Life, Interrupted: Crazy, Unsexy Cancer Tips

Life, Interrupted

Suleika Jaouad writes about her experiences as a young adult with cancer.

Every few weeks I host a “girls’ night” at my apartment in Lower Manhattan with a group of friends who are at various stages in their cancer treatments. Everyone brings something to eat and drink, and we sit around my living room talking to one another about subjects both heavy and light, ranging from post-chemo hair styling tips, fears of relapse or funny anecdotes about a recent hospital visit. But one topic that doesn’t come up as often as you might think — particularly at a gathering of women in their early 20s and 30s — is sex.

Actually, I almost didn’t write this column. Time and again, I’ve sat down to write about sex and cancer, but each time I’ve deleted the draft and moved on to a different topic. Writing about cancer is always a challenge for me because it hits so close to home. And this topic felt even more difficult. After my diagnosis at age 22 with leukemia, the second piece of news I learned was that I would likely be infertile as a result of chemotherapy. It was a one-two punch that was my first indication that issues of cancer and sexual health are inextricably tied.

But to my surprise, sex is not at the center of the conversation in the oncology unit — far from it. No one has ever broached the topic of sex and cancer during my diagnosis and treatment. Not doctors, not nurses. On the rare occasions I initiated the conversation myself, talking about sex and cancer felt like a shameful secret. I felt embarrassed about the changes taking place in my body after chemotherapy treatment began — changes that for me included hot flashes, infertility and early menopause. Today, at age 24, when my peers are dating, marrying and having children of their own, my cancer treatments are causing internal and external changes in my body that leave me feeling confused, vulnerable, frustrated — and verifiably unsexy.

When sex has come up in conversations with my cancer friends, it’s hardly the free-flowing, liberating conversation you see on television shows like HBO’s “Girls” or “Sex and the City.” When my group of cancer friends talk about sex — maybe it’s an exaggeration to call it the blind leading the blind — we’re just a group of young women who have received little to no information about the sexual side effects of our disease.

One friend worried that sex had become painful as a result of pelvic radiation treatment. Another described difficulty reaching orgasm and wondered if it was a side effect of chemotherapy. And yet another talked about her oncologist’s visible discomfort when she asked him about safe birth control methods. “I felt like I was having a conversation with my uncle or something,” she told me. As a result, she turned to Google to find out if she could take a morning-after pill. “I felt uncomfortable with him and had nowhere to turn,” she said.

This is where our conversations always run into a wall. Emotional support — we can do that for one another. But we are at a loss when it comes to answering crucial medical questions about sexual health and cancer. Who can we talk to? Are these common side effects? And what treatments or remedies exist, if any, for the sexual side effects associated with cancer?

If mine and my girlfriends’ experiences are indicative of a trend, then the way women with cancer are being educated about their sexual health is not by their health care providers but on their own. I was lucky enough to meet a counselor who specializes in the sexual health of cancer patients at a conference for young adult cancer patients. Sage Bolte, a counselor who works for INOVA Life With Cancer, a Virginia-based nonprofit organization that provides free resources for cancer patients, was the one to finally explain to me that many of the sexual side effects of cancer are both normal and treatable.

“Part of the reason you feel shame and embarrassment about this is because no one out there is saying this is normal. But it is,” Dr. Bolte told me. “Shame on us as health care providers that we have not created an environment that is conducive to talking about sexual health.”

Dr. Bolte said part of the problem is that doctors are so focused on saving a cancer patient’s life that they forget to discuss issues of sexual health. “My sense is that it’s not about physicians or health care providers not caring about your sexual health or thinking that it’s unimportant, but that cancer is the emergency, and everything else seems to fall by the wayside,” she said.

She said that one young woman she was working with had significant graft-versus-host disease, a potential side effect of stem cell transplantation that made her skin painfully sensitive to touch. Her partner would try to hold her hand or touch her stomach, and she would push him away or jump at his touch. It only took two times for him to get the message that “she didn’t want to be touched,” Dr. Bolte said. Unfortunately, by the time they showed up at Dr. Bolte’s office and the young woman’s condition had improved, she thought her boyfriend was no longer attracted to her. Her boyfriend, on the other hand, was afraid to touch her out of fear of causing pain or making an unwanted pass. All that was needed to help them reconnect was a little communication.

Dr. Bolte also referred me to resources like the American Association of Sexuality Educators, Counselors and Therapists; the Society for Sex Therapy and Research; and the Association of Oncology Social Workers, all professional organizations that can help connect cancer patients to professionals trained in working with sexual health issues and the emotional and physical concerns related to a cancer diagnosis.

I know that my girlfriends and I are not the only women out there who are wondering how to help themselves and their friends answer difficult questions about sex and cancer. Sex can be a squeamish subject even when cancer isn’t part of the picture, so the combination of sex and cancer together can feel impossible to talk about. But women like me and my friends shouldn’t have to suffer in silence.

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Suleika Jaouad (pronounced su-LAKE-uh ja-WAD) is a 24-year-old writer who lives in New York City. Her column, “Life, Interrupted,” chronicling her experiences as a young adult with cancer, appears regularly on Well. Follow @suleikajaouad on Twitter.

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Dorner manhunt: Investigators work to ID charred human remains

After what LAPD Chief Charlie Beck called "a bittersweet night," investigators Wednesday were in the process of identifying the human remains found in the charred cabin where fugitive ex-cop Christopher Dorner was believed to have been holed up after trading gunfire with officers, authorities said.

If the body is identified as Dorner’s, the standoff would end a weeklong manhunt for the ex-LAPD officer and Navy Reserve lieutenant suspected in a string of shootings following his firing by the Los Angeles Police Department several years ago. Four people have died in the case, allegedly at Dorner’s hands.

Beck said he would not consider the manhunt over until the body was identified as Dorner. Police remained on tactical alert and were conducting themselves as if nothing had changed in the case, officials said.

PHOTOS: Manhunt for ex-LAPD officer

The latest burst of gunfire came Tuesday after the suspect, attempting to flee law enforcement officials, fatally shot a San Bernardino County sheriff’s deputy and seriously injured another, officials said. He then barricaded himself in a wooden cabin outside Big Bear, not far from ski resorts in the snow-capped San Bernardino Mountains east of Los Angeles, according to police.

"This could have ended much better, it could have ended worse," said Beck as he drove to the hospital where the injured deputy was located. "I feel for the family of the deputy who lost his life."

The injured deputy is expected to survive but it is anticipated he will need several surgeries. The names of the two deputies have not been released.

TIMELINE: Manhunt for ex-LAPD officer

Just before 5 p.m., authorities smashed the cabin's windows, pumped in tear gas and called for the suspect to surrender, officials said. They got no response. Then, using a demolition vehicle, they tore down the cabin's walls one by one. When they reached the last wall, they heard a gunshot. Then the cabin burst into flames, officials said.

Last week, authorities said they had tracked Dorner to a wooded area near Big Bear Lake. They found his torched gray Nissan Titan with several weapons inside, the said, and the only trace of Dorner was a short trail of footprints in newly fallen snow.

According to a manifesto that officials say Dorner posted on Facebook, he felt the LAPD unjustly fired him several years ago, when a disciplinary panel determined that he lied in accusing his training officer of kicking a mentally ill man during an arrest. Beck has promised to review the case.

DOCUMENT: Read the manifesto

The manifesto vows "unconventional and asymmetrical warfare" against law enforcement officers and their families. "Self-preservation is no longer important to me. I do not fear death as I died long ago," it said.

On Tuesday morning, two maids entered a cabin in the 1200 block of Club View Drive and ran into a man who they said resembled the fugitive, a law enforcement official said. The cabin was not far from where Dorner's singed truck had been found and where police had been holding news conferences about the manhunt.

The man tied up the maids, and he took off in a purple Nissan parked near the cabin, the official said. About 12:20 p.m., one of the maids broke free and called police.

FULL COVERAGE: Sweeping manhunt for ex-cop

Nearly half an hour later, officers with the California Department of Fish and Wildlife spotted the stolen vehicle and called for backup, authorities said. The suspect turned down a side road in an attempt to elude the officers but crashed the vehicle, police said.

A short time later, authorities said, the suspect carjacked a light-colored pickup truck. Allan Laframboise said the truck belonged to his friend Rick Heltebrake, who works at a nearby Boy Scout camp.

Heltebrake was driving on Glass Road with his Dalmatian, Suni, when a hulking African American man stepped into the road, Laframboise said. Heltebrake stopped. The man told him to get out of the truck.

INTERACTIVE MAP: Searching for suspected shooter

"Can I take my dog?" Heltebrake asked, according to his friend.

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Navy: No New Weapons System on Our Future Carrier-Based Drone

The admiral in charge of the Navy’s drone development says there will be “no new weapons development program” for the drone the Navy wants to operate on an aircraft carrier.

Rear Adm. Matthias Winter told a drone-industry conference on Wednesday that the Navy isn’t going to design any new weapons for its future Unmanned Carrier Launched Airborne Surveillance and Strike System, or UCLASS. The futuristic drone, which the Navy wants to take off and land from an aircraft carrier at the click of a mouse, will use weapons already in the magazines of aircraft carriers.

In other words, even though the UCLASS will likely be the most advanced drone in the U.S. fleet, its weapons — most likely missiles — are going to be familiar.

Very little has been public about the weapons that the UCLASS will carry. Winter, a senior official with the Navy’s aviation branch, indicated that’s because little has been decided about them. The demonstration model built for UCLASS, the batwing-shaped X-47B, will “never carry a weapon,” Winter said in response to a Danger Room question about UCLASS’ weapons systems.

The Navy intends to issue a solicitation to defense companies as early as this year for industry to compete for what UCLASS should actually look like. Winter said the Navy plans on a “dialog” with defense companies about the weapons systems aboard the carrier drone, and how it integrates into the other systems on the drone, rather than a set Navy dictate. “There will be strike capability as part of this solicitation,” Winter said, without elaboration. “The specifics will be in the trade space.”

Ruling out weapons aboard the X-47B demonstrator raises an issue for UCLASS. Since the demonstrator’s tests, currently occurring at Patuxent River, Maryland, are supposed to inform the specifications for UCLASS, how can the Navy learn anything about operating UCLASS’ weapons systems and integrating them with the other systems on the drone?

Winter said that the Navy staff is talking with fleet commanders to understand the “best strike capability that the UCLASS should carry.”

“I will tell you that it will be something that, from a munitions perspective, it will be something that’s already been certified … that is carried in our magazines on our aircraft carriers,” Winter continued. “There is no new weapons development program associated with UCLASS, and that strike capability will be organic to the UCLASS system.”

The point of the program is hardly just lethality. UCLASS is supposed to provide persistent surveillance, intelligence and reconnaissance for an aircraft carrier battle group as well. Testing is underway with the X-47B to understand how the futuristic drone will operate alongside a deck crew used to shepherding human pilots, and alongside manned Navy jets in the air. The Navy also wants a common operating architecture that will allow it to control its multiple drones and robots — including UCLASS and, Winter said, also its Tomahawk missiles that are already kind of drone-like — and seamlessly share data.

By the spring, the Navy intends to launch the X-47B from an aircraft carrier out at sea for the first time. That’s meant to keep the Navy on track to getting its follow-on, the UCLASS, onto a carrier and into the fleet by 2019.

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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DealBook: Switzerland to Require Banks to Hold More Capital to Offset Mortgages

LONDON – Switzerland said on Wednesday that Swiss banks would be required to hold additional capital for residential mortgages amid concerns that the country’s booming property market was overheating.

The country, which already has more stringent capital rules for its banks than other European nations, said lenders would be required to hold an additional 1 percent of risk-weighted assets to make the financial system more stable in light of an “excessive rise in prices in the real estate market and exorbitant mortgage debt.” Banks have until Sept. 30 to comply.

Property values in Switzerland have been rising as investors spooked by the uncertainties of the economic crisis in the euro zone sought a more stable places for their money.

Greater demand for Swiss homes has pushed up prices at a time of low interest rates and led many buyers to take on larger mortgages. The Swiss central bank has been unable to cool the market by increasing borrowing rates because of an overvalued Swiss currency.

An index created by the Swiss bank UBS measuring the likelihood of a Swiss property bubble was “clearly in the risk zone,” the bank wrote in a note to investors this month.

In the final three months of 2012, house prices soared to six times the annual average Swiss household income compared with about four times in 2000, according to the bank. It called the ever-rising demand for properties not intended for personal use “remarkable.”

The government said it was following a recommendation by the Swiss National Bank to increase the capital buffers. “The sustained growth in mortgage debt and rise in real estate prices of residential properties has led to imbalances which pose a significant risk to the stability of the banking sector and to that of the economy,” the government said in a statement.

Mortgage debt has been growing faster than the economy, and mortgage volume in relation to income has reached “risky” levels, the government said, adding that residential property prices had risen more than what was justified by fundamental factors.

UBS and Credit Suisse, Switzerland’s biggest banks, both said this month that they were working on increasing their capital buffers and that the suggested increase would not change their plans.

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Ex-Bell officials defend themselves as honorable public servants

Less than three years ago, they were handcuffed and taken away in a case alleged to be so extensive that the district attorney called it "corruption on steroids."

But on Monday, two of the six former Bell council members accused of misappropriating money from the small, mostly immigrant town took to the witness stand and defended themselves as honorable public servants who earned their near-$100,000 salaries by working long hours behind the scenes.

During her three days on the stand, Teresa Jacobo said she responded to constituents who called her cell and home phone at all hours. She put in time at the city's food bank, organized breast cancer awareness marches, sometimes paid for hotel rooms for the homeless and was a staunch advocate for education.

"I was working very hard to improve the lives of the citizens of Bell," she said. "I was bringing in programs and working with them to build leadership and good families, strong families."

Jacobo, 60, said she didn't question the appropriateness of her salary, which made her one of the highest-paid part-time council members in the state.

Former Councilman George Mirabal said he too worked a long, irregular schedule when it came to city affairs.

"I keep hearing time frames over and over again, but there's no clock when you're working on the council," he said Monday. "You're working on the circumstances that are facing you. If a family calls … you don't say, '4 o'clock, work's over.' "

Mirabal, 65, said he often reached out to low-income residents who didn't make it to council meetings, attended workshops to learn how to improve civic affairs and once even made a trip to a San Diego high school to research opening a similar tech charter school in Bell.

"Do you believe you gave everything you could to the citizens of Bell?" asked his attorney, Alex Kessel.

"I'd give more," Mirabal replied.

Both Mirabal and Jacobo testified that not only did they perceive their salaries to be reasonable, but they believed them to be lawful because they were drawn up by the city manager and voted on in open session with the city attorney present.

Mirabal, who once served as Bell's city clerk, even went so far as to say that he was still a firm supporter of the city charter that passed in 2005, viewing it as Bell's "constitution." In a taped interview with authorities, one of Mirabal's council colleagues — Victor Bello — said the city manager told him the charter cleared the way for higher council salaries.

Prosecutors have depicted the defendants as salary gluttons who put their city on a path toward bankruptcy. Mirabal and Jacobo, along with Bello, Luis Artiga, George Cole and Oscar Hernandez, are accused of drawing those paychecks from boards that seldom met and did little work. All face potential prison terms if convicted.

Prosecutors have cited the city's Solid Waste and Recycling Authority as a phantom committee, created only as a device for increasing the council's pay. But defense attorneys said the authority had a very real function, even in a city that contracted with an outside trash company.

Jacobo testified that she understood the introduction of that authority to be merely a legal process and that its purpose was to discuss how Bell might start its own city-run trash service.

A former contract manager for Consolidated Disposal Service testified that Bell officials had been unhappy with the response time to bulky item pickups, terminating their contract about 2005, but that it took about six years to finalize because of an agreement that automatically renewed every year.

Deputy Dist. Atty. Edward Miller questioned Mirabal about the day shortly after his 2010 arrest that he voluntarily told prosecutors that no work was done on authorities outside of meetings.

Mirabal said that if he had made such a statement, it was incorrect. He said he couldn't remember what was said back then and "might have heed and hawed."

"So it's easy to remember now?" Miller asked.

"Yes, actually."

"More than two years after charges have been filed, it's easier for you to remember now that you did work outside of the meetings for the Public Finance Authority?"

"Yes, sir."

Miller later asked Mirabal to explain a paragraph included on City Council agendas that began with the phrase, "City Council members are like you."

After some clarification of the question, Mirabal answered: "That everybody is equal and that if they look into themselves, they would see us."

corina.knoll@latimes.com

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Haters Don't Hate Amazon (Facebook On the Other Hand ...)

Check the comments section on any tech blog: People love to hate Apple. They love to hate Microsoft. And Facebook. Each of these companies has spawned a parallel online hater community.

But Amazon? Not so much.

The Amazon haters are no doubt out there. But I contend that the intensity of that hatred just isn’t as high.

Backing me up on that is a new survey from Harris Interactive (HPOL) that found the general public respects Amazon more than any other U.S. corporation.

The marketing firm polled 19,000 U.S. residents in deep detail to find out how they felt about the country’s 60 “most visible” companies. For the first time in the “reputation quotient” poll’s 14-year history, Amazon came out on top.

Rounding out the top five were Apple, Disney, Google and Johnson & Johnson. (Apple’s number-two ranking shows great hate does not exclude great love.)

The poll — independently funded by Harris — broke down reputation into six main categories. Amazon trounced the competition in the category of “emotional appeal,” beating second-place Disney by five points on a 100-point scale – which seems bizarre considering the only contact most of us ever have with Amazon is via a cardboard box.

“Amazon is predominantly a virtual company where you don’t get to see the people. You don’t see brick and mortar,” says Robert Fronk, executive vice-president of reputation management at Harris. “For them to first of all have the highest reputation, but more importantly to be the company with far and away the highest emotional appeal, is amazing.” Harris defines emotional appeal as trust, admiration and respect, not whether you get weepy when your package arrives.

Amazon also topped the products and services category, which Fronk attributed not so much to Amazon-branded products like the Kindle, but the millions of other products it brings together and sells. Even Amazon’s customer service, which is sometimes criticized for being opaque and inaccessible, gets very high marks in the Harris survey from customers and non-customers alike.

Amazon is also helped in the overall survey results by what Fronk describes as the tech industry bump: Americans simply admire the tech industry more than any other. (In what other industry, he says, can a company take a swing at a product and miss and still get credit for taking a chance?) Industries at the bottom of the reputation rankings were tobacco in dead last, followed by government and banking.

Still, tech companies did not escape entirely unscathed. Despite its high rank, Fronk says Apple’s positive reputation is anchored in the survey by positive perceptions of its financial performance — the aspect of its business over which it has the least control. As the company’s plunging stock over the last several months shows, the investing public has no problem tarnishing the reputations of tech companies that don’t live up to expectations

“You don’t want to have the conversations about you moving from innovation and the joy you bring, to always being about the share price,” Fronk says.

Of the most talked-about tech companies, Facebook by far received the least love. While Amazon, Apple and Google all ranked in the top five with total scores above eighty out of 100, and Microsoft ranked 15th with a “good” score above 75, Facebook came in 42nd – sandwiched between Best Buy and T-Mobile – with a score of just over 65, or what Fronk described as the borderline between “average” and “poor.”

“Facebook suffers badly from lack of trust,” Fronk said.

Amazon arguably collects as much personal data about its customers as Facebook does about its users, or at least if not as much, then possibly more intimate: purchase history, product search history, home address, credit card numbers. The Harris survey didn’t ask specifically about individual companies’ use of personal data. Yet it’s hard not to infer that privacy concerns were on the minds of survey participants when answering questions about trust.

Forty-six percent of all respondents said they “definitely would trust” Amazon “to do the right thing.” Only 8 percent said the same about Facebook. Add in “probably would trust” and Amazon’s total shoots to 91 percent, while Facebook’s reaches 49 percent.

Whatever Amazon is doing, or not doing, to earn itself so many points, Facebook apparently needs to take some notes, at least according to this poll’s results. By Harris’ tally, Amazon is the first company in the survey’s history to score negligible negative results across every category. If the results are to be believed, no one really hates Amazon. Says Fronk: “There’s not a detractor base whatsoever.”

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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DealBook: Barclays to Cut 3,700 Jobs in Overhaul

8:13 a.m. | Updated

LONDON – Barclays announced a major restructuring that will eliminate 3,700 jobs and close several business units, as the bank reported a big loss in the fourth quarter of 2012.

The overhaul of its operations comes after a series of scandals at the bank, including the manipulation of benchmark interest rates, which led to the resignation of the firm’s former chief executive, Robert E. Diamond Jr.

In a bid to reduce its exposure to risky trading activity, Barclays plans to close a number of operations in Europe and Asia, including a tax-planning unit that has been criticized for tarnishing the firm’s reputation.

“There will be no going back to the old way of doing things,” the chief executive, Antony P. Jenkins, told reporters at a news conference in London on Tuesday. “We will never be in a position again of rewarding people for activities inconsistent with our values.”

Despite the revamp of its operations and a new emphasis on values, the bank plans to retain the majority of its investment banking unit, particularly its operations in Britain and the United States. The division generated roughly 60 percent of the bank’s adjusted pretax profit in 2012.

Barclays will close four business divisions, while another 17 units will either be closed, sold or pared back in response to subdued market activity, Mr. Jenkins said. In total, the expected layoffs across the bank’s operations represent around 3 percent of the firm’s global work force.

The investment banking division is to be among the hardest hit, where about 1,800 employees are expected to be laid off. The job cuts will primarily fall on the bank’s Asian and European equities divisions, as well as its agricultural commodities trading operations. Almost 90 percent of the reductions already have been made, according to Christopher G. Lucas, the bank’s departing chief financial officer.

Mr. Jenkins refused to comment specifically on the position of Rich Ricci, the head of Barclays investment banking, whose name has surfaced in the inquiry into the bank’s role in the rate-rigging scandal.

“No one can predict the future, but I am confident in the team around me,” Mr. Jenkins said. “Who knows what could happen in a year’s time.”

The restructuring plan includes an additional 1,900 job cuts in the bank’s European retail and business banking unit, where Barclays plans to close roughly 30 percent of its Continental branch network.

The reductions have been focused in areas where Barclays does not compete globally with other international banks or where the firm could experience reputational damage like the recent rate-rigging scandal and the inappropriate sales of loan insurance to customers.

“Not much of this is surprising,” said Ian Gordon, a banking analyst at Investec in London. “They are not removing any of the material activities from the investment bank.”

The recent scandals that have engulfed the bank weighed down the firm’s fourth-quarter earnings.

Barclays posted a net loss of £835 million ($1.3 billion) in the last three months of 2012, compared with a profit of £356 million in the period a year earlier.
The results were hampered by the need to set aside additional capital to compensate costumers who were inappropriately sold loan insurance and for small businesses that were improperly sold complex interest-rate hedging products. Barclays also took a charge against the value of its own debt.

Excluding the adjustments, the bank’s pretax profit for the fourth quarter would have been £1.1 billion, almost double the amount in the period a year earlier.
For 2012, the bank reported an annual net loss of £1 billion, compared with a £3 billion profit for 2011. The annual loss resulted from provisions to cover legal costs related to the rate-rigging scandal and other improper activities.

The bank added that it would reduce annual costs by around 10 percent, to £16.8 billion, by 2015. Its share price rose almost 6 percent in afternoon trading in London on Tuesday.

Barclays said it had reduced bonuses across its operations by 16 percent for 2012, compared with the previous year. In its investment banking division, total bonuses fell 20 percent, with the average bonus in the unit standing at £54,100, a 17 percent reduction, according to a company statement.

The bank added that it had cut compensation awards because of risks facing several business units, including the rate-rigging scandal.

In a settlement with American and British authorities in June, Barclays agreed to pay fines totaling $450 million after some of its traders manipulated the London interbank offered rate, or Libor, for financial gain. Some of the firm’s managers also altered the rate to portray the bank in a healthier financial position than it actually was.

The investment banking division reported a pretax profit of £858 million in the fourth quarter, compared with a pretax profit of £267 million in the fourth quarter of 2011. Pretax profit at the bank’s retail and business banking unit rose 17 percent, to £732 million, while pretax profit in its corporate banking division almost tripled, to £107 million.

Mr. Jenkins acknowledged that some of the firm’s past actions had fallen short. He added that the investment banking division would remain at the heart of the firm’s future operations, though wrongdoing would not be tolerated.

“The old ways weren’t the right way to behave nor did they deliver the right results,” Mr. Jenkins said. “Individuals must take responsibility for their own behavior.”

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Grammys 2013: Fun., Mumford, Gotye lead a newer generation

Grammy Awards voters gave their top honor to British roots music band Mumford & Sons for their album "Babel" on Sunday at the 55th awards ceremony. Other top honors were distributed to a broad array of younger acts, including indie trio Fun., electronic pop artist Gotye, rapper-R&B singer Frank Ocean and rock group the Black Keys.

"We figured we weren't going to win because the Black Keys have been sweeping up all day — and deservedly so," Mumford & Sons front man Marcus Mumford said after he and his band members strode to the stage at Staples Center in Los Angeles to collect the award from last year's winner, R&B-soul singer Adele.

Pop culture historians may look back at 2013, however, as the year the Grammy Awards gave up its long fight against new forms of music dissemination, embracing songs and videos that consumers soaked up by way of YouTube and other Internet outlets as opposed to purchasing them.

PHOTOS: 2013 Grammy Award winners

"Somebody That I Used to Know," the wildly popular collaboration between Gotye and New Zealand pop singer Kimbra, took the top award presented for a single recording upon being named record of the year, which recognizes performance and record production.

"Somebody…" not only was one of the biggest-selling singles of 2012 but also has notched nearly 400 million views on YouTube, powerfully demonstrating the increasingly vital role of the "broadcast yourself" video Internet phenomenon. Different YouTube posts of Ocean's "Thinking About You" single have totaled nearly 60 million views.

New York indie rock trio Fun. was named best new artist, an acknowledgment of the good-time music the group brought to listeners and viewers last summer largely through its runaway hit single "We Are Young," which has racked up nearly 200 million YouTube views. It also was named song of the year, bringing awards for the group's songwriters, Jack Antonoff, Andrew Dost and Nate Ruess, and collaborator Jeff Bhasker.

GRAMMYS 2013: Full coverage | Pre-show winners | Winners | Ballot

"Everyone can see our faces, and we are not very young — we've been doing this for 12 years," Ruess said as they collected the award.

The song's title could also serve as a theme for the evening, which was dominated by other relatively young acts in the most prestigious Grammy categories.

Singer, rapper and songwriter Ocean emerged the victor in the one category that pitted him directly against real-life rival Chris Brown, as his critically acclaimed solo debut album, "Channel Orange," won the urban contemporary album award. A few minutes later Ocean got a second Grammy with Kanye West, Jay-Z and the Dream in the rap-sung collaboration category for their single "No Church in the Wild."

GRAMMYS 2013: Winners list | Best & Worst |  Red carpet | Timeline | Fashion | Highlights

Ocean's tuxedo covered all but his hands, but it appeared as he picked up the urban album award that his left arm remained in a wrist brace he'd exhibited Thursday at rehearsals for this year's broadcast, a remnant of his scuffle last month with Brown over a parking space at a recording studio. Los Angeles Police Department investigators said Ocean informed them that he would not press charges against Brown.

It was the Black Keys' Dan Auerbach who quickly built up steam as the front-runner to dominate this year's awards, taking several statuettes barely an hour into the show, including producer of the year for himself and three with his group including rock performance, rock song and rock album for "El Camino."

The Black Keys homed in on the fundamentals of rock 'n' roll — big guitar riffs, lustful lyrics and a bevy of musical hooks on "El Camino," one of the best reviewed albums of the group's career.

FULL COVERAGE: Grammy Awards 2013

Auerbach picked up another award as producer of the blues album winner, Dr. John's "Locked Down."

Carrie Underwood grabbed the country solo performance Grammy for the title track from her album "Blown Away," which also won the country song award for writers Josh Kear and Chris Tompkins earlier during the pre-telecast ceremony at Nokia Theatre, across the street from Staples Center.

The Zac Brown Band added to its growing place as a new-generation country powerhouse with a win of the country album trophy for its "Uncaged," built on muscular Southern rock guitar riffs, elaborate multipart vocal harmonies and jam-band instrumental excursions.

Last year's big winner, Adele, collected the first statuette of the night for her single "Set Fire to the Rain" in the pop solo performance category.

The show got off to an eye-popping start with a Cirque du Soleil-inspired performance by Taylor Swift of her nominated single "We Are Never Ever Getting Back Together."

The preponderance of youthful acts not broadly known to mainstream TV audiences heightened the use of cross-generational pairings. Rising songwriter and singer Ed Sheeran shared the stage early with veteran Grammy darling Elton John, while Bruno Mars teamed with Sting and Rihanna in a Bob Marley tribute later in the show. Several members of Americana acts, including Alabama Shakes and Mumford & Sons, sang alongside veterans John, Mavis Staples and T Bone Burnett in a salute to drummer Levon Helm of the Band.

But it was the young guns to whom the evening — and perhaps the future — of the Grammy Awards belonged.

The Grammys are determined by about 13,000 voting members of the Recording Academy. The eligibility period for nominated recordings was Oct. 1, 2011, to Sept. 30, 2012. The show aired on CBS live except on the West Coast, which gets a tape delay.

randy.lewis@latimes.com

Twitter: @RandyLewis2

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