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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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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Last Pope to Resign Did So in Midst of Vatican Leadership Crisis





Pope Benedict XVI’s announcement on Monday that he was stepping down because he was too elderly and infirm for the job was the first papal resignation in 598 years. It put Benedict among the small handful, out of the 265 recognized popes in history, who have stepped down as the leader of the Roman Catholic Church. The circumstances behind the other departures generally had nothing to do with age or health, according to Vatican history experts and references.




The last pope to resign, Gregory XII, did so in 1415, 10 years into his tenure, in the midst of a leadership crisis in the church known as the Great Western Schism. Three rival popes had been selected by separate factions of the church, and a group of bishops called the Council of Constance were trying to heal the schism. In an interview with Vatican Radio, Donald S. Prudlo, a papal historian at Jacksonville State University in Jacksonville, Ala., said that Gregory XII offered to resign so that the council could choose a new pope that all factions would recognize. It took two years after Gregory XII’s departure to elect his successor, Martin V.


Other popes known to have resigned:


Pope Celestine V: A recluse who only reluctantly accepted his election in 1294, Celestine V resigned and fled the Vatican after just three months to wander in the mountains. According to a history timeline on Christianity.com, the bishop who became his successor, Boniface VIII, was intent on ensuring that Celestine V did not become an example for future popes, and ordered Celestine V seized and imprisoned as he was about to sail to Greece. He died in custody in 1296 at the age of 81, and was declared a saint in 1313.


Benedict IX: One of the youngest popes, he was elected at the age of 23 in 1035, and became notorious for licentious behavior and for selling the papacy to his godfather, Gregory VI, and then twice reclaiming the position; he finally resigned for good in 1045, at the age of 33.


Gregory VI: Considered a man of great reputation, Gregory VI had thought Benedict IX unworthy of the papacy, and essentially bribed him to resign. He was recognized as pope in Benedict’s stead, but when Benedict’s attempt at marriage failed and he wanted to return to the papacy, a power struggle ensued. A council of bishops called upon Gregory VI to resign after less than two years in office because he had obtained the papacy through bribery.


By contrast, the resignation of Benedict XVI after an eight-year tenure will essentially be a retirement at the age of 85, after the pope showed increasingly public signs of fatigue in recent months. His last day as pope will be Feb. 28, coincidentally the feast day of a revered fifth-century pope, Saint Hilarius.


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Eagles, QB Vick agree to restructured deal


PHILADELPHIA (AP) — Quarterback Michael Vick, who was slated to earn $16 million next season, has agreed to a restructured deal with the Philadelphia Eagles.


Vick, who was injured and inconsistent last season, eventually giving way to rookie Nick Foles, now has a three-year contract, and will compete with Foles over the next nine months to see who runs new coach Chip Kelly's offense this season.


Vick, who returned to start the season finale vs. the New York Giants in December because Foles was injured, finished the season with 2,362 yards passing, 12 touchdowns and 10 interceptions. The Eagles finished 4-12 and in last place in the NFC East.


Andy Reid was fired as coach the day after the season ended, and Kelly was hired last month. Vick, who will be 33 when next season begins, is still elusive when healthy, and seems equipped to run Kelly's aggressive, up-tempo offense that he is bringing to the Eagles from Oregon.


"He wanted to be here," Kelly said Monday in his first meeting with the media following his opening press conference on Jan. 17. "I had never met him before. The one thing that attracted me to him, is Michael is a competitor. Nick is, too. You want guys who want to compete."


Vick was signed by Philadelphia in 2009, and became the starter in 2010. He led the Eagles that season to an NFC East title, and a memorable 38-31 December win over the Giants in which he rallied the team from a 21-point deficit.


There are questions, of course, about his durability and his age, as he now seems far removed from that resurgent 2010 season. He finished that year with 3,018 yards passing, 676 yards rushing and 30 total touchdowns.


"He's younger than (Dallas quarterback) Tony Romo, and he's right about the same age as (Giants quarterback) Eli Manning," Kelly said. "The only reason I say that is because I told Michael that this morning, and he didn't know."


Vick only played in 10 games last season, and in the finale vs. New York, he had a quarterback rating of just 68.4 en route to a 42-7 loss.


"I looked at the films, and studied the tape. When you look at Michael, it's his toughness. That cannot be overrated at all," Kelly said. "We looked at his skillset. He still has that skillset. He can still throw the football.


"He's got an unbelievable release, and it's our job as coaches to make sure he can get the ball out quickly."


All told, Vick has started 35 games for Philadelphia over the last three seasons. Foles has started six. The Eagles scored just 280 points last season as they endured an eight- and a three-game losing streak. Only Arizona (250) scored fewer in the NFC.


When asked which quarterback would work with the first-team offense in training camp, Kelly smiled and quickly showed he's going to be able to handle the Philadelphia media just fine.


"We'll go alphabetical," he said with a grin. "First name? Last name? We'll flip a coin."


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Catholic Bishops Reject Contraception Compromise



The bishops said they would continue fighting the federal mandate in court.


The administration said the proposal, issued last Friday, would guarantee free employee coverage of birth control “while respecting religious concerns” of organizations that objected to paying or providing for it.


The bishops said the proposal seemed to address part of their concern about the definition of religious employers who could be exempted from the requirement to offer contraceptive coverage at no charge to employees. But they said it did not go far enough and failed to answer many questions, like who would pay for birth control coverage provided to employees of certain nonprofit religious organizations.


“The administration’s proposal maintains its inaccurate distinction among religious ministries,” said Cardinal Timothy M. Dolan of New York, the president of the United States Conference of Catholic Bishops. “It appears to offer second-class status to our first-class institutions in Catholic health care, Catholic education and Catholic charities. The Department of Health and Human Services offers what it calls an ‘accommodation,’ rather than accepting the fact that these ministries are integral to our church and worthy of the same exemption as our Catholic churches.”


The bishops’ statement, issued after they had reviewed President Obama’s proposal for six days, was more moderate and measured than their criticisms of the original rule issued by the White House early last year. Cardinal Dolan said the bishops wanted to work with the administration to find a solution.


The administration had no immediate reaction to the bishops’ statement, other than to say it was not a surprise.


Marcia D. Greenberger, co-president of the National Women’s Law Center, said that 99 percent of women used contraceptives at some point in their lives and that their interests must be considered.


“The health needs, the religious and conscience beliefs of women deserve to be respected and protected,” said Ms. Greenberger, who supports the White House proposal.


Under the latest proposal, churches and nonprofit religious groups that object to providing birth control coverage on religious grounds would not have to pay for it. Women who work for such organizations could get free contraceptive coverage through separate individual health insurance policies. The institution objecting to the coverage would not pay for the contraceptives. Costs would be paid by an insurance company, with the possibility that it could recoup the costs through lower health care expenses resulting in part from fewer births.


The administration refused to grant an exemption or accommodation to secular businesses owned by people who said they objected to contraceptive coverage on religious grounds.


The bishops rallied to the defense of such employers.


“In obedience to our Judeo-Christian heritage,” Cardinal Dolan said, “we have consistently taught our people to live their lives during the week to reflect the same beliefs that they proclaim on the Sabbath. We cannot now abandon them to be forced to violate their morally well-informed consciences.”


Federal courts have issued differing judgments on the legality of the federal rule. The litigation appears likely to end up in the Supreme Court.


Archbishop Charles J. Chaput of Philadelphia said that the administration’s proposal, at first glance, had “struck some people as a modest improvement.” The proposal, he said, appeared to increase the number of religiously affiliated entities that could claim exemption from the requirement.


But on closer examination, the archbishop said, the federal mandate “remains unnecessary, coercive and gravely flawed.”


“The White House has made no concessions to the religious conscience claims of private businesses, and the whole spirit of the ‘compromise’ is minimalist,” Archbishop Chaput said.


In court cases, judges have expressed keen interest in details of the arrangements for contraceptive coverage. The most difficult question, which the administration has yet to resolve, is how coverage will be provided and financed for employees of self-insured faith-based institutions, which serve as both employers and insurers.


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Advertising: Self Magazine Widens Its Focus for a Younger Audience





WHAT’S the point of having Michelle Obama’s triceps if you can’t show them off in a smart sleeveless sheath?




That seems to be the thinking behind a remake of Self magazine, the Condé Nast publication best known for teaching women how to crunch their abs, tone their thighs and eat the right foods.


Self is broadening its tight focus on exercise and wellness to become a more general lifestyle magazine infused with more beauty and fashion, an effort that will include editorial changes, a new look for the cover and logo and licensing agreements.


“We think there’s a shift in how women think of their bodies and beauty,” said Laura McEwen, the vice president and publisher of Self. “Being fit and fashionable are really one.”


According to Ms. McEwen, the magazine’s typical reader is in her mid-30s with a median household income of $75,000 a year; the rebranded magazine is meant to appeal to the generation of women 18 to 30 who are obsessed with social media. “The magazine is being edited for the women who think in 140 characters,” she said, referring to the character limit of a Twitter post.


That editorial shift can be most felt in the chatty headlines created for subsections in the magazine and its bolder, fashion-focused images. One section, “It’s a Thing,” highlights new trends (in March, the color will be lemon yellow). Others include “You Look Awesome in That,” featuring fashion coverage, and “Just Shoot Me Now,” which doles out advice to readers in embarrassing situations.


Self finds itself between two of its biggest competitors in women’s fitness magazines.


The magazine, which has a total print circulation of 1.5 million readers, had a slight increase in advertising dollars, but not ad pages, last year. Advertisers spent $163.2 million on ads in the magazine in 2012, a 1.8 percent increase from 2011, when they spent $160.2 million.


Total ad pages declined 2.3 percent to 905.4 in 2012 from 926 in 2011, according to data from the Publishers Information Bureau. Online, the magazine has 6.9 million unique visitors a month, executives said, with a fifth of that traffic coming from the social media content sharing site Pinterest.


Shape magazine, which is owned by American Media, claims a similarly strong print circulation of 1.63 million readers, but has had a tough time sustaining advertising dollars. The fitness and lifestyle magazine suffered an 18.4 percent decrease in advertising revenue from 2011, when advertisers spent $206.8 million, to 2012, when they spent $168.8 million on the magazine. The total number of ad pages in the magazine decreased 22.7 percent from 2011 to 2012.


Women’s Health, which is owned by Rodale, showed a 12.3 percent increase in paid advertising from 2011 to 2012, and a 6.8 percent increase in ad pages for the same period. In 2011 the magazine reported a circulation of 1.6 million.


Self magazine, its Web site and its mobile site will be divided into three main sections that focus on body, looks and lifestyle. The new look, which will make its debut this week, includes a larger font for the title and a clean white background. The changes will be consistent across all platforms.


Readers will also be able to download a new mobile application, called Self Plus. When users hover their phones over pages tagged with icons promoting the app, they can watch videos and skim through photo galleries and other content.


Millennial women, said Lucy Schulte Danziger, the editor in chief of Self, have “this sense that you want to be really healthy, but you also want to go drink martinis with your friends.” (To that end, the March issue will include a calorie-counting game on matching cocktails with bar food without blowing your diet.) “It’s trying to have fun. It should be fun; this is not rocket science,” she said.


Self’s last makeover was in 2010, when it overhauled its design, updated its logo and tweaked section headlines.


Beyond the latest editorial changes is a range of marketing efforts to get the word out. Print and digital ads will run in Condé Nast magazines like Allure, Glamour and Lucky and on taxi tops in New York City. Digital ads will also run on DailyCandy.com and Refinery29.com.


The March issue of Self, featuring the dancer Julianne Hough on the cover, will be available in print on Feb 19. Ms. Hough is the lead actress in the new film “Safe Haven.” Self will also be the co-host at a premiere party for the film on Monday in New York City.


The brand has also licensed its name to a new line of fitness gear including yoga mats and kettlebells and is considering extending that to healthy food products. Self is also capitalizing on its annual event, “Self Workout in the Park,” by announcing a college-themed contest, “Self Workout on the Quad,” where college students who participate most heavily with the Facebook “Workout in the Park” social game can win an event at their school.


Sponsors for the event include Garnier, Reebok, Calvin Klein, LaRoche-Posay, LeSportsac, Luna Bar and Club Med. Ads promoting the contest will be shown on HerCampus.com.


“This is clearly a strategy not only to reach young women readers where they’re at right now, but also to be more attractive to advertisers,” said Laura Portwood-Stacer, a visiting assistant professor of media, culture and communication at the Steinhardt School of Culture, Education and Human Development at New York University. “It seems to tap into this trend of fitness lifestyle consumption that you see a lot now.”


One new advertiser is LeSportsac, which in addition to sponsoring the workout events, will advertise in the April issue of Self.


“Seeing where the consumer is going today is very much lifestyle,” said Paula Spadaccini, the marketing director for LeSportsac. “They don’t just aspire to wear Christian Louboutin and be very fashionable. They also aspire to be fit and cook healthy recipes.”


Walter Coyle, the president of Pedone, an independent advertising agency, said that some of his clients like Burt’s Bees, the beauty product line, and Essie, the nail polish brand, will continue to advertise in Self, and that other clients including Clarins and Lacoste were considering it. “Whenever a formidable magazine like Self reimagines its position in the marketplace, it’s something everyone is going to look at,” he said.


This article has been revised to reflect the following correction:

Correction: February 11, 2013

An earlier version of this column misidentified the owner of the magazine Women’s Health. It is owned by Rodale, not Meredith.



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Militants Battle Malian and French Troops in Liberated Town





DAKAR, Senegal — Gunfire rang out in the streets of the strategic city of Gao in northern Mali on Sunday, two weeks after French troops appeared to have chased radical Islamists out of the city, which is at the edge of the desert and is the largest population center in the north.




The gun battle between Islamist militants and a force of Malian and French troops, which continued for much of Sunday afternoon, suggested that the quick French campaign against the local Al Qaeda affiliate and its allies was not over but had entered a new phase of guerrilla warfare.


Sunday’s attack by the Islamist fighters was the most serious escalation in the fighting since the French ended over six months of brutal Islamist occupation in Gao at the end of January. That victory came after a quick French bombing campaign and with barely a shot fired.


Continuous bursts of gunfire were heard around the police station, in the city’s center and in southern districts as French helicopters hovered overhead. Malian soldiers fought back against Islamists armed with AK-47 rifles as the streets cleared of residents. French troops were also patrolling the city, which has a population of about 86,000, including its surrounding areas.


By late Sunday afternoon, the Islamist fighters had been encircled by French troops, according to Gao’s municipal councilor, Abdheramane Oumarou, who said the situation was under control.


The attack appeared to have begun with an attempted suicide bombing late Saturday night, when an Islamist militant on foot blew himself up at a Malian Army checkpoint outside of town, in the second such episode in two days. The bomber’s attack, which wounded a Malian soldier, was merely a ruse to allow an Islamist commando unit to enter the city, Mr. Oumarou said.


“The Malian soldiers panicked; that’s how the MUJAO got into town,” Mr. Oumaro said, referring to the Islamist group, the Movement for Oneness and Jihad in West Africa, which is affiliated with Al Qaeda and controlled Gao from May to January. Mr. Oumarou said that the fighters who penetrated Gao were aided by local sympathizers, and that caches of armaments had been discovered by the local authorities.


A Malian Army spokesman said that the bomber was part of a commando team of about 20 Islamist fighters who assaulted a bridge in marshland linking Gao to neighboring villages.


The spokesman, Capt. Daouda Diarra, said the bomber appeared to be of Arab ancestry. He tried to penetrate the army checkpoint, the captain said, setting off his explosives as he did so.


“It’s pretty hot in the town right now,” said the mayor, Sadou H. Diallo, who was reached by phone on Sunday afternoon. “I can’t talk now.”


Though the French appeared to be leading the fight on Sunday, primary responsibility for patrols had been handed back to the Malian Army, still shaky after the defeats of last month that led the French to intervene, and which is still plagued by the internecine squabbles that led to a gun battle at a barracks in the capital, Bamako, on Friday.


Embarrassed by the recent events, Mali’s interim president, Dioncounda Traoré, apologized to the country’s foreign partners in a statement to the state news media. Mali is dependent on large-scale military assistance and other aid from overseas.


The explosion on Saturday night rocked the neighborhood. “We were very scared,” said a resident, Halimatou Touré. “There are lots of mujahedeen who come from this area,” she said. The bomber’s remains were later removed in a wheelbarrow, and French armored vehicles took up positions at the checkpoint.


While Sunday’s clashes showed that the northern cities are still vulnerable to attacks from Islamists, the bulk of their force is thought to have taken refuge in the Adrar des Ifoghas, a remote mountain range near Algeria and hundreds of miles to the north of Gao. Troops from France and Chad, supported by French aircraft, are pursuing the Islamists in this redoubt as well.


Adam Nossiter reported from Dakar, and Peter Tinti from Gao, Mali.



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Paternos issue report, challenge Freeh's findings


STATE COLLEGE, Pa. (AP) — A report commissioned by Joe Paterno's family says the late coach did nothing wrong in his handling of the Jerry Sandusky child sex abuse scandal and portrays Paterno as the victim of a "rush to injustice" created by former FBI director Louis Freeh's investigation of the case for Penn State.


The family's critique, released Sunday, argues that the findings of the Freeh report published last July were unsupported by the facts.


Former U.S. Attorney General Dick Thornburgh, one of the experts assembled by the family's lawyer to review Freeh's report last year to Penn State, called the document fundamentally flawed and incomplete.


Freeh's report reached "inaccurate and unfounded findings related to Mr. Paterno and its numerous process-oriented deficiencies was a rush to injustice and calls into question" the investigation's credibility, Thornburgh was quoted as saying.


In a statement released Sunday through a spokesman, Freeh defended his work.


"I stand by our conclusion that four of the most powerful people at Penn State failed to protect against a child sexual predator harming children for over a decade," he said.


Paterno's family released what it billed as an exhaustive response to Freeh's work, based on independent analyses, on the website paterno.com.


"We conclude that the observations as to Joe Paterno in the Freeh report are unfounded, and have done a disservice not only to Joe Paterno and the university community," the family's report said, "but also to the victims of Jerry Sandusky and the critical mission of educating the public on the dangers of child sexual victimization."


Freeh's findings also implicated former administrators in university president Graham Spanier, athletic director Tim Curley and retired vice president Gary Schultz. Less than two weeks after the Freeh report was released in July, the NCAA acted with uncharacteristic speed in levying massive sanctions against the football program for the scandal.


"Taking into account the available witness statements and evidence, it is more reasonable to conclude that, in order to avoid the consequences of bad publicity, the most powerful leaders at Penn State University — Messrs. Spanier, Schultz, Paterno and Curley — repeatedly concealed critical facts relating to Sandusky's child abuse" from authorities, trustees and the university community, Freeh wrote in releasing the report.


The former administrators have vehemently denied the allegations. So, too, has Paterno's family, though it reserved more extensive comment until its own report was complete.


The counter-offensive began in earnest this weekend. The family's findings said that Paterno:


— Never asked or told anyone not to investigate an allegation made against Sandusky 12 years ago, Saturday, Feb. 9, 2001.


— Never asked or told former administrators not to report the 2001 allegation.


— And never asked or told anyone not to discuss or hide information reported by graduate assistant Mike McQueary about the 2001 allegation.


"Paterno reported the information to his superior(s) pursuant to his understanding of university protocol and relied upon them to investigate and report as appropriate," the family's analysis said.


Paterno's widow, Sue, broke her silence Friday in a letter to hundreds of former players informing them of the report's impending release. "The Freeh report failed and if it is not challenged and corrected, nothing worthwhile will have come from these tragic events," she wrote.


"I had expected to find Louis Freeh had done his usual thorough and professional job," Thornburgh said in a video posted on paterno.com. "I found the report to be inaccurate in some respects, speculative and unsupported to the record compiled ... in short, fundamentally flawed as to the determinations made to the role — if any — Mr. Paterno played in any of this."


Freeh was brought in to conduct an independent investigation of the school's response to allegations and find any shortcomings in governance and compliance to make sure failures don't happen again, Penn State said in a statement Sunday. Freeh made 119 recommendations to strengthen policies, and the majority have been implemented, according to the school.


University trustees and leaders have been criticized by some dissatisfied alumni, ex-players and community residents for their handling of Paterno's dismissal, the Freeh report and the sanctions.


"It is understandable and appreciated that people will draw their own conclusions and opinions from the facts uncovered in the Freeh report," the school said.


Freeh, in his report, said his team conducted 430 interviews and analyzed over 3.5 million emails and documents. The former federal judge said evidence showed Paterno was involved in an "active agreement to conceal" and his report cited email exchanges, which referenced Paterno, between administrators about allegations against Sandusky in 1998 and 2001.


According to Thornburgh's findings, Freeh's report relied on about 30 documents, including three notes authored by Paterno, and 17 emails. Four emails referenced Paterno — none sent by the octogenarian coach who notoriously shunned modern electronic technology.


Sandusky, 69, was sentenced to at least 30 years in prison in October after being convicted last summer of 45 criminal counts. Prosecutors said assaults occurred off and on campus, including the football building.


His arrest in November 2011 triggered the turmoil that led to Paterno's firing days later. Under pressure, Spanier left as president the same day. Curley was placed on administrative leave, while Schultz retired.


Spanier, Curley and Schultz are awaiting trial on obstruction and conspiracy, among other charges. They have maintained their innocence.


Critics have said that Freeh's team didn't speak with key figures including Curley, Schultz and Paterno, who died in January 2012 at age 85. The authors of the emails referenced in Freeh's report, which included Curley and Schultz, were not interviewed by Freeh, the family's analysis said.


Spanier spoke to Freeh six days before the report was released July 12.


"They missed so many key people. They didn't interview most of the key players, with the exception of President Spanier, who at the last minute we brought in and interviewed at a time when frankly the report ... was pretty well all prepared," Thornburgh said on the video.


Freeh said he respected the family's right to conduct a campaign to "shape the legacy of Joe Paterno," but called the critique self-serving. Paterno's attorney was contacted for an interview with the coach, he said, and Paterno spoke with a reporter and biographer before his death but not Freeh's team.


Curley and Schultz also declined numerous requests for interviews, Freeh said. They have been facing criminal charges since November 2011.


Freeh on Sunday cited grand jury testimony by Paterno in 2011 in which Paterno said a graduate assistant relayed to him the 2001 allegation against Sandusky of a "sexual nature" with a child.


He referred to a key point in the July report in which he said Spanier, Schultz and Curley drew up a plan that called for reporting Sandusky to the state Department of Public Welfare in 2001. But Curley later said in an email that he changed his mind "after giving it more thought and talking it over with Joe," according to Freeh's findings.


Said Freeh on Sunday: "These men exhibited a striking lack of empathy for Sandusky's victims by failing to inquire as to their safety and well-being, especially by not even attempting to determine the identity of the child" in the 2001 allegation.


The Paterno family report said Freeh chose not to "present alternative, more plausible, conclusions" about Paterno's actions. Their attorney, Wick Sollers, responded Sunday that Freeh didn't take the time to read the family's critique, or address accusations of procedural shortcomings.


"A failure to consider the facts carefully is exactly the problem our expert analysis highlights," Sollers said. "Everyone, including Mr. Freeh, should take the time to study this report."


Sue Paterno had directed Sollers, to review Freeh's report and her husband's actions. Sollers brought in Thornburgh, as well as former FBI profiler and special agent Jim Clemente, described as a child molestation and behavioral expert.


Also brought in was Dr. Fred Berlin, a psychologist from Johns Hopkins Hospital and School of Medicine whose profile lists him as the founder of the Johns Hopkins Sexual Disorders Clinic.


The analysis included interviews, including of Paterno before his death, as well as a review of documents and testimony and "information from our access to the lawyers for other Penn State administrators."


The Paterno family's analysis said Freeh's report turned into a platform for scapegoating Paterno rather than seizing on an opportunity to educate about identifying child sex abuse victims, and ignored "decades of expert research and behavioral analysis regarding the appropriate way to understand and investigate a child victimization case."


It said expert analysis showed Sandusky "fooled qualified child welfare professionals and law enforcement, as well as laymen inexperienced and untrained in child sexual victimization like Joe Paterno." The coach respected Sandusky as an assistant, but knew little about Sandusky's personal life, the analysis said, though Freeh's report "missed that they disliked each other personally, had very little in common outside work, and did not interact much if at all socially."


Actions by entities outside of Penn State were not a focus for Freeh's review. "This was an internal investigation into Penn State's response ... and that is how the University has utilized the report," the school said.


Penn State removed a bronze statue of Paterno outside Beaver Stadium on July 22. The next day, the NCAA in levying sanctions said Freeh's report revealed "an unprecedented failure of institutional integrity leading to a culture in which a football program was held in higher esteem."


The NCAA improperly relied on that report and never identified a rules infraction "based on Sandusky's crimes, much less an infraction by Penn State that implicated the NCAA's jurisdiction and core mission of ensuring competitive balance," the Paterno family report said.


An NCAA spokeswoman said the organization stood by its previous statements and declined comment Sunday.


A four-year bowl ban and steep scholarship cuts were included among the sanctions, while 111 wins between 1998 and 2011 under Paterno were vacated. It meant Paterno no longer holds the record for most wins by a major college coach.


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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness





When a life starts to unravel, where do you turn for help?




Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.


In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.


“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”


That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”


Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.


One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.


“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”


On a recent afternoon, she described in her Midtown office the range of her practice.


“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”


Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”


Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.


One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.


“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”


Her son cut her off. “Are you comparing me to the guy that shot those people?”


“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”


“Did you really just compare me to that guy?”


“No, I didn’t compare you.”


“Then what did you say?”


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Israeli Says Syria Twisted Comments by Rebel Supporter





BEIRUT, Lebanon — A public relations controversy erupted Saturday after a leading Israeli newspaper published comments from a brief interview with the leader of Syria’s main exile opposition group.




The news media outlets of the Syrian government, and its ally Hezbollah, the Lebanese militant group, reported that the opposition leader had declared that Israel had “nothing to fear” from a rebel-led Syrian government. Moreover, the reports said, the opposition was working with other countries to keep Syria’s chemical weapons away from Hezbollah, which he called a “son of the devil.”


But the opposition leader, Sheik Ahmad Moaz al-Khatib, never said any of that, according to the article in the Israeli newspaper, Yediot Aharonot, and its author, a prominent Israeli defense expert, Ronen Bergman.


Sheik Khatib was quoted in the article reiterating the opposition’s promise to keep Syria’s chemical arsenal out of “the hands of unauthorized elements,” and it was the international community, he said, not Israel, that had “nothing to fear.”


When Sheik Khatib realized that Mr. Bergman was an Israeli — after glancing at his business card — he abruptly ended the conversation, Mr. Bergman said in a Skype interview, repeating what he had written.


The original article was published only in Hebrew — and only in print — so it was the Arabic and English versions put out by the Syrian government and Hezbollah that raced around the Internet on Saturday, provoking outrage from government supporters and opponents at Sheik Khatib, who posted a message on his Facebook page denying that he had given the interview.


Yet the episode appeared to have been more than a simple misunderstanding. Syria’s conflict is not only a shooting war but also a propaganda war. Pro-government media apparently could not resist the chance to bolster their contention that the rebellion had been promoted by Israel and the West to punish Syria and its president, President Bashar al-Assad, for taking uncompromising positions against Israel.


“Unfortunately, the original text was less exciting,” Mr. Bergman said. “I would be happy if he would say something like, ‘Yes, we will make peace with Israel’ — then I would get the front page.” As it was, the article elicited little reaction in Israel.


But misrepresentation of the article suggested that it hit a nerve on one issue. An unnamed opposition member, not Sheik Khatib, called Hezbollah “sons of the devil,” according to Mr. Bergman, and said the rebel coalition was working with other countries to ensure that “not one piece of military equipment, not chemical weapons and not any other item, will pass into their hands.”


Syria is Hezbollah’s main conduit for arms, and Hezbollah has backed Mr. Assad’s bloody crackdown at great cost to its popularity in the wider Arab world.


Although Mr. Bergman said the opposition member was offering his own opinion and not presenting official policy, his comments bolstered the widely held view that a rebel-led government might halt the shipment of Iranian arms through Syria to Hezbollah. Hezbollah, a Shiite group and political party, is also concerned about the rise within the rebel movement of extremist Sunni jihadists who view Shiites as apostates.


The misleading reports appeared to be an attempt to further divide the opposition. Sheik Khatib found himself fending off critics from within the anti-Assad movement who objected to his even speaking with an Israeli reporter, though by all accounts he did not initially realize that Mr. Bergman was an Israeli.


It was the second time in a month that Sheik Khatib found himself on the defensive. He recently proposed talks with members of Mr. Assad’s government, but had not built political support for the proposal.


On Friday, Syria’s information minister, Omran al-Zoubi, gave the first official response to the proposal, saying that the government would negotiate with any opposition members who agreed to lay down their arms.


On Saturday, Mr. Assad named new cabinet ministers for oil, finance, social affairs, labor, housing, public works and agriculture, as Syria faces growing economic problems and shortages of electricity, fuel and bread.


Anne Barnard reported from Beirut, and Isabel Kershner from Jerusalem. Hania Mourtada contributed reporting from Beirut.



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