Unlikely Model for H.I.V. Prevention: Adult Film Industry

Stephanie Diani for The New York Times

INDUSTRY DATABASE Shylar Cobi, right, a film producer, confirmed test results of the actors who perform as James Deen and Stoya.

LOS ANGELES — Before they take off all their clothes, the actors who perform as James Deen and Stoya go through a ritual unique to the heterosexual adult film industry.

First, they show each other their cellphones: Each has an e-mail from a laboratory saying he or she just tested negative for H.I.V., syphilis, chlamydia and gonorrhea.

Then they sit beside the film’s producer, Shylar Cobi, as he checks an industry database with their real names to confirm that those negative tests are less than 15 days old.

Then, out on the pool terrace of the day’s set — a music producer’s hilltop home with a view of the Hollywood sign — they yank down their pants and stand around joking as Mr. Cobi quickly inspects their mouths, hands and genitals for sores.

“I’m not a doctor,” Mr. Cobi, who wears a pleasantly sheepish grin, says. “I’m only qualified to do this because I’ve been shooting porn since 1990 and I know what looks bad.”

Bizarre as the ritual is, it seems to work.

The industry’s medical consultants say that about 350,000 sex scenes have been shot without condoms since 2004, and H.I.V. has not been transmitted on a set once.

Outside the world of pornography, the industry’s testing regimen is not well known, and no serious academic study of it has ever been done. But when it was described to several AIDS experts, they all reacted by saying that there were far fewer infections than they would have expected, given how much high-risk sex takes place.

“I don’t think there’s any question that it works,” said Dr. Allan Ronald, a Canadian AIDS specialist who did landmark studies of the virus in prostitutes in a Nairobi slum. “I’m a little uncomfortable, because it’s giving the wrong message — that you can have multiple sex partners without condoms — but I can’t say it doesn’t work.”

Despite the regimen’s apparent success, California health officials and an advocacy group, the AIDS Healthcare Foundation, are trying to make it illegal to shoot without condoms. They argue that other sexually transmitted diseases are rampant in the industry, though the industry trade group disputes that.

In January, the city of Los Angeles passed a law requiring actors to wear condoms. A measure to do the same for the whole county is on the ballot on Tuesday.

Producers say the condom requirement will drive them out of business since consumers will not buy such films. Local newspapers like The Los Angeles Times oppose the ballot measure, calling it well-intentioned but unenforceable, and warning that it could drive up to 10,000 jobs out of state.

Very frequent testing makes it almost impossible for an actor to stay infected without being caught, said Dr. Jacques Pepin, the author of “The Origins of AIDS” and an expert on transmission rates. “And if you are having sex mostly with people who themselves are tested all the time, this must further reduce the risk.”

When the virus first enters a high-risk group like heroin users, urban prostitutes or habitués of gay bathhouses, it usually infects 30 to 60 percent of the cohort within a few years, studies have shown. The same would be expected in pornography, where performers can have more than a dozen partners a month, but the industry says self-policing has prevented it.

“Our talent base has sex exponentially more than other people, but we’re all on the same page about keeping it out,” said Steven Hirsch, the founder of Vivid Entertainment, one of the biggest studios.

Performers have to test negative every 28 days, although some studios recently switched to every 14.

If a test is positive, all the studios across the country that adhere to standards set by the Free Speech Coalition, an industry trade group, are obliged to stop filming until all the on-screen partners of that performer, all their partners, and all their partners’ partners, are found and retested. In 2004, the industry shut down for three months to do that.

It has had briefer shutdowns in each of the last four years.

In 2009 and 2010, no other infected performers were found. Coalition representatives said an infected woman in 2009, from Nevada, may have had an infected boyfriend, and offered evidence that a man infected in 2010 in Florida had worked outside the industry as a prostitute. The 2011 test was a false positive.

A shutdown in August came after several actors got syphilis, not H.I.V. All performers were given a choice: Take antibiotics, or pass two back-to-back syphilis tests 14 days apart.

Read More..

Unlikely Model for H.I.V. Prevention: Adult Film Industry

Stephanie Diani for The New York Times

INDUSTRY DATABASE Shylar Cobi, right, a film producer, confirmed test results of the actors who perform as James Deen and Stoya.

LOS ANGELES — Before they take off all their clothes, the actors who perform as James Deen and Stoya go through a ritual unique to the heterosexual adult film industry.

First, they show each other their cellphones: Each has an e-mail from a laboratory saying he or she just tested negative for H.I.V., syphilis, chlamydia and gonorrhea.

Then they sit beside the film’s producer, Shylar Cobi, as he checks an industry database with their real names to confirm that those negative tests are less than 15 days old.

Then, out on the pool terrace of the day’s set — a music producer’s hilltop home with a view of the Hollywood sign — they yank down their pants and stand around joking as Mr. Cobi quickly inspects their mouths, hands and genitals for sores.

“I’m not a doctor,” Mr. Cobi, who wears a pleasantly sheepish grin, says. “I’m only qualified to do this because I’ve been shooting porn since 1990 and I know what looks bad.”

Bizarre as the ritual is, it seems to work.

The industry’s medical consultants say that about 350,000 sex scenes have been shot without condoms since 2004, and H.I.V. has not been transmitted on a set once.

Outside the world of pornography, the industry’s testing regimen is not well known, and no serious academic study of it has ever been done. But when it was described to several AIDS experts, they all reacted by saying that there were far fewer infections than they would have expected, given how much high-risk sex takes place.

“I don’t think there’s any question that it works,” said Dr. Allan Ronald, a Canadian AIDS specialist who did landmark studies of the virus in prostitutes in a Nairobi slum. “I’m a little uncomfortable, because it’s giving the wrong message — that you can have multiple sex partners without condoms — but I can’t say it doesn’t work.”

Despite the regimen’s apparent success, California health officials and an advocacy group, the AIDS Healthcare Foundation, are trying to make it illegal to shoot without condoms. They argue that other sexually transmitted diseases are rampant in the industry, though the industry trade group disputes that.

In January, the city of Los Angeles passed a law requiring actors to wear condoms. A measure to do the same for the whole county is on the ballot on Tuesday.

Producers say the condom requirement will drive them out of business since consumers will not buy such films. Local newspapers like The Los Angeles Times oppose the ballot measure, calling it well-intentioned but unenforceable, and warning that it could drive up to 10,000 jobs out of state.

Very frequent testing makes it almost impossible for an actor to stay infected without being caught, said Dr. Jacques Pepin, the author of “The Origins of AIDS” and an expert on transmission rates. “And if you are having sex mostly with people who themselves are tested all the time, this must further reduce the risk.”

When the virus first enters a high-risk group like heroin users, urban prostitutes or habitués of gay bathhouses, it usually infects 30 to 60 percent of the cohort within a few years, studies have shown. The same would be expected in pornography, where performers can have more than a dozen partners a month, but the industry says self-policing has prevented it.

“Our talent base has sex exponentially more than other people, but we’re all on the same page about keeping it out,” said Steven Hirsch, the founder of Vivid Entertainment, one of the biggest studios.

Performers have to test negative every 28 days, although some studios recently switched to every 14.

If a test is positive, all the studios across the country that adhere to standards set by the Free Speech Coalition, an industry trade group, are obliged to stop filming until all the on-screen partners of that performer, all their partners, and all their partners’ partners, are found and retested. In 2004, the industry shut down for three months to do that.

It has had briefer shutdowns in each of the last four years.

In 2009 and 2010, no other infected performers were found. Coalition representatives said an infected woman in 2009, from Nevada, may have had an infected boyfriend, and offered evidence that a man infected in 2010 in Florida had worked outside the industry as a prostitute. The 2011 test was a false positive.

A shutdown in August came after several actors got syphilis, not H.I.V. All performers were given a choice: Take antibiotics, or pass two back-to-back syphilis tests 14 days apart.

Read More..

India Ink: Mumbai's Historic Haji Ali Bans Women From Most Sacred Area

An iconic image of Mumbai – the Haji Ali mausoleum, 500 yards off the shoreline in the glittering Arabian sea – attracted controversy Tuesday after a Muslim women’s group said women have been banned from entering the inner tomb.

Barring women from the centuries-old tomb is against the spirit of Islam and against rights enshrined in the Indian constitution, said the group, Bharatiya Muslim Mahila Andolan.

“It’s hurting us not just as women but as citizens of this country,” the group’s founder, Noorjehan Safia Niaz, an activist who focuses on Muslim law and women’s rights, said in a telephone interview.

During a visit to the mausoleum in March 2011, her group, which promotes the development of Muslim women, was able to pray inside the area of the tomb, where the saint Pir Haji Ali Shah Bukhari is buried. Pilgrims typically enter the room, where the saint is buried in the center, to touch the grave and offer prayers and flowers.

When the women’s group came in July, Ms. Niaz said members were denied access to the inner area. “What happened in one year? Who took this decision?” Ms. Niaz said.

Ms. Niaz kicked off a media tour on the topic on Tuesday, after learning other mausoleums in Mumbai had also banned women. Her tour quickly sparked a debate in India about what areas of Muslim religious sites women are, or should be, allowed to visit.

A trustee at the Haji Ali dargah, or tomb, said there have been no recent changes to rules about women’s access to the tomb.

“They can see. They can pray,” said Abdul Sattar Merchant, chairman and managing trustee of the mausoleum. Asked whether women were allowed to enter the room where the saint is buried, called the astana, he said, “What has been happening is continuing.”

Other officials associated with the mausoleum confirmed Tuesday that there was a ban.

“If Islamic scholars have issued a fatwa, in accordance with the Islamic law of Sharia, and have demanded that women not be allowed in dargahs, we have only made a correction,” the news channel NDTV quoted a mausoleum trustee, Rizwan Merchant, as saying. “All that we are requesting to our sisters is not to enter inside the dargah.”

Religious scholars said there is nothing in the Koran, the Muslim holy book, or the Islamic law known as Sharia that bans women from mosques or mausoleums, or from inner tombs, like the one at Haji Ali.

“There’s no such command in the Koran. There’s no such principle in Sharia,” said Asghar Ali Engineer, director of the Institute of Islamic Studies in Mumbai. “This is mere conservatism and upholding patriarchal values.”

Nonetheless, women, except those in the Bora Muslim community, aren’t allowed access to most mosques and many mausoleums in India, although those considered “historical monuments,” like the Taj Mahal or the Jama Masjid, permit women.

Mr. Engineer attributed the lack of access for women in India, and across other areas in South Asia like Pakistan, to a feudal culture. Women in countries outside the subcontinent with large Muslim populations don’t face the same limitation, he said.

“Even today, in Arab countries, women can enter mosques and pray,” he noted.

At Haji Ali, a thread of cut rock connects the tomb and mosque to the Mumbai shore. It has been a scenic draw for locals and pilgrims for decades.

Mr. Merchant, the managing trustee there, said that there were tens of thousands of men and women pouring into the mausoleum every day, although women are a fraction of the number of men attending.

“How can we allow women to mix with men?” Mr. Merchant said. He also said that women sometimes didn’t wear burqas, a Muslim veil for women, inside the tomb.

Others worry that the new ban inside the tomb would spread to other mausoleums.

“If it can happen at Haji Ali, it can happen in smaller dargahs also,” said Ms. Niaz. She said that her group has visited about 20 mausoleums in Mumbai and found that seven didn’t allow women inside, although she isn’t sure how many of those always had a policy of banning women.

She said she plans to meet government officials in the coming weeks. “We’ll make this an issue of debate and discussion,” Ms. Niaz said.

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A Media Vow of Election Night Restraint Despite Social Media Clamor

This has been the year of the big media gaffe.

NBC News edited a 911 tape of George Zimmerman in a way that implied race as a factor in the Trayvon Martin shooting. CNN and Fox News falsely reported that the Supreme Court had struck down the individual mandate at the heart of the Obama administration’s health care law. ABC News wrongly suggested a link between a mass shooting in Colorado and the Tea Party. Just last week during the storm, CNN repeated a false rumor about flooding at the New York Stock Exchange.

Now the media are gearing up for election night, the finale of the year’s biggest story. It’s a chance to regain some credibility — presuming, of course, that television networks and other news organizations get their state-by-state projections right. They all say they will, still mindful of the mistakes made in 2000, when the networks prematurely called Florida for Al Gore and then George W. Bush.

The same precautions that were put in place after 2000 will be in place again this Tuesday. At NBC, for instance, the statisticians at the “decision desk” that makes projections “are literally sealed off from the rest of us,” said Mark Lukasiewicz, the senior vice president of specials for NBC News.

Different this time will be the level of noise on the Web, where armchair and professional pundits alike will react to the election results in real time. On election night in 2008, a few Web sites, including Slate and Time.com, stated the obvious — that Barack Obama was going to win the presidency — well before the TV networks and major newspapers said so. In large part that’s because the networks and newspapers were waiting for the polls to close on the West Coast.

They will abide by the same principle again on Tuesday night, ruling out any such pronouncement before 11 p.m. Eastern. But more Web sites and individual users will most likely try to call the race early, creating a cacophony on social networking sites like Facebook and Twitter.

A memo on Saturday to employees of The Associated Press, the country’s biggest news wire service, asked them to refrain from adding to the noise by posting to Twitter about other news outlets’ calls. “If A.P. has not called a particular state or race, it’s because we have specifically decided not to, based on the expertise and data we have spent years developing,” the memo read.

In calling a state for Mr. Obama or Mitt Romney, news organizations will consider several data sources, including exit poll results and raw vote totals — “a brain trust of data,” said Ingrid Ciprian-Matthews, the vice president for news for CBS News.

Executives at the major networks said in interviews that they don’t expect to be able to project a winner at 11 p.m. this year, given the closeness of the presidential race in several swing states. “I’m not even going to guess what time it will be,” said Marc Burstein, the senior executive producer for special events at ABC News. He predicted an abundance of caution this year because of the trend of early voting in many states.

For election night ABC is uniquely situated in Times Square, which filled up with supporters of Mr. Obama on election night in 2008. This time, too, “I expect a gigantic crowd,” Mr. Burstein said. NBC is expecting the same at Rockefeller Plaza, which it has re-christened Democracy Plaza with exhibits and video screens, just as it did in 2004 and 2008.

All of the executives interviewed said they would be entirely comfortable making projections after their competitors. “In a close contest, we’ll simply wait,” said Sam Feist, the Washington bureau chief for CNN. And all of them cited the journalism chestnut that it’s better to be right than first. “It’s always lovely when the two coincide,” said Ms. Ciprian-Matthews of CBS, “but everybody here is absolutely on the same page: accuracy comes first.”

Fox News did not respond to an interview request.

CNN, which was criticized for crowding its studio with anchors and analysts in 2008, will have more reporters in the field this time, including a half-dozen in Ohio alone. Reprising what it called “ballot cams” on primary nights, CNN will have crews at “key voting and vote-counting locations” in battleground states, Mr. Feist said.

“We proved during the primaries that doing real reporting on those nights can make a difference,” he said.

No matter the outcome, some partisans will claim that the election is illegitimate, if the election year rhetoric is to be believed. Continuing an effort that started in 2004, networks and other news outlets will ask the public to alert them to voter irregularities and allegations of voter suppression. “We have an entire team working on those stories,” Mr. Lukasiewicz of NBC said.

Dozens of news and opinion Web sites will offer essentially live coverage on election night, some with TV-like newscasts and others with live blogs. But the biggest audiences are still expected to tune to the big three broadcast networks, ABC, CBS and NBC, and the big three cable news networks, Fox News, MSNBC and CNN.

Four years ago, Brian Williams was the anchor on NBC, Charles Gibson on ABC and Katie Couric on CBS. Mr. Williams is back for his second presidential election night as anchor, but Mr. Gibson, who retired three years ago, will not; heading the coverage instead will be the pair that sat alongside him in 2008, Diane Sawyer and George Stephanopoulos. Ms. Couric, now of ABC, will join them from time to time with social media reaction — a role that did not exist on the network’s coverage last time.

On CBS, Scott Pelley will anchor his first presidential election night. It’s also the first time for Rachel Maddow, on MSNBC, and Bret Baier and Megyn Kelly, on Fox News. On PBS, Gwen Ifill and Judy Woodruff will make up national television’s first two-woman anchor team on election night.

Half a dozen smaller channels will also have hours of live election talk, as will countless local stations — paid for in part by the revenue from innumerable election ads. Discussing the extent of the coverage, Mr. Feist of CNN said, “You cannot find an available high-definition satellite path for Tuesday night in this country. There are none left. The country is at capacity.”

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Well: Winter Squash Recipes for Health

Some of the more varied vegetables of fall all go by the same name: squash. But as Martha Rose Shulman explains in this week’s Recipes for Health, you can discover new flavors by cooking with a squash of a different color.

This week it’s hard not to think about pumpkins, even though most of you won’t be cooking your jack-o’-lanterns. But along with the pumpkins in bins outside my supermarket, there are as many kabocha squashes, butternuts, acorns and large, squat European pumpkins that the French call potirons.

You can use either butternut or kabocha squash in this week’s recipes, though the two are not identical in texture or flavor. Butternut is a denser, slightly sweeter squash, and kabocha has an earthier flavor. Kabocha squash absorbs flavors beautifully and is especially well suited for salads because of the nice way it absorbs tart dressings.

For more ways to cook with these hardy vegetables, see all of the winter squash Recipes for Health.

Here are five new ways to cook with squash.

Puréed Winter Squash Soup With Ginger: One of the most comforting dishes you can make with winter squash is a puréed soup.

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Lasagna With Roasted Kabocha Squash and Béchamel: No-boil noodles make this rich-tasting lasagna easier to prepare.

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Roasted Beet and Winter Squash Salad With Walnuts: This composed salad sets the colors of the beets and the squash against each other beautifully.

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Winter Squash and Molasses Muffins: Add walnuts and raisins or chopped apricots to personalize these moist muffins.

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Balsamic Roasted Winter Squash and Wild Rice Salad: Tossing the squash with the vinegar before roasting deepens the flavors of both.

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Read More..

Well: Winter Squash Recipes for Health

Some of the more varied vegetables of fall all go by the same name: squash. But as Martha Rose Shulman explains in this week’s Recipes for Health, you can discover new flavors by cooking with a squash of a different color.

This week it’s hard not to think about pumpkins, even though most of you won’t be cooking your jack-o’-lanterns. But along with the pumpkins in bins outside my supermarket, there are as many kabocha squashes, butternuts, acorns and large, squat European pumpkins that the French call potirons.

You can use either butternut or kabocha squash in this week’s recipes, though the two are not identical in texture or flavor. Butternut is a denser, slightly sweeter squash, and kabocha has an earthier flavor. Kabocha squash absorbs flavors beautifully and is especially well suited for salads because of the nice way it absorbs tart dressings.

For more ways to cook with these hardy vegetables, see all of the winter squash Recipes for Health.

Here are five new ways to cook with squash.

Puréed Winter Squash Soup With Ginger: One of the most comforting dishes you can make with winter squash is a puréed soup.

---

Lasagna With Roasted Kabocha Squash and Béchamel: No-boil noodles make this rich-tasting lasagna easier to prepare.

---

Roasted Beet and Winter Squash Salad With Walnuts: This composed salad sets the colors of the beets and the squash against each other beautifully.

---

Winter Squash and Molasses Muffins: Add walnuts and raisins or chopped apricots to personalize these moist muffins.

---

Balsamic Roasted Winter Squash and Wild Rice Salad: Tossing the squash with the vinegar before roasting deepens the flavors of both.

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Read More..

Critic’s Notebook: ‘Start-Ups: Silicon Valley’ and ‘LOLwork’ on Bravo

When word got out about “Start-Ups: Silicon Valley,” the valley started to have conniptions. Among the more clever responses was a tweet by a TechCrunch editor: “Here Comes Silicon Valley Boo Boo.”

Bravo

The siblings Ben and Hermione Way bumble through a presentation after a toga party in “Start-Ups: Silicon Valley.”

Breaking news about the arts, coverage of live events, critical reviews, multimedia and more.

A sortable calendar of noteworthy cultural events in the New York region, selected by Times critics.

Of course the real geeks of Mountain View and Menlo Park are smart enough to know that reality is the last thing to expect from a Bravo reality show. What you expect is manufactured camaraderie and conflict, tears, cleavage and product placement, and when “Start-Ups” begins on Monday night that’s what you’ll get, along with togas and flying cocktails. Any new technology is strictly a rumor, and the only deal making happens between consenting adults at the toga party.

On the basis of a trailer released by Bravo, “Start-Ups” has already been criticized — and rightly so — for focusing on the lovely cityscapes of San Francisco rather than the flat expanses of San Jose, Sunnyvale and the other cities that actually make up Silicon Valley. The pilot has an aerial shot of downtown Mountain View and a few scenes inside the Four Seasons Hotel in East Palo Alto, but the dominant images are panoramic views of the sexier city to the north.

Also more than a little unreal, in Silicon Valley terms, is the homogeneity of the six-member principal cast, which is generally attractive — one woman is a former Milwaukee Bucks dancer — and entirely white; Asians and blacks appear around the edges as friends, bosses and hair and makeup women. Much of the episode is spent establishing the entrepreneurial bona fides of these six as well as the reality-TV personas they wear like wineglass tags: mean, vain, ambitious, alcoholic, gay, British.

That leaves time for just two significant scenes: the party, at which apps, Web sites and online shows (none of the six entrepreneurs plans to make a physical product) take a back seat to fighting, flirting and skimpy costumes; and an actual pitch, by two of the cast, to an actual Silicon Valley venture capitalist, Dave McClure.

The pitch is the episode’s high point, as the brother and sister Ben and Hermione bumble and brazen their way through a disastrous presentation of a health-and-fitness app that doesn’t yet exist. It begins badly when Mr. McClure finds Hermione, post-party, sleeping under a conference table, and doesn’t improve when he learns there is no product to look at, just a few screen shots on a laptop. Ben, whose explanation of the app is cut off by Mr. McClure, provides the pilot’s one laugh-out-loud moment when he huffs, “I found it slightly disrespectful, him just going through the whole thing and making his own judgments.”

Making its debut on Bravo on Wednesday night is “LOLwork,” another reality series set in the digital world. It takes us inside the offices of Cheezburger, a Seattle-based Internet humor publisher built on funny pictures of cats with fractured-English captions, and while its story lines appear to be as staged as those of “Start-Ups,” it has a depressed, workaday vibe that makes it by far the superior show.

“LOLwork” is about real people doing a real job. In the pilot the staff members of Cheezburger (its primary Web site is icanhascheezburger.com) are pitted against one another in a competition that was probably made for TV, but they’re not glamorized. We can see that they’re young, smart, prematurely cynical and fully aware of both the superficiality and profitability of what they do for a living.

In “Start-Ups” the would-be entrepreneurs describe their products in grandiose generalities: “It’s an app to help you live longer and stay fitter,” “It’s an app around personal goals,” “I want other people to have that same satisfaction that I’ve had in changing my life.” In “LOLwork” Ben Huh, the chief executive of Cheezburger, tells the employee whose idea wins the contest, “It was so bad that it was good, and ironically that’s actually the kind of stuff that works on the Internet.” You can practically hear the souls of his workers shriveling.

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Google Casts a Big Shadow on Smaller Web Sites

Annie Tritt for The New York Times

Jeffrey G. Katz, the chief executive of Wize Commerce, seen with employees. He says that about 60 percent of the traffic for the company’s Nextag comparison-shopping site comes from Google.

In a geeky fire drill, engineers and outside consultants at Nextag scrambled to see if the problem was its own fault. Maybe some inadvertent change had prompted Google’s algorithm to demote Nextag when a person typed in shopping-related search terms like “kitchen table” or “lawn mower.”

But no, the engineers determined. And traffic from Google’s search engine continued to decline, by half.

Nextag’s response? It doubled its spending on Google paid search advertising in the last five months.

The move was costly but necessary to retain shoppers, Mr. Katz says, because an estimated 60 percent of Nextag’s traffic comes from Google, both from free search and paid search ads, which are ads that are related to search results and appear next to them. “We had to do it,” says Mr. Katz, chief executive of Wize Commerce, owner of Nextag. “We’re living in Google’s world.”

Regulators in the United States and Europe are conducting sweeping inquiries of Google, the dominant Internet search and advertising company. Google rose by technological innovation and business acumen; in the United States, it has 67 percent of the search market and collects 75 percent of search ad dollars. Being big is no crime, but if a powerful company uses market muscle to stifle competition, that is an antitrust violation.

So the government is focusing on life in Google’s world for the sprawling economic ecosystem of Web sites that depend on their ranking in search results. What is it like to live this way, in a giant’s shadow? The experience of its inhabitants is nuanced and complex, a blend of admiration and fear.

The relationship between Google and Web sites, publishers and advertisers often seems lopsided, if not unfair. Yet Google has also provided and nurtured a landscape of opportunity. Its ecosystem generates $80 billion a year in revenue for 1.8 million businesses, Web sites and nonprofit organizations in the United States alone, it estimates.

The government’s scrutiny of Google is the most exhaustive investigation of a major corporation since the pursuit of Microsoft in the late 1990s.

The staff of the Federal Trade Commission has recommended preparing an antitrust suit against Google, according to people briefed on the inquiry, who spoke on the condition they not be identified. But the commissioners must vote to proceed. Even if they do, the government and Google could settle.

Google has drawn the attention of antitrust officials as it has moved aggressively beyond its dominant product — search and search advertising — into fields like online commerce and local reviews. The antitrust issue is whether Google uses its search engine to favor its offerings like Google Shopping and Google Plus Local over rivals.

For policy makers, Google is a tough call.

“What to do with an attractive monopolist, like Google, is a really challenging issue for antitrust,” says Tim Wu, a professor at Columbia Law School and a former senior adviser to the F.T.C. “The goal is to encourage them to stay in power by continuing to innovate instead of excluding competitors.”

SPEAKING at a Google Zeitgeist conference in Arizona last month, Larry Page, the company’s co-founder and chief executive, said he understood the government scrutiny of his company, given Google’s size and reach. “There’s very many decisions we make that really impact a lot of people,” he acknowledged.

The main reason is that Google is continually adjusting its search algorithm — the smart software that determines the relevance, ranking and presentation of search results, typically links to other Web sites.

Google says it makes the changes to improve its service, and has long maintained that its algorithm weeds out low-quality sites and shows the most useful results, whether or not they link to Google products.

“Our first and highest goal has to be to get the user the information they want as quickly and easily as possible,” says Matt Cutts, leader of the Web spam team at Google.

But Google’s algorithm is secret, and changes can leave Web sites scrambling.

Consider Vote-USA.org, a nonprofit group started in 2003. It provides online information for voters to avoid the frustration of arriving at a polling booth and barely recognizing half the names on the ballot. The site posts free sample ballots for federal, state and local elections with candidates’ pictures, biographies and views on issues.

In the 2004 and 2006 elections, users created tens of thousands of sample ballots. By 2008, traffic had fallen sharply, says Ron Kahlow, who runs Vote-USA.org, because “we dropped off the face of the map on Google.”

As founder of a search-engine optimization company and a recipient of grants that Google gives nonprofits to advertise free, Mr. Kahlow knows a thing or two about how to operate in Google’s world. He pored over Google’s guidelines for Web sites, made changes and e-mailed Google. Yet he received no response.

“I lost all donations to support the operation,” he said. “It was very, very painful.”

A breakthrough came through a personal connection. A friend of Mr. Kahlow knew Ed Black, chief executive of the Computer & Communications Industry Association, whose members include Google. Mr. Black made an inquiry on Mr. Kahlow’s behalf, and a Google engineer investigated.

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Opinion: Seeing Things? Hearing Things? Many of Us Do

HALLUCINATIONS are very startling and frightening: you suddenly see, or hear or smell something — something that is not there. Your immediate, bewildered feeling is, what is going on? Where is this coming from? The hallucination is convincingly real, produced by the same neural pathways as actual perception, and yet no one else seems to see it. And then you are forced to the conclusion that something — something unprecedented — is happening in your own brain or mind. Are you going insane, getting dementia, having a stroke?

In other cultures, hallucinations have been regarded as gifts from the gods or the Muses, but in modern times they seem to carry an ominous significance in the public (and also the medical) mind, as portents of severe mental or neurological disorders. Having hallucinations is a fearful secret for many people — millions of people — never to be mentioned, hardly to be acknowledged to oneself, and yet far from uncommon. The vast majority are benign — and, indeed, in many circumstances, perfectly normal. Most of us have experienced them from time to time, during a fever or with the sensory monotony of a desert or empty road, or sometimes, seemingly, out of the blue.

Many of us, as we lie in bed with closed eyes, awaiting sleep, have so-called hypnagogic hallucinations — geometric patterns, or faces, sometimes landscapes. Such patterns or scenes may be almost too faint to notice, or they may be very elaborate, brilliantly colored and rapidly changing — people used to compare them to slide shows.

At the other end of sleep are hypnopompic hallucinations, seen with open eyes, upon first waking. These may be ordinary (an intensification of color perhaps, or someone calling your name) or terrifying (especially if combined with sleep paralysis) — a vast spider, a pterodactyl above the bed, poised to strike.

Hallucinations (of sight, sound, smell or other sensations) can be associated with migraine or seizures, with fever or delirium. In chronic disease hospitals, nursing homes, and I.C.U.’s, hallucinations are often a result of too many medications and interactions between them, compounded by illness, anxiety and unfamiliar surroundings.

But hallucinations can have a positive and comforting role, too — this is especially true with bereavement hallucinations, seeing the face or hearing the voice of one’s deceased spouse, siblings, parents or child — and may play an important part in the mourning process. Such bereavement hallucinations frequently occur in the first year or two of bereavement, when they are most “needed.”

Working in old-age homes for many years, I have been struck by how many elderly people with impaired hearing are prone to auditory and, even more commonly, musical hallucinations — involuntary music in their minds that seems so real that at first they may think it is a neighbor’s stereo.

People with impaired sight, similarly, may start to have strange, visual hallucinations, sometimes just of patterns but often more elaborate visions of complex scenes or ranks of people in exotic dress. Perhaps 20 percent of those losing their vision or hearing may have such hallucinations.

I was called in to see one patient, Rosalie, a blind lady in her 90s, when she started to have visual hallucinations; the staff psychiatrist was also summoned. Rosalie was concerned that she might be having a stroke or getting Alzheimer’s or reacting to some medication. But I was able to reassure her that nothing was amiss neurologically. I explained to her that if the visual parts of the brain are deprived of actual input, they are hungry for stimulation and may concoct images of their own. Rosalie was greatly relieved by this, and delighted to know that there was even a name for her condition: Charles Bonnet syndrome. “Tell the nurses,” she said, drawing herself up in her chair, “that I have Charles Bonnet syndrome!”

Rosalie asked me how many people had C.B.S., and I told her hundreds of thousands, perhaps, in the United States alone. I told her that many people were afraid to mention their hallucinations. I described a recent study of elderly blind patients in the Netherlands which found that only a quarter of people with C.B.S. mentioned it to their doctors — the others were too afraid or too ashamed. It is only when physicians gently inquire (often avoiding the word “hallucination”) that people feel free to admit seeing things that are not there — despite their blindness.

Rosalie was indignant at this, and said, “You must write about it — tell my story!” I do tell her story, at length, in my book on hallucinations, along with the stories of many others. Most of these people have been reluctant to admit to their hallucinations. Often, when they do, they are misdiagnosed or undiagnosed — told that it’s nothing, or that their condition has no explanation.

Misdiagnosis is especially common if people admit to “hearing voices.” In a famous 1973 study by the Stanford psychologist David Rosenhan, eight “pseudopatients” presented themselves at various hospitals across the country, saying that they “heard voices.” All behaved normally otherwise, but were nonetheless determined to be (and treated as) schizophrenic (apart from one, who was given the diagnosis of “manic-depressive psychosis”). In this and follow-up studies, Professor Rosenhan demonstrated convincingly that auditory hallucinations and schizophrenia were synonymous in the medical mind.

WHILE many people with schizophrenia do hear voices at certain times in their lives, the inverse is not true: most people who hear voices (as much as 10 percent of the population) are not mentally ill. For them, hearing voices is a normal mode of experience.

My patients tell me about their hallucinations because I am open to hearing about them, because they know me and trust that I can usually run down the cause of their hallucinations. For the most part, these experiences are unthreatening and, once accommodated, even mildly diverting.

David Stewart, a Charles Bonnet syndrome patient with whom I corresponded, writes of his hallucinations as being “altogether friendly,” and imagines his eyes saying: “Sorry to have let you down. We recognize that blindness is no fun, so we’ve organized this small syndrome, a sort of coda to your sighted life. It’s not much, but it’s the best we can manage.”

Mr. Stewart has been able to take his hallucinations in good humor, since he knows they are not a sign of mental decline or madness. For too many patients, though, the shame, the secrecy, the stigma, persists.

Oliver Sacks is a professor of neurology at the N.Y.U. School of Medicine and the author, most recently, of the forthcoming book “Hallucinations.”

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Opinion: Seeing Things? Hearing Things? Many of Us Do

HALLUCINATIONS are very startling and frightening: you suddenly see, or hear or smell something — something that is not there. Your immediate, bewildered feeling is, what is going on? Where is this coming from? The hallucination is convincingly real, produced by the same neural pathways as actual perception, and yet no one else seems to see it. And then you are forced to the conclusion that something — something unprecedented — is happening in your own brain or mind. Are you going insane, getting dementia, having a stroke?

In other cultures, hallucinations have been regarded as gifts from the gods or the Muses, but in modern times they seem to carry an ominous significance in the public (and also the medical) mind, as portents of severe mental or neurological disorders. Having hallucinations is a fearful secret for many people — millions of people — never to be mentioned, hardly to be acknowledged to oneself, and yet far from uncommon. The vast majority are benign — and, indeed, in many circumstances, perfectly normal. Most of us have experienced them from time to time, during a fever or with the sensory monotony of a desert or empty road, or sometimes, seemingly, out of the blue.

Many of us, as we lie in bed with closed eyes, awaiting sleep, have so-called hypnagogic hallucinations — geometric patterns, or faces, sometimes landscapes. Such patterns or scenes may be almost too faint to notice, or they may be very elaborate, brilliantly colored and rapidly changing — people used to compare them to slide shows.

At the other end of sleep are hypnopompic hallucinations, seen with open eyes, upon first waking. These may be ordinary (an intensification of color perhaps, or someone calling your name) or terrifying (especially if combined with sleep paralysis) — a vast spider, a pterodactyl above the bed, poised to strike.

Hallucinations (of sight, sound, smell or other sensations) can be associated with migraine or seizures, with fever or delirium. In chronic disease hospitals, nursing homes, and I.C.U.’s, hallucinations are often a result of too many medications and interactions between them, compounded by illness, anxiety and unfamiliar surroundings.

But hallucinations can have a positive and comforting role, too — this is especially true with bereavement hallucinations, seeing the face or hearing the voice of one’s deceased spouse, siblings, parents or child — and may play an important part in the mourning process. Such bereavement hallucinations frequently occur in the first year or two of bereavement, when they are most “needed.”

Working in old-age homes for many years, I have been struck by how many elderly people with impaired hearing are prone to auditory and, even more commonly, musical hallucinations — involuntary music in their minds that seems so real that at first they may think it is a neighbor’s stereo.

People with impaired sight, similarly, may start to have strange, visual hallucinations, sometimes just of patterns but often more elaborate visions of complex scenes or ranks of people in exotic dress. Perhaps 20 percent of those losing their vision or hearing may have such hallucinations.

I was called in to see one patient, Rosalie, a blind lady in her 90s, when she started to have visual hallucinations; the staff psychiatrist was also summoned. Rosalie was concerned that she might be having a stroke or getting Alzheimer’s or reacting to some medication. But I was able to reassure her that nothing was amiss neurologically. I explained to her that if the visual parts of the brain are deprived of actual input, they are hungry for stimulation and may concoct images of their own. Rosalie was greatly relieved by this, and delighted to know that there was even a name for her condition: Charles Bonnet syndrome. “Tell the nurses,” she said, drawing herself up in her chair, “that I have Charles Bonnet syndrome!”

Rosalie asked me how many people had C.B.S., and I told her hundreds of thousands, perhaps, in the United States alone. I told her that many people were afraid to mention their hallucinations. I described a recent study of elderly blind patients in the Netherlands which found that only a quarter of people with C.B.S. mentioned it to their doctors — the others were too afraid or too ashamed. It is only when physicians gently inquire (often avoiding the word “hallucination”) that people feel free to admit seeing things that are not there — despite their blindness.

Rosalie was indignant at this, and said, “You must write about it — tell my story!” I do tell her story, at length, in my book on hallucinations, along with the stories of many others. Most of these people have been reluctant to admit to their hallucinations. Often, when they do, they are misdiagnosed or undiagnosed — told that it’s nothing, or that their condition has no explanation.

Misdiagnosis is especially common if people admit to “hearing voices.” In a famous 1973 study by the Stanford psychologist David Rosenhan, eight “pseudopatients” presented themselves at various hospitals across the country, saying that they “heard voices.” All behaved normally otherwise, but were nonetheless determined to be (and treated as) schizophrenic (apart from one, who was given the diagnosis of “manic-depressive psychosis”). In this and follow-up studies, Professor Rosenhan demonstrated convincingly that auditory hallucinations and schizophrenia were synonymous in the medical mind.

WHILE many people with schizophrenia do hear voices at certain times in their lives, the inverse is not true: most people who hear voices (as much as 10 percent of the population) are not mentally ill. For them, hearing voices is a normal mode of experience.

My patients tell me about their hallucinations because I am open to hearing about them, because they know me and trust that I can usually run down the cause of their hallucinations. For the most part, these experiences are unthreatening and, once accommodated, even mildly diverting.

David Stewart, a Charles Bonnet syndrome patient with whom I corresponded, writes of his hallucinations as being “altogether friendly,” and imagines his eyes saying: “Sorry to have let you down. We recognize that blindness is no fun, so we’ve organized this small syndrome, a sort of coda to your sighted life. It’s not much, but it’s the best we can manage.”

Mr. Stewart has been able to take his hallucinations in good humor, since he knows they are not a sign of mental decline or madness. For too many patients, though, the shame, the secrecy, the stigma, persists.

Oliver Sacks is a professor of neurology at the N.Y.U. School of Medicine and the author, most recently, of the forthcoming book “Hallucinations.”

Read More..