand director Jane Campion will screen her new six-hour epic, “Top Of The Lake,” a haunting mystery about a pregnant 12-year-old girl who disappears, with Holly Hunter.

Other big-name actors in the lineup include Steve Carell and Toni Collette in “The Way, Way Back,” Naomi Watts and Robin Wright in “Two Mothers”, Dakota Fanning and Elizabeth Olsen in “Very Good Girls,” and Shia LaBeouf and Evan Rachel Wood in “The Necessary Death of Charlie Countryman.”

Australian actresses Nicole Kidman, Mia Wasikowska and Jacki Weaver star in psychological thriller “Stoker,” which marks South Korean director Park Chan-wook’s English-language debut.

WIKILEAKS, POLITICS LEAD DOCUMENTARIES

Among documentaries premiering at Sundance in January is Oscar-winning documentary filmmaker Alex Gibney’s insight on WikiLeaks, the power of the Internet and the beginning of an information war in “We Steal Secrets: The Story of Wikileaks.”

Author and documentarian Sebastian Junger chronicles the life of late photojournalist Tim Hetherington in “Which Way Is The Front Line From Here?” after Hetherington’s death in Libya in 2011. The photojournalist had collaborated with Junger on the 2010 Oscar-nominated film “Restrepo” about the Afghanistan war.

“The World According to Dick Cheney” promises to examine the former vice president while “Anita” profiles how Anita Hill’s allegations in 1991 of sexual harassment against then-U.S. Supreme Court nominee Clarence Thomas brought sexual politics into the national consciousness for the next two decades.

“Linsanity” offers a portrait of basketballer Jeremy Lin and “Running From Crazy” follows actress Mariel Hemingway, granddaughter of Ernest Hemingway, and her insights into her family’s mental illness and suicide.

“Pandora’s Promise” looks at a growing number of environmentalists and anti-nuclear activists changing their minds after decades of opposition to support nuclear power.

Continuing the rise of music documentaries in the last several years, Foo Fighters’ musician Dave Grohl looks at the history of Sound City studios in California, where Grohl’s former band Nirvana had recorded their classic 1991 album “Nevermind.”

Veteran Los Angeles rock band The Eagles will also showcase their past in “The History of the Eagles Part 1.”

(Reporting By Christine Kearney, editing by Piya Sinha-Roy and Cynthia Osterman)

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Software Programs Help Doctors Diagnose, but Can’t Replace Them

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 of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.

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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