U.S. Approves First Method to Give the Blind Limited Vision

The F.D.A. Approves a Bionic Eye:
The Argus II allows Barbara Campbell, who lost her sight 20 years ago, to see the world through patterns of light. Scientists hope it is the beginning of even more treatments.

The Food and Drug Administration on Thursday approved the first treatment to give limited vision to people who are blind, involving a technology called the “artificial retina.”

With it, people with certain types of blindness can detect crosswalks on the street, burners on a stove, the presence of people or cars, and sometimes even oversized numbers or letters.

The artificial retina is a sheet of electrodes surgically implanted in the eye. The patient is also outfitted with a pair of glasses with an attached camera and a portable video processor. These elements together allow visual signals to bypass the damaged portion of the retina and be transmitted to the brain. The F.D.A. approval covers this integrated system, which the manufacturer calls Argus II.

The approval marks the first milestone in a new frontier in vision research, a field in which scientists are making strides with gene therapy, optogenetics, stem cells and other strategies.

“This is just the beginning,” said Grace Shen, director of the retinal diseases program at the National Eye Institute, which helped finance the artificial retina research and is supporting many other blindness therapy projects. “We have a lot of exciting things sitting in the wings, multiple approaches being developed now to address this.”

With the artificial retina or retinal prosthesis, a blind person cannot see in the conventional sense, but can identify outlines and boundaries of objects, especially when there is contrast between light and dark — fireworks against a night sky or black socks mixed with white ones in the laundry.

“Without the system, I wouldn’t be able to see anything at all, and if you were in front of me and you moved left and right, I’m not going to realize any of this,” said Elias Konstantopolous, 74, a retired electrician in Baltimore, one of about 50 Americans and Europeans who have been using the device in clinical trials for several years. He said it helps him differentiate curbs from asphalt roads, and detect contours, but not details, of cars, trees and people. “When you don’t have nothing, this is something. It’s a lot.”

The F.D.A. approved Argus II, made by Second Sight Medical Products, to treat people with severe retinitis pigmentosa, a group of inherited diseases in which photoreceptor cells, which take in light, deteriorate.

The first version of the implant had a sheet of 16 electrodes, but the current version has 60. A tiny camera mounted on eyeglasses captures images, and the video processor, worn on a belt, translates those images into pixelized patterns of light and dark. The processor transmits those signals to the electrodes, which send them along the optic nerve to the brain.

About 100,000 Americans have retinitis pigmentosa, but initially between 10,000 and 15,000 will likely qualify for the Argus II, according to the company. The F.D.A. says that up to 4,000 people a year can be treated with the device. That number represents people who are older than 25, who once had useful vision, have evidence of an intact inner retinal layer, have at best very limited light perception in the retina, and are so visually impaired that the device would prove an improvement. Second Sight will begin making Argus II available later this year.

But experts said the technology holds promise for other people who are blind, especially those with advanced age-related macular degeneration, the major cause of vision loss in older people, affecting about two million Americans. About 50,000 of them are currently severely impaired enough that the artificial retina would be helpful, said Dr. Robert Greenberg, Second Sight’s president and chief executive.

In Europe, Argus II received approval in 2011 to treat a broader group of people, those with severe blindness caused by any type of outer retinal degeneration, not just retinitis pigmentosa, although it is currently only marketed in Europe for that condition. In the U.S., additional clinical trials need to be completed before the company can seek broader FDA approval.

Eventually, Dr. Greenberg said, the plan is to implant electrodes not in the eye, but directly into the brain’s visual cortex. “That would allow us to address blindness from all causes,” he said.

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Buffet, 3G to buy Heinz for $23B

Warren Buffett's Berkshire Hathaway and private equity firm 3G Capital will buy ketchup and baby food maker H.J. Heinz Co for $23.2 billion in cash, a deal that combines 3G's ambitions in the food industry with Buffett's hunt for growth.

Including debt assumption, Heinz valued the transaction, which it called the largest in its industry's history, at $28 billion. Berkshire and 3G will pay $72.50 per share, a 19 percent premium to the stock's previous all-time high. Heinz shares actually rose slightly above the offer price, although Buffett cautioned he had no intention of raising his bid.

Analysts said the deal could be the first step in a broader wave of mergers for the food and beverage industry.

"Maybe for the consumer staples group in general this may start some talk about consolidation. Even corporate entities are flush with cash, interest rates are low, it would seemingly make sense," Edward Jones analyst Jack Russo said.

Companies like General Mills and Campbell Soup - itself long seen as a potential Heinz merge partner - rose on the news.

BUFFETT HUNTING GROWTH

The surprise purchase satisfies, at least in part, Buffett's hunt for growth through acquisition. He was frustrated in 2012 by the collapse of at least two deals in excess of $20 billion and said he might have to do a $30 billion deal this year to help fuel Berkshire's growth engine. In this case, Berkshire is putting up about $12 billion to $13 billion cash, Buffett told CNBC, leaving it ample room for another major transaction.

Berkshire Hathaway already has a variety of food assets, including the Dairy Queen ice cream chain, chocolatier See's Candies and the food distributor McLane. Buffett, famed for a love of cheeseburgers, joked he was well acquainted with Heinz's products already and that this was "my kind of deal."

It does represent an unusual teaming of Berkshire with private equity, though; historically, Buffett's purchases have been outright his own. He and 3G founder Jorge Paulo Lemann have known each other for years, and Buffett said Lemann approached him with the Heinz idea in December. One Berkshire investor said he had mixed feelings about the deal because of the limited growth prospects domestically.

"We're a little hesitant on the staple companies because they don't have any leverage in the United States," said Bill Smead, chief investment officer of Smead Capital Management in Seattle. But at the same time, he said, Buffett was likely willing to accept a bond-like steady return even if it was not necessarily a "home run."

3G EXPANDS

For 3G, a little-known firm with Brazilian roots, the purchase is something of a natural complement to its investment in fast-food chain Burger King, which it acquired in late 2010 and in which it still holds a major stake. Lemann, a globe-trotting financier with Swiss roots, made his money in banking and gained notoriety for helping to pull together the deals that ultimately formed the beer brewing giant AB InBev.

3G's Alex Behring runs the fund out of New York. He appeared at a Pittsburgh news conference on Thursday with Heinz management to discuss the deal - and to reassure anxious local crowds that the company will remain based there and will continue to support local philanthropy.

But at the same time, Behring said it was too soon to talk about cost cuts at the company. Unlike Berkshire, which is a hands-off operator, 3G is known for aggressively controlling costs at its operations.

PITTSBURGH ROOTS Also to be determined is whether CEO Bill Johnson would stay on. Only the fifth chairman in the company's history, Johnson is widely credited with Heinz's recent strong growth.

"I am way too young to retire," he told the news conference, adding that discussions had not yet started with 3G over the details of Heinz's future management.

The company, known for its iconic ketchup bottles, Heinz 57 sauces as well as other brands including Ore-Ida frozen potatoes, has increased net sales for the last eight fiscal years in a row.

Heinz said the transaction would be financed with cash from Berkshire and 3G, debt rollover and debt financing from J.P. Morgan and Wells Fargo. Buffett told CNBC that Berkshire and 3G would be equal equity partners.

Heinz shares soared 19.9 percent, or $12.06, to $72.54 on the New York Stock Exchange. A week ago the stock hit a long-term high of $61 a share - near records it set in 1998 - having risen almost 5 percent this year and nearly 12 percent since the beginning of 2012.

The deal is also a potential boon for new U.S. Secretary of State John Kerry, whose wife Teresa is the widow of H.J. Heinz Co heir John Heinz.

Kerry's most recent financial disclosures from his time in the U.S. Senate show a position in Heinz shares of more than $1 million, although the precise size is unclear.

Centerview Partners and BofA Merrill Lynch were financial advisers to Heinz, with Davis Polk & Wardwell LLP the legal adviser. Moelis & Company was financial adviser to the transaction committee of Heinz's board and Wachtell, Lipton, Rosen & Katz served as its legal adviser. Lazard served as lead financial adviser. J.P. Morgan and Wells Fargo also served as financial advisers to the investment consortium. Kirkland & Ellis LLP was legal adviser to 3G Capital, and Munger, Tolles & Olson LLP was legal adviser to Berkshire Hathaway.

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Cubs' plan for more night games in 2013 could be in trouble

The Chicago Cubs' push for more night games in the upcoming season could be in jeopardy, as Ald. Tom Tunney said he would not introduce legislation at today's City Council meeting.

The team has asked Tunney, whose 44^th ward encompasses Wrigley Field, to ease limits on night games, late Friday afternoon games, concerts and other non-game events that are part of a neighborhood protection ordinance. The Cubs want more flexibility in scheduling games and events to increase revenues as the owners of the team seek to embark on a $300 million renovation of Wrigley Field.

The Cubs currently schedule 27 night games and can add up to three more for national television purposes. The exact number of new night games the club seeks is unclear, but the team is eager to have more night games as soon as the upcoming season. The timetable depends on getting city approval as soon as possible so that Major League Baseball can adjust the 2013 schedule, which already has been unveiled.

The team had asked Tunney to introduce a measure amending the neighborhood protection ordinance at Wednesday’s meeting. But the alderman wants the Cubs to address parking, traffic and security issues in the Wrigleyville neighborhood.

The lack of a proposal today suggests Tunney is in no rush to give the Cubs what they want. Additional night games are just one of the changes the Cubs seek that are tied to Wrigley renovations. The team also wants the city to lift landmark restrictions on the stadium to allow for more advertising and change zoning around Wrigley to allow for pre-game street festivals.

Both Mayor Rahm Emanuel and Tunney said they wanted one comprehensive deal to rehab Wrigley and would not proceed first with just an ordinance to add more night games.

“It’s all of one piece,” the mayor said. “We’re going to do this comprehensively.”

He also suggested that a Major League Baseball deadline for scheduling night games provides pressure to seal a deal.

“The individual parties know there’s a deadline, because there is an actual one for them,” Emanuel said.

“But I will say one word to the parties,” he added. “There’s an agreement to be had. It’s right there. All you need is a little leadership and a little will. It’s right there at the table.”

A spokesman for the Ricketts family, the Cubs’ owners, said negotiations on several issues continue.

“Everybody has a sense of urgency,” said spokesman Dennis Culloton. “The team is still hoping to get things resolved by Opening Day at the latest.”

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Well: Straining to Hear and Fend Off Dementia

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

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

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

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

---

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

---

This post has been revised to reflect the following correction:

Correction: February 12, 2013

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

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Feds OK insurance exchange partnership

Health and Human Services Secretary Kathleen Sebelius on Wednesday said her department conditionally approved Illinois’ plan to operate a health insurance exchange in a partnership with the federal government, a widely expected move that makes the state the third to receive the official go ahead. 

Sebelius plans to make the announcement Wednesday afternoon at a West Side clinic alongside Gov. Pat Quinn, Sebelius said the approval will allow the state and the federal government to continue work on readying the online marketplace for Oct. 1, when uninsured Illinoisans can begin signing up for health insurance offered under the 2010 health care overhaul law.

Under the partnership model, Illinois will maintain its responsibility for regulating the insurance market, a function that will allow the state to tailor the types of private health insurance plans offered through the exchange. Illinois also will be in charge of customer assistance, which will allow it to conduct outreach efforts and aid people in signing up.

The federal government is responsible for building and operating the exchange.

Illinois becomes the third state to have its partnership plan approved, following Delaware and Arkansas. A handful of other states, including Iowa, Michigan, West Virginia and New Hampshire, also are interested in the partnership model. Other states have opted to set up and run their own exchanges, while a majority refused to participate, relying on the federal government to do so.

Sebelius is in town through Thursday to meet with several large stakeholders, including union leaders, clergy and community groups, to raise awareness about the forthcoming exchanges, a spokesman said.

The exchanges are a crucial part of the government's plan to expand the number of Americans who have some form of health insurance.

Eventually, an estimated 20 million people will benefit from federal tax credits starting in 2014 that will help offset the cost of paying for insurance premiums. Even so, the government estimates that about 6 million Americans will not sign up and will start paying tax penalties in 2014.

In the first year, those penalties are relatively modest, starting at $95 for adults and $47.50 per child. But they’re expected to increase in future years, eventually totaling nearly $7 billion in 2016, an average fine of about $1,200 per person.

While states were given the option of setting up and running their own exchanges, only 18 chose to do so, with most of the rest opting to allow the federal government to operate them, at least in the beginning.

Julie Hamos, director of the state Department of Healthcare and Family Services, has said she hopes to get legislation passed this spring to authorize a purely state-run exchange that will be up and ready in time for open enrollment for 2015.

Meanwhile, consumers can expect a marketing blitz during the summer and into the fall touting the exchanges, which will serve individuals who are not eligible for Medicare or Medicaid and not offered health insurance through their employers.

pfrost@tribune.com | Twitter: @peterfrost

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Hadiya Pendleton shooting suspect: 'She was just there'

The gunman in the slaying of Hadiya Pendleton told police he was in the middle of a three-year battle with a rival gang when he opened fire at a South Side park and hit the 15-year-old who "had nothing to do" with the feud, according to prosecutors.

"She was just there," Michael Ward, 18, told police after he was arrested with Kenneth Williams, 20, prosecutors said during a hearing where both were denied bail.

Williams told witnesses he and Ward were driving around on Jan. 29, looking for members of a rival gang that had killed one of Ward's friends, according to prosecutors. Williams had also been wounded by a rival gang member last summer, police said.

"Ward stated that his gang and the rival gang had been shooting at one another since 2010. [Ward] stated that when the rival gang killed one of his friends, he thought, 'If we keep standing for this, we are going to be some straight bitches,' " prosecutors said.

"It hurt, it hurt," he told police, according to prosecutors. "It hurt to a point where everyone had to go."

Ward confessed to police that he and Williams mistook a Pendleton companion for a rival gang member as the girl was with friends at the park near King College Prep High School, about a mile away from President Barack Obama's home.

In court today, prosecutors disclosed that surveillance video captured the white Nissan the two used to flee after the shooting. Police had identified Williams and Ward as occupants of the car "within approximately 10 minutes of the shooting," prosecutors said.

The two were not arrested until this past weekend.

Williams said he and Ward pulled up to Harsh Park in the North Kenwood neighborhood, according to prosecutors. Ward got out and "snuck up on the group and they didn't see him coming," prosecutors quoted Ward as telling police. "Ward admitted he approached the fence and fired the gun six times. He ran back to the car and both defendants fled."

Williams appeared in court in a black-hooded sweatshirt and his hair in dreadlocks, while Ward was dressed in a dark gray vest and blue jeans. Both defendants kept their hands behind their backs and stood silently before the judge as Assistant State’s Attorney Jennifer Sexton detailed the charges before a packed courtroom.

Relatives and supporters showed up in court for both Ward and Williams, but no one spoke to reporters following the bond hearing.

Ward’s lawyer, Jeffrey Granich, contended that police refused his client’s repeated requests for a lawyer while he was being questioned by detectives. He also maintained that Ward was being “railroaded” because of the high-profile homicide.

“This is a serious case, not a political platform,” Granich told reporters in the lobby of the Leighton Criminal Court Building.

Granich said Ward was attending Malcolm X College to obtain a GED, a requirement of his probation sentence for a weapons conviction.

Williams’ attorney, Matthew McQuaid, said his client had graduated from the same high school as Hadiya – King College Prep – and was working for an air courier service at O’Hare International Airport. He has no criminal background.

McQuaid also denied that Williams belonged to a gang.

David Smith, a close friend of the Pendleton family, said after the court hearing that the family was keeping tabs on developments from Washington. Hadiya’s parents are guests of First Lady Michelle Obama at the president’s State of the Union address tonight.
“They need to be off the streets, absolutely,” Smith said in expressing satisfaction that the two suspects were ordered held without bond. But at the same time, he said the entire case saddens him.

“I feel sad for Haydia and seeing those guys (in court) they looked sad, too, like little kids themselves,” Smith said.

Another family friend, Ray Hill, said he hoped the shooting would galvanize residents against violence.
“Everybody needs to wake up because if it can happen to our family, it can happen to yours,” Hill said. “We need to get the city more involved with our children.”

Detectives arrested the two Saturday night as the suspects were on their way to a suburban strip club to celebrate a friend's birthday, police said. Pendleton had been buried only hours earlier in a funeral attended by first lady Michelle Obama.

Police Superintendent Garry McCarthy said that two days before the killing, police had stopped Ward in his Nissan Sentra as part of a routine gang investigation. That information wound up being the starting point for detectives when witnesses in the shooting described seeing a similar car driving away from the shooting scene, he said.

Through surveillance and interviews — including several fruitful interviews with parolees in the neighborhood — detectives were able to home in on Ward and Williams, police said. On Saturday night, the decision was made to stop the two if they were spotted. Police watched as they departed in a caravan of cars headed to the strip club in Harvey. They were stopped near 67th Street and South King Drive and taken in for questioning.

McCarthy said Williams was shot July 11 at 39th Street and South Lake Park Avenue and an arrest was made. But that gunman was let go after Williams refused to cooperate, McCarthy said.

McCarthy noted that at the time of Hadiya's slaying, Ward was on probation for a weapons conviction. McCarthy said weak Illinois gun laws allowed Ward to avoid jail time because of the absence of mandatory minimum sentences.

"This incident did not have to occur," McCarthy said. "And if mandatory minimums existed in the state of Illinois, Michael Ward would not have been on the street to commit this heinous act."

State's Attorney Anita Alvarez echoed McCarthy's call for stronger sentencing laws for gun offenses.

After the hearing, she said prosecutors had asked for prison time for Ward when he was convicted of a weapon charge in 2011, but he was instead given probation because he was only 17 at the time of the offense. A state law that went into effect that year requires a mandatory minimum sentence of 1 year in prison for unlawful use of a weapon but only for offenders 18 or older, she said.

“What we want to do with the new legislation is to fix that so that we are holding these people responsible…and that they receive an amount of jail time that is going to serve as a deterrent,” she said.

Responding to a Tribune report that Ward had been arrested three times while on probation for his gun conviction but still was on the street, Alvarez said the Cook County Adult Probation Department was responsible for notifying prosecutors of the new arrests and filing for a violation of probation. That can result in an arrestee being sent to prison.

“What I’ve been told (is) the probation department has admitted that they did not notify us, so obviously we didn’t proceed on that violation of probation,” Alvarez said.

jmeisner@tribune.com

jgorner@tribune.com

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Well: Straining to Hear and Fend Off Dementia

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

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

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

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

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

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Chicago leads nation in gas-price spikes

Drivers in Chicago are seeing a painful rise in gas prices get even worse this month.

The average price of regular unleaded in the Chicago metro area on Tuesday is $3.93, according to AAA. That's up 12 cents from a week ago. A month ago, the average was $3.42. Statewide, the average is about $3.79, up 8 cents from last week and 46 cents last month.

Prices are rising at pumps across the country, too, but not as dramatically. The national average is $3.60, up about 7 cents from a week ago and 30 cents higher than this time last month.

It's not typical to see gas price spikes at this time of year. Demand is typically low and picks up in the spring before driving season. And in general, gas is cheaper to produce in the winter because refineries can use less expensive blends.

The main reason for the spike is the higher price of crude oil. The price of oil has gone from around $85 a barrel in December to around $97 now because of improving economic certainty as the country moved past the election and the fiscal cliff deadline, according to energy analyst Phil Flynn. It's also being driven by better-than-expected growth in China, the world's second largest economy.

Prices in the Chicago area are typically some the highest in the nation, but the cost of a local fill-up is accelerating at almost double the national rate.

Flynn attributes this to a number of refinery issues in the region. Some scheduled maintenance at refineries -- where gasoline and other products are produced from oil -- occurred earlier than usual, which cut off some supply, affecting prices. Many close at this time of year to start the switchover to lower-emission summer blends of gasoline.

Besides a major overhaul of BP's Whiting refinery, the largest supplier of gasoline to Midwest markets, that's believed to be driving prices higher, a fire temporarily shut down a refinery in northwest Ohio.

AAA, which tracks daily gasoline prices around the country, predicts they will continue their rapid climb as local refinery issues continue into the beginning of peak driving season.

Flynn is more optimistic.

He believes that once the major Whiting refinery overhaul is complete later this year, gas prices will stabilize.

"I'm probably in the minority but I think we are starting to see some light at the end of the tunnel," he said.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Charges in Hadiya Pendleton slaying could come soon: McCarthy

Charges could come this evening against two people being questioned in the shooting death of 15-year-old Hadiya Pendleton, Police Superintendent Garry McCarthy said today.
"We will bring this all to closure, probably sometime this evening we're anticipating hopefully that we'll have charges," McCarthy said at a news conference with Mayor Rahm Emanuel and Cook County State's Attorney Anita Alvarez to announce a push for stiffer jail terms for people convicted of gun crimes.
McCarthy declined to provide more specifics, saying the investigation is ongoing.

"We're still doing lineups. We're still crossing some t's and dotting some i's that we need to do before we can get charges approved for these individuals," he said.

Chicago police picked up the two men, 18 and 20, were picked up over the weekend, hours after first lady Michelle Obama attended the funeral for the teenager whose death has become a symbol of escalating violence in Chicago.

The men were pulled over near East 67th Street and South Chicago Avenue late Saturday night or early Sunday morning after detectives canvassed the area of the park where she was shot and killed Jan. 29 and tracked down witnesses, the sources said.

Hadiya was fatally shot in Vivian Gordon Harsh Park, about a mile north of President Barack Obama's Kenwood neighborhood home on the South Side, a little more than a week after the honor student performed with the King College Prep band in Washington during inauguration festivities. Two other teens were wounded.

The shooting in the 4400 block of South Oakenwald Avenue happened after classes were dismissed for the day during finals week at King. Hadiya, a sophomore at King, was at the park with a group of teens, primarily other students from the school, when a male gunman climbed over a fence, ran to the group and started firing, police have said. The shooter escaped in what has been described as a white Nissan vehicle, possibly driven by a getaway driver.

One of the sources said at least one of the men brought into custody was riding in a Nissan Sentra, one of the two vehicles police pulled over when bringing the pair into custody. The source didn't know that Nissan's color.

Police have insisted the teens in Hadiya's group who had gathered in the park were not involved in gangs. But police have been looking into whether the gunman may have mistaken them for rival gang members.

While police and neighbors have generally described Harsh Park and its immediate surroundings as safe, there has been an internal gang conflict brewing in the area between factions of the Gangster Disciples, police said. The two men being questioned Sunday are alleged members of the Gangster Disciples, sources said.

One of the two men has a previous weapons conviction, according to court records.

In addition to Hadiya's homicide, there have been at least three other shootings within blocks of Harsh Park so far this year, according to police records.

No charges have been filed against the men, who are being held at Area Central police headquarters on the South Side.

Mayor Rahm Emanuel personally called Hadiya's parents, Cleopatra Cowley-Pendleton and Nathaniel Pendleton, to inform them of the development, according to a source. Nathaniel Pendleton told the Tribune on Sunday night that he didn't want to say too much about the men being questioned because charges have not been filed.
“Right now, we're just happy that Chicago police have some leads and things are moving,” he said.

Shatira Wilks, a cousin of Hadiya's and a family spokesperson, said the development is a “good response” and better news than the family had Saturday.

Arrests and charges “will bring a small level of closure to the family, although (the shooter) still will be allowed to eat, drink, mingle,” Wilks said. “The thing about that is, Hadiya is no longer (able) to do so.”

On how Hadiya's family is doing, Wilks said, “Everyone keeps asking that. I don't know if you'll ever get an answer that we're feeling good or we're feeling fine.”

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The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

Editor’s Note: More information about “The American Bar Association Guide to Wills and Estates” can be found here.

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

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

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