Friday, July 27, 2007

The yuck factor: How scientific research into revulsion is shaping our supermarkets



The yuck factor: How scientific research into revulsion is shaping our supermarkets
Toenail clippings, creepy-crawlies, rotting food – scientists devote their research to the most disgusting things. But there are serious lessons to be learnt about revulsion.
By Simon Usborne
Published: 11 July 2007

You watch as a dead but sterilised cockroach is dipped for two seconds into a freshly poured glass of orange juice. Then you're offered a sip. Do you raise the glass to your lips and take a gulp – after all, there's nothing wrong with the juice – or do you turn up your nose in disgust and push it away?
That was the choice given to a group of scientists at a lecture by Professor Paul Rozin, a specialist in the psychology of disgust. Everyone rejected the juice, and if the very thought of it causes you emit a "yuck", Professor Rozin is proving his theory – the concept of touch-transference.
Rozin's research says that if something we perceive to be dirty or disgusting (such as a cockroach) touches something harmless (such as orange juice), in our minds the latter becomes "contaminated", even if the rational side of our brain knows there is nothing physically wrong with it.
Among the participants in Rozin's experiment were Andrea Morales, an assistant professor of marketing at Arizona State University, and Gavan Fitzsimons, a psychology and marketing professor at Duke University, North Carolina. The scientists were fascinated by Rozin's work and began to wonder how disgust could shape consumer behaviour.
An article Morales and Fitzsimons published in the Journal of Marketing Research last month suggests that as we push our trolleys around the supermarket, a lot more goes through our minds than how to nab the best bargain. According to their research, "disgusting" items on the supermarket shelf – such as lard, nappies, athlete's foot cream – can have a remarkable effect on the way we view other products that come into contact with them. "It's predominately a non-conscious effect," says Morales. "It sounds ridiculous to not want a packaged product that was touching another packaged product, but it's real."
So what separates a disgusting product from a desirable one? To find out, Morales drew up a list of the 200 top-selling food and non-food items from an average supermarket. She then asked volunteers to evaluate them using a 10-point scale of disgust. Scores above five indicated a moderate level of repulsion. These products included sanitary products and stomach medicines (" Just the word 'gastrointestinal' was enough to elicit a negative response," says Morales) as well as cat litter, dog food, and rubbish bags. Cigarettes topped the disgust chart.
"We didn't ask them to explain their choices," says Morales. " But in most cases you can kind of understand them." But there was one decision Morales couldn't explain. "There was an interesting reaction to mayonnaise," she says. "Half the population doesn't find it at all disgusting but the other half is grossed out by it."
With her "disgusting" trolley filled, Morales took a second basket of more appealing items such as biscuits and rice cakes, and arranged the products on a supermarket shelf for a number of tests. In all cases the items remained sealed, removing any risk of actual contact, much less contamination. The only variable was that in some instances the desirable products touched the disgusting ones, while in others they were separated by a few inches.
Volunteers were then asked to look at the shelf, but were not told why. After a few minutes they were asked questions such as "how much would you pay for this item?", or "how appealing do you find this item?" .
"The results were incredibly strong," says Morales. "We always found that in the touching conditions, ratings of the cookies or rice cakes would always be lower than when they were not touching." Even more surprising were the results of a second test in which participants were asked to evaluate the products more than an hour after viewing them, still not realising what the experiment was about. "The effect was the same," says Morales. "When my students hear the theory they always say it wouldn't happen to them, but they're amazed when they react in the same way."
British psychologist Dr David Lewis, an expert on the science of the supermarket, or "trolleyology", as it has become known, says these kinds of responses serve an important evolutionary function: "It seems irrational not to eat biscuits because they're on a shelf next to some nappies when both are wrapped up in layers of cellophane, but these inbuilt disgusts are designed to prevent us doing things which could harm us." Morales adds: "There are plenty of cases where the effect is rational – if a cockroach touches orange juice we know we shouldn't drink it – but we seem to have generalised what is rational to include cases where it simply doesn't apply."
So are supermarkets aware of product contagion? "They are generally aware of everything," says Dr Lewis, who has advised some of the UK's top retailers. "These aren't shops but machines designed to sell, and you'd be amazed how much thought goes into product placement."
But Morales suggests shop managers could do more. "Store layout is becoming more important as supermarkets start clustering products that wouldn't normally appear together." Morales points to "baby" aisles as a prime example where "disgusting" products such as nappies or wipes might appear next to baby food or toys. "If they separated them they'd sell more," she says.
Morales also advises supermarkets to let shoppers keep products apart away from the shelf. "They could put more separators in trolleys to keep things from coming into contact with each other. Or an extra bag to put diarrhoea medicine in."
Measures like this might seem unnecessary but Morales says they could affect profits. "Usually it takes a while for research like this to trickle down to managerial practice," she says. "But it's only a matter of time before they say, 'Wait – we should apply this.'"
This isn't the first time Morales has studied the psychology of disgust on the shop floor. She achieved similar results in earlier research into " consumer contamination". When picked up this newspaper, did you take the second one in the pile? If you did, you're not alone. "It's the same mechanism," says Morales. "We feel disgusted knowing someone else may have been in contact with the products we want to buy so we devalue these 'contaminated' products."
However irrational, this response serves the same evolutionary function: to prevent the spread of disease. If we know or assume an item has already been touched, we assume the "contaminator" has had a negative effect on it that could pose a risk. But in one experiment, where Morales hired models to handle T-shirts in a mock-up of a clothes shop, the opposite is also true.
It's no mystery that attractive sales assistants help sell more clothes, but Morales' research shows it's not as simple as that. In her experiment, shoppers who had seen someone attractive of the opposite sex touching a T-shirt were more likely to buy it. "It isn't enough for an attractive person to like a T-shirt – they have to touch it and 'transfer' their attractiveness on to it."
So what's next for Morales and Fitzsimons? A new study will take them back to the supermarket and to how we behave not when we see a disgusting product, but when we have to buy one. Preliminary research suggests that adding something nasty to our shopping list can affect what else we buy and even force us into making unplanned purchases.
"If we go in for antifungal foot cream, we might then subconsciously choose to get some soap to fight the feeling of disgust we have. We might also put off buying things like fruit and veg."
So could that spell the end of the in-store chemist and pet food aisle? " At f irst we thought the effect might cut down the size of the basket, so maybe that would have had implications on the kinds of products stores stock, but we found that it changes the types of products, not the quantity. If supermarkets sell more soap, well that's probably OK with them."

The anatomy of disgust

* International surveys have revealed universal sources of disgust, including bodily secretions, wounds, corpses, toenail clippings, decaying food, creepy crawlies, and people who are ill.

* Most scientists believe we are genetically hardwired to be disgusted by things that could make us ill, and that a "disgust gene" arose through the process of natural selection.

* Disgust grows as we learn what might pose a threat; babies presented with fake faeces find them fascinating, while older children and adults are repulsed.

* Studies have revealed culture-specific disgusts, including dog meat in the UK, food cooked by menstruating women in India, and fat people in the Netherlands.

* The way we express disgust is universal; we use the same facial expression, triggered by the anterior insular cortex part of the brain, and even the same word – "yuck".

Hard sell: the things that get left on the shelf

Baby food and nappies

It might seem logical to group baby products on the same supermarket aisle, but research suggests items that come into contact with nappies, with all their connotations, become contaminated in our minds.

Mayonnaise and soup

Researchers were surprised when many subjects singled out mayonnaise as a " disgusting" product which, when shelved next to more palatable products such as soup, might put customers off buying.

Feminine hygiene products and paper towels

According to research, tampons and face towels should never share shelf space. Psychologists say the "yucky" associations of hygiene products taint items that we choose for their cleansing qualities.

Diarrhoea medicine and aspirin

Anything with the word "diarrhoea" or "gastrointestinal" is enough to turn the stomach, and, on a subconscious level, could taint products such as aspirin, which ideally are seen by consumers to have cleansing connotations.

CCTV warning for Beijing kissers




CCTV warning for Beijing kissers
Wednesday, July 25, 2007
CCTV

The next time you're in Beijing and fancy kissing someone in public, be warned - you could be caught on closed-circuit television, and labeled as a criminal by the computers who monitor the footage.
According to reports, Beijing's couples are being warned that 'intimate acts of lovers may be initially categorized as "kidnapping" or "robbery" by the computers, which are programmed to be sensitive to violations of safe distances.'
But fortunately, the young lovers' fate won't be decided purely by some emotionless machine which doesn't understand the concept of 'love'. In such situations, police officers monitoring the cameras will look at the footage of the kissing people to decide if the situation really is dangerous. Which is both reassuring, and slightly creepy.
But there will be some warning for amorous couples, the Xinhua news agency said. Signs will go up next month in areas covered by the cameras, saying in Chinese and English 'you are entering a camera-monitored zone.' Which should kill any romance nicely.
Closed-circuit cameras are becoming more common in Beijing, and Xinhua said that before next year's Summer Olympics the city plans to unify the monitoring of the cameras. There are currently networks monitored separately by the police, and transport, public utilities and maintenance departments.

Pot smoking linked to psychotic disorders




Pot smoking linked to psychotic disorders
Heavy marijuana use doubles the risk, new research finds.
By Jia-Rui Chong, Times Staff Writer
July 27, 2007
People who smoke marijuana daily or weekly double their risk of developing a psychotic illness over their lifetime, according to a study published Thursday.
Among all cannabis users, including sporadic experimenters and habitual users, the lifetime risk of psychotic illness increased by 40%, the report said.
"It's not as if you smoke a joint and you're going to go crazy," said Richard Rawson, who directs the Integrated Substance Abuse Program at UCLA and was not involved in the study.
But he cautioned: "It's definitely not a good idea to use heavy amounts of marijuana."
The researchers found that the risk for psychotic illnesses did appear to increase with dose, suggesting that stopping marijuana use would decrease risk, said coauthor Dr. Stanley Zammit, a psychiatrist at Cardiff University and the University of Bristol in Britain.
Psychotic illnesses include schizophrenia and disorders with such symptoms as hallucinations or delusions.
Marijuana is the most commonly used illicit drug in the U.S., according to the federal government. In 2006, about 42% of America's high school seniors reported having tried marijuana at least once, according to an annual report funded by the National Institute on Drug Abuse.
Marijuana can cause psychiatric problems because it throws off the balance of neurotransmitters in the brain, Zammit said.
Previous studies have had difficulty untangling marijuana's role in psychiatric disorders. Smoking the drug could be a symptom of a disorder rather than a cause.
The study by Zammit and colleagues, published in the medical journal the Lancet, reanalyzed data from seven long-term studies on psychotic illnesses and marijuana involving 61,000 participants.
The researchers filtered out about 60 factors, such as preexisting mental illness and the use of other illicit drugs, and considered IQ and social class, to try to isolate the effect of marijuana, Zammit said.
Most of the studies that were analyzed indicated a range of increased risk for frequent users from 50% to 200%, with the average being about 100%, or double the risk, Zammit said.
The researchers also studied the relationship between marijuana use and mood disorders, such as depression and bipolar disorder. They analyzed 22 studies involving 52,000 participants.
The researchers found that any marijuana use increased the lifetime risk for mood disorders by about 40%, and weekly or daily use increased the risk by about 50%.
The mood disorder studies were less successful in filtering outside factors, so the increased risk may be unrelated to smoking marijuana, Zammit said.
Dr. Victor Reus, a psychiatrist at UC San Francisco who was not involved in this study, said he was unconvinced by Zammit's conclusions for both psychotic and mood disorders.
Too many outside factors contribute to the disorders, and the studies Zammit used were too vague to draw hard conclusions, he said.
"There's a limit to what you can do with the data that's in these studies," he said.
--
jia-rui.chong@latimes.com

Scorpion venom offers improved cancer surgery




Scorpion venom offers improved cancer surgery
By Sadie Gray
Published: 16 July 2007

A substance derived from scorpion venom could be the key to more effective treatment for a wide range of cancers, researchers say.
Turned into a "paint" which can distinguish even a small number of cancerous cells from healthy tissue, the venom would vastly improve surgeons' accuracy when removing tumours.
Scientists found that chlorotoxin, a chemical in the venom, would attach itself to cancer cells. Joined to a fluorescent marker, Cy5.5, it becomes a molecular beacon which emits light near the infra-red spectrum, illuminating whole tumours or even clusters of only a few hundred cancerous cells. When injected, it sticks to cancer cells within two minutes.
Precision is paramount in operations to remove tumours, when cancerous cells can be missed and left behind. It is especially important when dealing with the brain, where some 80 per cent of malignant cancers return at the edge of surgical sites and where surrounding neurons must not be damaged.
At the moment, surgeons use colour, texture and blood supply to tell cancerous from healthy tissue. The paint marks tumours with at least 500 times more sensitivity than a magnetic resonance imaging scan, which will only work if more than a million cancer cells are present. Lasting for two weeks, it also massively outperforms contrast agents currently used to show up cancers, which last only a few minutes.
The research team, from Seattle Children's Hospital and the Fred Hutchinson Cancer Research Centre in Washington, found in tests on mice that they could illuminate brain tumours as small as 1mm in diameter. In another case they detected 200 prostate cancer cells travelling through a mouse's lymph system.
Dr James Olson, who led the team, said: "My greatest hope is that tumour paint will fundamentally improve cancer therapy. By allowing us to see cancer that would be undetectable by other means, we can give our patients better outcomes."
Dr Richard Ellenbogen, a paediatric neurosurgeon at Seattle Children's Hospital, co-wrote the study, which was published in the journal Cancer Research. He said: "This development has the potential to save lives and make brain tumour resection safer."
The researchers are due to start clinical trials in humans and say the paint could be used in surgery in as little as 18 months.
Experts in the UK say more research is needed into why the molecule only binds to tumour cells, and to ensure it is not toxic in humans. Professor John Griffiths, head of molecular imaging at Cancer Research UK's Cambridge Research Institute, said: "The big problem with surgery for brain cancer is that tumours can infiltrate normal brain tissue, making it very hard to tell where the tumour ends and the normal tissue begins. If you could light up the tumour cells by shining an infra-red beam on them, it might be very helpful."
Chlorotoxin:Cy5.5 could be used as a non-invasive screening tool for the early detection of skin, cervical, oesophageal, colon and lung cancers, and may help identify positive lymph nodes in patients with breast, prostate and testicular cancers.

Are You Right Eyed Or Left Eyed?




Are You Right Eyed Or Left Eyed?

Science Daily — A person has two hands, two legs, two eyes, two cerebral hemispheres. But it is only at first sight that a human being is a symmetric creature. Firstly, we have a leading hand, the right one with the majority of people, secondly, we have a leading eye. Thirdly, the brain is functionally asymmetric: the left hemisphere (with the right-handers) is mainly connected with abstract-logical thinking and to a larger extent - with speech, the right hemisphere – with image sensitivity.
Coming back to eyes, the right eye is the leading one among the two thirds of people, and the left one among one third of people. Special tests have been developed to determine this. Do these individual differences influence the visual information perception process, for example, perception of texts, on the left and on the right? Investigations carried out at the Institute of Cognitive Neurology of the Modern University for the Humanities will help to answer this question.
The experiment involved all right-handed students, but some of them had the right eye leading, the others – the left eye leading. All probationers were offered to read a text on the PC screen, the text being placed either in the right or in the left part of the screen, while the probationers’ head was oriented to the center (in such conditions, visual information from the left half-field of vision was addressed to the right hemisphere, and vice versa). It has turned out that the “left-eyed” probationers read the text quicker when it is placed on the left, than the text placed on the right. As for the “right-eyed” individuals, no such differences were noticed with them.
More detailed analysis has proved that when the “left-eyed” probationers were reading the left-side text, the brain perceived (during a single eye fixation on some text fragment) more symbols than in case of reading the right-hand text.
In other words, in the left half-field of vision, glance fixation is characterized by higher “information capacity”. This is directly connected with the speed of reading: the more symbols the glance perceives during one fixation, the quicker a person reads. There is one more sign of successfulness of reading: in the course of reading, the glance periodically returns back to the already read word (apparently due to difficulty of perception). Thus, in the left-sided text, the “left-eyed” probationers made less returns than they did in the right-sided text, which means higher successfulness of the “left” text recognition. Besides, the majority of the “left-eyed” persons performed faster quick eye movements – saccades – to the left than to the right.
Physiologists can only make assumptions about the reasons for such differences.
As all the probationers are right-handed persons, the control over their leading right hand is performed by the left hemisphere. With the right-eyed, the same left hemisphere also controls the leading right eye. As for the left-eyed persons, the leading left eye is controlled by the right hemisphere, which is free from control over the leading hand’s movements.
And this works out better. Therefore, the “left-eyed” persons read quicker on their left.
Where can this knowledge prove useful? Apparently, it makes sense to take the leading eye into account for production of various video-products, for example, training ones. Special objects (spoons, door-handles) are produced, even though not in Russia, for the left-handed, but there is nothing special made for the “left-eyed” persons. Maybe this will be done in the future.

Note: This story has been adapted from a news release issued by Informnauka / Russian Science News Agency.

Brain Cells Need MicroRNA To Survive


Compared to healthy mouse Purkinje cells (left), those lacking the Dicer gene, which is required for cells to produce microRNAs, are significantly degenerated (right). The results suggest that the loss of microRNAs may be involved in neurodegenerative disorders. (Credit: Image courtesy of Rockefeller University)



Brain Cells Need MicroRNA To Survive

Science Daily — There are lots of things that brain cells need to survive. Add to that list microRNAs. New research from Rockefeller University shows that neurons that cannot produce microRNAs, tiny single strands of RNA that regulate the expression of genes, slowly die in a manner similar to what is seen in such human neurodegenerative disorders as Alzheimer’s and Parkinson’s diseases.
Reporting in July 2 online edition of the Journal of Experimental Medicine, the researchers say that although no one has yet found microRNAs to be involved in any disease, their study in mice shows that these tiny snippets of RNA are essential for survival of mature neurons.
“This research tells us that microRNAs are needed if certain neurons are to function and survive, and that means they are likely involved in survival of other neurons as well,” says the study’s senior investigator, Paul Greengard, head of the Laboratory of Molecular and Cellular Neuroscience. “That leads us to hypothesize that abnormalities in microRNA expression might be causing or modifying disease progression.”
The researchers specifically found that mice engineered to stop expression of microRNAs in cerebellar cortex neurons after birth experienced a slow decline in function, resulting in death of the neurons, known as Purkinje cells. Because this brain area helps control motor function, mice without functioning Purkinje neurons could no longer walk correctly.
Since the use of these particular cells was a model system testing deletion of microRNAs, the results can likely be extended to other types of neurons, such as those involved in memory and higher thinking, says the study’s lead author, Anne Schaefer, a postdoctoral fellow in Greengard’s lab. These findings are “very exciting,” she says. “There was no evidence that mature neurons, which are differentiated and don’t divide any more, would require microRNAs for their function or survival.”
Since their discovery in 1993, microRNAs have been found to be powerful regulators of gene expression, but mainly in cells that are developing. Differentiating neurons expressed a large variety of microRNAs, Schaefer says, and development stops if microRNAs cannot function. While these bits of RNA were also known to exist in mature neurons, no one knew if they play any role in the life of adult neuronal cells, she says.
To find out what role they do play, the research team cross-bred three different kinds of mice. One, created by co-author Dónal O’Carroll, in the Rockefeller Laboratory of Lymphocyte Signaling, is known as a “Dicer conditional” mouse. It gives researchers the ability to delete a gene known as Dicer, whose protein is required to produce microRNAs. They cross-bred these mice with another line, produced by researchers at the University of Hong Kong, that expresses a protein, Cre-recombinase, that inactivates Dicer in postnatal Purkinje cells. The offspring of these mice were then bred with a mouse engineered to express green fluorescent proteins when Dicer is deleted. In this way, the researchers were able to follow Dicer deletion and could then test for the presence of different microRNAs known to be expressed in the adult brain.
They found that some microRNAs were deleted right away but that others took longer, and during this time, the cells were basically stable although slowly degenerating. Eventually the “mice showed symptoms reminiscent of those seen in humans with neurodegenerative disorders, and by 18 weeks almost all of the Purkinje cells had died,” Schaefer says.
Whether changes in specific microRNAs contribute to human disorders remains to be seen, she says, but now researchers have ways to test that. They can compare microRNA expression between normal and diseased human brains and they can knock out specific microRNAs in their mouse model to determine which may be playing the more critical roles. “Now we have a roadmap for identification of genes which might be involved in neurodegeneration and that is very exciting,” Greengard says.

Note: This story has been adapted from a news release issued by Rockefeller University.

Brain's 'Hearing Center' May Reorganize After Implant Of Cochlear Device




Brain's 'Hearing Center' May Reorganize After Implant Of Cochlear Device

Science Daily — Cochlear implants--electronic devices inserted surgically in the ear to allow deaf people to hear--may restore normal auditory pathways in the brain even after many years of deafness.
The results imply that the brain can reorganize sound processing centers or press into service latent ones based on sound stimulation. Jeanne Guiraud, PhD, and colleagues at the University of Lyon, Edouard Herriot University Hospital, and Advanced Bionics, a firm that makes cochlear implants, worked with deaf subjects from 16 to 74 years old and found that younger subjects and those with a shorter history of deafness showed changes that mirrored patterns in people with normal hearing more closely.
"The results imply a restoration to some extent of the normal organization through the use of the cochlear implant," says Manuel Don, PhD, of the House Ear Institute in Los Angeles. "They also claim to find ties between the degree of restored organization and a hearing task. Such ties are of enormous importance in evaluating cochlear implant benefits." Don was not involved in this study.
Guiraud and her team studied 13 profoundly deaf adults who had received cochlear implants, on average, eight months before the study. Electrical stimulation to the ear allowed the team to locate where in the brain's auditory cortex various frequencies were processed and come up with a map for these tones. Their results demonstrated that in people who had cochlear implants for at least three months, normal frequency organization was somewhat restored.
"Our results strongly suggest that the recipient's auditory cortex presents a tonotopic organization that resembles the frequency maps of normal-hearing subjects," says Guiraud.
In the future, the team hopes to determine in detail the ways in which these maps may change as a result of cochlear implants by studying subjects immediately following implant surgery.
The work was a supported by a grant from Advanced Bionics Europe. The results were published in the July 18 Journal of Neuroscience.
Note: This story has been adapted from a news release issued by Society for Neuroscience.



New bionic ear uses smart plastic
Judy Skatssoon
ABC Science Online


Tuesday, 12 April 2005
Hearing loss can cause cells in the ear to die
The bionic ear technology, which coaxes nerve cells to regrow, may also one day help to repair damaged spinal cords (Image: iStockphoto)
Scientists are building a new bionic ear coated in a smart plastic that boosts the growth of nerve cells in the inner ear when it's zapped with electricity.
The technology, which also has potential for healing spinal cord injuries, is being developed at the Australian Centre for Medical Bionics and Hearing Science, part of Melbourne's Bionic Ear Institute.
Collaborator, Professor Gordon Wallace of the Intelligent Polymer Research Institute at the University of Wollongong, says the polymer polypyrrole is unusual because unlike most plastics, it can conduct electricity.
It can also act as a host structure for the molecules that stimulate nerve regrowth, known as neurotrophins.
Passing a small electric current through the plastic releases the molecules and helps to reverse the death and degeneration of hearing cells that occurs after prolonged deafness.
"We can encompass these molecules in the polymer structure," Wallace says.
"We inject small amounts of electricity into the structure and that causes the release of the molecules and makes them available to the nerve cells.
"The polymer controls the timing of release, and where the molecules are released, to maximise interaction with nerve cells."
The device would be powered by a small battery.
Wallace says the cell regrowth will create a better connection between the brain and the device, improving hearing when there's a noisy background and making listening to music easier.
Other applications of polypyrrole including batteries, biosensors, artificial muscles and generating solar energy, he says.
Encouraging cells to grow back
Wallace says his team has already demonstrated in the lab that it's possible to incorporate a particular neurotrophin, NT3, into the polymer and stimulate its release.
Once released, NT3 induced damaged nerve cells to grow again, he says.
He says the next step for developing the new bionic ear is improving the structure of the plastic to ensure the growth factors are released within the right time frame and in the right amount.
"When this is ascertained it would be programmed into the material," he says.
A senior researcher at the bionics centre, which was officially opened by Prime Minister John Howard this week, says the technology is also being investigated for spinal cord repair.
Dr Adrian Cameron says a polymer-coated tube-shaped device loaded with growth factors could be implanted at the site of a spinal cord injury to help mend damaged nerve fibres, or axons.
"What we want to do is to reconnect the broken axons above the injury with the intact motor control centres below the injury," he says.
"We intend to use the polymer growth factor device as bridge."

Thursday, July 26, 2007

How Can You Distinguish a Budding Pedophile From a Kid With Real Boundary Problems?




How Can You Distinguish a Budding Pedophile From a Kid With Real Boundary Problems?
By MAGGIE JONES

In the early 1980s, a therapist named Robert Longo was treating adolescent boys who had committed sex offenses. Their offenses ranged from fondling girls a few years younger than they were to outright rape of young children. As part of their treatment, the boys had to keep journals — which Longo read — in which they detailed their sexual fantasies and logged how frequently they masturbated to those fantasies. They created “relapse-prevention plans,” based on the idea that sex-offending is like an addiction and that teenagers need to be watchful of any “triggers” (pornography, anger) that might initiate their “cycle” of reoffending. And at the beginning of each group session, the boys introduced themselves much as an alcoholic begins an Alcoholics Anonymous meeting: “I’m Brian, and I’m a sex offender. I sexually offended against a 10-year-old boy; I made him lick my penis three times.”
Sex-offender therapy for juveniles was a new field in the 1980s, and Longo, like other therapists, was basing his practices on what he knew: the adult sex-offender-treatment models. “It’s where the literature was,” Longo, a founder of the international Association for the Treatment of Sexual Abusers, told me not long ago. “It’s what we’d been doing.”
As it turns out, he went on to say, “much of it was wrong.” There is no proof that what Longo calls the “trickle-down phenomenon” of using adult sex-offender treatments on juveniles is effective. Adult models, he notes, don’t account for adolescent development and how family and environment affect children’s behavior. Also, research over the past decade has shown that juveniles who commit sex offenses are in several ways very different from adult sex offenders. As one expert put it, “Kids are not short adults.”
That’s not to say that juvenile sexual offenses aren’t a serious problem. Juveniles account for about one-quarter of the sex offenses in the U.S. Though forcible rapes, the most serious of juvenile sex offenses, have declined since 1997, court cases for other juvenile sex offenses have risen. David Finkelhor, the director of Crimes Against Children Research Center at the University of New Hampshire, and others argue, however, that those statistics largely reflect increased reporting of juvenile sex offenses and adjudications of less serious offenses. “We are paying attention to inappropriate sexual behavior that juveniles have engaged in for generations,” he said.
The significant controversy isn’t whether there is a problem; it’s how to address it. In other words, when is parental or therapeutic intervention enough? What kind of therapy works best? And at what point should the judicial system get involved — and in what ways?
Longo and other experts have increasingly advocated for a less punitive approach. Over the past decade, however, public policy has largely moved in the opposite direction. Courts have handed down longer sentences to juveniles for sex offenses, while some states have created tougher probation requirements and, most significant, lumped adolescents with adults in sex-offender legislation.
The best-known example is Megan’s Law. Since 1994, federal legislation has required many sex offenders to register with the police, which can aid sex-crime investigations. But Megan’s Law, which went into effect in 1996, mandates that law enforcement also notify the public about certain convicted offenders in their communities. One of the ways states do this is through publicly accessible Web sites. At least 25 states now apply Megan’s Law, also known as a community-notification law, to juveniles, according to a recent survey by Brenda V. Smith, a law professor and the director of the National Institute of Corrections Project on Addressing Prison Rape at American University’s Washington College of Law. That means on many state sex-offender Web sites, you can find juveniles’ photos, names and addresses, and in some cases their birth dates and maps to their homes, alongside those of pedophiles and adult rapists.
Now that concept has reached the federal level. In May, Attorney General Alberto R. Gonzales proposed guidelines for the Adam Walsh Child Protection and Safety Act, named for a 6-year-old boy (and son of John Walsh, the host of TV’s “America’s Most Wanted”) abducted from a Florida store and murdered in 1981. Among other things, the legislation, sponsored by Representative F. James Sensenbrenner Jr., a Wisconsin Republican, and signed into law by President Bush last year, creates a federal Internet registry that will allow law enforcement and the public to more effectively track convicted sex offenders — including juveniles 14 and older who engage in genital, anal or oral-genital contact with children younger than 12. Within the next two years, states that have excluded adolescents from community-notification laws may no longer be able to do so without losing federal money.
Community notification makes people feel protected — who wouldn’t want to know if a sex offender lives next door? But studies have yet to prove that the law does, in fact, improve public safety. Meanwhile, when applied to youths, the laws undercut a central tenet of the juvenile justice system. Since juvenile courts were created more than 100 years ago, youths’ records have, with exceptions in some states, been sealed and kept out of the public’s hands. The theory is that children are less responsible for their actions, and thus less blameworthy, than adults and more amenable to rehabilitation. But by publishing their photographs and addresses on the Internet, community notification suggests that juveniles with sex offenses are in a separate, distinct category from other adolescents in the juvenile justice system — more fixed in their traits and more dangerous to the public. It suggests, in other words, that they are more like adult sex offenders than they are like kids.
Last year, an eighth grader at a Delaware middle school arrived one morning to find kids in the hallway pointing at him and snickering. At first, the boy, Johnnie, who asked me protect his privacy by identifying him by a friend’s nickname for him, was confused. He thought it might be because of his new haircut. Then one kid called him a rapist. Another jeered, “Hey, aren’t you a sex offender?” One teenage boy threatened to beat him up.
Four years earlier, when Johnnie was 11, he put his hand on his 4-year-old half-sister’s vagina over her underwear. And then several months later, he told her to perform oral sex on him, which she did. When Johnnie’s mother found out, she called the police. She may have felt she could no longer control Johnnie, who, according to his grandmother, both adored his sister (he made pancakes and snowmen for her) and tormented her (he punched and bullied her). Perhaps his mother also worried that her son might abuse other children. It’s hard to know what went through her mind that day, because she never explained it to Johnnie or to her own mother, with whom Johnnie eventually went to live. And she did not return my phone calls.
Johnnie, who has sandy-colored hair and freckles, did not resort to violence or use a weapon, according to police records, and when a detective interviewed him, the fourth grader admitted what he’d done. Soon after, Johnnie was sentenced to a residential juvenile-sex-offender program, where he spent 16 months. By the time he was released, he was considered a role model in his program, according to records that Johnnie’s therapist, Marc Felizzi, of the Delaware Guidance Services, received from the facility. His mother, though, had little interest in reuniting the family, so Johnnie bounced from a foster home to his uncle’s before going to live with his grandmother and then, ultimately, his father.
It was just two months after starting at a new school near his grandmother’s house that Johnnie’s childhood offense became the gossip of the hallways. It wasn’t entirely clear how kids found out. Johnnie heard that the mother of a girl to whom he’d written a love note discovered him on the Delaware Sex Offender Central Registry Web site. The mother may have typed in Johnnie’s last name. Or she may have been scanning her ZIP code for local sex offenders. In any case, she found him. And there on the Internet was a photo of Johnnie when he was 11, along with his address, birth date, height and weight at the time of his offense. Below that were two police charges: one was a misdemeanor for the touching over his sister’s underwear; the other was a felony for engaging his sister in oral sex, which because it involved mouth-to-genital contact was charged as “rape second degree.”
In dozens of interviews, therapists, lawyers, teenagers and their parents told me similar stories of juveniles who, after being discovered on a sex-offender registry, have been ostracized by their peers and neighbors, kicked out of extracurricular activities or physically threatened by classmates. Experts worry that these experiences stigmatize adolescents and undermine the goals of rehabilitation. “The whole world knows you did this bad thing,” notes Elizabeth Letourneau, an associate psychology professor at the Medical University of South Carolina and an expert on juveniles with sex offenses. “You could go to treatment for five years; you could be as straight as an arrow; but the message continues to be: You are a bad person. How does that affect your self-image? How does that affect your ability to improve your behaviors?”
It wasn’t long ago that therapists and victim advocates had to fight to get the justice system to take sex abuse by adults, much less by juveniles, seriously. If a case even made it past the police, the charges were often dismissed in court, notes Craig Latham, a Massachusetts psychologist who treats sex offenders and consults with law enforcement.
Around the same time, though, the victims’ rights movement began to burgeon, bringing much-needed attention to sexual abuse. Rape-crisis lines and centers were created; the federal government started providing states with money for victim services; and men, women and children went public with their stories about being sexually assaulted.
Robert Longo, now the director of clinical services at Old Vineyard Behavioral Health Youth Services, a psychiatric hospital in Winston-Salem, N.C., remembers appearing on “Donahue” and “Oprah” in the 1980s, making pronouncements like: “Sex offenders can’t be cured.” And: “Victims are damaged for life.” Neither statement was based on good research, he now says. “We were desperately trying to bring attention to the issue,” Longo says of himself and other sex-abuse experts, “and we went way overboard.”
Sex crimes became a media sensation. Though the overwhelming majority of offenses against kids — 80 percent to 90 percent — are committed by someone the victim knows, the news media focused on the rare and very chilling rapes and murders of young girls by strangers. Children as sex offenders became the next obvious step in our national anxiety about sex crimes, Philip Jenkins, author of “Moral Panic: Changing Concepts of the Child Molester in Modern America” and a professor of religious studies and history at Pennsylvania State University, told me. “First it’s adult predators, and then it’s what about children? To draw attention, you have to up the ante. The issue moves up a notch, and you can’t move it back easily.”
Among states that do include juveniles in community-notification laws, there is little consistency in terms of who is eligible and for how long. Some jurisdictions allow for judicial discretion on whether to include juveniles or permit youths to petition to be removed after a number of years. In some states, a juvenile has to be 14 to be listed on public sex-offender registries. In others, they may be eligible at 10 or 12. And while some states list only a handful of youths on their Web sites, Kansas currently includes about 340 on the Internet, and Texas lists more than 3,400 people for offenses committed when they were juveniles. Meanwhile, in South Carolina, anyone — whether adult or child — who is placed on its Internet registry is there for life.
When I heard about these juveniles, I wondered who they were and what types of offenses they’d committed. How old were they? Had they used violence or assaulted numerous children? Would they become adult offenders? I asked Mark Chaffin, one of the country’s leading experts and the director of research at the Center on Child Abuse and Neglect at the University of Oklahoma Health Sciences Center. Chaffin notes that while most juveniles who have committed sex offenses are boys around 13 or 14, in other ways they are not a homogeneous population. Though a small percentage — no one knows how many — will become adult rapists or pedophiles, the vast majority, 90 percent or more, will not, Chaffin says. Most have not committed violent assaults or abused multiple children repeatedly. Usually they have had sexual contact — from fondling to oral sex to intercourse — with a child who is at least two years younger than they are. Also, many of the juveniles have been sexually abused themselves, and as a consequence, they act out sexually, typically for a transitory period.
Some, whether they have been abused or not, are what therapists call “naïve experimenters” — overly impulsive or immature adolescents who are unable to approach girls or boys their own age; instead, they engage in inappropriate sexual acts with younger children. Others are generally delinquent juveniles for whom sexual abuse is just one of the ways they break laws, and according to studies, they are much more likely to commit a property crime than they are to commit a second sex offense. They are from working-class, middle-class and upper-middle-class homes, from intact families as well as very broken ones. There are also a number of children — how many is unclear — who are adjudicated for what some therapists would say is “playing doctor” or normative “sexual experimentation.” These are broadly considered to include sexual acts that are spontaneous, intermittent and “consensual” (legally, children under 16 usually cannot consent to sex) between youths within a couple of years age. Similarly, there are the so-called Romeo and Juliet cases, like the highly publicized one in Georgia involving Genarlow Wilson, who is serving an 11-year prison sentence for having consensual oral sex with a 15-year-old girl at a party when he was 17. There have also been court cases of 12- and 13-year-old boys who grabbed girls’ breasts or buttocks in school hallways and were adjudicated as “sex offenders.”
It’s not hard to categorize an act in which a 12-year-old grabs a girl’s rear end. And, on the other extreme, it’s not difficult to classify a 17-year-old who rapes young children. But many juveniles adjudicated (a term used in juvenile court to indicate a determination of delinquency) for sex offenses fall somewhere in between, both in terms of ages and offenses. How, for instance, should we categorize a 13-year-old who rubbed his penis against the rectum of a 9-year-old? Or a 14-year-old who was sexually aroused and asked a kindergarten-age girl to lick his penis? Both were adjudicated in juvenile court and placed on an Internet registry. Their offenses don’t fall under what therapists consider childhood experimentation. Any parent would be very upset if her elementary-school daughter was asked to perform oral sex — much less if she did it — by an adolescent boy; and depending on the offense and circumstances, there could be lasting damage to the victim. But should these adolescents be in a different legal category than teenagers who commit robberies or physically assault young children?
Under the Adam Walsh Act, a 35-year-old who has a history of repeatedly raping young girls will be eligible for the public registry, and so will a 14-year-old boy adjudicated as a sex offender for touching an 11-year-old girl’s vagina. According to the law, the teenager will remain on the national registry for life. He will have to register with authorities every three months. And if he fails to do so — not an unlikely prospect for some teenagers, especially those without involved parents — he may be imprisoned for more than one year.
Also, under the proposed guidelines issued by the attorney general’s office in May, the law is retroactive: hundreds of juveniles who are on probation for sex offenses that preceded the law could be eligible for the nationwide registry. Regardless, the Adam Walsh Act sets only the minimum guidelines; many states will retain their own, more stringent community-notification laws for juveniles. Already the Juvenile Law Center in Philadelphia and other organizations are considering challenges to the law based on, among other things, the fact that juveniles are subject to the same registration requirements as adults without the benefit of a jury trial or similar protections.
Amie Zyla was 8 years old when a 14-year-old family friend named Joshua Wade molested her. Wade was adjudicated for a misdemeanor in juvenile court in Wisconsin, where he and Zyla lived, and sent to a residential juvenile facility. That was the last Zyla knew about Wade until almost a decade later, in 2005, when she heard a TV news report that Wade was arrested for sexually assaulting numerous children. At the time of his arrest, Wade was 23. Authorities said that Wade befriended children, molesting many in his apartment and secretly videotaping some of them in the shower. He is currently serving a 25-year prison sentence.
It is a disturbing story that still haunts Zyla, who is now 19 and has become an advocate for including juveniles on public registries. If Wade had been subject to community notification as a teenager, parents and other community members would have been able to find out about his past record. During her testimony to the House Judiciary Sub-Committee in support of the Adam Walsh Act, Zyla said, “The simple truth is that juvenile sex offenders turn into adult predators.”
That was certainly the case for Wade, who showed signs of heading for trouble long before he became an adult. When he was at his juvenile treatment program for molesting Zyla, Wade made almost no progress and admitted that he had also assaulted numerous other children, according to records obtained by The Milwaukee Journal Sentinel. (His defense attorney said that the police were never able to confirm those assaults.) He was also considered a high-enough risk that he was sent to a detention facility following his juvenile program.
Experts say there are, indeed, warning signs that one teenager may be at higher risk for committing repeat offenses. Not surprisingly, a pattern of multiple sexual offenses is of greater concern than a single instance, and the prognosis for a 16- and 17-year-old is typically worse than it is for a 12- or 13-year-old boy. And though age alone doesn’t predict recidivism, a 16-year-old with a long list of criminal and antisocial behaviors, who fails to complete a court-mandated therapy program, as Joshua Wade failed to do, and has a clear and persistent sexual interest in very young children is at real risk for becoming a pedophile, experts say.
According to the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of pedophilia requires a person to be at least 16 years old and with “recurrent, intense, sexually arousing fantasies” over a period of six months or longer, that he acts upon with a child who is at least five years younger. Many sex-abuse therapists, however, say they’d be wary of diagnosing pedophilia in even a 16- or a 17-year-old. At 16, a teenager’s history of sexual interest is relatively short, notes David Prescott, a therapist and the president-elect of the Association for the Treatment of Sexual Abusers, and it is still subject to change, compared with the history of a 40-year-old who is sexually attracted to young children.
Though there is no definitive way to predict, unfortunately, who will be the next Joshua Wade, some juvenile-assessment tests — which include questions about a youth’s sexual history, antisocial behavior and support system — can help clinicians evaluate the risk of that individual committing another offense. The questionnaires, however, have not been scientifically validated, and no single actuarial tool — even for adults — is airtight. For juveniles, the task is even trickier because, by definition, adolescence is a time of development and flux; a boy who seems at high risk for repeat offenses at 14 may no longer be so at 16. And a low-risk 14-year-old boy could become higher risk by the time he is 16. Indeed, the manual of one juvenile-assessment test highlights the complications: “No aspect of their development, including their cognitive development, is fixed or stable. In addition, their life circumstances often are very unstable. In a very real sense, we are trying to assess the risk of ‘moving targets.’ ”
The image of 15-year-old boys as moving targets is not terribly comforting for those of us worried about whether a neighborhood teenager might be a budding pedophile. And the fear of the unknown sexual predator certainly influences public policy. As Mark Green, a former Republican congressman from Wisconsin and one of more than three dozen co-sponsors of the 2006 Adam Walsh Act, told me: “If we are going to have a sex-offender registry that’s a useful tool for authorities and the public, it has to cover a broad enough spectrum of offenders. I err on the side of covering more offenders because these crimes are so destructive to victims, families and communities.”
But the Adam Walsh Act and similar legislation may risk ensnaring low-risk teenagers who were never headed toward becoming adult sex offenders. Numerous studies show that recidivism for juveniles who commit sex offenses is about 10 percent. That’s lower than most other juvenile offenses, including property and drug crimes. It’s also a significantly lower recidivism rate than that of adult sex offenders, which ranges from about 25 percent to, for the most serious offenders, 50 percent or higher. (Official recidivism rates are lower than actual rates; some sex offenders commit later offenses that go undetected.) And though the Adam Walsh Act requires many first-time teenage offenders to publicly register for life, if an adolescent hasn’t committed another sex crime within five years of his first offense, research suggests that he is unlikely to do so, notes Mark Chaffin of the University of Oklahoma.
As Elizabeth Letourneau, the professor at the Medical University of South Carolina, explains, most adolescents don’t have the sexual deviancy that prompts an adult predator to offend repeatedly. “If you’re an adult child molester, you’re violating clear age and legal boundaries. You’re crossing over a lot of lines, so you have to be highly motivated,” she said. “Kids typically don’t cross as many lines when they offend; they do stupid things all the time because their brains aren’t developed.”
As research by the National Institutes of Health shows, our brains don’t finish maturing until we are in our mid-20s. In its 2005 Roper v. Simmons decision, the United States Supreme Court acknowledged this when it said that adolescents, even those as old as 17, were not eligible for the death penalty because they “cannot with reliability be classified among the worst offenders,” because of their immaturity.
The last part of the brain to develop is the frontal lobe, which is responsible for impulse control, moral reasoning and regulating emotions — the things that adolescents lack when they decide, if they make a conscious decision, to molest a younger kid. So, instead of being compulsive like pedophiles, adolescents tend to be impulsive, which means tactics like “grooming,” in which an offender woos a child for weeks or months before a sexual assault, tend not to apply to the majority of juveniles, Chaffin notes. It’s not that juveniles can’t distinguish right from wrong; it’s that they don’t perceive risks and consequences the way adults do — as parents of teenagers know all too well. “I’ve been arguing for a classification called ‘puberty in the first degree,’ ” said Timothy Kahn, a Seattle therapist who has treated and evaluated thousands of juveniles with sex offenses, “which gives them a break for what they do when they are 12, 13, 14.”
After being adjudicated for a sex offense, a juvenile is often sent to a community-based or residential treatment program, where he might spend anywhere from a few months to a few years or more. In some cases, a judge might recommend a residential program because a boy has sexually abused a family member and the family can’t adequately supervise him. But in other cases, adolescents wind up in residential programs simply because their community lacks outpatient programs.
Whether residential or outpatient, the treatment philosophies among the programs vary widely. Some focus on family dynamics and teaching boundaries and understanding social cues, as well as helping immerse juveniles in mainstream activities. Other programs embrace the model that Longo and some of his colleagues once practiced but now see as outdated, in which youths are treated much like adult offenders.
In a Newton, Kan., program, teenagers keep logs of their masturbation habits, in which they detail their fantasies and how often they masturbate to those fantasies, which therapists then read, in addition to working on anger management and doing other exercises. Some of the teenagers also participate in what’s known as psychodrama. During these exercises, a teenager stands in front of an audience of peers, parents and other relatives who attend the group therapy. Then, the teenager describes the victim — hair color, personality, age — and what the offender did.
The teenager often chooses a friend in the program to play the role of the victim, whose task it is to pepper the teenager with questions: “Why me?” “Did you molest other kids?” “I thought we were friends; will we ever be friends?” Then audience members offer their own questions, along with praise for the teenager’s bravery and honesty, during a process that lasts about an hour and a half. Jeffrey King, the director of the program, explains the rationale behind psychodrama, saying: “Sharing is a way of getting it out of their soul. If they are moving forward with treatment, they’ll be able to say, ‘I was only thinking of myself and getting my needs met.’ ”
But Longo argues that when these exercises re-enact offenses, they may shame boys and reinforce their self-image as “sex offenders” with bad, deviant traits rather than as kids needing lessons in setting boundaries and creating better relationships. Critics complain, too, that intensive monitoring of adolescents may have similar consequences. Adolescents in some therapy and probation programs, for example, aren’t allowed to go to playgrounds or swimming pools, even with adult supervision. “You can’t see what they are doing underwater,” a Colorado probation officer, DeeDee Cagle, told me, referring to the pool rule, which applies to adolescents with a single sexual offense, as well as those with multiple offenses.
But Barbara Bonner, a longtime expert on children and sex offenses and a co-director of the Adolescent Sex Offender Treatment Program at the University of Oklahoma Health Sciences Center, questions such practices. For 20 years, the program has been letting kids go on supervised visits to parks and swimming pools. “We’ve never had an incident,” she told me. Her program, whose population includes juveniles adjudicated for a wide range of offenses, does have rules: no baby-sitting; no supervisory role with young children; no pornography. But the program also makes a point of encouraging mainstream activities with peers as much as possible. “It’s different if a particular child has a history of going to the park and grabbing kids,” notes Bonner, who was recently the president of the International Society for Prevention of Child Abuse and Neglect. “But why make it a rule for everyone?”
Some programs also monitor adolescents by requiring them to undergo polygraphs. While the exams are not typical in other juvenile-delinquent programs, according to a 2002 report by the Safer Society Foundation, a sexual-abuse research and advocacy organization, about 44 percent of outpatient adolescent-sex-offender programs use polygraphs — up from 25 percent eight years earlier. Researchers have long questioned the reliability of the polygraph as a lie detector, and Elizabeth Letourneau says that adolescents may be particularly vulnerable to “admitting” to more than they actually did. “A polygrapher might say, ‘You failed this part; is there something else you’re not telling me?’ Then you may give up more information to try to pass.”
Judith V. Becker is a professor of psychology at the University of Arizona and is considered one of the foremost experts in juvenile-sex-offender evaluation and treatment. She told me that she and her colleague Kurt Bumby have visited adolescent-sex-offender programs and asked teenagers if polygraphs ever failed to pick up lies the boys told. Yes, some of them said. Becker and Bumby also asked if the boys ever told the truth and polygraph results indicated it was a lie. That happened, too. Similarly, Mark Chaffin, co-director of an Oklahoma program for adolescents, said that teenagers there told counselors that in previous programs they felt pressured to confess to sex offenses they didn’t commit. “They thought they would never get out of there otherwise,” he told me. “It’s not an uncommon occurrence; it’s part of the culture of some facilities.”
Adolescents’ treatment progress may also be delayed by unfavorable results from a test known as PPG, or penile plethysmography, in which a band is placed around a boy’s genitals to measure his erectile response to audio or visual stimuli. Only about 10 percent of adolescent outpatient programs in the United States still use PPGs, according to a 2002 Safer Society report. “Years ago, people were using them on children as young as 11 and 12,” says Peter M. Byrne, the C.E.O. of Behavioral Technology Inc., which distributes PPG technology in the United States. Now Byrne doesn’t generally recommend PPG for anyone under the age of 16.
But according to Colorado’s state guidelines on juvenile sex offenders, adolescents 14 and older are eligible for PPGs. Cagle, the probation officer, told me that while she requires every adolescent client with a sex offense to undergo either a PPG or a much less invasive viewing time test, which measures sexual interest by the length of time someone looks at photographs, she prefers the PPG. “I like to know what kind of kiddo I’ve got,” she said. But no one has ever done a controlled trial of PPG comparing “normal” adolescents to those with sex offenses. “Kids are aroused by anything,” said Craig Latham, the psychologist, who along with other sex-abuse experts have been trying to ban the use of PPG with adolescents. “They are aroused by sitting there with this thing on their penises.”
Last October, Johnnie, the Delaware teenager on the sex-offender registry, sat slumped in a chair in his therapist’s office. After the bullying incidents at his middle school earlier in the year, he enrolled in an alternative school for juvenile delinquents. He wasn’t required to attend, and he didn’t particularly like it. But there wasn’t a lot of choice. And now he was telling his therapist, Marc Felizzi, about a new incident that took place two weeks earlier on the school bus. “He said, ‘Hey, dude, you’re a sex offender.’ And the other one said, ‘You tried to rape your sister!’ ”
Trying to catch Johnnie’s gaze, which was focused at his feet, Felizzi said: “Maybe you need to talk to a teacher and say you need to have your back covered. If you don’t tell someone at school and you smack some kid, you could pick up a new police charge,” Felizzi said. Johnnie had already been suspended for mouthing off to a teacher shortly after the incident on the school bus.
For much of his life, Johnnie has struggled with anger and depression. Twice, he spent several days in a psychiatric hospital. The first time was last year after he walked into oncoming traffic near his grandmother’s house; he told the police officer who found him that he wanted to die. The second time was several months ago. He had transferred to yet another school and sought out a counselor to tell her he felt both suicidal and so enraged at a fellow student who continually taunted him that he wanted to kill the student. “He was at the end of his rope, and he knew where to turn when he needed help,” said a school staff member who asked that I not use her name to protect Johnnie’s privacy. Johnnie, she told me, had no disciplinary problems at her school and is a “wonderful and very respectful student and a leader in the school.”
It has been five years since Johnnie sexually abused his sister and, though it is impossible to know with certainty if he has sexually assaulted anyone since then, no one I spoke to knew about any other offense: not the staff at his school, not Felizzi, not Johnnie’s prosecuting and defense attorneys. And Johnnie, whom Felizzi told me had always been forthcoming about his past, repeatedly told me he’s never sexually abused anyone else. “I was young and stupid,” he said, recalling what he did to his sister. “It was really terrible.”
In part, he said, his struggles with depression are related to his guilt about his sister, as well as his troubled relationship with his mother, who, family members told me, verbally and physically abused her son. Added to that, Johnnie was sexually assaulted by a family friend when he was 5. (In abusing his sister, Felizzi said, Johnnie “was re-enacting what was done to him.”) And then there’s the Internet registry. His first suicide attempt was two weeks after his sex offense became known at school. The day students found out, he told me, “my whole world dropped to the ground.”
Marc Felizzi has seen the pattern before. Kids Google one another’s names; curious neighbors type in their ZIP codes on sex-offender Web sites. And the problems begin. “A large part of treatment,” he said, “is coping mechanisms: ‘ What do I do when I’m found out?’ ”
I spoke to a 14-year-old girl who was on a state’s public registry. When she was 11, she repeatedly fondled a 7-year-old boy’s penis and had him touch her vagina; the incidents were then reported to authorities by a therapist. “I was going to try out for the basketball and volleyball teams,” she told me, but decided the team wasn’t worth the risk, after one of the players sent her an instant message on her computer: “What did you do? I saw you on the Internet!” While posted on the Internet registry, she said, she lost all of her friends but one. (“People think I’ve done something worse than I did,” she told me. “They think I’m not a virgin.”) She also received anonymous phone calls from guys wanting to “hook up” with her, while neighbors asked her family to move away. And her father was worried that his daughter’s Internet listing made her easy prey for adult men looking for adolescents who they assume are sexually experienced. But the girl is fortunate in one respect. She lives in a state that recently gave judges discretion about placing juveniles on public registries. Several months ago, her lawyer won a motion to have her information removed.
Lucy Berliner, the director of the Harborview Center for Sexual Assault and Traumatic Stress, in Seattle, notes that the stories of teenagers like these are only anecdotes; there are no studies on how community notification affects children’s development and self-image. And, as Berliner says, some juveniles stay on public registries for a limited period and are unscathed by it. But given that few labels carry as much stigma in our society as “sex offender,” it makes sense that some adolescents become depressed and isolated.
Certainly, one consequence of community notification is that as these adolescents move into adulthood, they may struggle to stay in the mainstream because they have a hard time finding and holding jobs. Becoming a teacher or a doctor or joining the military may be virtually impossible for those labeled as sex offenders on public registries. Even job prospects at Target, McDonald’s or any business that performs background checks aren’t promising. In interviews, people in their 20s told me that they have been either fired or turned down for jobs at retail stores, fast-food restaurants and social-service organizations after employers discovered they were adjudicated as juveniles for sex offenses.
Another unintended consequence may be that some families will remain silent to protect their children from decades on an Internet registry rather than seek intervention that would benefit both the victim and the offender. One mother I spoke to regretted not keeping quiet. When she discovered that her 11-year-old son had engaged in a sexual act with his younger sister (the mother wouldn’t specify the offense except to say that it did not involve penetration and no force was involved), she called a therapist. “I thought it was the right thing to do,” she told me. “I figured counseling would help.” She thought she knew how the law worked and that her son’s behavior might be reported to law enforcement. “But I thought: O.K., it will teach him a lesson. He’ll get a little probation, but his record will be sealed.” She didn’t realize that one year earlier her state had made children as young as 10 eligible for the state’s Internet sex-offender registry. Police entered her son’s DNA into a database. They took his fingerprints and mug shots. And they placed him on the state’s Web site. That’s where his photo and address have been for the past four years. “I feel it was my fault,” the mother told me. “I did it.”
Of all the worries the public registries create, though, the most frightening for many families is vigilantism. In 2005, a man killed two adult sex offenders he tracked through a Washington State community-notification Web site. And last year, a 20-year-old Canadian man with a list of 29 names and addresses from the Maine Sex Offender Registry went to the homes of two convicted offenders, shooting and killing them. Both men were strangers to the killer. One of the offenders had raped a child. The other was convicted for statutory rape; he was 19 when he had sex with his girlfriend, who was two weeks shy of her 16th birthday.
One question about juveniles with sex offenses that remains unanswered is what kind of treatment works best. New studies are, however, beginning to suggest potential directions. One of the most promising is what’s known as multisystemic therapy, which tries to minimize antisocial behavior by helping caregivers more effectively supervise their children. Multisystemic therapy typically focuses on improving parent-child bonds and encouraging teenagers’ involvement in class work and after-school activities, as well as healthy friendships. Two small, controlled studies with juveniles who committed sex offenses suggest MST reduces recidivism more effectively than individual psychotherapy and some other treatments. In a third, a federally financed clinical trial led by Elizabeth Letourneau, researchers are looking at 127 juveniles adjudicated for sex offenses, between ages 11 and 18, and their families. About half of the kids were randomly assigned to multisystemic therapy and half to a traditional sex-offender treatment program that focuses on, among other things, relapse prevention. Both programs are outpatient. (No published study, Letourneau notes, has ever shown that residential programs — which she and other critics contend are overused — are more effective than less costly outpatient programs.) According to Letourneau, early results from the MST study are promising.
And last year, Mark Chaffin, at the University of Oklahoma, and other researchers published the results of a longitudinal study of 135 children ages 5 to 12 who had sexual-behavior problems and participated in a therapy program. The program took just 12 weeks, during which counselors addressed inappropriate sexual behavior, concrete sexual-behavior rules, self-control techniques and sex education. Given that the children were under 13, it’s hard to know if the results can be replicated with older adolescents, though Chaffin has just such a study under way. But in the study of younger children, the 10-year recidivism rate was 2 percent. “You can’t get a whole lot lower than that,” Chaffin said. “That’s a functional definition of a cure.”
Best, of course, would be stopping juveniles before they offend. While some sex education in schools includes lessons on how kids can avoid perpetrators, it is much less common for children to learn how to avoid committing sex offenses themselves. “It is morally wrong,” said Timothy Kahn, the Seattle therapist, “to do nothing to educate kids about the laws and then have them have to register as sex offenders and they haven’t even hit puberty.”
In his book “An American Travesty: Legal Responses to Adolescent Sexual Offending,” Franklin E. Zimring, a professor of criminal law at the University of California, Berkeley, suggests, as an alternative to community-notification laws for juveniles something known as “time-conditional record sealing.” Under Zimring’s plan, if an adolescent with a sex offense goes on to commit another offense as an adult, law enforcement would be able to access the juvenile records to help assess the offender’s recidivism risk and make judicial decisions accordingly. “The number of career sex offenders who would be able to hide official records behind the protective policies of juvenile justice would fast approach zero,” Zimring writes. “The number of low-risk juveniles kept from permanent stigma would be quite large.” Other experts have suggested a restricted registration system that would allow certain child-centered employers — like camps and schools — to access high-risk juveniles’ records for several years to help ensure that those adolescents and young adults don’t work with children.
As Zimring notes, keeping juveniles off public Internet registries isn’t just a civil rights issue. “It’s also about bringing some kind of rationality into law enforcement,” he says, given that including low-risk offenders in these laws adds to police workloads with no proof that it’s actually effective.
In the meantime, if thousands of juveniles do accumulate on state and federal Internet registries, Mark Chaffin argues that at the very least we should be studying the impact on these adolescents. “We’d need to follow these kids for 10 years to look at their different experiences and outcomes,” he said. “Frankly, we could easily find these policies do more harm than good.”
As Elizabeth Letourneau told me recently, “If kids can’t get through school because of community notification, or they can’t get jobs, they are going to be marginalized.” And marginalized people, she noted, commit more crimes.
Maggie Jones is a contributing writer for the magazine. Her last article was about boys in Japan who refuse to leave their homes.


Copyright 2007 The New York Times Company

The market for CDs has collapsed


Millencolin


Off the record
by Robert Sandall
In recent years, the economics of pop music have been upended. The market for CDs has collapsed, and not even the rise of legal downloading can offset the damage to record companies. Meanwhile, demand for live performances has rocketed
Robert Sandall worked as director of communications for Virgin Records from 1996 to 2002



There is a story doing the rounds in the US that says a lot about the state of the music business. It concerns a young rock band who decided to stop selling their CDs at concerts. Selling CDs has, for many years, been a good way for an act to reclaim the margin that would otherwise have been snaffled by a retailer. But it made no sense to this band once they discovered that by selling CDs for $10 they were cannibalising sales of their $20 T-shirts.
There are two points to note here. First, that a simple garment with a logo stamped across it, probably manufactured for pennies in a third-world sweatshop, now costs twice as much as an album of digitally pristine, highly wrought music recorded in a state of the art western studio. Second, most bands, however successful, now make their money from live work and the merchandising opportunities that go with it, rather than from recordings.
The record companies know this, which is why when EMI re-signed Robbie Williams in 2002, the £80m deal guaranteed the label a share in the profits generated by Williams's tours. Such spinoffs are often now make or break issues in contractual negotiations. Gerd Leonhard, a music business consultant, predicts that by 2010, recorded music sales will make up only 30 per cent of a successful label's revenues. The rest will be generated by artists' extra-musical brand extensions. Like those $20 T-shirts.
The artists are getting wise to this new value chain. One of the hottest new names to emerge recently, the rave metal band Enter Shikari, have refused to sign any of the deals they have been offered, instead releasing their debut album Take to the Skies on their own label, Ambush Reality, in March. In the past, these tiny, so-called "indie," labels have usually been funded by majors anxious to covertly purchase credibility for their products with a young audience. The celebrated label Creation, home to Oasis and other Britpop stars in the 1990s, was owned entirely by Sony. Had it not been, the marketing spend which turned Oasis into a huge international draw would not have been available.
But this is not the case with Ambush Reality. The marketing of Take to the Skies was undertaken largely by the band themselves, who have played nearly 700 gigs since forming in St Albans in 2003. Word of mouth, coupled with the inevitable presence on MySpace, has done the rest. In November 2006, they became only the second unsigned band (after the Darkness) to sell out the 2,000-capacity Astoria in London. Five months later, Take to the Skies entered the British album chart at number four. In May, Enter Shikari started out on their first American tour.
They have set an inspirational example, not least by their single-minded prioritising of their performances. Groups used to tour, often at a loss, to stimulate sales of their latest album. Now it's the other way around. Hence the widely reported decision earlier this year by the Crimea, a band previously signed to Warner Bros, to release their new album as a free download. The band explained this not as an anarcho-hippie gesture in support of the principle that music ought to be free, but as a sensible promotional tactic. Their hope is that by disseminating their music online, they will expand their fan base and increase their returns from touring. Having seen the small size of the cheques they got from Warner, they know where not to look for their future income.
This view is shared by a far more famous former Warner artist: Prince. Anyone attending his shows at the London O2 arena in August will receive a free copy of his latest CD, Planet Earth, as did anyone who bought the Mail on Sunday on 15th July. Prince's new label, Sony/BMG, which did not know about the deal, has withdrawn the album from British shelves.
"Record sales as we know them are in long-term decline," says music business analyst Keith Jopling. "Whereas the wider music market—live, merchandising, streaming video and music social networking—is in rude health. After seven years of gradual change, we are about to see a major shift. Record companies are, at last, in a hurry to transform themselves into proper consumer marketing companies."
The catastrophic slide in the value of recorded music, and particularly in the price consumers are prepared to pay for it, has been felt hard on the high street. HMV announced in June that its profits had halved over the past year. Soon afterwards, the discount CD chain Fopp went out of business.
The industry that for years appeared to possess a licence to print money is reeling. The "big four" labels—Sony/BMG, Warner Music, EMI and Universal—have in recent years embarked on cost-cutting operations leading to major culls of staff: EMI's recorded music division has shrunk by almost half since 2001, from 9,388 employees worldwide to 4,818 today. Meanwhile, a senior industry executive reports that of this year's breakthrough British acts, just one, Mika, will make money for his record company. This decline in fortunes has been noticed in the financial markets: EMI is being bought up by private equity group Terra Firma, for £3.2bn.
Almost as soon as the offer was accepted, Terra Firma were reported to be in discussions with Warner to offload EMI's recorded music division. The side of EMI that interested Terra Firma was its song publishing arm, the world's largest and a profitable performer. It is regarded as a safer bet because the exploitation of song copyrights is not subject to the same feasts and famines as the hitmaking process. As well as receiving around 14 per cent of the profit on any CD sale, the publisher has its fingers in other pies, such as licensing fees for films, adverts or any of the other myriad outlets which now employ music. Once upon a time, EMI's publishing arm accounted for about a third of the market value of the whole group. Now it's the only part that's worth anything to the people who venture their capital. It is no coincidence that Terra Firma's offer valued EMI at about a third, in real terms, of what it nearly fetched ten years ago when a sale to its competitor Universal was mooted.
That decline roughly mirrors what has happened over the same period to the retail price of new—as opposed to catalogue reissue—CDs. When EMI's subsidiary Virgin put out the Spice Girls debut album in 1996, it sold for around £13 in Britain, from which the company cleared more than £5 in profit. New CDs now seldom cost more than £9, from which the label can expect to make £2, if it is lucky.
Although Britons still buy more CDs per head than anyone else—2.7 in 2006—the market for recorded music is in rapid decline. In the first quarter of 2007, the market for the top-selling 200 CDs in Britain shrank by 20 per cent compared to the same period in 2006. In the US, CD sales in 2007 are down by 15 per cent, in France 25 per cent, in Canada 35 per cent. The German market, once the largest in Europe, is now no bigger than that of the Netherlands.
The market for digital downloads was worth around $981m in the US last year, around a tenth of the value of the CD market. Yet the labels' great hope is that the slump in demand for physical formats will be offset by growth in the download market. This looks wildly optimistic. The latest figures from the US reveal that while paid-for downloads are increasingly popular—up 74 per cent in 2006 on the previous year—the surge in demand is slowing. And while the total value of music sales across all formats remained more or less static in 2004 and 2005, it declined by more than 6 per cent in 2006. The trade body of the American record industry, the RIAA, optimistically predicts that by 2011, the global online music market will be worth $6.6bn; three times what it currently amounts to. This situation will, as the RIAA delicately puts it, "leave the industry better positioned to offset physical sales."
Yet however it finds itself in 2011, the underlying truth is that recorded music, on or offline, has moved from being a high-margin, "high-end" product to a low-margin, low-prestige commodity. The album, for 35 years the basic, pricey unit of the industry—such a handy way of getting fans to shell out for ten songs when they might have wanted only three or four—increasingly seems, for young consumers, a clunky, old-fashioned and uneconomical way of building a music library on a portable MP3 player.
Far better to download songs; at the iTunes music store, tracks retail for 99 cents in America and 79p here. In Britain, at the end of the 1990s, CD singles sold for £4. Of that, the artist received about 50p, while the record company took as much as £1. Under the new web-style arrangement, the artist is lucky to get 10p, and the company might gross 30p.
This destruction of the value of individual recordings explains why, even if we were to carry on buying recorded music in the quantity we did at the end of the last century, the prospects for suppliers would still be bleak. However high the record companies worldwide pile their audio products in future, the only way they will be able to sell them is cheap. In Britain, the 10 per cent of singles still sold on CD now retail for just £1.49.
Record company insiders are aghast at the demise of what was, for the last two decades of the 20th century, their golden goose. And some of them know that they were partly responsible for killing it.
Arriving on the market in 1982, just after record sales began to revive following a three-year downturn, the compact disc ushered in the biggest boom in profits the record companies had known since 7" singles gave way to 12" LPs in the late 1960s. The CD persuaded many music fans to replace their vinyl collection with digital copies of music they had already paid for. And the rise of the CD permitted record companies to double the price of their basic product without incurring a huge uplift in costs. Even allowing for the royalty paid to the joint inventors of the CD—Philips and Sony—the discs were soon being manufactured for little more than it cost to crank out vinyl records on ancient presses.
Initial anxieties that consumers might be resistant to the more expensive format proved unfounded. Research revealed that music fans were more worried about the cost of acquiring a CD player than by the price of the discs. Paying £12 (£30 in today's money) for an album that, nearly everybody agreed, sounded better and was easier to manipulate than a vinyl LP, didn't feel steep in the mid-1980s. In 1994, the CD supplanted the cassette as the most popular platform for recorded music in western markets.
Yet in some ways the CD contained the seeds of its own destruction. One of the few industry moguls to raise his voice against the digital format in its early days was the late Maurice Oberstein, an American who was latterly head of the Polygram UK (later Universal) label. "Do you realise we are giving away our master tapes here?" he asked at an industry event. At the time, everybody was too busy counting the cash to listen. But as the advent of recordable CDs kickstarted a black economy in counterfeits in the 1990s, Oberstein was proved right.
Anybody who owned a CD could indeed use it as record companies had traditionally used master tapes: to clone thousands more, and quickly, using kit available on any high street. And at home, CD burning hardware on computers made it simple to produce copies in seconds. Developing markets in South America and southeast Asia collapsed under the weight of cheap copies. More damaging was the loss of the German market. Within the space of five years, the 82m Germans turned into a nation of CD copiers, paying pfennigs for albums that once cost 40DM.
Still, the market in the rest of the west, while not exactly booming, did hold up. The next development to shake up the music industry was the emergence in the late 1990s of illegal "file-sharing" websites, such as Napster. Online piracy, often identified by the media as the wrecker of the CD business, did seem a big threat at the time, although it was difficult to find hard data to support the claim that it damaged sales. Rather like the "Home Taping is Killing Music" campaign mounted by record companies in the 1980s, the arrival of illegal file-sharing coincided with an increase in legitimate sales of recorded music in the three largest markets: America, Japan and Britain. This supported the file-sharers' defence that their activities were no more harmful to music sales than the arrival of free radio airplay in the 1930s.
Instead, it has been the iTunes era of the 21st century—the creation of a growing legitimate online trade in cheap music—that has coincided with the drop-off in CD sales. The burgeoning popularity of portable MP3 players, notably Apple's iPod, seems to be turning the compact disc into the 21st-century equivalent of shellac—the precursor to vinyl.
Yet the music industry itself must take some of the blame for the decline of the CD. For the past 15 years, free covermounts on magazines and newspapers, licensed or even paid for by record companies, have diluted the perceived value of recorded music in general and CDs in particular. The practice of dumping free music CDs on the newsstands peaked in 2004, when 454 were licensed in Britain. It may seem odd that at the same time the industry was trying, and failing, to maintain a £10 price point for its premium CD products. But for years, record companies clung to the view that covermounts were a promotional benefit to them and their artists. Just as they allowed MTV to build its business by supplying it with free videos, they did newspaper and magazine publishers a huge favour on what turned out to be a hunch.
They maintained this position even after their trade body, the BPI, showed that the only beneficiaries of such giveaways were the publications carrying them. In the mid-1990s, Mark Ellen, editor of Q, Britain's leading rock title, described a CD giveaway as "like pinning a £10 note to the cover." When the Sunday Times gave away a free CD of old Oasis songs in 2000, it registered its highest circulation ever. In the following weeks, the BPI noted, retail sales of Oasis albums actually declined. But now even newspapers and magazines seem to have lost their appetite for covermounts. Last year, Q discontinued them on the grounds that the cost of manufacturing the discs was no longer justified by a spike in circulation. No clearer sign exists that, at least for musically savvy Q readers, you can't give CDs away.
Labels now tend only to use covermounts to showcase the music of new or developing acts. But old habits die hard. In April, EMI licensed Mike Oldfield's album Tubular Bells to the Mail on Sunday. The company charged Northcliffe Newspapers £200,000 for the right to dispense 2.3m CD covermounts of Britain's 11th bestselling album ever. The deal valued Oldfield's classic—the LP that launched Virgin as a successful record label in 1973—at a little over 8p a copy. This led the head of Woolworths, one of the largest of the dwindling band of CD retailers in Britain, to ask: "And how many copies of Tubular Bells do you think we will sell this week?"
It is difficult to prove that the rising popularity and price of live music has been directly affected by the superfluity and cheapness of the recorded stuff. But it seems more than a coincidence that just as fans are spending less on the tunes they listen to at home, they will pay unprecedented sums to hear them in concert. Ticket prices, especially for A-list artists, have soared.
Back in the 1980s, a seat at a concert by a superstar cost about the same as one CD album. By contrast, last summer you could have bought Madonna's entire catalogue for less than half of what it cost to see her perform at Wembley Arena. The best seats in Madge's house went for £160. With the Rolling Stones at Twickenham last August, a decent view would have set you back £150, or £350 for a seat on the side of the stage. To put this in historical perspective, when the Stones played Wembley in 1990, they took some stick for charging £25, top whack. Now that demand for live music is on the up, nobody bothers to complain about what it costs any more. Euphoria at the news earlier this year that the Police had reformed obliterated all concerns that it would cost £90 to see them play at Twickenham in September.
This is not a local phenomenon. The $690 (£345) it cost to watch Elton John at Las Vegas in May set a new record for an American rock show. In Hong Kong last year, Robbie Williams charged £180. Even the less prosperous citizens of Chile were asked to pay £80 to watch Coldplay in Santiago's Espacio Riesco, a considerable sum in a city where the average monthly salary is around £250. Ticket inflation with smaller bands is less intense. But even a relative unknown like the American singer-songwriter Laura Veirs charged £15 for her London show at Bush Hall this July. More telling is the ubiquitous presence of touts outside low-key venues where no secondary market for tickets existed ten years ago.
Attendance at arena rock shows grew by 11 per cent in Britain last year, and looks set to rise again in 2007. The bigger the concerts, the more we seem to like them. Hence the explosion in the festival trade. In 2007, there are 450 such large-scale gatherings scheduled, ranging from the recent Glastonbury festival to the one-day Underage festival in Hackney on 10th August, which claims to be the first to be aimed exclusively at 14 to 18 year olds.
A rediscovery, or a renewed appreciation, of the communal source of music-making—and listening— must lie near the root of this upending of the music business. As personal stereos and MP3 players have grown in popularity, so has an appreciation that music isn't just something that goes on between your ears. The guitarist of the American hardcore band Anthrax expressed this rather neatly: "Our album is the menu," he explained. "The concert is the meal."
In his book e-Topia, William Mitchell relates the increasing value of shared experience to the isolating nature of electronic or online virtual worlds. "In conducting our daily transactions, we will find ourselves constantly considering the benefits of the different grades of presence that are now available to us, and weighing these against the costs," he writes. Being in the same place at the same time as a live performance, music fans appear to have decided, is the rarest and most precious presence of all.

Tuesday, July 24, 2007

New Orleans Recovery Is Slowed by Closed Hospitals



New Orleans Recovery Is Slowed by Closed Hospitals
By LESLIE EATON

NEW ORLEANS — At the tip of Bayou St. John in the Mid-City neighborhood here, the brown and white bulk of Lindy Boggs Medical Center looms behind a chain-link fence. Nineteen people died at the medical center after Hurricane Katrina, and now the hospital itself is dead, sold to developers who plan to replace it with a shopping mall.
On the surrounding streets — Bienville and Canal and Jefferson Davis — lies the wreckage of a once-bustling medical corridor. Doctors’ offices sit empty behind five-foot-high water marks, and nearby clinics wait to be demolished. In back of one medical building, a gaping refrigerator still holds jars of mayonnaise and Mt. Olive Dill Relish.
Harder to see, but just as tangible, people here say, are the other ripple effects of the flood and the closed hospital: workers displaced, houses for sale and, of course, patients forced to seek health care many miles away. If they have returned to New Orleans at all, that is, given the grave wounds to the health care system.
“I’ve been telling people, don’t bring your parents back if they are sick,” said Dr. David A. Myers, an internist who lived and worked in Mid-City before the flood and has moved his home and practice to the suburbs.
Of all the factors blocking the economic revival of New Orleans, the shattered health care system may be the most important — and perhaps the most intractable.
Except for tourism and retailing, health care was the city’s biggest private employer, and it paid much higher wages than hotels or stores. But there are now 16,800 fewer medical jobs than before the storm, down 27 percent, in part because nurses and other workers are in short supply.
Only one of the city’s seven general hospitals is operating at its pre-hurricane level; two more are partially open, and four remain closed. The number of hospital beds in New Orleans has dropped by two-thirds. In the suburbs, half a dozen hospitals in adjacent Jefferson Parish are open — but are packed.
Fixing the city’s health care system “is critical both for the short and the long term,” said Andy Kopplin, executive director of the Louisiana Recovery Authority. “Short-term, having confidence that the health care residents need will be available and accessible is vital for folks who are returning,” Mr. Kopplin said. “Long-term, it’s important for employers — and health care is a huge business in New Orleans."
Studies suggest that hundreds of doctors never returned. And some of those who did, especially specialists and young physicians, are leaving, said Dr. Ricardo Febry, president of the Orleans Parish Medical Society, which has lost more than 200 of its 650 members. The exodus has “been a steady trickle,” Dr. Febry said.
The city’s mortality rate appears to have risen sharply in 2006, although state and local officials disagree about the level and persistence of the increase.
With the stress of life in the flood-ravaged city, the limited health care and insurance, the lingering mold and the discomfort of living in trailers, doctors report that the patients they see are often far sicker than those they treated before the storm. And even residents with health insurance can have a difficult time finding someone to treat them.
Government officials and civic leaders are floating plans for the future of the city’s medical system, for a state-of-the-art hospital, for a cutting-edge system to cover the uninsured, even for a “bio-innovation center” that would be an engine for economic growth. The question is what will happen in the meantime, which is likely to be many years long.
“We have to find a way to survive to that point, to provide care, or our city will collapse,” said John J. Finn, president of the Metropolitan Hospital Council of New Orleans.
Waiting for Care
The problems with health care hit hardest on the poor and the newly uninsured, but they also affect doctors and patients, politicians and entrepreneurs, the displaced and the returned — and everyone at any level who has the misfortune to turn up in a jam-packed emergency room.
Consider the case of Bernadine R. Fields, 50, who learned firsthand how far people have to go for major medical care. A supervisor of city 911 dispatchers, Ms. Fields was among the many laid off after the storm.
The money she had saved for her retirement went for repairs to her house in New Orleans East. By last July, she could no longer afford the $367 a month it cost to continue her health insurance, or all the medicines she needed to treat her high blood pressure, or the $250 it would cost to see a doctor.
So she kept ending up in one of the few open emergency rooms, waiting for hours. After one of these episodes in April, she was told she needed transfusions to treat anemia — but there was not a bed available in New Orleans for an uninsured patient.
Ms. Fields finally got the treatment she needed — but only after an ambulance took her to the state-run hospital in Baton Rouge, 80 miles from her home and family. She stayed there four days.
“I devoted 15 years of my life to serving the public,” she said, “and when I need to be served, there is no one to count on.”
Ms. Fields’s neighborhood in the eastern section of the city, like other stretches of town, cannot recover unless medical care becomes available there, officials say, and neither can large sections of the economy. Doctors and hospitals, though, are reluctant to return unless the population does.
“I’m just hoping and praying nobody dies,” said Frederick C. Young Jr., president of the Methodist Health System Foundation, which is working with the city to try to reopen a hospital there.
The sharp contraction in the health care industry has economic effects, too, for coffee shops and florists and medical-supply companies. Marshall F. Gerson, whose family has owned the Ellgee Uniform Shop downtown for almost 70 years, said sales of scrubs and other medical uniforms had fallen to about half their pre-storm level.
“At this time of day when times were good, it was bustle-bustle here,” said Mr. Gerson, 63, standing in his shop late one recent afternoon. Now, “the foot traffic is almost nil.”
By working harder and selling more industrial and restaurant uniforms, Mr. Gerson has kept his business going but, he said, “I’m not a happy person when I get home.”
An Era’s End
The future of Mr. Gerson’s shop — and in many ways the future of health care in New Orleans — is bound up in the thorny question of what if anything will replace the hospital known as Big Charity.
Since it opened in 1939, Charity Hospital’s imposing building downtown has provided basically all the medical care — emergency, acute and basic — for the city’s poor, and served as a training ground for generations of doctors.
Despite some community protests, Louisiana State University, which ran the hospital, closed it permanently after the storm, saying it was too damaged by basement flooding. The state plans to replace it with a $1.2 billion complex that officials believe will attract insured patients as well as the poor, will also care for veterans and will serve as an economic catalyst for the city. But the hospital’s future is now the subject of a debate about the best use of federal health care dollars, even after the state agreed to pay $300 million to get the project off the ground.
The federal government would prefer that the state build a small hospital and use its federal dollars to buy private insurance for the poor. Dr. Frederick P. Cerise, the secretary of Louisiana’s Department of Health and Hospitals, said that plan would help less than half of the uninsured.
On a positive note, the city’s trauma center, which treats gunshot wounds and other serious emergencies, reopened in February at University Hospital downtown, which like Charity is part of the Medical Center of Louisiana at New Orleans. But the number of beds at University remains limited, and the building is so outdated that it will eventually have to be replaced, said Dr. Cathi Fontenot, the medical director.
In the meantime, the sick have to go somewhere. Often, that somewhere is Ochsner Medical Center, a huge private hospital complex in the western suburb of Metairie that looks like a mall, with a computerized grand piano that entertains patrons in a sunny atrium.
Before Hurricane Katrina, patients waited just 20 minutes to be seen, said Dr. Joseph Guarisco, chairman of emergency services at Ochsner, and surveys found that 99 percent were satisfied with their care.
After the storm, the number of people coming to the emergency room jumped, on some days reaching nearly twice the pre-hurricane volume. The number of psychiatric patients soared.
The uninsured, who had made up a small percentage of emergency patients at Ochsner, began accounting for more than a quarter of emergency room patients. Waiting times routinely topped an hour. The patient satisfaction rate fell to 34 percent.
This year, Dr. Guarisco reorganized the emergency room and cut the waiting time back to about 20 minutes.
But the other problems remain. “The hospital, post-Katrina, struggled financially,” Dr. Guarisco said, “and it still struggles to this day.”
Bad Time for a Fracture
No one thinks that emergency rooms are a good way to provide basic everyday health care, but government efforts to attract doctors and to open more neighborhood clinics have gotten off to a slow start.
Volunteers and nonprofit groups are trying to fill the breach, treating thousands of patients a month in more than a dozen low-cost clinics in the city. In many ways, the clinics have been a success for their patients, as they are elsewhere in the country, but they represent just a drop in the city’s ocean of medical need, health officials say.
Some were open before the storm but have expanded; others are new, like the Common Ground Health Clinic, which provides free medical care four days a week in an old corner store in the Algiers neighborhood, across the Mississippi from the French Quarter. People wait outside in the heat for the clinic to open, and it is always jammed.
One recent Tuesday, the patients included a city employee with a neck problem, a college student with uncontrolled menstrual bleeding, a bartender with high blood pressure and glaucoma, and Nellie M. Lindsey, 54, a scrap hauler who was suffering from what she called “cancer stones.”
Before the storm, Ms. Lindsey said, she would have sought treatment at Charity, but she is so happy with the Common Ground clinic — despite the long waits — that she took her adult sons and daughter there for checkups.
Most of the people who come to the clinic hold at least one job, and many are working two, said Anne Mulle, a family nurse practitioner who came from California after the storm to help and ended up staying.
In addition to longstanding problems like hypertension, diabetes and heart disease, most patients have anxiety, depression and stress, which are even harder to treat, the clinic staff says.
“We can take the health piece off your worry list,” said Dr. Ravi Vadlamudi, a Tulane University doctor who serves as the clinic’s volunteer medical director. “But we can’t get you a better job market or housing market; we can’t do anything about the schools; we can’t do much with police problems. I can’t do anything about most of what bothers you.”
For patients who need more complicated care, including mammograms, stress tests and vision treatments, the clinic can make referrals to St. Thomas Community Health Center, which Dr. Donald T. Erwin founded in 1987. The fact that clinics are now collaborating — and recently qualified for federal financing — is a new and welcome development in what can seem like a bleak medical landscape, Dr. Erwin said.
Another change he has seen, he said, is that even people with insurance are having a hard time finding doctors, getting tests and continuing prescriptions, so are turning up at his clinic, where they now make up about a quarter of the patients.
“Before the storm?” Dr. Erwin continued, and held a thumb and forefinger together to make a zero.
Counseling and mental health treatment are notoriously hard to find in New Orleans these days, and doctors say this is an especially bad time to break a leg, given the shortage of orthopedists.
Even patients with the means to pay and doctors who have returned can face long waits for treatment. Dr. Myers, the internist who used to practice in Mid-City, said recently that a new patient would probably have to wait two months for an appointment, though he would find a way to get existing patients in sooner. He estimates that 80 percent of those patients have returned.
Dr. Myers said he had been trying for months to lure another doctor to the area to join his practice.
“This is a great opportunity for people who have courage,” he said.
So far, he has found no takers.

Copyright 2007 The New York Times Company



Brad Loper/Dallas Morning News/Corbis




No Indictment in Katrina Hospital Deaths

- - - - - - - - - - - -

By MARY FOSTER Associated Press Writer

July 24,2007 | NEW ORLEANS -- A grand jury Tuesday declined to indict Dr. Anna Pou, the surgeon accused of killing four seriously ill patients in the aftermath of Hurricane Katrina.
Pou and two nurses were arrested last summer after Attorney General Charles Foti's investigation concluded they killed four people with a "lethal cocktail" at Memorial Medical Center during the chaotic conditions that followed the August 2005 storm.
Lawyers for the three said they acted heroically by staying to treat patients rather than evacuating.
Charges against the nurses, Lori Budo and Cheri Landry, were dropped after they were compelled to testify last month before the grand jury under legal guidelines that kept their testimony from being used against them.
The Orleans Parish grand jury had been investigating the charges since March.
Pou, whose specialty is eye, ear, nose and throat surgery, gave up her private practice after she was arrested. She has been teaching at LSU medical school in Baton Rouge.
When the levees broke in New Orleans following the hurricane's hit, 80 percent of the city flooded. The lower level Memorial Medical Center was under 10 feet of water, and electricity was out across the city. Inside the hospital, the temperature topped 100 degrees.
At least 34 people died at Memorial, many from dehydration during the four-day wait for rescuers to evacuate them.
The four Pou was accused of killing ranged in age from 61 to 90 years old. Foti said they would have survived if they hadn't been given morphine and midazolam hydrochloride, central nervous system depressants.

© 2007 The Associated Press. All rights reserved. The information contained in the AP News report may not be published, broadcast, rewritten or redistributed without the prior written authority of The Associated Press.




Medics in hurricane deaths probe

Rescue from Memorial hospital after Katrina flooding
Hospital officials said there were problems with its evacuation
US prosecutors have called dozens of hospital staff to give evidence over claims of a euthanasia policy in dealing with Hurricane Katrina victims.
A total of 73 staff at New Orleans' Memorial Hospital were issued with the subpoenas, a spokeswoman for Louisiana's attorney general said.
Those called include doctors, nurses, and support staff.
A spokesman for Tenet Healthcare Corporation, the hospital's owner, said it was co-operating with investigators.
Previously, Tenet said that 34 patients had died after the hospital was cut off by flood waters, and 24 of those had been in a facility on the hospital grounds run by a separate company.
In all, more than 970 people are known to have died in the city and the surrounding state of Louisiana, and more than 200 in neighbouring Mississippi.
Legal rights
Louisiana attorney general's office said on Tuesday it was investigating the deaths of more than 200 people in total at nursing homes and hospitals during and after the hurricane.
Allegations range from negligence to euthanasia, spokeswoman Kris Wartelle told Reuters news agency, adding that many were likely to be unsubstantiated.
However, on Wednesday prosecutors issued the 73 summonses "for all levels of personnel" at Memorial Hospital.
"All we can say is that we had to issue the subpoenas to get those people to talk to us," Ms Wartelle said.
Two weeks ago Tenet's assistant general counsel, Audrey Andrews, sent out a memo detailing the legal rights of staff and pointing out that employees could decide whether or not they wanted to be interviewed.
The Memorial Hospital denied any attempt to dissuade people from coming forward.
"We have never discouraged any employee from working with the Louisiana attorney-general's office," CNN quoted a spokesman as saying.
Two nursing home owners were charged with manslaughter in September over the deaths of 34 people at St Rita's home.
Mable Mangano and Salvador Mangano Sr were accused of ignoring mandatory orders to evacuate residents.