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May 31, 2010

China pins food-security hopes on humble potato

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Farmers wash mud off just-harvested potatoes in Hunan province. (Lauren Keane - Twp)

By Lauren Keane
Washington Post Foreign Service
Monday, May 31, 2010; A01

JIUTIAOLONG, HUNAN PROVINCE, CHINA -- In the land of rice, China is looking at an unlikely tool for maintaining growth and social harmony: the potato.

The Chinese government has begun ramping up research, production and training related to the humble spud, and hopes are high that it could help alleviate poverty and serve as a bulwark against famine.

The challenge of feeding a growing nation on a shrinking supply of arable land while confronting severe water shortages has long been a major concern here. China has to feed one-fifth of the world's population on one-tenth of its arable land, and the nation's expanding cities are consuming farmland at breakneck speed. China estimates that by 2030, when its population is expected to level off at roughly 1.5 billion, it will need to produce an additional 100 million tons of food each year.

That statistical reality could change eating habits here. Potatoes need less water to grow than rice or wheat, and they yield far more calories per acre. In rice-cultivating regions of southern China, farmers can squeeze a round of fast-growing potatoes into their rice fields in between planting seasons. In some of the poorest parts of arid northern China, potatoes are among the few crops that grow.

"Potatoes have so much potential here," said Xie Kaiyun, a leading potato scientist at the Chinese Academy of Agricultural Sciences, a government think tank. "Rice, wheat, corn -- we've gone about as far as we can go with them. But not the potato."

Ever keen to seize opportunity, Chinese entrepreneurs are turning potatoes into forms more familiar to Chinese palates: buns, noodles, cakes. They are developing exotic varieties and have even sent seeds into orbit, saying that zero gravity makes them more nutritious and charging astronomical premiums for the seeds' offspring back on Earth.

Potatoes won't replace rice or wheat as mainstays of Chinese cuisine anytime soon, if ever. They are eaten as side dishes, and the government has not yet named them a staple, a distinction that would mean preferential treatment in domestic markets and would carry significant cultural weight.

But they are increasingly seen here as an underutilized resource.

With that in mind, the government in February signed an agreement with the International Potato Center, a research organization, to jointly launch a major potato research center in Beijing. Part of the center's broad mandate will be to develop varieties that grow quickly and dependably in specific regions throughout China. Last month, the State Council announced subsidies for farmers who grow high-yield seed potatoes. And government-funded pilot programs have been expanding in nearly every province, training farmers in innovative methods that raise crop yields and, with them, rural incomes.

Eye on the future

"It's unusual to see a country explicitly name a commodity as an instrument of development," said Pamela K. Anderson, director general of the International Potato Center. "It shows how seriously the Chinese government is taking its commitment to food security."

China has a long-standing policy of food self-sufficiency, growing 95 percent of the grain required to feed its people. The country's sheer size means that a major crop failure or other food emergency here could have international ramifications, overwhelming world food markets with sudden demand. "Were China to need to import a large amount of grain, it would have a very dramatic impact on world food prices," said Anthea Webb, director of World Food Program China.

China produces and consumes more potatoes than any other country. But that's largely because of its huge population. The Chinese lag in per capita terms, eating one-third the amount of potatoes that Russians do and two-thirds the amount Americans eat.

The average acre of potato plants in China yields far fewer edible spuds than in other developing countries, mostly because farmers plant cheap, disease-prone seed. China's national and local governments are trying to change that by increasing potato funding, hoping the investments will raise rural incomes and help maintain social stability by keeping farmers on their land in the country's poorest areas.

Researchers from Hunan Agricultural University started working with the province's potato farmers in 2005 and last year used government grant funds to provide training and seeds. Farmers plant in rice fields during the winter, when the land would otherwise produce nothing; potato plants then improve the soil for the next season's rice cultivation.

It's a good time to be in the Chinese potato business. Wholesale prices increased 85 percent from November to April, thanks in part to a severe drought in the nation's southwest that has limited supply.

"We earn the same from one potato crop that we get from three rice crops" or 10 cabbage crops, said Huang Weihua, 40, the leader of the local farmers association. He pointed across a terraced field of flowering potato plants to his house, a two-story brick-and-tile structure. His son was hard at work remodeling the first floor -- potato money, Huang said.

Market potential

But if potatoes are to become a key to China's food security, the market for them must expand even more.

"Chinese don't know enough about potatoes and their nutritional benefits," said Xie, the potato scientist. "If they eat one more potato dish every day -- well, there are 1.3 billion of us. That's a huge new market."

Liang Xisen was dubbed China's "potato king" last year. The lifelong entrepreneur, who made it into a 2006 list of the nation's richest men, has poured his wealth into potatoes. His company churned out 150,000 tons of high-quality seed potatoes last year, assisted by government subsidies, and sold them to farmers nationwide for a profit of about $22 million, according to company statistics.

Liang has even opened China's first Potato Museum. An altar outside presents burned offerings to a giant plaster statue of a Peruvian potato god. A red banner pulled taut above the entrance proclaims: "Little potatoes, big industry."

Premier Wen Jiabao has joined the cause. He shared a meal of steamed potatoes with farmers last fall in Gansu, one of China's poorest and most significant potato-growing provinces. He donned tennis shoes to shovel out spuds, with the video footage running on China's most-watched nightly news broadcast.

In China, where government endorsements mean business, Wen's message has trickled down to the Hunan potato fields. On a recent afternoon, Huang stood calf-deep in an irrigation ditch, surveying his ripening crop in a downpour from under a blue polka-dot umbrella.

"Wen Jiabao said potatoes are important -- on national television!" Huang said, wide-eyed. "I figure that's a good sign for us, right?"

Researcher Liu Liu contributed to this report.

Oil could spew until August, officials say

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Top Kill Fails; BP Trying other options

BP's 'top kill' operation has failed to plug the oil leak in the Gulf. The company is now planning to cut off the damaged riser from which the oil is leaking and cap it with a containment valve. (May 29)

By Steven Mufson and David S. Hilzenrath
Monday, May 31, 2010; A01

As BP readied its latest fallback plan to stop oil gushing from one of its wells in the Gulf of Mexico, the Obama administration and the company warned that the crude could continue flowing until August, compounding threats to coastal wetlands, fisheries and beaches.

White House energy and climate adviser Carol M. Browner said Sunday that the oil spill was "probably the biggest environmental disaster we've ever faced in this country" and that "we are prepared for the worst." On the CBS show "Face the Nation," she said that the "American people need to know that it is possible we will have oil leaking from this well until August when the relief wells will be finished."

Those two wells, which BP began drilling early this month, are expected to intersect the damaged one and seal it near the reservoir far below the seafloor. The first has reached 7,000 feet below the seafloor, and the second has reached 3,500 feet below the floor, but progress gets slower the deeper the wells go. With the arrival of hurricane season Tuesday, the drilling could be slowed if the rigs need to be evacuated during storms.

The grim assessment came in the wake of the failure last week of BP's "top kill" effort to stop the flow of oil from the damaged well by shooting heavy drilling mud into the hole.

BP managing director Bob Dudley, who also made the rounds of Sunday-morning shows, said on ABC's "This Week" that "the next step is to make sure that we minimize the oil and pollution going into the gulf." He added: "The main thing now is to contain it."

BP plans to saw off a bent and broken pipe attached to the five-story tall blowout preventer that sits over the well. The company will then lower a new apparatus that would funnel oil and gas to vessels on the sea surface. But until the new apparatus is in place, cutting the riser pipe will temporarily increase the flow of oil into the sea by 10 to 20 percent, because the procedure will remove a section of pipe where a kink is limiting the flow, Browner said.

4th fallback plan so far

Dudley expressed optimism about the latest fallback plan -- the fourth so far -- saying on CBS, "With this, we think we can contain the majority of the oil and gas."

BP and the Obama administration were also trying to contain the rising tide of public frustration as the oil spill comes to the end of its messy sixth week.

Drilling experts said they feared that BP's effort last week to stop the flow of oil and gas with heavy drilling mud might have done further damage to the well and the blowout preventer, possibly complicating the next effort to capture the oil and gas and bring them to surface vessels.

Some drilling experts said that the "top kill" effort failed over the weekend because the force of the oil and gas pushing up from the reservoir 13,000 feet below the seafloor was so great that it had shoved most of the drilling mud through the blowout preventer and into the sea.

Tadeusz W. Patzek, chairman of petroleum and geosystems engineering at the University of Texas at Austin, said it was the "equivalent of six or seven fire hoses blasting oil and gas up, while two fire hoses were used to blast the drilling mud down. They never stood much of a chance."

Sources at two companies involved with the well said that BP also discovered new damage inside the well below the seafloor and that, as a result, some of the drilling mud that was successfully forced into the well was going off to the side into rock formations.

"We discovered things that were broken in the sub-surface," said a BP official who spoke on the condition of anonymity. He said that mud was making it "out to the side, into the formation." The official said he could not describe what was damaged in the well.

Documents released Sunday by the House Committee on Energy and Commerce point to problems BP was having drilling the Macondo well, although some of them date to 2009 when BP was using a different rig with different equipment. Some documents describe previously reported trouble BP was having controlling the well. The company later drilled a new well section, costing it more than $20 million.

The longer oil seeps out of the ground, the more politics are seeping into the public debate as people question why the oil industry and the government were so ill-prepared.

In an echo of the counting of days during the politically debilitating Iranian hostage crisis during President Jimmy Carter's administration, Jake Tapper on ABC introduced his program as "Day 41 of the Gulf oil spill."

Sen. David Vitter (R-La.) said BP "made enormous mistakes and probably cut corners." Appearing on CNN's "State of the Union," Vitter also said the federal government has failed in its response to the crisis, "particularly with the effort to protect our coast and our marsh."

Last week, Minnesota Gov. Tim Pawlenty (R) questioned the administration's reliance on BP's estimates of the volume of oil, which has been flowing into the gulf since a blowout set fire to the Deepwater Horizon drilling rig, which sank, killing 11 people.

Browner conceded on CBS that "BP has a financial interest in these numbers" on the volume of the leak. "They will pay penalties at the end of the day, a per-barrel, per-day penalty," she said. But she said the latest, increased estimates of oil flowing from the well were produced by an independent government review panel.

"At the end of the day, the government tells BP what to do, and at the end of the day, we will hold BP accountable for all of this," she said.

She also sought to portray the administration as in charge and engaged. She said an administration "brain trust" led by Energy Secretary Steven Chu urged BP to stop adding pressure to the well through the top-kill maneuver because "things could happen that would make the situation worse."

But she stopped short on CBS of saying that Chu ordered an end to the top-kill maneuver.

Pressed to give an example of administration influence, Browner cited the drilling of two relief wells instead of one. A BP official said that it was "not unusual" to drill a second relief well and that it "very likely" would have been done anyway.

But Browner said that "BP said we're going to drill one relief well. These are expensive wells for them to drill. We said that's not good enough. You're going to drill a second one."

BP has said it would take responsibility for damage from the spill, but BP chief executive Tony Hayward on Sunday disputed claims by scientists that large undersea plumes have been set adrift by the gulf oil spill.

The Associated Press reported that during a tour of a company staging area for cleanup workers, Hayward said BP's samples showed "no evidence" that oil was suspended in large masses beneath the surface.

"The oil is on the surface," Hayward said. "Oil has a specific gravity that's about half that of water. It wants to get to the surface because of the difference in specific gravity."

Scientists from several universities have reported plumes of what appears to be oil suspended in clouds stretching for miles and reaching hundreds of feet beneath the gulf's surface.

Murder on the Flotilla ...

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May 30, 2010

Healing by 2-Way Video - The Rise of Telemedicine

Michael Stravato for The New York Times

Dr. Jerry Jones uses two-way video at his home in Houston to consult with a patient across town. Dr. Jones is under contract to NuPhysicia, one of the new telemedicine companies.

By MILT FREUDENHEIM

ONE day last summer, Charlie Martin felt a sharp pain in his lower back. But he couldn’t jump into his car and rush to the doctor’s office or the emergency room: Mr. Martin, a crane operator, was working on an oil rig in the South China Sea off Malaysia.

He could, though, get in touch with a doctor thousands of miles away, via two-way video. Using an electronic stethoscope that a paramedic on the rig held in place, Dr. Oscar W. Boultinghouse, an emergency medicine physician in Houston, listened to Mr. Martin’s heart.

“The extreme pain strongly suggested a kidney stone,” Dr. Boultinghouse said later. A urinalysis on the rig confirmed the diagnosis, and Mr. Martin flew to his home in Mississippi for treatment.

Mr. Martin, 32, is now back at work on the same rig, the Courageous, leased by Shell Oil. He says he is grateful he could discuss his pain by video with the doctor. “It’s a lot better than trying to describe it on a phone,” Mr. Martin says.

Dr. Boultinghouse and two colleagues — Michael J. Davis and Glenn G. Hammack— run NuPhysicia, a start-up company they spun out from the University of Texas in 2007 that specializes in face-to-face telemedicine, connecting doctors and patients by two-way video.

Spurred by health care trends and technological advances, telemedicine is growing into a mainstream industry. A fifth of Americans live in places where primary care physicians are scarce, according to government statistics. That need is converging with advances that include lower costs for video-conferencing equipment, more high-speed communications links by satellite, and greater ability to work securely and dependably over the Internet.

“The technology has improved to the point where the experience of both the doctor and patient are close to the same as in-person visits, and in some cases better,” says Dr. Kaveh Safavi, head of global health care for Cisco Systems, which is supporting trials of its own high-definition video version of telemedicine in California, Colorado and New Mexico.

The interactive telemedicine business has been growing by almost 10 percent annually, to more than $500 million in revenue in North America this year, according to Datamonitor, the market research firm. It is part of the $3.9 billion telemedicine category that includes monitoring devices in homes and hundreds of health care applications for smartphones.

Christine Chang, a health care technology analyst at Datamonitor’s Ovum unit, says telemedicine will allow doctors to take better care of larger numbers of patients. “Some patients will be seen by teleconferencing, some will send questions by e-mail, others will be monitored” using digitized data on symptoms or indicators like glucose levels, she says.

Eventually, she predicts, “one patient a day might come into a doctor’s office, in person.”

Although telemedicine has been around for years, it is gaining traction as never before. Medicare, Medicaid and other government health programs have been reimbursing doctors and hospitals that provide care remotely to rural and underserved areas. Now a growing number of big insurance companies, like the UnitedHealth Group and several Blue Cross plans, are starting to market interactive video to large employers. The new federal health care law provides $1 billion a year to study telemedicine and other innovations.

Michael Stravato for The New York Times

From thousands of miles away, Dr. Oscar Boultinghouse checks the eye of a patient.

With the expansion of reimbursement, Americans are on the brink of “a gold rush of new investment in telemedicine,” says Dr. Bernard A. Harris Jr., managing partner at Vesalius Ventures, a venture capital firm based in Houston. He has worked on telemedicine projects since he helped build medical systems for NASA during his days as an astronaut in the 1990s.

Face-to-face telemedicine technology can be as elaborate as a high-definition video system, like Cisco’s, that can cost up to hundreds of thousands of dollars. Or it can be as simple as the Webcams available on many laptops.

NuPhysicia uses equipment in the middle of that range — standard videoconferencing hookups made by Polycom, a video conferencing company based in Pleasanton, Calif. Analysts say the setup may cost $30,000 to $45,000 at the patient’s end — with a suitcase or cart containing scopes and other special equipment — plus a setup for the doctor that costs far less.

Telemedicine has its skeptics. State regulators at the Texas Medical Board have raised concerns that doctors might miss an opportunity to pick up subtle medical indicators when they cannot touch a patient. And while it does not oppose telemedicine, the American Academy of Family Physicians says patients should keep in contact with a primary physician who can keep tabs on their health needs, whether in the virtual or the real world.

“Telemedicine can improve access to care in remote sites and rural areas,” says Dr. Lori J. Heim, the academy’s president. “But not all visits will take place between a patient and their primary-care doctor.”

Dr. Boultinghouse dismisses such concerns. “In today’s world, the physical exam plays less and less of a role,” he says. “We live in the age of imaging.”

ON the rig Courageous, Mr. Martin is part of a crew of 100. Travis G. Fitts Jr., vice president for human resources, health, safety and environment at Scorpion Offshore, which owns the rig, says that examining a worker via two-way video can be far cheaper in a remote location than flying him to a hospital by helicopter at $10,000 a trip.

Some rigs have saved $500,000 or more a year, according to NuPhysicia, which has contracts with 19 oil rigs around the world, including one off Iraq. Dr. Boultinghouse says the Deepwater Horizon drilling disaster in the Gulf of Mexico may slow or block new drilling in United States waters, driving the rigs to more remote locations and adding to demand for telemedicine.

NuPhysicia also offers video medical services to land-based employers with 500 or more workers at a site. The camera connection is an alternative to an employer’s on-site clinics, typically staffed by a nurse or a physician assistant.

Mustang Cat, a Houston-based distributor that sells and services Caterpillar tractors and other earth-moving equipment, signed on with NuPhysicia last year. “We’ve seen the benefit, ” says Kurt Hanson, general counsel at Mustang, a family-owned company. Instead of taking a half-day or more off to consult a doctor, workers can get medical advice on the company’s premises.

NuPhysicia’s business grew out of work that its founders did for the state of Texas. Mr. Hammack, NuPhysicia’s president, is a former assistant vice president of the University of Texas Medical Branch at Galveston, where he led development of the state’s pioneering telemedicine program in state prisons from the mid-1990s to 2007. Dr. Davis is a cardiologist.

Working with Dr. Boultinghouse, Dr. Davis and other university doctors conducted more than 600,000 video visits with inmates. Significant improvement was seen in inmates’ health, including measures of blood pressure and cholesterol, according to a 2004 report on the system in the Journal of the American Medical Association.

In March, California officials released a report they had ordered from NuPhysicia with a plan for making over their state’s prison health care. The makeover would build on the Texas example by expanding existing telemedicine and electronic medical record systems and putting the University of California in charge.

California spends more than $40 a day per inmate for health care, including expenses for guards who accompany them on visits to outside doctors. NuPhysicia says that this cost is more than four times the rate in Texas and Georgia, and almost triple that of New Jersey, where telemedicine is used for mental health care and some medical specialties.

“Telemedicine makes total sense in prisons,” says Christopher Kosseff, a senior vice president and head of correctional health care at the University of Medicine and Dentistry of New Jersey. “It’s a wonderful way of providing ready access to specialty health care while maintaining public safety.”

Georgia state prisons save an average of $500 in transportation costs and officers’ pay each time a prisoner can be treated by telemedicine, says Dr. Edward Bailey, medical director of Georgia correctional health care.

With data supplied by the California Department of Corrections and Rehabilitation, which commissioned the report, NuPhysicia says the recommendations could save the state $1.2 billion a year in prisoners’ health care costs.

Gov. Arnold Schwarzenegger wants the university regents and the State Legislature to approve the prison health makeover. After lawsuits on behalf of inmates, federal courts appointed a receiver in 2006 to run prison medical services. (The state now runs dental and mental health services, with court monitoring.) Officials hope that by putting university doctors in charge of prison health, they can persuade the courts to return control to the state.

“We’re going to use the best technology in the world to solve one of our worst problems — the key is telemedicine,” the governor said.

WITHOUT the blessing of insurers, telemedicine could never gain traction in the broader population. But many of the nation’s biggest insurers are showing growing interest in reimbursing doctors for face-to-face video consulting.

Starting in June, the UnitedHealth Group plans to reimburse doctors at Centura Health, a Colorado hospital system, for using Cisco advanced video to serve UnitedHealth’s members at several clinics. And the insurer plans a national rollout of telemedicine programs, including video-equipped booths in retail clinics in pharmacies and big-box stores, as well as in clinics at large companies.

“The tide is turning on reimbursement,” says Dr. James Woodburn, vice president and medical director for telehealth at UnitedHealth.

Both UnitedHealth and WellPoint, which owns 14 Blue Cross plans, are trying lower-cost Internet Webcam technology, available on many off-the-shelf laptops, as well as advanced video.

UnitedHealth and Blue Cross plans in Hawaii, Minnesota and western New York are using a Webcam service provided by American Well, a company based in Boston. And large self-insured employers like Delta Air Lines and Medtronic, a Blue Cross Blue Shield customer in Minneapolis, are beginning to sign up.

Delta will offer Webcam consultations with UnitedHealth’s doctor network to more than 10,000 Minnesota plan members on July 1, says Lynn Zonakis, Delta’s managing director of health strategy and resources. Within 18 months, Webcam access will be offered nationally to more than 100,000 Delta plan members.

Dr. Roy Schoenberg, C.E.O. of American Well, says his Webcam service is “in a completely different domain” than Cisco’s or Polycom’s. “Over the last two years, we are beginning to see a side branch of telemedicine that some call online care,” he says. “It connects doctors with patients at home or in their workplace.”

Doctors “are not going to pay hundreds of thousands of dollars for equipment, so we have to rely on lower tech,” he adds. The medical records are stored on secure Web servers behind multiple firewalls, and the servers are audited twice a year by I.B.M. and other outside computer security companies, Dr. Schoenberg says.

In Hawaii, more than 2,000 Blue Cross plan members used Webcams to consult doctors last year, says Laura Lott, a spokeswoman for the Hawaii Medical Service Association. Minnesota Blue Cross and Blue Shield started a similar Webcam service across the state last November.

Doctors who use the higher-tech video conferencing technology say that Webcam images are less clear, and that Webcams cannot accommodate electronic scopes or provide the zoom-in features available in video conferencing. “If they are not using commercial-grade video conferencing gear, the quality will be much lower,” says Vanessa L. McLaughlin, a telemedicine consultant in Vancouver, Wash.

Last month, Charlie Martin, the crane operator, was back in the infirmary of the Courageous for an eye checkup. In Houston, his face filled the big screen in NuPhysicia’s office.

After an exchange of greetings, Chris Derrick, the paramedic on the oil rig, attached an ophthalmological scanner to a scope, pointed it at Mr. Martin’s eye, and zoomed in.

“Freeze that,” Dr. Boultinghouse ordered, as a close-up of the eye loomed on the screen. “His eyes have been bothering him. It may be from the wind up there on the crane.”

When Patients Meet Online, Are There Side Effects?

Brian Stauffer

By NATASHA SINGER

COULD we cure diseases faster, or at least better control them, through crowd-sourcing?

That is the premise behind social networking sites like CureTogether.com and PatientsLikeMe.com, which offer online communities for patients and collect members’ health data for research purposes.

PatientsLikeMe provides forums where more than 65,000 members with epilepsy, multiple sclerosis and more than a dozen other disorders are encouraged to share details about their conditions and the success or pitfalls of specific drug treatments.

“When patients share real-world data, collaboration on a global scale becomes possible,” the site says. “New treatments become possible.”

Moreover, in a world where serious side effects often emerge only years after a new medication enters the market, such real-time information from real-world patients may also provide an early warning signal for drug safety problems.

PatientsLikeMe has an innovative for-profit business model, too. It sells health data, gathered from member profiles but with certain identifying information removed, to drug makers and others for scientific and marketing research.

Jamie Heywood, the company’s chairman, says both patients and drug makers delve into that data to meet their own needs.

Members can seek out patients of the same age, sex, and disease progression, whose profiles are displayed on the site, to see which drugs or doses worked for them. Drug makers can pinpoint subgroups — say, severely depressed middle-aged men — who reported the greatest improvement on a particular medication.

“What we have done is made a system that allows you to think about personalized medicine,” says Mr. Heywood. He co-founded the site in 2004 with his brother Ben and a friend after another brother, Stephen Heywood, developed amyotrophic lateral sclerosis, or A.L.S., commonly known as Lou Gehrig’s disease. (Stephen died in 2006.)

But pharmaceutical crowd-sourcing also raises important questions about the trade-off between the benefits of information sharing and the risk of patient exploitation.

Some people share their health information for the sake of the greater good. Yet they typically have no way of knowing whether their health profiles contribute directly to the development of more effective treatments — or are simply mined to create more effective drug marketing.

“Do we need to protect people who have illnesses from being exploited?” says Cathy Dwyer, an associate professor at Pace University who has studied how advertisers market to consumers based on their online behavior. “It’s a very tricky line because people absolutely need emotional support when they are dealing with illness.”

PatientsLikeMe is one of many sites that promote the idea of the “e-patient,” a health consumer empowered by online information gathering. Along with offering health resources, many of these sites are also engineered to foster an environment where patients effectively promote treatments to other patients, without a doctor as intermediary.

The lines become blurry in these new arenas. There are unbranded “disease awareness” communities — for example, on Facebook or YouTube — where a drug maker may pay people to moderate patient forums or give testimonials but might not prominently display that fact to participants. Other sites collect consumer health data to help drug makers aim at specific kinds of consumers, using psychological cues.

Unlike television viewers, who can immediately spot direct-to-consumer drug ads, consumers on some health sites may not fully understand that they could be subject to marketing or marketing research, even if they have read the site’s privacy policy.

“We are talking about a digital pharma stealth economy that is emerging,” says Jeff Chester, the director of the Center for Digital Democracy, a nonprofit group that works to safeguard user privacy. “You don’t know who is being paid to moderate. You don’t know who’s listening in to your conversation. You don’t know what exactly they are focused on and what they are doing with the information.”

The Health Insurance Portability and Accountability Act of 1996 restricts the way health care providers use and disseminate patients’ information, but entities like consumer health Web sites are not subject to it. The Food and Drug Administration, meanwhile, which strictly regulates direct-to-consumer drug commercials and print ads, is still developing a policy on drug marketing through social media.

In many ways, PatientsLikeMe is open and clear about its data collection and how it makes its money.

The site’s privacy policy explains that it shares members’ data, shorn of certain personal identifiers, with drug makers and others. Even as the policy encourages people to share their health information so others can learn from their experiences, it advises members that the more personal details they disclose, the more they risk being publicly identified.

For corporate clients, the site also functions as a sophisticated data-mining tool that allows them to better pinpoint consumers and to develop new or improved drugs. PatientsLikeMe adopts a more bottom-line approach to companies than it does when advocating its greater-good policy to consumers.

“Yesterday, you couldn’t engage with patients because of regulatory conflicts and lack of patient access,” one corporate pitch says on the site. “Today, all that has changed. It’s time to interact directly with your new customers: patients.”

Among the services the site provides to its corporate clients is analysis of members’ conversations, broken down by age, sex, disease progression and treatments, to “learn not only what’s being said about your brand, but by whom.” Another service allows drug makers to conduct market research on 25 to 50 of the most active users on the site — typically those who post messages often and have emerged as opinion leaders — who consent to participate. Afterward, drug makers can refine their marketing efforts based on the effect of the program “on patient dialogues across the entire community,” the site says.

Ms. Dwyer of Pace says she has been “really, really shocked at the blatant manipulative language” that some sites use to describe their corporate services to industry versus how they describe themselves to consumers.

Ben Heywood, president of PatientsLikeMe, says the program for drug makers that focuses on the site’s most active users is not meant to promote specific messages. After participating in the program, he says, members do not disseminate industry ideas on the site. Some members, he says, simply want to share their opinions with drug makers, but they aren’t paid to do so.

Jamie Heywood says that such data analyses provide insight for drug makers on how best to reach patients, but the site itself does not market drugs to its members. Moreover, the Heywood brothers say, the site openly describes its industry services.

“Our objective is to teach the company,” he says, “not teach the patient about the company’s products.”

Still, some of PatientsLikeMe’s competitors have taken a less aggressive approach to how they market patient data.

CureTogether.com, for example, has occasionally earned money by e-mailing advertisements aimed at its members who have certain health conditions on behalf of drug makers seeking participants for clinical trials, says Daniel Reda, who co-founded the site with his wife, Alexandra Carmichael.

But CureTogether does not post a person’s profile for other members on the site to see or give drug makers access to members’ health data in any form, he says. “The best way to protect people,” Mr. Reda says, “is to collect as little information as possible.”

How Computers Know What We Want Before We Do

Image by Drew Olanoff via Flickr

Photo-Illustration by C.J. Burton for TIME

By Lev Grossman

Here's an experiment: try thinking of a song not as a song but as a collection of distinct musical attributes. Maybe the song has political lyrics. That would be an attribute. Maybe it has a police siren in it, or a prominent banjo part, or paired vocal harmony, or punk roots. Any one of those would be an attribute. A song can have as many as 400 attributes — those are just a few of the ones filed under p.

This curious idea originated with Tim Westergren, one of the founders of an Internet radio service based in Oakland, Calif., called Pandora. Every time a new song comes out, someone on Pandora's staff — a specially trained musician or musicologist — goes through a list of possible attributes and assigns the song a numerical rating for each one. Analyzing a song takes about 20 minutes.

The people at Pandora — no relation to the alien planet — analyze 10,000 songs a month. They've been doing it for 10 years now, and so far they've amassed a database containing detailed profiles of 740,000 different songs. Westergren calls this database the Music Genome Project. (See the world's most influential people in the 2010 TIME 100.)

There is a point to all this, apart from settling bar bets about which song has the most prominent banjo part ever. The purpose of the Music Genome Project is to make predictions about what kind of music you're going to like next. Pandora uses the Music Genome Project to power what's known in the business as a recommendation engine: one of those pieces of software that gives you advice about what you might enjoy listening to or watching or reading next, based on what you just listened to or watched or read. Tell Pandora you like Spoon and it'll play you Modest Mouse. Tell it you like Cajun accordion virtuoso Alphonse "Bois Sec" Ardoin and it'll try you out on some Iry LeJeune. Enough people like telling Pandora what they like that the service adds 2.5 million new users a month. (See the 100 best albums of all time.)

Over the past decade, recommendation engines have become quietly ubiquitous. At the appropriate moment — generally when you're about to consummate a retail purchase — they appear at your shoulder, whispering suggestively in your ear. Amazon was the pioneer of automated recommendations, but Netflix, Apple, YouTube and TiVo have them too. In the music space alone, Pandora has dozens of competitors. A good recommendation engine is worth a lot of money. According to a report by industry analyst Forrester, one-third of customers who notice recommendations on an e-commerce site wind up buying something based on them. (Watch TIME's video "The Brains Behind Pandora Radio.")

The trouble with recommendation engines is that they're really hard to build. They look simple on the outside — if you liked X, you'll love Y! — but they're actually doing something fiendishly complex. They're processing astounding quantities of data and doing so with seriously high-level math. That's because they're attempting to second-guess a mysterious, perverse and profoundly human form of behavior: the personal response to a work of art. They're trying to reverse-engineer the soul.

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They're also changing the way our culture works. We used to learn about new works of art from friends and critics and video-store clerks — from people, in other words. Now we learn about them from software. There's a new class of tastemakers, and they're not human.

Learning to Love Dolph Lundgren
Pandora makes recommendations the same way people do, more or less: by knowing something about the music it's recommending and something about your musical taste. But that's actually pretty unusual. It's a very labor-intensive approach. Most recommendation engines work backward instead, using information that comes not from the art but from its audience. (See the 50 best websites of 2009.)

It's a technique called collaborative filtering, and it works on the principle that the behavior of a lot of people can be used to make educated guesses about the behavior of a single individual. Here's the idea: if, statistically speaking, most people who liked the first Sex and the City movie also like Mamma Mia!, then if we know that a particular individual liked Sex and the City, we can make an educated guess that that individual will also like Mamma Mia!

It sounds simple enough, but the closer you look, the weirder and more complicated it gets. Take Netflix's recommendation engine, which it has dubbed Cinematch. The algorithmic guts of a recommendation engine are usually a fiercely guarded trade secret, but in 2006 Netflix decided it wasn't completely happy with Cinematch, and it took an unusual approach to solving the problem. The company made public a portion of its database of movie ratings — around 100 million of them — and offered a prize of $1 million to anybody who could improve its engine by 10%.

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The Netflix competition opened a window onto a world that's usually locked away deep in the bowels of corporate R&D departments. The eventual winner — which clinched the prize last fall — was a seven-man, four-country consortium called BellKor's Pragmatic Chaos, which included Bob Bell and Chris Volinsky, two members of AT&T's research division. Talking to them, you start to see how difficult it is to make a piece of software understand the vagaries of human taste. You also see how, oddly, software understands things about our taste in movies that a human video clerk never could.

The key point to grasp about collaborative-filtering software is that it knows absolutely nothing about movies. It has no preconceptions; it works entirely on the basis of the audience's reaction. So if a large enough group of people claim to have enjoyed, say, both Saw V and On Golden Pond, the software would be forced to infer that those two movies share some common quality that the viewers enjoyed. Crazy? Or crazy genius? (See the 100 best movies of all time.)

In such a case, the software would have discovered an aesthetic property that we might not even be aware of or have a name for but which in a mathematical sense must be said to exist. Even Bell and Volinsky don't always know what the properties are. "We might be able to describe them, or we might not be able to," Bell says. "They might be subtleties like 'action movies that don't have a lot of blood, don't have a lot of profanity but have a strong female lead.' Things like that, which you would never think to categorize on your own." As Volinsky puts it, "A lot of times, we don't come up with explanations that are explainable."

That makes recommendation engines sound practically psychic, but everyday experience tells us that they're actually pretty fallible. Everybody has felt the outrage that comes when a recommendation engine accuses one of a secret desire to watch Rocky IV, the one with Dolph Lundgren in it. In 2006, Walmart was charged with racism when its recommendation engine paired Planet of the Apes with a documentary about Martin Luther King. But generally speaking, the weak link in a recommendation engine isn't the software; it's us. Collaborative filtering works only as well as the data it has available, and humans produce noisy, low-quality data.

The problem is consistency: we're just not good at expressing our desires in rating form. We rate things differently after a bad day at work than we would if we were on vacation. Some people are naturally stingy with their stars; others are generous. We rate movies differently depending on whether we rate them right after watching them or if we wait a week, and differently again depending on whether we saw a lousy movie or a good movie in that intervening week. We even rate differently depending on whether we rate a whole batch of movies together or one at a time. (See the 50 best inventions of 2009.)

All this means that there's a ceiling to how accurate collaborative filtering can get. "There's a lot of randomness involved," Volinsky admits. "There's some intrinsic level of error associated with trying to predict human behavior."

The Great Choice Epidemic
Recommendation engines are a response to the strange new world of online retail. It's a world characterized by a surplus of something we usually can't get enough of: choice.

We're drowning in it. As Sheena Iyengar points out in her book The Art of Choosing, in 1994 there were 500,000 different consumer goods for sale in the U.S. Now Amazon alone offers 24 million. When faced with such an oversupply of choice, our little lizard brains go straight to vapor lock. "We think the profusion of possibilities must make it that much easier to find that perfect gift for a friend's birthday," Iyengar writes, "only to find ourselves paralyzed in the face of row upon row of potential presents." We're living through an epidemic of choice. We require an informational prosthesis to navigate it. The recommendation engine is that prosthesis: it winnows the millions of options down to a manageable handful.

But there's a trade-off involved. Recommendation engines introduce a new voice into the cultural conversation, one that speaks to us when we're at our most vulnerable, which is to say at the point of purchase. What is that voice saying? Recommendation engines aren't designed to give us what we want. They're designed to give us what they think we want, based on what we and other people like us have wanted in the past.

Which means they don't surprise us. They don't take us out of our comfort zone. A recommendation engine isn't the spouse who drags you to an art film you wouldn't have been caught dead at but then unexpectedly love. It won't force you to read the 18th century canon. It's no substitute for stumbling onto a great CD just because it has cool cover art. Recommendation engines are the enemy of serendipity and Great Books and the avant-garde. A 19th century recommendation engine would never have said, If you liked Monet, you'll love Van Gogh! Impressionism would have lasted forever.

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The risk you run with recommendation engines is that they'll keep you in a rut. They do that because ruts are comfy places — though often they're deeper than they look. "By definition, we keep you in the same musical neighborhood you start in," says Westergren of the Music Genome Project, "so you could say that's limiting. But even within a neighborhood, there is a ton of room for discovery. Forty-five percent of the people who use Pandora buy more music after they start, and only 1% buy less." And not being based solely on data from its audience, Pandora isn't as vulnerable to peer pressure as most recommendation engines are. It doesn't follow the crowd.

Pandora is unusual, though. The general effect of recommendation engines on shopping behavior is a hot topic among econometricians, if that's not an oxymoron, but the consensus is this: they introduce us to new things, which is good, but those new things tend to be a lot like the old things, and they tend to be drawn from the shallow pool of things other people have already liked. As a result, they create a blockbuster culture in which the same few runaway hits get recommended over and over again. It's the backlash against the "long tail," the idea that shopping online is all about near infinite selection and cultural diversity. It has a bad habit of eating its own tail and leaving you back where you started. (See the latest geek culture stories at Techland.com.)

But this isn't just about retail. The Web has transformed how we shop. Now it's transforming our social lives too, and recommendation engines are coming along for the ride. Just as Netflix reverse-engineers our response to art, dating sites like Match.com and eHarmony and OKCupid use algorithms to make predictions about that equally ineffable human phenomenon, love; or, failing that, lust. The idea is the same: they break down human behavior into data, then look for patterns in the data that they can use to pair up the humans.

Even if you're not into online dating, you're probably on Facebook, currently the second most visited site on the Web. Facebook gives users the option of switching between a straight feed, which shows all their friends' news in chronological order, and an algorithmically curated selection of the updates Facebook's recommendation engine thinks they'd most like to see. And in the right-hand column, Facebook uses a different set of algorithms to recommend new friends. If you loved Jason, why not try Jordan?! (See pictures of Facebook headquarters.)

And as for the first most trafficked site on the Web, if you cock your head only slightly to one side, Google is, effectively, a massive recommendation engine, advising us on what we should read and watch and ultimately know. It used to return the same generic results to everyone, but in December it put a service called Personalized Search into wide release. Personalized Search studies the previous 180 days of your searching behavior and skews its results accordingly, based on its best guess as to what you're looking for and how you look for it.

The principle is almost endlessly generalizable. Anywhere the specter of unconstrained choice confronts us, we're meeting it by outsourcing elements of the selection process to software. Largely unconsciously, we radiate information about ourselves and our personal preferences all day long, and more and more recommendation engines of all shapes and sizes are hoovering up that data and feeding it back to us, reshaping our reality into a form that they fondly hope will be more to our liking — in an endless feedback loop. The effect is to create a customized world for each of us, one that is ever so slightly childproofed, the sharp edges sanded off, and ever so slightly stifling, like recirculated air. (See 25 websites you can't live without.)

How far will it go? Will we eventually surf a Web that displays only blogs that conform to our political leanings? A social network in which we see only people of our race and religion? Our horizons, cultural and social, would narrow to a cozy, contented, claustrophobic little dot of total personalization.

Let's hope not. People weren't built to play it safe all the time. We were meant to be bored and disappointed and offended once in a while. It's good for us. That's what forces us to evolve. Even if it means watching Rocky IV, with Dolph Lundgren. Who knows? You might even like it.

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May 29, 2010

South Korea Expands Aid for Internet Addiction

Park Jin-Hee for the International Herald Tribune

Teenagers at online game parlor in Gwangmyeong, Seoul.

By CHOE SANG-HUN

SUWON, South Korea — Neither had a job. They were shy and had never dated anyone until they met through an online chat site in 2008. They married, but they knew so little about childbearing that the 25-year-old woman did not know when her baby was due until her water broke.

But in the fantasy world of Internet gaming, they were masters of all they encountered, swashbuckling adventurers exploring mythical lands and slaying monsters. Every evening, the couple, Kim Yun-jeong and her husband, Kim Jae-beom, 41, left their one-room apartment for an all-night Internet cafe where they role-played, often until dawn. Each one raised a virtual daughter, who followed them everywhere, and was fed, dressed and cuddled — all with a few clicks of the mouse.

On the morning of Sept. 24 last year, they returned home after a 12-hour game session to find their actual daughter, a 3-month-old named Sa-rang — love in Korean — dead, shriveled with malnutrition.

In South Korea, one of the world’s most wired societies, addiction to online games has long been treated as a teenage affliction. But the Kims’ case has drawn attention to the growing problem here of Internet game addiction among adults.

Sa-rang, born prematurely and sickly, was fed milk two or three times a day — before and after her parents’ overnight gaming and sometimes when her father woke up during the day, prosecutors said. The baby died “eyes open and her ribs showing,” said the couple’s lawyer, Kim Dong-young.

After six months on the run, they were arrested in March and charged with negligent homicide. On Friday they were sentenced to two years in prison, but the judge suspended Ms. Kim’s sentence because she was seven months pregnant and he said she needed some “mental stability.”

“I am sorry for being such a bad mother to my baby,” Ms. Kim said, sobbing, during the couple’s trial.

Thanks partly to government counseling programs, the estimated number of teenagers with symptoms of Internet addiction has steadily declined, to 938,000 in 2009, from more than a million in 2007, the Ministry of Public Administration and Safety said in April.

But the number of addicts in their 20s and 30s has been increasing, to 975,000 last year. Many of these adult addicts grew up with online games and now resort to them when they are unemployed or feeling alienated from society, said Dr. Ha Jee-hyun, a psychiatrist at Konkuk University Hospital.

This development and a recent string of cases like that of the Kims have prompted the government to announce plans to open rehabilitation centers for adult addicts and expand counseling for students and the unemployed, groups considered the most vulnerable to compulsive gaming.

“Unlike teenagers, these grown-ups don’t have parents who can drag them to counselors,” Dr. Ha said. He treats an average of four adults a month for an addiction to online games, he said. Two years ago, it was one a month.

More than 90 percent of South Korean homes are fitted with high-speed Internet connections. Nearly every street corner has a computer parlor with computers available for a fee. In these dim, 24-hour-a-day establishments, “the line blurs between reality and the virtual world,” said Jung Young-chul, a psychiatrist at Yonsei University.

Especially popular among adult players are large multiplayer online role-playing games.

In these games, players form alliances and wage battles that can last for days, with players operating in shifts to keep the action. The more time a player spends online, the more powerful the game character — and the player’s online status — becomes.

Cyberbattles can spill into the real world. There have been several reports of players tracking down and attacking others for killing the online characters they had identified with for years.

If the games are addictive, they are also highly commercial. “Items” — cyberweapons, outfits and special abilities acquired through gaming that strengthen their owners’ combat prowess — are traded for real money online. Such trades were valued at more than $1.2 billion last year.

Park Ki-hoon and his wife, Choi Jin-hee, both 37, run a swimsuit shop by day and play online games at night. During the winter off-season, Mr. Park said, he has played up to 18 hours a day and won up to $2,400 a month, enough to cover the rent on the couple’s shop.

If Mr. Park knows how to juggle his offline and online lives, many do not.

In February, a 22-year-old man was arrested and accused of killing his mother for nagging him about his obsessive playing. In the same month, a 32-year-old man dropped dead of exhaustion in a computer parlor after playing through the five-day Lunar New Year holiday. “Some jobless men come here in hope of a financial breakthrough,” said Hong Seong-in, the owner of a computer parlor.

South Korea promotes online games, with exports growing by 50 percent, according to the government, to $1.5 billion last year — by far South Korea’s single largest cultural export item. Its games are hugely popular in China and other Asian countries.

Although the country has become one of the first to address Internet addiction, little help is available for adults.

Computer parlor owners and game buffs assert that compulsive playing has actually been decreasing as the prices of items fall.

Enterprising players in South Korea and China have been running “item factories,” where hundreds of computers are programmed to play the games without human users for the sole purpose of generating items for cash.

“Online games are a culture,” Mr. Park said. “To me, people who hike or fish are as crazy as they think I am.”