No Clear Link Between Cancer and 9/11 Debris, New York Health Dept. Study Finds

Six months after the federal government added cancer to the list of sicknesses covered by the $4.3 billion World Trade Center fund, a New York City health department study has found no clear link between cancer and the dust, debris and fumes released by the burning wreckage of the twin towers.

The study was by far the largest to date. It examined 55,700 people, including rescue and recovery workers who were present at the World Trade Center site, on barges or at the Staten Island landfill where debris was taken in the nine months after Sept. 11, 2001, as well as residents of Lower Manhattan, students, workers and passers-by exposed on the day of the terrorist attacks.

Over all, there was no increase in the cancer rate of those studied compared with the rate of the general population, researchers concluded after looking at 23 cancers from 2003 to 2008. The prevalence of three cancers — multiple myeloma, prostate and thyroid — was significantly higher, but only in rescue and recovery workers and not in the rest of the exposed population. But since the number of actual cases was small and the subjects of the study may have been screened more frequently for cancer than other people on average, the researchers noted that it was too early to draw any correlation to time spent at ground zero.

In one of many counterintuitive findings, the incidence of cancer was not higher among those who were exposed more intensely to the toxic substances than among those who were exposed less.

The lack of clear evidence of a link between cancer and the debris from Sept. 11 casts into doubt the decision by the federal government in June to add 50 different types of cancer to the list of illnesses covered by the James Zadroga 9/11 Health and Compensation Act, signed by President Obama in early 2011. That decision meant that people with other sicknesses linked more strongly to ground zero were likely to receive less money.

Dr. Thomas A. Farley, the health commissioner in New York City, said in an interview on Monday that it was too soon to take the study as a repudiation of the government’s decision.

“Cancers take 20 years to develop,” Dr. Farley said, “and we might see something different 20 years down the line.” But echoing Dr. John Howard, head of the National Institute for Occupational Safety and Health, who made the final decision on covering cancer, the commissioner added, “You don’t want to wait 20 to 30 years to get a definitive answer” to people suffering today.

On Tuesday, Dr. Howard issued a statement that said, “The W.T.C. Health Program welcomes this addition to the peer-reviewed scientific literature, and we have long encouraged the growth of such peer-reviewed research.”

Dr. Alfred I. Neugut, an oncologist and professor of epidemiology at the Mailman School of Public Health at Columbia University, said he was not surprised by the study. “I think, given the time frame and the exposures,” he said, “that there wasn’t a high likelihood that there would be an elevated risk, certainly for cancer, and to the degree that it was, it would not be for the cancers that they’re finding.”

Dr. Neugut said he sympathized with people who had cancer they attributed to the disaster, but added that their emotional response was not necessarily valid scientifically. “The 9/11 attack was a terrible thing, but it doesn’t cause everything in the world,” he said. “Cancer is a very specific outcome, and in most exposures, you have to be exposed for an extended time before you get the cancer.”

Initially, the money set aside by the law — $2.8 billion to compensate victims and $1.5 billion for monitoring and treatment costs not covered by health insurance — covered mainly respiratory illnesses. (Mental health problems were included in the treatment fund but not the compensation fund.) Studies by the city health department have found asthma and post-traumatic stress disorder to be linked to the 2001 attacks. But cancer is expected to be far more expensive to treat than other qualifying illnesses, and the economic loss caused by cancer could require more compensation, since many cancer patients cannot work, and some have died.

The study was released on Tuesday, and was to be published in the Wednesday issue of The Journal of the American Medical Association — too late to influence Dr. Howard’s decision, but perhaps not too late to influence public opinion going forward or to affect whether Congress will decide to replenish the victim compensation fund should more money be needed.

The fund has not yet begun making payments, and it is supposed to make its final payments in 2016-17. In the meantime, some police officers and other rescue and recovery workers who worked at ground zero and have cancer have been receiving enhanced pension benefits based on a 2005 state law that said they were presumed to have contracted cancer from the ground zero substances.

Read More..

No Clear Link Between Cancer and 9/11 Debris, New York Health Dept. Study Finds

Six months after the federal government added cancer to the list of sicknesses covered by the $4.3 billion World Trade Center fund, a New York City health department study has found no clear link between cancer and the dust, debris and fumes released by the burning wreckage of the twin towers.

The study was by far the largest to date. It examined 55,700 people, including rescue and recovery workers who were present at the World Trade Center site, on barges or at the Staten Island landfill where debris was taken in the nine months after Sept. 11, 2001, as well as residents of Lower Manhattan, students, workers and passers-by exposed on the day of the terrorist attacks.

Over all, there was no increase in the cancer rate of those studied compared with the rate of the general population, researchers concluded after looking at 23 cancers from 2003 to 2008. The prevalence of three cancers — multiple myeloma, prostate and thyroid — was significantly higher, but only in rescue and recovery workers and not in the rest of the exposed population. But since the number of actual cases was small and the subjects of the study may have been screened more frequently for cancer than other people on average, the researchers noted that it was too early to draw any correlation to time spent at ground zero.

In one of many counterintuitive findings, the incidence of cancer was not higher among those who were exposed more intensely to the toxic substances than among those who were exposed less.

The lack of clear evidence of a link between cancer and the debris from Sept. 11 casts into doubt the decision by the federal government in June to add 50 different types of cancer to the list of illnesses covered by the James Zadroga 9/11 Health and Compensation Act, signed by President Obama in early 2011. That decision meant that people with other sicknesses linked more strongly to ground zero were likely to receive less money.

Dr. Thomas A. Farley, the health commissioner in New York City, said in an interview on Monday that it was too soon to take the study as a repudiation of the government’s decision.

“Cancers take 20 years to develop,” Dr. Farley said, “and we might see something different 20 years down the line.” But echoing Dr. John Howard, head of the National Institute for Occupational Safety and Health, who made the final decision on covering cancer, the commissioner added, “You don’t want to wait 20 to 30 years to get a definitive answer” to people suffering today.

On Tuesday, Dr. Howard issued a statement that said, “The W.T.C. Health Program welcomes this addition to the peer-reviewed scientific literature, and we have long encouraged the growth of such peer-reviewed research.”

Dr. Alfred I. Neugut, an oncologist and professor of epidemiology at the Mailman School of Public Health at Columbia University, said he was not surprised by the study. “I think, given the time frame and the exposures,” he said, “that there wasn’t a high likelihood that there would be an elevated risk, certainly for cancer, and to the degree that it was, it would not be for the cancers that they’re finding.”

Dr. Neugut said he sympathized with people who had cancer they attributed to the disaster, but added that their emotional response was not necessarily valid scientifically. “The 9/11 attack was a terrible thing, but it doesn’t cause everything in the world,” he said. “Cancer is a very specific outcome, and in most exposures, you have to be exposed for an extended time before you get the cancer.”

Initially, the money set aside by the law — $2.8 billion to compensate victims and $1.5 billion for monitoring and treatment costs not covered by health insurance — covered mainly respiratory illnesses. (Mental health problems were included in the treatment fund but not the compensation fund.) Studies by the city health department have found asthma and post-traumatic stress disorder to be linked to the 2001 attacks. But cancer is expected to be far more expensive to treat than other qualifying illnesses, and the economic loss caused by cancer could require more compensation, since many cancer patients cannot work, and some have died.

The study was released on Tuesday, and was to be published in the Wednesday issue of The Journal of the American Medical Association — too late to influence Dr. Howard’s decision, but perhaps not too late to influence public opinion going forward or to affect whether Congress will decide to replenish the victim compensation fund should more money be needed.

The fund has not yet begun making payments, and it is supposed to make its final payments in 2016-17. In the meantime, some police officers and other rescue and recovery workers who worked at ground zero and have cancer have been receiving enhanced pension benefits based on a 2005 state law that said they were presumed to have contracted cancer from the ground zero substances.

Read More..

Mind: A Misguided Focus on Mental Illness in Gun Control Debate

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

Read More..

Mind: A Misguided Focus on Mental Illness in Gun Control Debate

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

Read More..

Bobby Kotick of Activision, Drawing Praise and Wrath

J. Emilio Flores for The New York Times

Bobby Kotick, chief executive of Activision Blizzard, with images of characters from the Skylanders series, one of the company’s successful franchises.

PEOPLE who love video games love to hate Bobby Kotick.

Mr. Kotick, the C.E.O. of Activision Blizzard, the world’s largest video game publisher, inspired a stocky, auburn-haired character named Money Sack, who, in a game created by a competitor and a former employee, wields a wide grin and an automatic weapon. In another video, Mr. Kotick pops up from behind a fortified wall, and in a husky, ominous voice says he’ll set the price of his biggest game, Call of Duty, to “your soul” — a dig at its cost. Then fiery lasers shoot out of his eyes, wreaking havoc on an apocalyptic fantasy world. In several online photographs he is depicted as the Devil, with red horns against a Hades-like background.

On this particular Sunday, it’s those Photoshopped horns that really irk Mr. Kotick. He is seated at a corner table in the cavernous breakfast room of the Pierre hotel, across the street from Central Park, shaking a leg nervously and whispering in a conspiratorial hush.

“Think about what it’s like for my dating life when the first picture that comes up is me as the Devil,” says Mr. Kotick, who is recently divorced. “You see all this chatter and you realize that they game the search results. These super-sophisticated 19-year-olds are smarter than our expensive P.R. firm.” (His publicist, Steven Rubenstein, shrugs sheepishly.)

Mr. Kotick, 49, has reason to be annoyed. Not since the music industry’s heyday has there been a business with such a wide disparity between the popularity of its products and its customers’ perception of the chief executive who made those products possible. Video games are among the most successful segments in the entertainment industry, and the disdain heaped on Mr. Kotick in video game blogs is second only to the admiration for him on Wall Street.

He bought the company that is now Activision in 1990, when it was nearly bankrupt and when analysts dismissed video games as fads. But in his 22 years as C.E.O. he has built Activision into a company with a stock market value of $12.7 billion, almost three times that of its top rival, Electronic Arts.

Mr. Kotick isn’t the most technology-driven executive. (He still prefers a BlackBerry.) And he doesn’t get into the weeds of creative storytelling; he leaves that to the studios Activision has acquired. But like David Geffen, who never played a musical instrument well but signed Bob Dylan, Joni Mitchell and the Eagles, Mr. Kotick has a knack for identifying hit after blockbuster hit. He wakes up each day thinking about those hits — some would say obsessing about them — and how Activision can lavish games like Call of Duty, Diablo and World of Warcraft with ever more bells and whistles to keep customers happy and ensure that the next release is a big success, too.

The latest edition of Activision’s biggest game, the shoot’em-up megahit Call of Duty: Black Ops II, was released Nov. 13 and had sales of $500 million in its first 24 hours and more than $1 billion in the first 15 days. That fell short of some analysts’ expectations but was nevertheless more than the total domestic box-office revenue of “Avatar,” the highest-grossing movie of all time.

BUT expensive, immersive games now face a challenge as free online games from companies like Zynga and Rovio compete for users’ attention. Retail sales of video games in the United States totaled $7.5 billion from January to October, down 26 percent from the same period in 2011, according to the NPD Group.

In response, Activision is doubling down on a handful of games with high margins. The strategy is to have customers pay $60 or more to traverse for hundreds of hours through story lines with orchestral soundtracks and realistic, hologram-like heroes and heroines. With each new version “we need more resources, more time, and our development schedule has to get longer,” Mr. Kotick says. “How do you make the games better each year?”

Developers of Call of Duty took the risky step of bringing the mostly historical war series into the not-so-distant future of 2025. David S. Goyer, co-writer of the story for “The Dark Knight Rises,” was a co-writer on the story for the latest Call of Duty. Trent Reznor, the Nine Inch Nails singer who won an Oscar for the soundtrack of “The Social Network,” did the theme song. Oliver L. North served as an adviser for the game, which features a virtual David H. Petraeus, the former Central Intelligence Agency director.

The Activision strategy relies heavily on the holiday season. “This is a nail-biting time for us,” said Brian G. Kelly, Mr. Kotick’s longtime business partner, who is co-chairman of the Activision Blizzard board.

In the three months ended Sept. 30, Activision exceeded analysts’ expectations and increased its earnings by 53 percent, to $226 million, or 20 cents a share, even as video game console sales declined slightly.

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Lashkar Gah Journal: A Pristine Afghan Prison Faces a Murky Future

Bryan Denton for The New York Times

Inmates at the Helmand Central Prison in Lashkar Gah, Afghanistan, in an outdoor area.

LASHKAR GAH, Afghanistan — The first thing one notices about the new prison here is the smell, or rather the absence of it. Helmand Central Prison does not reek of sewage or sweat or old clothes or rancid cooking oil, the typical odors of an Afghan lockup. The air smells, dare one say, fresh.

Also noteworthy are the bathroom floors, which are sparkling, and the outer walls, which are made of concrete, not mud, like so much of this country’s prison infrastructure.

Built in the insurgency’s southern heartland with $6.5 million from the British government, there is no doubt that Helmand Central Prison is impressive. The only question is how long it will stay that way once Western forces leave and Western money dwindles.

That prospect is not something that Col. Hajji Raz Mohammed, the deputy warden, even wanted to contemplate as he proudly walked visitors through every corner of the prison, the bathrooms included.

Asked what will happen when the British Provincial Reconstruction Team that is a few miles away packs up in the coming year or so, he squinted in the bright winter sunlight of the prison yard. “It’s very early to comment on this,” he said.

He went on to detail all that the British are supplying to the prison — air-conditioners, refrigerators and even computers that allow the inmates, many of them former Taliban affiliates, to learn PowerPoint and Excel. There is also the clinic that treats those with tuberculosis, depression and a variety of other illnesses. The British team even provided two minivans to act as ambulances for prisoners who need transport to the hospital.

As for the Afghan government, which has been managing the prison since mid-2011, it pays for the salaries of prison employees and food. Colonel Mohammed expressed grave doubts about whether the prison could keep up its standards solely with Afghan government backing.

“No, our government will not be able to afford this,” he said. “Our government is poor.”

If a prison is, in some measure, a mirror of the larger society, then the Helmand Central Prison offers a glimpse of southern Afghanistan just as the surge in Western troops is ending. It not only shows the largess and aspirations of the Western militaries, but also the fragility of their efforts against the Taliban, whose presence in the prison reflects its prevalence in the province.

In 2009, the British razed the run-down structure that used to house prisoners here, with its poor plumbing and its dirt yard that turned to mud in the rainy winter. The new prison is just the first piece of an ambitious complex that will include a modern juvenile detention center, a women’s prison and, with the aid of the Danish government, a rehabilitation center.

A walk through the prison with Colonel Mohammed reveals conditions far removed from the dungeonlike atmosphere that still exists in some places in the rest of the country. The prisoners, who wear traditional Afghan dress, live in groups of 8 to 10 in bunk rooms with the television tuned to local channels. Afghan news and music seemed to be favorites.

The hallways are swept clean, and the floors washed. The prison yard accommodates several hundred prisoners who sit in large groups, some reading the Koran, others taking literacy classes and still others standing in a line to use a communal cellphone — monitored by the intelligence service.

Colonel Mohammed said the prison had 37 surveillance cameras, which helped employees keep track of what was going on. When one breaks, “the P.R.T. pays to repair them,” he said. What will happen when the Provincial Reconstruction Team is no longer there? “We will do it,” Colonel Mohammed said, though he looked less than certain.

Gen. Bismullah Hamid, who runs Helmand Central and is described by the Westerners who work with him as a “visionary” in the Afghan prison system, recalled that when he was assigned to the prison, it was a squalid, crowded place filled with gangs and drugs. (Helmand Province leads Afghanistan in opium production.)

“Drug addicts were easily manipulated by subversive inmates, and they would start protests and rebellions,” he said.

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The Media Equation: Buffeted by the Web, but Now Riding It

When the consumer Web exploded in the mid-1990s, part of the promise was that it would transform careers and the concept of work. Remember the signs on telephone poles and banners all over the Internet? “Work at home and turn your computer into a cash register! Ask me how.” The next generation of Americans would be able to work on their own terms.

It didn’t turn out that way. If anything, digital technology has overwhelmed those who sought to master it. The Web may be a technological marvel, but to most people who use it for work, it functions like an old-fashioned hamster wheel, except at Internet speed.

Brian Lam was both a prince and a casualty of that realm. After interning at Wired, he became the editor of Gizmodo, Gawker Media’s gadget blog. A trained Thai boxer, he focused his aggression on cranking out enough copy to increase the site’s traffic, to a peak of 180 million page views from 13 million in the five years he was there.

He and his writers broke news, sent shrapnel into many subject areas with provocative, opinionated copy and was part of the notorious pilfered iPhone 4 story that had law enforcement officials breaking down doors on Apple’s behalf. I saw Mr. Lam on occasional trips to San Francisco, and he crackled with jumpy digital energy.

And then, he burned out at age 34. He loved the ocean, but his frantic digital existence meant his surfboard was gathering cobwebs. “I came to hate the Web, hated chasing the next post or rewriting other people’s posts just for the traffic,” he told me. “People shouldn’t live like robots.”

So he quit Gizmodo, and though he had several lucrative offers, he decided to do exactly nothing. He sold his car, rented out his house, took time to mull things over and eventually moved to Hawaii because he loves surfing.

This is the point in the story where we generally find out that the techie is now a wood carver, or an oboe player.

But leopards don’t change their spots, and they certainly don’t turn into unicorns. An accomplished technologist and writer, Mr. Lam worked to come up with a business that he could command instead of the other way around.

The problem is that these days, ad-supported media business models all depend on scale, because rates go lower every day. Success in Web media generally requires constant posting to build a big audience. Mr. Lam knew where that led.

With friends — including Brian X. Chen, who now works at The New York Times — he came up with his own version of a gadget site. But instead of chasing down every tidbit of tech news, he built The Wirecutter, a recommendation site that posts six to 12 updates a month — not a day — and began publishing in partnership with The Awl, a federation of blogs founded by two other veterans of Gawker Media, Choire Sicha and Alex Balk.

While there are many technology sites that evaluate and compare products, usually burying their assessments in a tsunami of other posts, Mr. Lam and his staff of freelancers decided to rely on deep examinations of specific product categories.

Using expert opinions, aggregated reviews and personal research, they recommend a single product in each category. There are no complicated rankings or deep analytics on the entire category. If you want new earphones or a robot vacuum, The Wirecutter will recommend The One and leave it at that.

“I was tired of doing posts that were obsolete three hours after I wrote them,” Mr. Lam said. “I wanted evergreen content that didn’t have to be updated constantly in order to hunt traffic. I wanted to publish things that were useful.”

He bootstrapped the site, spurning outside investment. “If you take the money, you have to pony up in terms of scale, and I don’t want to do that,” he said.

The clean, simple interface, without the clutter of news, is a tiny business; it has fewer than 350,000 unique visitors a month at a time when ad buyers are not much interested in anything less than 20 million.

But The Wirecutter is not really in the ad business. The vast majority of its revenue comes from fees paid by affiliates, mostly Amazon, for referrals to their sites. As advertising rates continue to tumble, affiliate fees could end up underwriting more and more media businesses.

“Brian’s insight is that in a world of loudest and fastest, he has turned it down, doing it slow and doing it right,” Mr. Sicha said. “And by being consumer facing, he doesn’t have to have monster numbers. The people come ready to buy.”

In fact, 10 to 20 percent of its visitors click on links, a rate that would make ad sellers drool. Mr. Lam hardly invented the model. The Web is full of mom-and-pop shops that live on referral fees for things like pet supplies and camping gear. Many companies also pay for referrals — eBay, Half.com, even retailers like Gap and Old Navy. A business that used to be mired in spam is becoming far more legitimate.

For small businesses like Wirecutter, it’s risky to rely so much on a single company, but Amazon seems disinclined to mess with its very successful model.

“We have been working hard to give publishers of all sizes the tools to work with Amazon,” said Steve Shure, Amazon’s vice president for worldwide marketing.

But it’s not just the little guys. Hearst’s Good Housekeeping has commerce links to Amazon, and Gawker Media, Mr. Lam’s old employer, is building affiliate revenue and other nonadvertising revenue into a seven-figure business by next year. In a sense, it’s back to the future, the days of the Whole Earth Catalog and its compendium of splendid things. Kevin Kelly, its former editor and publisher and now “senior maverick” at Wired, has a site called Cool Tools that will be observing its 10th anniversary.

“Affiliate income is six times as much as advertising by now,” Mr. Kelly said in a phone call, describing the revenue at Cool Tools. “Part of what is attractive about our site and Brian’s is that it is a distillation, a trusted friend. You don’t find out everything, just what you need to know.”

Mr. Lam’s revenue is low, about $50,000 a month, but it’s doubling every quarter, enough to pay his freelancers, invest in the site and keep him in surfboards. And now he actually has time to ride them. In that sense, Mr. Lam is living out that initial dream of the Web: working from home, working with friends, making something that saves others time and money.

“I don’t want to get too hippie about it, but surf is bad when it comes in lots of messy waves,” he said. “Our traffic is spaced out in manageable ways that we will grow over time. And even if it doesn’t, that’s fine by me.”

E-mail: carr@nytimes.com;

Twitter: @carr2n

This article has been revised to reflect the following correction:

Correction: December 16, 2012

An earlier version of this article said that Mr. Lam’s Web site revenue was doubling every month. It should have said doubling every quarter.

This article has been revised to reflect the following correction:

Correction: December 17, 2012

An earlier version of this article said that Mr. Lam worked at Gizmodo for six years. It should have said five years.

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The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and have been married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number of postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and an associate professor in the department of psychiatry and behavioral sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said she did it because she thought that they would run out of money, “even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment, or M.C.I., comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently, usually badly, due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in The Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that Dr. Waite said “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in The Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it is hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and on Tuesday we will try to provide some advice from experts.

Read More..

The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and have been married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number of postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and an associate professor in the department of psychiatry and behavioral sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said she did it because she thought that they would run out of money, “even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment, or M.C.I., comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently, usually badly, due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in The Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that Dr. Waite said “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in The Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it is hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and on Tuesday we will try to provide some advice from experts.

Read More..

Nickelodeon and PBS Pursue Preschool Apps Alongside TV Shows

In 2014, the preschool cable network Nick Jr. plans to introduce a television show featuring a little boy, his miniature pet dragon and a magic stick.

But the show, “Wallykazam,” will not be new to users of smartphones and tablets. Educational applications built around it will start appearing in app stores late next year, making “Wallykazam” Nickelodeon’s first major show to be introduced as a mobile product first, said Steve Youngwood, Nickelodeon’s executive vice president and general manager for digital media.

Driving the change, at Nickelodeon and other preschool television brands, are parents who are increasingly putting mobile devices into preschoolers’ hands and laps.

According to new research commissioned by Sesame Workshop, producer of PBS’s “Sesame Street,” mobile device ownership is booming as TV set ownership declines. Eighty-eight percent of the parents surveyed said they owned a television, down from 95 percent in 2010.

Twenty-one percent said their children first interacted with “Sesame Street” someplace other than television, with YouTube and PBS.org the top alternative sources. (PBS said separately that its free PBS Kids Video app, which has been downloaded 2.4 million times, reached 120 million streams of PBS Kids shows in November, surpassing 100 million for the first time.)

“On-air does still drive digital,” said Diana Polvere, Sesame Workshop’s vice president for market research, citing the 79 percent of viewers who still come to television first. But given the rapid changes, she said, Sesame’s research will now be conducted every six months instead of every two years.

Nickelodeon’s research, done in April and updated in October, shows striking growth in educational app use. In October, 27 percent of United States households with children ages 3 to 5 had an iPad, up from 22 percent in April. In those households, 40 percent of preschoolers used the iPad for educational apps, up from 27 percent in April.

The study also found that Apple device users were willing to pay 15 to 23 percent more for educational apps than for general apps.

“Parents want to feel good about what they are purchasing and downloading for their kids,” said Scott Chambers, Sesame Workshop’s senior vice president for digital worldwide distribution. Adding an educational element to an entertaining app, he said, “makes everybody feel better.”

Parents’ feelings aside, apps are strong educational tools, said Lesli Rotenberg, who oversees PBS’s children’s programming, including its more than two dozen apps.

While television “is somewhat of a passive experience” for children, she said, interactive apps give them immediate feedback and tailored experiences that become more difficult as they gain skills.

Though numerous producers are entering the app business, three of the top 10 paid educational apps in the iTunes store last week were Nickelodeon’s. They included the $1.99 Bubble Guppies: Animal School Day, already profitable six weeks after its introduction, Nickelodeon said. A Team Umizoomi math app was still in the top 10 after a year on the market.

Originally scheduled for August release, the Bubble Guppies app, filled with the same silly jokes as the show, was revised after focus group testing with preschoolers showed, among other things, that their small fingers had a hard time maneuvering a virtual latch and that the children wanted more control over their exploration.

“We were hearing kids say in testing: ‘I want to play with the dolphin. I want to play with the penguin,’ ” said Jordana Drell, Nickelodeon’s senior director of preschool games.

Nickelodeon’s educational apps normally take six to eight months to create and, even with lush graphics like the shimmery underwater background in Bubble Guppies, cost about half as much as a single episode of one of the company’s preschool shows, officials said.

The Bubble Guppies creators, Jonny Belt and Robert Scull, said they approached the app as they would a television episode, reading the 90-page game document aloud, technical material and all. “That really brings it to life, and you know what you’re getting,” Mr. Scull said.

A Nickelodeon rival, Disney Junior, has taken a less integrated approach to apps, developing television shows first and apps later to expand on the content, said Albert Cheng, executive vice president for digital media at the Disney/ABC Television Group.

The free Mickey Mouse Clubhouse Road Rally Appisode, released in May, is a repurposed version of an episode of the “Mickey Mouse Clubhouse” television program, reconfigured to be highly interactive.

It proved so popular that “we definitely feel there’s something here we want to invest in,” Mr. Cheng said.

Although the app had educational elements, it was not intended as such. The sprawling Walt Disney Company has published educational apps through other units, however.

Since releasing its first app three years ago, Sesame Workshop has added more than three dozen, including Elmo Loves 123s, which was introduced Dec. 10 and draws on new research for developers and parents that Sesame plans to release this week. App users, Mr. Chambers said, tend to come back regularly, a loyalty that executives have noted as they consider future expansion in the category.

The rush to apps is changing the development process for PBS, which will no longer develop television-only shows, Ms. Rotenberg said. PBS’s newest property, “Daniel Tiger’s Neighborhood,” came out as an app — already the company’s third best-selling — the day of the television premiere in September.

Ms. Rotenberg said her team had “sent away” a number of producers who came to PBS with ideas for television shows with no thought-out mobile component, telling them, “ ‘Come back when you have a plan.’ ”

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