Netflix Gambles on Big Data to Become the HBO of Streaming

Reed Hastings has a dream. Actually, it’s more of an obsession. The Netflix CEO wants his streaming video service to become the next HBO, but without the hassle of a cable subscription. It’s a bold plan, and if Netflix can pull it off, it’ll change the way you watch TV.

Netflix is gunning for the HBO original-content legacy. Its first exclusive series, Lillyhammer, debuted in January 2012. Critically acclaimed sitcom Arrested Development is being resurrected for an exclusive run on Netflix. Plus the first episode of the Kevin Spacey vehicle House of Cards will be directed by David Fincher.

All of this is big news for a company that started off by shipping DVDs to customers too lazy to return rentals to brick-and-mortar stores before incurring late fess. Netflix doesn’t just want to compete head-to-head with the established television networks with exclusive content. It wants to do it by using something that traditional networks don’t have: Access to your viewing habits and preferences. It knows who watches what and it’s making huge bets that their algorithm will help it determine which shows will be hits.

Plus, by delivering an entire season at once, the company would be putting all the power in the hands of viewers and could destroy “Event TV.”

But, securing original and exclusive content is a far cry from stuffing envelopes or making sure its network can handle weekend streaming traffic. Still, Netflix believes that it needs original content to keep ahead of streaming video challenges from Amazon, Vudu and even HBO GO. It wants to be the first real network of the Internet.

It better move quick.

Netflix accounts for 33 percent of peak streaming downloads, according to network traffic tracker Sandvine Inc. Its closest competitor, Amazon, accounts for 1.8 percent. That’s a comfortable lead, but even Hastings realizes the company must differentiate itself and keep ahead of the pack.

“If we do our job right, there’s always a reason to be a Netflix member on the original side in addition to the license side,” Hastings told reporters during the third quarter earnings call.

To get people excited about its original content, Netflix needs a hit, and its process of mining for gold is different from traditional networks. Shows like the Walking Dead are hits out of the gate, while others, like X Files, gained viewers as the show matured. Netflix, like all networks, wants a string of hits. But instead of generating a ton of content and hoping something resonates with viewers, it is using its vast data set of 29 million subscribers’ viewer habits and preferences.

While networks traditionally order a show based on whether it likes a pilot, Netflix ordered two full seasons (26 episodes) of House of Cards without seeing a single scene. It reportedly bid more than $100 million to secure first rights to the show, outbidding HBO and AMC because it is utterly convinced the show will be a big hit.

Why? Because it is counting on data mining and algorithms to provide an edge. The company knows how many people are watching Kevin Spacey and David Fincher movies and it knows how many viewers watch political thrillers. If that audience is large enough, getting exclusive access to House of Cards makes sense.

“We know what people watch on Netflix and we’re able with a high degree of confidence to understand how big a likely audience is for a given show based on people’s viewing habits,” company communications boss Jonathan Friedland said. “We want to continue to have something for everybody. But as time goes on, we get better at selecting what that something for everybody is that gets high engagement.”

Pages: 1 2 View All

Read More..

R&B star Mary J. Blige sued for defaulting on $2.2 million loan

(Reuters) – R&B star Mary J. Blige was hit with a lawsuit on Wednesday alleging the Grammy winner and her husband defaulted on a $ 2.2 million bank loan.

According to court documents filed in New York State Supreme Court in Manhattan, Signature Bank is seeking to recoup the original loan plus $ 58,000 in interest.

Blige, 41, who has sold more than 50 million albums worldwide, and her husband Martin Isaacs took out the loan in October 2011 and defaulted in July 2012, the suit alleges.

Blige’s publicist declined comment on the lawsuit. The singer’s attorney did not immediately return a request to comment.

The lawsuit also names Blige’s production company, Mary Jane Productions Inc.

The lawsuit is the latest financial headache for the New York City native. The “Family Affair” singer’s charity, The Mary J. Blige and Steve Stoute Foundation for the Advancement of Women Now Inc, was accused earlier in this year of mishandling funds and cheating scholarship students.

Blige acknowledged the problems in a June interview.

“The lives of young women are at stake,” the singer told Reuters when asked about the allegations. “I feel what they feel. I don’t want them to suffer. I promised them something and I’m gonna deliver. Period.”

(Reporting by Eric Kelsey, editing by Jill Serjeant and Todd Eastham)

Music News Headlines – Yahoo! News

Read More..

The New Old Age Blog: New Help for Hoarders

There were times, Sandra Stark remembers, when she couldn’t use her kitchen or sit on her sofa. Her collections — figurines, vases, paperweights — had overtaken every closet, drawer and surface. Stacks of clothing and old magazines added to the clutter.

Her daughters came in and threw everything away — to Ms. Stark’s horror — but a year later her home was again barely navigable. “I couldn’t throw out my garbage,” she said. “I put it in plastic bags, but I couldn’t take it out.”

A drop-in support group sponsored by the Mental Health Association of San Francisco helped her begin to control her hoarding behavior, and she has made considerable headway. “My bedroom is still a work in progress,” said Ms. Stark, 67. “But I can cook again.”

She has become a trained peer responder who works with others with this disorder. Many of the Mental Health Association’s clients are older adults: A woman in her 70s occupies one small room because the rest of her spacious house — leaking and mildewed — is filled with stuff she can’t discard. An 87-year-old, a compulsive thrift-store shopper, faces eviction because the city health department says she has created a safety hazard. “I’ll say, ‘Of these dozen black leather coats, pick two,’” Ms. Stark said, mapping her strategy to help keep the woman in her home.

Researchers are not sure if hoarding intensifies with age, but the problems it creates certainly do. “The older you get, the more stuff you’ve been able to accumulate,” said Randy Frost, co-author of the book “Stuff” and a Smith College psychologist. “And older people are less physically able to deal with it.” They are more prone to falls as they try to maneuver between piles of possessions and in a crisis, emergency crews may have trouble even entering their dwellings.

When I last wrote about hoarding almost three years ago (uncorking a wave of readers’ lamentation), I couldn’t offer much in the way of help except to steer people to the OCD Foundation. Though hoarding may not be a form of obsessive-compulsive disorder, its site remains useful.

At the time, experts knew what didn’t solve the problem, namely psychoactive drugs or “dumpster therapy,” in which well-meaning friends or family toss hoarders’ possessions, in a temporary fix that doesn’t change their behavior. But researchers were only starting to figure out what did work.

“This is an area in which there haven’t been a lot of answers,” said Eduardo Vega, executive director of the Mental Health Association of San Francisco. Now, “there’s a lot more hope and good will.”

Across the country, for example, cities, counties and states have formed about 80 hoarding task forces so that housing and health departments, senior service agencies, law enforcement and emergency units can coordinate their responses.

On the mental health front, the revised Diagnostic and Statistical Manual V is scheduled for publication in the spring, and many expect it will recognize hoarding as a distinct disorder with diagnostic criteria and a numeric code. That will make psychologists and other professionals more aware of the problem and, Mr. Vega said, “it will be easier to get insurers and providers to pay for treatment.”

Increasingly, there is treatment. Researchers have published studies showing that cognitive behavioral therapy can help, by encouraging people to reevaluate their attachment to possessions and supporting their decisions to start discarding.

Among patients in therapy groups, Dr. Frost has shown, 70 to 80 percent showed some improvement, he said. “That doesn’t mean they’re freed of symptoms, but their lives are improved and the behavior significantly reduced.”

Questions remain; several published studies use small samples that are heavily comprised of females, though hoarding may be more common among men. It is not clear, Dr. Frost said, whether cognitive therapy is as effective among older adults. And it is easier to find an individual therapist or a group in major cities than elsewhere. (Here’s a locator.)

But Dr. Frost and his co-authors have published a workbook called “Buried in Treasures,” along with a free facilitator’s guide, that allows people with hoarding disorders to form their own 15-session action workshops, led by peers rather than professionals. That approach, too, has brought measurable improvement (when used in groups, not individually), a study shows. “Here’s a way people can start working on this on their own,” Dr. Frost said.

Diagnostic criteria, treatment centers, workbooks, published research — all this is more than mental health professionals could offer years back. Still, compulsive hoarding remains a stubborn problem, a safety risk for older people and a heartache for their families.

“It’s really difficult for adult children,” who worry about their parents, but can’t induce them to change, Dr. Frost said. “There may be a history of animosity. Many report they grew up feeling their hoarding parents cared more about their possessions than about them.” The children, young or grown, could probably use a support group, too.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

The Next War: In Federal Budget Cutting, F-35 Fighter Jet Is at Risk

Luke Sharrett for The New York Times

Vice Adm. David Venlet was named to lead the Joint Strike Fighter program in 2010 after problems had left it behind schedule and over budget.

LEXINGTON PARK, Md. — The Marine version of the F-35 Joint Strike Fighter, already more than a decade in the making, was facing a crucial question: Could the jet, which can soar well past the speed of sound, land at sea like a helicopter?

Luke Sharrett for The New York Times

An F-35B, the Marine Corps version of the Joint Strike Fighter.

On an October day last year, with Lt. Col. Fred Schenk at the controls, the plane glided toward a ship off the Atlantic coast and then, its engine rotating straight down, descended gently to the deck at seven feet a second.

There were cheers from the ship’s crew members, who “were all shaking my hands and smiling,” Colonel Schenk recalled.

The smooth landing helped save that model and breathed new life into the huge F-35 program, the most expensive weapons system in military history. But while Pentagon officials now say that the program is making progress, it begins its 12th year in development years behind schedule, troubled with technological flaws and facing concerns about its relatively short flight range as possible threats grow from Asia.

With a record price tag — potentially in the hundreds of billions of dollars — the jet is likely to become a target for budget cutters. Reining in military spending is on the table as President Obama and Republican leaders in Congress look for ways to avert a fiscal crisis. But no matter what kind of deal is reached in the next few weeks, military analysts expect the Pentagon budget to decline in the next decade as the war in Afghanistan ends and the military is required to do its part to reduce the federal debt.

Behind the scenes, the Pentagon and the F-35’s main contractor, Lockheed Martin, are engaged in a conflict of their own over the costs. The relationship “is the worst I’ve ever seen, and I’ve been in some bad ones,” Maj. Gen. Christopher Bogdan of the Air Force, a top program official, said in September. “I guarantee you: we will not succeed on this if we do not get past that.”

In a battle that is being fought on other military programs as well, the Pentagon has been pushing Lockheed to cut costs much faster while the company is fighting to hold onto a profit. “Lockheed has seemed to be focused on short-term business goals,” Frank Kendall, the Pentagon’s top weapons buyer, said this month. “And we’d like to see them focus more on execution of the program and successful delivery of the product.”

The F-35 was conceived as the Pentagon’s silver bullet in the sky — a state-of-the art aircraft that could be adapted to three branches of the military, with advances that would easily overcome the defenses of most foes. The radar-evading jets would not only dodge sophisticated antiaircraft missiles, but they would also give pilots a better picture of enemy threats while enabling allies, who want the planes, too, to fight more closely with American forces.

But the ambitious aircraft instead illustrates how the Pentagon can let huge and complex programs veer out of control and then have a hard time reining them in. The program nearly doubled in cost as Lockheed and the military’s own bureaucracy failed to deliver on the most basic promise of a three-in-one jet that would save taxpayers money and be served up speedily.

Lockheed has delivered 41 planes so far for testing and initial training, and Pentagon leaders are slowing purchases of the F-35 to fix the latest technical problems and reduce the immediate costs. A helmet for pilots that projects targeting data onto its visor is too jittery to count on. The tail-hook on the Navy jet has had trouble catching the arresting cable, meaning that version cannot yet land on carriers. And writing and testing the millions of lines of software needed by the jets is so daunting that General Bogdan said, “It scares the heck out of me.”

With all the delays — full production is not expected until 2019 — the military has spent billions to extend the lives of older fighters and buy more of them to fill the gap. At the same time, the cost to build each F-35 has risen to an average of $137 million from $69 million in 2001.

The jets would cost taxpayers $396 billion, including research and development, if the Pentagon sticks to its plan to build 2,443 by the late 2030s. That would be nearly four times as much as any other weapons system and two-thirds of the $589 billion the United States has spent on the war in Afghanistan. The military is also desperately trying to figure out how to reduce the long-term costs of operating the planes, now projected at $1.1 trillion.

“The plane is unaffordable,” said Winslow T. Wheeler, an analyst at the Project on Government Oversight, a nonprofit group in Washington.

Todd Harrison, an analyst at the Center for Strategic and Budgetary Assessments, a research group in Washington, said Pentagon officials had little choice but to push ahead, especially after already spending $65 billion on the fighter. “It is simultaneously too big to fail and too big to succeed,” he said. “The bottom line here is that they’ve crammed too much into the program. They were asking one fighter to do three different jobs, and they basically ended up with three different fighters.”

Read More..

Twin car bombs in Damascus kill at least 34 people

Dozens of people were killed Wednesday morning in four consecutive explosions that rocked a pro-regime suburb of the Syrian capital.

Twin car bombings first struck Jaramana around rush hour near the town’s main square. An eyewitness told activists that the first bomb went off near the entrance of a building and as people gathered to help the injured a nearby Mercedes also exploded. Witnesses reported many bodies lying in the street and photos from the scene showed damaged buildings and cars under rubble.

Soon after planted explosives were set off on the nearby Qariyat highway, said Damascus activist Alexia Jade.

The Syrian Arab News Agency reported that the last two explosions happened in Damascus in the Nahda and Qerayyat neighborhoods.

The opposition reported 45 people were killed, mostly civilians, and state media said the death toll was 34. Many more are injured, some in critical condition.

Jaramana is a mostly pro-government town but has also become a safe haven for many refugees fleeing violence in nearby areas. But this was not the first time the town has been attacked.

State media blamed the bombings on “terrorists,” the catch-all term the government has used to describe the opposition since the beginning of the uprising last year.

Opposition activists said no rebel group had claimed responsibility for the bombings and they pinned the blame on the government. Ambulances and state media were on the scene almost immediately, they said.

“Checkpoints surround Jaramana from all sides and are manned by the People’s Committee, so where did the car bombs enter from?” Jade said. “It is just a message of fear for the residents of Jaramana.”

Jaramana's hospital was inundated with victims and many had to be transferred elsewhere.

Schools that were already in session closed for the day and parents rushed to pick up their children, Jade said.

Roads around the town were closed in the wake of the bombings and security forces and members of the pro-regime People’s Committee were patrolling throughout the area, activists reported.

“Till this moment indications are that the regime was behind it,” Jade said. “And if (a rebel group) claims responsibility I’m going to be angry, because there are civilians lying in the street.”

ALSO:

Yasser Arafat's grave dug up in poisoning probe 

Egyptians pour into Tahrir Square to protest presidential decree

Kim Jong Un 'sexiest man,' Onion says; China's People's Daily buys it

-- Times staff in Amman, Jordan

Read More..

Geek Researcher Spends Three Years Living With Hackers

When you’re starting off as an anthropologist, you aim is to explore a subculture your peers have yet to uncover, spending years living with the locals and learning their ways.

That’s what Gabriella Coleman did. She went to San Francisco and lived with the hackers.

Coleman, an anthropologist who teaches at McGill University, spent three years living in the Bay Area, studying the community that builds the Debian Linux open source operating system and other hackers — i.e., people who pride themselves on finding new ways to reinvent software. More recently, she’s been peeling away the onion that is the Anonymous movement, a group that hacks as a means of protest — and mischief.

When she moved to San Francisco, she volunteered with the Electronic Frontier Foundation — she believed, correctly, that having an eff.org address would make people more willing to talk to her — and started making the scene. She talked free software over Chinese food at the Bay Area Linux User Group’s monthly meetings upstairs at San Francisco’s Four Seas Restaurant. She marched with geeks demanding the release of Adobe eBooks hacker Dmitry Sklyarov. She learned the culture inside-out.

Now, she’s written a book on her experiences: Coding Freedom: The Ethics and Aesthetics of Hacking. It’s a scholarly work of anthropology that examines the question: What does it mean to be a hacker?

Earlier this month, she dropped by Wired’s offices to talk about the book. Here’s an edited transcript of the conversation:

Wired: What made you decide to live with the hackers?

Gabriella Coleman: I did want to be somewhere with a high density of hackers. I didn’t want to just do online research — which a lot of my Anonymous research has been. I was like: “No, there are hackers and they’re in places, so let me go to San Francisco. There seem to be a lot of them here.”

What I quickly discovered was that there is a lot going on in hacking which has very little to do with open source. You know, like Infosec, and the transgressive tradition, and — a little later on — the hardware explosion. And that became the focus of my teaching. Because while the book is on open source, I wanted to grapple with and grasp the different dimensions of hacking, and I got really interested in what divided hackers.

It was interesting when I started hanging out with info security hackers in New York. That’s a really different beast. They’re like, if you’re a builder, you’re not a hacker. You’ve got to be breaking something. But the Infosec really tend to police their boundaries quite a bit.

Wired: What did your peers in the academic world think about your work?

Coleman: They, I think, thought that it was interesting and kind of great that someone was moving forward. But I think there was this idea that the geek hacker world, especially in the context of the west, was culturally thin and anemic. “Oh very interesting politically — they’re coming up with these alternative licenses — but isn’t it just about white men tinkering with their computers?”

And in some ways, I think I thought that too. But then, I was like, wait a minute, when it comes to the culture of computer hacking and the aesthetics of hacking, I was blown away by how culturally deep it was.

There’s a whole chapter on joking, humor and cleverness among hackers. And that, to me, was one of the fascinating areas. And I feel that I’ve just scratched the surface with that chapter — to how deep and complex their oral histories are and their folklore is. And how they record it in everything from how they name pieces of software, which are often historical references to the past, to just the enormous amount of writing that computer hackers do in the non-technical sense: manifestos and zines and science fiction, you know

And I was just kind of astounded by that at some level. And astounded by the way in which on the one hand the hacker world was the place where the culture of civil liberties was on fire. And that’s something that anyone can relate to because people beyond the hacker world know about free speech and privacy. And on the other hand, there was this aesthetic world that was intensely focused on itself and was very difficult to translate to the general public.

And so that kind of melding of the deep pleasures of hacking and the cultures of civil liberties were something that I thought was quite anthropological. But my peers were really unconvinced of it.

Wired: Did you get grief for not traveling to somewhere exotic?

Coleman: Yes. All the time. They just kind of laughed at it. They were like, ‘You’re so lucky. You get to be in San Francisco going to cafes and hanging out with hackers. I had to really sweat it out and be in the jungle. It was really difficult.’

It’s funny because my committee loved my dissertation, and it did very well and won all these prizes, but I always had trouble getting job talks in anthropology departments. Even today, I rarely get invited to give talks in anthropology departments.

Wired: What is the funniest hacker joke you know?

Coleman: I absolutely love the Mutt flea one. The man page for Mutt, in the man page, the bug category is flea, because fleas are on mutts.

Wired: It’s hard to tell a good geek joke because there are all these layers to them.

Often, the humor you talk about is used as a way of identifying like-minded people. I think that a lot of people from that community spend a lot of their time not being understood or talking to people who don’t care about the same things that they do. So they need a shorthand to figure out, “OK we can have a conversation.”

It’s actually a hack that allows you to connect with people who it’s worth your time time talk to.

Coleman: One of the things in that chapter that I argue is that hackers, first of all, are good at joking because to hack is to rearrange form. That’s what jokes are. That’s a pragmatic utilitarian argument, but they really culturally value it for all sorts of reasons.

Even a wonderful piece of code is up for debate, but a very funny joke, it gets affirmed with laughter and then it’s kind of indisputable.

Wired: Do you think that it’s possible to convey what’s interesting about hackers in film?

Coleman: I have generally thought that it’s really difficult. And I was pretty impressed with We Are Legion. He [Director Brian Knappenberger] did a very good job. And one of the reasons why he did a good job is because the world of Anonymous has a very rich visual vocabulary that they’ve created through their artifacts. They come from the meme world.

But let’s just say that you’re trying to convey the open source geeks and the transgressive hackers. Man, I have thought about this and I think it would take a kind of genius filmmaker to do it. I’ve talked to a lot of filmmakers to try to kind of inspire them to do it, and to spend time at CCC and the camps to get a sense of what it’s like and be, like, ‘Can you convert it?’” Because I haven’t seen any film yet that I think does it well.

Read More..

Leads, director of Motown musical visit Hitsville

DETROIT (AP) — The stars of the upcoming Broadway musical about Motown Records have read pretty much every book about and listened to every song from that golden era of American music.

The research only took them so far, so they decided to come and see Hitsville, U.S.A., for themselves.

Brandon Victor Dixon, who portrays the label’s founder, Berry Gordy, and Valisia LeKae, who plays its signature songstress, Diana Ross, visited the Motown Museum on Tuesday, taking a lengthy tour of the two-level home that produced the soundtrack of a generation.

“I’m trying not to get emotional,” LeKae said as she methodically inspected the hundreds of mementos — posters, gold records, clothing and more — on display at the Motown Museum.

LeKae, a Broadway veteran who has appeared in “The Book of Mormon” and “Ragtime” among others, worried about losing her composure when it came time to visit Studio A, the famed space in which Gordy and his army of artists, writers, producers and engineers signed, sealed and delivered hit after hit throughout the 1960s.

And she succeeded, descending a small flight of stairs into the square, smallish room and calmly checking out the famed studio affectionately called the “Snake Pit.” LeKae marveled at an oversized black-and-white snapshot on the wall of Ross singing with a smiling Gordy looking on.

It wasn’t until later, while visiting the home’s upstairs, that LeKae’s emotions kicked in.

Standing underneath the “echo chamber,” a hole cut in the upper level’s ceiling designed to create unique sounds for the recording process, LeKae belted out the first few lines of the Supremes’ “Where Did Our Love Go.”

“Baby, baby / Baby, don’t leave me,” she wailed, before the tears began to well up and she had to stop singing.

“This is, like, amazing,” she said.

LeKae and Dixon, who earned a Tony nomination for his work in “The Color Purple” and bears more than a passing resemblance to a Motown-era Gordy, will be front and center when the show debuts this spring.

“Motown: The Musical” begins its run of preview performances March 11 ahead of the official opening on April 14 at New York’s Lunt-Fontanne Theatre.

That gives Dixon, LeKae, Gordy (who’s producing and writing the book) and director Charles Randolph-Wright four months to bring the show to the stage.

To that end, Randolph-Wright also was at Hitsville on Tuesday, seeing prospective actors during a callback session in Studio A. He’s still looking for understudies and others to play smaller parts.

It wasn’t Randolph-Wright’s first visit to Motown’s birthplace as it was for his two leads, but for the 56-year-old who proclaims that “Motown’s in my DNA,” it was no less special.

“What a joy to be a part of (the Motown) movement and what a responsibility to try and place that in the world,” Randolph-Wright said, sitting on a piano bench in Studio A. “So, I’ve been very careful about trying to do that the right way.”

And he has, working for the past three years on “Motown: The Musical,” holding a nationwide casting call and working with Gordy and the other producers to identify which of the overwhelming number of songs from the Motown catalog to include on stage.

“The show is 15 hours,” Randolph-Wright joked.

The first version had 100 songs in it, he said, and “I wanted every song.”

While he said the show’s decision-makers are still deliberating about which songs make the final cut, one thing is certain about the musical selections: A few numbers in the show will be Gordy originals, written specifically for it.

“It’s so interesting to see him go back to being a songwriter after all these years,” said Randolph-Wright, who described one Gordy-penned song as having “all the textures of what Motown is and was, but it’s new.”

As for the man playing the man, Dixon spent his Tuesday walking through the halls of the Motown Museum, taking in every word tour guide Eric Harp and the other docents offered and, as he put it, “soaking it all in.”

At one point, he kneeled down and softly touched the cushion of a red-orange couch upstairs on which Marvin Gaye would take the occasional slumber.

Dixon burst out laughing, then leaped up and continued the tour.

Asked what was so funny, he quickly responded: “Because Marvin Gaye slept on this couch!”

All three of the Hitsville visitors spoke of their great respect and admiration for Gordy and the history of Motown and how important they felt it was to do it justice on stage.

“There’s an energy here that is palpable still,” Randolph-Wright said. “And it remains in this space. I think more than anything, the second I walked in here, it told me that I have to be honest” in telling the Motown story.

The first time he visited the museum, Randolph-Wright remembered walking into the gift shop, where he “bought everything,” including a Temptations T-shirt that read: “Live It Again.”

“I love that, because that’s what we’re doing,” he said.

___

Online:

http://www.motownthemusical.com

Entertainment News Headlines – Yahoo! News

Read More..

The New Old Age Blog: Doctor's Orders? Another Test

It is no longer news that Americans, and older Americans in particular, get more routine screening tests than they need, more than are useful. Prostate tests for men over 75, annual Pap smears for women over 65 and colonoscopies for anyone over 75 — all are overused, large-scale studies have shown.

Now it appears that many older patients are also subjected to too-frequent use of the other kind of testing, diagnostic tests.

The difference, in brief: Screening tests are performed on people who are asymptomatic, who aren’t complaining of a health problem, as a way to detect incipient disease. We have heard for years that it is best to “catch it early” — “it” frequently being cancer — and though that turns out to be only sometimes true, we and our doctors often ignore medical guidelines and ongoing campaigns to limit and target screening tests.

Diagnostic tests, on the other hand, are meant to help doctors evaluate some symptom or problem. “You’re trying to figure out what’s wrong,” explained Gilbert Welch, a veteran researcher at the Dartmouth Institute for Health Policy and Clinical Practice.

For these tests, medical groups and task forces offer many fewer guidelines on who should get them and how often — there is not much evidence to go on — but there is general agreement that they are not intended for routine surveillance.

But a study using a random 5 percent sample of Medicare beneficiaries — nearly 750,000 of them — suggests that often, that is what’s happening.

“It begins to look like some of these tests are being routinely repeated, and it’s worrisome,” said Dr. Welch, lead author of the study just published in The Archives of Internal Medicine. “Some physicians are just doing them every year.”

He is talking about tests like echocardiography, or a sonogram of the heart. More than a quarter of the sample (28.5 percent) underwent this test between 2004 and 2006, and more than half of those patients (55 percent) had a repeat echocardiogram within three years, most commonly within a year of the first.

Other common tests were frequently repeated as well. Of patients who underwent an imaging stress test, using a treadmill or stationery bike (or receiving a drug) to make the heart work harder, nearly 44 percent had a repeat test within three years. So did about half of those undergoing pulmonary function tests and chest tomography, a CAT scan of the chest.

Cytoscopy (a procedure in which a viewing tube is inserted into the bladder) was repeated for about 41 percent of the patients, and endoscopy (a swallowed tube enters the esophagus and stomach) for more than a third.

Is this too much testing? Without evidence of how much it harms or helps patients, it is hard to say — but the researchers were startled by the extent of repetition. “It’s inconceivable that it’s all important,” Dr. Welch said. “Unfortunately, it looks like it’s important for doctors.”

The evidence for that? The study revealed big geographic differences in diagnostic testing. Looking at the country’s 50 largest metropolitan areas, it found that nearly half the sample’s patients in Miami had an echocardiogram between 2004 and 2006, and two thirds of them had another echocardiogram within three years — the highest rate in the nation.

In fact, for the six tests the study included, five were performed and repeated most often in Florida cities: Miami, Jacksonville and Orlando. “They’re heavily populated by physicians and they have a long history of being at the top of the list” of areas that do a lot of medical procedures and hospitalizations, Dr. Welch said.

But in Portland, Ore., where “the physician culture is very different,” only 17.5 percent of patients had an echocardiogram. The places most prone to testing were also the places with high rates of repeat testing. Portland, San Francisco and Sacramento had the lowest rates.

We often don’t think of tests as having a downside, but they do. “This is the way whole cascades can start that are hard to stop,” Dr. Welch said. “The more we subject ourselves, the more likely some abnormality shows up that may require more testing, some of which has unwanted consequences.”

Properly used, of course, diagnostic tests can provide crucial information for sick people. “But used without a good indication, they can stir up a hornet’s nest,” he said. And of course they cost Medicare a bundle.

An accompanying commentary, sounding distinctly exasperated, pointed out that efforts to restrain overtesting and overtreatment have continued for decades. The commentary called it “discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health care resources.”

It is hard for laypeople to know when tests make sense, but clearly we need to keep track of those we and our family members have. That way, if the cardiologist suggests another echocardiogram, we can at least ask a few pointed questions:

“My father just had one six months ago. Is it necessary to have another so soon? What information do you hope to gain that you didn’t have last time? Will the results change the way we manage his condition?”

Questions are always a good idea. Especially in Florida.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

California Shows Signs of Resurgence

Sam Hodgson/Bloomberg News

Prosperous coastal places like La Jolla, here, are better off than the state as a whole; many inland areas still have high jobless rates.

LOS ANGELES — After nearly five years of brutal economic decline, government retrenchment and a widespread loss of confidence in its future, California is showing the first signs of a rebound. There is evidence of job growth, economic stability, a resurgent housing market and rising spirits in a state that was among the worst hit by the recession.

California reported a 10.1 percent unemployment rate last month, down from 11.5 percent in October 2011 and the lowest since February 2009. In September, California had its biggest month-to-month drop in unemployment in the 36 years the state has collected statistics, from 10.6 percent to 10.2 percent, though the state still has the third-highest jobless rate in the nation.

The housing market, whose collapse in a storm of foreclosures helped worsen the economic decline, has snapped back in many, though not all, parts of the state. Houses are sitting on the market for a shorter time and selling at higher prices, and new home construction is rising. Home sales rose 25 percent in Southern California in October compared with a year earlier.

After years of spending cuts and annual state budget deficits larger than the entire budgets of some states, this month the independent California Legislative Analyst’s Office projected a deficit for next year of $1.9 billion — down from $25 billion at one point — and said California might post a $1 billion surplus in 2014, even accounting for the tendency of these projections to vary markedly from year to year.

A reason for the change, in addition to a series of deep budget cuts in recent years, was voter approval of Proposition 30, promoted by Gov. Jerry Brown to raise taxes temporarily to avoid up to $6 billion in education cuts.

“The state’s economic recovery, prior budget cuts and the additional, temporary taxes provided by Proposition 30 have combined to bring California to a promising moment: the possible end of a decade of acute state budget challenges,” the report said. “Our economic and budgetary forecast indicates that California’s leaders face a dramatically smaller budget problem in 2013-14.”

And 38 percent of Californians say the state is heading in the right direction, according to a survey this month by U.S.C. Dornsife/Los Angeles Times. For most places, that figure would seem dismal. But it is double what it was 13 months ago.

California’s recovery echoes a rebound across much of the country; the state suffered not only one of the longest downturns but also one of the most severe. Economists say the turnaround, should it continue, is a positive harbinger for the nation, given the size and diversity of the state’s economy.

Democrats here have been quick to argue that the improvements in fiscal conditions that the state is now projecting after voters approved the temporary tax increase may embolden other states, and Congress, to raise some taxes rather than turn to a new round of cuts.

Yet California still faces major problems. The economic recovery is hardly uniform. Central California and the Inland Empire — the suburban sprawl east of Los Angeles — continue to stagger under the collapse of the construction market, and some economists wonder if they will ever join the coastal cities on the prosperity train. Cities, most recently San Bernardino, are facing bankruptcy, and public employee pension costs loom as a major threat to the state budget and those of many municipalities, including Los Angeles.

A federal report this month said that by some measures, California has the worst poverty in the nation. The river of people coming west in search of the economic dream, traditionally an economic and creative driver, has slowed to a crawl.

Still, the fear among many Californians that the bottom had fallen out appears to be fading. Economists said they were spotting many signs of incipient growth, including a surge in rental costs in the Bay Area, which suggests an influx of people looking for jobs.

“I think the state is turning a corner,” said Enrico Moretti, a professor of economics at the University of California, Berkeley. He said that the recovery was creating regional lines of economic demarcation — “We are going to see a more and more polarized state,” he said — but that over all, California was emerging from the recession.

Read More..

Much talk, little action on 'fiscal cliff' as Congress returns

WASHINGTON — Congress returned to a lame-duck session with no signs of quick compromise to ease the nation's budget deadlock, and the White House rolled out a strategy Monday to marshal popular support for raising taxes on the wealthiest tier of income earners.

Closed-door talks by senior aides produced no clear progress despite President Obama's private phone call over the weekend to House Speaker John A. Boehner (R-Ohio) in an effort to forge a deficit reduction deal in the five weeks before current tax rates expire, which would lead to tax increases for most Americans.

Familiar lines began to form as both sides jockeyed to avoid the so-called fiscal cliff, the combination of $500 billion in automatic federal tax increases and spending cuts that economists warn could send the nation back into recession next year.

But the battle assumed new contours as some senior Republican lawmakers distanced themselves from their party's strict anti-tax pledge and Obama took his case public. He warned that the threat of a tax hike on ordinary Americans could dampen winter holiday spending and create a crisis in consumer confidence.

"The president has called on Congress to take action and stop holding the middle class and our economy hostage over a disagreement on tax cuts for households with incomes over $250,000 per year," the White House said in a statement.

Obama got a boost from billionaire investor Warren Buffett, who said wealthier Americans, including himself, should pay more taxes. He dismissed Republican arguments that such tax increases would hamper investment.

"In recent years, my gang has been leaving the middle class in the dust," Buffett wrote in an op-ed for the New York Times. "Let's forget about the rich and ultrarich going on strike and stuffing their ample funds under their mattresses if — gasp — capital gains rates and ordinary income rates are increased."

The broad outline of a deal could be seen, although any accord appeared far from imminent.

Over the last week, three top Republican lawmakers — Sen. Lindsey Graham of South Carolina, Sen. Saxby Chambliss of Georgia and Rep. Peter T. King of New York — all indicated they were willing to raise some taxes in exchange for an agreement from Democrats to curb spending. They broke publicly with conservative stalwart Grover Norquist, the influential president of Americans for Tax Reform.

"It's fair to ask my party to put revenue on the table," Graham said on ABC's "This Week." "I will violate the pledge, long story short, for the good of the country — only if Democrats will do entitlement reforms."

A framework for a compromise had emerged after the Nov. 6 election. Boehner proposed a two-step process that would put a down payment on deficit reduction this year and set targets for undertaking a comprehensive overhaul of taxes and entitlement spending in 2013.

In the days since, however, talks have become "slow," according to one congressional aide. Republicans insist that new revenue must come from economic growth, which they believe would be produced by revamping the tax code to lower all tax brackets — an approach Democrats reject as "fairy tale" economics.

Democrats are unwilling to discuss cuts to Medicare, Medicaid or other government programs unless Republicans put upfront revenue on the table, aides said.

Frustrations over the standoff have grown, and one lawmaker, Sen. Bob Corker (R-Tenn.), proposed his own solution Monday — capping itemized deductions at $50,000 in exchange for changes to Medicare and cuts to other government programs.

Such an approach is in line with proposals being discussed, though Obama has promised the tax increases would hit incomes only above $250,000 for couples or $200,000 for singles.

No talks among the principal players are scheduled this week, even though both sides say they want to avoid brinkmanship as they push toward a Christmas deadline. All tax rates expire on Dec. 31, which would result in automatic tax increases; spending cuts are set for Jan. 2.

Aides to the president acknowledged they didn't hold high hopes after Obama spoke to Boehner over the weekend. But they didn't go so far as to echo Senate Republican leader Mitch McConnell of Kentucky, who used the word "impasse" Monday in discussing the long pursuit of a grand budget deal.

"We remain confident we can achieve an agreement," White House Press Secretary Jay Carney said. "We remain hopeful and optimistic we can reach a deal."

Staff negotiations continue, and the White House's Council of Economic Advisers said Monday the automatic tax increases would not only hurt the rest of the holiday shopping season, but they could also trim consumer spending by about $200 billion in 2013. Overall, the council warned, economic growth could drop by 1.4 percentage points.

That's no small matter, said the council's chairman, Alan Krueger, given the role retail sales play in the economy. The American economy has grown at an average annual rate of just over 2% since the recovery began in 2009.

The report is broadly consistent with forecasts by the Congressional Budget Office and leading private economists, and it comes after retailers amassed a record $59.1 billion in sales from Thanksgiving through Sunday, up from $52.4 billion a year earlier, according to estimates from the National Retail Federation.

But the White House report warned that "the hard-earned rise in consumer confidence will be at risk if the middle-class tax cuts are not soon extended with a minimum of political drama."

Publicly and behind closed doors, White House officials expressed hope that the political environment would improve over the coming week.

Obama will meet with business leaders at the White House this week in an attempt to build support for his agenda.

On Friday, the president plans to travel to Montgomery County in Pennsylvania to visit a local business that "depends on middle-class consumers during the holiday season," the White House said. The business, Rodon Group, is the sole American manufacturer for K'NEX Brands, a construction toy company whose products include Tinkertoy, K'NEX and Angry Bird building sets.

lisa.mascaro@latimes.com

christi.parsons@latimes.com

Times staff writer Don Lee contributed to this report.

Read More..