Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

---

Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

---

This post has been revised to reflect the following correction:

Correction: February 14, 2013

An article on Tuesday about hearing loss and dementia misidentified the city in which the Medical College of Wisconsin is located. It is in Milwaukee, not in Madison.

Read More..

Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

---

Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

---

This post has been revised to reflect the following correction:

Correction: February 14, 2013

An article on Tuesday about hearing loss and dementia misidentified the city in which the Medical College of Wisconsin is located. It is in Milwaukee, not in Madison.

Read More..

In Japan, the Fax Machine Is Anything but a Relic

Kosuke Okahara for The New York Times

Yuichiro Sugahara, whose company delivers bento lunchboxes, mostly through fax orders.

TOKYO — Japan is renowned for its robots and bullet trains, and has some of the world’s fastest broadband networks. But it also remains firmly wedded to a pre-Internet technology — the fax machine — that in most other developed nations has joined answering machines, eight-tracks and cassette tapes in the dustbin of outmoded technologies.

Last year alone, Japanese households bought 1.7 million of the old-style fax machines, which print documents on slick, glossy paper spooled in the back. In the United States, the device has become such an artifact that the Smithsonian is adding two machines to its collection, technology historians said.

“The fax was such a success here that it has proven hard to replace,” said Kenichi Shibata, a manager at NTT Communications, which led development of the technology in the 1970s. “It has grown unusually deep roots into Japanese society.”

The Japanese government’s Cabinet Office said that almost 100 percent of business offices and 45 percent of private homes had a fax machine as of 2011.

Yuichiro Sugahara learned the hard way about his country’s deep attachment to the fax machine, which the nation popularized in the 1980s. A decade ago, he tried to modernize his family-run company, which delivers traditional bento lunchboxes, by taking orders online. Sales quickly plummeted.

Today, his company, Tamagoya, is thriving with the hiss and beep of thousands of orders pouring in every morning, most by fax, many with minutely detailed handwritten requests like “go light on the batter in the fried chicken” or “add an extra hard-boiled egg.”

“There is still something in Japanese culture that demands the warm, personal feelings that you get with a handwritten fax,” said Mr. Sugahara, 43.

Japan’s reluctance to give up its fax machines offers a revealing glimpse into an aging nation that can often seem quietly determined to stick to its tried-and-true ways, even if the rest of the world seems to be passing it rapidly by. The fax addiction helps explain why Japan, which once revolutionized consumer electronics with its hand-held calculators, Walkmans and, yes, fax machines, has become a latecomer in the digital age, and has allowed itself to fall behind nimbler competitors like South Korea and China.

“Japan has this Galápagos effect of holding on to some things they’re comfortable with,” said Jonathan Coopersmith, a technology historian who is writing a book on the machine’s rise and fall. “Elsewhere, the fax has gone the way of the dodo.”

In Japan, with the exception of the savviest Internet start-ups or internationally minded manufacturers, the fax remains an essential tool for doing business. Experts say government offices prefer faxes because they generate paperwork onto which bureaucrats can affix their stamps of approval, called hanko. Many companies say they still rely on faxes to create a paper trail of orders and shipments not left by ephemeral e-mail. Banks rely on faxes because, they say, customers are worried about the safety of their personal information on the Internet.

Even Japan’s largest yakuza crime syndicate, the Kobe-based Yamaguchi-gumi, has used faxes to send notifications of expulsion to members, the police say.

After the deadly earthquake and tsunami in northeastern Japan in 2011, there was a small boom in fax sales to replace machines that had been washed away. One of the hottest sellers is a model that is powered by batteries so it will keep working during power failures caused by natural disasters.

At Tamagoya, Mr. Sugahara has turned his company’s reliance on the fax and standard telephones into an art form. Every morning, orders for about 62,000 lunches pour in, about half by fax. Most of those lunches are cooked and put onto trucks even before the last order is taken. A small army of 100 fax and telephone operators carefully coordinate deliveries, and fewer than 60 lunches — or 0.1 percent — are wasted.

Hisako Ueno contributed reporting.

Read More..

India Ink: In India, Kisses Are on Rise, Even in Public

Manpreet Romana for The New York Times

A couple in a public park in New Delhi. Indians have long tended to view outward expressions of love with suspicion, but kissing is increasing.

NEW DELHI — India may be the birthplace of the Kama Sutra, the ancient how-to manual on kissing and sex. But for many years, Indian couples did not widely embrace kissing, at least not in public. Now that is changing.

The Mahabharata, an epic poem written 3,000 years ago, is believed to include the first written description of mouth-to-mouth kissing. But anthropological studies done over the past century in India and elsewhere in Asia showed that kissing was far from universal and even seen as improper by many societies, said Elaine Hatfield, a professor of psychology at the University of Hawaii.

Sanjay Srivastava, a professor of sociology at the Institute of Economic Growth at Delhi University, said: “Until recently, kissing was seen as Western and not an Indian thing to do. That has changed.”

In India, most marriages are still arranged, and the rate of sex before marriage is low, according to a government survey, so passionate kissing among the unmarried has long been discouraged. Many married couples refrained as well, at least in front of other people. But recent studies, backed by interviews with sociologists and psychiatrists in India, suggest that kissing’s popularity has risen considerably.

Chastity is viewed as highly desirable in India, and Indians, as a result, have also tended to view outward expressions of love, be they physical or verbal, with suspicion, said Dr. Roy Abraham Kallivayalil, president of the Indian Psychiatric Society.

“I don’t tell my wife that I love her,” Dr. Kallivayalil said. “My father has never in 88 years told me that he loved me. We don’t do that.”

A study led by James Witte, a professor of sociology at George Mason University in Virginia, reported that more than half of a set of volunteer respondents in India said they kissed at least several times a week. He solicited respondents through Internet portals, in English, but cautioned that his sample was not random. He said he reached people who were “well educated, younger and more urban” and who had access to the Internet.

In Professor Witte’s study, of the 112 respondents in the kissing module, 24.1 percent said they kissed passionately “many times a day,” but when asked about kissing, hugging or caressing in public, 41.1 percent of participants chose “hardly ever or not at all.”

A pivotal screen kiss reflected the changing romantic landscape here. Kissing scenes were banned by Indian film censors until the 1990s, and Shah Rukh Khan, a Bollywood heartthrob who is one of the world’s biggest movie stars, has been teasing Indian audiences in dozens of films since then by bringing his lips achingly close to those of his beautiful co-stars. But his lips never touched any of theirs until he kissed the Bollywood bombshell Katrina Kaif in “Jab Tak Hai Jaan,” which was released in December 2012.

Mr. Khan tried to soften the impact by saying in a published interview that his director made him do it. But the cultural Rubicon had been crossed.

“That kiss was an incredibly important moment,” Dr. Srivastava said. “Shah Rukh Khan defines what is mainstream. If he does it, it becomes acceptable.”

Kissing’s rise here may also reflect the growing power of young women in deciding who to marry, said Debra Lieberman, an assistant professor of evolutionary psychology at the University of Miami. In many cases, “women are now able to select mates without having to negotiate as much with family members,” Dr. Lieberman said.

And Dr. Avdesh Sharma, a psychiatrist practicing in New Delhi, said that his younger female patients are far more insistent than their mothers were that their emotional needs be met. That often involves kissing, he said.

“The terms and timing of intimacy used to be initiated and decided entirely by the man,” Dr. Sharma said. “That is no longer true.”

Indeed, while arranged marriages are still the norm in India, a growing share of young couples say that their views play a role in the process. If a young woman does not like the man her parents have picked, many families now offer her a veto.

Shreeya Sinha contributed reporting from New York.

Read More..

Media Decoder Blog: Comcast Buys Rest of NBC in Early Sale

8:53 p.m. | Updated Comcast gave NBCUniversal a $16.7 billion vote of confidence on Tuesday, agreeing to pay that sum to acquire General Electric’s remaining 49 percent stake in the entertainment company. The deal accelerated a sales process that was expected to take several more years.

Brian Roberts, chief executive of Comcast, said the acquisition, which will be completed by the end of March, underscored a commitment to NBCUniversal and its highly profitable cable channels, expanding theme parks and the resurgent NBC broadcast network.

“We always thought it was a strong possibility that we’d some day own 100 percent,” Mr. Roberts said in a telephone interview.

He added that the rapidly changing television business and the growing necessity of owning content as well as the delivery systems sped up the decision. “It’s been a very smooth couple of years, and the content continues to get more valuable with new revenue streams,” he said.

Comcast also said that NBCUniversal would buy the NBC studios and offices at 30 Rockefeller Center, as well as the CNBC headquarters in Englewood Cliffs, N.J. Those transactions will cost about $1.4 billion.

Mr. Roberts called the 30 Rockefeller Center offices “iconic” and said it would have been “expensive to replicate” studios elsewhere for the “Today” show, “Saturday Night Live,” “Late Night With Jimmy Fallon” and other programs produced there. “We’re proud to be associated with it,” Mr. Roberts said of the building.

With the office space comes naming rights for the building, according to a General Electric spokeswoman. So it is possible that one of New York’s most famous landmarks, with its giant red G.E. sign, could soon be displaying a Comcast sign instead.

When asked about a possible logo swap on the building, owned by Tishman Speyer, Mr. Roberts told CNBC, that is “not something we’re focused on talking about today.” Nevertheless, the sale was visible in a prominent way Tuesday night: the G.E. letters, which have adorned the top of 30 Rock for several decades, were no longer illuminated.

Comcast, with a conservative, low-profile culture, had clashed with the G.E. approach, according to employees and executives in television. Comcast moved NBCUniversal’s executive offices from the 52nd floor to the 51st floor — less opulent space that features smaller executive offices and a cozy communal coffee room instead of General Electric’s lavish executive dining room.

Comcast took control of NBCUniversal in early 2011 by acquiring 51 percent of the media company from General Electric. The structure of the deal gave Comcast the option of buying out G.E. in a three-and-a-half to seven-year time frame. In part because of the clash in corporate cultures, television executives said, both sides were eager to accelerate the sale.

Price was also a factor. Mr. Roberts said he believed the stake would have cost more had Comcast waited. Also, he pointed to the company’s strong fourth-quarter earnings to be released late Tuesday afternoon, which put it in a strong position to complete the sale.

Comcast reported a near record-breaking year with $20 billion in operating cash flow in the fiscal year 2012. In the three months that ended Dec. 31, Comcast’s cash flow increased 7.3 percent to $5.3 billion. Revenue at NBCUniversal grew 4.8 percent to $6 billion.

“We’ve had two years to make the transition and to make the investments that we believe will continue to take off,” Mr. Roberts said.

The transactions with General Electric will be largely financed with $11.4 billion of cash on hand, $4 billion of subsidiary senior unsecured notes to be issued to G.E. and a $2 billion in borrowings.

Even with the investment in NBCUniversal, Comcast said it would increase its dividend by 20 percent to 78 cents a share and buy back $2 billion in stock in 2013.

When it acquired the 51 percent stake two years ago, Comcast committed to paying about $6.5 billion in cash and contributed all of its cable channels, including E! and some regional sports networks, to the newly established NBCUniversal joint venture. Those channels were valued at $7.25 billion.

The transaction made Comcast, the single biggest cable provider in the United States, one of the biggest owners of cable channels, too. NBCUniversal operates the NBC broadcast network, 10 local NBC stations, USA, Bravo, Syfy, E!, MSNBC, CNBC, the NBC Sports Network, Telemundo, Universal Pictures, Universal Studios, and a long list of other media brands.

Mr. Roberts and Michael J. Angelakis, vice chairman and chief financial officer for the Comcast Corporation, led the negotiations that began last year with Jeffrey R. Immelt, chief executive of General Electric, and Keith Sharon, the company’s chief financial officer. JPMorgan Chase, Goldman Sachs, Centerview Partners and CBRE provided financial and strategic advice.

The sale ends a long relationship between General Electric and NBC that goes back before the founding days of television. In 1926, the Radio Corporation of America created the NBC network. General Electric owned R.C.A. until 1930. It regained control of R.C.A., including NBC, in 1986, in a deal worth $6.4 billion at the time.

In a slide show on the company’s “GE Reports” Web site titled “It’s a Wrap: GE, NBC Part Ways, Together They’ve Changed History,” G.E. said the deal with Comcast “caps a historic, centurylong journey for the two companies that gave birth to modern home entertainment.”

Mr. Immelt has said that NBCUniversal did not mesh with G.E.’s core industrial businesses. That became even more apparent when the company became a minority stakeholder with no control over how the business was run, according to a person briefed on G.E.’s thinking who could not discuss private conversations publicly.

“By adding significant new capital to our balanced capital allocation plan, we can accelerate our share buyback plans while investing in growth in our core businesses,” Mr. Immelt said in a statement. He added: “For nearly 30 years, NBC — and later NBCUniversal — has been a great business for G.E. and our investors.”

Read More..

Prostate Cancer Study Suggests Shorter Treatments

Men with high-risk prostate cancer treated with only 18 months of hormone therapy live just as long as those treated for a more standard 36 months, a new study has found.

If the study results are applied in practice, it could mean much shorter treatment, sparing men months of unpleasant side effects, researchers said Tuesday.

“This may well change the standard of care,” said Dr. Bruce J. Roth, a prostate cancer specialist at Washington University in St. Louis. “Three years of hormonal therapy was almost picked randomly, and there’s nothing magical about that duration.”

Dr. Roth was not involved in the study, but he moderated a news conference for the Genitourinary Cancers Symposium, which will take place starting Thursday in Orlando, Fla., and is where the results will be presented.

Hormone therapy is essentially chemical castration, in which drugs are used to block the body’s production of testosterone, which fuels prostate tumor growth.

The side effects, including hot flashes, loss of sexual desire, fatigue and the weakening of bones and muscles, make life “quite miserable,” said Dr. Abdenour Nabid of Sherbrooke University Hospital Center in Sherbrooke, Quebec, who was the lead investigator.

The study involved 630 patients with localized but high-risk prostate cancer who were treated with radiation therapy and hormone therapy. While that description fits only a small portion of the 240,000 new cases of prostate cancer diagnosed each year in the United States, the results would still apply to thousands of men, researchers said.

After a median follow-up of about six and a half years, 77.1 percent of the men who received 36 months of therapy were still alive, as were 76.2 percent of the men treated for 18 months.

While slightly more men receiving the longer treatment were alive at five years, the difference was not statistically significant, and for the patients already followed for 10 years, the survival rates were similar. The death rate specifically from prostate cancer was also the same after 10 years.

There were also no statistically significant differences in the rate of biochemical failure — when the P.S.A. marker rises — or in the spread of cancer to the bone, Dr. Nabid said. The difference between the two therapy durations on the quality of the patients’ lives is still being studied.

Dr. David I. Quinn, medical director of the University of Southern California Norris Cancer Hospital, said the results “will change the approach for men who’ve got the worst localized prostate cancer that we see.” He said the results went against some previous studies that suggested that “more is better.”

But Dr. Michael J. Morris, associate professor at the Memorial Sloan-Kettering Cancer Center, said that 630 patients might be too few to draw “a relatively sweeping conclusion.” A study meant to prove that two treatments are equivalent may need to be much larger, he said.

Dr. Matthew R. Smith, professor of medicine at Massachusetts General Hospital, said it might be “overreaching” to make a conclusion yet because not many trial patients had died. “I think we need longer follow-up,” he said.

Dr. Nabid, the principal investigator, said that patients would be followed for two or three more years but that he was confident the results would hold up.

The trial enrolled patients at 10 hospitals in Quebec from October 2000 to January 2008. The drugs used were bicalutamide and goserelin, sold by AstraZeneca as Casodex and Zoladex, respectively, but now subject to generic competition. AstraZeneca paid for the study.

Read More..

Prostate Cancer Study Suggests Shorter Treatments

Men with high-risk prostate cancer treated with only 18 months of hormone therapy live just as long as those treated for a more standard 36 months, a new study has found.

If the study results are applied in practice, it could mean much shorter treatment, sparing men months of unpleasant side effects, researchers said Tuesday.

“This may well change the standard of care,” said Dr. Bruce J. Roth, a prostate cancer specialist at Washington University in St. Louis. “Three years of hormonal therapy was almost picked randomly, and there’s nothing magical about that duration.”

Dr. Roth was not involved in the study, but he moderated a news conference for the Genitourinary Cancers Symposium, which will take place starting Thursday in Orlando, Fla., and is where the results will be presented.

Hormone therapy is essentially chemical castration, in which drugs are used to block the body’s production of testosterone, which fuels prostate tumor growth.

The side effects, including hot flashes, loss of sexual desire, fatigue and the weakening of bones and muscles, make life “quite miserable,” said Dr. Abdenour Nabid of Sherbrooke University Hospital Center in Sherbrooke, Quebec, who was the lead investigator.

The study involved 630 patients with localized but high-risk prostate cancer who were treated with radiation therapy and hormone therapy. While that description fits only a small portion of the 240,000 new cases of prostate cancer diagnosed each year in the United States, the results would still apply to thousands of men, researchers said.

After a median follow-up of about six and a half years, 77.1 percent of the men who received 36 months of therapy were still alive, as were 76.2 percent of the men treated for 18 months.

While slightly more men receiving the longer treatment were alive at five years, the difference was not statistically significant, and for the patients already followed for 10 years, the survival rates were similar. The death rate specifically from prostate cancer was also the same after 10 years.

There were also no statistically significant differences in the rate of biochemical failure — when the P.S.A. marker rises — or in the spread of cancer to the bone, Dr. Nabid said. The difference between the two therapy durations on the quality of the patients’ lives is still being studied.

Dr. David I. Quinn, medical director of the University of Southern California Norris Cancer Hospital, said the results “will change the approach for men who’ve got the worst localized prostate cancer that we see.” He said the results went against some previous studies that suggested that “more is better.”

But Dr. Michael J. Morris, associate professor at the Memorial Sloan-Kettering Cancer Center, said that 630 patients might be too few to draw “a relatively sweeping conclusion.” A study meant to prove that two treatments are equivalent may need to be much larger, he said.

Dr. Matthew R. Smith, professor of medicine at Massachusetts General Hospital, said it might be “overreaching” to make a conclusion yet because not many trial patients had died. “I think we need longer follow-up,” he said.

Dr. Nabid, the principal investigator, said that patients would be followed for two or three more years but that he was confident the results would hold up.

The trial enrolled patients at 10 hospitals in Quebec from October 2000 to January 2008. The drugs used were bicalutamide and goserelin, sold by AstraZeneca as Casodex and Zoladex, respectively, but now subject to generic competition. AstraZeneca paid for the study.

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Advertising: Small Rival Music Service Takes Aim at Pandora

ONE of advertising’s great (or at least most amusing) traditions is the challenger attack ad, in which a field’s No. 2 (or No. 3) player tries to distinguish itself by taking aim at the leader. When artfully done it can have a great effect, as in Avis’s long-running “We try harder” campaign against Hertz, or Samsung’s recent ads mocking the obedience of iPhone fans.

The latest example is in digital music services, with Pandora as the Goliath and its much smaller competitor Slacker in the role of David with the 30-second sling.

In an online-only spot that will start running Wednesday, a young woman at a coffee shop vexes everyone in earshot when she opens a blue “Pandora’s box” — labeled “P,” like Pandora’s app icon — and unleashes a singularly annoying song.

“It plays that over and over again,” the woman complains to a friend, who blames Pandora’s “small music library” for the repetition. With Slacker helpfully loaded on her phone, the friend points out that Slacker has 10 times as many songs, and other features, too.

Like Pandora, Slacker offers free, ad-supported Internet radio and has two tiers of premium service. Listeners can eliminate ads for a $4 monthly subscription, and $10 a month also adds features that — like Spotify and other “on-demand” services — let users play any song they choose.

Since its founding in 2006, however, Slacker has struggled to stand out. With four million monthly users, 560,000 of them paying, its audience is a fraction of Pandora’s, which is more than 65 million a month; Clear Channel Communications has nearly 50 million online listeners through its station sites and iHeartRadio app.

To promote itself among such formidable competition — and to introduce a revamped version of its site — Slacker wants to show that it tries harder.

“We had to be very honest with where we were in the marketplace,” said Craig Rechenmacher, Slacker’s chief marketing officer. “We had to be disruptive in the marketplace, and we needed something that targets our competitors and the holes in their service.”

Slacker will spend $5.5 million on media placements this year, Mr. Rechenmacher said. In addition to the video spot, by Liquid Advertising, the campaign will include display ads by the agency Questus, and they will run on music and pop-culture sites like YouTube, Vevo, Brooklyn Vegan and College Humor.

The ads show off what Slacker says is its human touch, with playlists created by music experts and stations featuring D.J.’s and commentators. Pandora caters to listeners’ tastes through a secret algorithm that analyzes each song’s musical “genome.” (Others, like Songza, have grown quickly through expert programming, but Pandora is the field’s leader by far.)

“When we did research on our core users, what they love the most, what came back was the idea that it felt like somebody was home,” said Jack Isquith, Slacker’s senior vice president of strategic development. “There was someone who loves music at the controls.”

The campaign is also evidence of a slow change in the marketing of digital music services, many of which have avoided advertising in favor of online word-of-mouth (and, of course, lots of free music). Pandora, for example, is often featured in commercials by its partners, like car companies, but has made none of its own.

“It costs a lot of money to build a brand if you didn’t hit it luckily through viral channels, like Pandora did,” said David Hyman, the former chief executive of the music service Mog, which was sold last year to Beats Electronics.

The biggest force in promoting digital music over the years, music executives say, was Apple’s iTunes and iPod commercials. Rhapsody, too, has run dozens of television ads, including a memorable one with Jay-Z in 2009.

For the most part the recent wave of streaming services has not been heavily advertised, but that is changing as the field grows more competitive. Last year, Rdio, a subscription service, did a multimillion-dollar campaign that included billboards in Times Square. Spotify, which has grown quickly but has not fully penetrated the mainstream market, recently hired its first agency of record, Droga5 — the former agency of Rhapsody.

For its campaign, Slacker wanted to focus on how digital services serve consumers. In the coffee shop video, the patrons align with the demographics of the service — 18 to 44 years old, and slightly more females than males, said Will Akerlof, the chief executive of Liquid Advertising — and visibly express their reactions to the music playing.

To find a sufficiently irritating soundtrack, the agency looked at a 2007 Rolling Stone magazine feature, “The 20 Most Annoying Songs,” Mr. Akerlof said, and recorded a techno-pop version of the folk song “Cotton-Eyed Joe,” in the style of Rednex’s version from the mid-1990s (No. 13 on the list).

That lighthearted approach, with a focus on the consumer, has been missing from many digital-music ads, Mr. Isquith said.

“The approaches of many of the people in the space has been, ‘Hey, we’re standing next to big stars,’ or, ‘Hey, we’ve got the slickest, most cutting-edge tech product,’ but that’s not why people use it,” he said.

“Our ads,” Mr. Isquith added, “are meant to say that this is a great listener experience that will delight you.”

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India Ink: Silicon Valley and Immigrant Groups Find Common Cause

SAN FRANCISCO — What do computer programmers and illegal immigrants have to do with each other?

When it comes to the sweeping overhaul of the nation’s immigration laws that Congress is considering this year, the answer is everything.

Silicon Valley executives, who have long pressed the government to provide more visas for foreign-born math and science brains, are joining forces with an array of immigration groups seeking comprehensive changes in the law. And as momentum builds in Washington for a broad revamping, the tech industry has more hope than ever that it will finally achieve its goal: the expanded access to visas that it says is critical to its own continued growth and that of the economy as a whole.

Signs of the industry’s stepped-up engagement on the issue are visible everywhere. Prominent executives met with President Obama last week. Start-up founders who rarely abandon their computers have flown across the country to meet with lawmakers.

This Tuesday, the Technology CEO Council, an advocacy organization representing companies like Dell, Intel and Motorola, had meetings on Capitol Hill. On Wednesday, Steve Case, a founder of AOL, is scheduled to testify at the first Senate hearing this year on immigration legislation, alongside the head of the deportation agents’ union and the leader of a Latino civil rights group.

“The odds of high-skilled passing without comprehensive is close to zero, and the odds of comprehensive passing without high-skilled passing is close to zero,” said Robert D. Atkinson, president of the Information Technology and Innovation Foundation, a nonpartisan research group based in Washington.

The push comes as a clutch of powerful Senate Republicans and Democrats have reached a long-elusive agreement on some basic principles of a “comprehensive” revamping of immigration law. Separately, a bipartisan bill introduced in the Senate in late January focuses directly on the visa issue.

The industry’s argument for more so-called high-skilled visas has already persuaded the president.

“Real reform means fixing the legal immigration system to cut waiting periods, reduce bureaucracy, and attract the highly-skilled entrepreneurs and engineers that will help create jobs and grow our economy,” Mr. Obama said in Tuesday’s State of the Union speech.

In a speech in Las Vegas in January in which he introduced his own blueprint for overhauling immigration law, Mr. Obama embraced the idea that granting more visas was essential to maintaining innovation and job growth. He talked about foreigners studying at American universities, figuring out how to turn their ideas into businesses.

In part, the new alliance between the tech industry and immigration groups was born out of the 2012 elections and the rising influence of Hispanic voters.

“The world has changed since the election,” said Peter J. Muller, director of government relations at Intel, pointing out that the defeat of many Republican candidates had led to a softening of the party’s position on broad changes to immigration law. “There is a focus on comprehensive. We’re thrilled by it.”

“At this point,” he added, “our best hope for immigration reform lies with comprehensive reform.”

Mr. Case, the AOL co-founder, who now runs an investment fund, echoed that sentiment after meeting with the president last Tuesday.

“I look forward to doing whatever I can to help pass comprehensive immigration reform in the months ahead,” he said, “and ensure it includes strong provisions regarding high-skilled immigration, so we are positioned to win the global battle for talent.”

That sort of sentiment delights immigrants’ rights advocates who have banged their heads against the wall for years to rally a majority of Congress around their agenda.

“The stars are aligning here,” said Ali Noorani, executive director of the National Immigration Forum. “You’ve got the politics of immigration reform changing. You’ve got tech leaders leaning in not just for high-skilled but for broader immigration reform.”

Senator Orrin G. Hatch, Republican of Utah, who is co-sponsoring the bill to increase the number of visas available for highly skilled immigrants, said the cooperation went both ways.

“All the talk about the STEM field — science, technology, engineering, mathematics — has awakened even those who aren’t all that interested in the high-tech world,” he said.

While the growing momentum has surprised many in Washington, comprehensive change is still not a sure thing, especially in the Republican-controlled House.

Mr. Hatch said he would push forward with his measure even if the broader efforts foundered. But his Democratic co-sponsor, Amy Klobuchar of Minnesota, said she would press for the bill to be part of the comprehensive package.

Last year, technology executives had a taste of what could happen with stand-alone legislation.

In November the House passed a bill, sponsored by Representative Lamar S. Smith, Republican of Texas, that would have provided 55,000 visas for foreigners graduating from American universities with advanced degrees in STEM fields. Mr. Smith, then the chairman of the House Judiciary Committee, brought considerable clout, and the tech industry rallied behind the bill.

But the legislation died in the Senate, because Democrats wanted any technology-specific measure to be part of a broader bargain that would include more visas for family members.

In pressing its case, the industry has used some vivid examples to sway lawmakers, arguing that if skilled workers cannot get visas, tech companies will simply move the jobs overseas.

Facebook was the latest to make this case. It said it had to place nearly 80 engineers in its office in Dublin in 2011 because it could not obtain even temporary work visas to employ them at the company’s headquarters in Menlo Park, Calif. Those temporary visas, called H-1B visas, are capped at 60,000 a year and usually run out within a couple of months. The bill proposed by Mr. Hatch and Ms. Klobuchar would more than double that number.

Microsoft has also argued that the visa backlog takes jobs out of the United States, saying it was forced to open a development office in Vancouver.

Hundreds of thousands of foreigners, the largest share from India and China, come to American universities every year to study science and engineering. But it can take so long for them to get permanent residency that many end up returning home. Mr. Hatch said he was keen to see foreign-born graduates of American universities remain in this country rather than work for competitive firms elsewhere.

“China, India — they would love to have these Ph.D.’s return to their countries,” he said. “They see the benefits. Why can’t we?”

There is no dearth of jobs in Silicon Valley. Employment in San Francisco and its southern suburbs grew about 3.6 percent in 2012, twice the growth rate nationally, according to a study released last week by Joint Venture Silicon Valley, a nonpartisan research organization.

But many of those jobs are filled by foreigners. In San Mateo and Santa Clara Counties, nearly two-thirds of those employed in science- and engineering-related jobs were born abroad, compared with about one-fourth nationwide, according to the study.

Industry executives hope to employ many more.

“The issue has truly ripened,” said Bruce Mehlman, a veteran Washington lobbyist and executive director of the Technology CEO Council. “Levels of optimism are higher than they’ve been in a while.”

Julia Preston contributed reporting from New York.

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DealBook: S.E.C. Nominee Mary Jo White Discloses Law Firm Wealth

It is no secret that the partners at the white-shoe law firms Debevoise & Plimpton and Cravath, Swaine & Moore earn a decent living. The financial disclosure form of Mary Jo White, the Obama administration’s pick to become the next chairwoman of the Securities and Exchange Commission, reveals just how decent.

Ms. White and her husband, John White, have amassed at least $16 million, according to the filing. Ms. White, 65, heads the litigation department at Debevoise; Mr. White, 65, is co-chairman of the corporate governance practice at Cravath.

As part of her disclosures, Ms. White also explained how she would deal with potential conflicts of interest. In a surprise move, she wrote that her husband would convert his partnership at Cravath from equity to nonequity status.

While many large corporate law firms have nonequity partners, meaning they hold the title of partner but have no ownership stake, each of Cravath’s 87 partners has equity in the firm. As a nonequity partner, Mr. White will receive a fixed salary and an annual performance bonus, according to the filing.

Ms. White also said that, for the time she serves as the S.E.C.’s chairwoman, Mr. White would not communicate with the commission on behalf of Cravath or any client in connection with rules proposed by the S.E.C. Such a restriction is not immaterial for Cravath, as Mr. White has vast experience in securities law and deep connections to the S.E.C., having served as the director of the commission’s corporation finance unit from 2006 to 2008.

The disclosure form contained a number of other revelations. Mr. White has investments in three hedge funds, including a vehicle managed by Och-Ziff, a large publicly traded investment firm started by a former Goldman Sachs partner. He will divest his interest in all three funds upon her confirmation, according to the filing.

The couple also owns 40 acres of farmland and unsold crops in Pocahontas County, Iowa, that are valued at $100,000 to $250,000.

As for Ms. White, a former United States attorney in Manhattan, she received more than $2.4 million as a Debevoise partner last year, according to the filing. And she said that she planned to retire as a Debevoise partner upon becoming S.E.C. chairwoman, at which point she would enjoy the benefits of the firm’s lucrative retirement plan. The disclosure says that Ms. White will receive a monthly lifetime retirement payment of $42,500, amounting to $510,000 annually.

However, instead of making a monthly retirement payment for the next four years while she runs the commission, Debevoise will make a lump-sum payment within 60 days of her appointment, the filing disclosed.

The Whites’ net worth is most likely far greater than $16 million, which represents the low number in a range of possible amounts. Government officials are required to disclose their net worth only within broad ranges.

For instance, the Whites own seven different investments — including a Vanguard high yield bond fund and a Vanguard emerging markets fund — worth $1 million to $5 million. At the low end, those seven funds would be worth $7 million; but at the high end, they would be valued at $35 million.

Ms. White also said that she would avoid some matters for a period of time that involve her former clients, a list that includes JPMorgan Chase, Microsoft and UBS.

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