A backyard nuclear shelter? Yes, paranoia does sell








One sterling quality of American businesses is that they'll try to make money from anything.


Paranoia, for instance. So say hello to Ron Hubbard, the owner of Montebello-based Atlas Survival Shelters, which converts huge corrugated metal tubes up to 50 feet long into fully equipped, all-the-comforts-of-home underground shelters at a price of up to about $78,000 each, not including shipping and interment.


You may have spotted the Atlas shop from the 5 Freeway as you're heading into downtown. There's a corrugated tube out front, painted bright yellow and looking like a tipped-over corn silo. High on the exterior wall facing the road is a banner declaring that the shelters offer protection from nuclear blasts, nuclear fallout, EMP (that's electromagnetic pulses, which can foul electrical systems), solar flares, mobs, looters, earthquakes and chemical warfare. If there's anything left off that list, it's probably not worth worrying about.






"People who buy my shelters are not radical crazy people," Hubbard told me recently as he guided me around the Montebello shop. "I get maybe three crazy calls a year. They're practical people."


Hubbard, 50, is a big Texan with a toothy grin and the friendly enthusiasm of someone trying to sell you something. He'll expound cheerily on the basic practicality, not to mention the sheer joy, of having a 40-foot corrugated steel drum buried 20 feet deep in your yard and tricking it out with a big-screen TV and Internet connection for those long days and nights hunkered down against nuclear blasts, the Chinese army or domestic looters. His shelters also offer such necessities as microwave ovens, space for a year's worth of provisions and high-grade air filtration.


"We don't know where our country will go," he said. "If we're going to be attacked, my shelters will protect you from Sarin gas or super flu. If we go bankrupt and we don't pay China, that could be the start of World War III. We could attack Iran or back Israel, and that could start a war. This is insurance. Why do we carry insurance on our homes? Just. In. Case."


Hubbard doesn't describe these dystopias as though he actually believes in them, but rather with the air of a salesman trying out any buzzword that might trigger a deal. During the couple of hours we were together, he described his products serially as underground condos, second homes, combination second homes and bomb shelters, man caves, man caves that happen to be bombproof, weekend cabins and hunting cabins.


Atlas Survival Shelters hasn't turned a significant profit yet. Hubbard said it made no money in the start-up year of 2011, was modestly in the black last year and may show a profit for 2013. But the business is unusual enough that it has won featured spots on several reality shows. An episode on A&E Network's "Shipping Wars" shows a team of moving experts trying to figure out how to transport a 32-foot shelter on their flatbed truck. During the episode Hubbard regales them with the virtues of the unit's escape-hatch feature, a second portal that opens only from the inside, in case of an attack.


"Somebody sees you going down; while they're trying to smoke you out, you're going to the back tunnel, you're gonna come up through an escape hatch that's hidden underground, you can shoot 'em in the back. Pretty cool, huh?" (Remarked one of the show's plainly creeped-out female cast members, "Remind me to never pay him a visit.")


More recently, Atlas was featured on an episode of the National Geographic Channel series "Doomsday Preppers," which chronicles the lifestyles of the scared and nervous. Hubbard's customer is described in network publicity as Brian Smith, a father of 12 "preparing for a total collapse of the U.S. monetary system."


Hubbard got into the underground shelter business a little more than a year ago after years of selling wrought-iron doors from the same location, operating as Hubbard Iron Doors. That business was brought low by the poor economy and cheap Chinese knockoffs, Hubbard says. It filed for bankruptcy in 2011; Hubbard says it's now owned and run by his brother, though the two companies share space with each other.


While he was casting about for a new business, Hubbard said, he happened across a brochure for Radius Engineering International, a Texas company that manufacturers fiberglass shelters mostly for business, government and military buyers. But the Radius products were expensive — they run from $150,000 up to millions, depending on the design and capacity. Hubbard thought he could do better on price while turning out a more appealing hideaway.


He's still trying to get a feel for the market, however. With his six or seven full-time workers, he can turn out one shelter a week. Orders, he said, come in at somewhere between one a month and one a week, more in periods of publicity-driven paranoia — during the run-up to the supposed Mayan apocalypse at the end of December, he said, calls jumped up to one a day.


The joke was on the callers, however, because Hubbard's six-week lead time meant that no one who called because they had just seen a Mayan feature on TV could get a shelter built, much less on site and in the ground, in time to beat the end of the world. Luckily, the apocalypse was a bust.


And for all that he plays up Armageddon in all its possible varieties in his sales pitch, doomsday may not be that great a marketing tool. "If I just sold bomb shelters, there would be about this big of a market." Hubbard holds his thumb and forefinger a half-inch apart. "But if I say, 'man cave,' 'wine cellar,' 'getaway,' then I get the recreational shelter owner too."


He says most of his calls come from retired military men, doctors, lawyers and business owners — possibly because the latter are among the few categories of buyers with the wherewithal to plunk down $60,000 or $70,000 for a man cave/bomb shelter, plus installation.


The size of the overall shelter market is unclear, in part because its promoters make a point of secrecy about whom they sell to and where. Privately held Radius has claimed to sell more than $30 million worth of shelters a year, but you have to take their word for it.


Then there are firms like Vivos Group, a Del Mar, Calif., company that claims to have started survivalist communities in three states — but they appear to be sort of co-op arrangements in which you have to apply to be considered for "co-ownership" of your refuge community. Once you're chosen, they'll let you know where to go when the end times come.


"This is just the threshold of something that's going to become common," Hubbard said, putting a hopeful spin on his words as though aware that paranoia may be peaking today, but gone tomorrow. "So I say, don't buy a bomb shelter. Buy an underground cabin, and enjoy it."


Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.






Read More..

Twitter co-founders move Obvious Corp into spacious new digs






SAN FRANCISCO (Reuters) – Evan Williams and Biz Stone, the co-founders of Twitter, have leased three sprawling floors in a historic downtown San Francisco tower for their low-profile start-up incubator, The Obvious Corporation.


Obvious said Friday it leased 75,000 square feet at the busy 760 Market Street location – known as the Phelan Building – in one of the city’s larger commercial real estate deals in recent months.






The downtown space will be able to hold roughly 500 employees and signals ambitions at Obvious, which was re-constituted when Williams and Stone both left Twitter in 2011.


The incubator, with no more than two dozen employees, has mostly stayed out of the press except when it unveiled two new blogging platforms called Medium and Branch last September.


Although still thinly staffed, Obvious’s new space is larger than start-up Pinterest’s recently inked lease in the city.


“We need the right space from which to grow the Medium team and position Obvious to focus on bringing our new ideas to life,” Obvious CEO Williams said in a statement Friday about the new lease.


The company will occupy the seventh, eighth and ninth floors of the triangular building, which wraps around a central courtyard, said Jenny Haeg, a real estate agent who has brokered leases for Square Inc, Dropbox, Airbnb and other large tech startups.


(Reporting by Gerry Shih; Editing by Bob Burgdorfer)


Internet News Headlines – Yahoo! News





Title Post: Twitter co-founders move Obvious Corp into spacious new digs
Url Post: http://www.news.fluser.com/twitter-co-founders-move-obvious-corp-into-spacious-new-digs/
Link To Post : Twitter co-founders move Obvious Corp into spacious new digs
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment




Read More..

J.J. Abrams to produce Lance Armstrong biopic


LOS ANGELES (AP) — He's already gotten the Oprah treatment. Now Lance Armstrong is headed for the silver screen.


Paramount Pictures and J.J. Abrams' production company, Bad Robot, are planning a biopic about the disgraced cyclist, a studio spokeswoman said Friday.


They've secured the rights to New York Times reporter Juliet Macur's upcoming book "Cycle of Lies: The Fall of Lance Armstrong," due out in June. Macur covered the seven-time Tour de France winner for over a decade.


No director, writer, star or start date have been set.


Armstrong is in the midst of a two-part interview with Oprah Winfrey in which he admits to using performance-enhancing drugs to reach his historic victories, something he'd defiantly denied for years. The International Olympic Committee stripped him of his 2000 bronze medal this week.


Read More..

Business Briefing | Medicine: F.D.A. Clears Botox to Help Bladder Control



Botox, the wrinkle treatment made by Allergan, has been approved to treat adults with overactive bladders who cannot tolerate or were not helped by other drugs, the Food and Drug Administration said on Friday. Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity. “Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence,” Dr. Hylton V. Joffe, director of the F.D.A.’s reproductive and urologic products division, said in a statement. “Today’s approval provides an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.”


Read More..

A backyard nuclear shelter? Yes, paranoia does sell








One sterling quality of American businesses is that they'll try to make money from anything.


Paranoia, for instance. So say hello to Ron Hubbard, the owner of Montebello-based Atlas Survival Shelters, which converts huge corrugated metal tubes up to 50 feet long into fully equipped, all-the-comforts-of-home underground shelters at a price of up to about $78,000 each, not including shipping and interment.


You may have spotted the Atlas shop from the 5 Freeway as you're heading into downtown. There's a corrugated tube out front, painted bright yellow and looking like a tipped-over corn silo. High on the exterior wall facing the road is a banner declaring that the shelters offer protection from nuclear blasts, nuclear fallout, EMP (that's electromagnetic pulses, which can foul electrical systems), solar flares, mobs, looters, earthquakes and chemical warfare. If there's anything left off that list, it's probably not worth worrying about.






"People who buy my shelters are not radical crazy people," Hubbard told me recently as he guided me around the Montebello shop. "I get maybe three crazy calls a year. They're practical people."


Hubbard, 50, is a big Texan with a toothy grin and the friendly enthusiasm of someone trying to sell you something. He'll expound cheerily on the basic practicality, not to mention the sheer joy, of having a 40-foot corrugated steel drum buried 20 feet deep in your yard and tricking it out with a big-screen TV and Internet connection for those long days and nights hunkered down against nuclear blasts, the Chinese army or domestic looters. His shelters also offer such necessities as microwave ovens, space for a year's worth of provisions and high-grade air filtration.


"We don't know where our country will go," he said. "If we're going to be attacked, my shelters will protect you from Sarin gas or super flu. If we go bankrupt and we don't pay China, that could be the start of World War III. We could attack Iran or back Israel, and that could start a war. This is insurance. Why do we carry insurance on our homes? Just. In. Case."


Hubbard doesn't describe these dystopias as though he actually believes in them, but rather with the air of a salesman trying out any buzzword that might trigger a deal. During the couple of hours we were together, he described his products serially as underground condos, second homes, combination second homes and bomb shelters, man caves, man caves that happen to be bombproof, weekend cabins and hunting cabins.


Atlas Survival Shelters hasn't turned a significant profit yet. Hubbard said it made no money in the start-up year of 2011, was modestly in the black last year and may show a profit for 2013. But the business is unusual enough that it has won featured spots on several reality shows. An episode on A&E Network's "Shipping Wars" shows a team of moving experts trying to figure out how to transport a 32-foot shelter on their flatbed truck. During the episode Hubbard regales them with the virtues of the unit's escape-hatch feature, a second portal that opens only from the inside, in case of an attack.


"Somebody sees you going down; while they're trying to smoke you out, you're going to the back tunnel, you're gonna come up through an escape hatch that's hidden underground, you can shoot 'em in the back. Pretty cool, huh?" (Remarked one of the show's plainly creeped-out female cast members, "Remind me to never pay him a visit.")


More recently, Atlas was featured on an episode of the National Geographic Channel series "Doomsday Preppers," which chronicles the lifestyles of the scared and nervous. Hubbard's customer is described in network publicity as Brian Smith, a father of 12 "preparing for a total collapse of the U.S. monetary system."


Hubbard got into the underground shelter business a little more than a year ago after years of selling wrought-iron doors from the same location, operating as Hubbard Iron Doors. That business was brought low by the poor economy and cheap Chinese knockoffs, Hubbard says. It filed for bankruptcy in 2011; Hubbard says it's now owned and run by his brother, though the two companies share space with each other.


While he was casting about for a new business, Hubbard said, he happened across a brochure for Radius Engineering International, a Texas company that manufacturers fiberglass shelters mostly for business, government and military buyers. But the Radius products were expensive — they run from $150,000 up to millions, depending on the design and capacity. Hubbard thought he could do better on price while turning out a more appealing hideaway.


He's still trying to get a feel for the market, however. With his six or seven full-time workers, he can turn out one shelter a week. Orders, he said, come in at somewhere between one a month and one a week, more in periods of publicity-driven paranoia — during the run-up to the supposed Mayan apocalypse at the end of December, he said, calls jumped up to one a day.


The joke was on the callers, however, because Hubbard's six-week lead time meant that no one who called because they had just seen a Mayan feature on TV could get a shelter built, much less on site and in the ground, in time to beat the end of the world. Luckily, the apocalypse was a bust.


And for all that he plays up Armageddon in all its possible varieties in his sales pitch, doomsday may not be that great a marketing tool. "If I just sold bomb shelters, there would be about this big of a market." Hubbard holds his thumb and forefinger a half-inch apart. "But if I say, 'man cave,' 'wine cellar,' 'getaway,' then I get the recreational shelter owner too."


He says most of his calls come from retired military men, doctors, lawyers and business owners — possibly because the latter are among the few categories of buyers with the wherewithal to plunk down $60,000 or $70,000 for a man cave/bomb shelter, plus installation.


The size of the overall shelter market is unclear, in part because its promoters make a point of secrecy about whom they sell to and where. Privately held Radius has claimed to sell more than $30 million worth of shelters a year, but you have to take their word for it.


Then there are firms like Vivos Group, a Del Mar, Calif., company that claims to have started survivalist communities in three states — but they appear to be sort of co-op arrangements in which you have to apply to be considered for "co-ownership" of your refuge community. Once you're chosen, they'll let you know where to go when the end times come.


"This is just the threshold of something that's going to become common," Hubbard said, putting a hopeful spin on his words as though aware that paranoia may be peaking today, but gone tomorrow. "So I say, don't buy a bomb shelter. Buy an underground cabin, and enjoy it."


Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.






Read More..

Algeria raid puts a lawless region in the spotlight









CAIRO — The offensive by Algerian soldiers to free hostages at a natural gas complex has refocused world attention on the dangers of a lawless desert region bristling with gunrunners, smugglers and a virulent strain of Islamic ideology.


Coming days after French airstrikes on Islamist militants in neighboring Mali, the raid Thursday killed or wounded many militants and an unspecified number of Western and Algerian hostages, the Algerian government said. Officials in Algiers, the capital, said late in the evening that they had wrapped up the assault on the compound near the Algerian-Libyan border deep in the Sahara desert.


"The operation resulted in the neutralization of a large number of terrorists and the freeing of a considerable number of hostages," Communications Minister Mohamed Said Belaid told state-run media. "Unfortunately we deplore also the death of some.... We do not have final numbers."





The Algerian news agency said 45 hostages, including Americans, escaped the site. But later Algerian media reports indicated that only four to six foreign hostages were freed and that there were a number of "victims."


A Mauritanian news organization quoting a militant spokesman suggested that gunfire from Algerian military helicopters struck two vehicles attempting to flee the compound, killing 35 foreigners and 15 kidnappers, including the militant group's commander. The differing accounts were impossible to confirm or reconcile and epitomized a chaotic day that appeared to raise questions from Western leaders over the operation's planning.


In addition to as many as seven Americans, captives included Algerians, Britons, Japanese, Norwegians and other foreigners.


The army raid marked a surprising twist in a drama that had raised fears of a long siege and highlighted the revived Islamist extremism in the region.


To the west of Algeria lies Mali, where Islamist rebels have intensified their fight in recent days to overthrow the government, prompting French military action backed by American logistical support. To the east lie Tunisia and Libya, where revolutions beginning in 2010 overthrew President Zine el Abidine ben Ali in Tunis and Moammar Kadafi in Tripoli.


Since then, militant and radical Islamist groups, including Algeria's Al Qaeda in the Islamic Maghreb, have become more emboldened amid the political upheaval of new governments. Western countries have grown increasingly concerned that North Africa could become a seedbed for international terrorism.


The hostage drama unfolded in a gas field known as In Amenas, close to the border with Libya, a country of particular concern to Algeria. Extremists and weapons looted from Kadafi's military and police have flowed across the border for months.


Farther east, Egyptian authorities are concerned that militants from Algeria and Libya have joined terrorist cells in the Sinai Peninsula along the Israeli border.


It was the strife in Mali, however, that apparently led to the militant takeover of the Western-run gas compound Wednesday. The Algerian militants, who belonged to an Al Qaeda-linked group called the Signed-in-Blood Battalion, said they were acting in retaliation for French airstrikes against advancing Malian rebels. They reportedly threatened to blow up the plant if Algerian commandos attempted to free the hostages.


After the compound was seized by the militants, hundreds of Algerian soldiers firing warning shots ringed the remote compound as helicopters skimmed overhead. The militants asked for safe passage to Libya, with the hostages accompanying them. Algerian officials, who over the years have cracked down harshly on Islamic radicals, said they would not consider such requests.


"The authorities do not negotiate, no negotiations," Interior Minister Daho Ould Kabila said on state television. "We have received their demands, but we didn't respond to them."


The Algerian government was under pressure from the U.S., Britain and other countries whose nationals were taken hostage. But the raid caught some by surprise and appeared to irritate some Western leaders. British Prime Minister David Cameron's office said he would have preferred to have been told in advance of the operation.


"I think we should be prepared for the possibility of further bad news, very difficult news in this extremely difficult situation," Cameron said.


The State Department declined to provide details of the Algerian offensive, saying it could endanger hostages, some of whom were reportedly forced to wear explosives-laden belts.


White House spokesman Jay Carney told reporters, "We are certainly concerned about reports of loss of life and we are seeking clarity from the government of Algeria."


The Algerians are "used to fighting terrorism, in their own, quite hard way," said Mathieu Guidere, a professor of "Islamology" at the University of Toulouse in France and author of "The New Terrorists." "It's likely the deaths at the petrol base were as a result of the assault by the Algerian security forces."


Reports have suggested that as many as 41 foreigners were being held along with scores of Algerians. An Irishman who was among them contacted his family to say he had been freed.


The natural gas field complex at In Amenas, which supplies Europe and Turkey, is a joint venture operated by BP; Statoil, a Norwegian firm; and Sonatrach, the Algerian national oil company.


The assault on the compound dramatically changed the dynamics of Algeria's decades-long campaign against radicals. Militants had rarely, if ever, targeted oil and gas operations, even during the 1990s civil war, when few rules applied amid beheadings and massacres. Their seizure of the compound was a direct strike at the government and the nation's economic and political stability.


The civil war in Algeria, a country rich in oil and gas and with a spectacular coast and vast deserts, killed more than 100,000 people. The conflict began when the military, fearing Islamists would come to power, shut down parliamentary elections and the country collapsed into turmoil.


The government offered an amnesty program more than a decade ago. Thousands of militants accepted, but hard-core members of what had become Al Qaeda in the Islamic Maghreb resisted. The group publicly joined Al Qaeda in 2006, sending recruits to fight U.S. forces in Iraq while expanding its suicide bombings and kidnappings of businessmen and Westerners for ransom in Algeria.


AQIM and other Algerian radicals are heavily armed and fluid, shifting much of their attention last year to neighboring Mali, where they joined rebels and Islamists in a war to overthrow the government. Mali has attracted extremists from across Africa and the Middle East who are attempting to exploit the country's instability to create an Islamist state.


Two top radicals are believed to be connected to the gas field seizure: Abdelmalek Droukdel, AQIM's leader, who has called for militants to target France over its intervention in Mali, and Mokhtar Belmokhtar, a mercurial, one-eyed smuggler and kidnapper who runs the Signed-in-Blood Battalion, an AQIM splinter group that claims to have carried out Wednesday's predawn attack.


The hostages at the complex "who managed to reach loved ones abroad said the terrorists that captured them have Egyptian, Tunisian, Libyan accents," said an Algerian risk-assessment analyst who asked to remain anonymous because of the sensitivity of his job.


jeffrey.fleishman@latimes.com


Special correspondents Kim Willsher in Paris and Reem Abdellatif in Cairo and Times staff writers Henry Chu in London and Paul Richter in Washington contributed to this report.





Read More..

Robert Wagner not interviewed in new Wood inquiry


LOS ANGELES (AP) — Robert Wagner has declined to be interviewed by detectives in a renewed inquiry into the drowning death of his wife Natalie Wood three decades ago, an investigator said Thursday.


Wagner was interviewed by authorities soon after Wood's drowning in 1981, but the actor is the only person who was on the yacht the night Wood died who has not spoken to detectives as part of the latest inquiry, despite repeated requests and attempts, sheriff's Lt. John Corina said.


Blair Berk, an attorney for Wagner and his family, said the actor had cooperated with authorities since his wife died.


Detectives began re-investigating the case in November 2011. Since then investigators have interviewed more than 100 people, but Wagner has refused and Corina said the actor's representatives have not given any reason for his silence.


The detective's remarks provided new insight into the case that has remained one of Hollywood's enduring mysteries. Earlier this week, coroner's officials released an updated autopsy report that had been under a security hold. It detailed why Wood's death had been reclassified from an accidental drowning to a drowning caused by "undetermined factors."


"Mr. Wagner has fully cooperated over the last 30 years in the investigation of the accidental drowning of his wife in 1981," Berk said in a prepared statement. "Mr. Wagner has been interviewed on multiple occasions by the Los Angeles sheriff's department and answered every single question asked of him by detectives during those interviews."


After 30 years, Berk said, neither Wagner nor his daughters have any new information to add. She said the latest investigation was prompted by people seeking to exploit and sensationalize the 30th anniversary of the death.


The renewed inquiry came after the yacht's captain Dennis Davern told "48 Hours" and the "Today" show that he heard Wagner and Wood arguing the night of her disappearance and believed Wagner was to blame for her death.


Authorities have not identified any suspects in the case.


Wood, 43, was on a yacht with Wagner, Christopher Walken and the boat captain on Thanksgiving weekend of 1981 before she somehow ended up in the water.


Corina said Walken gave a prepared statement and spoke to detectives for an hour.


Detectives have also interviewed other actors who knew both Wagner and Wood to learn more about their relationship.


Corina said detectives have tried at least 10 times to interview Wagner but have been refused. He said some of the refusals have come from the actor's attorney, and that detectives at one point traveled to Colorado to try to speak with Wagner but were unsuccessful.


Corina said the latest inquiry had turned up new evidence.


"Most of the people we've talked to were never talked to 30 years ago," he said. "We've got a lot of new information."


Asked if the information might lead to criminal charges, Corina said that would be up to prosecutors if they are presented a case.


"All we can do is collect the facts," he said. "We're still trying to collect all the facts."


Corina said new people have emerged with information each time the case is in the news. Detectives would like to interview other people who haven't agreed to talk, he said.


Coroner's officials released an update autopsy report on Monday that detailed the reasons Wood's death certificate was changed last year from a drowning death to "drowning and other undetermined factors."


The updated report states the change was made in part because investigators couldn't rule out that some of the bruises and marks on Wood's body happened before she went into the water.


"Since there are unanswered questions and limited additional evidence available for evaluation, it is opined by this medical examiner that the manner of death should be left as undetermined," Chief Medical Examiner Dr. Lakshmanan Sathyavagiswaran wrote in the report completed in June.


Officials also considered that Wood wasn't wearing a life jacket, had no history of suicide attempts and didn't leave a note as reasons to amend the death certificate.


Wood was famous for roles in films such as "West Side Story" and "Rebel Without a Cause" and was nominated for three Academy Awards.


Conflicting versions of what happened on the yacht have contributed to the mystery of her death. Wood, Wagner and Walken had all been drinking heavily in the hours before the actress disappeared.


Wagner wrote in a 2008 memoir that he and Walken argued that night. He wrote that Walken went to bed and he stayed up for a while, but when he went to bed, he noticed that his wife and a dinghy that had been attached to the yacht were missing.


"Nobody knows," he wrote. "There are only two possibilities; either she was trying to get away from the argument, or she was trying to tie the dinghy. But the bottom line is that nobody knows exactly what happened."


___


Anthony McCartney can be reached at http://twitter.com/mccartneyAP


Read More..

Well: The Fallout of a Chance Medical Finding

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

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

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

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

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

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

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

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

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


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

Read More..

Boeing faces battles: fixing Dreamliner and winning back fliers









Marian Burkhart was looking forward to traveling on Boeing's 787 Dreamliner. She and her husband settled into their seats, picked a movie and waited for what she called the "Taj Mahal plane" to take them from Houston to Los Angeles.


Then the pilot came on the intercom with surprising news: All passengers had to get off the plane because federal regulators had grounded the so-called aircraft of the future, concerned by fires caused by its electronics system.


Burkhart, 48, now isn't sure whether she'll fly on a 787.





"It's a beautiful plane…but I would wait awhile," she said, moments after arriving in Los Angeles on an older airplane. "I want to make sure there aren't any additional incidents."


Boeing Co. is now battling on two fronts: fixing the source of the problem and regaining the trust of the flying public. This is not what the aerospace giant had planned for the 787, which the company promoted as "defining 21st century flight."


FULL COVERAGE: Boeing's troubled Dreamliner


The last time the Federal Aviation Administration grounded a large commercial jet was 36 years ago when a DC-10 crashed at Chicago O'Hare International Airport, killing all 271 aboard.


The FAA's move to ground the Dreamliner has shaken confidence among travelers and the aviation community at large as regulators around the world took similar action against the 787.


In the latest 787 incident, smoke was seen coming from the right side of a plane belonging to Japanese carrier All Nippon Airways shortly after an emergency landing. All 137 passengers and crew were evacuated from the aircraft and slid down the Dreamliner's emergency slides. Video of the event was captured by an onboard passenger and has been broadcast worldwide.


"Welcome to the era of social media, Boeing," said Michel Merluzeau, managing partner of aerospace consultant G2 Solutions in Kirkland, Wash. "That sort of thing is going to be seen by millions of people. As much as Boeing says it's 'teething issues' with a new plane, they're running out of time."


New planes, in general, have growing pains. But the FAA's examination into the 787's power system is incredibly rare for a plane in service more than a year.


At issue is the Dreamliner's electrical system and power-distribution panels, which involve pervasive use of lithium-ion batteries. The technology, also found in cellphones and electric automobiles, has a history of being involved in fires. The Dreamliner is the first large commercial aircraft to use the technology on such a large scale.


Oliver McGee, a former deputy assistant secretary at the Department of Transportation, said he believes the FAA acted appropriately in grounding the Dreamliner fleet.


"The worst thing we could have is a massive fire 30,000 feet in the air," McGee said. "I think the grounding and improvements are essential. That said, the Boeing 787 is a safe airplane.... Any time you're doing mass engineering you have to be patient as you take out the glitches."


Boeing said in a statement that it believes the 787 is safe and is working with its airline customers and regulators to resolve the issue.


"The safety of passengers and crew members who fly aboard all Boeing airplanes is our highest priority," Boeing said in the statement. "We are confident the 787 is safe, and we stand behind its overall integrity. Our customers are also standing behind the 787 and understand the value it brings to them and their passengers."


Correcting the problem is only part of Boeing's battle. It must repair the Dreamliner's image with airlines as well as passengers.


"The longer it drags on, it obviously isn't great for Boeing's reputation or credibility," said J.B. Groh, an aerospace analyst who covers Boeing for D.A. Davidson & Co. "Boeing unfortunately lives in a fish bowl, so every issue with the 787 is analyzed ad nauseam. I don't think there's a lot you can do to fix that."


Boeing should be open with the public as it finds a solution, said Prashant Malaviya, a marketing professor at Georgetown University.


"In the mind of the customer, the brand has eroded already," Malaviya said. "Fixing the real problem is not enough. The biggest thing they can do is have some transparency in the process of fixing it and then publicize that."





Read More..

U.S. finalizes rules for financial firms to avoid foreclosures









In a major effort to heal the $10-trillion U.S. mortgage market, the Consumer Financial Protection Bureau has finalized rules designed to ensure financial firms offer every available option to keep delinquent borrowers in their homes.


The regulations, to be announced Thursday, address widespread complaints that loan servicers — the companies that collect mortgage payments and repossess homes — were woefully unprepared to help borrowers during the tsunami of foreclosures after the housing bust.


They are designed to complement previous settlements by major banks over allegations of widespread servicing and foreclosure abuses. But unlike earlier settlements, they will apply to all large mortgage servicers, not just banks, in all states.





Still, the rules drew immediate criticism from a prominent consumer group, which said they don't do enough to force servicers to consider easing the terms of mortgages and expressed fears that the rules might preempt stronger existing provisions.


"While the establishment of industrywide standards is important, the failure to require meaningful loan modification protections is a retreat from current safeguards under the soon-to-expire [Obama administration] loan modification program," said Alys Cohen, an attorney with the National Consumer Law Center.


The consumer bureau was created when Congress passed the sweeping Dodd-Frank financial reform act in reaction to the mortgage meltdown and the global economic crisis that ensued. The law also required lenders to ensure that they only make loans that borrowers can reasonably be expected to repay.


Last week, the bureau issued major regulations providing a "safe harbor" from lawsuits under that new requirement for lenders who make certain types of presumably sound home loans. A key requirement is that total debt payments for borrowers — including principal, interest, taxes and insurance on home loans — be no more than 43% of gross income.


The rules to be released Thursday, which take effect in a year, bar lenders from pursuing foreclosure proceedings against borrowers while applications for loan modifications are pending — the much-criticized practice of "dual tracking."


The consumer bureau said banks also must provide "direct, easy, ongoing access" to employees who are required to alert borrowers to missing information, provide status reports on modification requests and ensure documents don't get lost.


Banks also are required to inform borrowers who miss two monthly payments about options to avoid foreclosure and to wait until loans go 120 days delinquent before beginning a foreclosure — a provision that would preempt a 90-day requirement under California law.


Richard Cordray, the consumer bureau's director, said distressed borrowers had not gotten the help and support they deserved, such as "timely and accurate information about their options for saving their homes."


"Servicers failed to answer phone calls, routinely lost paperwork and mishandled accounts," Cordray said in remarks to be delivered at an industry conference Thursday.


"Communication and coordination were poor, leading many to think they were on their way to a solution, only to find that their homes had been foreclosed on and sold," he said. "At times, people arrived home to find they had been unexpectedly locked out."


The new rules don't apply to most small banks and credit unions. Bureau officials said they have had few complaints about these small institutions, which are more likely to keep loans on their books, rather than sell them, and generally devote more attention to individual customers.


Servicers often are collecting payments on behalf of loan owners, who may be the banks themselves but more often are trusts created on behalf of mortgage investors. The investors have mandated a wide range of relief programs for troubled borrowers in addition to government-sponsored programs such as the Obama administration's Home Affordable Modification Program.


In the past, servicers would sometimes not inform troubled borrowers about all the options, instead steering them into foreclosure or programs that provided the servicers with greater financial rewards, bureau officials said.


The servicers are now supposed to clearly explain all alternatives to borrowers so they can pick the best one. The new rules also establish clearer opportunities for borrowers to appeal servicers' denials of loan modifications.


In addition to worries that the bureau has not cracked down hard enough on servicers, consumer advocates expressed concern that the new rules will not take effect for a year.


"While we understand that servicers need time to implement complex procedures, we're still in the middle of a foreclosure crisis," Cohen said. "Many people will unnecessarily lose their homes if we wait a year."


scott.reckard@latimes.com





Read More..