DealBook: Buffett to Pay $23 Billion for Heinz, as Big Mergers Revive

10:12 a.m. | Updated

Warren E. Buffett has found another American icon worth buying: H. J. Heinz.

Berkshire Hathaway, the giant conglomerate that Mr. Buffett runs, said on Thursday that it would buy the food giant for about $23 billion, adding Heinz ketchup to its stable of prominent brands.

The proposed acquisition, coming fast on the heels of a planned $24 billion buyout of the computer maker Dell and a number of smaller deals, heralds a possible reemergence in merger activity.  The number of deals and the prices being paid for companies are still a far cry from the lofty heights of the boom before the financial crisis.  But an improving stock market, growing confidence among business executives and mounting piles of cash held by corporations and private equity funds all favor a return to deal-making. 

Mr. Buffett is teaming up with 3G Capital Management, a Brazilian-backed investment firm that owns a majority stake in a company whose business is complementary to Heinz’s: Burger King.

Under the terms of the deal, Berkshire and 3G will pay $72.50 a share, about 20 percent above Heinz’s closing price on Wednesday. Including debt, the transaction is valued at $28 billion.

“This is my kind of deal and my kind of partner,” Mr. Buffett told CNBC on Thursday. “Heinz is our kind of company with fantastic brands.”

In many ways, Heinz fits Mr. Buffett’s deal criteria almost to a T. It has broad brand recognition – besides ketchup, it owns Ore-Ida and Lea & Perrins Worcestershire sauce – and has performed well. Over the last 12 months, its stock has risen nearly 17 percent.

Mr. Buffett told CNBC that he had a file on Heinz dating back to 1980. But the genesis of Thursday’s deal actually lies with 3G, an investment firm backed by several wealthy Brazilian families, according to a person with direct knowledge of the matter.

One of the firm’s principal backers, Jorge Paulo Lemann, brought the idea of buying Heinz to Berkshire about two months ago, this person said. Mr. Buffett agreed, and the two sides approached Heinz’s chief executive, William R. Johnson, about buying the company.

“We look forward to partnering with Berkshire Hathaway and 3G Capital, both greatly respected investors, in what will be an exciting new chapter in the history of Heinz,” Mr. Johnson said in a statement.

Berkshire and 3G will each contribute about $4 billion in cash to pay for the deal, with Berkshire also paying $8 billion for preferred shares. The rest of the cost will be covered by debt financing raised by JPMorgan Chase and Wells Fargo.

Mr. Buffett told CNBC that 3G would be the primary supervisor of Heinz’s operations, saying, “Heinz will be 3G’s baby.”

The food company’s headquarters will remain in Pittsburgh, Heinz’s home for over 120 years.

Heinz’s stock was up nearly 20 percent in morning trading, at $72.51, closely mirroring the offered price. Berkshire’s class A stock was also up slightly, rising 0.64 percent to $148,691 a share.

Heinz was advised by Centerview Partners, Bank of America Merrill Lynch and the law firm Davis Polk & Wardwell. A transaction committee of the company’s board was advised by Moelis & Company and Wachtell, Lipton, Rosen & Katz.

Berkshire’s and 3G’s lead adviser was Lazard, with JPMorgan and Wells Fargo providing additional advice. Kirkland & Ellis provided legal advice to 3G, while Berkshire relied on its usual law firm, Munger, Tolles & Olson.

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Movie Review: ‘A Good Day to Die Hard,’ With Bruce Willis





“It’s not 1986 anymore,” a sneering Russian villain (one of several in “A Good Day to Die Hard”) says to John McClane. “Reagan is dead.”




McClane is in no position to argue at just that moment, though you can be sure he will have the last word. (It’s not “Yippee ki-yay,” which is reserved for a different Russian villain and which has somehow joined “Make my day” and “I’ll be back” in the lexicon of deathless action-movie catchphrases.) But the bad guy’s remark pays oblique homage to the longevity of the “Die Hard” franchise, which made a movie star of Bruce Willis in 1988, and also perhaps to its patriarchal, populist politics.



Back then McClane was an avatar of embattled American masculinity, a regular working stiff whose essential good humor was challenged by Japanese corporations, bureaucratic red tape, feminism and a nasty Euro-nihilist with a fancy suit and a silky accent. That those days are gone is signaled by the portrait of Barack Obama on the wall of the shooting range where we first encounter McClane in this movie, the fifth in the series.



McClane himself has evolved from angry Everyman to weary, worried dad. He travels to Moscow to help his son, Jack (Jai Courtney), who at first looks like a bad seed but turns out to be a chip off the old block. Some dads take their boys fishing or to the ballgame or to a movie like this one, but the McClanes prefer a more primal form of bonding — killing miscreants, though Pop McClane uses a more evocative word.



And there is never a shortage. The cold war may be a fading memory, and C.I.A. superspies (like the younger McClane) may have displaced big-city cops (like his dad) in the pop-culture pantheon. But this off-the-shelf blend of car chases, fireballs and the rat-a-tat, thunk-a-thunk of automatic weapons fire is not likely to go out of style. Style, sad to say, is precisely what is missing from “A Good Day to Die Hard,” the latest entry in the flourishing geezer-action genre. Directed by John Moore (“Max Payne,” “Behind Enemy Lines”), it consists of a handful of extended set pieces — each more elaborate and therefore somehow less exciting than the last — linked by a simple-minded plot and a handful of half-clever lines, most of them muttered by Mr. Willis.



It’s hard to hear the words over the noise of weapons, vehicles and Marco Beltrami’s bludgeoning score, but I’m pretty sure that McClane refers to a beautiful Russian woman named Irina (Yulia Snigir) as “Solzhenitsyn,” though he might be referring to her father, Komarov (Sebastian Koch), who looks a bit more literary. The relationship between those two — Komarov is a former mogul at odds with the Russian government; Irina is an avid consumer of lipstick — might have made an interesting parallel to the McClane father-son drama, but interesting is the last thing this movie wants to be.



Though it will most likely scare up some domestic business in the pre-Oscar lull (happy Valentine’s Day!), “A Good Day to Die Hard” is squarely aimed at the overseas marketplace. About a third of the dialogue is already subtitled, and the rest would take a competent translator about 15 minutes to render.



The movie’s real idiom is the Esperanto of violence — sex is a more culturally sensitive issue, so there’s none of that — and sweaty machismo. Mr. Willis himself is something of a universal language, or at least a popular international brand. There’s a newish Rolling Stones song playing over the end credits.



This is what the new global cinema looks like. The special effects sequences are put together with some ingenuity, though the last one (spoiler alert: Mr. Willis drives a truck off the back of a helicopter in Chernobyl) shows signs of sloppy digital overkill. But everything that made the first “Die Hard” memorable — the nuances of character, the political subtext, the cowboy wit — has been dumbed down or scrubbed away entirely. I’m not saying I wish it was the ’80s again — or maybe I am. If that makes me a grumpy old man, it’s John McClane’s fault.



“A Good Day to Die Hard” is rated R (Under 17 requires accompanying parent or adult guardian). Yippee ki-yay, my friends.



A Good Day to Die Hard



Opens on Thursday nationwide.



Directed by John Moore; written by Skip Woods and Jason Keller; director of photography, Jonathan Sela; edited by Dan Zimmerman; music by Marco Beltrami; production design by Daniel T. Dorrance; costumes by Bojana Nikitovic; produced by Alex Young and Wyck Godfrey; released by 20th Century Fox. Running time: 1 hour 37 minutes.



WITH: Bruce Willis (John McClane), Jai Courtney (Jack McClane), Sebastian Koch (Komarov), Rasha Bukvic (Alik), Cole Hauser (Collins) and Yulia Snigir (Irina).


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Actress considers deal in NY Baldwin stalking case


NEW YORK (AP) — A Canadian actress accused of stalking Alec Baldwin is considering a plea deal.


Genevieve Sabourin (JEHN'-uh-veev SAB'-oo-rihn) appeared Wednesday in a Manhattan court. The case was adjourned until Thursday as she and prosecutors try to hammer out a deal.


Sabourin lives in Quebec and has acted in television and film.


She and Baldwin met on the set of the 2002 sci-fi comedy "The Adventures of Pluto Nash." He had a cameo and she was a publicist. Baldwin says they had dinner together in 2010.


Police originally arrested Sabourin after authorities said she had implored Baldwin to see and to marry her in emails sent only days after he became engaged to yoga instructor Hilaria Thomas.


His publicist confirmed Tuesday that Baldwin and his now-wife are expecting their first child together.


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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.

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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 your audience. You need to 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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Olympics Moves to Drop Wrestling in 2020





  Wrestling, one of the most ancient and traditional Olympic sports, was dropped from the Summer Games in a stunning and widely criticized decision Tuesday by the International Olympic Committee.







Chang W. Lee/The New York Times

Freestyle and Greco-Roman wrestling will be contested at the 2016 Olympics in Rio de Janeiro, but they may be excluded from the 2020 Summer Games.







Freestyle and Greco-Roman wrestling will be contested at the 2016 Olympics in Rio de Janeiro, but they will be excluded from the 2020 Summer Games, for which a host city has not yet been named, the Olympic committee said Tuesday.


The decision to drop wrestling was made by secret ballot by the committee’s 15-member executive board at its headquarters in Lausanne, Switzerland. The exact vote and the reasons for the decision were not given in detail.


There is a chance that the Olympic committee can reverse that decision in May, when it considers a 26th sport to add to the 2020 Games. A final decision will be made in September, but wrestling’s Olympic future seems doubtful, said veteran observers of the Games.


In recent years the I.O.C. has expressed concern about the size of the Summer Games and wanted to cap the number of athletes at about 10,500. It has also said it wants to enhance its modernity by drawing younger viewers among the international television audience. On Tuesday the Olympic committee said in a statement that it wanted to ensure that it remained “relevant to sports fans of all generations.”


Olympic-style wrestling, with its amateur roots and absence of visibility except during the Games, lacks superstars with widespread international acclaim like Lionel Messi in soccer, Kobe Bryant in basketball and Tiger Woods in golf. And the popularity of Olympic-style wrestling in the United States is far surpassed by the staged bombast of professional wrestling.


Sports like snowboarding have been added to the Winter Games to broaden the audience. Golf and rugby will be added to the 2016 Rio Games. Among the sports that wrestling must compete with for future inclusion are climbing, rollerblading and wakeboarding.


The committee may have also grown frustrated that Greco-Roman wrestling did not include women, experts said. Women began participating in freestyle wrestling at the 2004 Athens Games.


Politics also play an inevitable role in the workings of the I.O.C. Among the sports surviving Tuesday’s vote was modern pentathlon, also threatened and less popular internationally than wrestling. But modern pentathlon, a five-event sport that includes shooting, horseback riding and running, was invented by Pierre de Coubertin, founder of the modern Games. And it is supported by Juan Antonio Samaranch Jr., son of the former Olympic Committee president and a member of its board.


Mark Adams, a spokesman for the I.O.C., told reporters in Lausanne that Tuesday’s vote was a “process of renewing and renovating the program for the Olympics.” He also said: “In the view of the executive board, this was the best program for the Olympic Games in 2020. It’s not a case of what’s wrong with wrestling, it is what’s right with the 25 core sports.”


Wrestling’s world governing body, known by its initials as FILA and based in Switzerland, said it was “greatly astonished” by Tuesday’s decision and would take “all necessary measures” to persuade the I.O.C. to keep the sport in the Summer Games.


The dropping of wrestling faced immediate and widespread criticism.


“I think this is a really stupid decision,” the Olympic historian David Wallechinsky said. Wrestling, he said, “was in the ancient Olympics.” He added: “It has been in the modern Olympics since 1896. In London, 29 different countries won medals. This is a popular sport.”


Wrestling seemed in many ways to be the perfect Olympic sport. It is as fundamental as running; held in 180 countries from the United States to Russia to India to Iran; and contested in a small area that is easily followed on television. And, unlike soccer and basketball, the Olympics are considered the sport’s ultimate competition.


“When you think of the Olympics, you think of wrestling,” said Cael Sanderson, the wrestling coach at Penn State and a 2004 Olympic champion. “It was a marquee event in ancient Greece and in the modern Games. After running, it was the next sport to be part of the Games. Like track and field, the Olympics are the highest level. Some sports, it’s just not as special.”


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Penelope Cruz having 2nd baby with Javier Bardem


MADRID (AP) — Penelope Cruz and Javier Bardem are expecting their second child.


Cruz publicist Javier Giner told The Associated Press on Tuesday that the Spanish actress is pregnant.


He declined to provide any further details, including when the baby is due.


The 38-year-old Cruz and 43-year-old Bardem had their first child, a boy called Leo, in January 2011.


The couple became romantically involved after appearing together in Woody Allen's 2008 film "Vicky Cristina Barcelona" and later married.


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The New Old Age Blog: Debate Over Brain Scans and Alzheimer's

Should brain scans for older adults with suspected Alzheimer’s disease be covered by Medicare?

Many medical experts say yes. But late last month, an expert panel convened by the Centers for Medicare and Medicaid Services concluded that data supporting use of the scans was weak.

Specifically, the panel noted there is no solid evidence that these imaging tests have a meaningful impact on patients’ health; studies that might establish this have not yet been done.

This controversy deserves attention because positron emission tomography, known as PET scans, are becoming available across the country, and proposed guidelines for their use have just been published by the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging.

Currently, Medicare does not pay for the tests, which cost about $3,000 — an amount that puts them out of reach for many families. The expert panel’s findings will be used by the government later this year to determine whether Medicare should change this policy.

Nearly 400 medical centers already offer this technology or are preparing to do so, according to Eli Lilly, which makes a radioactive agent used in the scans. That agent binds to protein clusters known as amyloid plaques that are a signature characteristic of Alzheimer’s disease, making it possible to see them for the first time in the brains of living patients.

The Medicare panel confronted the question: “How useful is this information, for which patients and under what conditions?” Several experts who testified in late January suggested that the PET imaging tests could help physicians diagnose Alzheimer’s disease or other types of dementia. Currently, diagnosis proceeds from a comprehensive medical evaluation, a careful patient history, and typically, a round of neuropsychiatric tests.

“Should I tell my patients that we have a test available to help clarify their diagnosis but we can’t use it because Medicare doesn’t cover it?” asked Dr. Stephen Salloway, a professor of neurology at the Warren Alpert Medical School at Brown University.

If scans show a lack of amyloid plaques, the “worried well” could be reassured that they don’t have Alzheimer’s and doctors could pursue other lines of medical inquiry, like investigating the potential for thyroid problems, depression or vitamin B12 deficiency, said Dr. Paul Aisen, a professor of neuroscience at the University of California, San Diego, School of Medicine.

If the tests are positive, they could rule out conditions like frontotemporal dementia and motivate patients to start taking medications for Alzheimer’s, enroll in clinical trials and get their financial, legal and household affairs in order, other experts said.

But while amyloid plaques are closely associated with Alzheimer’s, their role has not yet been definitively established. They could be a cause of this condition, a byproduct or serve another function not yet understood. Underscoring this is a notable research finding: about 30 percent of older adults with no symptoms of dementia have been found to have amyloid plaque buildup in their brains.

That means the brain scans cannot ensure the accurate diagnosis of Alzheimer’s. “I see a big potential for overuse and misuse,” warned Dr. Raymond Faught, Jr., a member of the Medicare advisory panel and a professor of neurology at Emory University in Atlanta.

Given that large caveat, the question emerges of which patients would benefit most from getting the tests.

The Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging tried to address that in their recently published “appropriate use” guidelines. The guidelines, which have no binding force, suggest that scans should be considered for patients with Alzheimer’s-type symptoms but “an unclear clinical presentation”; those who develop dementia symptoms before age 65; and those with “persistent” mild cognitive impairment, a condition that often precedes Alzheimer’s.

Tests should not be given to “normal” patients or those who have Alzheimer’s disease already, they say. In other words, if you’re getting older, have mild memory loss, but are still functioning well, you’re not a candidate. Nor is there any value in giving the tests to people who are already deep in the throes of dementia.

The recommendations assume that there is value in knowing test results for physicians, patients and families; that physicians will be better able to manage patients’ care as a consequence; and that doctors will order fewer diagnostic tests or more appropriate tests once they have findings from amyloid PET imaging in hand.

But those assumptions are not backed up by solid evidence yet. Medications for patients with Alzheimer’s have a modest impact on symptoms for a limited period of time and no impact on the underlying illness. Given this, “the clinical utility of a diagnostic test to alter patient management and result in a quantifiable benefit is very difficult to establish,” the panel writes in the journal Alzheimer’s & Dementia. Also, they note, “data supporting specific outcomes for amyloid PET are not yet available.”

This lack of data was the reason the Medicare panel gave amyloid brain imaging such low marks late last month. Dr. Rita Redberg, chairwoman of the Medicare Evidence Development and Coverage Advisory Committee and a professor of medicine at the University of California, San Francisco, summed up that group’s deliberations this way:

We were there to evaluate the impact of this test on patient outcomes. But all of the speakers said there wasn’t any data linking amyloid scans to outcomes . . . They presented evidence that the test is very good at identifying amyloid, but they did not present evidence that it was very good at identifying the clinical presence of Alzheimer’s disease.

Wei-Li Shao, senior director of the Alzheimer’s business division of Eli Lilly, which stands to benefit from the greater use of the scans, disagreed, saying, “Lilly remains steadfast and resolved in its belief that amyloid imaging provides significant clinical value for clinicians and patients.” The company will work with Medicare going forward to try to secure coverage, he said.

For Dr. Redberg, the essential question is this: “Would you want to know you have an increased chance of getting a disease in (the future) when there are no effective treatments available and you might not even get it in the end? Is that of benefit to patients?”

What do you think, readers?

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DealBook Column: Relationship Science Plans Database of Names and Connections

It sounds like a Rolodex for the 1 percent: two million deal makers, power brokers and business executives — not only their names, but in many cases the names of their spouses and children and associates, their political donations, their charity work and more — all at a banker’s fingertips.

Such is the promise of a new company called Relationship Science.

Never heard of it? Until recently, neither had I. But a few months ago, whispers began that this young company was assembling a vast trove of information about big names in corporate America. What really piqued my interest was that bankrolling this start-up were some Wall Street heavyweights, including Henry R. Kravis, Ronald O. Perelman, Kenneth G. Langone, Joseph R. Perella, Stanley F. Druckenmiller and Andrew Tisch.

It turns out that over the last two years, with a staff of more than 800 people, mostly in India, Relationship Science has been quietly building what it hopes will be the ultimate business Who’s Who. If it succeeds, it could radically change the way Wall Street does business.

That’s a big if, of course. There are plenty of other databases out there. And there’s always Google. Normally I wouldn’t write about a technology company, but I kept hearing chatter about it from people on Wall Street.

Then I got a glimpse of this new system. Forget six degrees of Kevin Bacon. This is six degrees of Henry Kravis.

Here’s how it works: Let’s say a banker wants to get in touch with Mr. Kravis, the private equity deal maker, but doesn’t know him personally. The banker can type Mr. Kravis’s name into a Relationship Science search bar, and the system will scan personal contacts for people the banker knows who also know Mr. Kravis, or perhaps secondary or tertiary connections.

The system shows how the searcher is connected — perhaps a friend, or a friend of a friend, is on a charitable board — and also grades the quality of those connections by identifying them as “strong,” “average” or “weak.” You will be surprised at the many ways the database finds connections.

The major innovation is that, unlike Facebook or LinkedIn, it doesn’t matter if people have signed up for the service. Many business leaders aren’t on Facebook or LinkedIn, but Relationship Science doesn’t rely on user-generated content. It just scrapes the Web.

Relationship Science is the brainchild of Neal Goldman, a co-founder of CapitalIQ, a financial database service that is used by many Wall Street firms. Mr. Goldman sold CapitalIQ, which has 4,200 clients worldwide, to McGraw-Hill in 2004 for more than $200 million. That may explain why he was able to easily round up about $60 million in funds for Relationship Science from many boldface names in finance. He raised the first $6 million in three days.

“I knew there had to be a better way,” Mr. Goldman said about the way people search out others. Most people use Google to learn about people and ask friends and colleagues if they or someone they know can provide an introduction.

Relationship Science essentially does this automatically. It will even show you every connection you have to a specific company or organization.

“We live in a service economy,” Mr. Goldman said. “Building relationships is the most important part for selling and growing.”

Kenneth Langone, a financier and co-founder in Home Depot, said that when he saw a demonstration of the system he nearly fell off his chair. He used an unprintable four-letter word.

“My life is all about networking,” said Mr. Langone, who was so enthusiastic he became an investor and recently joined the board of Relationship Science. “How many times do I say, ‘How do I get to this guy?’ It is scary how much it helps.”

Mr. Goldman’s version of networking isn’t for everyone. His company charges $3,000 a year for a person to have access to the site. (That might sound expensive, but by Wall Street standards, it’s not.)

Price aside, the possibility that this system could lead to a deal or to a new wealth management client means it just might pay for itself.

“If you get one extra deal, the price is irrelevant,” Mr. Goldman said.

Apparently, his sales pitch is working. Already, some big financial firms have signed up for the service, which is still in a test phase. Investment bankers, wealth managers, private equity and venture capital investors have been trying to arrange meetings to see it, egged on, no doubt, by many of Mr. Goldman’s well-heeled investors. Even some development offices of charities have taken an interest.

The system I had a peek at was still a bit buggy. In some cases, it was missing information; in other cases the information was outdated. In still other instances, the program missed connections. For example, it didn’t seem to notice that Lloyd C. Blankfein, the chief executive of Goldman Sachs, should obviously know a certain senior partner at Goldman.

But the promise is there, if the initial kinks are worked out. I discovered I had paths I never knew existed to certain people or companies. (Mr. Goldman should market his product to reporters, too.)

One of the most vexing and perhaps unusual choices Mr. Goldman seems to have made with Relationship Science is to omit what would be truly valuable information: phone numbers and e-mail addresses.

Mr. Goldman explained the decision. “This isn’t about spamming people.” He said supplying phone numbers wouldn’t offer any value because people don’t like being cold-called, which he said was the antithesis of the purpose of his database.

Ultimately, he said, as valuable as the technology can be in discovering the path to a relationship, an artful introduction is what really counts.

“We bring the science,” he said. “You bring the art.”


This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this column misspelled the surname of one of the backers of Relationship Science. He is Ron O. Perelman, not Pearlman.

A version of this article appeared in print on 02/12/2013, on page B1 of the NewYork edition with the headline: A Database Of Names, And How They Connect.
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