Seeing Through the Fog of ‘Chemo-Brain’

Two weeks ago, Diem Brown, contestant of the Real World/Road Rules Challenge, shared on her PEOPLE.com blog her frustration with her chemo-brain, after having received chemotherapy over the Thanksgiving holiday for recently diagnosed ovarian cancer.

She writes, “Stressed out, overwhelmed and soooo annoyed that your mind isn’t working as it should. This, my friends, is an example of chemo brain!”

Unfortunately, as a surgeon, I have witnessed too many patients get the diagnosis of cancer. If they can transcend the initial shock, there is a desperation to understand what their lives will be like as cancer patients, and what the odds are that they will be cancer survivors.

But for many women, their fear of death is as strong as their fear of chemotherapy, the poison that along with hope, is inseparable from the Hollywood images of the sick, nauseated, thin and bald.

Diem refers to “chemo-brain”, also known as “chemo-fog”, a side effect of chemotherapy that causes problems with memory, information processing, and mood –- effects that can persistent for as many as 20 years after treatment has subsided.

Mental dullness or fatigue and an inability to focus characterized by difficulty organizing thoughts and keeping memories has also been described by patients who suffer from chemotherapy induced cognitive dysfunction.

For years, chemo-brain went largely unrecognized by health care professionals, and those who suffered from it were left without answers to their confusion.

Recently, through the Internet, web chatting and blogging, many women who suffered from chemo-brain realized they were not alone, and over the last few years, several studies have been done giving credit to the condition. But, as they say, you have to see it to believe it.

And now we can see it. In the process of presenting my own research discussing the use of imaging in breast cancer patients at this week’s San Antonio Breast Cancer Symposium, I stumbled across a presentation discussing how scientists are trying to clear the chemo-fog by imaging the brain.

Dr. Bernadine Cimprich from the University of Michigan, along with a group of scientists from the University of Washington and University of Toronto took the stage in San Antonio Friday to shed some light through the fog, and offer a strategy at prevention.

Since chemo-brain doesn’t affect all cancer patients to the same degree, they asked the question, are some patients who receive chemotherapy predisposed to developing the disease?

Chemo-brain has been studied before, but has been difficult to characterize because so many different types of drugs and regimens are used, and for the most part patient’s memory and cognition are not studied prior to starting cancer therapy.

To help shed some light on the subject, these researchers used functional magnetic resonance imaging, or fMRI – a technology that uses magnets to image the brain as it works.

By taking pictures of the brain before and after chemotherapy, they found that patients who suffered from this condition had inherently different function from those who did not before they had even received treatment.

“Brain imaging before treatment showed reduced function in frontal [brain] regions” says Dr. Cimprich, the precise regions that are needed to perform working memory and guide our day-to-day activities, such as remembering the shopping list, our finding our way home.

Identifying patients who may be predisposed to developing chemo-brain can help oncologists alter treatment strategies in efforts to reduce or eliminate the fog.

Who are the patients at highest risk? Dr. Cimprich’s team used surveys to evaluate pre-treatment cognitive function and found that fatigue is a major factor. He suggests that “early interventions targeting fatigue may improve cognitive function and reduce the distress of chemo-brain”.

While the small study involved 98 patients, only 29 of which received chemotherapy, it still lays ground to understand the true nature of chemo-brain, and as Dr. Cimprich emphasizes, identifying the problem early is crucial, because early cognitive problems can become worse over time.

In her blog, Diem suggests making lists as a way to overcome her chemo-brain. And while we all know that stressful times can side track our minds and dull our spirits, until science can give us better answers, research suggests that a deep breath and a little yoga may help do the job of lifting the fog on chemo-brain.

Dr. Christopher Tokin is a surgical resident at the University of California, San Diego School of Medicine and a resident alumnus of the ABC News Medical Unit.

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The Fiscal Cliff Isn’t the Problem

Early in Bill Bryson’s book A Walk in the Woods, the story of his ill-starred Appalachian Trail expedition, the author’s out-of-shape and impulsive hiking companion, Katz, decides his backpack is too heavy. So he starts throwing out the food they’d packed for the trip: rice, pepperoni, cheese, peanuts, Spam—he even discards coffee filters, which weigh next to nothing.

Panic about the fiscal cliff is threatening to lead Congress into the same short-term thinking. Investments in education, scientific research, and infrastructure—which account for a tiny portion of federal spending but make the economy more productive in the long run—are at risk. Restraining them by spending cap or sequester would be as dumb as discarding coffee filters to lighten one’s backpack. Yet if Democrats and Republicans don’t agree on a budget compromise by the end of the year, that’s what could happen.

A new Bloomberg Government analysis makes clear just how much pressure Washington is under. Instead of needing $ 4 trillion in deficit cuts over 10 years to stabilize the ratio of debt to gross domestic product ratio, negotiators need $ 5.9 trillion in cuts, according to Bloomberg Government’s calculations. In a Dec. 4 interview with Bloomberg Television, President Obama said he’ll fight to protect investments in things like education. He’s right. House Speaker John Boehner says the U.S. needs to grapple with big projected deficits in Medicare, Medicaid, and Social Security. He’s right, too. But their two rights have made a wrong: stalemate.

Illustration by Ana Benaroya

The solution is to figure out what problems need solving on which time scale. The most urgent priority is keeping the roughly $ 600 billion hit to GDP from kicking in. Edward Kleinbard, a professor at the University of Southern California’s Gould School of Law, who was chief of staff for the Joint Committee on Taxation from 2007 to 2009, proposes turning the cliff into a ramp. He would suspend the automatic spending cuts and allow the Bush tax cuts to expire in three years instead of overnight. Congress would commit to devote all of the savings from future spending cuts to lowering tax rates, but starting with the lowest brackets, not the highest. Says Kleinbard: “None of this is impossible.”

After that comes a bigger challenge: getting the economy to grow faster and foster innovation to make burdens on future generations as light as possible. Supporting the aged and infirm will be far easier if median household income rises to, say, $ 75,000 adjusted for inflation, rather than remaining stuck at just over $ 50,000. And Medicare and Medicaid expenses will be less daunting if medicine can find cures for killers such as diabetes and dementia.

That’s why it’s foolish to slash public programs indiscriminately to get out of the fiscal hole. It’s up to government to fund growth-enhancing investments that the private sector does too little of. James Heckman, a Nobel prize-winning economist at the University of Chicago, has shown that the return on a dollar invested in human capital is highest from birth to age five, lower during the school years, and lowest for adult job training. Yet the budget for Head Start, which helps children from low-income families aged five and younger to get ready for school, is paltry relative to the benefits bestowed on older Americans.

Physical capital is underfunded as well. In 2009 the American Society of Civil Engineers gave the U.S. a grade of D for infrastructure. It’s doubtful that things are much better now; only about $ 100 billion of the Obama administration’s nearly $ 800 billion stimulus program went toward roads, bridges, and other needs. Infrastructure investment would make the U.S. more competitive in the long run while creating jobs in the short run, and since the U.S. can borrow for next to nothing, the financing would be cheap. But Boehner is opposing Obama’s debt proposal—which includes $ 50 billion in infrastructure spending—because it doesn’t cut spending enough. That’s unfortunate.

Where could the U.S. cut that wouldn’t damage its growth potential? The obvious targets are defense and entitlements, which together account for nearly three-quarters of federal spending outside of interest payments. The U.S. spends more on its military than the next 13 countries combined; that would suggest potential for some nips and tucks. Social Security’s imbalance could be fixed by raising the ceiling for wages subject to the payroll tax. The knottier problems are Medicare and Medicaid, whose costs have been driven up by extraordinarily inefficient health-care spending. The U.S. spends 53 percent more on health care per capita than No. 2 Norway while getting worse results. (Norwegians’ life expectancy at birth is a year and a half longer.)

Making benefits less generous is the no-brainer way to close the gap. The forward-thinking way is to conquer diseases that sap America’s human and economic potential, as Jonas Salk’s vaccine did for polio in the 1950s. Medicare and Medicaid alone spend $ 140 billion a year on dementia care, the Alzheimer’s Association estimates, yet the U.S. spends only about half a billion dollars a year researching cures. George Vradenburg, chairman of USAgainstAlzheimer’s, argues that the disease could be mostly eliminated by 2020 with Manhattan Project-size funding; cuts to research could make the problem worse. “This disease could very well become the financial and social sinkhole of the 21st century,” says gerontologist Ken Dychtwald, chief executive officer of the consulting firm Age Wave.

Taxes, too, need to be reformed to amplify growth. Loopholes are a good place to start. The home mortgage interest deduction could be phased out over a long period, since all it does is encourage people to buy bigger houses and take on more debt. Savings incentives in the tax code mostly benefit the rich without actually increasing the rate of savings. But zeroing out all tax breaks would be a mistake. Some, like the one for research and development, enhance growth.

There is, of course, a point at which high tax rates slow the economy. Conservatives argue for holding down rates on capital gains and dividends while preserving all of the Bush high-end cuts on ordinary income. But the U.S. appears to be well shy of the tipping point at which hiking taxes would be counterproductive. The economy grew faster in the 1950s when the highest rate was 91 percent.

What’s limiting business investment and hiring today isn’t the prospect of slightly higher tax rates but the fear that there won’t be enough customers. Weak, uncertain demand is the lasting legacy of the Great Recession and the slow rebound since. In manufacturing, mining, and utilities, depreciation has outpaced fresh investment since the start of the recession in December 2007, leaving the sector with a decline in productive capacity, according to Federal Reserve data. Recessions have lasting consequences: Eroding capacity, they limit the economy’s ability to grow—and generate tax revenue—in the future.

Refocusing the budget debate on the future is something that both conservatives and liberals should support. Representative Jim Cooper of Tennessee, a fiscally conservative Democrat, worries that Congress isn’t taking the long-term entitlements crisis seriously. He says the government should copy the private sector by adopting accrual accounting instead of just measuring each year’s cash in and cash out. Accrual accounting would acknowledge how much the country owes future retirees. It would also differentiate investments in roads, bridges, and Head Start from day-to-day spending on paper clips and electricity. “The government is the last major entity left in America that doesn’t use accrual accounting,” says Cooper. “The business mantra is, if you can’t measure it, you can’t manage it.” Without that kind of discipline, he says, “Congress has very poor eyesight and won’t necessarily cut in the right place.”

Or, to put it in terms Katz might understand: When you still have 2,000 miles to hike, don’t throw away all of your pepperoni.

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Software guru McAfee did not have heart attack: lawyer

GUATEMALA CITY (Reuters) – Software pioneer John McAfee did not have a heart attack in Guatemala as originally thought, but is suffering from stress and hypertension, his lawyer Telesforo Guerra said on Thursday.

“He never had a heart attack. Nothing like that,” Guerra said in Guatemala City. “I’m not a doctor. I’m just telling you what the doctors told me. He was suffering from stress, hypertension and tachycardia (an abnormally rapid heartbeat).”

After being rushed to a hospital in an ambulance on Thursday, McAfee, 67, was later spirited out of the building out of sight of reporters and into a police patrol car, Guerra said.

McAfee, who is fighting deportation from Guatemala, was detained on Wednesday after crossing illegally into the country from neighboring Belize. Police in Belize want to question McAfee in connection with his neighbor’s murder.

Earlier, Guerra said McAfee had suffered two mild heart attacks in the morning.

(Reporting by Lomi Kriel; Editing by Stacey Joyce)

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Kevin Smith: “Clerks III” will be my last writing/directing effort

LOS ANGELES (TheWrap.com) – “Clerks III” will be Kevin Smith‘s last writing/directing effort, the filmmaker tweeted on Friday morning:

“So with the ‘HIT SOMEBODY‘ shift, the minute Jeff Anderson signs on, my last cinematic effort as a writer/director will be ‘CLERKS III’”

Referring to the ice-hockey comedy he’s writing that takes place over the course of 30 years, the “shift” means now it will be not a theatrical release but a television mini-series.

“Since ‘HIT SOMEBODY’ is now gonna be a mini-series,” the 42-year-old wrote. “Yes – that leaves room for a new final flick before I retire from directing feature films.”

So pending the participation of Anderson, the actor who played Randal Graves in the first two “Clerks” films, Smith’s fans will get the ultimate goodbye gift – a complete trilogy for the convenient store comedy franchise.

The first installment was the director’s mirco-budgeted breakthrough independent film, which launched characters Jay and Silent Bob into pop culture and led to four more spinoffs.

Minimum-wage earners Randal and Dante (Brian O’Halloran) were featured in a series of “Clerks” comics in the late ’90s before becoming the focus of a short-lived animated television series in 2000 (and eventually making it back to the big screen for a quick cameo in 2001′s “Jay and Silent Bob Strike Back”). Smith finally finished their story in 2006′s “Clerks II.”

Or so we thought. Apparently, he wants to end his film-directing career with the characters and actors that helped it begin. However, the tweet heard around the world of cinema suggests it may be somewhat of a challenge to persuade at least one half of the “Clerks” duo to come aboard.

Beyond “Hit Somebody” and “Clerks III,” Smith will keep himself busy with “SModcast,” a weekly podcast, and AMC’s “Comic Book Men,” which has been renewed for a second season.

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Health workers march in Spain’s capital against cuts, reforms

MADRID (Reuters) – Thousands of health workers, on strike since last month, marched on Sunday in Madrid to protest against budget cuts and plans from the Spanish capital’s regional government to privatize the management of public hospitals and medical centers.

It was the third time doctors, nurses and health workers have rallied since the local authorities put forward a plan in October to place six hospitals and dozens of medical practices under private management. The plan also calls for patients to be charged a fee of 1 euro for prescriptions.

Workers launched an indefinite strike last month against the plan, which has not been endorsed by the centre-right government of Prime Minister Mariano Rajoy. Health workers in the capital are striking Monday-Thursday each week and seeing patients only on Fridays, while also responding to emergencies.

Spain’s 17 autonomous regions control health and education policies and spending. They have all had to implement steep cuts this year as the country struggles to meet tough European Union-agreed deficit targets.

Dressed in white scrubs, the protesters shouted slogans such as “Health is not for sale” and “Health 100 percent public, no to privatizations”.

“Of course, privatization can be reversed. Actually the question is not if it can be reversed, because privatization should never have a future,” said Luis Alvarez, an unemployed man from Madrid attending the demonstration.

Belen Padilla, a doctor at Madrid’s hospital Gregorio Maranon, said one million citizens had already signed a petition rejecting the plan.

(Reporting by Reuters Television; Writing by Julien Toyer; Editing by Peter Graff)

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Exclusive: U.S. authorities probe SAC for Weight Watchers – sources

(Reuters) – U.S. authorities are investigating Steven A. Cohen’s SAC Capital Advisors hedge fund for possible insider trading in the shares of the popular diet company Weight Watchers International Inc, according to people familiar with the matter.

The investigation focuses on trading in Weight Watchers shares in the first half of 2011, when SAC Capital had taken a sizeable position in the stock, and potentially could implicate the billionaire hedge fund manager, the sources said on Friday.

Regulatory filings show that Cohen’s $ 14 billion fund briefly held 2.1 million shares in Weight Watchers during the period under scrutiny by authorities – at which time the diet company’s stock price roughly doubled.

The inquiry is in its early stages and it is not clear whether anything improper was done either by SAC Capital or Cohen himself, said the people familiar with the matter, who requested anonymity. The trading in Weight Watchers would be permissible as long as it was based on fundamental research or derived from individuals who did not have access to non-public corporate information.

An SAC Capital spokesman said the firm was not aware of any investigation involving Weight Watchers. A spokeswoman for Manhattan U.S. Attorney Preet Bharara declined to comment. A spokesperson for Weight Watchers did not immediately respond to a request for comment.

The new line of pursuit ratchets up pressure on Cohen, 56, one of the hedge fund industry’s most successful and best-known managers. The spotlight the probe casts on SAC Capital and Cohen could further rattle the hedge fund’s investors, who account for roughly 40 percent of the firm’s capital.

Two weeks ago, U.S. prosecutors charged a former SAC Capital employee, Mathew Martoma, with using inside information to generate profits and avoid losses totaling $ 276 million in shares of two drug stocks. The U.S. Securities and Exchange Commission also has formally warned SAC Capital that the firm could face civil charges.

A number of SAC’s investors have said they have not made a decision on whether to redeem money from the firm. Investors have until mid-February to put in a redemption notice.

Martoma has not entered a plea but his lawyer has said he expects to be exonerated. SAC has declined to comment beyond saying, “Mr. Cohen and SAC are confident that they have acted appropriately.”

Martoma is the seventh former SAC Capital employee to be charged or implicated by federal authorities for insider trading. The criminal complaint against Martoma, who last worked for CR Intrinsic, an affiliated fund of SAC Capital in 2010, for the first time alleges that Cohen personally approved the decision to sell-out of a big stake the hedge fund had in shares of Elan Corp and Wyeth, now part of Pfizer Inc.

Separately, U.S. authorities are also investigating SAC for suspicious trading in shares of biotech company InterMune Inc. in 2010, according to one of the people familiar with the probes. Officials at InterMune weren’t immediately available for comment. The SAC spokesman declined to comment on the InterMune investigation.

Federal authorities have not charged Cohen, whose net worth is estimated by Forbes at about $ 8.8 billion as of September this year. The hedge fund manager has told his investors and 900 employees that neither he nor the firm has done anything improper in response to Martoma’s arrest.

It’s not clear what has prompted federal authorities to look into Stamford, Conn.-based SAC Capital‘s trading in shares of Weight Watchers. One of the people familiar with the investigation said authorities are looking at trading that both booked hefty profits and avoided losses for SAC Capital.

BIG MOVE INTO WEIGHT WATCHERS

Over his 20 years in the business, Cohen has emerged as one of the pioneers of sophisticated trading. His funds, which charge some of the highest fees in the $ 2 trillion industry, has boasted an average annual return of 30 percent since launch in 1992.

This year, SAC Capital‘s main fund is up about 12 percent, compared to the industry average of just over 5 percent. SAC Capital‘s only down year was in 2008, when it lost 19 percent of its value.

Cohen has endured federal authorities looking into trading at his firm for about five years now. The investigation into SAC Capital ran parallel with the federal government’s undercover investigation that led to the October 2009 arrest of Galleon founder Raj Rajaratnam, who was convicted by a federal jury on May 2011 on 14 counts of insider trading.

SAC Capital‘s big move into Weight Watcher’s stock in early 2011 gained attention in part because it came at a time that the once-heavyset Cohen had lost about 20 pounds. (It’s not clear if he used Weight Watchers.) The trader has said he lost the weight to help with a chronic bad back.

A first quarter 2011 regulatory filing for SAC Capital showed the firm had acquired 2.1 million shares of the stock. But by the end of the next quarter, a subsequent filing revealed the hedge fund had unloaded nearly all of those shares.

It is not uncommon for a rapid-fire trading firm like SAC Capital to move in and out stocks – even big positions. SAC Capital, in particular, is not known for holding stocks for a long time.

SAC Capital’s trading strategy relies on analysts and portfolio managers gathering information about a company’s prospects before making a trading decision. Cohen has told people privately he believes his firm has drawn unwanted scrutiny from the government because of its long history of success.

Cohen has become an avid art collector in recent years, with a number of Jeff Koons sculptures gracing the grounds of his 30-room mansion in Greenwich, Conn.

Cohen, who grew up on Long Island in Great Neck, New York, is also pursuing the kind of charitable legacy building done by other famous Wall Street money managers. In 2010, the North Shore-LIJ’s pediatric hospital was renamed the Steven and Alexandra Cohen Children’s Medical Center of New York, after Cohen and his second wife in recognition of their donations.

More recently, he took a minority ownership stake in the New York Mets baseball team after failing to win the rights to buy another team, the Los Angeles Dodgers.

(Reporting by Matthew Goldstein, Jennifer Ablan and Emily Flitter; Editing by Tiffany Wu and Bernard Orr)

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Zynga seeks real-money gambling license in Nevada

SAN FRANCISCO (Reuters) – Social games maker Zynga Inc said on Wednesday it filed a preliminary application to run real-money gambling games in Nevada, a significant step in cracking a complex but potentially massive new market that could resuscitate its faltering business.

The Nevada Gaming Control Board will now examine whether Zynga is fit to hold a gaming license that would allow gamblers in the state to bet real money on the San Francisco-based company’s popular games like Zynga Poker, which currently involve only virtual chips with no monetary value.

Zynga is hoping that a lucrative real-money market could make up for a steep slide in revenue from its games like “FarmVille” and other fading titles that still generate the bulk of its sales.

“We anticipate that the process will take approximately 12 to 18 months to complete,” Zynga Chief Revenue Officer Barry Cottle said in a statement. “As we’ve said previously, the broader U.S. market is an opportunity that’s further out on the horizon based on legislative developments, but we are preparing for a regulated market.”

Zynga, along with many major gaming industry players, is hoping that a tide of proposed legislation to regulate gaming could sweep through states across the U.S. and open a massive new online market.

Nevada, Delaware and New Jersey are among the states that have moved or are moving toward interactive gaming after the U.S. Justice Department last year declared that only online betting on sporting contests was unlawful, presenting the opportunity for states to legalize some forms of online gambling, from lotteries to poker.

Although widespread legalization of online gaming in the United States appears years away at the minimum, obtaining a license in Nevada would be a meaningful foot in the door for Zynga’s nationwide aspirations.

Zynga has told investors in recent quarters that a concerted move into real-money gaming could represent a hefty – and badly needed – source of new revenue for the company, which has seen revenues sag and its stock plummet by more than three-quarters in the past year as gamers abandoned titles like “CityVille.”

In October, the company slashed its 2012 full-year earnings outlook for the second time and laid off employees to trim costs, while CEO Mark Pincus implored investors to give him time to turn around the company by pursuing initiatives like real-money gaming.

That month, Zynga struck a deal with bwin.party, a Gibraltar-based gaming company, to provide real money casino games like poker and slots in the United Kingdom beginning in the first half of 2013.

(Reporting By Gerry Shih; Editing by Chris Gallagher)

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Quentin Tarantino: if you think “Django Unchained” is violent, try slavery

LOS ANGELES (TheWrap.com) – If you think “Django Unchained” is violent, Quentin Tarantino has a historical reality check for you: Try slavery.

The “Pulp Fiction” auteur is back with an Antebellum revenge flick that according to early screenings pours on the blood and gore. Tarantino told an audience of British Academy of Film and Television Arts members on Thursday that if anything he spared the lash in his depiction of slavery, according to the Guardian.

“We all intellectually ‘know’ the brutality and inhumanity of slavery,” Tarantino said, “but after you do the research it’s no longer intellectual any more, no longer just historical record – you feel it in your bones. It makes you angry and want to do something … I’m here to tell you, that however bad things get in the movie, a lot worse shit actually happened.”

Tarantino’s comments indicate that he anticipates the irreverent “Django Unchained” – which opens on Christmas Day – will court controversy for setting its story against the backdrop of the slave trade.

The film centers on a bounty hunter (Christoph Waltz) who partners with a freed slave (Jamie Foxx) to take down a plantation owner, Calvin Candie (Leonardo DiCaprio) who controls his wife. Candie, who speaks with Magnolia-scented menace in the trailers, owns a mixed-race club in Greenville, Miss., and deals in slave-fights.

Perhaps because the film features Tarantino’s trademark sardonic humor, some early viewers have compared “Django Unchained” to the works of Mel Brooks.

“Just watched what was basically a three-hour homage to BLAZING SADDLES,”@LouLumenick tweeted.

But despite the humor, in an interview with Howard Stern this week, Tarantino indicated that he took the responsibility of depicting slavery very seriously. In particular, he said that shooting a scene where a female slave is brutalized brought him to tears and deeply impacted the crew.

“It was early on in the production, and it was the first time we started officially dealing with that kind of ugliness,” Tarantino said. “We later got used to dealing with that kind of ugliness. But that first – it was traumatizing to everybody, none less because of the fact that we were doing it in the real slave area of a real plantation where the slaves lived.

“This actually happened on the grounds,” he added. “There was blood in that ground. Those trees had memories of everything that happened there. We could feel the spirits of the old slaves on the property.”

Of course, Tarantino has taken on controversial subjects before. He turned an ultra-violent and satiric eye at the Nazis and an SD colonel nicknamed the “Jew Hunter” and turned it into “Inglourious Basterds.” Dealing with charges of insensitivity, it nonetheless collected over $ 300 million worldwide and was nominated for a Best Picture Oscar.

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S.Africa’s Mandela admitted to hospital for tests

JOHANNESBURG (Reuters) – Former South African president Nelson Mandela was admitted to hospital on Saturday for medical tests, although the government said there was no cause for alarm.

A statement from President Jacob Zuma‘s office gave no details of the condition of the 94-year-old anti-apartheid leader.

“Former President Mandela will receive medical attention from time to time which is consistent with his age,” the statement said.

“President Zuma assures all that Madiba is doing well and there is no cause for alarm,” it added, referring to Mandela by his clan name.

Mandela, who became South Africa‘s first black president after the country’s first all-race elections in 1994, was admitted to hospital in February because of abdominal pain but released the following day after a keyhole examination showed there was nothing seriously wrong with him.

He has since spent most of his time in his ancestral home in Qunu, a village in the impoverished Eastern Cape province.

His frail health prevents him from making any public appearances in South Africa, although in the last few months he has continued to receive high-profile visitors, including former U.S. President Bill Clinton.

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The Star is Dead. Her Film Isn’t

Three years after actress Brittany Murphy’s untimely death from pneumonia and anemia in 2009, her final film, an indie thriller called Something Wicked, finally completed post-production this week. The Eugene (Ore.) production company Merchant Films, which is currently seeking a distributor for the film, is caught in the unfortunate position of having to market a film without its most recognizable star. As of now, Merchant does not intend to include Murphy’s image in the main posters, says the movie’s writer and producer, Joe Colleran. Still, he says, many distributors have expressed interest in the past few days, and he is hoping for a spring 2013 release. Bloomberg Businessweek spoke with Colleran about how the filmmakers plan to manage in this difficult situation.

How have you had to change plans to market the film?
We did an original deal with Brillstein Entertainment Partners to represent the movie, and they have relationships with major studios. That hasn’t changed. What has changed is the time we delayed it to avoid exploitation. Normally it would be a two-year process. We shot it in Oregon, which takes longer than if you shoot it in Hollywood. The delay has been close to a year.

How will you walk that delicate line of promoting the film without being exploitative?
We don’t intend to run around marketing it as Brittany’s last movie. People know it is. I don’t think there’s any point in mentioning that any further. Her face is not on the key art. We will market it as a very suspenseful thriller. We’ll be marketing the genre of the movie. …You can go out virally, immediately [after her death] and build fan pages, and we didn’t. We thought that would be distasteful. We’re just starting that process now.

A lot of promoting the film involves doing interviews and red carpets.
That is a big difference. We won’t have [Brittany] promoting the movie nationally and internationally. We will not be able to have Brittany go on Letterman and Leno to do nationwide publicity, which she was excited to do. She was what they would have built the marketing campaign around. The other stars will have to replace her. The lead actress [Shantel VanSanten] is tremendous. They are very excited. They have larger responsibilities now, and they are anxious to promote it, because they really do look good in this movie.

Was the film altered after her death in any way?
No. There was only one scene she shot that was not in the film. It was one of the alternate endings. We’ll probably put it on the DVD so fans can see the different endings.

Tell me about finding a distributor for this film.
Genre movies—which are basically everything besides drama and comedy: action, thrillers, sci-fi—have a very loyal following. There’s a large segment of the younger audience, which is a key audience for distributors, that just goes to genre movies. The movie will probably get an R rating, which means the core audience will be 17 to 29, with a crossover of up to 34, because that’s what Brittany’s fan base is. That is the key audience that distributors go after, because they are easy to market to, they know where to find them, and they are frequent moviegoers.

Are you worried about critics?
Genre movies generally don’t tend to get critical acclaim anyway. Even if you’re a huge success like Twilight, critics trash it. Most critics don’t flock to genre movies. Fortunately, the audience we’re going after is not dependent on critics. They are dependent on word of mouth from their peers.

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