U.S. Approves First Method to Give the Blind Limited Vision

The F.D.A. Approves a Bionic Eye:
The Argus II allows Barbara Campbell, who lost her sight 20 years ago, to see the world through patterns of light. Scientists hope it is the beginning of even more treatments.

The Food and Drug Administration on Thursday approved the first treatment to give limited vision to people who are blind, involving a technology called the “artificial retina.”

With it, people with certain types of blindness can detect crosswalks on the street, burners on a stove, the presence of people or cars, and sometimes even oversized numbers or letters.

The artificial retina is a sheet of electrodes surgically implanted in the eye. The patient is also outfitted with a pair of glasses with an attached camera and a portable video processor. These elements together allow visual signals to bypass the damaged portion of the retina and be transmitted to the brain. The F.D.A. approval covers this integrated system, which the manufacturer calls Argus II.

The approval marks the first milestone in a new frontier in vision research, a field in which scientists are making strides with gene therapy, optogenetics, stem cells and other strategies.

“This is just the beginning,” said Grace Shen, director of the retinal diseases program at the National Eye Institute, which helped finance the artificial retina research and is supporting many other blindness therapy projects. “We have a lot of exciting things sitting in the wings, multiple approaches being developed now to address this.”

With the artificial retina or retinal prosthesis, a blind person cannot see in the conventional sense, but can identify outlines and boundaries of objects, especially when there is contrast between light and dark — fireworks against a night sky or black socks mixed with white ones in the laundry.

“Without the system, I wouldn’t be able to see anything at all, and if you were in front of me and you moved left and right, I’m not going to realize any of this,” said Elias Konstantopolous, 74, a retired electrician in Baltimore, one of about 50 Americans and Europeans who have been using the device in clinical trials for several years. He said it helps him differentiate curbs from asphalt roads, and detect contours, but not details, of cars, trees and people. “When you don’t have nothing, this is something. It’s a lot.”

The F.D.A. approved Argus II, made by Second Sight Medical Products, to treat people with severe retinitis pigmentosa, a group of inherited diseases in which photoreceptor cells, which take in light, deteriorate.

The first version of the implant had a sheet of 16 electrodes, but the current version has 60. A tiny camera mounted on eyeglasses captures images, and the video processor, worn on a belt, translates those images into pixelized patterns of light and dark. The processor transmits those signals to the electrodes, which send them along the optic nerve to the brain.

About 100,000 Americans have retinitis pigmentosa, but initially between 10,000 and 15,000 will likely qualify for the Argus II, according to the company. The F.D.A. says that up to 4,000 people a year can be treated with the device. That number represents people who are older than 25, who once had useful vision, have evidence of an intact inner retinal layer, have at best very limited light perception in the retina, and are so visually impaired that the device would prove an improvement. Second Sight will begin making Argus II available later this year.

But experts said the technology holds promise for other people who are blind, especially those with advanced age-related macular degeneration, the major cause of vision loss in older people, affecting about two million Americans. About 50,000 of them are currently severely impaired enough that the artificial retina would be helpful, said Dr. Robert Greenberg, Second Sight’s president and chief executive.

In Europe, Argus II received approval in 2011 to treat a broader group of people, those with severe blindness caused by any type of outer retinal degeneration, not just retinitis pigmentosa, although it is currently only marketed in Europe for that condition. In the U.S., additional clinical trials need to be completed before the company can seek broader FDA approval.

Eventually, Dr. Greenberg said, the plan is to implant electrodes not in the eye, but directly into the brain’s visual cortex. “That would allow us to address blindness from all causes,” he said.

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Media Decoder Blog: Indian Music Service, Taking Page From Spotify, Goes Pro

Western music fans have no shortage of digital music services to choose from, and that abundance is spreading around the world. Apple’s iTunes is now in 119 countries, and others are racing to plant their digital flags everywhere. This week, for example, Spotify opened in Italy, Poland and Portugal, bringing its reach to 23 countries.

But just as interesting, and in the long run perhaps as significant to competition, is the rise of services that serve regional markets intensely. One is Saavn, a Spotify-like streaming service that specializes in Indian music, and has garnered 10.5 million monthly users with advertising-supported free listening. This week it will announce that it has taken another page from Spotify’s book, by offering a premium version at $4 a month that eliminates the ads, lets users listen to songs offline and will eventually add other features like higher quality audio.

Saavn, which has offices in New York, India and Mountain View, Calif., has a catalog of 1.1 million songs in nine languages and is available in more than 200 countries, with about 70 percent of its consumption within India, said Rishi Malhotra, one of its founders. Like Spotify, iHeartRadio and other Western services, it is an official partner of Facebook. About 80 percent of its use is on mobile devices, Mr. Malhotra said, and when the premium service, Saavn Pro, is opened in March, it will at first be available only for Apple devices.

The pricing is significantly lower than Western services. “We wanted to make it globally acceptable,” said Mr. Malhotra, who is based in New York. “The $10 price point that you see from a lot of music services we use here is way out of reach from what would fly in India or a lot of other emerging markets.”

Saavn believes it can succeed in India not only through its catalog of Bollywood hits, but through technological touches that may be meaningful only to Indian listeners. One example is the ability to search for a Bollywood song based on the actor who lip-synchs it — often more memorable to fans than the “playback” singer who actually provided the voice.

If successful, Saavn Pro could give the company an advantage in India’s quickly developing digital music market, which already has a handful of streaming services, like Dhingana, as well as a strong presence in downloads from Nokia. Yet that market is still tiny for a country of India’s size and overall media spending. According to the International Federation of the Phonographic Industry, recorded music had only $141 million in trade (or wholesale) value in 2011. A recent report by Ernst & Young said that music and radio combined count for only 2.4 percent of India’s media and entertainment spending, which for 2011 it estimated at $18 billion.

Part of the reason for music’s small proportion of India’s media economy is that popular music in India is dominated by the film industry. But a greater reason is piracy; the federation estimates that 55 percent of Internet users in India go to unlicensed music services on a monthly basis. That is slowly starting to change, music executives say, as courts there crack down on infringement and legitimate digital services proliferate. Apple’s iTunes opened there in December, and Nokia says it sells 1.4 million songs a day at its download store in India.

And Indian record companies are approaching digital business without the baggage that has been complicating deals with Western labels and services for more than a decade, Mr. Malhotra added.

“The labels in India are not reluctant about digital,” he said. “It’s not like they are protecting against some established, older revenue stream. It’s all found revenue for them.”

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Ben Sisario writes about the music industry. Follow @sisario on Twitter.

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Traces of Anxiety Drug May Affect Fish Behavior, Study Shows

Traces of a common psychiatric medication that winds up in rivers and streams may affect fish behavior and feeding patterns, according to a new study in the journal Science.

Researchers in Sweden exposed wild European perch to water with different concentrations of Oxazepam, a generic anti-anxiety medication that can show up in waterways after being flushed, excreted or discarded.

Researchers reported that fish exposed to Oxazepam became less social, more active and ate faster, behaviors they said could have long-term consequences for aquatic ecosystems.

Scientists who study pharmaceuticals in waterways said the research was intriguing because it examined the potential effect on animals of a specific medication designed to affect human behavior.

“It seems to be a solid study with an environmentally relevant species,” said Donald Tillitt, an environmental toxicologist with the United States Geological Survey who was not involved in the study. He said it made sense that a medication that binds with a certain brain receptor in people could act similarly in fish, and the measures of behavior — activity, sociability, boldness and feeding rate — “are all important ones that we like to look at when we’re trying to see the environmental effects of pharmaceuticals.”

Still, because even the lowest concentration of Oxazepam in the study was higher than that found in the Swedish waterway researchers tested, “the relevance of their study to the real world is unclear,” the Environmental Protection Agency said in written answers to questions.

The agency said that while “most pharmaceuticals do not seem to pose known risks to humans, animals or the rest of the ecosystem” at the levels they occur in the environment, there are some medications “for which some researchers have noted physiological effects in fish exposed to levels close to those occasionally reached in the environment. These include some ingredients used for contraception, hypertension and mood disorders.”

The agency said how often this occurs and the possible environmental repercussions are unknown.

The study joins a small but growing body of research exploring the possible environmental impact of chemicals in pharmaceuticals, cosmetics and other products. Many of these chemicals are not removed by wastewater treatment plants, which were designed to remove bacteria and nutrients, experts said.

The topic is difficult to study partly because concentrations of chemicals in waterways can vary with season, hour and distance from treatment plants, and other medications in water may influence a chemical’s effects.

The United States Geological Survey has found “intersex fish,” or male fish that develop female sexual characteristics, in the Potomac River and its tributaries, raising questions about whether hormone residues might be responsible. A study in the journal Environmental Science and Technology found antidepressants like Prozac and Zoloft in the brains of fish collected downstream from wastewater discharge in Colorado and Iowa. But some antidepressants that were more common in those waterways, including Zyban and Citalopram, were not found as frequently in the fish.

In the Swedish study, researchers first tested perch in the wastewater-treated Fyris River, near the city of Uppsala, and found their muscle tissue contained six times the river’s concentration of Oxazepam, said Tomas Brodin, the lead author and an assistant professor of ecology at Umea University.

Researchers then took baby fish hatched from the roe of wild perch in what they considered a drug-free waterway, and divided them into three groups of 25. One group had no exposure to Oxazepam; the other two were placed in water with what researchers called a low concentration, at three times higher than the River Fyris, or an extremely high concentration, at 1,500 times higher.

The more Oxazepam they ingested the more active the fish were, measured by the number of swimming motions in a 10-minute period. They were also less social, spending less time near a section of the tank with other fish and more time near an empty compartment. And they were quicker to grab and eat zooplankton. At the highest Oxazepam concentration, fish were also bolder, measured by how long it took them to leave a box in the tank and explore new territory.

“Basically, no one left the box before they were subjected to the drug,” said Dr. Brodin, who said he saw the difference when he entered the room each day. The non-exposed fish “were hiding basically,” while the others “were out there, greeting me. They were totally different fish.”

In a statement, Matthew Bennett, senior vice president of the Pharmaceutical Research and Manufacturers of America, said the study yielded “somewhat expected results” because of its higher-than-natural concentrations. He said the behavioral changes were small, and the study methods contradicted “widely accepted protocols that determine how the low levels of Oxazepam found in the environment accumulate in fish. The environmental relevance and potential for long-term impact from this drug, which has been in use for decades are therefore debatable.”

Joel A. Tickner, an environmental scientist at the University of Massachusetts, Lowell, who was not involved in the research, said he considered the study significant. “These effects may be very subtle,” he said, but “what they’re finding is it’s biologically relevant.”

Dr. Brodin, the lead author of the study, said the implications were unclear for perch, which might benefit from Oxazepam exposure by becoming more efficient eaters or be disadvantaged because enhanced risk-taking behavior might increase their vulnerability to predators. Zooplankton, algae and other organisms could also be affected by changes in fish behavior, he said.

Dr. Tillett, the toxicologist with the Geological Survey, said, “We’re smart enough and we should be able to design chemicals that fulfill these same sorts of functions but with less stress on the environment.”

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DealBook: Societe Generale to Restructure After 4th-Quarter Loss

5:05 a.m. | Updated

PARIS – Société Générale, one of the largest French banks, posted a larger fourth-quarter loss on Wednesday than the market had expected and said it would restructure to cut costs and simplify operations.

The bank reported a net loss of 476 million euros ($640 million), compared with a profit of 100 million euros in the period a year earlier. Analysts surveyed by Reuters had expected a net loss of about 237 million euros.

Profit was hurt by a charge of 686 million euros as the bank revalued its own debt, an accounting obligation as the market for those securities improved. It also set aside 300 million euros as a provision against legal costs, and it wrote down 380 million euros of good will in its investment banking business, mostly on the Newedge Group, a brokerage in which it owns a 50 percent stake.

Excluding the one-time items, it said fourth-quarter net income would have been about 537 million euros.

Under Frédéric Oudéa, its chairman and chief executive, Société Générale has been working to emerge from the financial crisis as a leaner institution. It said that from mid-2011 to the end of 2012, it disposed of 16 billion euros of loan portfolio assets from the corporate and investment banking unit, and an additional 19 billion euros of other assets.

The bank’s restructuring, and an improvement in sentiment in the euro zone economy, have helped to restore its market standing. After a difficult 2011 that was marred by questions about Société Générale’s exposure to Greece, the bank’s shares have rallied, gaining 49 percent in the last year.

In a research note to investors, Andrew Lim, a banking analyst at Espirito Santo in London, said that while “management has dealt convincingly with concerns about weak capital adequacy and liquidity in 2012, Société Générale is still struggling to convince investors that it can achieve improved returns.”

Shares in Société Générale, based in Paris, fell 3.5 percent in morning trading on Wednesday.

Société Générale said on Wednesday that Philippe Heim would take over as chief financial officer. Mr. Heim succeeds Bertrand Badré, who is leaving to take a position as managing director for finance at the World Bank. The bank also said Jacques Ripoll, the bank’s asset management chief, “has decided to pursue his career outside the group.”

The restructuring measures announced on Wednesday aim to focus the bank on three core businesses: French retail banking; international retail banking and financial services; and corporate and investment banking and private banking.

The Société Générale group employs about 160,000 employees around the world, and it was not immediately clear if the announcement of a new organization meant the bank would follow the lead of other large global institutions with a round of layoffs.

“There will be review processes to define the target organizations for each entity in the weeks to come,” the bank said. “The organization proposals will be addressed in the framework of an enhanced employee dialogue in keeping with agreements with trade unions and the procedures for consulting with worker councils.”

Mr. Oudéa said in a statement that the purpose of the changes was “to make our organization more efficient and flexible.”

Société Générale said its Tier 1 capital ratio, a measure of the bank’s ability to withstand financial shocks, stood at 10.7 percent at the end of December, up 1.65 percentage points from a year earlier. The French firm said it expected to attain a Core Tier 1 capital target under the accounting rules known as the Basel III regime of 9 percent to 9.5 percent by the end of 2013.

The French bank published its latest results a little more than five years after Jérôme Kerviel, a trader in the bank’s equity derivatives business, built unauthorized positions that led to a 4.9 billion euro loss for Société Générale.

Mr. Kerviel’s conviction on charges of breach of trust and forgery was upheld in October by the Paris Court of Appeals. He also was ordered to serve a three-year prison term, pending appeal, and to repay the bank for the full amount of the 4.9 billion euro loss.

On Tuesday, Mr. Kerviel told the French radio station RTL that he was challenging the repayment order in a labor court, saying he had been ordered to pay without a third-party expert being allowed to study the damages. He added that he was suing Société Générale for an amount equivalent to the 4.9 billion euro trading loss.

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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.

---

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.

---

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.

Read More..

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.

---

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.

---

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.

Read More..

Tool Kit: How to Make Your Video Go Viral

It would take 72 hours to watch all the videos uploaded to YouTube every minute by would-be commentators, comedians, cosmetologists and various other content creators all hoping for a breakout hit.

And, let’s be honest, most of it is cringe-worthy.

While the vagaries of taste and timing determine which videos go viral and which YouTube channels develop large and loyal followings, it’s easier to tell which videos will make viewers feel as if they can’t click away fast enough.

It boils down to narcissism. If you’re an aspiring video blogger, remember, it’s not about you, it’s about who is watching you. . Be conscious and considerate of your audience and its needs, rather than getting mired in your own egotism or insecurity. (It’s good advice for life but essential to making quality video.)

Of course you want to have a decent camera. “If you have an iPhone or Android phone, you pretty much do,” said Eddie Codel, a video consultant in San Francisco, who produces content mostly for corporate clients. A hand-held video camera is nice and offers more features and flexibility, but your smartphone is fine.

The only additional equipment you might consider is a separate lavaliere or lapel microphone ($100-$200) for clearer audio. And if there isn’t enough ambient light to illuminate your face, spring for a clamp lamp ($10-$20) that you can find at most hardware stores. No one wants to watch you talking in the dark like someone in a witness protection program. For a flattering glow, Mr. Codel suggested putting wax paper in front of the lamp to diffuse the light.

O.K., so now you’re ready to perform — and you are always performing when the camera is rolling. “If you can’t communicate in an interesting, entertaining, energetic way — I don’t care how much education you have, how brilliant you are, how many degrees you have — it’s going to be painful to watch you,” said Karen Melamed, a television producer and online video consultant in Los Angeles. “Dr. Phil is not on TV because he’s the best therapist in the world, and Paula Deen is not the best chef in the world. They are good performers.”

That’s not to say you have to have an outsize personality or acting experience. But you do need to be comfortable in front of the camera, which is no easy feat. “There’s something sort of horrifying and anxiety-producing about shooting when you are alone,” said Ze Frank, who has more than 126,000 subscribers to his YouTube channel and whose quirky videos can attract as many as 20 million views.

The camera lens is a dark, bottomless void that doesn’t provide the feedback you get in normal face-to-face conversation, like a nod, a raised eyebrow and utterances like “hmmm” and “aah.” Lacking that, people tend to focus more on themselves and, in their self-consciousness, become either bland and monotone (as interesting as a lecture on the Hawley-Smoot Tariff) or hyper-excited and agitated (as annoying as a used-car commercial).

Mr. Frank, who lives in Los Angeles, said he tended to “over-gesticulate and mug too aggressively to the camera” when he first started posting Web videos in 2006. Now he has another person in the room operating the camera. “It’s wonderful to have someone else there to tell you if you are falling a little flat or that look was so cheesy it’s just ridiculous,” Mr. Frank said. Buzzfeed bought his channel last year, and he is now the company’s executive vice president for video, while continuing to create his own content.

If you don’t have the money to hire a camera operator or a willing friend to watch you record, just imagine you are talking to your typical viewer. “Your only concern should be how it’s going to benefit who is watching,” said Eileen Winnick, a media consultant and former actress whose past clients include the celebrity chefs Ina Garten and Bobby Flay. “When you do that, you take the focus off yourself and put it into what you want to get across, which changes the way you communicate,” she said.

You don’t even necessarily have to be on camera. John Mitzewich, of the YouTube channel “Food Wishes,” never appears in his cooking tutorials, which can attract as many as two million views. All you see are his hands at work in his San Francisco kitchen.

“It’s not, ‘Here I am, check out my personality.’ It’s, ‘Let’s make this thing,’ ” said Mr. Mitzewich, whose clever voice-over might compare peaking egg whites to “a voluptuous woman under a white cotton sheet.” Allrecipes.com bought his channel, which has 308,000 subscribers, last year, but he continues to have creative control. “The whole ‘follow your bliss’ thing totally works out,” he said.

Online video is different from television or film in that the audience is often watching on a small screen (laptop, tablet or smartphone). Viewers are up close, leaning in and may also be interacting with the content by posting comments, so it feels more intimate. “The viewer wants to be spoken to as a friend would talk to them,” said Ben Relles, head of programming strategy for YouTube, a division of Google. “They view these channels as friendships.”

As a result, they gravitate toward creators who seem genuine and responsive, such as Charlie McDonnell, a musician and professed nerd with soulful eyes, who has 1.8 million subscribers to the video blog, or vlog, he films in his London apartment. Or Jenna Marbles, who has attracted almost six million subscribers by her Tourette-like revelations of whatever is on her peculiar and profane mind.

Moreover, viewers appreciate content that they can’t get elsewhere. Creators are successful when they tap into “narrow but deep niches,” said Steve Woolf, senior vice president for content at Blip, a curated Web video site.

Paul Klusman, an engineer in Wichita, Kan., gained fame from his cat videos, in which he talks comically yet earnestly about the pleasures (companionship) and pains (kitty constipation) of cat ownership. The first video he made, “Engineer’s Guide to Cats,” was rejected by a short-film festival. But when he posted it on YouTube in 2008, it went viral with almost six million views and several marriage proposals.

He now has more than 33,000 subscribers with whom he regularly communicates (and sometimes dates). “I’m not a YouTube superstar, but I’m on the map,” said Mr. Klusman, who added that he also earns a nice supplemental income through advertising on his channel but “not enough for me to want to live on.”

While Mr. Klusman’s videos can be as long as seven minutes, most online media specialists say it’s better to crisply edit videos down to two to four minutes. That means getting rid of any vanity shots and self-indulgent rambling. “You want to be clean and concise, and if you don’t grab viewers in the first 15 seconds, they’re gone and aren’t coming back,” said Ms. Melamed, the producer and consultant. You don’t need fancy editing software either. Programs like iMovie and Windows Movie Maker, which come standard on many computers, are adequate.

A last bit of advice is to be consistent in churning out content. Post at least weekly if your vlog is topical. If you are more interested in building a library of content such as tutorials, the time between postings can be longer.

“Be patient and realize you are probably going to be a bit terrible in the beginning,” Mr. Frank said. “If you don’t end up making a living at it, there are other reasons to create online media. It’s certainly a validation of life.”

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International Military Officials Investigate Afghan Deaths

KABUL, Afghanistan — International military officials are investigating two episodes in which as many as 11 Afghan civilians may have been killed in what appeared to be American-led military actions.

In the more lethal episode, Afghan officials said 10 civilians were killed overnight in Kunar Province in eastern Afghanistan in a village where two known Taliban commanders were visiting family members.

“Ten civilians were killed last night in a joint Afghan and American operation that took place in Chogam Valley in Shigal District,” said Fazullah Wahidi, the provincial governor. He said four women, one man and five children between the ages of 8 and 13 were killed; four teenagers were wounded, three of whom were girls.

Increasingly over the last two years, foreign insurgents, sometimes with links to Al Qaeda and other non-Afghan groups, have taken refuge in Kunar and neighboring Nuristan Province. Both provinces have a long border with Pakistan, and insurgents can hide easily in the rugged and forested mountain terrain Mr. Wahidi said the target of Kunar operation was a Taliban leader named Shahpour, “a known and really dangerous Afghan Taliban commander with links to Al Qaeda operatives in Kunar” and another Taliban commander, known as “Rocketi,” a Pakistani citizen from the Northwest Frontier Province. Both men were killed in the attack.

Mr. Wahidi said that the operation was not coordinated with Afghan security forces, but that locally hired Afghan paramilitaries were involved in the raid, which included an airstrike and a ground operation. Sometimes other United States government agencies rather than the military use special commandos.

Maj. Adam Wojack, a spokesman for the International Security Assistance Force, said they had no information on the operation but “were aware of the reports” of civilian deaths and were looking into it.

Local officials in Kunar said that Shahpour was believed to have links to Al Qaeda and narrowly escaped being killed last year when the Americans attacked another Al Qaeda-linked Taliban commander known as Abu Hafez Al-Najde, who also went by the name Commander Ghani. Shahpour was the Taliban leader in charge of nearby Dangam district but was visiting relatives at the time of the raid.

People from Chogam, who brought injured from the remote village where the attack took place to the main hospital in the provincial capital of Asadabad, described a precise but damaging hit on two adjacent houses.

“Two homes were totally destroyed; air power was used during the operation,” said a man who brought a boy with cuts to the hospital for treatment, but refused to give his name. “There are still dead bodies under the rubble and human flesh scattered in the area.”

The other episode in which an Afghan civilian was killed by foreign troops occurred on Tuesday during daylight hours.

It took place as NATO-led forces were checking a stretch of heavily traveled highway between Kandahar and Spin Boldak for explosives during a road clearance mission and shot at an oncoming car that did not stop when signaled to do so, Major Wojack said.

An Afghan policeman, Taj Mohammed, the local Border Police commander, corroborated much of the ISAF account, but did not see the shooting himself. He said the car was carrying people from a wedding party.

Major Wojack said that the forces had followed standard procedure of signaling to the car to stop. After the driver stopped, he then started to accelerate toward the convoy, at which point the soldier ISAF shot at the car, Mr. Wojack said.

Reporting was contributed by Taimoor Shah in Kandahar and by an employee of The New York Times in Kunar Province.

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DealBook: Nexen Secures U.S. Approval of Its Sale to Cnooc

Nexen said on Tuesday that it had received the last regulatory approval needed for its $15 billion sale to a major Chinese oil company, after the Obama administration declared the deal free from national security concerns.

With all necessary regulatory approvals in place, Nexen is set to become the latest acquisition by the Chinese oil industry, as the country seeks more and more sources of oil and natural gas to fuel its economy.

The deal is expected to close around Feb. 25.

The buyer in this transaction, the China National Offshore Oil Corporation, or Cnooc, has been among the most acquisitive. It has announced six deals in the last two years, according to Standard & Poor’s Capital IQ. Nexen, based in Calgary, is the biggest proposed deal by Cnooc since its failed attempt to buy Unocal for $18.5 billion in 2005.

Though most of its holdings are abroad, Nexen has major operations in the Gulf of Mexico, which fall under the jurisdiction of the Committee on Foreign Investment in the United States, or Cfius.

The approval by the Obama administration comes two months after the Canadian government approved the deal. That was regarded as perhaps the biggest hurdle, given spurts of nationalistic concern over foreign buyers claiming big tracts of natural resources in Canada.

A review by Cfius (pronounced SIF-ee-us) is still regarded as potentially tough, however. The organization, which is chaired by the Treasury secretary, makes its decisions behind closed doors, and buyers are not always told why a deal is rejected.

But Cfius has approved several potentially sensitive deals recently, including the sale of the bankrupt car battery maker A123 Systems to the Wanxiang Group.

Lawyers at Cleary Gottlieb Steen & Hamilton wrote in a note to clients on Monday that the A123 approval “is evidence that even when politics, protectionism and xenophobia all appear to be significant obstacles, Cfius will not raise objections if it believes no security issues exist.”

“With proper planning and transparency,” Cleary Gottlieb added, “even politically controversial transactions can successfully negotiate the Cfius process.”

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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.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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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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