A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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DC Comics Turns the Occupy Movement Into a Superhero Title

Eighteen months after the phrase first entered the collective public consciousness, the plight of the 99 percent is coming to mainstream superhero comics — via a new series from the second biggest publisher in the American comic industry, which just happens to be a subsidiary of a multi-national corporation that makes around $12 billion a year. Irony, anybody?

In May, DC Comics will launch two new series taking place in their mainstream superhero universe that offer different insights into the class struggle in a world filled with superheroes, alien races and inexplicable events. The Green Team, written by Tiny Titans and Superman Family Adventures creators Art Baltazar and Franco, with art by Ig Guara, revives an obscure 1975 concept about teenage rich kids who try to make the world a better place with their outrageous wealth. In an interview promoting the series, Franco promised that it would address questions like “Can money make you happy?” and “If you had unlimited wealth, could you use that to make the lives of people better?”

Obviously, this is one of the more fanciful series DC will be publishing.

But while DC is promoting The Green Team series as the adventures of the “1%,” its companion title, The Movement, is teased as a chance for us to “Meet the 99%… They were the super-powered disenfranchised — now they’re the voice of the people!”

“It’s a book about power,” explained The Movement writer Gail Simone. “Who owns it, who uses it, who suffers from its abuse. As we increasingly move to an age where information is currency, you get these situations where a single viral video can cost a previously unassailable corporation billions, or can upset the power balance of entire governments. And because the sources of that information are so dispersed and nameless, it’s nearly impossible to shut it all down.”

“The thing I find fascinating and a little bit worrisome is, what happens when a hacktivist group whose politics you find completely repulsive has this same kind of power and influence,” she elaborated in an interview at Big Shiny Robot. “What if a racist or homophobic group rises up and organizes in the same manner?”

While the concept is ambitious, the idea that a comic capable of living up to the book’s populist inspiration could come from DC Entertainment still strikes some as unlikely. Matt Pizzolo, the editor of the Occupy Comics anthology, told Wired that “though DC Comics did help launch Alan Moore and David Lloyd’s seminal anarchist epic V For Vendetta over two decades ago, it’s unlikely they would do so today. Between dismantling Vertigo and frankensteining Watchmen, the past year has demonstrated DC isn’t a safe place for bold creators who want to tell the kinds of stories that would inspire things like Occupy, rather than just cash in on them.”

Still, Simone says that the use of the iconography and language of a real-world populist movement is deliberate, promising that the book will reflect today’s decentralized political world and offer ”a slice of rarity that we’re unlikely to see in most superhero books.”

This wouldn’t the first time that DC has attempted to offer pre-packaged populist rebellion, of course; in addition to the aforementioned publication of the anti-establishment V For Vendetta, the company’s Vertigo imprint also published Grant Morrison’s The Invisibles, a series centering around an international organization struggling against forces of authority and repression that included anti-corporate themes.

Only time will tell whether The Movement will live up to the subversive examples of these earlier books, or just end up a well-intentioned piece of topical super heroics that trades on, and commodifies, a real political movement.

The Movement #1 will be available in both print and digital formats on May 1, while The Green Team #1 will be released on May 22.

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Springsteen says “freaky” to be honored at pre-Grammys tribute

LOS ANGELES (Reuters) – Bruce Springsteen was honored as MusiCares Person of the Year on Friday at a star-studded pre-Grammys event where some of the biggest names in music like Sting, Alabama Shakes and Neil Young paid homage to “The Boss.”

The annual event, now in its 23rd year, celebrates a star’s musical achievements and philanthropic work, and is hosted by Grammy organizers to kick off the weekend of the awards show.

The 55th annual Grammy Awards will air this Sunday on CBS.

Past Musicares honorees include Bono, Tony Bennett, Aretha Franklin and ex-Beatle Paul McCartney.

“It’s kind of a freaky experience,” said Springsteen, 63, as he accepted the award, saying it was “like the Italian wedding” he never had with his wife Patti Scialfa, or a “huge Bar Mitzvah.”

Scialfa later accompanied Springsteen on vocals and guitar, along with other members of his band, as he performed a set of his hits, including “We Take Care of Our Own,” “Born to Run” and “Glory Days.”

Earlier in the night, he helped boost the value of an auctioned signed guitar. “With this guitar comes one free guitar lesson with me,” he said to the audience to trigger more bids. Then he threw in a ride in the sidecar of his Harley motorcycle, and his mom’s lasagna. The guitar sold for $ 250,000.

All of the proceeds from the show and silent auction go to Musicares, which provides support to struggling musicians in financial, medical and personal need.

Other artists including Ben Harper, Emmylou Harris, Jackson Browne, John Legend and Patti Smith performed songs to honor Springsteen.

Springsteen recently performed at the 12/12/12 Hurricane Sandy charity concert in Madison Square Garden to raise funds for the thousands affected by the superstorm.

The singer-songwriter from New Jersey has sold more than 120 million albums worldwide and is vying for three Grammys on Sunday, including best rock album for “Wrecking Ball.” His single “We Take Care of Our Own” is nominated for both Best Rock Song and Best Rock performance.

President Barack Obama used “We Take Care of Our Own” as one of his top campaign songs in last year’s election, in which he defeated Mitt Romney.

(Editing by Mark Trevelyan)

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Fair Game: Credit-Rating Club Is Tough to Get Into

Ozier Muhammad/The New York Times

Ann Rutledge and her husband, Sylvain Raynes, of R&R Consulting, which has been trying to gain S.E.C. recognition as a debt ratings agency.

That was probably a common response to the news last week that the Justice Department had filed a civil suit against Standard & Poor’s, one of the two big credit ratings agencies that were so central to the mortgage boom and bust. The department said that S.& P. misled investors by presenting its ratings as the product of objective analyses when, the suit says, they were more about generating revenue to the firm. S.& P. denied the allegations, saying it was prepared to go to trial. 

Many people have been disappointed that S.& P. and Moody’s Investors Service, the big and powerful companies that are supposed to assess the creditworthiness of bonds, have escaped culpability. Not only do these companies still hold sway in securities markets, they’ve also hung on to their lush profits from the glory days of mortgage origination. During 2005 and 2006, for example, Moody’s made $238 million by rating complex mortgage instruments. Investors who trusted those ratings lost billions.

Given that the financial crisis began unfolding more than five years ago, it is discouraging to see how entrenched the large and established ratings companies remain. Ratings are still used to determine bank capital requirements, and investors rely heavily on them.

Over the years, lawmakers have tried to open up the duopolistic world of ratings agencies to greater competition and, therefore, better performance. Legislation in 2006 encouraged the Securities and Exchange Commission to let new companies into the ratings club. The commission set up the Office of Credit Ratings to register new entrants and to monitor all participants’ activities. Today, 10 credit ratings agencies are recognized by the S.E.C.

But gaining regulatory approval to join the ratings arena is exceedingly burdensome. That, at least, has been the experience of R&R Consulting, a firm with a stable of highly respected credit analysts and an enviable record of having predicted the mortgage mess in 2003.

R&R has been trying to get recognition as a credit rating agency since 2011. Frustrated by what it perceives as roadblocks erected by the S.E.C., its executives are beginning to wonder if the commission really wants increased competition.

The firm was founded in 2000 by Ann Rutledge and Sylvain Raynes, experts in structured finance who previously worked at Moody’s. It is a small shop, with seven employees, but its clients include investors, small and medium-size banks, financial regulators and other institutions. R&R’s specialty is risk measurement for all asset types.

R&R’s approach differs from traditional ratings agencies because, in addition to being able to rate new issues, it analyzes risks in securities that are trading in the secondary, or resale, market, after they are issued. By contrast, S.& P. and Moody’s became known for giving mortgage securities high ratings and downgrading them only when defaults were soaring. 

 “In the primary market, everyone prices a security around the credit rating,” Ms. Rutledge says. “In the secondary market, no one cares about the credit rating; what they want is valuation. We connect primary-market ratings with secondary-market valuations.”

THE R&R distinction between a rating and a valuation, however, seems to pose a problem when it comes to getting S.E.C. approval as a ratings agency, Ms. Rutledge says.

By law, many requirements must be met before a firm can become a ratings agency. Chief among them is that the applicant must provide letters from 10 “qualified institutional buyers” that have used the company’s ratings over the previous three years.

R&R has had difficulties with its letters. One was rejected because its writer identified the firm’s work as ratings or valuations, not simply as ratings, Ms. Rutledge says. Another letter failed to pass muster because it was from a German institution that characterized itself as the equivalent of a qualified institutional buyer. When a foreign institution could not get its letter notarized as required — notaries are not as common overseas — it was not good enough for the S.E.C.

And not all clients want to write such a letter for use by the S.E.C. Instead, some said they would discuss the company’s work by telephone. The S.E.C. rejected the idea.

“It’s extremely difficult for us to satisfy the ‘10 qualified institutional buyers’ requirement,” Ms. Rutledge says. “Proof that you’ve done business with them is not enough; it says you must have letters. And they have a suggested text for the letter. When we changed the text slightly they said it was not in conformity.”

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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How a Charming Doodling App Arose From the Web's Wildest West

Christopher Poole, the man behind some of the web’s biggest hits like 4Chan and Canvas, launched a new iPad app today. DrawQuest is a painting app that lets you doodle on templates to create cartoon scenes and share them with others. The idea, says Poole, is to give people not only the tools but also the inspiration to have fun drawing.

Fire up the app, and you’re presented with a daily “quest,” basically just a template to doodle on that gets you started. For example, yesterday’s was “draw a superhero” and featured an outline of a figure in a cape, set against a blue sky. You can also go back and doodle on previous quests. There’s a color palette to work with, a brush, marker and pen tool, plus an eraser. It’s enough to get you started, but the tools also let you color over the template itself and create something wholly original. The idea is to give some direction and inspiration, but also leave as much room as people need to get creative. “We didn’t just want it to just be color-in-the-lines,” Poole told Wired.

Here, for example, is yesterday’s Draw a Superhero template, and my subsequent drawing. It’s quite awful! But I had fun making it, which, really, is the point.

DrawQuest isn’t a game, exactly, although you can score points (largely for participation) that let you buy in-game tools, like additional colors for your paint palette. There’s a social component that lets you follow other people and see their drawings, but you could certainly use it in complete isolation as well. And one of its most interesting features isn’t creative at all, but a feature that lets you play back videos of others’ drawing processes, showing artworks as they are made from start to finish.

What’s maybe most interesting about DrawQuest, however, isn’t its canvas tools. It’s that it’s not just a drawing app, but an attempt to kick-start the creative process for people who don’t think of themselves as creatives. Both 4Chan and Canvas rely completely on user-generated content. But Poole tells Wired that a small minority of people who visit either site are actually creating content — most just consume. It’s a classic one-percent rule situation. “People think of creativity as binary, like its either on or its off,” Poole explained, “but that’s not true.”

Instead, he argues, creativity is a continuum. And while one person may be able to sit down to a blank slate and come away with something utterly amazing, others need lots of direction. DrawQuest is an attempt to inspire both of those types of people, and everyone in between. The result is a quirky and charming little app. It’s free, and currently only available on iOS for the iPad.

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HMV boss Moore axed as one of 60 redundancies: source

LONDON (Reuters) – Administrators at HMV, the British music and video retailer which hit the rocks last month, have made the group’s chief executive Trevor Moore redundant, according to a source familiar with the situation.

Deloitte, which was appointed as administrator by HMV after the firm struggled against competition from online retailers, supermarkets and streaming sites, had on Friday announced 60 redundancies across HMV’s head office network.

It would not comment on whether Moore was one of those leaving the firm. He joined HMV in 2012 from camera specialist Jessops, which also went into administration this year.

The redundancies follow a move on Thursday to close 66 loss-making HMV stores over the next two months, putting almost 1,000 jobs at risk. The group currently operates from 220 stores in the UK and employs around 4,000 people.

Deloitte is seeking a buyer for all or parts of the business, with analysts expecting it to survive in a much smaller form with an online offering.

In January restructuring specialist Hilco bought HMV’s debt, giving the firm a big say in the fate of the 92-year-old group.

(Reporting by Neil Maidment; Editing by Kate Holton)

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The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

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

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Media Decoder Blog: Macmillan Settles With Justice Department on E-book Pricing

11:58 a.m. | Updated Macmillan said on Friday that it had agreed to settle a lawsuit brought by the Department of Justice over the pricing of e-books, asserting that the potential costs of continuing to fight the action were too high.

The agreement means that all five major publishing houses have settled the charges brought by the government last spring.

Apple, which is also a defendant, will continue to trial in June, according to the Department of Justice. A company spokeswoman declined to comment on Friday.

In a letter addressed to authors, illustrators and agents, Macmillan’s chief executive, John Sargent, said that the risks were too great to go it alone.
“Our company is not large enough to risk a worst case judgment,” he said. “In this action the government accused five publishers and Apple of conspiring to raise prices. As each publisher settled, the remaining defendants became responsible not only for their own treble damages, but also possibly for the treble damages of the settling publishers (minus what they settled for). A few weeks ago I got an estimate of the maximum possible damage figure. I cannot share the breathtaking amount with you, but it was much more than the entire equity of our company.”

In a suit filed last April, the Justice Department accused the publishers and Apple of conspiring in e-mails and over lavish dinners to set the price of e-books at an artificially high level. The publishers had moved from a wholesale pricing model, which allowed retailers to charge what they wanted, to a system that allowed publishers to begin setting their own e-book prices, a model known as “agency pricing.”

The defendants said they were trying to protect themselves from Amazon, which was pricing e-books below their actual cost, putting financial pressure on the publishers that they said would drive them out of business.

Nevertheless, three publishing houses, HarperCollins, Simon & Schuster and Hachette, settled with the government immediately. Penguin, Macmillan and Apple decided to fight the charges. But in December, to clear the way for its merger with Random House, Penguin settled too.

The terms of the Macmillan settlement mirrors that agreed to by the other publishers. Macmillan will immediately lift restrictions it has imposed on discounting and other promotions by e-book retailers and will be prohibited until December 2014 from entering into new agreements with similar restrictions. The publisher must also notify the government in advance about any e-book ventures it plans with other publishers.

Macmillan had been holding firm that it wouldn’t settle, and analysts offered varying explanations for the sudden turnabout. James McQuivey, an analyst for Forrester Research, said that potential merger talks might be one motivation. The publishing industry has begun to consolidate to respond to the threat from Amazon, and when Penguin and Random House announced last October that they would merge, it fueled speculation that more alliances would follow.

“This was a fight not worth fighting in the first place,” Mr. McQuivey said of the lawsuit, “and given the likely nature of merger conversations behind the scenes, that’s where you finally decide the litigation is an obstacle to those talks, which are much more important.”

But Mike Shatzkin, the founder and chief executive of the Idea Logical Company, a publishing consultant, downplayed the role of a potential merger. “There have been no rumors and no signs that Macmillan is merging,” he said. “I would actually take their statement at face value.”

He said he thought it was more likely that Macmillan realized that their stand on pricing was having no effect on the market. E-book prices have been declining steadily but not precipitously since the settlement with the first three publishers went into effect last September. “Their settling doesn’t change the overall market, and it looks much more that way to them now than when they were originally fighting,” Mr. Shatzkin said.

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Women delivering papers shot by police during manhunt

By Los Angeles Times staff

February 7, 2013, 9:09 a.m.

Two women delivering newspapers were shot in Torrance early today by LAPD officers involved in a manhunt for an ex-LAPD officer suspected of shooting three police officers and an Irvine couple, sources say.

The women, shot in the 19500 block of Redbeam Avenue, were taken to area hospitals, police said. One of the women was shot in the hand, and the other in the back, according to witness Jesse Escochea.

Police said the women were riding in a truck similar to the one that suspect Christopher Jordan Dorner is believed to be driving.

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Magnetic Memories May Guide Salmon Home

After years at sea, sockeye salmon returning to their freshwater homes may be guided by an early memory of the Earth’s magnetic field, encoded at the site where natal streams empty into the Pacific Ocean, according to a study published today in Current Biology.

“Lots of folks have been wondering for decades how salmon and other animals, like sea turtles or seals and whales, go out in the ocean for a couple of years and then return with remarkable accuracy back to their home,” said study coauthor Nathan Putman, a marine biologist at Oregon State University. “The magnetic field is an important part of the [salmon's] migratory decision.”

To study salmon navigation, Putman and his colleagues took advantage of a serendipitous natural experiment. Near the mouth of British Columbia’s Fraser River is 460-kilometer-long Vancouver Island. Salmon returning from sea and aiming for the river face a choice: swim north around the island, or go around to the south. Putman pored over 56 years of data from federal fishery scientists who tracked salmon in both waterways, then matched that up with measurements of the Earth’s geomagnetic field, which shifts predictably in strength and orientation over time. He found that fish tended to choose the path where the field strength was more similar to that of the river mouth when they’d left, two years before.

“The magnetic field at each route predicts the proportion coming in,” Putman said. He speculates that reaching saltwater triggers the fish to remember the magnetic field at the river’s mouth when they first head to sea — and then seek that same field on the return journey.

Scientists hope the finding will help solve the mystery of how salmon find their way home from thousands of miles away, across an ocean with no lanes or landmarks. It’s already accepted that in the final stages of the journey to their breeding grounds, salmon use odors to guide them back to the stream or inlet where they hatched. But how the fish find their target river is still a mystery, although scientists have suspected for a while that magnetic cues play a role. Last summer, a team reported that rotating magnetite crystals in a fish nose responded to magnetic field orientation, providing a possible biological mechanism for this sensory capability.

“In general, we know much less about how salmon complete the ocean part of their migration compared to fresh water,” said quantitative ecologist Chloe Bracis, a graduate student at the University of Washington who also studies geomagnetic salmon navigation. “The authors cleverly take advantage of spatial differences in a salmon migration route to provide the first solid evidence that salmon use geomagnetic cues to direct their oceanic migration.”

Putman now hopes to investigate this correlation in experiments with captive fish subjected to artificial magnetic fields.

But even if those experiments bolster the case that salmon use geomagnetic cues, these cues can’t be the whole story. The new study also revealed that sea surface temperature is an important guide for the fish — but even the interaction of water temperature and magnetic cues can’t explain all of the fishes’ knack for navigation. Temperature, olfaction and magnetoreception, while clearly important, may be just some of the tools salmon use to find their way home.  “They might use … a sun compass or other cues,” Bracis said. “Geomagnetic cues could guide them to the vicinity of the river, then they would need to switch to other local cues to navigate the rest of the way to the river mouth or through the estuary.”

Photo: Current Biology, Putman et al.; Map: Oregon State University/NSF

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Frank Ocean, FUN. are front-runners heading into Sunday’s Grammys

LOS ANGELES (Reuters) – R&B artist Frank Ocean and indie-pop group FUN. go into Sunday’s Grammy Awards ceremony as front-runners for the music industry’s top accolades in a year where new talent and male artists have attracted most of the attention.

After last year’s Grammy ceremony was dominated by British singer Adele, and her best-selling album “21,” this year’s awards show will be all about men.

FUN., Ocean, British folk band Mumford & Sons, rocker Dan Auerbach, Jay-Z and Kanye West each received six nominations, while Auerbach’s band, The Black Keys, got five.

“It will be a very exciting night because it’s so much the antithesis of last year, which was a once-in-a-lifetime show with Adele and her moment,” Jim Donio, president of the National Association of Recording Merchandisers, told Reuters.

With the absence of new music from many major pop artists in the past year, emerging talent features prominently at the Grammys.

Pop chart staples Kelly Clarkson, Katy Perry, Adele and Rihanna all picked up nominations for the 55th annual Grammy Awards, but only Clarkson and Taylor Swift received Record of the Year nods.

In the Album of the Year category, one style of music is making a comeback.

“This year seems very different … we’re seeing rock music and guitar music coming back to the Grammys and being appreciated this year,” said Patrick Doyle, assistant editor of Rolling Stone magazine.

New York-based FUN., made up of Nate Ruess, Andrew Dost and Jack Antonoff, stormed the charts in 2012 and are back this year. They are the only artists going into Sunday’s awards with nominations in the top four categories – Album, Record and Song of the Year as well as Best New Artist.

But unlike last year, where Adele was a clear favorite and went home with six Grammys, this year’s big winners are less predictable. Experts said the chances are slim of one person or band winning the coveted trifecta of Song, Record and Album of the Year.

“I think voters went out of their way almost to assure that you’re not going to see the photo of one person clutching six Grammy awards. There won’t be one unified winner,” said James Montgomery, senior writer at MTV News.

OCEAN MAKING WAVES

FUN. had one of the biggest-selling singles of 2012 with their infectious hit “We Are Young” featuring Janelle Monae, which is up for three Grammy awards. Both Doyle and Montgomery think they may take both the Song and Record of the Year titles.

“They’re taking a classic sound and putting hip hop productions and fresh sounding beats on top of anthem-like melodies,” Doyle said.

The trio face strong competition from Ocean, who is nominated in six categories, including Best New Artist, Album of the Year and Record of the Year.

Ocean, 25, has paved an unconventional path to the Grammys after emerging on the music scene a few years ago as part of the Odd Future hip hop collective.

His debut album “Channel Orange,” released in July, has been both a commercial and critical success.

The singer made waves after revealing that his first love was another man, an admission of same-sex attraction that was seen as groundbreaking in the hip hop community, which is often criticized for hostility towards homosexuals.

Ocean and FUN. will be competing with blues-rockers Alabama Shakes, folk-indie group The Lumineers and country singer Hunter Hayes for Best New Artist.

“Alabama Shakes, The Lumineers and Hunter Hayes may all draw from the some basic vote group, which leaves the race between FUN. and Frank Ocean. And due to his album success and story, I think it may be Frank Ocean,” Montgomery said.

Both Montgomery and Doyle said Ocean may be also win the night for Album of the Year.

“His album was so soulful and new, and it sounds really like nothing else. It’s a completely honest record that people can really relate to, something that hasn’t been seen or heard in a long time,” Doyle said.

“He’s going to be a huge presence at the Grammys because there’s no one like him.”

The Grammys Awards will be presented in Los Angeles and shown live on CBS television on Sunday.

(Reporting By Piya Sinha-Roy, editing by Jill Serjeant and Stacey Joyce)

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Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”

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Have you written a poem about cancer? Please share them with us in the comments section below.

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Retailers' Sales Beat Forecasts, but Worries Remain

(Reuters) - Many top retailers reported strong January sales on Thursday after offering merchandise and deals that drew in shoppers in spite of higher payroll taxes.

But shares of many retailers fell as investors worried that the sales owed too much to margin-sapping discounts and that the tax hit to take-home pay would hurt spending in coming months.

Macy's Inc, whose shares rose 0.4 percent, was an exception. Its sales at stores open at least a year jumped 11.7 percent, in part because it got new merchandise into stores quickly. The results easily beat Wall Street forecasts, and the department store chain raised its profit forecast.

In contrast, Kohl's Corp, reported a 13.3 percent jump, but that came in large part from clearing out merchandise at a discount ahead of spring. The department store operator left its profit outlook unchanged, and its shares fell 1.8 percent.

"January sales don't give you much of a sense what's coming," said Dan Hess, chief executive of Merchant Forecast, which provides financial research on the retail sector. "How much of it was clearance; how much of it was new merchandise?"

Besides Macy's, low-priced retailers TJX Cos Inc and Ross Stores Inc as well as teen chain Zumiez Inc raised their outlooks. Department store operator Stage Stores Inc, said it would hit or beat the high end of its earlier estimate.

Overall, same-store sales rose 5 percent in January across 20 retailers, according to Thomson Reuters I/B/E/S. That was above both analysts' estimates of a 3.1 percent increase and the year-earlier 2.8 percent gain.

Gap Inc's sales came in slightly above Wall Street forecasts, as the company's affordable Old Navy chain offered colored denims, coats and dresses that were a hit with shoppers. But Janney Capital Markets said in a note that investors would view Gap's modest profit estimate for the fourth quarter ended on February 2 as "not good enough." The company's shares were down 4.5 percent.

Costco Wholesale Corp, Target Corp and Victoria's Secret parent Limited Brands Inc also reported stronger-than-expected January sales.

Analysts said a number of factors gave January an artificial boost: Unusually cold weather mid-month in big parts of the country helped clear out winter merchandise, and a long weekend before New Year's Day helped. January is also a low-volume month, so the numbers are less important than, say, those for November and December.

The International Council of Shopping Centers said it expects February same-store sales to rise 2.8 percent to 3 percent.

The Standard & Poor's Retail Index was down 1 percent in midday trading, compared with a 0.8 percent decline for the broad S&P 500.

LITTLE TAX EFFECT, SO FAR

The mood of U.S. consumers improved in January after a deal in Washington at the start of the month averted the country going over the "fiscal cliff" that could have raised taxes significantly, a survey released last week showed.

At the same time, the take-home pay of millions of Americans fell in January because of a 2-percentage-point increase in payroll taxes.

That higher tax could pinch shoppers in coming months as relief about the "fiscal cliff" gives way to the reality of smaller paychecks.

"The amount of money that is being taken out (from the tax increase) is a real amount of money, and you may see more paycheck-to-paycheck cycles," said Kurt Kendall, a retail strategist at consulting firm Kurt Salmon.

Cato Corp, a specialty retailer offering low-price fashion, reported a 12 percent drop in same-store sales and pinned part of the blame on the payroll tax.

Target CEO Gregg Steinhafel said in a statement that customers are showing "discipline in the face of a slow economic recovery and new pressures," including payroll tax increases.

In that environment, retailers have little room for error.

Ann Inc said the brightly colored clothes it sold at its Loft chain failed to catch on with shoppers, and its sales estimate for the fourth quarter ended on January 31 disappointed Wall Street, sending its shares down 7 percent.

Department store operator Bon-Ton Stores Inc and teen chains Buckle Inc and Wet Seal Inc also reported disappointing sales.

At the higher end, Nordstrom Inc reported an 11.4 percent jump in same-store sales, probably buoyed by a stock market run-up.

"The stock market has also helped - it frees higher-end individuals to go shopping," said David Bassuk, head of AlixPartners' global retail practice.

The same-store sales retail index offers only a glimpse of retail spending as major chains like Wal-Mart Stores Inc, Sears Holdings Corp and Best Buy Co Inc do not report monthly sales.

(Reporting by Phil Wahba in New York, and Nivedita Bhattacharjee and Jessica Wohl in Chicago; Editing by Lisa Von Ahn)

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Postal Service seeks to end Saturday mail delivery

Postal Service to Cut Saturday Mail

By Michael Muskal

February 6, 2013, 8:34 a.m.

The U.S. Postal Service, struggling under a financial load and facing tough competition, will stop delivering mail on Saturdays beginning this summer, officials announced.

The announcement, which had been expected, is seen as an attempt to force Congress to deal with the Postal Service's increasing financial woes. Congress has tried to reorganize the agency, but efforts have been derailed because of politics.

Material prepared for a Wednesday news conference by Postmaster General Patrick R. Donahoe says that Postal Service market research and other research has indicated that nearly 7 in 10 Americans support the switch to five-day delivery as a way for the agency to reduce costs.

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"The Postal Service is advancing an important new approach to delivery that reflects the strong growth of our package business and responds to the financial realities resulting from America's changing mailing habits," Donahoe said. "We developed this approach by working with our customers to understand their delivery needs and by identifying creative ways to generate significant cost savings."

The Postal Service contends that it has the authority to cut back service, though some in Congress insist that lawmakers have the final word. In any case, the announcement is expected to move the issue to a front burner.

According to postal officials, the end of Saturday delivery would begin on Aug. 1. The service said it will continue to deliver packages on Saturdays.

Ending Saturday service is estimated to save the agency about $2 billion a year. Officials said it lost about $16 billion in fiscal 2012, which ended Sept. 30 -- about three times the loss it had a year ago.

The proposal comes as the agency has closed post offices and changed procedures to try to stem its hemorrhaging of billions of dollars in recent years. More people have been turning to alternatives to traditional mail service, including electronic tools such as email and outside competitors such as Fed Ex, both of which have seriously cut into the Postal Service's erstwhile monopoly.

Congress in recent years has prohibited the Postal Service from dropping Saturday mail delivery, but the initial response to Wednesday's announcement was more accepting of what might be inevitable.

"This common-sense reform would save the Postal Service more than $2 billion annually," two top Republicans, Rep. Darrell Issa of California and Sen. Tom Coburn of Oklahoma, said in a statement.

"In his recent inaugural address, President Obama spoke about the need to find real solutions to our nation’s problems. Supporting the U.S. Postal Service's plan to move forward with 5-day mail delivery is one such solution worthy of bipartisan support," they said.

Rep. Elijah E. Cummings of Maryland, the top Democrat on the House Oversight and Government Reform Committee chaired by Issa, agreed that action was needed, but questioned whether the Postal Service could act alone.

"The Postal Service's declining mail volume poses a significant challenge, and the enactment of comprehensive postal reform legislation must be an urgent priority for the current Congress," Cummings said in a statement. “However, the issue of service delivery frequency should be addressed in that legislation rather than through arbitrary action by the Postal Service.”

Recent national polls show that a majority of respondents support ending Saturday mail delivery, and Obama has proposed halting such service as part of his budget-cutting proposals. Though the Postal Service is a quasi-governmental, self-funding entity, its worker compensation and retirement plans are tied to the federal budget.

Lawmakers have tried unsuccessfully for years to overhaul the Postal Service, but efforts have fallen victim to different needs in different areas. Representatives of rural areas tend to argue that traditional mail delivery is needed, a position backed by magazine publishers and other heavy users of the Postal Service.

The president of the National Assn. of Letter Carriers, Fredric Rolando, said in a statement that the end of Saturday mail delivery is "a disastrous idea that would have a profoundly negative effect on the Postal Service and on millions of customers,” particularly businesses, rural communities, the elderly, the disabled and others who depend on Saturday delivery for commerce and communication.

ALSO:

Alabama kidnapper, who had bombs, reportedly died in shootout

Florida judge denies request to postpone George Zimmerman trial

Gov. Christie eats doughnut with Letterman; talks Sandy storm aid

Times staff writers Richard Simon and Jim Puzzanghera contributed to this report.

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<i>Game of Thrones</i> Creator George R. R. Martin to Develop New Shows for HBO

Game of Thrones fans, time to get excited — or, perhaps, just conflicted: George R.R. Martin, the creator of the Song of Ice and Fire novels the series is based on (and occasional episode scriptwriter), has signed a new deal with HBO that will not only see him continuing as executive producer of the hit fantasy series for the next two years, but also developing and producing new series for the cable network.

The news comes ahead of the debut of the third season of GoT, which launches on March 31. Many fans of the novels are already reacting with mixed feelings about the announcement, complaining that these new duties will mean a longer delay for the next Game of Thrones novel, particularly after six years elapsed between the release of the fourth novel, A Feast for Crows, and the 2011 release of the most recent novel, Dance with Dragons — a delay that upset many readers.

Outside of his connection with the Game of Thrones show, Martin already has a long history in television. He worked on the 1980s incarnations of both The Twilight Zone and Beauty and the Beast as writer and producer, and also created a science-fiction pilot for a potential ABC series called Doorways in 1993 that ended up going nowhere; the script was eventually published in the DreamSongs: A RRetrospective collection in 2006, and turned into a comic book in 2010 by IDW Publishing.

Whether or not his new HBO projects will consist of all-new ideas or adaptations of his earlier, non-Game of Thrones work remains to be seen. If nothing else, his super-hero shared world anthology series Wild Cards may be one of the more obvious candidates for translation to television, if the rights have returned to Martin following a seemingly abortive attempt to adapt the series to the big screen a couple of years ago.

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Boy band The Wanted sign on for E! reality series

NEW YORK (AP) — The Wanted is trying to keep it real: The boy band has signed on to do a reality series on E!

The British fivesome announced Wednesday that their show will debut in June. A press release said the behind-the-scene series will be “unvarnished” and “nonglossy.”

The Wanted broke onto the U.S. music scene with the Top 5 hit “Glad You Came.” They dropped their self-titled U.S. debut EP last year, and have released two successful albums and multiple singles in the United Kingdom.

The group is planning a full-length album and international tour for the fall.

Their U.S. manager is Scooter Braun, who also manages Justin Bieber. The band members include Max George, Nathan Sykes, Jay McGuiness, Tom Parker and Siva Kaneswaran.

___

Online:

http://www.thewantedmusic.com/

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Well: Gluten-Free for the Gluten Sensitive

Eat no wheat.

That is the core, draconian commandment of a gluten-free diet, a prohibition that excises wide swaths of American cuisine — cupcakes, pizza, bread and macaroni and cheese, to name a few things.

For the approximately one-in-a-hundred Americans who have a serious condition called celiac disease, that is an indisputably wise medical directive.

---

One woman’s story of going gluten-free.

---

Now medical experts largely agree that there is a condition related to gluten other than celiac. In 2011 a panel of celiac experts convened in Oslo and settled on a medical term for this malady: non-celiac gluten sensitivity.

What they still do not know: how many people have gluten sensitivity, what its long-term effects are, or even how to reliably identify it. Indeed, they do not really know what the illness is.

The definition is less a diagnosis than a description — someone who does not have celiac, but whose health improves on a gluten-free diet and worsens again if gluten is eaten. It could even be more than one illness.

“We have absolutely no clue at this point,” said Dr. Stefano Guandalini, medical director of the University of Chicago’s Celiac Disease Center.

Kristen Golden Testa could be one of the gluten-sensitive. Although she does not have celiac, she adopted a gluten-free diet last year. She says she has lost weight and her allergies have gone away. “It’s just so marked,” said Ms. Golden Testa, who is health program director in California for the Children’s Partnership, a national nonprofit advocacy group.

She did not consult a doctor before making the change, and she also does not know whether avoiding gluten has helped at all. “This is my speculation,” she said. She also gave up sugar at the same time and made an effort to eat more vegetables and nuts.

Many advocates of gluten-free diets warn that non-celiac gluten sensitivity is a wide, unseen epidemic undermining the health of millions of people. They believe that avoiding gluten — a composite of starch and proteins found in certain grassy grains like wheat, barley and rye — gives them added energy and alleviates chronic ills. Oats, while gluten-free, are also avoided, because they are often contaminated with gluten-containing grains.

Others see the popularity of gluten-free foods as just the latest fad, destined to fade like the Atkins diet and avoidance of carbohydrates a decade ago.

Indeed, Americans are buying billions of dollars of food labeled gluten-free each year. And celebrities like Miley Cyrus, the actress and singer, have urged fans to give up gluten. “The change in your skin, physical and mental health is amazing!” she posted on Twitter in April.

For celiac experts, the anti-gluten zeal is a dramatic turnaround; not many years ago, they were struggling to raise awareness among doctors that bread and pasta can make some people very sick. Now they are voicing caution, tamping down the wilder claims about gluten-free diets.

“It is not a healthier diet for those who don’t need it,” Dr. Guandalini said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.”

Nonetheless, Dr. Guandalini agrees that some people who do not have celiac receive a genuine health boost from a gluten-free diet. He just cannot say how many.

As with most nutrition controversies, most everyone agrees on the underlying facts. Wheat entered the human diet only about 10,000 years ago, with the advent of agriculture.

“For the previous 250,000 years, man had evolved without having this very strange protein in his gut,” Dr. Guandalini said. “And as a result, this is a really strange, different protein which the human intestine cannot fully digest. Many people did not adapt to these great environmental changes, so some adverse effects related to gluten ingestion developed around that time.”

The primary proteins in wheat gluten are glutenin and gliadin, and gliadin contains repeating patterns of amino acids that the human digestive system cannot break down. (Gluten is the only substance that contains these proteins.) People with celiac have one or two genetic mutations that somehow, when pieces of gliadin course through the gut, cause the immune system to attack the walls of the intestine in a case of mistaken identity. That, in turn, causes fingerlike structures called villi that absorb nutrients on the inside of the intestines to atrophy, and the intestines can become leaky, wreaking havoc. Symptoms, which vary widely among people with the disease, can include vomiting, chronic diarrhea or constipation and diminished growth rates in children.

The vast majority of people who have celiac do not know it. And not everyone who has the genetic mutations develops celiac.

What worries doctors is that the problem seems to be growing. After testing blood samples from a century ago, researchers discovered that the rate of celiac appears to be increasing. Why is another mystery. Some blame the wheat, as some varieties now grown contain higher levels of gluten, because gluten helps provide the springy inside and crusty outside desirable in bread. (Blame the artisanal bakers.)

There are also people who are allergic to wheat (not necessarily gluten), but until recently, most experts had thought that celiac and wheat allergy were the only problems caused by eating the grain.

For 99 out of 100 people who don’t have celiac — and those who don’t have a wheat allergy — the undigested gliadin fragments usually pass harmlessly through the gut, and the possible benefits of a gluten-free diet are nebulous, perhaps nonexistent for most. But not all.

Anecdotally, people like Ms. Golden Testa say that gluten-free diets have improved their health. Some people with diseases like irritable bowel syndrome and arthritis also report alleviation of their symptoms, and others are grasping at gluten as a source of a host of other conditions, though there is no scientific evidence to back most of the claims. Experts have been skeptical. It does not make obvious sense, for example, that someone would lose weight on a gluten-free diet. In fact, the opposite often happens for celiac patients as their malfunctioning intestines recover.

They also worried that people could end up eating less healthfully. A gluten-free muffin generally contains less fiber than a wheat-based one and still offers the same nutritional dangers — fat and sugar. Gluten-free foods are also less likely to be fortified with vitamins.

But those views have changed. Crucial in the evolving understanding of gluten were the findings, published in 2011, in The American Journal of Gastroenterology, of an experiment in Australia. In the double-blind study, people who suffered from irritable bowel syndrome, did not have celiac and were on a gluten-free diet were given bread and muffins to eat for up to six weeks. Some of them were given gluten-free baked goods; the others got muffins and bread with gluten. Thirty-four patients completed the study. Those who ate gluten reported they felt significantly worse.

That influenced many experts to acknowledge that the disease was not just in the heads of patients. “It’s not just a placebo effect,” said Dr. Marios Hadjivassiliou, a neurologist and celiac expert at the University of Sheffield in England.

Even though there was now convincing evidence that gluten sensitivity exists, that has not helped to establish what causes gluten sensitivity. The researchers of the Australian experiment noted, “No clues to the mechanism were elucidated.”

What is known is that gluten sensitivity does not correlate with the genetic mutations of celiac, so it appears to be something distinct from celiac.

How widespread gluten sensitivity may be is another point of controversy.

Dr. Thomas O’Bryan, a chiropractor turned anti-gluten crusader, said that when he tested his patients, 30 percent of them had antibodies targeting gliadin fragments in their blood. “If a person has a choice between eating wheat or not eating wheat,” he said, “then for most people, avoiding wheat would be ideal.”

Dr. O’Bryan has given himself a diagnosis of gluten sensitivity. “I had these blood sugar abnormalities and didn’t have a handle where they were coming from,” he said. He said a blood test showed gliadin antibodies, and he started avoiding gluten. “It took me a number of years to get completely gluten-free,” he said. “I’d still have a piece of pie once in a while. And I’d notice afterwards that I didn’t feel as good the next day or for two days. Subtle, nothing major, but I’d notice that.”

But Suzy Badaracco, president of Culinary Tides, Inc., a consulting firm, said fewer people these days were citing the benefits of gluten-free diets. She said a recent survey of people who bought gluten-free foods found that 35 percent said they thought gluten-free products were generally healthier, down from 46 percent in 2010. She predicted that the use of gluten-free products would decline.

Dr. Guandalini said finding out whether you are gluten sensitive is not as simple as Dr. O’Bryan’s antibody tests, because the tests only indicate the presence of the fragments in the blood, which can occur for a variety of reasons and do not necessarily indicate a chronic illness. For diagnosing gluten sensitivity, “There is no testing of the blood that can be helpful,” he said.

He also doubts that the occurrence of gluten sensitivity is nearly as high as Dr. O’Bryan asserts. “No more than 1 percent,” Dr. Guandalini said, although he agreed that at present all numbers were speculative.

He said his research group was working to identify biological tests that could determine gluten sensitivity. Some of the results are promising, he said, but they are too preliminary to discuss. Celiac experts urge people to not do what Ms. Golden Testa did — self-diagnose. Should they actually have celiac, tests to diagnose it become unreliable if one is not eating gluten. They also recommend visiting a doctor before starting on a gluten-free diet.

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This post has been revised to reflect the following correction:

Correction: February 4, 2013

An earlier version of this article misspelled the surname of Thomas O'Bryan. It is O'Bryan, not O'Brien.

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