November 25, 2009

Re emotional epidemics. The vulcan scientists have poorly estimated the emotional vicissitudes of fear w novel disease

Published at www.nejm.org November 25, 2009 (10.1056/NEJMp0911047)

The Emotional Epidemiology of H1N1 Influenza Vaccination

Danielle Ofri, M.D., Ph.D.


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Last spring, when 2009 H1N1 influenza first came to our attention,my patients were in a panic. Our clinic was flooded with callsand walk-in patients, all with the same question: "When willthere be a vaccine?"

It was all so new then, and we didn't have an answer. That lackof answer seemed to fuel anxiety to a fever pitch. A substantialcohort of my patients continued calling, almost on a weeklybasis, to ask about the vaccine.

These, of course, were the same patients who routinely refusedthe seasonal flu vaccine. Each year we'd go through the samedrill: I'd offer them the flu shot. I'd explain the clinicalreasoning behind this recommendation. I'd strongly encouragevaccination.

"No, thanks," they'd say. "The vaccine makes me sick." Or "Mybrother had a bad reaction." Or, simply, "I don't do flu shots."

The irony was painful. No matter how often I trotted out thestatistics of 30,000 to 40,000 annual deaths from influenza,the patients would not be moved. So when they demanded the H1N1vaccine last spring, I reminded them of their reluctance overthe seasonal flu shot. "Oh, that's different," they said.

Six months have passed. Flu season is now here. After repeateddelays, H1N1 vaccine finally arrived in our clinic earlier thismonth to the uniform relief of the medical staff. But my formerlydesperate patients were now leery. "It's not tested," they said."Everyone knows there are problems with the vaccine." "I'm notputting that in my body."

I was unprepared for this response, but maybe I shouldn't havebeen. For weeks now, in the schoolyard of my children's elementaryschool, other parents had been sidling up to me, seemingly inneed of validation. "You're not giving your kids that swineflu shot, are you?" they'd say, their tone nervous, if a bitderisive.

How to explain this dramatic shift in 6 short months? It certainlyisn't related to logic or facts, since few new medical databecame available during this period. It seems to reflect a sortof psychological contagion of myth and suspicion.

Just as there are patterns of infection, there seem to be patternsof emotional reaction ("emotional epidemiology") associatedwith new illnesses. When 2009 H1N1 influenza was first detected,it fit a classic pattern that Priscilla Wald recently outlinedin her bookContagious¹: It was novel and mysterious; it emergedfrom a teeming third-world city, and it was now making its insidious— and seemingly unstoppable — way toward the "civilized"world.

This is the story line for most headline-grabbing illnesses— HIV, Ebola virus, SARS, typhoid. These diseases captureour imagination and ignite our fears in ways that more prosaicillnesses do not. These dramatic stakes lend themselves quitenaturally to thriller books and movies; Dustin Hoffman hasn'tstarred in any blockbusters about emphysema or dysentery.

When the inoculum of dramatic illness is first introduced intosociety, the public psyche rapidly becomes infected. Almostlike an IgE-mediated histamine release, there is an immediateflooding of fear, even if the illness — like Ebola —is infinitely less likely to cause death than, say, a run-inwith the Second Avenue bus. This immediate fear of the unknownwas what had all my patients demanding the as-yet-unproducedH1N1 vaccine last spring.

As the novel disease establishes itself within society, a certainamount of emotional tolerance is created. H1N1 infection waxedand waned over the summer, and my patients grew less anxious.There was, of course, no medical basis for this decreased vigilance.Unusual risk groups and atypical seasonality should, in fact,have raised concern. By late summer, the perceived mysteriousnessof H1N1 had receded, and the number of messages on my clinicphone followed suit.

But emotional epidemiology does not remain static. As autumnrolled around, I sensed a peeved expectation from my patientsthat this swine flu problem should have been solved already.The fact that it wasn't "solved," that the medical professionseemed somehow to be dithering, created an uneasy void. Notknowing whether to succumb to panic or to indifference, patientsinstead grew suspicious.

No amount of rational explanation — about the naturalvariety of influenza strains, about the simple issue of outbreaktiming that necessitated a separate H1N1 vaccine — couldallay this wariness.

Similarly, reassuring fellow parents that I was indeed vaccinatingmy own children did little to ease their apprehension. Whenthe New York City public school system offered free vaccinationsfor both students and families, there was an abysmally poorturnout. Less than one quarter of the consent forms sent homein kids' backpacks were returned.

The dramatic shift in public sentiment over the course of thisH1N1 epidemic is both fascinating and frustrating. It is clearthat there is a distinct emotional epidemiology and that itbears only a faint connection to the actual disease epidemiologyof the virus.

We cannot combat H1N1 influenza merely by ensuring adequatesupplies of vaccine and oseltamivir. Unless the medical professionconfronts the emotional epidemiology of H1N1 with a full-courtpress, we run the risk of an uncontrollable epidemic.

There is no doubt that we are far behind the curve in termsof public relations. Our science has not been dithering at all,but our articulation of that science has often seemed that way,from the unfortunate initial appellation of swine flu to ourinability to clarify distinctions between vaccine-productionissues and clinical-risk issues. Suspicion has its own contagion,and we have not been aggressive enough in countering it.

Every practicing clinician is, to some degree, an armchair epidemiologist.We register patterns of disease as they play out among our patients.We are also keen detectives of emotional epidemiology, thoughwe often aren't aware of this as such. Keeping tabs on the emotionalepidemiology as well as the disease epidemiology, and treatingboth with equal urgency, are the essential clinical tools forthis influenza season.

Financial and other disclosures provided by the author are availablewith the full text of this article at NEJM.org.

Source Information

From New York University School of Medicine and Bellevue Hospital, New York.

This article (10.1056/NEJMp0911047) was published on November 25, 2009, at NEJM.org.

References

Wald P. Contagious: cultures, carriers, and the outbreak narrative. Durham, NC: Duke University Press, 2008.


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November 19, 2009

on identity fraud

Building an Online Bulwark to Fend Off Identity Fraud

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By RIVA RICHMOND

Published: November 18, 2009

A clotheshorse racked up thousands of dollars in mystery charges on a friend’s credit card. Phantoms emptied your uncle’s bank account. Someone took out a car loan in your colleague’s name and stuck her with the bill.

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SafeCentral verifies the authenticity of sites it visits, and offers a stripped-down, secure browser to use when banking or shopping online.

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Shop Shield, from Kemesa, creates a “digital fortress” to keep personal data safe from online attackers.

Identity fraud has been on the rise, as criminal cunning may be mixing with desperation during the downturn. Schemes seem to multiply daily, as scammers often half a world away dream up new ways to steal data to enrich themselves. According toJavelin Strategy and Research, 9.9 million Americans were victims of identity theft in 2008, up from 8.1 million in 2007.

With all kinds of private information residing in all kinds of places, vigilance can be difficult. Using caution when surfing the Internet and keeping antivirus software up to date are vital steps, experts say, but they are not enough. And most tools for fighting identity fraud — credit-monitoring services, fraud alerts and credit freezes — are reactive, not proactive, and they primarily address abuse of financial accounts, not other types of identity fraud.

But a new breed of products is tackling the trickier matter of preventing identity theft. New approaches include scouring the Internet in search of signs that criminals have your information, so you can move to block them. Others focus on keeping your data away from criminals in the first place, locking it down while you bank, shop or do other personal tasks online. Here are some ways to keep your information yours.

ASSESSING RISK The Internet is awash in personal data, which means yours may never be found. Several services look for signs of sticky fingers, to know when data reaches the hands of criminals so people can act quickly.

With the help of partners like the United States Postal Service, Discover Card and companies that perform background checks, LifeLock monitors change-of-address filings and applications for credit cards and jobs made in the names of its customers, so it can alert them. TrustedID, a LifeLock competitor, recently introduced a service that analyzes both public and proprietary data to assess a person’s risk of identity theft — for example, the risk would increase if a person’s Social Security number was found to be associated with a different address — and recommends actions to lower your risk score.

LifeLock and CardCops, among others, scour the Internet and hacker chat rooms and warn customers if their data is spotted. LifeLock, for one, also tries to infiltrate hacker communities.

Perhaps the most interesting new arrival in this space is StolenIDsearch.com, a site operated by TrustedID, which uses a database created by Colin Holder, a 30-year veteran of Scotland Yard, that contains stolen records gathered from longtime, trusted informants.

The database holds about 138 million records tied to an estimated 54 million people, about 98 percent of whom live in the United States, and searching it is free. “It shows you who the bad guys are looking for: the rich Americans,” said Scott Mitic, TrustedID’s chief.

If any personal information — e-mail address and password, credit card number, Social Security number, bank account login details — is there, the site will describe, generically, what it has. It costs $15 to see the records, which Mr. Holder says covers administrative costs and helps ensure that only people entitled to the information receive it. (He also provides the data to banks and law enforcement agencies.)

SIDESTEPPING MALWARE Other products focus on outmaneuvering malicious programs that infiltrate PCs. Such malware has mushroomed recently, and antivirus companies have struggled to catch every new attack.SafeCentral ($40 for up to three computers; Windows only), a product from the security software company Authentium, protects users even if there’s malware on the computer. It includes a stripped-down and secure browser to use when banking, trading stocks, viewing health information or shopping online.

When a user visits such a site, SafeCentral asks if the user wants to proceed securely. If the answer is yes, a background resembling armor plating appears. In this safe room of sorts, certain Windows features regularly abused by attackers have been disabled.

Computer programming interfaces known as A.P.I.’s, which game makers can use to turn keyboards into controllers, for example, are turned off because “keylogger” programs use them to capture information. SafeCentral also turns screenshots of Web pages blank to defeat these programs. Also off are A.P.I.’s that programmers use for browser plug-ins. This stops malicious plug-ins that monitor encrypted Web sessions — the ones where the URL changes from “http” to “https” — in case credit card numbers are transmitted.

And because so-called phishing scams use fake Web sites to collect username and password information, SafeCentral takes an extra step to verify the authenticity of the sites it visits.

GIVE OUT NOTHING Another alternative is to avoid sharing information online in the first place. Kemesa, a software company, has created a shopping-safety product called Shop Shield that starts with a familiar browser-based tool for managing passwords and auto-filling Web forms — which helps defend against keyloggers (which can record every keystroke made on a keyboard). In addition, Shop Shield users can give online merchants anonymous personal data, like single-use credit card numbers and specialized e-mail addresses.

Of course, you have to trust Kemesa with your personal information. “They become a target. They’re very tempting now,” Mr. Vamosi of Javelin said.

Kemesa says it has created a “digital fortress.” To start, the product (which uses an add-on for the Internet Explorer and Firefox browsers and a Web site), puts an encrypted token on the computer, which makes it extremely difficult for a remote attacker to gain access to personal records. This also means the user must authorize each computer to run the program.

At Kemesa, customer information is not just encrypted, it’s broken up into tiny pieces that are then stored in different databases on different networks, making reassembly by an attacker grueling. It also monitors for intrusions, regularly tests its defenses, keeps its physical location in lockdown and otherwise sticks to Defense Department security standards.

Shop Shield offers three pricing plans: a scaled-back service that’s free if payments to merchants are tied to a checking account; one that charges $2 each time you use a credit card and small fees for other features; and an unlimited, full-service plan for $10 a month or $99 a year. Kemesa also profits from interchange fees that credit card companies collect on purchases.

Shop Shield is “a phenomenal concept,” said Jay Foley, co-founder of theIdentity Theft Resource Center, a nonprofit consumer advocacy group. He brought up the case of theft involving a DSW Shoe Warehouse database in 2005, in which hackers obtained 1.4 million credit card numbers and the names on those accounts. “Imagine if with DSW, all the data that they had was from Shop Shield: one-time-use credit card numbers, no home addresses, no phone numbers.”

The chief executive of Kemesa, Steve Bachenheimer, would agree. “Thieves can’t steal what isn’t there,” he said.

--
John C Kim MD

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November 19, 2009

tough love, and urban legends zjoy

Tough Love vs. Spanking - Good Argument

Most people think it's improper to spank children, so I have tried other methods to control my kids when they have one of 'those moments.'

One that I found effective is for me to just take the child for a car ride and talk.

Some say it's the vibration from the car, others say it's the time away from any distractions such as TV, Video Games, Computer, IPod , etc.

Either way, my kids usually calm down and stop misbehaving after our car ride together. Eye to eye contact helps a lot too.

I've included a photo below of one of my sessions with my son, in case you would like to use the technique.

This works with grandchildren,
nieces, and nephews as well.

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November 18, 2009

on how to handle kids anxiety; under 5, tell the evil monster is really a goofy.

Ghosts, monsters, dragons: What to tell kids

By Elizabeth Landau, CNN

November 14, 2009 7:16 a.m. EST

Melinda Roberts has come up with strategies to assuage the fears of her kids Logan, 11, Dylan, 9, and Daphne, 7.

STORY HIGHLIGHTS

Study suggests preschoolers want to be told the monster under the bed is nice
Others say it's always better to tell them "it's not real"
Thinking about the process of making a film can help children cope with scary images
It's OK for parents to turn off the television if the program or movie is too scary

RELATED TOPICS

(CNN) -- When Melinda Roberts is watching animated movies with her kids -- 7, 9, and 11 -- she'll help them recognize voice actors and talk about the creation process so they won't get scared.

"They can get into the story, but feel a little bit safer about it because they know who the actor is," said Roberts of San Jose, California.

A new study in the journal Child Development suggests that reassuring kids by telling them scary images aren't real is helpful for those around 7 and up, but for the younger ones it may not be preferred. Researchers at the University of California, Davis, found that when preschoolers get scared, they prefer to think of the fantastical threat as "nice."

Children ages 4, 5, and 7 were asked questions about stories involving a protagonist of the same gender encountering real and imaginary creatures such as bears, snakes and dragons. They found that the girls tended to suggest that the protagonist avoid the creatures, while boys wanted to attack them.

The study's recommendation that may seem counterintuitive to parents is that even though 4-year-olds recognize the difference between fantasy and reality, they would rather be comforted by a positive pretense than by the notion that "it's not real."

In other words, if a child believes there's a boogie monster under the bed, parents should say that it's friendly or "wants to play" in the heat of the moment, rather than dismissing the fear by saying it's all in the child's head, they said. Later, when he or she has calmed down, parents can explain that the monster was not real, the study authors say.

Dawn Huebner, a psychologist in Exeter, New Hampshire, and author of "What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety," disagrees. If children are old enough to understand the difference between fantasy and reality, they should learn to cope with the idea that the image that haunts them is not real.

Parents can teach their children how to differentiate fears in their heads from actual danger, she said. Concepts such as "false alarms" can help kids understand that the fear they feel does not mean there is an actual threat, and that they can reassure themselves.

"It's helpful for parents to talk about the elements that make it not real," Huebner said.

But the study authors, psychologists Liat Sayfan and Kristin Hansen Lagattuta, say they've each used the "it's a nice monster" strategy with their own children when they were younger, and it worked.

"It's not suppressing the negative thoughts. It's sort of staying in it and reframing it a little bit more positively," Lagattuta said.

Still, it's unclear how much any kind of verbal coping will help, said Joanne Cantor, professor at the University of Wisconsin, Madison. She recommends distracting the child and allowing him or her to hug a stuffed animal or sit in a parent's lap.

It may be that they are able to deal with the notion of a "friendly ghost" before they can cope with the "it's not real" explanation, but previous research has shown that 3- and 4-year-olds can't use reasoning to make themselves feel better, she said.

The new study was small, with 48 participants, and the authors are already engaged in a follow-up to see how children react to the coping strategies they identified.

The study authors and Huebner agree that it's OK for parents to turn off the television if the program or movie on the screen is too scary for young audiences.

Jamie Reeves of Nashville, Tennessee, who runs the Blonde Mom Blog, is also closely monitoring her daughters' (4 and 7) TV content.

"Explain to them that if they are scared of something, they might not understand what something is, they can always talk to you about it," Reeves said.

Still, says Huebner, it's better for a child not to leave the room or cover his or her eyes when watching a scary character, because that little glimpse can leave a more lasting impression than prolonged exposure, Huebner said.

For example, some children get scared even when they see the cover of a DVD, she said. Rather than walking away, parents should show the image to the child and talk about how it was created.

Thinking about the process of making a film can help children cope with scary images, experts say.

Kids are fascinated by the details of special effects -- for example, how fake blood is released from a bag at the same time that a gunshot is heard, said Roberts, who has run The Mommy Blog since 2002.

Jennifer James of Winston Salem, North Carolina, founder of the Mom Bloggers Club, agrees. Her daughters, now 8 and 11, were around age 5 or 6 when they started questioning what was real and what wasn't.

James said she made a conscious effort to shield her kids from scary content in books, TV and movies, and can't even name anything that made them particularly afraid.

Roberts, though, remembers two months ago when her 7-year-old daughter, Daphne, came in the room near the end of the violent drama "Kill Bill" and insisted on watching. As it turned out, Daphne was fine with the sword fighting, but freaked out at the portrayal of a spot of blood in snow. Her mother turned off the movie after that scene.

"Even when you think you can take a chance, you can't be sure what's going to flip them out," Roberts said.

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November 18, 2009

not all that looks like h1n1 is swine , may be mutating rhinovirus. Wow what a time we live in.

Not Just Swine Flu - New Cold Virus May Lurk, Too

By Maggie Fox, Health and Science Editor

Reuters

WASHINGTON

Runny nose, fever, cough, even pneumonia -- the symptoms sound like swine flu but children hospitalized at one U.S. hospital in fact had a rhinovirus, better known as a common cold virus, doctors said on Tuesday.

Hundreds of children treated at Children's Hospital of Philadelphia had a rhinovirus, and federal health investigators are trying to find out if it was a new strain, and if this is going on elsewhere in the country.

"What began to happen in early September is we started seeing more children coming to our emergency room with significant respiratory illness," said Dr. Susan Coffin, medical director of infection control and prevention at the hospital.

Doctors and parents assumed it was the new pandemic H1N1 swine flu, which would be expected to re-emerge as schools began in September. But it was not, Coffin said in a telephone interview.

The hospital, unlike most hospitals in the United States, runs a test that can diagnose 10 different respiratory viruses, including influenza but also rhinoviruses, parainfluenza viruses and other germs that make kids sick.

"The data showed us it wasn't H1N1 but instead was this rhinovirus infection," Coffin said.

Usually rhinoviruses cause an annoying but benign illness that looks a lot like flu, but with more runny nose and usually less of a fever. This one was causing severe symptoms and even pneumonia.

"Some of these kids had really bad wheezing," Coffin said -- so bad they had to be hospitalized and treated with a nebulizer, which delivers drugs into the lungs to help keep oxygen in the blood.

"We don't terribly often have large numbers of children test positive for it," Coffin said.

CDC INVESTIGATING

But she estimated that 500 were hospitalized in September and October, with no deaths that she knows of. Starting in mid-October, H1N1 swine flu started to show up, too.

The U.S. Centers For Disease Control and Prevention is investigating, said CDC spokesman Dave Daigle.

"While rhinovirus outbreaks are common in the fall, the outbreak that occurred this year was unusually large and resulted in a lot of hospital admissions, including many children that required intensive care," Daigle said.

"We're still testing the strains from the outbreak, but from what we've seen so far, it doesn't appear that there's a single predominant strain."

The CDC says while swine flu is above epidemic levels, only 30 percent of cases of so-called influenza-like illness that are tested actually turn out to be H1N1.

Coffin and CDC officials say it is important for people not to assume if they or their children have flu-like symptoms that it was swine flu and that they do not need to be vaccinated.

H1N1 has infected an estimated 22 million people and killed 3,900 in the United States alone. It continues to spread globally and governments are just at the beginning of efforts to vaccinate people against the virus.

There is no vaccine for rhinovirus and no good treatment. For severely ill patients hospitals can try to keep blood oxygen levels up and keep the patients hydrated, often with intravenous lines if they are coughing or wheezing too hard to eat or drink.

(Editing by Philip Barbara)

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November 13, 2009

This is Illinois data ,the interesting thing about it that the death rates for hospitalized adulte is almost 10 times that of infants. Probably represents the fact that the infants hospitalized are not as sick as the adults. But not sure.

H1N1 2009 Cumulative Hospitalizations and Deaths by Age Group* (As of November 13, 2009, 10 a.m.) Updated on Fridays
Age range	Hospitalized cases (confirmed)	Deaths
0-4	282	2
5-18	369	7
19-24	113	3
25-49	314	21
50-64	212	9
65 +	80	6
Unknown	1	0
TOTAL	1371	48

* Outpatients are not being routinely tested for influenza; therefore reports of confirmed cases cannot be relied upon to provide an accurate picture of novel H1N1 cases that do not require hospitalization. In order to assess influenza activity among outpatients, IDPH continues toobtain information from sentinel providers across the state, and will post surveillance reports on a weekly basis atwww.idph.state.il.us/flu/fluupdate08-09.htm.

More Illinois H1N1 Statistics

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November 12, 2009

a primer on what could go wrong in housing

November 11th, 2009

The Comprehensive State of the U.S. Housing Market: Learning to Love the Housing Data and Forgetting the Economic Facts. Everything you wanted to know about U.S. Housing Trends.

America has built a large part of its economy on homeownership. Owning a home is part of the ever more elusive American Dream. Yet over time, owning a home became a larger and larger burden as new buyers were required to take on bigger debt loads merely to buy a basic home. Incomes weren’t rising so debt was the new subsidy. The apex of the bubble was reached in 2005 although prices didn’t start falling in drastic fashion for a couple years later. TheU.S. Treasury and Federal Reserveare largely to blame for inciting the biggest housing bubble the world has come to know. Wall Street is equally to blame for creating the structure that allowed this to happen as they championed de-regulation and completely neglected any fiscal responsibility.

In today’s article, I will dissect the housing market from every angle. It is easy to get caught up in the day to day data but the bigger picture is usually missed. Let us first look at the total number of housing units in the U.S.:

us housing units

In the United States we have approximately 129,000,000 housing units. These are made up of owner-occupied, rented, and vacant units. The largest of these three categories is the owner-occupied category and most of the media focuses on this number. Yet the other categories carry as much weight in determining a housing recovery. Let us look at the vacant housing units:

The vacancy rate for both owner-occupied and rental properties is still near all time highs. With so many sales, how can it be that this number is so high? I’ll get into this later in the article. But part of this has to do with demographics, the makeup of current housing inventory, and years of over building. It is also the case that we are shifting a large number of would be renters into homes and causing the rental vacancy rate to spike. Many of these apartment projects are financed with commercial real estate loans and theFederal Reserve is essentially shifting defaults from residential loans to commercial loans. That is why we are seeing rents fall as owners compete to fill vacant units.

So now we have the universe of housing units including vacant units. Let us drill down and examine the number of owner-occupied homes and renter-occupied units:

75 million Americans own their home. The homeownership rate is derived from only looking at occupied units. That is why it is important to also keep in mind the vacant units sitting on the market.

You’ll notice that the ownership rate does not factor in the vacant units. The vacancy rate is at historical highs and this is another factor that will drag on the housing market for years to come. 37 million Americans rent their housing. This can be apartments or actual detached homes. The number of renters has recently increased as homeownership has fallen:

The chart has a few patterns worth noting. From 1985 to 1995 the homeownership rate in the U.S. hovered around 64 percent. The only recession during this time was in the early 1990s yet the rate remained steady. The first spike started after 1995. This trend went from 1995 to 2000 and pushed the homeownership rate from 64 to above 67 percent. Part of this had to do with the technology bubble and the growth in the economy. But then we hit the early 2000s recession largely brought on by the burst of the technology bubble. Instead of homeownership declining which is typical in recessions, the homeownership rate expanded upward. Much of this was due to Federal ReserveChairman Alan Greenspan dropping the Fed funds rate to record lows. Wall Street looking for the new-new thing, went from tech IPOs to mortgage backed securities and the toxic mortgage party started.

This easy access to credit and excessive risk pushed the homeownership rate to nearly 70 percent in 2005. But that was it. The bubble burst and the homeownership rate is now on a steady decline. While the above chart is moving lower, one chart is moving higher. The U.S. home vacancy rate:

Rental properties always have higher vacancy rates merely by the nature of their use. Someone renting a home is more likely to move than say someone who buys a home and plans to stay in their home for many years. Yet the above chart shows an unmistakable pattern. The rental vacancy rate from 1968 to 1984 hovered between 5 and 6 percent. From 1985 to 1999, it was in a range of 6 to 8 percent. And finally, from 2000 to our present situation it went from 8 percent to 10 percent. This is historically as high as it has gone. You will notice that the rental vacancy rate dipped after the peak in 2005 since many people opted for rental units instead of buying a home. Yet the pattern is still holding steady.

Now looking at the homeowner vacancy rate shows another story. Too much building. From 1968 to 2004, the rate never crossed the 2 percent mark. Now, we are closing in on 3 percent. That rate may not be reached now that the market is shifting gears. But if we do have another foreclosure wave, 3 percent is possible. What happened here? Too much building and ignoring demographic trends:

From 2001 to 2006 home building was off the charts. Single-family housing starts were up to a seasonally adjusted rate of 1.8 million a year even though population growth did not warrant this amount of new inventory. From 1999 to 2001 the rate was hovering around 1.2 million. So 600,000 properties were being added each year above the normal trend and this lasted for 6 years. Of course, this number has collapsed at a pace not seen since the Great Depression but why did it occur? People ignored the trend and demographics:

The above data exemplifies the housing bubble. Each year roughly 500,000 homes are destroyed for a variety of reasons. This of course isn’t discussed in the mainstream media but it helps to figure out a more accurate figure of what is going on. Most households will buy their first home in the 25 to 34 years age group creating a demand of 1.9 million homes. We also have homes hitting the market because of the other side of the age equation. We have 11.6 million households in the 65 to 74 age range and 9 million in the 75 to 84 age range. Life trend dynamics (i.e,. death and downsizing) add 1.1 million units per year to the market. In other words, here is the breakdown:

$housing math$

Now this data is using trends up to the end of 2008. We were burning through 350,000 excess units per year at the end of 2008. Of course, housing starts have now collapsed and are adding new units at an annual rate of 500,000 homes. So a significant indicator of returning to a healthy market is more linked to the actual vacancy rate. In fact, adding up the units we have about 3 million too many units on the market over historical trends. Depending on our current burn rate, we have:

3 million / 350,000 = 8.5 years

3 million / 850,000 = 3.5 years

And this is the time it will take at current rates to get to a more normal market if there is such a thing. Yet the 850,000 figure is too optimistic because we now have a new factor in the mix in the sales data. Foreclosures:

For the past year, each month over 300,000 homes enter some stage of foreclosure. This is either a notice of default, a scheduled auction, or a home going back to the bank as an REO. This number actually increases the length of time before we reach a stable housing market. As you can see from the chart above, the rate is still at a record. Now why is this the case? Think of the dynamics of a healthy market. Those in the household formation age, sell a home and in many cases will buy a move up home. This can be a new home or an existing home. Either way, they are clearing some of the vacant inventory off the market with typically two transactions taking place (buy and sell). With foreclosures, it is normally a one and done deal. Someone loses their home, and the person buying that home is merely taking over inventory that has already been accounted for. This is why looking at foreclosure figures is so important. Even in 2006 foreclosures were elevated. If you consider that year as normal, foreclosure starts should range around 100,000 per month. We are solidly over 300,000.

We still have many more foreclosures coming down the pipeline with Alt-A and option ARMs hitting significant recast dates. This will only make it harder for us to clear that massive amount of excess inventory just sitting on the market. With nearly one-third of homes sold nationwide as foreclosure re-sales, the excess inventory is sure to linger for a very long time. Take a look at existing home sale data:

I’m taking the non-seasonally adjusted rate because with historical foreclosure rates, looking at typical data really does little in answering the real question of where we are going. In September 472,000 existing homes sold. Add in about 40,000 new homes sold and you are looking at 512,000 total home sales. However, in the same month 343,000 homes entered into some stage of foreclosure. Forget the data on HAMP for the moment since the 650,000 or so pre-trial loan mods means very little, the actual cure rates are extremely low:

We’ll be optimistic and use the 6.6% figure. That means, of those 343,000 foreclosure starts 321,000 units are going to be additional inventory. So even with 512,000 homes minus the 321,000 added units, we are not burning off excess inventory in any significant number. And that is why the vacancy rate is still jumping and homeownership rates are falling.

It also doesn’t help that mortgages are delinquent at a rate never before seen (aside from the Great Depression):

Over 9 percent of all mortgage holders are now delinquent on their mortgages. Of the 75 million homeowners 51 million have mortgages. So that means as things stand today, close to 5 million mortgage holders are delinquent on their loans. Since we are not seeing this in the REO data, this must mean the following:

(a) 30+ days late and no notice of default

(b) 90+ days late and a notice of default (reflects in monthly foreclosure data) – or 90+ days late and no action at all

(c) Auction scheduled

(d) HAMP – 650,000 in pre-trial

Yet the cure rate is at 6 percent and this is for prime loans. We know that we have Alt-A and option ARMs coming due in the next few months and none of these qualify for HAMP. Wells Fargo announced that they are converting over $100 billion in Pick-A-Pay option ARMs to interest only loans but who really knows if this will even help. Already for the option ARM universe, some 45% of option ARM borrowers are 30+ days late.

Conclusion

What can we gather from the above data? Home prices are falling even though data in the short-term might state otherwise. This is due to artificial inventory figures because of mortgage moratoriums and banks not moving on distressed homes in a typical fashion. There is an enormous amount of overhang in the market. Using typical measures the data doesn’t show up but does show up in shadow inventory data. The reason home sales have increased recently is because prices have collapsed:

Why are we to assume that if prices go up, people will keep on buying? The driving force right now is affordability brought on by:

-Large number of foreclosure re-sales (nationwide about one-third of all sales, in California it was up to 50 percent of all sales)

-Government programs including the $8,000 tax credit

-Federal Reserve buying GSE MBS – no one else is buying them

-Artificially lowering mortgage rates (hovering around 5% while 40 year average is closer to 9%)

With all the above, we are merely treading water. What we can gather from the above is we have years to work through this. Also, the growing number of baby boomers shifting into retirement will also add to the additional housing units at a higher pace since those in the 25 to 34 years of age group are no longer having families in large size. Many may opt to rent for much longer since some are delaying having kids until later in life. In other words, the trend is not conducive to the McMansion world.

There are many factors to consider in the current housing market and it is my hope that this article helps to show the bigger picture of what is going on. This is how I learned to stop worrying and love the housing bubble.

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November 10, 2009

When the Problems Come Home to Roost - NYTimes.com on the real life challenges of raising chickens

When the Problems Come Home to Roost

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By KIM SEVERSON

Published: October 22, 2009

THE Bay Area is unmatched in its embrace of the urban backyard chicken trend. But raising chickens, which promises delicious, untainted eggs and instant membership in the local food movement, isn’t all it’s cracked up to be.

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Dean C.K. Cox for The New York Times

Sharon Lane with one of her three chickens in the coop atop her garage in Berkeley, Calif. "I'm discouraged but I'm determined to figure this out," she said of her flock's mystery ailments.

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Chickens, it turns out, have issues.
They get diseases with odd names, like pasty butt and the fowl plague. Rats and raccoons appear out of nowhere. Hens suddenly stop laying eggs or never produce them at all. Crowing roosters disturb neighbors.
The problems get worse. Unwanted urban chickens are showing up at local animal shelters. Even in the best of circumstances, chickens die at alarming rates.
“At first I named them but now I’ve stopped because it’s just too hard,” said Sharon Jones, who started with eight chickens in a coop fashioned from plywood and chicken wire in the front yard of her north Berkeley home. She’s down to three.
Ms. Jones, who is close friends with the restaurateur Alice Waters, wanted exceptional eggs, plain and simple. But her little flock has been plagued with mysterious diseases.
She has not taken them to the vet because of the high cost, but she goes to workshops and searches out cures on the Internet. She has even put garlic down their throats in hopes that the antibacterial qualities of the cloves might help.
“I’m discouraged but I’m determined to figure this out,” Ms. Jones said. “I still get more than I give.”
Most Bay Area communities allow at least a few hens, and sometimes even permit roosters. Some elementary schools and restaurants keep flocks. The Web site backyardchickens.com, which calls itself the largest community of chicken enthusiasts in the world, started here. Seminars on the proper and humane way to kill chickens are becoming popular.
But with increased chicken popularity comes a downside: abandonment. In one week earlier this month, eight were available for adoption at the Oakland shelter and five were awaiting homes at the San Francisco shelter. In Berkeley, someone dropped four chickens in the animal control night box with a note from their apologetic owner, said Kate O’Connor, the manager.
For some animal rights workers, the backyard chicken trend is as bad as the pot-bellied pig craze in the 1980s or puppy fever set off by the movie “101 Dalmatians.” In both cases, the pets proved more difficult to care for than many owners suspected.
“It’s a fad,” said Susie Coston, national shelter director for Farm Sanctuary, which rescues animals and sends them to live on farms in New York and California. “People are going to want it for a while and then not be so interested.”
She said that farm animal rescue groups field about 150 calls a month for birds, most of them involving chickens — especially roosters.
“We’re all inundated right now with roosters,” she said. “They dump them because they think they are getting hens and they’re not.”
Some chicken owners buy from large hatcheries, which determine the sex of the birds and kill large numbers of baby roosters, because most people want laying hens. But sexing a chicken is an inexact science. Sometimes backyard farmers end up with a rooster, which are illegal in most cities.
In Berkeley, which does allow roosters, Steve Frye is in the middle of a cockfight with Ace Dodsworth, who lives about four houses away and tends a flock of hens and roosters that his community household uses for eggs and meat.
“I’m not an antichicken guy whatsoever,” Mr. Frye said. “It’s a noise issue.”
During the worst of it, Mr. Frye said, the roosters woke him up 13 times in one month. He recently filed a complaint with the city.
Mr. Dodsworth believes a crowing rooster is a happy rooster, but he says he does his best to keep his roosters cooped to minimize noise. He has offered Mr. Frye eggs and dinner and said other neighbors don’t seem to mind the chickens. Down the street at Kate Klaire’s house, there are no roosters. But the elementary school teacher has other problems. She has been through three different flocks in four years.
She ticks through a list of all the ways her chickens have died. There was the breakout of Marek’s disease. Her dog got to one chicken before some rules of the roost were laid down. She suspects a fox or a coyote carried off several when she was away.
More upsetting were the two she found with their necks broken.
“I believe they were murdered,” she said, pointing to a chain link fence that appeared to have been bent by a human foot.
Like many of her fellow Bay Area backyard chicken owners, Ms. Klaire remains determined. The eggs are local, the composting contributions to the garden are significant and the chickens themselves are fascinating.
And for her, there has been one more benefit.
“Having chickens is a really great way of dealing with loss and death,” she said.
Kitty Bennett contributed research.

A previous version of this article mis-stated the surname of one chicken owner. She is Sharon Jones, not Lane.

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November 3, 2009

A Vanishing Diagnosis for Asperger’s Syndrome - NYTimes.com

A Powerful Identity, a Vanishing Diagnosis

Daniel Tammet

PERCEPTIONS The drawings of Daniel Tammet, above, who wrote the 2007 book “Born on a Blue Day,” about living with autism, show how he visualizes some numbers.

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By CLAUDIA WALLIS

Published: November 2, 2009

It is one of the most intriguing labels in psychiatry. Children with Asperger’s syndrome, a mild form of autism, are socially awkward and often physically clumsy, but many are verbal prodigies, speaking in complex sentences at early ages, reading newspapers fluently by age 5 or 6 and acquiring expertise in some preferred topic — stegosaurs, clipper ships, Interstate highways — that will astonish adults and bore their playmates to tears.

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Daniel Tammet Jerome Tabet

BEAUTIFUL MINDS Daniel Tammet paints in France. John Elder Robison, above, shown about 1979, wrote about having Asperger's syndrome in “Look Me in the Eye.”

In recent years, this once obscure diagnosis, given to more than four times as many boys as girls, has become increasingly common.
Much of the growing prevalence of autism, which now affects about 1 percent of American children, according to federal data, can be attributed to Asperger’s and other mild forms of the disorder. And Asperger’s has exploded into popular culture through books and films depicting it as the realm of brilliant nerds and savantlike geniuses.
But no sooner has Asperger consciousness awakened than the disorder seems headed for psychiatric obsolescence. Though it became an official part of the medical lexicon only in 1994, the experts who are revising psychiatry’s diagnostic manual have proposed to eliminate it from the new edition, due out in 2012.
If these experts have their way, Asperger’s syndrome and another mild form of autism, pervasive developmental disorder not otherwise specified (P.D.D.-N.O.S. for short), will be folded into a single broad diagnosis, autism spectrum disorder — a category that encompasses autism’s entire range, or spectrum, from high-functioning to profoundly disabling.
“Nobody has been able to show consistent differences between what clinicians diagnose as Asperger’s syndrome and what they diagnose as mild autistic disorder,” said Catherine Lord, director of the Autism and Communication Disorders Centers at the University of Michigan, one of 13 members of a group evaluating autism and other neurodevelopmental disorders for the manual.
“Asperger’s means a lot of different things to different people,” Dr. Lord said. “It’s confusing and not terribly useful.”
Taking Asperger’s out of the manual, known as D.S.M.-V for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, does not mean the term will disappear. “We don’t want to say that no one can ever use this word,” Dr. Lord said, adding: “It’s not an evidence-based term. It may be something people would like to use to describe how they see themselves fitting into the spectrum.”
But the change, if approved by the manual’s editors and consultants, is likely to be controversial. The Asperger’s diagnosis is used by health insurers, researchers, state agencies and schools — not to mention people with the disorder, many of whom proudly call themselves Aspies.
Some experts worry that the loss of the label will inhibit mildly affected people from being assessed for autism. “The general public has either a neutral or fairly positive view of the term Asperger’s syndrome,” said Tony Attwood, a psychologist based in Australia who wrote “The Complete Guide to Asperger’s Syndrome” (Jessica Kingsley Publishers, 2006). But if people are told they should be evaluated for autism, he went on, “they will say: ‘No, no, no. I can talk. I have a friend. What a ridiculous suggestion!’ So we will miss the opportunity to assess people.”
The proposed changes to the autism category are part of a bigger overhaul that will largely replace the old “you have it or you don’t” model of mental illness with a more modern view — that psychiatric disorders should be seen as a continuum, with many degrees of severity. The goal is to develop “severity measures within each diagnosis,” said Dr. Darrel A. Regier, research director at the American Psychiatric Association and vice chairman of the diagnostic manual’s task force.
Another broad change is to better recognize that psychiatric patients often have many health problems affecting mind and body and that clinicians need to evaluate and treat the whole patient.
Historically, Dr. Regier said, the diagnostic manual was used to sort hospital patients based on what was judged to be their most serious problem. A patient with a primary diagnosis of major depression would not be evaluated for anxiety, for example, even though the two disorders often go hand in hand.
Similarly, a child with the autism label could not also have a diagnosis of attention deficit hyperactivity disorder, because attention problems are considered secondary to the autism. Thus, they might go untreated, or the treatment would not be covered by insurance.
The new edition, by contrast, will list not only the core issues that characterize a given diagnosis but also an array of other health problems that commonly accompany the disorder. For autism, this would most likely include anxiety, attention disorders, gastrointestinal problems, seizures and sensory differences like extreme sensitivity to noise.
Parents and advocates have been clamoring for an approach that addresses the multiple health problems that plague many children with autism. “Our kids will do much better if medical conditions like gut issues or allergies are treated,” said Lee Grossman, president of the Autism Society of America, a leading advocacy group.
The new diagnostic approach addresses another source of confusion: the current labels may change over time. “A child can look like they have P.D.D.-N.O.S., then Asperger’s, then back to autism,” Dr. Lord said. The inconsistent use of these labels has been a problem for researchers recruiting subjects for studies of autism spectrum disorder.
And it can be a problem for people seeking help. In some states, California and Texas, for example, people with traditional autistic disorder qualify for state services, while those with Asperger’s and pervasive developmental disorder do not.
A big challenge for the diagnostic manual team working on autism is how to measure severity in a condition that often causes a very uneven profile of abilities and disabilities. Mr. Grossman gives the example of a woman who serves on an advisory panel to his organization. She is nonverbal and depends on an electronic device to communicate, is prone to self-injury and relies on a personal aide. And yet “she’s absolutely brilliant, she runs a newsletter, and she’s up on all the science,” he said, adding, “Where would somebody like that come out on the rating scale?”
Recent books by people with Asperger’s give insights into the workings of some oddly beautiful minds. In “Embracing the Wide Sky” (Free Press, 2009), Daniel Tammet, a shy British math and linguistic savant, tells how he was able to learn enough Icelandic in a week to manage a television interview and how he could recite the value of pi to 22,514 decimal places by envisioning the digits “as a rolling numerical panorama” of colors, shapes and textures.
In “Look Me in the Eye” (Crown, 2007), John Elder Robison describes a painfully lonely childhood and an ability to look at a circuit design and imagine how it will transform sound — a talent he used to invent audio effects and exploding guitars for the rock band Kiss.
Not all people with Asperger’s have such extraordinary abilities, and some who do are so crippled by anxiety and social limitations that they cannot hold down a job or live on their own.
Dr. Susan E. Swedo, a senior investigator at the National Institute of Mental Health who heads the diagnostic manual group working on autism, acknowledges the difficulty of describing such a variable disorder. Dr. Swedo said the plan was to define autism by two core elements — impaired social communication and repetitive behaviors or fixated interests — and to score each of those elements for severity.
The trick is to “walk the tightrope of truth,” Dr. Swedo said, between providing clear, easily used diagnostic guidance to clinicians and capturing the individual variation that is relevant to treatment. “People say that in autism, everybody is a snowflake,” she said. “It’s the perfect analogy.”
The proposed elimination of autism subtypes comes at the very moment when research suggests that the disorder may have scores of varieties. Investigators have already identified more than a dozen gene patterns associated with autism, but Dr. Lord, of Michigan, said the genetic markers “don’t seem to map at all into what people currently call Asperger’s or P.D.D.”
Nor have many of these genes been linked to distinct sets of symptoms. Until research can identify reliable biological markers for autism subtypes, Dr. Lord and other experts say, it is better to have no subtypes than the wrong ones.
In interviews, people with Asperger’s and mild autism were divided on the prospect of losing the label. Temple Grandin, a Colorado State University animal scientist who is perhaps the best-known autistic American, said Asperger’s was too well established to be thrown overboard. “The Asperger community is a big vocal community,” Dr. Grandin said, “a reason in itself” to leave the diagnosis in place.
“P.D.D.-N.O.S., I’d throw in the garbage can,” she added. “But I’d keep Asperger’s.”
But some younger people involved in the growing autism self-advocacy movement see things differently.
“My identity is attached to being on the autism spectrum, not some superior Asperger’s identity,” said Ari Ne’eman, 21, an activist who founded the Autistic Self-Advocacy Network, a 15-chapter organization he has built while in college, adding, “I think the consolidation to one category of autism spectrum diagnosis will lead to better services.”
All interested parties will have an opportunity to weigh in on the proposed changes. The American Psychiatric Association is expected to post the working group’s final proposal on autism diagnostic criteria on the diagnostic manual’s Web site in January and invite comment from the public. Dr. Swedo and company are bracing for an earful.
Correction: An earlier version of this article incorrectly said Temple Grandin was a professor at the University of Colorado.

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November 3, 2009

Well - Running New York City Marathon in the Slow Lane - NYTimes.com the sublime beauty of slow

A Marathon Run in the Slow Lane

Suzy Allman for The New York Times

THIRSTY Runners hit a water station on Sunday during the New York City Marathon.

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By TARA PARKER-POPE

Published: November 2, 2009

After a 10-kilometer road race this summer, a friend apologized for missing me at the finish line. The truth was, she hadn’t lost me in the crowd. She just didn’t wait long enough.

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Avi Gerver for The New York Times

MILES FROM HOME Michel Bach of Pomponne, France, guess who, in New York's marathon.

I’m a slow runner. A really slow runner. In that field of 625, I finished in 619th place.
There was a time when I was embarrassed by my painfully slow pace, but not anymore. Since I began training for a marathon this spring, I’ve discovered that the view is a lot more interesting in the back of the pack.
During a five-mile run in Central Park last spring, I paced alongside a double amputee who was using crutches and a single metal leg to propel himself along the course.
At the 13.1-mile Philadelphia Distance Run this fall, I spent a good part of the race alongside an athlete who jumped rope the entire way. Later, I trotted with two women wearing pink feather boas. There was also a “joggler,” someone who juggles and runs at the same time. Nearby was 81-year-old Robert Welsh of Wallingford, Pa. (He won his age group.)
My shirt that day read, “Slow Is the New Fast.”
This weekend, I was again at the back of the pack of the estimated 43,000 who participated in the New York City Marathon, and I was thrilled to be there. About five months ago, I declared that I was going to transform myself from couch potato to runner and complete a fall marathon. I trained using a combination of running and walking, a method espoused by the Olympian distance runner Jeff Galloway and now used by hundreds of thousands of runners around the country.
During my marathon, I ran next to a man wearing an Eiffel Tower costume. Several women raising money for breast cancer drew cheers from the crowds for running in their decorated bras. I also spent time alongside several members of the Achilles Track Club, for athletes with disabilities.
My marathon included four stops to hug my daughter along the route, a quick jaunt into a deli in Queens to buy a banana, and countless high fives with kids along the course. I also spent about three miles talking and walking with Maureen Donohue, 68, of Long Island, who began running at age 56 and was taking part in her 10th marathon. To train, she run-walks a five mile course near her home, takes a coffee break and heads back out again for five more miles. I found her inspiring, and so did the crowd. As we passed by, onlookers shouted, “Go, Mo, go!”
Despite their pace, back-of-the-packers still struggle with leg cramps, blisters and back spasms, and so did I. I finished my first marathon in 6 hours 58 minutes 19 seconds. I know faster marathoners are bothered by so-called plodders. A recent front-page article in my own newspaper quoted a number of marathoners to that effect, saying we had ruined the race’s mystique.
It’s true that marathons around the country are getting slower, as more charity runners and run-walkers take part. In 1980 the average marathon time was about three and a half hours for men and about four hours for women, according to Running USA. Today, the averages are 4:16 for men and 4:43 for women. About 20 percent of the participants in the New York City Marathon take longer than five hours to finish.
But the legendary gold medalist Frank Shorter says the criticisms of slow runners are “snobbery.” “You never hear that from elite runners,” he told me. “Elite runners admire other people’s performance. I find it much better to welcome slow runners to the club than to vote them out.”
Greg Meyer, who in 1983 was the last American man to win the Boston Marathon, says that when he hears such complaints from average marathoners, he replies, “If it wasn’t for the run-walkers, you wouldn’t be finishing in front of anybody.”
The main benefit of the run-walk method is that it eases your body into exercise, makes marathon training less grueling and gives muscles time to recover, reducing the risk of injury. Walk breaks are an ideal way for new runners and older, less fit and overweight people to take part in a sport that would otherwise be off limits.
The downside is that just as you are out on the marathon course about 50 percent longer than the average runner, your training time is much longer, too — four and five hours a weekend for long runs.
About 10 days before the marathon, I began to doubt my ability to finish the race. A flulike illness had sidelined me for a few weeks, and I’d missed some important training runs. I questioned whether it would be worth the effort to straggle over the finish line long after most of the runners had left.
But then, during an easy run on a trail near my house, I spotted another slow runner ahead of me. It took a moment before I realized his off-kilter gait was due to the fact that he was running on a Cheetah foot, an artificial limb that uses a flexible blade for the foot. He was young and fit, and I wanted to know his story, but didn’t stop him to ask. Instead I just watched his rhythmic run, and felt my own worries about race day fade away. It didn’t matter how fast I finished, just that I was out there, enjoying the view from the back of the pack.

Recommend Next Article in Health (2 of 42) » A version of this article appeared in print on November 3,