Massachusetts Plans Stricter Control of Compounding Pharmacies

BOSTON — New laws to strengthen state control of compounding pharmacies were proposed on Friday by Gov. Deval Patrick, in hopes of preventing another public health disaster like the current outbreak of meningitis caused by a contaminated drug made in Massachusetts.

The laws will be among the strongest in the country, said Kevin Outterson, a law professor at Boston University and a member of the expert panel that advised the state on how to curb abuses by companies like the New England Compounding Center, the Framingham pharmacy that made the tainted drug responsible for the nationwide meningitis outbreak.

The legislation would establish strict licensing requirements for compounding sterile drugs; let the state assess fines against pharmacies that break its rules; protect whistle-blowers who work in compounding pharmacies; and reorganize the state pharmacy board to include more members who are independent of the industry and fewer who are part of it.

Alec Loftus, a spokesman for the state’s Office of Health and Human Services, said that Mr. Patrick expected the new legislation to be passed quickly.

Daniel Carpenter, a professor of government at Harvard, said the proposed laws seemed sound and comprehensive. But he warned that if other states did not take similar steps, compounding pharmacies engaging in shoddy practices would just move to places with the weakest laws and the least oversight.

“The remaining question is not what Massachusetts is doing or will do, but will there be a minimum level of regulation like this in the rest of the states?” Professor Carpenter said.

The meningitis outbreak, first detected in September, was caused by contaminated batches of a steroid, methylprednisolone acetate, made by the New England Compounding Center. The drug was injected into about 14,000 people’s spinal area to treat back and neck pain.

As of Dec. 28, 656 people in 19 states had become ill with meningitis or other infections, like severe internal abscesses in the area where the drug was injected. Some have had both meningitis and spinal infections. The case count is expected to keep rising. Thirty-nine have died.

The New England Compounding Center was shut down, and inspections found extensive contamination. Investigations uncovered a long history of questionable practices that had drawn warnings from the state and the Food and Drug Administration.

On Dec. 21, the company announced that it had filed for bankruptcy. Numerous lawsuits have been filed against it.

At the heart of the problem have been gaps in regulation that have allowed such companies to avoid both state and federal controls. The company called itself a pharmacy, and pharmacies are generally regulated by states, while large drug companies are regulated federally, by the Food and Drug Administration.

Compounding pharmacies mix their own drug preparations, like skin creams and cough syrups, supposedly for individual patients with special needs. But the New England Compounding Center began to act like a manufacturer, making and shipping large amounts of injectable drugs, for which sterility is essential. No state law required it to obtain a license for this type of large-scale compounding, to follow good manufacturing processes or to let the state know it was shipping all over the country.

Dr. Lauren Smith, interim commissioner of the Massachusetts Department of Public Health, said the company “was a manufacturer in pharmacy clothing.”

Governor Patrick said, “The tragic meningitis outbreak has shown us all that the board’s governing authority has not kept up with an industry that has evolved from corner drugstores to the types of large manufacturers that have been at the center of so much harm.”

Dr. Smith said she thought the most important part of the new legislation was the requirement of a license for sterile compounding. “Now we are going to have the ability to develop specialty licenses that will allow us to track and identify those pharmacies that are engaged in different practices that could potentially put higher numbers of individuals at risk, such as those who engage in sterile compounding,” she said.

Professor Carpenter said a particularly powerful part of the proposal is that it requires licensure for out-of-state pharmacies that ship medication to Massachusetts. The state, he said, is a huge market for injectable drugs.

“Basically, if you think about the large hospitals, the amount of medical care that goes on in the state, it’s in a sense using the purchasing power of the state of Massachusetts to induce changes elsewhere,” he said.

The state has also taken other steps recently to rein in compounding, apart from the new legislation. It began conducting surprise inspections, and has required compounding pharmacies to report how much medication they are shipping and where, so that it can keep tabs on those that begin acting like manufacturers. It also requires the pharmacies to report when they become subjects of regulatory actions by other states or the federal government.

Abby Goodnough reported from Boston, and Denise Grady from New York.

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Avis and Hertz Expand, Raising Questions Over Future Rates

Chang W. Lee/The New York Times

Hertz acquired Dollar Thrifty last November, but it was barred from controlling about 30 sites at airports.

In the short term, industry analysts do not think so. They are less certain about what will happen in the long term.

With the Hertz deal, the number of major car rental companies is dropping to three, from four, but there are still enough brands to keep prices stable, analysts said. Prices, they added, tend to be driven by supply and demand in regional markets.

With the Avis deal, analysts said, Zipcar users may actually gain options.

Zipcar, founded in 2000, works on a car-sharing business model and has a fleet of just 12,000 cars worldwide, compared with about 1.7 million rental cars in the United States alone. Its acquisition by Avis gives members “more alternatives and the potential of having more options,” said Neil Abrams, the founder of the Abrams Consulting Group, a car rental consulting and travel market research organization in Purchase, N.Y.

Zipcar members can rent by the hour or by the day, which is appealing to people who drive infrequently. “Why pay for something you don’t need?” Mr. Abrams said. “It’s a very cost-effective system if used properly.” On the other hand, he said, if you pay by the hour and need the car for a whole day, a Zipcar can cost more, depending on the model, than a traditional rental car.

Zipcars are not typically located in airports, where competition is greater. The company serves a different market, including drivers younger than 25, who may not be able to rent from traditional companies. It also serves large urban areas like New York, Los Angeles, Washington, London and Barcelona, Spain, where people do not want to own a car but want quick access to one for short periods.

Analysts say Zipcar can raise its hourly rate only so much before it will drive away customers.

“Prices can only go so high,” said Chris Brown, executive editor of Auto Rental News, based in Torrance, Calif. “If prices go too high, consumers won’t rent. They will use other types of transportation. They’ll borrow a friend’s car, use public transportation or take a train.”

Avis has indicated that it intends to increase the size of the Zipcar fleet. “We expect to apply Avis Budget’s experience and efficiencies of fleet management with Zipcar’s proven, customer-friendly technology to accelerate the growth of the Zipcar brand and to provide more options for Zipsters in more places,” Ronald L. Nelson, chairman and chief executive of Avis, said in a statement.

In the Hertz deal, the Federal Trade Commission has played a major role in preserving competition in airport car rental markets by requiring Hertz to sell its Advantage Rent a Car business and the rights to operate about 30 Dollar Thrifty locations in airports throughout the United States.

A proposed agreement was open to public comment through Dec. 17, and the F.T.C. will determine soon whether to make it final.

The commission complained that Hertz’s original plans for acquiring Dollar Thrifty would be anticompetitive. It contended that by reducing the number of major competitors to three, the acquisition would create “substantially more concentration in 72 airport rental car markets nationwide” and “eliminate head-to-head competition between Hertz and Dollar Thrifty” at several airports, including Baltimore-Washington International Airport, Chicago O’Hare International Airport and Kennedy Airport in New York.

The F.T.C. said the deal, as originally proposed, would have harmed competition by reducing the number of competitors and enabling Hertz to raise rental car prices.

Precisely because the commission has stepped into the acquisition, prices are likely to remain stable, industry analysts said.

“Better pricing, higher pricing, may be the case, but not in the near future,” Mr. Brown of Auto Rental News said of the Hertz-Dollar Thrifty deal.

He and other analysts described four tiers of rental cars: the premium brands of Avis, Hertz and National; the midprice brands of Budget and Alamo; the value brands of Dollar, Thrifty and Enterprise; and the deep discount brands of Advantage, Payless and Fox, an emerging player.

A deep discount brand like Fox or Sixt, based in Europe, is likely to step into the markets where the F.T.C. requires Hertz to sell its Advantage business and Dollar Thrifty locations, Mr. Brown said, because premium brands are already in those markets.

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A solution to La Jolla's smell problem proves elusive

LA JOLLA — There's a political stink rising in this seaside community, blown ashore from the rocks of La Jolla Cove, where myriad seabirds and marine mammals roost, rest and leave behind what animals leave behind.

The offal accumulation is offending noses at trendy restaurants, tourist haunts, and expensive condos perched on some of the most pricey real estate in the country. But finding a solution to the olfactory assault has proved elusive.

Environmental regulations have thwarted proposals to cleanse the rocks with a non-toxic, biodegradable solution. Even a low-tech idea to scrub the rocks with brooms may need official approval.

The state-protected cove area falls under the permitting jurisdiction of the California Coastal Commission and San Diego Regional Water Quality Control Board. Since wildlife is involved, the National Oceanic and Atmospheric Administration and the U.S. Fish and Wildlife Service also have authority.

The normally low-key Sherri Lightner, who represents La Jolla on the San Diego City Council, has challenged — some say dared — Gov. Jerry Brown to tour the cove area in high stink season.

"Everybody is pointing fingers, and nobody is doing anything," said a La Jolla resident who strolled the sidewalk along the community's famed corniche on New Year's Day, tissue to her nose to battle the smell.

A San Diego park ranger assigned to the La Jolla beaches takes a more philosophic approach toward the excretory matter. "It's a natural process," said ranger Richard Belesky. "But would I want to buy a multimillion-dollar condo with the stink nearby? I don't think so."

The difficulty of reconciling the habits of sea creatures and the needs of humankind is not new to La Jolla. South of the La Jolla Cove is the Children's Pool where harbor seals lounge on the beach.

For two decades a legal and political dispute has raged between people who say the seals should be removed because they are blocking access to the water and those who say the seals should be allowed to stay, particularly during pupping season. Signs warn bathers that seal excrement has resulted in a high bacteria count that can cause disease.

At the La Jolla Cove, the droppings began to pile up after restrictions were put in place to keep people from climbing down the delicate bluffs to the rocks below. The birds and mammals suddenly had no reason to scatter.

The La Jolla Village Merchants Assn. gathered more than 1,000 signatures demanding an immediate solution. But immediate is not in the governmental lexicon when it comes to issues involving the ocean and wildlife.

To wash down the rocks would require a National Pollutant Discharge Elimination System permit from the San Diego Regional Water Quality Control Board. The city, probably the full City Council, would need to endorse a specific wash-down proposal — but that, according to Lightner's staff, would mean submitting the issue to an application process that could take at least two years, given the backlog at the water board.

And even if the water board approved the application, the issue would then proceed to the Coastal Commission, an agency not known for its speed.

In hopes of finding a faster, if more limited, solution, city officials are considering arming Park and Recreation Department employees with brooms to scrub down the rocks. They assure that steps will be taken to ensure that no runoff reaches the ocean and no birds or mammals are hurt.

Talks are planned with regional, state and federal agency staff members to see if such a limited approach could be taken without a full-tilt application process. A radio talk-show host has shown the way, taking his own broom to the cove.

Meanwhile, restaurateurs say the smell continues to discourage patrons. Some tourists complain that it mars their vacations. Shirley Towlson, a bookkeeper who arrived in La Jolla from Phoenix, was shocked at the smell along the promenade and outside her hotel.

"I thought La Jolla meant 'The Jewel,' '' she said. "This smells more like 'The Toilet.' "

Other tourists find the smell but a small downer amid the other joys of La Jolla as a seaside place of visual beauty, fine dining and chic shopping.

"It smells like fish," said Mark Bain, a general contractor from Sacramento, enjoying a New Year's week idyll. "It happens."

He said the smell is not nearly as noxious as when dead fish line the banks of the Sacramento River. "Now, that's really bad," he said.

tony.perry@latimes.com

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Looney Gas and Lead Poisoning: A Short, Sad History

Author’s note: Most people don’t realize that we knew in the 1920s that leaded gasoline was extremely dangerous. And in light of a Mother Jones story this week that looks at the connection between leaded gasoline and crime rates in the United States, I thought it might be worth reviewing that history. The following is an updated version of an earlier post based on information from my book about early 10th century toxicology, The Poisoner’s Handbook.

In the fall of 1924, five bodies from New Jersey were delivered to the New York City Medical Examiner’s Office. You might not expect those out-of-state corpses to cause the chief medical examiner to worry about the dirt blowing in Manhattan streets. But they did.

To understand why you need to know the story of those five dead men, or at least the story of their exposure to a then mysterious industrial poison.

The five men worked at the Standard Oil Refinery in Bayway, New Jersey. All of them spent their days in what plant employees nicknamed “the loony gas building”, a tidy brick structure where workers seemed to sicken as they handled a new gasoline additive. The additive’s technical name was tetraethyl lead or, in industrial shorthand, TEL. It was developed by researchers at General Motors as an anti-knock formula, with the assurance that it was entirely safe to handle.

But, as I wrote in a previous post, men working at the plant quickly gave it the “loony gas” tag because anyone who spent much time handling the additive showed stunning signs of mental deterioration, from memory loss to a stumbling loss of coordination to  sudden twitchy bursts of rage. And then in October of 1924, workers in the TEL building began collapsing, going into convulsions, babbling deliriously. By the end of September, 32 of the 49 TEL workers were in the hospital; five of them were dead.

The problem, at that point, was that no one knew exactly why. Oh, they knew – or should have known – that tetraethyl lead was dangerous. As Charles Norris, chief medical examiner for New York City pointed out, the compound had been banned in Europe for years due to its toxic nature. But while U.S. corporations hurried TEL into production in the 1920s, they did not hurry to understand its medical or environmental effects.

In 1922,  the U.S. Public Health Service had asked Thomas Midgley, Jr. – the developer of the leaded gasoline process – for copies of all his research into the health consequences of tetraethyl lead (TEL).

Midgley, a scientist at General Motors, replied that no such research existed. And two years later, even with bodies starting to pile up,  he had still not looked into the question.  Although GM and Standard Oil had formed a joint company to manufacture leaded gasoline – the Ethyl Gasoline Corporation - its research had focused solely on improving the TEL formulas. The companies disliked and frankly avoided the lead issue. They’d deliberately left the word out of their new company name to avoid its negative image.

In response to the worker health crisis at the Bayway plant, Standard Oil suggested that the problem might simply be overwork. Unimpressed, the state of New Jersey ordered a halt to TEL production. And because the compound was so poorly understood, state health officials asked the New York City Medical Examiner’s Office to find out what had happened.

In 1924, New York had the best forensic toxicology department in the country; in fact,, it had one of the few such programs period. The chief chemist was a dark, cigar-smoking, perfectionist named Alexander Gettler, a famously dogged researcher who would sit up late at night designing both experiments and apparatus as needed.

It took Gettler three obsessively focused weeks to figure out how much tetraethyl lead the Standard Oil workers had absorbed before they became ill,  went crazy, or died. “This is one of the most difficult of many difficult investigations of the kind which have been carried on at this laboratory,” Norris said, when releasing the results. “This was the first work of its kind, as far as I know. Dr. Gettler had not only to do the work but to invent a considerable part of the method of doing it.”

Working with the first four bodies, then checking his results against the body of the last worker killed, who had died screaming in a straitjacket, Gettler discovered that TEL and its lead byproducts formed a recognizable distribution, concentrated in the lungs, the brain, and the bones. The highest levels were in the lungs suggesting that most of the poison had been inhaled; later tests showed that the types of masks used by Standard Oil did not filter out the lead in TEL vapors.

Rubber gloves did protect the hands but if TEL splattered onto unprotected skin, it absorbed alarmingly quickly. The result was intense poisoning with lead, a potent neurotoxin. The loony gas symptoms were, in fact, classic indicators of heavy lead toxicity.

After Norris released his office’s report on tetraethyl lead, New York City banned its sale, and the sale of “any preparation containing lead or other deleterious substances” as an additive to gasoline. So did New Jersey. So did the city of Philadelphia. It was a moment in which health officials in large urban areas were realizing that with increased use of automobiles, it was likely that residents would be increasingly exposed to dangerous lead residues and they moved quickly to protect them.

But fearing that such measures would spread,  that they would be forced to find another anti-knock compound, as well as losing considerable money, the manufacturing companies demanded that the federal government take over the investigation and develop its own regulations. U.S. President Calvin Coolidge, a Republican and small-government conservative, moved rapidly in favor of the business interests.

The manufacturers agreed to suspend TEL production and distribution until a federal investigation was completed. In May 1925, the U.S. Surgeon General called a national tetraethyl lead conference, to be followed by the formation of an investigative task force to study the problem. That same year, Midgley published his first health analysis of TEL, which acknowledged  a minor health risk at most, insisting that the use of lead compounds,”compared with other chemical industries it is neither grave nor inescapable.”

It was obvious in advance that he’d basically written the conclusion of the federal task force. That panel only included selected industry scientists like Midgely. It had no place for Alexander Gettler or Charles Norris or, in fact, anyone from any city where sales of the gas had been banned, or any agency involved in the producing that first critical analysis of tetraethyl lead.

In January 1926, the public health service released its report which concluded that there was “no danger” posed by adding TEL to gasoline…”no reason to prohibit the sale of leaded gasoline” as long as workers were well protected during the manufacturing process.

The task force did look briefly at risks associated with every day exposure by drivers, automobile attendants, gas station operators, and found that it was minimal. The researchers had indeed found lead residues in dusty corners of garages. In addition,  all the drivers tested showed trace amounts of lead in their blood. But a low level of lead could be tolerated, the scientists announced. After all, none of the test subjects showed the extreme behaviors and breakdowns associated with places like the looney gas building. And the worker problem could be handled with some protective gear.

There was one cautionary note, though. The federal panel warned that exposure levels would probably rise as more people took to the roads. Perhaps, at a later point, the scientists suggested, the research should be taken up again. It was always possible that leaded gasoline might “constitute a menace to the general public after prolonged use or other conditions not foreseen at this time.”

But, of course, that would be another generation’s problem. In 1926, citing evidence from the TEL report, the federal government revoked all bans on production and sale of leaded gasoline. The reaction of industry was jubilant; one Standard Oil spokesman likened the compound to a “gift of God,” so great was its potential to improve automobile performance.

In New York City, at least, Charles Norris decided to prepare for the health and environmental problems to come. He suggested that the department scientists do a base-line measurement of lead levels in the dirt and debris blowing across city streets. People died, he pointed out to his staff; and everyone knew that heavy metals like lead tended to accumulate. The resulting comparison of street dirt in 1924 and 1934 found a 50 percent increase in lead levels – a warning, an indicator of damage to come, if anyone had been paying attention.

It was some fifty years later – in 1986 – that the United States formally banned lead as a gasoline additive. By that time, according to some estimates, so much lead had been deposited into soils, streets, building surfaces, that an estimated 68 million children would register toxic levels of lead absorption and some 5,000 American adults would die annually of lead-induced heart disease. As lead affects cognitive function, some neuroscientists also suggested that chronic lead exposure resulted in a measurable drop in IQ scores during the leaded gas era. And more recently, of course, researchers had suggested that TEL exposure and resulting nervous system damage may have contributed to violent crime rates in the 20th century.

Which is just another way of say that we never got out of the loony gas building after all.

Images: 1) Manhattan, 34th Street, 1931/NYC Municipal Archives 2) 1940s gas station, US Route 66, Illinois/Deborah Blum

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NBC says it’s not the ‘shoot-’em-up’ network

PASADENA, Calif. (AP) — NBC says it is conscious about the amount of violence it airs in the wake of real-life tragedies, but it isn’t really an issue because NBC isn’t the “shoot-’em-up” network.

Network entertainment President Jennifer Salke said Sunday that NBC hasn’t taken any specific steps to ask show creators to tone down violence. She said it would be different if NBC was perceived as a “shoot-’em-up” network with many crime procedurals, but she said it wasn’t an issue.

NBC has in development a drama based on the life of Hannibal Lecter, one of fiction’s most indelible serial killers, but hasn’t scheduled it for the air.

Entertainment Chairman Robert Greenblatt said a tonic for people disturbed by violence is to watch an episode of “Parenthood.”

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Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

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Design: Who Made That Universal Product Code?

On a Sunday afternoon in 1971, an I.B.M. engineer stepped out of his house in Raleigh, N.C., to consult his boss, who lived across the street. “I didn’t do what you asked,” George Laurer confessed.

Laurer had been instructed to design a code that could be printed on food labels and that would be compatible with the scanners then in development for supermarket checkout counters. He was told to model it on the bull’s-eye-shaped optical scanning code designed in the 1940s by N. Joseph Woodland, who died last month. But Laurer saw a problem with the shape: “When you run a circle through a high-speed press, there are parts that are going to get smeared,” he says, “so I came up with my own code.” His system, a pattern of stripes, would be readable even if it was poorly printed.

That pattern became the basis for the Universal Product Code, which was adopted by a consortium of grocery companies in 1973, when cashiers were still punching in all prices by hand. Within a decade, the U.P.C. — and optical scanners — brought supermarkets into the digital age. Now an employee could ring up a cereal box with a flick of the wrist. “When people find out that I invented the U.P.C., they think I’m rich,” Laurer says. But he received no royalties for this invention, and I.B.M. did not patent it.

As the U.P.C. symbol proliferated, so, too, did paranoia about it. For decades, Laurer has been hounded by people convinced that he has hidden the number 666 inside the lines of his code. “I didn’t get the meat,” Laurer said ruefully, “but I did get the nuts.”

CODE BREAKER
Bill Selmeier runs the ID History Museum, an online archive dedicated to the bar code.

You worked at I.B.M. in the 1970s and then helped promote the U.P.C.?
Yes, I started the seminars where we invited people from the grocery and labeling industry into I.B.M. We were there to reduce their fear.

What were they afraid of?
They were afraid that anything that didn’t work right would reflect badly on them — particularly if it was only their own package that wouldn’t scan. The guy from Birds Eye said, “My stuff always has ice on it when it goes through the checkout.” So we put his package in the freezer and took it out and showed him how it scanned perfectly.

Why are you still so interested in the history of the U.P.C.?
Let me put it this way: What bigger impact can you have on the world than to change the way everyone shops?

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Four killed, including gunman, at Aurora, Colo., townhome

Four people died at an Aurora, Colo., townhome early Saturday morning, including a gunman who barricaded himself inside for hours, police said.

Around 9 a.m., police said the suspect shot at officers from a second-story window. They returned fire, hitting the man. The suspect was pronounced dead in an upstairs bedroom.

Inside the home, police discovered two other men and one woman dead.

Another woman was able to escape early Saturday morning when she jumped from an upstairs window, and called police around 3 a.m., Aurora Police Sgt. Cassidee Carlson told the Denver Post. The woman, who escaped unharmed, told police she saw three bodies that "appeared lifeless," police said.

Several neighboring homes were evacuated and police sent out emergency notifications to neighbors at 3 a.m., KUSA-TV , an NBC affiliate, reported.

“After we arrived on scene, there were no more shots fired up until he fired at us,” Carlson told the Associated Press. “During this time he was all over the house. He moved furniture. He was throwing things. He was agitated. He was irrational.”

Aurora, a Denver suburb, is where a gunman killed 12 people and injured at least 70 others at a movie theater July 20.

[Updated at 1:41 p.m., Jan. 5: Carlson said in an email to the Los Angeles Times that there was no indication the four people had any connection to the theater shooting.]

Police said they told the suspect by phone and a bullhorn to exit the townhome. Police reached him by phone "intermittently" over several hours and the suspect hung up multiple times on hostage negotiators, police said.

Authorities did not release the name of the victims or suspect.

andrew.khouri@latimes.com

@khouriandrew

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Analysis: Obama’s ad team used cable TV to outplay Romney

(Reuters) – As political experts assess Republican Mitt Romney‘s failed U.S. presidential bid, an analysis of how his campaign and President Barack Obama‘s winning team used cable TV to target ads at specific groups of voters may offer some valuable tips for the future.

During the final weeks before the November 6 election, with polls showing a tight race, Obama’s campaign exploited cable TV’s diverse lineup to target women on channels such as Food Network and Lifetime and men on networks such as ESPN.

The Obama team used the fragmentation of cable TV’s audience to its fullest advantage to target tailored messages to voters in battleground states.

Meanwhile, Romney’s campaign relied on a more traditional mass saturation of broadcast TV. The Romney camp was entirely dark on cable TV for two of the campaign’s last seven days.

“We don’t know why. This was a week before the election and you’re in the fight for your life,” said Timothy Kay, political director for NCC Media, a cable TV industry consortium.

The race had narrowed to key counties in several battleground states, the kind of isolation ideally suited for cable’s geographical targeting and niche-marketing capabilities.

Republican Party operatives dismayed by Romney’s defeat continue to debate what went wrong in a campaign awash in cash and run by a candidate with a business background. The former Massachusetts governor’s campaign, like Democrat Obama‘s, spent a record-setting amount of cash; in Romney’s case, it was $ 580 million in 20 months.

Obama’s campaign outspent Romney’s campaign on advertising by as much as $ 200 million, according to a Reuters analysis. But when spending by pro-Romney and pro-Obama outside groups is considered, Romney had the edge in overall TV advertising spending.

Republican consultants and advertising experts said Romney had enough money to compete with Obama’s final advertising effort. Yet Obama cruised to a commanding Electoral College victory after a final concentration on a small group of battleground states.

“In market after market, the Obama campaign ended up putting more ads on target than the Romney campaign did,” said Ken Goldstein, president of Kantar Media’s Campaign Media Analysis Group, a nonpartisan consulting firm that tracked political ads and worked with both campaigns.

Stephanie Kincaid, who managed Romney’s advertising campaign, declined to answer questions and referred inquiries to top Romney campaign officials Stuart Stevens and Russell Schriefer, her bosses at The Stevens and Schriefer Group, a political consulting firm. They did not respond to phone calls.

OBAMA’S ADVANTAGE

Cable television political advertising jumped from $ 136 million in 2006 to $ 650 million in 2012, although broadcast TV still garnered 80 percent of the campaign advertising spending last year.

Even with major broadcast networks and their affiliates, the Obama campaign appeared to out-perform the Romney camp.

A campaign spending review shows the Obama camp frequently spent far less than Romney for ads aired by the same stations during the same shows.

For example, a review of TV station filings with the Federal Communications Commission showed Romney, on the Sunday before Election Day, paid $ 1,100 for an ad aired during CBS’s “Face the Nation” program on WRAL in Raleigh, North Carolina. Obama paid $ 200 for a comparable ad on the same station during the same program.

Part of the reason for the Obama campaign’s pricing advantage is that the president faced no Democratic primary challenge and was able to buy autumn TV time months in advance when the slots – like airline tickets – were discounted. Romney faced a tough battle for the Republican nomination.

The Romney campaign also simply did not have enough bodies to handle the labor-intensive business of planning, negotiating and placing ads on hundreds of TV stations simultaneously, according to several Republican consultants and media analysts who asked not to be identified.

Obama’s campaign had 30 full-time media buyers. The Romney campaign relied heavily on a single person, Kincaid, with help from one or two others from time to time, according to sources close to the campaign. Senior officials with the campaign declined to discuss its advertising staffing.

“It’s the equivalent of having a budget the size of a Coca- Cola commercial campaign and having two people managing it, where a Madison Avenue agency might have 50 people,” said NCC’s Kay. Kincaid and her small staff were overwhelmed, according to numerous political vendors who dealt with them.

Jim Margolis, an Obama campaign senior adviser whose firm GMMB handled its advertising, said the campaign also took advantage of information provided by companies like Rentrak Corp, a Portland, Oregon-based company that monitors the digital boxes attached to TVs in households using satellite dishes.

EXPLOITING FRAGMENTATION

In the past, political advertisers relied on the major networks rather than cable TV in a quest to reach the most television viewers.

But cable TV’s increasing popularity has brought dramatic fragmentation to television viewership. In many markets, cable offers a hundred or more channels, giving advertisers a chance to target specific demographics.

For instance, the Obama campaign identified zip codes surrounding Ohio tire-manufacturing plants and purchased cable ads touting Obama’s efforts to block tire imports from China.

Obama ran 600,000 cable ads to the Romney’s 300,000 around the nation during the campaign, said NCC’s Kay. Obama’s cable TV push started in April. Romney’s began in September.

Obama’s team also mixed and matched its messages to sharpen the appeal in key counties.

“My impression was there was much more examination and analytics done with the Obama campaign,” Kay said. “The Romney campaign had the same rigid schedule in every state.”

(Reporting by Marcus Stern in Washington and Tim McLaughlin in Boston; Editing by Claudia Parsons, Marilyn W. Thompson and Will Dunham)

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The New Old Age: Murray Span, 1922-2012

One consequence of our elders’ extended lifespans is that we half expect them to keep chugging along forever. My father, a busy yoga practitioner and blackjack player, celebrated his 90th birthday in September in reasonably good health.

So when I had the sad task of letting people know that Murray Span died on Dec. 8, after just a few days’ illness, the primary response was disbelief. “No! I just talked to him Tuesday! He was fine!”

And he was. We’d gone out for lunch on Saturday, our usual routine, and he demolished a whole stack of blueberry pancakes.

But on Wednesday, he called to say he had bad abdominal pain and had hardly slept. The nurses at his facility were on the case; his geriatrician prescribed a clear liquid diet.

Like many in his generation, my dad tended towards stoicism. When he said, the following morning, “the pain is terrible,” that meant agony. I drove over.

His doctor shared our preference for conservative treatment. For patients at advanced ages, hospitals and emergency rooms can become perilous places. My dad had come through a July heart attack in good shape, but he had also signed a do-not-resuscitate order. He saw evidence all around him that eventually the body fails and life can become a torturous series of health crises and hospitalizations from which one never truly rebounds.

So over the next two days we tried to relieve his pain at home. He had abdominal x-rays that showed some kind of obstruction. He tried laxatives and enemas and Tylenol, to no effect. He couldn’t sleep.

On Friday, we agreed to go to the emergency room for a CT scan. Maybe, I thought, there’s a simple fix, even for a 90-year-old with diabetes and heart disease. But I carried his advance directives in my bag, because you never know.

When it is someone else’s narrative, it’s easier to see where things go off the rails, where a loving family authorizes procedures whose risks outweigh their benefits.

But when it’s your father groaning on the gurney, the conveyor belt of contemporary medicine can sweep you along, one incremental decision at a time.

All I wanted was for him to stop hurting, so it seemed reasonable to permit an IV for hydration and pain relief and a thin oxygen tube tucked beneath his nose.

Then, after Dad drank the first of two big containers of contrast liquid needed for his scan, his breathing grew phlegmy and labored. His geriatrician arrived and urged the insertion of a nasogastric tube to suck out all the liquid Dad had just downed.

His blood oxygen levels dropped, so there were soon two doctors and two nurses suctioning his throat until he gagged and fastening an oxygen mask over his nose and mouth.

At one point, I looked at my poor father, still in pain despite all the apparatus, and thought, “This is what suffering looks like.” I despaired, convinced I had failed in my most basic responsibility.

“I’m just so tired,” Dad told me, more than once. “There are too many things going wrong.”

Let me abridge this long story. The scan showed evidence of a perforation of some sort, among other abnormalities. A chest X-ray indicated pneumonia in both lungs. I spoke with Dad’s doctor, with the E.R. doc, with a friend who is a prominent geriatrician.

These are always profound decisions, and I’m sure that, given the number of unknowns, other people might have made other choices. Fortunately, I didn’t have to decide; I could ask my still-lucid father.

I leaned close to his good ear, the one with the hearing aid, and told him about the pneumonia, about the second CT scan the radiologist wanted, about antibiotics. “Or, we can stop all this and go home and call hospice,” I said.

He had seen my daughter earlier that day (and asked her about the hockey strike), and my sister and her son were en route. The important hands had been clasped, or soon would be.

He knew what hospice meant; its nurses and aides helped us care for my mother as she died. “Call hospice,” he said. We tiffed a bit about whether to have hospice care in his apartment or mine. I told his doctors we wanted comfort care only.

As in a film run backwards, the tubes came out, the oxygen mask came off. Then we settled in for a night in a hospital room while I called hospices — and a handyman to move the furniture out of my dining room, so I could install his hospital bed there.

In between, I assured my father that I was there, that we were taking care of him, that he didn’t have to worry. For the first few hours after the morphine began, finally seeming to ease his pain, he could respond, “OK.” Then, he couldn’t.

The next morning, as I awaited the hospital case manager to arrange the hospice transfer, my father stopped breathing.

We held his funeral at the South Jersey synagogue where he’d had his belated bar mitzvah at age 88, and buried him next to my mother in a small Jewish cemetery in the countryside. I’d written a fair amount about him here, so I thought readers might want to know.

We weren’t ready, if anyone ever really is, but in our sorrow, my sister and I recite this mantra: 90 good years, four bad days. That’s a ratio any of us might choose.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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