The New Old Age Blog: Hospital Alarms Fail to Prevent Injury, Study Finds

When it comes to protecting older people from falls, it can take a long time to figure out what helps and sometimes an even longer time to take action against things that were supposed to help but don’t.

A case in point: the so-called safety rails on hospital and nursing home beds. Their hazards, as The New Old Age reported more than two years ago, are well documented. They are intended to keep sick, drugged or confused people from climbing or falling out of bed. What they actually do is make falls more dangerous; they also trap patients between the rails and the mattress until they asphyxiate, causing hundreds of deaths annually.

The Consumer Product Safety Commission is finally investigating these hazards, with findings due soon.

Alarms — sensors that alert aides or nurses when someone at risk of falling attempts to get out of bed or up from a chair or toilet — sound better, right? Lots of health care facilities thought so.

Use of these alarms has increased “over the past 10 or 15 years as the problems of physical restraints and bed rails became better known,” said Ronald Shorr, who directs geriatric research at the V.A. Medical Center in Gainesville, Fla. “This was the next wave in fall prevention.”

The trouble is, hospital bed alarms don’t appear to reduce falls, according to the study that Dr. Shorr just published in The Annals of Internal Medicine.

Lots of patients, of all ages, fall in hospitals, and about a quarter of those falls cause injuries. They also cost hospitals money, because Medicare will no longer reimburse facilities for treating injuries from falls that in theory shouldn’t have happened.

Though there aren’t statistics on the number of systems, it is rare these days to find a large hospital that doesn’t use alarms, in some cases built right into the beds.

Yet “their efficacy hadn’t been established,” Dr. Shorr told me in an interview. The few studies that reported reduced falls from alarms were small, lacked control groups, or didn’t continue for very long. Dr. Shorr and his colleagues set out to remedy those shortcomings.

Over 18 months, they documented falls among patients in 16 medical and surgical units, with a combined 349 beds, at Methodist Healthcare-University Hospital in Memphis, Tenn. Half those units were randomly designated “usual care.” In the other eight, the “intervention” units, Dr. Shorr and study coordinator Michelle Chandler held repeated education sessions to explain the alarms — in this case, flexible pads made by Bed-Ex and widely-used — and demonstrate their use in beds and on chairs and commode seats.

Ms. Chandler visited the intervention units daily — the staff started calling her “Mrs. Falls” — and even brought fresh alarm pads and help set them up to encourage their use.

The intervention worked, in that those units used the alarms far more often. But when the researchers tallied up the falls among the 27,672 patients (half of them over age 63) in these units — controlling for many variables, including not only demographic factors but staffing levels and psychotropic drug regimens — they found the alarms had no significant effect.

Patients in the units that used alarms more heavily fell just as often as patients in the control units that used alarms much less frequently. (The numbers: 5.62 falls per 1,000 patient-days, a measure of how many people spent how long in the hospital, versus 4.56 falls in the control units, not a statistically significant difference.)

There were no fewer injuries in the more-alarmed units, nor any less use of physical restraints.

There were likely higher costs, though. A Bed-Ex monitor and cables cost about $350 at the time, and each disposable sensor pad cost $23.

Why didn’t the alarms help? Dr. Shorr hypothesized that the staff developed what he called alarm fatigue. “How many times a week do you hear a car alarm go off?” he asked. “You become desensitized.”

But it is also possible, he said, that when the alarms sounded and the nurses scampered, “the patients who weren’t alarmed fell more often.”

My own 2 cents: If an alarm sounds when someone stirs, is any hospital or nursing home so well-staffed that someone can materialize within seconds? Does a staff become less vigilant when patients have alarms and are presumed – wrongly, it seems – to be safer?

Nursing homes also frequently use alarms, and while this hospital data might not apply in another setting, Dr. Shorr said his findings made him skeptical about their effectiveness there, too.

So we probably shouldn’t feel reassured about our elders’ safety when they are in a hospital, alarms or no alarms. Even younger people, recovering from surgery and feeling the effects of anesthesia or sedatives, can and do fall.

“The more eyes on your loved one, the better,” said Dr. Shorr. “And it’s best if they’re your eyes.”

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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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The New Old Age Blog: Hospital Alarms Fail to Prevent Injury, Study Finds

When it comes to protecting older people from falls, it can take a long time to figure out what helps and sometimes an even longer time to take action against things that were supposed to help but don’t.

A case in point: the so-called safety rails on hospital and nursing home beds. Their hazards, as The New Old Age reported more than two years ago, are well documented. They are intended to keep sick, drugged or confused people from climbing or falling out of bed. What they actually do is make falls more dangerous; they also trap patients between the rails and the mattress until they asphyxiate, causing hundreds of deaths annually.

The Consumer Product Safety Commission is finally investigating these hazards, with findings due soon.

Alarms — sensors that alert aides or nurses when someone at risk of falling attempts to get out of bed or up from a chair or toilet — sound better, right? Lots of health care facilities thought so.

Use of these alarms has increased “over the past 10 or 15 years as the problems of physical restraints and bed rails became better known,” said Ronald Shorr, who directs geriatric research at the V.A. Medical Center in Gainesville, Fla. “This was the next wave in fall prevention.”

The trouble is, hospital bed alarms don’t appear to reduce falls, according to the study that Dr. Shorr just published in The Annals of Internal Medicine.

Lots of patients, of all ages, fall in hospitals, and about a quarter of those falls cause injuries. They also cost hospitals money, because Medicare will no longer reimburse facilities for treating injuries from falls that in theory shouldn’t have happened.

Though there aren’t statistics on the number of systems, it is rare these days to find a large hospital that doesn’t use alarms, in some cases built right into the beds.

Yet “their efficacy hadn’t been established,” Dr. Shorr told me in an interview. The few studies that reported reduced falls from alarms were small, lacked control groups, or didn’t continue for very long. Dr. Shorr and his colleagues set out to remedy those shortcomings.

Over 18 months, they documented falls among patients in 16 medical and surgical units, with a combined 349 beds, at Methodist Healthcare-University Hospital in Memphis, Tenn. Half those units were randomly designated “usual care.” In the other eight, the “intervention” units, Dr. Shorr and study coordinator Michelle Chandler held repeated education sessions to explain the alarms — in this case, flexible pads made by Bed-Ex and widely-used — and demonstrate their use in beds and on chairs and commode seats.

Ms. Chandler visited the intervention units daily — the staff started calling her “Mrs. Falls” — and even brought fresh alarm pads and help set them up to encourage their use.

The intervention worked, in that those units used the alarms far more often. But when the researchers tallied up the falls among the 27,672 patients (half of them over age 63) in these units — controlling for many variables, including not only demographic factors but staffing levels and psychotropic drug regimens — they found the alarms had no significant effect.

Patients in the units that used alarms more heavily fell just as often as patients in the control units that used alarms much less frequently. (The numbers: 5.62 falls per 1,000 patient-days, a measure of how many people spent how long in the hospital, versus 4.56 falls in the control units, not a statistically significant difference.)

There were no fewer injuries in the more-alarmed units, nor any less use of physical restraints.

There were likely higher costs, though. A Bed-Ex monitor and cables cost about $350 at the time, and each disposable sensor pad cost $23.

Why didn’t the alarms help? Dr. Shorr hypothesized that the staff developed what he called alarm fatigue. “How many times a week do you hear a car alarm go off?” he asked. “You become desensitized.”

But it is also possible, he said, that when the alarms sounded and the nurses scampered, “the patients who weren’t alarmed fell more often.”

My own 2 cents: If an alarm sounds when someone stirs, is any hospital or nursing home so well-staffed that someone can materialize within seconds? Does a staff become less vigilant when patients have alarms and are presumed – wrongly, it seems – to be safer?

Nursing homes also frequently use alarms, and while this hospital data might not apply in another setting, Dr. Shorr said his findings made him skeptical about their effectiveness there, too.

So we probably shouldn’t feel reassured about our elders’ safety when they are in a hospital, alarms or no alarms. Even younger people, recovering from surgery and feeling the effects of anesthesia or sedatives, can and do fall.

“The more eyes on your loved one, the better,” said Dr. Shorr. “And it’s best if they’re your eyes.”

---

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

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Moscow Journal: Russian Web Site Roszkh Fights Corruption Through Housing

MOSCOW — Not since Joe the Plumber have contractors taken on such political overtones.

In a city where it is often impossible to get a plumber or any other repairman, somebody just figured out how to fix the pipes — and replace light bulbs, scrub off graffiti and patch leaky roofs. Throughout Moscow and other Russian cities, such elementary building repairs are suddenly in full swing as the city’s craftsmen, their reputations for surliness, laziness and drunkenness undiminished, are hurrying from one appointment to another.

Delighted Muscovites are crediting a new Web site for the unaccustomed Calvinist work ethic. Called Roszkh, it streamlines the process for filing complaints about maintenance of the communal areas of apartment buildings, like hallways and entryways, that remained public property after post-Soviet privatizations.

Stymied by a loss of momentum after street protests, Russian opposition leaders had been casting about for other approaches to remain relevant through what promises to be a long tenure for President Vladimir V. Putin. Aleksei Navalny, a blogger and political activist, hit upon the idea of the Web site, which is run under the auspices of his Foundation for Fighting Corruption.

“It’s difficult to say when the next wave of protests will come,” Mr. Navalny said in an interview about his new site, named after an acronym Russians use for their combined utility and building maintenance bills, ZhKKh.

Roszkh was an instant sensation. Since the site went up on Nov. 8, 28,354 users have filed 45,835 complaints, mostly in Moscow and other large cities. So far, repairmen have fixed about 2,600 reported problems. That may not sound like much, but in Russia it qualifies as extraordinary.

“I live in an old five-story building where the hallway has no light and no windows,” one Muscovite, Boris Frantskevich, wrote in a post. It seemed it would be that way forever. But on a lark, he tried logging a complaint on the Web site.

“Just today, I walk out of my apartment and an electrician is digging in the wires,” Mr. Frantskevich wrote. “Wow, he’s fixed the light.”

Mr. Navalny attributes the site’s success to official sensitivities to a deep vein of public anger over the deplorable state of housing in Russia, and particularly in Moscow. In a leaked letter, Russia’s chief housing inspector issued an order that the complaints on Mr. Navalny’s Web site be addressed immediately.

The inspector, Nikolai Vasyutin, clarified the government response in a letter to subordinates: Applicants needed to be helped immediately, not in spite of the site’s political character, but because of it.

“It’s become obvious this is a policy by the opposition to discredit all levels of the government,” the letter said. “But this shouldn’t confuse the organs of the state housing inspection.” It instructed city officials to counteract the tactic by fixing problems quickly.

Public opinion surveys indicate that the steady rise in ZhKKh fees is the issue that upsets Russians most; a planned increase was delayed during presidential elections last winter, only to kick in this year.

The fees have been rising faster than inflation. Many Russians are incensed about paying more — currently about $130 a month in Moscow, and less in other cities — while hallways, even in upscale buildings, are often yawning black tunnels, splattered with graffiti and reeking of septic odors.

These problems have become a vulnerability for Mr. Putin, but one largely of his own making. The governing political party, United Russia, went to great pains to ensure that it dominated not only national but also regional and local politics, often suppressing opponents to do so. The party also dominates city councils.

As Mr. Navalny, a former real estate lawyer, has been gleefully pointing out, this means that every broken light bulb and burst pipe is now the party’s problem.

“We are trying to attract people who can fight corruption together with us,” Mr. Navalny said. “It’s clear that an ordinary person has a hard time helping us fight corruption at Gazprom,” the big state energy company. “But unfortunately in Russia, corruption surrounds a person everywhere. We are trying to create a mechanism for people to fight corruption themselves.”

The site asks users to enter their address and choose from a menu of common Russian repair problems: water flowing a rich orange color from rusted pipes, say, or a boiler failing in midwinter.

The program then automatically pastes on a lengthy legal text composed by Mr. Navalny and his volunteer group of lawyers for the benefit of the receiving bureaucrat, citing ordinances that mandate a response or repair, usually within 45 days.

The site automatically routes complaints to the appropriate municipal authority in thousands of cities in Russia’s 83 regions. So far, though, Muscovites and residents of a few other large cities where Internet use is high have filed most of the complaints.

The site is easy to use. It saves profiles, allowing angry Russians to return whenever they have another leaky pipe or a new buildup of filth in a hallway.

In St. Petersburg, building inspectors initially declined to respond to several thousand complaints generated on the site. Whether that was for political reasons or out of laziness remains unclear.

But by early December, the office was working overtime to fix communal areas, and a housing maintenance official had been arrested for mismanagement, one of several moves by the government in an apparent effort to get ahead of the issue.

Even as complaints pile up, site moderators urge users to keep on filing.

One man, Sergei Sadko, wrote that an entire delegation of city officials promptly visited his apartment after he complained about a leaky roof.

“They said they would fix it in the spring,” he wrote. “Should I change my status to ‘problem solved’?”

The response: “File another complaint. They are required to fix everything immediately.”

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Gadgetwise Blog: Q&A: Getting YouTube on the TV Screen

How do you play YouTube videos on TV if you don’t have an iPad or an Apple TV?

Getting YouTube to play on the TV depends on the hardware you have. If you have a computer, you can connect it to the TV with compatible audio-video cables (just like you would a DVD player) and then switch the display input source on the TV to the computer. You can then select and play the YouTube videos on the computer and watch on the connected TV screen.

The exact cables you need for this depend on what connections are on your TV and computer. If you have fairly new devices, you might be able to link the computer to the TV with an HDMI cable. For older gear, VGA and audio cables can connect the two, as long as your computer’s video card can handle it. To see what you need, check the audio and video ports on the back of both the TV and the computer and buy matching cables.

YouTube is so popular that it has turned up on a number of other devices besides the Apple TV. Some TiVo video recorders offer a built-in YouTube channel, as does the Boxee Box and Google TV devices, among many others.

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Another Look at a Drink Ingredient, Brominated Vegetable Oil

James Edward Bates for The New York Times

Sarah Kavanagh, 15, of Hattiesburg, Miss., started an online petition asking PepsiCo to change Gatorade’s formula.

Sarah Kavanagh and her little brother were looking forward to the bottles of Gatorade they had put in the refrigerator after playing outdoors one hot, humid afternoon last month in Hattiesburg, Miss.

But before she took a sip, Sarah, a dedicated vegetarian, did what she often does and checked the label to make sure no animal products were in the drink. One ingredient, brominated vegetable oil, caught her eye.

“I knew it probably wasn’t from an animal because it had vegetable in the name, but I still wanted to know what it was, so I Googled it,” Ms. Kavanagh said. “A page popped up with a long list of possible side effects, including neurological disorders and altered thyroid hormones. I didn’t expect that.”

She threw the product away and started a petition on Change.org, a nonprofit Web site, that has almost 200,000 signatures. Ms. Kavanagh, 15, hopes her campaign will persuade PepsiCo, Gatorade’s maker, to consider changing the drink’s formulation.

Jeff Dahncke, a spokesman for PepsiCo, noted that brominated vegetable oil had been deemed safe for consumption by federal regulators. “As standard practice, we constantly evaluate our formulas and ingredients to ensure they comply with federal regulations and meet the high quality standards our consumers and athletes expect — from functionality to great taste,” he said in an e-mail.

In fact, about 10 percent of drinks sold in the United States contain brominated vegetable oil, including Mountain Dew, also made by PepsiCo; Powerade, Fanta Orange and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

The ingredient is added often to citrus drinks to help keep the fruit flavoring evenly distributed; without it, the flavoring would separate.

Use of the substance in the United States has been debated for more than three decades, so Ms. Kavanagh’s campaign most likely is quixotic. But the European Union has long banned the substance from foods, requiring use of other ingredients. Japan recently moved to do the same.

“B.V.O. is banned other places in the world, so these companies already have a replacement for it,” Ms. Kavanagh said. “I don’t see why they don’t just make the switch.” To that, companies say the switch would be too costly.

The renewed debate, which has brought attention to the arcane world of additive regulation, comes as consumers show increasing interest in food ingredients and have new tools to learn about them. Walmart’s app, for instance, allows access to lists of ingredients in foods in its stores.

Brominated vegetable oil contains bromine, the element found in brominated flame retardants, used in things like upholstered furniture and children’s products. Research has found brominate flame retardants building up in the body and breast milk, and animal and some human studies have linked them to neurological impairment, reduced fertility, changes in thyroid hormones and puberty at an earlier age.

Limited studies of the effects of brominated vegetable oil in animals and in humans found buildups of bromine in fatty tissues. Rats that ingested large quantities of the substance in their diets developed heart lesions.

Its use in foods dates to the 1930s, well before Congress amended the Food, Drug and Cosmetic Act to add regulation of new food additives to the responsibilities of the Food and Drug Administration. But Congress exempted two groups of additives, those already sanctioned by the F.D.A. or the Department of Agriculture, or those experts deemed “generally recognized as safe.”

The second exemption created what Tom Neltner, director of the Pew Charitable Trusts’ food additives project, a three-year investigation into how food additives are regulated, calls “the loophole that swallowed the law.” A company can create a new additive, publish safety data about it on its Web site and pay a law firm or consulting firm to vet it to establish it as “generally recognized as safe” — without ever notifying the F.D.A., Mr. Neltner said.

About 10,000 chemicals are allowed to be added to foods, about 3,000 of which have never been reviewed for safety by the F.D.A., according to Pew’s research. Of those, about 1,000 never come before the F.D.A. unless someone has a problem with them; they are declared safe by a company and its handpicked advisers.

“I worked on the industrial and consumer products side of things in the past, and if you take a new chemical and put it into, say, a tennis racket, you have to notify the E.P.A. before you put it in,” Mr. Neltner said, referring to the Environmental Protection Agency. “But if you put it into food and can document it as recognized as safe by someone expert, you don’t have to tell the F.D.A.”

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Another Look at a Drink Ingredient, Brominated Vegetable Oil

James Edward Bates for The New York Times

Sarah Kavanagh, 15, of Hattiesburg, Miss., started an online petition asking PepsiCo to change Gatorade’s formula.

Sarah Kavanagh and her little brother were looking forward to the bottles of Gatorade they had put in the refrigerator after playing outdoors one hot, humid afternoon last month in Hattiesburg, Miss.

But before she took a sip, Sarah, a dedicated vegetarian, did what she often does and checked the label to make sure no animal products were in the drink. One ingredient, brominated vegetable oil, caught her eye.

“I knew it probably wasn’t from an animal because it had vegetable in the name, but I still wanted to know what it was, so I Googled it,” Ms. Kavanagh said. “A page popped up with a long list of possible side effects, including neurological disorders and altered thyroid hormones. I didn’t expect that.”

She threw the product away and started a petition on Change.org, a nonprofit Web site, that has almost 200,000 signatures. Ms. Kavanagh, 15, hopes her campaign will persuade PepsiCo, Gatorade’s maker, to consider changing the drink’s formulation.

Jeff Dahncke, a spokesman for PepsiCo, noted that brominated vegetable oil had been deemed safe for consumption by federal regulators. “As standard practice, we constantly evaluate our formulas and ingredients to ensure they comply with federal regulations and meet the high quality standards our consumers and athletes expect — from functionality to great taste,” he said in an e-mail.

In fact, about 10 percent of drinks sold in the United States contain brominated vegetable oil, including Mountain Dew, also made by PepsiCo; Powerade, Fanta Orange and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

The ingredient is added often to citrus drinks to help keep the fruit flavoring evenly distributed; without it, the flavoring would separate.

Use of the substance in the United States has been debated for more than three decades, so Ms. Kavanagh’s campaign most likely is quixotic. But the European Union has long banned the substance from foods, requiring use of other ingredients. Japan recently moved to do the same.

“B.V.O. is banned other places in the world, so these companies already have a replacement for it,” Ms. Kavanagh said. “I don’t see why they don’t just make the switch.” To that, companies say the switch would be too costly.

The renewed debate, which has brought attention to the arcane world of additive regulation, comes as consumers show increasing interest in food ingredients and have new tools to learn about them. Walmart’s app, for instance, allows access to lists of ingredients in foods in its stores.

Brominated vegetable oil contains bromine, the element found in brominated flame retardants, used in things like upholstered furniture and children’s products. Research has found brominate flame retardants building up in the body and breast milk, and animal and some human studies have linked them to neurological impairment, reduced fertility, changes in thyroid hormones and puberty at an earlier age.

Limited studies of the effects of brominated vegetable oil in animals and in humans found buildups of bromine in fatty tissues. Rats that ingested large quantities of the substance in their diets developed heart lesions.

Its use in foods dates to the 1930s, well before Congress amended the Food, Drug and Cosmetic Act to add regulation of new food additives to the responsibilities of the Food and Drug Administration. But Congress exempted two groups of additives, those already sanctioned by the F.D.A. or the Department of Agriculture, or those experts deemed “generally recognized as safe.”

The second exemption created what Tom Neltner, director of the Pew Charitable Trusts’ food additives project, a three-year investigation into how food additives are regulated, calls “the loophole that swallowed the law.” A company can create a new additive, publish safety data about it on its Web site and pay a law firm or consulting firm to vet it to establish it as “generally recognized as safe” — without ever notifying the F.D.A., Mr. Neltner said.

About 10,000 chemicals are allowed to be added to foods, about 3,000 of which have never been reviewed for safety by the F.D.A., according to Pew’s research. Of those, about 1,000 never come before the F.D.A. unless someone has a problem with them; they are declared safe by a company and its handpicked advisers.

“I worked on the industrial and consumer products side of things in the past, and if you take a new chemical and put it into, say, a tennis racket, you have to notify the E.P.A. before you put it in,” Mr. Neltner said, referring to the Environmental Protection Agency. “But if you put it into food and can document it as recognized as safe by someone expert, you don’t have to tell the F.D.A.”

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Deal Professor: In Netflix Case, a Chance to Re-examine Old Rules

Netflix is in the Securities and Exchange Commission’s sights over a post on Facebook by Reed Hastings, its chief executive, saying that the video streaming company’s monthly viewing had reached a billion hours. Yet, the case is more convincing as an illustration of how the regulator clings to outdated notions of how markets work.

In July, Mr. Hastings posted three lines stating that “Netflix monthly viewing exceeded 1 billion hours for the first time ever in June.”

While his comments may have seemed as innocuous as yet another Facebook post about cats, for the S.E.C., it was something more sinister, a violation of Regulation FD.

Regulation FD was the brainchild of Arthur Levitt, a former chairman of the commission. During Mr. Levitt’s time, companies would often disclose earnings estimates and other important information not to the markets but to select analysts. Companies did so to preserve confidentiality and drip out earnings information gently to the markets, and in that way avoid the volatility associated with a single announcement.

For Mr. Levitt, this was heresy. He believed not only in disclosure, but in the principle that all investors should have equal access to company information. Regulation FD was the answer.

In general, Regulation FD says that when a public company gives material nonpublic information to anyone, the company must also publicly disclose that information to all investors. Regulation FD in that way prevents selective leaks and, according to the S.E.C., promotes “full and fair disclosure.”

It seems so simple. How can more disclosure be bad? But both public companies and investment banks argued that the rule would actually reduce the flow information, as companies, now forbidden from disclosing only to analysts, would simply choose not to release the information. And because analysts would no longer have that advantage in knowledge, their value would be harder to justify, resulting in fewer analysts. Stockholders would be worse off as less information was in the market.

The S.E.C. disputed these arguments, and Regulation FD went into effect over a decade ago.

Subsequent studies of Regulation FD’s effects have shown that the critics may have been right. One of the most-cited studies found that analyst coverage of smaller companies dropped. And since there was now less information in the market about these smaller companies, investors subsequently demanded a bigger premium to invest, increasing financing costs. Another study found that the introduction of Regulation FD increased market volatility because information was no longer informally spread. In fairness, some studies found different results, but the bulk of findings are that Regulation FD is at best unhelpful.

Despite these studies and companies’ complaints about the costs of compliance, the S.E.C. has stuck to the rule. Until the Netflix case, however, the agency appeared to try to keep the peace by seeking redress in only the most egregious cases.

In all, there have been only about a dozen Regulation FD cases since its adoption, including one against Office Depot in 2010, for which it was fined $1 million for hinting its earnings estimates to analysts. But while enforcement actions have been rare, it has required that companies fundamentally change the way they disclose information.

Then Netflix came along.

The S.E.C.’s case appears to be rest on much weaker grounds than previous ones involving Regulation FD. To make a Regulation FD claim, the agency must show the information was released privately and that it was material. But neither element seems certain here.

Mr. Hastings’s announcement that the milestone of one billion hours was achieved seems more like a public relations stunt than a disclosure of material information. And Netflix had previously said that it was close to this milestone, so followers knew it was coming.

But while it seems like this information was a nonevent, this post occurred as Netflix’s stock was beginning to rise, and by two trading days later, it had jumped almost 20 percent. While some may view this as proof of the post’s materiality, it is hard to read too much; Netflix shares can be volatile, and a Citigroup analysts’ report released during that time could have also moved the stock.

Then there is the issue of whether this was privately disclosed information.

Some have seized on this requirement to claim that the S.E.C. is in essence saying that Facebook is not a “public” Web site. This is laughable; after all, Mr. Hastings is popular — he has more than 200,000 subscribers to his Facebook account. It is certain that more people read this comment on Facebook than if it had been in an S.E.C. filing.

But the S.E.C.’s argument is likely to be more technical than saying Facebook is private. In a 2008 release on Web site disclosure, the S.E.C. asserted that a Web site or a blog could be public for Regulation FD purposes but only if it was a “recognized channel of distribution of information. ”

In other words, a public disclosure is not about being public but about being made where investors knew the company regularly released investor information.

So the S.E.C. is likely to sidestep the issue of Facebook’s “public” nature and simply argue that Netflix never alerted investors that Facebook was the place to find Netflix’s investor information. Mr. Hastings appeared to concede this, and in a Facebook post last week, he argued that while Facebook was “very public,” it was not where the company regularly released information. If this dispute goes forward, expect the parties to spend thousands of hours arguing about whether the post contained material information rather than whether Facebook is public.

But it all seems so silly and technical and shows the S.E.C.’s fetish of trying to control company disclosure to the nth degree. It’s easy to criticize the agency for not understanding social media, but I would argue that in trying to bring a rare Regulation FD enforcement action, it truly missed an opportunity. Rather than focus on technicalities that few people understand, it could have used this case to examine what it means to be public and how social media results in more, not less, disclosure.

If the idea behind Regulation FD is to encourage disclosure, then allowing executives to comment freely on Facebook and Twitter, recognizing them as a public space akin to a news release, is almost certain to result in more disclosure, not less, and reach many more people than an S.E.C. filing would. The agency’s position will only force executives to check with lawyers and avoid social media, chilling disclosure.

And this leads to the bigger issue. Regulation FD was always about principles of fairness that belied the economics of the rule. If the S.E.C. really wanted to encourage disclosure, then it might want to take a step back and consider whether after a decade, Regulation FD is worth all the costs. Perhaps shareholders would even prefer more disclosure on Facebook and fewer regulatory filings. I suspect they might, if it meant more information and generally higher share prices.

In any event, this case still has a way to go. Netflix disclosed only the receipt of a Wells notice, which meant the S.E.C. staff was recommending to the commissioners that an enforcement action be brought. It is now up to the commissioners to decide. Given the issues with this case, they may decide it isn’t worth it. It would still leave Netflix with substantial legal fees, but perhaps save the agency from another embarrassing defeat.

But while that may end the matter, it shouldn’t. The regulator could use the Netflix case to rethink its disclosure policies in light of not only the rise of social media but how the market actually works. After all, even the S.E.C. has a Twitter account these days.

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A version of this article appeared in print on 12/12/2012, on page B1 of the NewYork edition with the headline: In Netflix Case, a Chance for the S.E.C. to Re-examine an Old Regulation.

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The New Old Age Blog: The Gift of Reading

This is the year of the tablet, David Pogue of The Times has told us, and that may be good news for seniors who open holiday wrappings to find one tucked inside. They see better with tablets’ adjustable type size, new research shows. Reading becomes easier again.

This may seem obvious — find me someone over 40 who doesn’t see better when fonts are larger — but it’s the business of science to test our assumptions.

Dr. Daniel Roth, an eye specialist and clinical associate professor at the Robert Wood Johnson Medical School in New Brunswick, N.J., offered new evidence of tablets’ potential benefits last month at the annual meeting of the American Academy of Ophthalmology.

His findings, based on tests conducted with 66 adults age 50 and over: older people read faster (a mean reading speed of 128 words per minute) when using an iPad, compared to a newspaper with the same 10-point font size (114 words per minute).

When the font was increased to 18 points — easy to do on an iPad — reading speed increased to 137 words per minute.

“If you read more slowly, it’s tedious,” Dr. Roth said, explaining why reading speed is important. “If you can read more fluidly, it’s more comfortable.”

What makes the real difference, Dr. Roth theorizes, is tablets’ illuminated screen, which heightens contrast between words and the background on which they sit.

Contrast sensitivity — the visual ability to differentiate between foreground and background information — becomes poorer as we age, as does the ability to discriminate fine visual detail, notes Dr. Kevin Paterson, a psychologist at the University of Leicester, who recently published a separate study on why older people struggle to read fine print.

“There are several explanations for the loss of sensitivity to fine detail that occurs with older age,” Dr. Paterson explained in an e-mail. “This may be due to greater opacity of the fluid in the eye, which will scatter incoming light and reduce the quality of the projection of light onto the retina. It’s also hypothesized that changes in neural transmission affect the processing of fine visual detail.”

Combine these changes with a greater prevalence of eye conditions like macular degeneration and diabetic retinopathy in older adults, and you get millions of people who cannot easily do what they have done all their lives — read and stay connected to the world of ideas, imagination and human experience.

“The No. 1 complaint I get from older patients is that they love to read but can’t, and this really bothers them,” Dr. Roth said. The main option has been magnifying glasses, which many people find cumbersome and inconvenient.

Some words of caution are in order. First, Dr. Roth’s study has not been published yet; it was presented as a poster at the scientific meeting and publicized by the academy, but it has not yet gone through comprehensive, rigorous peer review.

Second, Dr. Roth’s study was completed before the newest wave of tablets from Microsoft, Google, Samsung and others became available. The doctor made no attempt to compare different products, with one exception. In the second part of his study, he compared results for the iPad with those for a Kindle. But it was not an apples to apples comparison, because the Kindle did not have a back-lit screen.

This section of his study involved 100 adults age 50 and older who read materials in a book, on an iPad and on the Kindle. Book readers recorded a mean reading speed of 187 words per minute when the font size was set at 12; Kindle readers clocked in at 196 words per minute and iPad readers at 224 words per minute at the same type size. Reading speed improved even more drastically for a subset of adults with the poorest vision.

Again, Apple’s product came out on top, but that should not be taken as evidence that it is superior to other tablets with back-lit screens and adjustable font sizes. Both the eye academy and Dr. Roth assert that they have no financial relationship with Apple. My attempts to get in touch with the company were not successful.

A final cautionary note should be sounded. Some older adults find digital technology baffling and simply do not feel comfortable using it. For them, a tablet may sit on a shelf and get little if any use.

Others, however, find the technology fascinating. If you want to see an example that went viral on YouTube, watch this video from 2010 of Virginia Campbell, then 99 years old, and today still going strong at the Mary’s Woods Retirement Community in Lake Oswego, Ore.

Ms. Campbell’s glaucoma made it difficult for her to read, and for her the iPad was a blessing, as she wrote in this tribute quoted in an article in The Oregonian newspaper:

To this technology-ninny it’s clear
In my compromised 100th year,
That to read and to write
Are again within sight
Of this Apple iPad pioneer

Caregivers might be delighted — as Ms. Campbell’s daughter was — by older relatives’ response to this new technology, a potential source of entertainment and engagement for those who can negotiate its demands. Or, they might find that old habits die hard and that their relatives continue to prefer a book or newspaper they can hold in their hands to one that appears on a screen.

Which reading enhancement products have you used, and what experiences have you had?

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The New Old Age Blog: The Gift of Reading

This is the year of the tablet, David Pogue of The Times has told us, and that may be good news for seniors who open holiday wrappings to find one tucked inside. They see better with tablets’ adjustable type size, new research shows. Reading becomes easier again.

This may seem obvious — find me someone over 40 who doesn’t see better when fonts are larger — but it’s the business of science to test our assumptions.

Dr. Daniel Roth, an eye specialist and clinical associate professor at the Robert Wood Johnson Medical School in New Brunswick, N.J., offered new evidence of tablets’ potential benefits last month at the annual meeting of the American Academy of Ophthalmology.

His findings, based on tests conducted with 66 adults age 50 and over: older people read faster (a mean reading speed of 128 words per minute) when using an iPad, compared to a newspaper with the same 10-point font size (114 words per minute).

When the font was increased to 18 points — easy to do on an iPad — reading speed increased to 137 words per minute.

“If you read more slowly, it’s tedious,” Dr. Roth said, explaining why reading speed is important. “If you can read more fluidly, it’s more comfortable.”

What makes the real difference, Dr. Roth theorizes, is tablets’ illuminated screen, which heightens contrast between words and the background on which they sit.

Contrast sensitivity — the visual ability to differentiate between foreground and background information — becomes poorer as we age, as does the ability to discriminate fine visual detail, notes Dr. Kevin Paterson, a psychologist at the University of Leicester, who recently published a separate study on why older people struggle to read fine print.

“There are several explanations for the loss of sensitivity to fine detail that occurs with older age,” Dr. Paterson explained in an e-mail. “This may be due to greater opacity of the fluid in the eye, which will scatter incoming light and reduce the quality of the projection of light onto the retina. It’s also hypothesized that changes in neural transmission affect the processing of fine visual detail.”

Combine these changes with a greater prevalence of eye conditions like macular degeneration and diabetic retinopathy in older adults, and you get millions of people who cannot easily do what they have done all their lives — read and stay connected to the world of ideas, imagination and human experience.

“The No. 1 complaint I get from older patients is that they love to read but can’t, and this really bothers them,” Dr. Roth said. The main option has been magnifying glasses, which many people find cumbersome and inconvenient.

Some words of caution are in order. First, Dr. Roth’s study has not been published yet; it was presented as a poster at the scientific meeting and publicized by the academy, but it has not yet gone through comprehensive, rigorous peer review.

Second, Dr. Roth’s study was completed before the newest wave of tablets from Microsoft, Google, Samsung and others became available. The doctor made no attempt to compare different products, with one exception. In the second part of his study, he compared results for the iPad with those for a Kindle. But it was not an apples to apples comparison, because the Kindle did not have a back-lit screen.

This section of his study involved 100 adults age 50 and older who read materials in a book, on an iPad and on the Kindle. Book readers recorded a mean reading speed of 187 words per minute when the font size was set at 12; Kindle readers clocked in at 196 words per minute and iPad readers at 224 words per minute at the same type size. Reading speed improved even more drastically for a subset of adults with the poorest vision.

Again, Apple’s product came out on top, but that should not be taken as evidence that it is superior to other tablets with back-lit screens and adjustable font sizes. Both the eye academy and Dr. Roth assert that they have no financial relationship with Apple. My attempts to get in touch with the company were not successful.

A final cautionary note should be sounded. Some older adults find digital technology baffling and simply do not feel comfortable using it. For them, a tablet may sit on a shelf and get little if any use.

Others, however, find the technology fascinating. If you want to see an example that went viral on YouTube, watch this video from 2010 of Virginia Campbell, then 99 years old, and today still going strong at the Mary’s Woods Retirement Community in Lake Oswego, Ore.

Ms. Campbell’s glaucoma made it difficult for her to read, and for her the iPad was a blessing, as she wrote in this tribute quoted in an article in The Oregonian newspaper:

To this technology-ninny it’s clear
In my compromised 100th year,
That to read and to write
Are again within sight
Of this Apple iPad pioneer

Caregivers might be delighted — as Ms. Campbell’s daughter was — by older relatives’ response to this new technology, a potential source of entertainment and engagement for those who can negotiate its demands. Or, they might find that old habits die hard and that their relatives continue to prefer a book or newspaper they can hold in their hands to one that appears on a screen.

Which reading enhancement products have you used, and what experiences have you had?

Read More..

DealBook: China Woos Overseas Companies, Looking for Deals

HONG KONG — Even as Wall Street deal makers await a revival of the moribund merger market, Chinese companies are shopping abroad with their wallets out.

Yet they are also facing scrutiny, particularly in Washington, as Chinese corporate buying trips coincide with a growing assertiveness in Chinese foreign policy, including the deployment in recent months of surveillance vessels and even naval destroyers and frigates in a series of territorial confrontations with American allies like Japan, Vietnam and the Philippines.

So far this year, the dollar volume of Chinese acquisitions overseas is up 28 percent from the same period a year ago, according to Thomson Reuters data. That compares with a 2.8 percent slump in global merger and acquisition volume over all.

Chinese international acquisitions are ahead for the year despite a slump during the third quarter, as state-owned enterprises, which are the main Chinese buyers, and some private enterprises waited for a change in the country’s political leadership at the Communist Party Congress in mid-November. But now the Chinese buyers are back.

Two deals by Chinese companies were announced this week, and bankers and lawyers say that discussions are starting or are already under way on numerous other transactions. Many of those, however, may take as long as a year to complete given China’s bureaucratic approval processes.

“You will see an acceleration — you see it now,” although it would not amount to an immediate flood of transactions, said André Loesekrug-Pietri, the chairman and managing partner of A Capital, a Hong Kong-based private equity fund.

Indeed, Beijing is pushing for additional deals, and has encouraged the state-controlled banking sector to finance them.

“An increase in overseas investment by Chinese companies is an inevitable trend,” the commerce minister, Chen Deming, said at a conference two weeks ago, adding that China did not want to remain overwhelmingly invested in fixed-income securities.

“With foreign reserves of $3 trillion in hand,” he added, “we will not sit back and watch the assets depreciate with the third round of quantitative easing. We must inject it into the real economy and make our contribution to global prosperity.”

Wanxiang Group agreed on Sunday to pay $256 million to buy most of A123 Systems, a bankrupt manufacturer of high-tech batteries. And a consortium of Chinese investors agreed on the same day to pay $4.2 billion for a controlling stake in the American International Group’s aircraft leasing business.

On Friday, Canada approved the $15 billion acquisition of Nexen, an energy company, by the China National Offshore Oil Corporation, or Cnooc. That deal is still pending approval by the American committee that reviews foreign investments on national security grounds, commonly known as Cfius.

A few deals may be completed this winter, but the real surge is likely to happen by next summer, bankers and lawyers said. State-owned enterprises account for as much as four-fifths of China’s overseas acquisitions by value and many of their top executives are expected to change jobs this winter as the country’s new leaders start promoting their followers.

While the Communist Party Congress in November produced a new Politburo, a new slate of government ministers and vice premiers must still be selected at the National People’s Congress in March, a process that could also slow down deals.

Chinese regulations further require that at least three different agencies approve each overseas acquisition — the Ministry of Commerce, the National Development and Reform Commission and the State Administration of Exchange Control. The assent of a fourth, the Ministry of Industry and Information Technology, is needed to qualify for extra financing and faster approval in certain sectors deemed strategic, like clean energy, said Mao Tong, a partner at the law firm Squire Sanders.

But despite the long lead time for Chinese deals, bankers say the process is clearly starting.

Two of the biggest deals by Chinese companies this year were for control of North American companies. The bid for the A.I.G. business, the International Lease Finance Corporation, or I.L.F.C., is the biggest takeover by Chinese entities on record, according to data from Thomson Reuters.

The roots of that transaction were planted last fall. Members of China’s new government wanted to show the country’s seriousness in pursuing investments outside of China, and spent time assembling the most fitting consortium to pursue a deal for the business.

The government chose as the face of the deal Weng Xianding, a veteran of China’s financial regulatory agencies who has turned to investing. His company, New China Trust, is essentially a major Chinese commercial lender, counting Western firms like Barclays among its investors.

Once the preferred consortium was formed around September, it began talking with A.I.G., with many of the details being negotiated between Mr. Weng and the American insurer’s chief executive, Robert H. Benmosche. A goal for the Chinese, a person with direct knowledge of the matter said, was to conduct the talks in a “Western way,” using Western advisers and not getting bogged down in traditional bureaucratic mire.

The talks were completed in just over three months, and the buyers successfully negotiated a discount of nearly half of I.L.F.C.’s book value.

Two evolving trends are apparent in Chinese international deal making, Chinese government officials, bankers, lawyers and trade experts said in interviews.

The government is putting heavy pressure on Chinese companies to seek minority stakes, and not to automatically seek full control, so as to tap foreign management expertise, two officials said. At the same time, Chinese companies are broadening their range of acquisition targets to include more industrial manufacturers and consumer brand companies, even as they maintain their interest in natural resources and financial services.

“I wouldn’t say there’s a desire to buy minority stakes, but I think there’s a greater acceptance that’s an appropriate thing to do,” said Michael S. Weiss, the head of China mergers and acquisitions at Morgan Stanley.

Other bankers said that one big obstacle to the purchase of minority stakes lay in the wariness of many foreign companies in accepting a Chinese partner — particularly since nearly four-fifths of Chinese acquirers are state-owned enterprises, and most of the rest tend to have Chinese government links.

Many of today’s buyers have drawn lessons from past failures and moved to assuage government regulators before striking deals. Cnooc, in particular, learned from its failed bid to buy the oil company Unocal seven years ago, and tried to apply those lessons in its pursuit of Nexen.

The Chinese company considered the deal in part because it believed that a takeover could win approval, according to a person with direct knowledge of the matter. While a big player in Canada’s energy community, Nexen was not one of the country’s iconic companies, heading off the sort of brutal fight that surrounded a takeover battle for Potash, the producer of an important fertilizing ingredient.

Cnooc hired an army of advisers, including lobbyists and public relations specialists, to press the point that a deal would only strengthen the Canadian energy company. And Cnooc was open about much of its financing, aiming to halt concerns that it was being financed cheaply by state-run banks.

Still, national security concerns could also slow some deals. Bankers and lawyers say that Cfius, which stands for the Committee on Foreign Investment in the United States, can sometimes prove frustrating to would-be buyers. The group scrutinizes deals to ensure that they do not harm the country’s national security interests.

Unlike the process in Canada, where negotiations with the foreign investment watchdog are public, the Cfius review takes place largely behind closed doors, and buyers are not always told why deals are rejected.

A Treasury spokeswoman, Natalie Earnest, said in a statement: “As we consider foreign investments in the United States, of course, we have an obligation — like any country — to protect our national security, and that is the exclusive focus of Cfius.”

Michael R. Wessel, a Democratic appointee to the United States-China Economic and Security Review Commission, said that bipartisan concern was growing in Congress about the first of the Chinese deals to be announced this autumn, a $117.6 million acquisition of Complete Genomics, a company in Mountain View, Calif., that does DNA sequencing.

Mr. Wessel, who also advises the United Steelworkers union on trade issues, was also critical of the A.I.G. deal. He said that the Chinese government could pressure airlines to buy Chinese-made parts for their leases, and could eventually urge airlines to lease Chinese-made civilian airliners now being developed.

A spokesman for the buyers’ group said in a statement that I.L.F.C. already had one of the largest aircraft order books in aviation, with a commitment to purchase up to 279 Boeing and Airbus aircraft between now and 2020. “We will continue to add to this order book as we see opportunities in the marketplace based on the market appeal of the aircraft and the economics offered by the manufacturers,” he added.

Some would-be Chinese buyers have not fully considered how much work is needed to ensure that their investments will go through, advisers say.

“I think many Chinese companies in particular have not taken into account the need to be in touch with Washington policy makers about their needs,” said Nancy L. McLernon, the chief executive of the Organization for International Investment, a group that represents domestic subsidiaries of foreign companies. “Those who do, fare best.”

Keith Bradsher reported from Hong Kong, and Michael J. de la Merced from New York.

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