Life, Interrupted: Crazy, Unsexy Cancer Tips

Life, Interrupted

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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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Dorner manhunt: Investigators work to ID charred human remains

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

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

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

PHOTOS: Manhunt for ex-LAPD officer

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

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

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

TIMELINE: Manhunt for ex-LAPD officer

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

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

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

DOCUMENT: Read the manifesto

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

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

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

FULL COVERAGE: Sweeping manhunt for ex-cop

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

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

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

INTERACTIVE MAP: Searching for suspected shooter

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

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

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

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

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

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

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

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

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

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

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

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

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Well: Straining to Hear and Fend Off Dementia

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

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

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

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

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

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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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Ex-Bell officials defend themselves as honorable public servants

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

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

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

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

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

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

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

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

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

"I'd give more," Mirabal replied.

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

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

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

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

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

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

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

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

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

"Yes, actually."

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

"Yes, sir."

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

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

corina.knoll@latimes.com

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Here's How Geology Shows North Korea's Nukes Are Getting Bigger

You don’t want to be woken up by a magnitude 5.1 earthquake under any circumstances. But you really don’t want to be woken up by one that indicates North Korea’s just tested a nuclear weapon. Especially this one, since it means North Korea’s nukes are getting larger.

North Korea’s third nuclear test, conducted overnight while much of the United States slept, follows a pattern set by its first atomic detonations in 2006 and 2009. It doesn’t occur outside, where satellite imagery might spot it and where radioactive fallout could block back on the testers. That means understanding the detonation requires understanding the geology of it. (Just a bit.)

For one thing, the earthquake in North Korea is unlikely to be a routine geological event. Check out this chart on seismic patterns in northeast Asia since 2005, offered by the Vienna-based organization that oversees the international ban on nuclear testing, known as CTBTO: North Korea is typically spared. (Though seven years may be an insufficient period of time to for geological data.) CTBTO terms the North Korean earthquake a “seismic event with explosion-like characteristics.”

More saliently, according to Robert Avagyan, a research analyst with the Institute for Science and International Security, international seismic monitoring stations around North Korea pick up seismic waves emanating from the center of the blast, believed to be at Punggye-ri. Seismic waves don’t travel uniformly through the earth, but the size and speed of their travel — as well as their wave patterns — enable an extrapolation that indicates the yield of a nuclear device. If you want to get really technical, here’s the raw data from the seismic event, compiled by the United States Geological Survey.

That seismic data may be difficult for laymen to interpret, but there’s a clear conclusion from it. The North Koreans “have a bigger yield than previous [nuclear] devices,” Avagyan says. “They’re getting better at doing this.”

In 2006, the North’s first nuclear test led to a seismic blast of magnitude 4.3. That allowed nuclear experts to estimate that its device yielded a blast of less than 1 kiloton. The 2009 nuclear test was around magnitude 4.7, leading scientists to estimate the North had reached a much higher yield, of between 4 and 7 kilotons. (The estimated relationship between earthquake magnitude and blast yield isn’t linear.)

The overnight seismic event, according to the U.S. Geological Survey, was magnitude 5.1. Avagyan estimates the device the North detonated was 10 kilotons. The Director of National Intelligence hedges and estimates only a “several kiloton” yield.

There are caveats to all of this. The world now has more and better monitoring stations closer to North Korea than in previous tests, Avagyan says, which might mean that the 2006 or 2009 detections of Pyongyang’s nuclear tests might have been inexact. And North Korea might have used “boosters, specialized materials,” he adds, for bigger explosive yields unrelated to the nuclear device itself to make a bigger boom.

There’s another big unknown in the North Korean nuclear test: what nuclear material Pyongyang used. North Korean bombs often rely on plutonium, but in 2010, a former Los Alamos National Laboratories director revealed that North Korean officials had showed him an advanced and heretofore unknown plant for enriching uranium. The plant appeared configured for a crash program. Since bombs reliant on high-enriched uranium are considered more powerful than plutonium ones, a switch in nuclear material might indicate — and, perhaps, account for — a decision to go for more powerful bombs.

Avagyan says it’ll take another day or two for atmospheric readings to indicate if the third North Korean nuclear test used highly enriched uranium or plutonium. Until then, the geologic record from the detonation says plenty, and none of it welcome in Washington.

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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.”

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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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