Vast cache of Kaiser patient details was kept in private home

Federal and state officials are investigating whether healthcare giant Kaiser Permanente violated patient privacy in its work with an Indio couple who stored nearly 300,000 confidential hospital records for the company.

The California Department of Public Health has already determined that Kaiser "failed to safeguard all patients' medical records" at one Southern California hospital by giving files to Stephan and Liza Dean for about seven months without a contract. The couple's document storage firm kept those patient records at a warehouse in Indio that they shared with another man's party rental business and his Ford Mustang until 2010.

Until this week, the Deans also had emails from Kaiser and other files listing thousands of patients' names, Social Security numbers, dates of birth and treatment information stored on their home computers.

The state agency said it was awaiting more information from Kaiser on its "plan of correction" before considering any penalties.

Officials at the U.S. Department of Health and Human Services began looking into Kaiser's conduct last year after receiving a complaint from the Deans about the healthcare provider's handling of patient data, letters from the agency show. Kaiser said it hadn't been contacted by federal regulators, and a Health and Human Services spokesman declined to comment.

Kaiser said it remained confident that this patient information was never disclosed or accessed inappropriately. It said that some employees were disciplined because company policies were not followed and that it had informed regulators of the steps it had taken to ensure this type of incident didn't happen again.

"Kaiser Permanente is committed to protecting the medical and personal privacy of its patients," spokesman John Nelson said. "In retrospect, we certainly wish we'd never done business with Mr. Dean."

Even with tougher government oversight of medical privacy in recent years, this case underscores how confidential patient information remains vulnerable in the hands of big healthcare institutions and legions of outside contractors.

"Kaiser has shown extraordinary recklessness in this situation," said Beth Givens, director of the Privacy Rights Clearinghouse in San Diego. "Healthcare companies have to make sure their contractors adhere to ironclad security practices."

Federal and state laws impose strict standards on anyone dealing with patient information. The privacy rule of the federal Health Insurance Portability and Accountability Act, known as HIPAA, bans the unauthorized disclosure of individuals' medical records and requires healthcare providers and vendors, such as billing and storage companies, to protect the information.

Despite those rules, personal medical information of 21 million people nationwide has been improperly exposed since 2009, according to federal data. Last year, Blue Cross Blue Shield of Tennessee agreed to pay $1.5 million to resolve allegations it violated federal law after 57 computer hard drives with patient information were stolen from an outside facility.

In October, Kaiser sued the Deans in Riverside County Superior Court, accusing them of violating their contract by not returning all of its patient information two years ago when Kaiser picked up the paper records.

In court filings, Kaiser said the Deans put patient data at risk by leaving two computer hard drives in their garage with the door open. In response, Stephan Dean moved them to a spare room. On a recent day they sat next to a red recliner where Ziggy, the family's black-and-white cat, curled up for a nap. Dean said those hard drives contained spreadsheets on thousands of Kaiser patients, prepared at the company's request.

At one point, Dean told Kaiser he was planning to contact patients about the whereabouts of their medical information because he felt Kaiser hadn't taken proper precautions. The company sought a temporary restraining order against Dean, barring him from disclosing any confidential information. A Superior Court judge granted Kaiser's request until Thursday, when another hearing is scheduled.

Dean, 47, got his foot in the door at Kaiser from his previous work labeling paper folders for courthouses, hospitals and doctors.

But the demand for folders was slipping as hospitals and doctors used computers more. Kaiser was at the forefront of this as it invested billions of dollars in its HealthConnect system, which it bills as the largest private-sector electronic health record in the world. Kaiser, with more than 9 million customers, is the nation's largest nonprofit insurer and hospital system.

Dean said his small business, Sure File Filing Systems, got a big break when Kaiser acquired the Moreno Valley Community Hospital in 2008. The company needed to organize and clear out thousands of old patient files and it gave the job to the Deans, Kaiser records show.

In August 2008, the Deans started packing up thousands of files from Moreno Valley and moving them to the warehouse in Indio.

Hospital clerks routinely messaged Dean asking him to pull records on specific patients, emails sent by Kaiser to Sure File show. Dean said some Kaiser employees would put the patient's full name in the subject line of the email, and other messages listed the patient's Social Security number, date of birth, doctors' names and treatment dates. One message started, "Good Morning Sure File," and requested adoption records for a child.

Dean said Kaiser showed little concern for patient privacy in handling those requests. Only one out of more than 600 emails from Kaiser was password-protected with encryption, he said. Many medical providers use such technology so information isn't visible to others.

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House approves $9.7 billion in Sandy disaster aid

WASHINGTON — Responding to the political storm over delays in disaster aid to the Northeast, the House on Friday approved a $9.7-billion flood insurance bill, the first segment of a possible $60-billion Superstorm Sandy recovery package.

The measure’s approval comes after New Jersey Gov. Chris Christie and Rep. Pete King of New York, among others, publicly slammed House Speaker John Boehner, a fellow Republican, for putting off a vote on a relief measure in the closing days of the 112^thCongress.

The 354-67 vote sent the bill to the Senate, where it could be approved by the end of the day. 

But Democrats were still fuming that it has taken 68 days for the House to act – and that a  broader relief bill still must be approved.

"Talk about fiddling while New York City burns,’’ said Rep. Nydia Velazquez (D-N.Y.), calling the delay an "embarrassment’’ to the House. 

"How dare you come to this floor and make people think everything is OK,’’ Rep. Bill Pascrell Jr. (D-N.J.) told Republicans.

Rep. Frank LoBiondo (R-N.J.), among the Northeast lawmakers who complained earlier this week about congressional inaction on a relief bill, called the vote a "key step in getting critical federal assistance to the residents, businesses and communities devastated by Hurricane Sandy.

“This week’s events make it clear that the need for help is real and that any additional delays in providing federal aid will be met with fierce resistance from myself, members of the delegation, and Gov. Christie,’’ he added.

The larger aid package, due to come before the House on Jan. 15, would fund such things as repairing roads, the electric grid, transportation system and Liberty Island, where the Statue of Liberty has been closed since the storm hit, and shoring up defenses against future storms.

That measure, expected to cost $51 billion, could still run into resistance from conservative lawmakers, some of whom have sought to offset the new spending with budget cuts elsewhere.

The conservative Club for Growth urged a no vote on the flood insurance measure, saying, "Congress should not allow the federal government to be involved in the flood insurance industry in the first place, let alone expand the national flood insurance program's authority."

The measure approved Friday  would increase the borrowing authority for the national flood insurance program to cover insurance claims for flood damage.

The Federal Emergency Management Agency has warned that without congressional action, funds available to pay claims would be exhausted next week.   

Sandy, which was a hurricane before the center of the storm made landfall  Oct. 29 in New Jersey, caused more than 125 deaths in the United States.

ALSO:

Sandy Hook students 'happy to see their friends'

House Democrats call for inquiry into beached Alaskan oil rig

New York state, county officials revolt over map of gun-permit holders

Richard.simon@latimes.com

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Did Microsoft Just Announce the Next Xbox with a Countdown? Probably.

Go countdowns, saving marketing departments untold piles of cash! Microsoft’s Larry Hryb, colloquially known by his Xbox LIVE handle “Major Nelson,” just threw one up on his blog, and it’s causing precisely the sort of speculative stir the company doubtless intended.

“And it’s on…” reads the ultra-austere post, followed by a simple Flash-based timer titled “Counting down to E3 2013″ (cribbed from a generic countdown-building site).

“O rly?” as a certain memetic predator might say.

I won’t speculate past the probability of the new console itself — everything I’ve noticed about specs and pricing amounts to echo chamber gossip. If you’d rather just goof around, hop on over to NeoGAF, where gamers go mostly to make fun of each other (and everything between), and you’ll find a rollicking thread full of cracks, quips, the usual goofy/creepy animated GIFs and occasional chants of “Let’s go, Durango” (“Durango” is supposedly what the next Xbox’s development kits are codenamed).

Could the countdown be to anything but the next Xbox? At this point, much as I’d like to see Microsoft wait another year or two before introducing new hardware to give developers more time to do amazing things with the Xbox 360′s more than competent internals, and as gimmicky as countdowns are, this one’s punchline feels inexorable.

Besides, imagine the disappointment in five months if it turned out to be simply a new franchise, the next Halo or heaven forbid, a standalone “Kinect 2.”

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'Lincoln,' 'Argo' earn Writers Guild nominations

LOS ANGELES (AP) — "Lincoln" and "Zero Dark Thirty" are adding to their front-runner status for Hollywood's awards season.

The two dramas earned nominations from the Writers Guild on Friday for outstanding screen writing.

"Lincoln" is up for adapted screenplay, along with "Argo," ''Silver Linings Playbook," ''Life of Pi" and "The Perks of Being a Wallflower."

"Zero Dark Thirty" was nominated for original screenplay, along with "Flight," ''Looper," ''The Master" and "Moonrise Kingdom."

In the documentary category, "The Central Park Five," ''The Invisible War," ''Mea Maxima Culpa, "West of Memphis," ''We Are Legion: The Story of the Hacktivists," and "Searching for Sugar Man" earned nominations.

Winners will be announced during simultaneous ceremonies in New York and Los Angeles on Feb. 17.

___

Online:

www.wga.org

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Scant Proof Is Found to Back Up Claims by Energy Drinks

Energy drinks are the fastest-growing part of the beverage industry, with sales in the United States reaching more than $10 billion in 2012 — more than Americans spent on iced tea or sports beverages like Gatorade.

Their rising popularity represents a generational shift in what people drink, and reflects a successful campaign to convince consumers, particularly teenagers, that the drinks provide a mental and physical edge.

The drinks are now under scrutiny by the Food and Drug Administration after reports of deaths and serious injuries that may be linked to their high caffeine levels. But however that review ends, one thing is clear, interviews with researchers and a review of scientific studies show: the energy drink industry is based on a brew of ingredients that, apart from caffeine, have little, if any benefit for consumers.

“If you had a cup of coffee you are going to affect metabolism in the same way,” said Dr. Robert W. Pettitt, an associate professor at Minnesota State University in Mankato, who has studied the drinks.

Energy drink companies have promoted their products not as caffeine-fueled concoctions but as specially engineered blends that provide something more. For example, producers claim that “Red Bull gives you wings,” that Rockstar Energy is “scientifically formulated” and Monster Energy is a “killer energy brew.” Representative Edward J. Markey of Massachusetts, a Democrat, has asked the government to investigate the industry’s marketing claims.

Promoting a message beyond caffeine has enabled the beverage makers to charge premium prices. A 16-ounce energy drink that sells for $2.99 a can contains about the same amount of caffeine as a tablet of NoDoz that costs 30 cents. Even Starbucks coffee is cheap by comparison; a 12-ounce cup that costs $1.85 has even more caffeine.

As with earlier elixirs, a dearth of evidence underlies such claims. Only a few human studies of energy drinks or the ingredients in them have been performed and they point to a similar conclusion, researchers say — that the beverages are mainly about caffeine.

Caffeine is called the world’s most widely used drug. A stimulant, it increases alertness, awareness and, if taken at the right time, improves athletic performance, studies show. Energy drink users feel its kick faster because the beverages are typically swallowed quickly or are sold as concentrates.

“These are caffeine delivery systems,” said Dr. Roland Griffiths, a researcher at Johns Hopkins University who has studied energy drinks. “They don’t want to say this is equivalent to a NoDoz because that is not a very sexy sales message.”

A scientist at the University of Wisconsin became puzzled as he researched an ingredient used in energy drinks like Red Bull, 5-Hour Energy and Monster Energy. The researcher, Dr. Craig A. Goodman, could not find any trials in humans of the additive, a substance with the tongue-twisting name of glucuronolactone that is related to glucose, a sugar. But Dr. Goodman, who had studied other energy drink ingredients, eventually found two 40-year-old studies from Japan that had examined it.

In the experiments, scientists injected large doses of the substance into laboratory rats. Afterward, the rats swam better. “I have no idea what it does in energy drinks,” Dr. Goodman said.

Energy drink manufacturers say it is their proprietary formulas, rather than specific ingredients, that provide users with physical and mental benefits. But that has not prevented them from implying otherwise.

Consider the case of taurine, an additive used in most energy products.

On its Web site, the producer of Red Bull, for example, states that “more than 2,500 reports have been published about taurine and its physiological effects,” including acting as a “detoxifying agent.” In addition, that company, Red Bull of Austria, points to a 2009 safety study by a European regulatory group that gave it a clean bill of health.

But Red Bull’s Web site does not mention reports by that same group, the European Food Safety Authority, which concluded that claims about the benefits in energy drinks lacked scientific support. Based on those findings, the European Commission has refused to approve claims that taurine helps maintain mental function and heart health and reduces muscle fatigue.

Taurine, an amino acidlike substance that got its name because it was first found in the bile of bulls, does play a role in bodily functions, and recent research suggests it might help prevent heart attacks in women with high cholesterol. However, most people get more than adequate amounts from foods like meat, experts said. And researchers added that those with heart problems who may need supplements would find far better sources than energy drinks.

Hiroko Tabuchi contributed reporting from Tokyo and Poypiti Amatatham from Bangkok.

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Stocks head for big weekly gain after jobs report

NEW YORK — Stocks edged higher after a report showed that hiring held up in December, keeping the Dow on track for its best week in more than six months.

The Dow Jones industrial average was up 16 points to 13,407 as of 1:22 p.m. EST Friday. It's up 3.6% for the week, putting it on track for its biggest weekly advance since June. The Standard & Poor's 500 index rose four points to 1,464 and is up 4.4% in the week, its biggest gain in more than a year. The Nasdaq was up less than a point at 3,101.

Stocks have surged this week after lawmakers passed a bill to avoid a combination of government spending cuts and tax increases that have come to be known as the "fiscal cliff." The law passed late Tuesday night averted that outcome, which could have pushed the economy back into recession.

The Labor Department said U.S. employers added 155,000 jobs in December, showing that hiring held up during the tense fiscal negotiations in Washington. It also said hiring was stronger in November than first thought. The unemployment rate held steady at 7.8%.

The jobs report failed to give stocks more of a boost because the number of jobs was exactly in line with analysts' forecasts, said JJ Kinahan, chief derivatives trader for TD Ameritrade.

"The jobs report couldn't have been more in line," said Kinahan. "The market had more to lose than to gain from it."

Among stocks making big moves, Eli Lilly and Co. jumped $1.87 to $51.59 after saying that its earnings will grow more than Wall Street expects, even though the drugmaker will lose U.S. patent protection for two more product types this year.

Walgreen Co., the nation's largest drugstore chain, fell 30 cents to $37.49 after the company said that a measure of revenue fell more than analysts had expected in December, even as prescription counts continued to recover.

Stocks may also be benefiting as investors adjust their portfolios to favor stocks over bonds, said TD Ameritrade's Kinahan. A multi-year rally in bonds has pushed up prices for the securities and reduced the yield that they offer, in many cases to levels below company dividends.

Goldman Sachs today reiterated its view that stocks "can be an attractive source of income," and warned that there is a risk that bonds may fall. In a note to clients, the investment bank said that an index of AAA rated corporate bonds offers a yield of 1.6%, that's less than the S&P 500's dividend yield of 2.2%.

The 10-year Treasury note fell, pushing its yield higher. The yield on the 10-year note rose 2 basis points to 1.93%. The note's yield has now climbed 54 basis points since falling to its lowest in at least 20 years in July.

Other notable stock moves;

-- Accuray Inc. plunged $1.36 to $5.42 after the radiation oncology equipment company reported weak sales and said it would cut 13% of its staff.

-- Lululemon, a yoga apparel maker, dropped $3.64 to $71.45 after Credit Suisse predicted slowing momentum and downgraded its stock.

-- Finish Line, an athletic footwear and clothing company, fell $1.12 to $17.92 after it reported a small loss after sneaker trends changed and customers didn't take to its new web site launched in November. Analysts had forecast a profit.

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Bieber urges crackdown on paparazzi after photographer's death

Justin Bieber and his collection of exotic cars have been tantalizing targets for celebrity photographers ever since the young singer got his driver's license.

A video captured the paparazzi chasing Bieber through Westside traffic in November. When Bieber's white Ferrari stops at an intersection, the video shows the singer turning to one of the photographers and asking: "How do your parents feel about what you do?"

A few months earlier, he was at the wheel of his Fisker sports car when a California Highway Patrol officer pulled him over for driving at high speeds while trying to outrun a paparazzo.

This pursuit for the perfect shot took a fatal turn Tuesday when a photographer was hit by an SUV on Sepulveda Boulevard after taking photos of Bieber's Ferrari. And the singer now finds himself at the center of the familiar debate about free speech and the aggressive tactics of the paparazzi.

Since Princess Diana's fatal accident in Paris in 1997 while being pursued by photographers, California politicians have tried crafting laws that curb paparazzi behavior. But some of those laws are rarely used, and attorneys have challenged the constitutionality of others.

On Wednesday, Bieber went on the offensive, calling on lawmakers to crack down.

"Hopefully this tragedy will finally inspire meaningful legislation and whatever other necessary steps to protect the lives and safety of celebrities, police officers, innocent public bystanders and the photographers themselves," he said in a statement.

It remained unclear if any legislators would take up his call. But Bieber did get some support from another paparazzi target, singer Miley Cyrus.

She wrote on Twitter that she hoped the accident "brings on some changes in '13 Paparazzi are dangerous!"

Last year, a Los Angeles County Superior Court judge threw out charges related to a first-of-its-kind anti-paparazzi law in a case involving Bieber being chased on the 101 Freeway by photographer Paul Raef. Passed in 2010, the law created punishments for paparazzi who drove dangerously to obtain images.

But the judge said the law violated 1st Amendment protections by overreaching and potentially affecting such people as wedding photographers or photographers speeding to a location where a celebrity was present.

The L.A. city attorney's office is now appealing that decision.

Raef's attorney, Dmitry Gorin, said new anti-paparazzi laws are unnecessary.

"There are plenty of other laws on the books to deal with these issues. There is always a rush to create a new paparazzi law every time something happens," he said. "Any new law on the paparazzi is going to run smack into the 1st Amendment. Truth is, most conduct is covered by existing laws. A lot of this is done for publicity."

Coroner's officials have not identified the photographer because they have not reached the next of kin. However, his girlfriend, Frances Merto, and another photographer identified him as Chris Guerra.

The incident took place on Sepulveda Boulevard near Getty Center Drive shortly before 6 p.m. Tuesday. A friend of Bieber was driving the sports car when it was pulled over on the 405 Freeway by the California Highway Patrol. The photographer arrived near the scene on Sepulveda, left his car and crossed the street to take photos. Sources familiar with the investigation said the CHP told him to leave the area. As he was returning to his vehicle, he was hit by the SUV.

Law enforcement sources said Wednesday that it was unlikely charges would be filed against the driver of the SUV that hit the photographer.

Veteran paparazzo Frank Griffin took issue with the criticism being directed at the photographer as well as other paparazzi.

"What's the difference between our guy who got killed under those circumstances and the war photographer who steps on a land mine in Afghanistan and blows himself to pieces because he wanted the photograph on the other side of road?" said Griffin, who co-owns the photo agency Griffin-Bauer.

"The only difference is the subject matter. One is a celebrity and the other is a battle. Both young men have left behind mothers and fathers grieving and there's no greater sadness in this world than parents who have to bury their children."

Others, however, said the death focuses attention on the safety issues involving paparazzi

"The paparazzi are increasingly reckless and dangerous. The greater the demand, the greater the incentive to do whatever it takes to get the image," said Blair Berk, a Los Angeles attorney who has represented numerous celebrities. "The issue here isn't vanity and nuisance, it's safety."

richard.winton@latimes.com

andrew.blankstein@latimes.com

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Depardieu, in tax fight, gets Russian citizenship

MOSCOW (AP) — The Kremlin has cast Gerard Depardieu in one of the most surprising roles of his life — as a new Russian citizen.

The announcement Thursday that President Vladimir Putin has approved Depardieu's application for citizenship is almost a real-life analogue to the French actor's 1990 comedy "Green Card," in which his character enters into a sham marriage in order to work in the United States.

But in this version, taxes appear to be at the heart of the matter. Depardieu has waged a battle against a proposed super tax on millionaires in his native country.

French President Francois Hollande plans to raise the tax on earned income above €1 million ($1.3 million) to 75 percent from the current 41 percent, while Russia has a flat 13-percent tax rate.

A representative for the former Oscar nominee declined to say whether he had accepted the Russian offer.

Thursday was a holiday in Russia and officials from the Federal Tax Service and Federal Migration Service could not be reached for comment on whether the decision would require Depardieu to have a residence in Russia.

But it's clearly an image buffer for Russia, calling attention to the country's attractive tax regime and boosting Putin's efforts to show that the economic chaos of the early post-Soviet period has passed.

"The distinctiveness of our tax system is poorly known about in the West. When they know about it, we can expect a massive migration of rich Europeans to Russia," Deputy Prime Minister Dmitry Rogozin bragged on Twitter.

Others aren't so sure.

Political analyst Pavel Svyatenkov told the state news agency RIA Novosti that the move was "very good, very high-quality PR for Russia" but he was didn't think it would ignite a flood of new residents.

"I don't expect a massive movement of rich people to here, for the reason that Russia remains a pretty poor country by Western measurements and here there are bigger problems with crime and corruption," he said.

As Depardieu's criticism of the proposed tax roiled his country, French Prime Minister Jean-Marc Ayrault called him "pathetic."

Depardieu responded angrily in an open letter.

"I have never killed anyone, I don't think I've been unworthy, I've paid €145 million ($190 million) in taxes over 45 years," the 64-year-old actor wrote. "I will neither complain nor brag, but I refuse to be called 'pathetic'."

Depardieu said in the letter that he would surrender his passport and French social security card. In October, the mayor of a small Belgian border town announced that Depardieu had bought a house and set up legal residence there, a move that was slammed by Hollande's newly-elected Socialist government.

Najat Vallaud-Belkacem, the French government spokeswoman, didn't comment directly on Depardieu's tax fight. But she drew a clear distinction between people who have personal or professional reasons to live abroad and "French citizens who proclaim loudly and clearly that they they're exiling themselves for fiscal reasons."

She said Putin's offer "is an exclusive prerogative of the Russian chief of state."

Depardieu has had increasingly high-profile ties with Russia.

Last October he visited Grozny, the capital of the Russian province of Chechnya, to celebrate the birthday of Chechen President Ramzan Kadyrov. And in 2011, he was in Russia's Arkhangelsk region to play the lead role in the film "Rasputin."

He is well known in the country, where he appears in an ad for Sovietsky Bank's credit card and is prominently featured on the bank's home page.

"You have to understand that Depardieu is a star in Russia," Vladimir Fedorovski, a Russian writer living in France, told the Europe 1 network on Thursday. "There are crowds around Depardieu. He's a symbol of France. He's a huge ambassador of French culture."

Depardieu has made more than 150 films and was nominated for an Academy Award for his role as Cyrano de Bergerac in the 1990 film of the same name.

The Kremlin statement gave no information on why Putin made the citizenship grant, but the Russian president had expressed sympathy with the actor in December, days after Depardieu reportedly said he was considering Russian citizenship.

"As we say, artists are easily offended and therefore I understand the feelings of Mr. Depardieu," Putin said.

Although France's highest court struck down the new tax on Dec. 29, the government has promised to resubmit the law in a slightly different form. On Wednesday, the French government estimated the court decision to overturn the tax would cost the country €210 million ($275 million) in 2013.

In an interview, Depardieu told the Sunday Parisien the court decision made no difference.

France's debt burden is around 90 percent of national income — not far off levels that have caused problems elsewhere in the 17-country eurozone.

Depardieu is not the only high-profile Frenchman to object to the super tax. Bernard Arnault — chief of the luxury goods and fashion giant LVMH and worth an estimated $41 billion — has said he would leave for Belgium.

____

Hinnant contributed from Paris. Silvie Corbet also contributed from Paris.

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Advertising: Planet Fitness Sheds Aspirational Approach

COMMERCIALS for gyms tend to feature actors who look like Calvin Klein underwear models, with physiques that most will not achieve no matter how long they spend on an elliptical machine.

Planet Fitness, a national chain of about 600 fitness clubs, is introducing a campaign that mocks fitness fanatics, especially those whose devotion infringes on others.

A new commercial opens with a slight woman who is curling small dumbbells in a drab gym as a brawny man berates her like a drill sergeant.

“If you can’t handle a big girl’s workout, the little girl’s gym is right across the street!” shouts the man, a whistle hanging around his neck and his hands balled into fists, as the woman appears to be on the brink of tears. “If you were committed to this workout the way you committed to that morning doughnut, you’d be puking out your ears right now!”

The spot cuts to a flashing light and siren and the words “Lunk Alarm,” and then to the same woman in street clothes being given a tour of a Planet Fitness facility.

“And that’s why I don’t like gyms,” she says.

“Well,” begins the employee showing her around, “we’re not a gym — we’re Planet Fitness.”

The ad closes with a voice-over, which says: “No gymtimidation. No lunks. Just $10 a month.”

The ad, by Red Tettemer & Partners in Philadelphia, will be introduced widely on Jan. 10. Three other spots in the campaign follow the same structure, opening with overbearing gym rats and closing with assurances that Planet Fitness is more laid back.

Planet Fitness will spend an estimated $10 million to $12 million on the campaign. It spent $15.8 million on advertising in the first nine months of 2012, more than the $14.9 million it spent in all of 2011, according to Kantar Media, a unit of WPP.

Rather than being just a narrative device in the spots, lunk alarms have actually been fixtures at Planet Fitness gyms. Members who exhibit lunk behavior, which the company defines on posters in its facilities as grunting, dropping weights loudly and being judgmental, are subject to a public shaming when a manager at the facility sounds the alarm.

In some cases, Planet Fitness even revokes memberships, as it did at a location in Wappingers Falls, N.Y., in 2006. Albert Argibay, a bodybuilder whose exertions were considered grunting by Planet Fitness, but which Mr. Argibay countered in news accounts as merely heavy breathing, kept lifting after he was told to leave, and was eventually escorted from the premises by police officers.

While the slogan “No Gymtimidation” is being introduced with the new campaign, the company has for years promised what it calls a “judgment-free zone.” That, in the words of the Planet Fitness Web site, “means members can relax, get in shape, and have fun without being subjected to the hard-core, look-at-me attitude that exists in too many gyms.”

Jamie Medeiros, director of marketing at Planet Fitness, said that only about 15 percent of Americans belonged to gyms, and that the company was focused not on trying to lure consumers from other facilities but on enticing those who had avoided gyms altogether.

“We go after the 85 percent who don’t belong to a gym now or who have never belonged to a gym,” Ms. Medeiros said.

While many chains sell protein powders and a wide range of supplements, Planet Fitness takes the counterintuitive approach of serving the type of food that dieters typically avoid.

Every month members are treated to pizza on the first Monday night and bagels on the second Tuesday morning, while Tootsie Rolls are handed out daily.

“The common person doesn’t have time to work out every day, and they may not aspire to the type of person who has six-pack abs and eats egg whites,” Ms. Medeiros said. “But we want to be the type of facility that people want to go to as opposed to, ‘Oh my god, I have to go to the gym today!’ ”

The company has thrived even during the economic downturn, growing to four million members today from about 3.2 million a year ago, according to Ms. Medeiros. About 60 percent of its members are women, much higher than what Ms. Medeiros said is the national average of 20 percent.

Health clubs, like cellphone carriers, tend to sell one- or two-year contracts, but Planet Fitness instead has a month-to-month plan, at $10 monthly, which the company believes knocks down a barrier to joining.

Among consumers who exercise, 71 percent agreed with the statement that fitness clubs were too expensive, according to a survey by Mintel, a market research firm. As for the atmosphere, only 27 percent said that they enjoyed the social aspects of gyms.

When brands hire celebrity endorsers and attractive models, marketers typically refer to the advertisements as aspirational, meaning that consumers do not see themselves reflected in the ad as much as an ideal to which they aspire. But Steve Red, the chief creative officer of Red Tettemer & Partners, said the aspirational approach can backfire when it comes to promoting health clubs.

“I’m never going to get to be that washboard-stomach, super-cut guy that I see in the Equinox ads,” said Mr. Red, referring to the chain of upscale gyms. “There are a ton of gym brands that are all about being cut and sinewy and having a six-pack, but I would argue that approach is not aspirational — it’s inaccessible.”

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World's 100 richest people got $241 billion richer in 2012

The richest people on the planet got even richer in 2012, adding $241 billion to their collective net worth, according to the Bloomberg Billionaires Index, a daily ranking of the world's 100 wealthiest individuals.

The aggregate net worth of the world's top 100 stood at $1.9 trillion at the market close Dec. 31, according to the index. Of the people who appeared on the final ranking of 2012, only 16 registered a net loss for the 12-month period.

"Last year was a great one for the world's billionaires," said John Catsimatidis, the billionaire owner of Red Apple Group Inc., in an email written poolside on his BlackBerry in the Bahamas. "In 2013, they will continue looking for investments around the world — and not necessarily in U.S. — that will give them an advantage."

Amancio Ortega, the Spaniard who founded retailer Inditex, was the year's biggest gainer. The 76-year-old tycoon's fortune increased to $57.5 billion, a gain of $22.2 billion, according to the index, as shares of the retailer that operates the Zara clothing chain rose 66.7%.

"It's an amazing company that has done great, and the gains are quite justified given its performance," said Christodoulos Chaviaras, an analyst at Barclays in London who's had an "equalweight" rating on Inditex for about a year. "Can they repeat that? It will be harder. A lot of the positive news is already reflected in the share price."

Global stocks soared in 2012. The MSCI World Index gained 13.2% during the year to close at 1338.50 on Dec. 31. The Standard & Poor's 500 index rose 13.4% to close at 1426.19.

European stocks surged in the second half of the year. The Stoxx Europe 600 index is up 19.6% since June 4, advancing as the European Central Bank introduced bond-buying programs, S&P upgraded Greece's debt and German business confidence rose more than forecast. The benchmark gauge's 14.4% advance for the year was the best annual return since 2009.

Carlos Slim, the telecommunications magnate who controls Mexico's America Movil, maintained his title as the richest person on Earth for the entire year. The 72-year-old's net worth rose $13.4 billion, or 21.6%, through Dec. 31, making him the second-biggest gainer by dollars.

Gains by Slim's industrial conglomerate, Grupo Carso, and Grupo Financiero Inbursa, his banking and insurance operation, more than offset the decline posted by America Movil, his biggest holding. The largest mobile phone operator in the Americas by subscribers fell 5.8% to close at 14.9 pesos at the end of the year.

U.S. software mogul Bill Gates, 57, ranks second on the list, trailing Slim by $12.5 billion. The Microsoft Corp. co-founder added $7 billion to his net worth as shares of the Redmond, Wash., company rose 2.9%. Microsoft stock accounts for less than 20% of the billionaire's fortune.

Warren Buffett, 82, lost his title as the world's third-richest man to Ortega on Aug. 6. The Berkshire Hathaway Inc. chairman gained $5.1 billion during the year, even after donating 22.3 million Berkshire Class B shares in July to charity. The billionaire, who has pledged to give away most of his fortune, spent much of the year pressing for higher taxes on the wealthy.

Ikea founder Ingvar Kamprad, 86, is the world's fifth-richest person with a $42.9-billion fortune. The complex ownership structure behind Ikea, the world's largest furniture retailer, became more transparent in August after Ikea's franchisor published its financial performance publicly for the first time. His net worth rose 16.6% in 2012.

Brazil's Eike Batista, 56, was the year's biggest loser by dollars, falling $10.1 billion. The commodities maven, who vowed a year ago that he'd become the world's wealthiest man by 2015, sold a 5.63% stake in his EBX Group Co. in March to Abu Dhabi's Mubadala Development Co.

As part of the deal, he pledged an unspecified additional stake in 2019 if he fails to meet a 5% annual return on the sovereign wealth fund's $2-billion investment, according to a person with knowledge of the deal. Batista now ranks 75th in the world with a net worth of $12.4 billion. On March 27, he was worth $34.5 billion and ranked 8th on the Bloomberg index.

Batista's former title as the richest Brazilian is now held by 73-year-old banker Jorge Paulo Lemann, who ranks 37th on the index with an $18.8-billion fortune. The country's second-richest person is Dirce Camargo, the matriarch behind Camargo Correa, the Sao Paulo conglomerate that has interests in cement, electricity and Havaianas flip-flops. Her net worth is $13.4 billion, according to the Bloomberg ranking.

Camargo, who doesn't appear on any other major international wealth ranking, is one of 54 billionaires the index uncovered during the year. Among the others: Hamdi Ulukaya, the 40-year-old Turkish immigrant owner of Chobani, the bestselling yogurt brand in the U.S.; South Africa's Nathan "Natie" Kirsh, 80, who amassed a $5.4-billion fortune in retail and real estate; and Elaine Marshall, 70, whose 14.6% ownership of closely held Koch Industries makes her the fourth-richest woman in America. She is worth $14.1 billion.

Koch Industries' two other shareholders, the brothers Charles and David Koch, are each worth $40.9 billion, up $7.1 billion, or 20.9%, for the year.

Oracle Corp. founder Larry Ellison rose $6.4 billion in 2012 as shares of the world's largest database company jumped 31.7%. Ellison, 68, who has more than tripled the amount of Oracle stock he has pledged against lines of credit in the last year, agreed to buy 98% of Hawaii's Lanai island. The 141-square-mile parcel with no traffic lights was purchased from billionaire David Murdock, the 89-year-old chairman of Dole Food Co., the world's largest producer of fresh fruit and vegetables.

The bulk of Ellison's fortune comes from his 23.5% stake in Oracle. He also has interests in software makers NetSuite Inc. and LeapFrog Enterprises Inc., as well as property holdings, including estates in California and Newport, R.I.

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