With Graph Search, Facebook Bets on More Sharing


SAN FRANCISCO — Facebook’s greatest triumph has been to persuade a seventh of the world’s population to share their personal lives online.


Now the social network is taking on its archrival, Google, with a search tool to mine that personal information, just as people are growing more cautious about sharing on the Internet and even occasionally removing what they have already put up.


Whether Facebook’s more than one billion users will continue to divulge even more private details will determine whether so-called social search is the next step in how we navigate the online world. It will also determine whether Facebook has found a business model that will make it a lot of money.


“There’s a big potential upside for both Facebook and users, but getting people to change their behaviors in relation to what they share will not be easy,” said Andrew T. Stephen, who teaches marketing at the University of Pittsburgh and studies consumer behavior on online social networks.


This week, Facebook unveiled its search tool, which it calls graph search, a reference to the network of friends its users have created. The company’s algorithms will filter search results for each person, ranking the friends and brands that it thinks a user would trust the most. At first, it will mine users’ interests, photos, check-ins and “likes,” but later it will search through other information, including status updates.


“While the usefulness of graph search increases as people share more about their favorite restaurants, music and other interests, the product doesn’t hinge on this,” a Facebook spokesman, Jonathan Thaw, said.


Nevertheless, the company engineers who created the tool — former Google employees — say that the project will not reach its full potential if Facebook data is “sparse,” as they call it. But the company is confident people will share more data, be it the movies they watch, the dentists they trust or the meals that make their mouths water.


The things people declare on Facebook will be useful, when someone searches for those interests, Tom Stocky, one of the creators of Facebook search, said in an interview this week. Conversely, by liking more things, he said, people will become more useful in the eyes of their friends.


“You might be inclined to ‘like’ what you like so when your friends search, they’ll find it,” he said. “I probably would never have liked my dentist on Facebook before, but now I do because it’s a way of letting my friends know.”


Mr. Stocky offered these examples of how more information may be desirable: A single man may want to be discovered when a friend of a friend is searching for eligible bachelors in San Francisco or a restaurant that stays open late may want to be found by a night owl.


“People have shared all this great stuff on Facebook,” Mr. Stocky said. “It’s latent value. We wanted a way to unlock that.”


Independent studies suggest that Facebook users are becoming more careful about how much they reveal online, especially since educators and employers typically scour Facebook profiles.


A Northwestern University survey of 500 young adults in the summer of 2012 found that the majority avoided posting status updates because they were concerned about who would see them. The study also found that many had deleted or blocked contacts from seeing their profiles and nearly two-thirds had untagged themselves from a photo, post or check-in.


“These behavioral patterns seem to suggest that many young adults are less keen on sharing at least certain details about their lives rather than more,” said Eszter Hargittai, an associate professor of communication studies at Northwestern, who led the yet unpublished study among men and women aged 21 and 22.


Also last year, the Pew Internet Center found that social network users, including those on Facebook, were more aggressively pruning their profiles — untagging photos, removing friends and deleting comments.


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The Lede Blog: Analysis of Armstrong’s Confession

As the second part of Lance Armstrong’s televised confession that he doped and lied his way to seven Tour de France titles is broadcast on the Oprah Winfrey Network Friday night, The Lede will have real-time fact-checking and analysis from New York Times reporters, including Juliet Macur and Naila-Jean Meyers. We will also round up reactions from fans, bloggers, journalists and fellow riders once the broadcast and live stream gets underway, at 9 p.m. Eastern Time.

10:20 P.M. |Video Highlights of Armstrong’s Confession

Now that the broadcast is over, the Oprah Winfrey Network has posted highlights on its YouTube channel.

Lance Armstrong on his “most humbling moment.”
Lance Armstrong on what he was thinking when he attacked his critics for telling the truth.
“If you’re asking me if I want to compete again? The answer’s, Hell yes.”
Lance Armstrong argued that his punishment was “a death penalty.”
Lance Armstrong on talking to his children about his cheating.

That concludes our live-blog coverage of Lance Armstrong’s confession. Thanks for joining us and thanks to all of the bloggers and journalists whose Twitter commentary we quoted.

Robert Mackey

10:09 P.M. |A More Emotional Interview

More than Part 1, the second part of the interview felt like the old Oprah Winfrey show. Among the questions Winfrey asked Armstrong in the final 10 minutes of the interview:

“Will you rise again? Are you a better human being? What is the moral of the story?”

The answers: “I don’t know.” “Without a doubt. “I don’t have a great answer.”

O.K., Armstrong said more than that:

“I do not know the outcome here and I’m getting comfortable with that. That would have driven me crazy in the past.”

“I am deeply sorry for what I did. I can say that thousands of times and it may never be enough.”

“When I was diagnosed, I was a better human being after that. And I was a smarter human being after that. And then I lost my way. Here’s the second time. And it’s easy to sit here and say I feel different, I feel smarter, I feel like a better man today, but I can’t lose my way again. And only I can control that.”

“The ultimate crime is the betrayal of these people that supported me and believed in me and they got lied to.”

Winfrey even ended the interview by repeating what Kristin Armstrong told her ex-husband in 2009: “The truth will set you free.” That’s the Oprah many people expected when the interview was announced.

Naila-Jean Meyers

10:04 P.M. |The Financial Implications of the Truth

Clarification was needed when Oprah asked him the financial toll of his demise.

“Have you lost everything?” she asked.

He would say only that he lost $75 million in future income.

”Gone,” he said, “and probably never coming back.”

But it would be wrong to imply that he is without money. The bigger question is not about lost earnings but what he believes he will lose.

What has he paid lawyers? What does he estimate that will pay in potential civil liability or settlements? What does he have to give back to sponsors? Oprah let Armstrong control the narrative.

One more point: did it seem to everyone that Armstrong never uncrossed his legs for the entire two and a half hours he talked to Oprah?

Richard Sandomir

10:02 P.M. |A Shifting Account of the Impact on Cancer

Tonight Armstrong is saying that following his cancer diagnoses “I was a better human being after that, I was a smarter human being after that.” Last night, however, he said that his recovery from cancer turned him into a no-holds-barred, win-at-all-costs hyper-competitor. Given that he’s now comparing his current situation to the cancer diagnoses, what does this all mean?

Ian Austen and Juliet Macur

9:52 P.M. |How Editing Changes Impressions

The previous segment saw Lance Armstrong talking at length, and breaking down in tears, talking about his children. After the commercial break, a seemingly composed Armstrong was asked whether anyone on his team had paid off the United States Anti-Doping Agency. He said no.

But the change in tone of the interview was abrupt and odd. It makes me wonder about how the interview was edited.

Naila-Jean Meyers

9:48 P.M. |Armstrong Chokes Up

Armstrong, in many ways, seems to be dictating this part of the interview. He’s asking a lot of questions of himself, and Winfrey is, again, not asking critical follow-ups.

When she asked, was there anybody who knew the whole truth? Armstrong said, “Yeah.” But Winfrey didn’t ask who.

Armstrong has been allowed to go on long narratives about his family, his children, his “process,” and change subjects without Winfrey asserting herself into the conversation.

Her silence, though, helped create what has so far been the most emotional part of the interview, Armstrong’s description of what he told his 13-year-old son, Luke, over the holidays about the case against him. “I told him not to defend me anymore,” Armstrong said after a long pause during which became choked up.

Naila-Jean Meyers

Oprah opened up a significant door with Armstrong that Armstrong danced around and then shut: did people tell him to stop doping, stop the lying and, one assumes, stop steamrolling people who disagreed with him?

“Could they have done anything?” she asked.

“Probably not,” he said. But then, he detoured, with Oprah’s help, into discussing a conversation with his ex-wife, Kristin, about whether he should return to cycling from his retirement. She told him if he did it without doping and not to cross the line again.

He said that Kristin was “not curious,” and perhaps “did not want to know.”

Still, did Kristin, or anyone else, plead with him, intervene with him, tell him he’s a jerk? Right now, we don’t know. “I said, `You’ve got a deal,’ ” he said. Of course, others disagree that he did not use performance-enhancing drugs during his comeback in 2009 and ’10.

Oprah opened yet another area of inquiry when she asked Armstrong if he is in therapy; he said that he was and that he had been in therapy sporadically throughout his life but now needed to do more. But just like that, the door closed before any questions about whether therapy enabled him to confess his doping sins, even if his admissions have not satisfied everyone.

Richard Sandomir

9:44 P.M. |On Losing the 2009 Edition of the Tour

Armstrong said he expected to win the 2009 Tour in his first year back from a several-year break. Finishing third was hard for him. He eventually rationalized that finish by saying he “just got beat” by two guys who were better than him. I would beg to disagree. Armstrong did everything he could to sabotage Alberto Contador’s victory that year, Contador has said. He left Contador stranded at the team hotel without a ride to the individual time trial. He also harassed Contador at team dinners, knowing full well that Contador, a Spaniard, could understand English. He also criticized Contador for attacking at the end of one mountaintop finish, but Contador later said he attacked because he thought his team was plotting against him.

Juliet Macur

9:38 P.M. |On the Yellow Jersey Twitter Picture

Oprah asked about the picture Armstrong posted on Twitter of him lying on his couch surrounded by framed yellow jerseys.

“That was another mistake,” he said.

Then Oprah basically laughed at him for showing such hubris, essentially saying, “What were you thinking?!??!”

“That was just more defiance,” he said.

Naila-Jean Meyers

9:33 P.M. |A More Contrite Armstrong, but Questions Linger

Armstrong is sounding much, much more contrite than he was in Oprah Part 1 on Thursday. He said his lowest moment was cutting all ties with his charity and that he was in therapy now. He called it “sick” that he told a lawyer in sworn testimony in 2005 that he would never dope because it would disappoint the millions of cancer survivors who looked up to him. Yet he still said he deserved a six-month suspension, which is the punishment his teammates received when they came clean to the United States Anti-Doping Agency. The difference, though, is that those teammates came forward to tell the truth about their doping, while he kept his secrets for months and months more. (And most likely would have kept them forever if he had never been caught.)

Armstrong said his former wife, Kristin, believed in honesty and the truth. But at least one rider who testified in the United States Anti-Doping Agency case said Kristin was complicit in Armstrong’s doping. She allegedly handed out cortisone pills to riders at the 1998 world championships, prompting another rider to say, “Lance’s wife is handing out joints.” Armstrong said Kristin was only on a “need to know” basis regarding the drugs, but some of Armstrong’s teammates would disagree.

Juliet Macur

9:31 P.M. |Armstrong Admits He Wants to Compete Again

As my colleague Juliet Macur reported two weeks ago, close associates said that he was considering making a confession “because he wants to persuade antidoping officials to restore his eligibility so he can resume his athletic career.”

In response to questions from Winfrey, Armstrong said that he did want to compete again and that was part of the reason he finally admitted cheating.

Armstrong was given a lifetime ban against competition after first attempted to use the courts to block the United States Anti-Doping Agency’s investigation of him and then, when that failed, he refused to participate in the process. The World Anti-Doping Agency, or WADA, has the power to amend that ban if he provides it with “substantial assistance.” But David Howman, its executive director, told me Friday that not only has Armstrong not done that yet, he hasn’t even contacted WADA.

Some observers of the interview who doubt Armstrong’s contention that he did not cheat during his comeback in 2009, when he continued to work with the infamous doping doctor Michele Ferrari, have suggested that he might be thinking of the statute of limitations, or presenting a case that his ban should be shorter and back-dated to 2005.

Armstrong continues to assert that he didn’t dope during his post retirement Tours de France. Here’s the conclusion of the United States Anti-doping Agency: “Armstrong’s Blood Test Results During the 2009 and 2010 Tours de France are Consistent with His Continued Use of Blood Doping.”

After Thursday’s broadcast, antidoping officials were clear. “If Mr. Armstrong truly wants to make amends for his doping past, then he needs to make a full confession under oath to the relevant anti-doping authorities,” the World Anti-Doping Agency said.

The U.S. Anti-Doping Agency added: “His admission that he doped throughout his career is a small step in the right direction. But if he is sincere in his desire to correct his past mistakes, he will testify under oath about the full extent of his doping activities.”

Robert Mackey and Ian Austen

9:22 P.M. |Oprah Presses for an Emotional Reaction

Oprah’s first question was: What was the humbling moment that brought you face to face with yourself?

Armstrong began talking about when his sponsors, starting with Nike, bailed out. He knew then that he was losing control of the story. But the most humbling moment came later:

“The one person I didn’t think would leave was the foundation,” Armstrong said. “And that was the most humbling moment.”

Calling the foundation his “sixth child,” he said that stepping aside from the foundation was “the lowest point.”

Armstrong said that he wasn’t forced out but was aware of the pressure and that it was the best thing for the organization that he leave.

After watching the clip of his 2005 deposition, Armstrong said, “I don’t like that guy.”

Winfrey followed up by asking, “Who is that guy?”

“That is a guy who felt invincible, was told he was invincible, truly believed he was invincible,” Armstrong said.

He conceded: “That guy’s still there. I’m not going to lie to you.”

He also talked more about apologies, and when Winfrey asked what he would say to the millions of people who supported him, Armstrong said: “I understand your anger, your sense of betrayal. You supported me forever through all of this, you believed, and I lied to you. And I’m sorry. I will spend — and I’m committed to spend — as long as I have to make amends.”

(And “process” continues to be Armstrong’s favorite word in this interview.)

Naila-Jean Meyers

9:19 P.M. |Did Armstrong’s Doping Cause His Cancer?

Winfrey finally asked Armstrong the question that many people have been wondering: If he thought his doping had caused his testicular cancer. She asked if he thought it did. He said no. And that was it! Winfrey, obviously, should have pushed him on that and asked why he doped even after cancer nearly killed him.

Juliet Macur

9:16 P.M. |Armstrong’s Lowest Point: Leaving Livestrong

Armstrong told Winfrey his lowest moment of his doping scandal: leaving his charity, Livestrong, behind. He said Livestrong had asked him to step down as chairman last fall, then weeks later asked him to cut all ties. He said he wasn’t forced out or told to leave. But that walking away from it “hurt the most.” The charity needed to distance itself from him because it was losing support, two people with knowledge of the situation said. Corporate sponsors were pulling their support or cutting their support in the aftermath of Armstrong’s scandal.

During the interview, Winfrey asked Armstrong to watch video of his own sworn testimony in 2005, when he said that the reason he would never dope was that he would lose “the faith of all of the cancer survivors around the world.” He added: “It’s not about the money for me — everything — it’s also about the faith that people have put in me over the years. So all of that would be erased. So I don’t need it to say in a contract, ‘You’re fired if you test positive.’ That’s not as important as losing the support of hundreds of millions of people.”

Part of Lance Armstrong’s deposition in a 2005 suit against SCA Promotions, a firm that had promised to pay him a huge bonus for winning the Tour de France five straight times.

Juliet Macur and Robert Mackey

9:06 P.M. |What Did Armstrong Tell His Children?

Oprah Winfrey did ask several of the questions that my colleague Juliet Macur suggested the other day, but based on the promos for Part 2, Winfrey will be asking about Armstrong’s children.

To refresh your memory, here is what Juliet suggested Oprah ask about Lance’s children:

When you briefly retired from cycling after winning the 2005 Tour, you said you did so to spend time with your children and be a better father. Do your five children, ages 2 to 13, know about your doping past? If so, when and how did you tell them?

Naila-Jean Meyers

9:03 P.M. |LeMond Gets In a Dig

Greg LeMond, the only American winner of the Tour de France not to be later stripped of the title for cheating, was at odds with Lance Armstrong for more than a decade over suspicions that the Texan had doped.

On Thursday, he reminded readers of his Twitter feed of one of Armstrong’s most adamant declarations that he never doped: a Nike commercial in which he declared that all he was “on” was his bike, six hours a day.

Writing on Twitter, LeMond made a puckish referee to that ad in a message drawing attention to his own latest product, a LeMond Revolution cycling trainer.

Robert Mackey

8:55 P.M. |Annals of Great Televised Confessions

While we are waiting for Lance Armstrong to complete the confession of all confessions, let us revisit some memorable occasions from the past when public figures went on television to express remorse (or not) for things they did.

Who could forget Bill Clinton’s humiliating declaration that oops, he had in fact had an inappropriate relationship with “that woman … Miss Lewinsky” after all?

Or Mark Sanford’s ragged, rambling confession that “hiking the Appalachian Trail” had nothing to do with hiking, or even with Appalachia, and everything to do with his South American mistress?

Or the excruciating spectacle of a squirming Tiger Woods owning up to “irresponsible and selfish behavior” after being exposed as a serial philanderer and sender of unsavory hook-up texts?

Then there was Anthony Weiner’s teary confession that he had for some horrifying reason posted on Twitter a photograph of his underpants (with him inside them) and then lied about it.

There are many more, obviously: this is a great American ritual, the televised confession and plea for forgiveness. But the most interesting one in recent years, to my mind, was David Letterman’s extraordinary admission, in a long, often ruefully funny, monologue in 2009 that seemed to be a brilliant shaggy-dog story until it wasn’t, that he had slept with women on his staff. (He revisited the issue the following week, when he apologized to his staff and to his wife, Regina).

Sarah Lyall

8:51 P.M. |What About the Ratings?

The question on the minds of media types Friday night is: how well will Part 2 of Winfrey’s interview fare?

Part 1 of her sit-down with Armstrong attracted about 3.2 million viewers to OWN. Another 1.1 million watched a repeat of the interview, for a total of 4.3 million for the night. While great for OWN, many executives and producers at other networks thought Armstrong’s confession would draw a bigger total audience.

Maybe the public knew enough from the leaks ahead of time (namely, that Armstrong was certain to confess) or maybe he wasn’t an appealing enough figure to spend 90 minutes with (he didn’t show all that much remorse to Winfrey, some said). Maybe they just wanted to watch “American Idol” instead. Regardless, Armstrong’s messages were seen and heard by a much bigger audience than the one that tuned into OWN — his story blanketed television newscasts on Thursday night and Friday morning.

Typically Friday nights are much lower-rated than Thursday nights across the American TV universe. But OWN is hoping to draw in millions of people for Part 2. The early ratings will be available as early as Saturday.

Brian Stelter

8:34 P.M. |Color Victims of Armstrong’s Bullying Unimpressed

As my colleague Ian Austen reported, among the viewers of Thursday’s broadcast who came away less than impressed by Lance Armstrong’s limited confession were several members of the professional cycling community he attacked after they testified to his doping over the years.

One was the Italian cyclist Filippo Simeoni, who angered Armstrong by testifying against the doping doctor both had been clients of, Michele Ferrari. Armstrong took his revenge by using his position as leader of the 2004 Tour de France to intimidate other riders into agreeing to block Simeoni from competing for a stage win.

Two women who were once part of Armstrong’s inner circle, Emma O’Reilly, his former masseuse, and Betsy Andreu, the wife of a former teammate, both told the Irish journalist David Walsh that the American champion had cheated. In part of his sworn testimony in a 2005 lawsuit, Armstrong denied the allegations made by both women and attacked their characters.

Part of Lance Armstrong’s deposition in a 2005 suit against SCA Promotions, a firm that tried not to pay him a huge bonus for winning the Tour de France because of allegations that he had cheated to win.

In the part of the interview broadcast on Thursday night, Armstrong said that he had tried to apologize to both women. He confirmed that he had lied under oath in denying O’Reilly’s account of how he managed to get out of a failed drug test after the very first stage of his first Tour win in 1999, but he refused to address Andreu’s contention that he had acknowledged using drugs in 1996 to doctors treating him for cancer.

Lance Armstrong admitting to Oprah Winfrey that he attacked critics who told the truth about his doping.

On Friday, O’Reilly responded by saying that it was too late for apologies and called him a “little runt” on British television.

Emma O’Reilly, Lance Armstrong’s former masseuse, on British television on Friday.

As my colleague Juliet Macur reported, Andreu reacted with anger on CNN minutes after the conclusion of Thursday’s night’s broadcast of Armstrong’s interview with Oprah Winfrey.

Armstrong’s almost casual admission that he had, in fact, attempted to assassinate the characters of O’Reilly and Betsy Andreu were one of Thursday’s low points for some of his critics.

Two cyclists who admitted to doping during their careers but are leading a movement to reform the sport through better testing and a team committed to clean riding, Jonathan Vaughters and David Miller, responded to Armstrong’s confession in different ways. Vaughters called the admissions a good start, albeit one that Armstrong needed to back up by coming clean in real detail to the proper authorities.

Millar, who was in Spain working with antidoping authorities, pointed readers of his Twitter feed to a fierce destruction of Armstrong’s character by the ESPN writer Bonnie Ford.

The South African sports physiologists who run the Science of Sports blog drew attention to what they said was evidence that Armstrong lied to Winfrey about not doping during his aborted comeback to the sport in 2009.

Robert Mackey

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Media Decoder Blog: Tribune Company Names Peter Liguori as Chief After Ending Bankruptcy

Peter Liguori, a longtime television executive, was named the new chief executive of the Tribune Company on Thursday, two and a half weeks after the newspaper and television station owner emerged from a wrenching four-year bankruptcy process.

Mr. Liguori’s appointment had been expected for more than a month.

Analysts expect Tribune to sell some of its newspaper assets and rely more heavily on its television stations and Web sites as it restructures itself in the months ahead.

Tribune’s newspaper holdings include The Chicago Tribune, The Los Angeles Times and The Baltimore Sun. In an interview with The Los Angeles Times on Thursday, Mr. Liguori acknowledged that there were potential buyers for some of the newspapers and that “it is my fiduciary responsibility to hear them out and see if in fact their interest is real and their commitment is concomitant with the value of these newspapers.” But he also emphasized an internal goal to maximize revenue from the newspapers.

In an e-mail message to employees, Mr. Liguori brought up the television stations first, saying, “We must find efficient ways to create our own fresh programming.” When he brought up the newspapers, he said, “We must accelerate our digital offerings and get paid for them.”

Mr. Liguori is best known for his time at News Corporation, where he ran the popular cable channel FX and then became the chairman of entertainment for Fox Broadcasting. In 2009, he joined Discovery Communications as chief operating officer.

Eddy W. Hartenstein, Tribune’s previous chief executive, will remain the publisher of The Los Angeles Times and will be a special adviser to Mr. Liguori’s office, Tribune said Thursday.

The company also said Bruce Karsh, the president of the private equity firm Oaktree Capital Management, had been elected the chairman of Tribune’s new board. Oaktree owns nearly a quarter of Tribune. Mr. Karsh said in a statement: “The company is well-positioned across its markets and now has a strong balance sheet, significant liquidity and low debt, so there is a lot of opportunity ahead.”


This post has been revised to reflect the following correction:

Correction: January 18, 2013

Because of an editing error, an earlier version of this article misstated when The Los Angeles Times interview with Peter Liguori occurred. It was Thursday, not last week.

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Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

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Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

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Duke Researchers Develop a New Way to Compress Images


Using a new class of artificial materials, scientists at Duke University have designed a sensor that compresses images far more efficiently than existing technologies like JPEG.


The materials, called metamaterials, have exotic qualities that bend light, X-rays and radio waves in unusual ways.


While they are barely a decade old, they are fast falling in cost and are expected to become commercially available beginning within two years for a wide array of applications, including radio communications, security and automotive safety.


In 2006, the Duke researchers made headlines by demonstrating that an “invisibility cloak” could be created by bending the light that strikes a metamaterial.


The researchers, at the Center for Metamaterials and Integrated Plasmonics, reported Thursday in the journal Science that their scanning sensor captures both still and video images while simplifying compression by integrating it directly into the sensor array.


A cost advantage of the new technology is that it permits image compression to be performed directly by the sensor hardware, rather than by the specialized hardware and software in use today.


Although the cost of optical sensors has fallen rapidly, automobile manufacturers have been searching for alternatives to expensive laser radar, or Lidar, to provide sensors that work in a range of natural light conditions, including night, dust clouds and snowstorms.


The current generation of airport millimeter-wave security scanners has gained popularity because they do not rely on X-ray radiation and its attendant health risks.


But they require an elaborate mechanical arm that sweeps around a passenger standing in a scanning booth.


“The drawbacks are that it takes time and adds a lot of expense because of complicated mechanical rotors,” said the lead author of the Science paper, John Hunt, a graduate researcher at the Duke center. “We have been trying to replace the whole system with one that has no moving parts.”


Although the design of metamaterial sensors might offer high compression ratios, Mr. Hunt said the real advantage lay in the potential for reductions in size. For example, he noted, even the most advanced planes and boats today use a mechanically steered dish antenna for radar. This requires setting aside a large space to swivel the dish.


“Our system could potentially replace that with a flat sheet wrapped onto the side of the fuselage,” he said.


Another potential advantage is speed. Intellectual Ventures, established by the former Microsoft chief scientist Nathan Myhrvold, has started a company to develop communications antennas made from metamaterials.


The company, Kymeta, has said it will introduce an inexpensive high-speed satellite antenna as soon as the end of next year. Bill Gates, the Microsoft co-founder, is an investor.


Depending on the wavelength they are focused on, metamaterials are made with either printed circuit boards or semiconductors. The sensor elements can be laid out in a linear array or as a three-dimensional matrix.


If the elements are small enough, the materials can manipulate visible light; other researchers are exploring applications with both sound waves and seismic waves.


Metamaterials bend radiation more sharply than natural materials. One of their strangest qualities is the ability to create a structure with what scientists call a “negative refractive index” — a behavior of light and other forms of radiation that is not found when light waves pass through materials like glass or water. They can be aimed in many different directions, or used in parallel to increase bandwidth.


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The Lede Blog: Analysis of Armstrong’s Interview With Winfrey

The Lede rounded up online reaction to Lance Armstrong’s interview with Oprah Winfrey on Thursday night in real-time, with additional fact-checking and context provided by Juliet Macur, Sarah Lyall, Brian Stelter, David Carr and Robert Mackey. The second part of the interview is scheduled to be broadcast at 9 p.m. Eastern Time on Friday and will be streamed live on the Oprah Winfrey Network’s Web site.
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DealBook: Report Details Missteps in Trading at JPMorgan

Long seen as one of the most careful banks on Wall Street, JPMorgan Chase on Wednesday drew back a curtain on a rare breakdown, showing traders acting on their own and concealing losses while managers seemingly turned a blind eye.

In a 129-page internal report dissecting a bad bet on credit derivatives that cost the bank more than $6 billion, the bank confessed, in painstaking detail, to widespread “failures.”

Yet the report, written by a JPMorgan management task force, is not the final word on the trading blunder. Federal investigators are examining whether fraud was committed and are planning to use the report as a guide for pursuing their inquiries, say officials briefed on the matter.

The report describes traders making overly optimistic estimates of their losses, but stops short of claiming outright fraud. Showing that traders crossed a legal line presents a challenge for investigators. In some derivatives markets, traders are afforded flexibility to estimate the value of their positions.

But the F.B.I., suspecting that some employees intentionally hid the losses last year, is using taped phone conversations to build criminal cases against London-based traders involved in the debacle, according to the officials briefed on the matter. And the report could help that effort, the officials said. Authorities expect to interview one of the junior traders in the coming weeks, one official said.

Congress is exploring potential wrongdoing, as well. The Permanent Subcommittee on Investigations has taken testimony, people close to the inquiry said, from Jamie Dimon, the bank’s chief executive, and Ina R. Drew, the former leader of the chief investment office,where the trading losses occurred.

The subcommittee’s investigation has already complicated things for the bank. It is rare for a bank to expose its missteps so publicly, but JPMorgan knew that the subcommittee would have eventually received the document from regulators and made it public.

The regulators at the Office of the Comptroller of the Currency, the people close to the inquiry said, are required to turn over such documents under a subpoena they received from the subcommittee. So last fall, a person close to JP Morgan said, the bank decided to release the report on its own terms.

“This was getting out there anyway,” another person close to the situation said. This person and others interviewed for this article spoke on the condition of anonymity because the details of the case are not public.

Federal authorities responded positively to the internal report. One Congressional official privately told JPMorgan that the bank was wise to release such a detailed document, one person briefed on the matter said, while some regulators at the comptroller’s office praised it as an “important step” for corporate governance.

The report centered on a breakdown at the chief investment office in London, a group created to invest JPMorgan’s own money and offset potential losses across the bank’s disparate businesses.

JPMorgan’s troubles began in January 2012, when the investment office ignored the basic rules of trading. On a well-functioning Wall Street desk, traders are told to end a deeply vulnerable position early, even if it means sustaining some minor losses.

But under Ms. Drew, the report said, JPMorgan traders did the opposite. In response to adverse moves in the markets and regulatory changes, the group made a series of aggressive derivatives trades. As these bets began to sour, the London team increased their trades rather than exiting. The traders thought that reducing the assets was too costly, the report says.

Some questioned the strategy. By the end of January, one trader became deeply unnerved. In an e-mail to a more senior trader, he said the size of the trades were becoming “scary” and advised that the unit take the “full pain” now.

But the traders “continued to build the notional size of the positions through late March,” according to the report, which was led by Michael J. Cavanagh, the bank’s co-head of corporate and investment banking.

In an April e-mail, Mr. Dimon asked JPMorgan’s chief risk officer, John Hogan, why the chief investment office hadn’t simply cut some of its positions to reduce risk. The office, Mr. Hogan replied, indicated that adding positions was the “most ‘efficient’ way to do it.”

The report does not name the architects of the trade; British privacy laws prevented it from doing so. But they are known to be Javier Martin-Artajo, a manager who oversaw the trading strategy from the bank’s London offices; Bruno Iksil, the trader known as the London Whale for placing the outsize bet; and Achilles Macris, the executive in charge of the international chief investment office. None of the employees have been accused of any wrongdoing. They have all since departed the bank.

The JPMorgan report, while taking aim at the London office’s strategy, also exposes major gaps in oversight that allowed this headstrong team of traders to carry out their wager. Ms. Drew, who helped steer the bank through the financial crisis, received the brunt of the blame.

“Ina Drew failed in three critical areas,” the report said, pointing to lax controls and a failure to ensure that her team “understood and vetted” the trade.

The management missteps also ensnared Barry L. Zubrow, a former chief risk officer, and Douglas L. Braunstein, formerly the bank’s chief financial officer but now a vice chairman at the bank. While the report acknowledged that Mr. Dimon could “appropriately rely upon” senior managers who oversaw the trading strategy, it also concluded that he “could have better tested his reliance on what he was told.”

This slipshod culture magnified the impact of simple human errors across the bank. At one point, the mathematical mistakes of an employee in London prevented others in the bank from seeing the potential losses accumulating beneath the surface.

Still, the problems lurking in the investment office should have set off alarms for executives outside the office. The report reveals, however, that the bank dismantled its early-warning system.

The investment office’s alarm system, based on a computer model, showed risk limits were exceeded in late January, according to the report. Senior executives made a temporary exemption for the investment office, which was approved by Mr. Dimon and others. But then, the bank introduced a new model that underestimated the losses building in the investment office, and allowed the traders to fly below the bank’s internal risk radar.

The flawed model, the report says, was built by a London-based mathematician who also provided analysis to the investment office’s traders. It appears the employee, who built the model with a simple spreadsheet, was out of his depth. The model wasn’t properly back-tested and contained errors, the report said.

JPMorgan’s report raises the possibility that the investment office pressured the managers to approve the new model. The model-builder received an e-mail on Jan. 23 from the trader to whom he reported, saying that he should “keep the pressure on our friends” in a group that validated models.

The public disclosures by the bank also came under scrutiny in the report. Failure to properly report trading losses could make JPMorgan vulnerable to lawsuits from investors. The bank’s disclosures are the subject of the Congressional investigation and an inquiry from the Securities and Exchange Commission.

The problem stems in part from the London traders, who underestimated the size of their losses, a misstep that has drawn the scrutiny of the F.B.I. and federal prosecutors. The bank restated its first-quarter results to reflect that the traders may have masked their losses by $459 million.

“In the course of the task force’s ensuing work, it became aware of evidence — primarily in the form of electronic communications and taped conversations — that raised questions about the integrity of the marks,” the report said.

Still, obstacles remain for a criminal prosecution. Authorities planned to interview Mr. Macris in his native Greece, but the talks have broken down. Instead, officials said, they now expect to interview a lower-level employee.

Some people close to the investigation also note that traders have some leeway when marking the value of trades. And the internal report shows how JPMorgan, after consulting its auditor, PricewaterhouseCoopers, approved the investment office’s valuations of its trades.

The report highlighted an episode that, in theory, might have made JPMorgan think twice before initially signing off on the first-quarter results. An “internal audit group” identified deficiencies in the unit that double-checked its traders’ valuations, calling out the group last March with a simple concern: it “needs improvement.”

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Some With Autism Diagnosis Can Recover, Study Finds


Doctors have long believed that disabling autistic disorders last a lifetime, but a new study has found that some children who exhibit signature symptoms of the disorder recover completely.


The study, posted online on Wednesday by the Journal of Child Psychology and Psychiatry, is the largest to date of such extraordinary cases and is likely to alter the way that scientists and parents think and talk about autism, experts said.


Researchers on Wednesday cautioned against false hope. The findings suggest that the so-called autism spectrum contains a small but significant group who make big improvements in behavioral therapy for unknown, perhaps biological reasons, but that most children show much smaller gains. Doctors have no way to predict which children will do well.


Researchers have long known that between 1 and 20 percent of children given an autism diagnosis no longer qualify for one a few years or more later. They have suspected that in most cases the diagnosis was mistaken; the rate of autism diagnosis has ballooned over the past two decades, and some research suggests that it has been loosely applied.


The new study should put some of that skepticism to rest.


“This is the first solid science to address this question of possible recovery, and I think it has big implications,” said Sally Ozonoff of the MIND Institute at the University of California, Davis, who was not involved in the research. “I know many of us as would rather have had our tooth pulled than use the word ‘recover,’ it was so unscientific. Now we can use it, though I think we need to stress that it’s rare.”


She and other experts said the findings strongly supported the value of early diagnosis and treatment.


In the study, a team led by Deborah Fein of the University of Connecticut at Storrs recruited 34 people who had been diagnosed before the age of 5 and no longer had any symptoms. They ranged in age from 8 to 21 years old and early in their development were in the higher-than-average range of the autism spectrum. The team conducted extensive testing of its own, including interviews with parents in some cases, to gauge current social and communication skills.


The debate over whether recovery is possible has simmered for decades and peaked in 1987, when the pioneering autism researcher O. Ivar Lovaas reported that 47 percent of children with the diagnosis showed full recovery after undergoing a therapy he had devised. This therapy, a behavioral approach in which increments of learned skills garner small rewards, is the basis for the most effective approach used today; still, many were skeptical and questioned his definition of recovery.


Dr. Fein and her team used standardized, widely used measures and found no differences between the group of 34 formerly diagnosed people and a group of 34 matched control subjects who had never had a diagnosis.


“They no longer qualified for the diagnosis,” said Dr. Fein, whose co-authors include researchers from Queens University in Kingston, Ontario; Children’s Hospital of Philadelphia; the Institute of Living in Hartford; and the Child Mind Institute in New York. “I want to stress to parents that it’s a minority of kids who are able to do this, and no one should think they somehow missed the boat if they don’t get this outcome.”


On measures of social and communication skills, the recovered group scored significantly better than 44 peers who had a diagnosis of high-functioning autism or Asperger’s syndrome.


Dr. Fein emphasized the importance of behavioral therapy. “These people did not just grow out of their autism,” she said. “I have been treating children for 40 years and never seen improvements like this unless therapists and parents put in years of work.”


The team plans further research to learn more about those who are able to recover. No one knows which ingredients or therapies are most effective, if any, or if there are patterns of behavior or biological markers that predict such success.


“Some children who do well become quite independent as adults but have significant anxiety and depression and are sometimes suicidal,” said Dr. Fred Volkmar, the director of the Child Study Center at the Yale University School of Medicine. There are no studies of this group, he said.


That, because of the new study, is about to change.


Read More..

Some With Autism Diagnosis Can Recover, Study Finds


Doctors have long believed that disabling autistic disorders last a lifetime, but a new study has found that some children who exhibit signature symptoms of the disorder recover completely.


The study, posted online on Wednesday by the Journal of Child Psychology and Psychiatry, is the largest to date of such extraordinary cases and is likely to alter the way that scientists and parents think and talk about autism, experts said.


Researchers on Wednesday cautioned against false hope. The findings suggest that the so-called autism spectrum contains a small but significant group who make big improvements in behavioral therapy for unknown, perhaps biological reasons, but that most children show much smaller gains. Doctors have no way to predict which children will do well.


Researchers have long known that between 1 and 20 percent of children given an autism diagnosis no longer qualify for one a few years or more later. They have suspected that in most cases the diagnosis was mistaken; the rate of autism diagnosis has ballooned over the past two decades, and some research suggests that it has been loosely applied.


The new study should put some of that skepticism to rest.


“This is the first solid science to address this question of possible recovery, and I think it has big implications,” said Sally Ozonoff of the MIND Institute at the University of California, Davis, who was not involved in the research. “I know many of us as would rather have had our tooth pulled than use the word ‘recover,’ it was so unscientific. Now we can use it, though I think we need to stress that it’s rare.”


She and other experts said the findings strongly supported the value of early diagnosis and treatment.


In the study, a team led by Deborah Fein of the University of Connecticut at Storrs recruited 34 people who had been diagnosed before the age of 5 and no longer had any symptoms. They ranged in age from 8 to 21 years old and early in their development were in the higher-than-average range of the autism spectrum. The team conducted extensive testing of its own, including interviews with parents in some cases, to gauge current social and communication skills.


The debate over whether recovery is possible has simmered for decades and peaked in 1987, when the pioneering autism researcher O. Ivar Lovaas reported that 47 percent of children with the diagnosis showed full recovery after undergoing a therapy he had devised. This therapy, a behavioral approach in which increments of learned skills garner small rewards, is the basis for the most effective approach used today; still, many were skeptical and questioned his definition of recovery.


Dr. Fein and her team used standardized, widely used measures and found no differences between the group of 34 formerly diagnosed people and a group of 34 matched control subjects who had never had a diagnosis.


“They no longer qualified for the diagnosis,” said Dr. Fein, whose co-authors include researchers from Queens University in Kingston, Ontario; Children’s Hospital of Philadelphia; the Institute of Living in Hartford; and the Child Mind Institute in New York. “I want to stress to parents that it’s a minority of kids who are able to do this, and no one should think they somehow missed the boat if they don’t get this outcome.”


On measures of social and communication skills, the recovered group scored significantly better than 44 peers who had a diagnosis of high-functioning autism or Asperger’s syndrome.


Dr. Fein emphasized the importance of behavioral therapy. “These people did not just grow out of their autism,” she said. “I have been treating children for 40 years and never seen improvements like this unless therapists and parents put in years of work.”


The team plans further research to learn more about those who are able to recover. No one knows which ingredients or therapies are most effective, if any, or if there are patterns of behavior or biological markers that predict such success.


“Some children who do well become quite independent as adults but have significant anxiety and depression and are sometimes suicidal,” said Dr. Fred Volkmar, the director of the Child Study Center at the Yale University School of Medicine. There are no studies of this group, he said.


That, because of the new study, is about to change.


Read More..