Well: Straining to Hear and Fend Off Dementia

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

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

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


Katherine Bouton speaks about her own experience with hearing loss.


A transcript of this interview can be found here.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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


This post has been revised to reflect the following correction:

Correction: February 12, 2013

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

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Chicago leads nation in gas-price spikes









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

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

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

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

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

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

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

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

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

Flynn is more optimistic.

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

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

sbomkamp@tribune.com | Twitter: @SamWillTravel



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Cardinal George: Pope showing 'great courage' in stepping down









Cardinal Francis George said today that Pope Benedict XVI "placed the will of God for the good of the church before every other consideration" when he decided to step down.


"He has taught with clarity and charity what God has revealed to the world in Christ, he has handed on the apostolic faith, he has loved all of God’s people with all his heart," George said in a statement. "He has now shown great courage in deciding, after prayer and soul-searching, to resign his office at the end of this month.
 
"With the gratitude of sons and daughters in our hearts, we ask the Lord to bless him and give him strength, as we begin to pray now for the one who will succeed him as Bishop of Rome, Successor of Peter and Vicar of Christ."


Joliet Bishop Daniel Conlon said the pope's decision "is consistent with the humble disposition that I have come to recognize in him, both in my brief personal encounters with him and in his deportment generally as earthly shepherd of the church.

"He recognized that he no longer had the physical gifts necessary to carry out an office that becomes increasingly demanding," Conlon said. "He has been a steady and calm presence in the face of tumult in the world.  He has persevered in Blessed John Paul II’s determination to confront the scandal of child abuse in the church."








Pope Benedict shocked the world by saying he no longer had the mental and physical strength to cope with his ministry, in an announcement that left his aides "incredulous" and will make him the first pontiff to step down since the Middle Ages.

The German-born pope, 85, admired as a hero by conservative Roman Catholics and viewed with suspicion by liberals, told cardinals in Latin that his strength had deteriorated recently. He will step down on Feb. 28 and the Vatican expects a new Pope to be chosen by the end of March.


Vatican spokesman Father Federico Lombardi said the pope had not decided to resign because of "difficulties in the papacy" and the move had been a surprise, indicating that even his inner circle was unaware that he was about to quit.

A priest at St. Peter's Church in the Loop said the news is "surprising but not terrifying," saying it will allow the church to continue to renew itself.

“It’s a new beginning and a chance for new energy in the church,” said the Rev. Ed Shea. "This is good news.”

The selection of a new pope will offer the church the chance to continue its emergence into the “the modern light, the modern world,” Shea said. 

It will also provide a chance to choose a pope from Africa or South America, he said, to reflect the growth of the church on those continents.

“I was shocked, like everybody else,” Father Ed Shea said.  “It kind of surprised me that we didn’t know about it ahead of time.”

As worshipers left a morning mass at St. Peter’s this morning, several said the pope’s announcement had caught them completely by surprise.

“I hadn’t read anything leading up to it about that he was failing in health or anything like that,” said Michael Muldoon of La Grange. “I knew he was in his mid-80s, but I didn’t know that it was coming.”

Asked about the selection of Benedict’s successor, Muldoon said he’d like to see a more youthful pope, “someone a little more forward thinking, someone a little more accepting.”

At St. Alphonsus Church, which still offers a Sunday mass in German, parishioners said they were stunned by the resignation.

Errol Kunz, a 65-year-old retiree who lives by the church in Lakeview, said the Rev. Michael O'Connell mentioned the news at the beginning of the 8:30 a.m. Mass.

"I was shocked," Kunz said. "I couldn't believe it."

Others had heard about the resignation when they woke up.

When a news alert flashed on her phone around 7 a.m., Kathleen Falk said she was confused. "I always thought the popes don't retire," said Falk, a 27-year-old nurse who has been attending St. Alphonsus for five years.

"If you can't fulfill the duties to guide the church, then you can't argue with that," Falk added.

Ian McBride, a 29-year-old social worker who has been going to St. Alphonsus for a few years, called it a "measure of humility" that the pope could recognize his health issues and step down.

For the pope's legacy, "time will tell," McBride said. "In the American church, dealing with the abuse and all that — he took that personally. . .He seemed to be very genuine and ashamed of how things happened."


Contributing: Reuters





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Famous film couple back 9 years on in “Before Midnight”






BERLIN (Reuters) – Ethan Hawke and Julie Delpy reprise the roles of Jesse and Celine in “Before Midnight”, the third but not necessarily the last movie in their long-running series based on the same characters as they age over time.


In this film, set 18 years after “Before Sunrise”, the couple is on holiday in Greece and we learn that they live with their twin daughters in Paris while Jesse’s son has stayed with his mother in Chicago.






Screening at the Berlin film festival on Monday, “Before Midnight” examines how life’s twists have taken their toll on the American tourist and French student who met on a train bound for Vienna in 1995 and again in Paris nine years later in “Before Sunset”.


They still love each other but this time they are older, heavier, and bicker more, and the forces pulling Jesse back towards his teenage son and Celine’s determination to pursue her career in France test that bond to its limits.


Director Richard Linklater, on board throughout the series, underlined the organic nature of the “Before…” films when he was asked whether there might be a fourth installment, presumably sometime around 2022.


“The fact that we’ve made two sequels, I guess it begs the question, but I think I speak for the group here, I’m sure we have absolutely no idea what that (sequel) could possibly be,” he told reporters at the 11-day film festival.


“We probably won’t for another six years. Who knows the future?”


French actress Delpy joked that the final film in the series would be a remake of Michael Haneke’s Oscar-nominated drama “Amour”, about an elderly couple aged in their 80s facing the inevitability of imminent death.


“STIFLING” EXPECTATIONS


Critical reaction to “Before Midnight” has been mixed.


In its review, the Guardian newspaper said the movie felt forced, but The Hollywood Reporter wrote: “Though this stage is harder to watch, audiences who have aged along with Celine and Jesse will treasure this new episode.”


Hawke said he, Delpy and Linklater, who jointly developed the script over two years, felt the weight of expectation as they embarked on the third part of a story which many viewers identified with so closely.


“I haven’t met a director in the last nine years that didn’t tell me what he or she thought the third film should be. So we knew we were up against a lot of people having an agenda about where Jesse and Celine should be. That agenda is stifling.”


“Before Midnight” consists of a handful of long, single-shot scenes focusing on the couple as they navigate a life complicated by broken families, work pressures and the familiarity of living together.


In the first scene Jesse sees his son off at the airport in an awkward exchange that underlines how the two have grown apart. In the next Jesse and Celine discuss children, work and their relationship in frank and often funny exchanges.


At one point Celine says men measure themselves against leading figures from history. When Jesse counters that women do too, he mentions Joan of Arc.


“She was burned at the stake and was a virgin,” jokes Celine. “Who wants to be Joan of Arc?”


As the film goes on, banter becomes bickering, then descends into a blazing row. Linklater stressed that the dialogue may seem off-the-cuff but it required a lot of hard work.


“It feels improvised. It’s not,” he said. “It’s meticulously rehearsed and structured.”


(Reporting by Mike Collett-White; Editing by Belinda Goldsmith)


Movies News Headlines – Yahoo! News





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Well: Price for a New Hip? Many Hospitals Are Stumped

Jaime Rosenthal, a senior at Washington University in St. Louis, called more than 100 hospitals in every state last summer, seeking prices for a hip replacement for a 62-year-old grandmother who was uninsured but had the means to pay herself.

The quotes she received might surprise even hardened health care economists: only about half of the hospitals, including top-ranked orthopedic centers and community hospitals, could provide any sort of price estimate, despite repeated calls. Those that could gave quotes that varied by a factor of more than 10, from $11,100 to $125,798.

Ms. Rosenthal’s grandmother was fictitious, created for a summer research project on health care costs. But the findings, which form the basis of a paper released on Monday by JAMA Internal Medicine, are likely to fan the debate on the unsustainable growth of American health care costs and an opaque medical system in which prices are often hidden from consumers.

“Transparency is all the rage these days in government and business, but there has been little push for pricing transparency in health care, and there’s virtually no information,” said Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa, who wrote the paper with Ms. Rosenthal. He added: “I can get the price for a car, for a can of oil, for a gallon of milk. But health care? That’s not so easy.”

President Obama’s Affordable Care Act focused primarily on providing insurance to Americans who did not have it. But the high price of care remains an elephant in the room. Although many experts have said that Americans must become more discerning consumers to help rein in costs, the study illustrates how hard that can be.

“We’ve been trying to help patients get good value, but it is really hard to get price commitments from hospitals — we see this all the time,” said Jeff Rice, the chief executive of Healthcare Blue Book, a company that collects data on medical procedures, doctors visits and tests. “And even if they say $20,000, it often turns out $40,000 or 60,000.”

There are many caveats to the study. Most patients — or insurers — never pay the full sticker price of surgery, because insurance companies bargain with hospitals and doctors for discounted rates. When Ms. Rosenthal balked at initial high estimates, some hospitals produced lower rates for a person without insurance.

But in other ways the telephone quotations underestimated prices, because they did not include the fees for outpatient rehabilitation, for example.

In an accompanying commentary, Andrew Steinmetz and Ezekiel J. Emanuel of the University of Pennsylvania acknowledged that there was “no justification” for the inability to provide estimates or for the wide range of prices. But they said that more rigorous data on quality — like infection rates and unexpected deaths — were required to know when high prices were worth it.

“Without quality data to accompany price data, physicians, consumers and other health care decision makers have no idea if a lower price represents shoddy quality of if it constitutes good value,” they wrote.

But, broadly, researchers emphasized that studies had found little consistent correlation between higher prices and better quality in American health care. Dr. Cram said there was no data that “Mercedes” hip implants were better than cheaper options, for example.

Jamie Court, the president of the California-based Consumer Watchdog, said: “If one hospital can put in a hip for $12,000, then every hospital should be able to do it. When there’s 100 percent variation in sticker price, then there is no real price. It’s about profit.”

Dr. Cram said the study did contain some good news: some of the country’s top-ranked hospitals came up with “bargain basement prices” in response to repeated calls. “If you’re a good consumer and shop around, you can get a good price — you don’t have to pay $120,000 for a Honda,” he said.

But that shopping can be arduous in a market not set up to respond to consumers. To get a total price, Ms. Rosenthal often had to call the hospital to get its estimate for on-site care, and a separate quote from doctors. And many were simply perplexed when she asked for a price upfront, Ms. Rosenthal said, adding, “The people who answered didn’t know what to do with the question.”

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Dozens of airline fees rose, changed in 2012









Airline travel fees — including charges to check a bag and to board early — have become so prevalent that travelers almost need an advanced degree in mathematics to calculate overall trip costs.


Last year at least 36 airline fees increased, and 16 others were redefined, bundled or unbundled with other services, according to a recent study by the consumer travel website Travelnerd.


One bright spot in the Travelnerd study of 14 U.S. airlines is that most fee increases were only $5 to $10 each.





In one case an airline had a big fee reduction. The study found that United Airlines reduced its fee for checking an overweight bag to $100 from $200 for bags 50 to 70 pounds and to $200 from $400 for bags 71 to 100 pounds.


"Travelers really have to be extra cautious when booking a flight," said Alicia Jao, vice president of travel media at Travelnerd, who predicts travelers will see even more fees in 2013. "U.S. carriers are becoming creative at charging consumers extra fees."


But some airlines seem to charge fees arbitrarily, said Perach Mazol, a Los Angeles resident who recently flew to Florida with friends from Romania to take a cruise.


On her flight from L.A. to Fort Lauderdale, Fla., on Spirit Airlines, she said the Florida airline did not charge for the carry-on bags she and her friends were carrying, but the carrier asked for $50 each to carry the same bags on the flight back. (Spirit is one of only two airlines in the U.S. that charge passengers for carry-on luggage.)


"I don't understand why they charged us on one flight and they don't on the other," Mazol said. "It's confusing."


A spokeswoman for Spirit said the airline tries to enforce its policies consistently.


"Maybe she got lucky one way and didn't have to pay," Spirit spokeswoman Misty Pinson said.


United offering satellite-based Wi-Fi


United Airlines was one of the last major airlines to offer onboard wireless Internet. But the Chicago carrier is trying to make up for its tardiness.


United offers Wi-Fi in about 3% of its fleet of about 700 planes, one of the lowest rates of any major carrier in the nation, according to a recent study.


But United recently became the first U.S.-based international carrier to offer satellite-based Wi-Fi Internet for passengers traveling on long-haul overseas flights.


The carrier has installed satellite-based Wi-Fi on nearly a dozen planes, with plans to expand the service to more than 300 planes, or about 43% of the fleet, by the end of the year.


"With this new service, we continue to build the airline that customers want to fly," said Jim Compton, vice chairman and chief revenue officer at United.


Satellite-based Wi-Fi is typically as fast as ground-based Wi-Fi, experts say, but the advantage is that it can give passengers Internet access when flying over areas where cellular towers don't exist — such as the Pacific or Atlantic oceans.


But, of course, there is a price to pay for the service.


United is charging $3.99 to $14.99 for standard speed, depending on the duration of the flight, and $5.99 to $19.99 for faster speeds.


United is not the only airline to offer satellite-based Wi-Fi. Southwest Airlines, the nation's largest domestic carrier, offers it through Westlake Village-based Row 44.


Delta to raise fee to access lounges


Airline fees are rising not only for onboard services but for amenities at the airport too.


Delta Air Lines, which has invested more than $20 million in its airport lounges over the last two years, announced that it would raise the cost for annual membership to access its lounges across the country by $50, starting March 1.


The increase means that an annual membership will range from $350 to $450, depending on membership level. (The more miles passengers fly on Delta the less they pay for membership.)


Among the investments Delta has made is the addition of a new luxury bar that opened recently at Delta's lounge at Los Angeles International Airport. Instead of helping themselves at a self-serve bar, members can now belly up to a fully stocked bar and order a drink from a bartender.


hugo.martin@latimes.com





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Woman killed when 2 cars collide on Tri-State













Photo: Scene of crash


Photo: Scene of crash
(February 10, 2013)


























































A Chicago woman died after she was thrown from a car in an accident along the Tri-State Tollway in Glenview, authorities said.

Danielle M. Pisterzi, 21, of the 5700 block of North Nina Avenue, died about an hour after the crash near Willow Road, according to Illinois State Police Master Sgt. Brian McKinney.


Two cars collided around 10:45 p.m., McKinney said. Pisterzi was taken to Advocate Lutheran General Hospital, where she was pronounced dead at 11:52 p.m.


The woman was the only person in her 2004 Hyundai when it crashed with an Audi SUV which had four people inside, police said.





No one else was taken to the hospital, McKinney said.

The crash happened in the southbound lanes of the tollway which were closed for hours as police investigated. By 4 a.m. all four southbound lanes had been reopened.


chicagobreaking@tribune.com


Twitter: @ChicagoBreaking






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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness





When a life starts to unravel, where do you turn for help?




Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.


In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.


“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”


That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”


Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.


One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.


“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”


On a recent afternoon, she described in her Midtown office the range of her practice.


“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”


Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”


Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.


One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.


“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”


Her son cut her off. “Are you comparing me to the guy that shot those people?”


“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”


“Did you really just compare me to that guy?”


“No, I didn’t compare you.”


“Then what did you say?”


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The fine line between legitimate businesses and pyramid schemes









Controversy is again casting a shadow over the multilevel marketing industry, as nutritional supplement company Herbalife Inc., which has thousands of distributors in the Chicago region, has been publicly called a pyramid scheme by a prominent investor — an allegation the company vigorously denies.


Meanwhile, a different multilevel marketer, Fortune Hi-Tech Marketing, was shut down in recent weeks after a lawsuit was brought by regulators and several states, including Illinois, alleging the company scammed consumers out of $169 million. The scheme affected an estimated 100,000 Americans, including some in Chicago, where it targeted Spanish-speaking consumers, the Federal Trade Commission alleged.


Most people outside the industry might have only a vague notion about multilevel marketing, also called network marketing and direct selling. It often involves personal sales of cosmetics, wellness products or home decor items — or as critics flippantly call it, "pills, potions and lotions" — usually sold through product parties hosted by friends or relatives.





For sellers, the companies offer the appeal of starting a business on the cheap with little training, working from home and being their own boss, if only for part-time money. Some might recruit friends and family to become sellers, which augments their own commissions and gives them a shot at the six-figure compensation many such marketing companies tout but few distributors attain.


The largest multilevel marketing companies, often known as MLMs, are household names: Avon, Mary Kay, Pampered Chef and Amway. MLMs have annual sales of about $30 billion, with about 16 million people in the United States selling their products, according to the industry group Direct Selling Association, which represents these firms and others.


The recent controversies might raise the question: What's the difference between a legitimate multilevel marketing company and an illegal pyramid scheme, in which only people who get in first — at the top of the pyramid-like structure — make money and everyone else is a dupe?


The harshest critics maintain there is no difference, that there's no such thing as a legitimate MLM and that the industry's secrets stay safe because of a cultlike mentality and a blind eye of regulators.


Jon M. Taylor, who was once a seller for an MLM company, said he has studied the industry for 18 years and analyzed more than 500 MLM companies. He maintains the website MLM-thetruth.com and offers a free e-book there.


"I have not yet found a good MLM — a good MLM is an oxymoron," Taylor said.


He said all MLM companies have the same flaw: They depend on endless chains of recruiting new members.  "There is no more unfair and deceptive practice than multilevel marketing," Taylor said.


Tracy Coenen, a forensic accountant and fraud investigator with Sequence Inc. in Chicago and Milwaukee, is author of the Fraud Files Blog. She is also a critic.


"Multilevel marketing companies are pyramid schemes that the government allows to operate," said Coenen. "The only difference is that Herbalife, or any multilevel marketing company, has a tangible product that they use to make their pyramid appear legitimate."


The Direct Selling Association says MLMs are legitimate businesses, and that the group has about 200 members carefully screened by the organization to ensure they are not pyramid schemes and don't use deceptive practices.


The Federal Trade Commission agrees there are legitimate MLMs. The difference between a legitimate business and pyramid scheme comes down to products.


If the company and its distributors make money primarily from the sale of products to end-users (and not boxes of product accumulating in a distributor's garage), it's OK.


By contrast, a pyramid scheme compensates those at the top of the pyramid with participation fees paid by those recruited at the bottom. It eventually collapses when the scheme can't recruit more people.


But identifying a pyramid scheme can be difficult because MLMs typically have product sales, along with recruitment fees and recruitment incentives.


"It gets cloudy when you have a situation where you have fees being paid for both," said Monica Vaca, assistant director of the FTC's division of marketing practices. "It's very nuanced."


While prosecuting an MLM can seem somewhat of a judgment call, cases have a common factor: deceptive promises about how much money distributors will earn, Vaca said.


In the Fortune Hi-Tech Marketing case filed last month, C. Steven Baker, director of the FTC's Midwest region, said, "These defendants were promising people that if they worked hard they could make lots of money. But it was a rigged game, and the vast majority of people lost money."





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Hadiya Pendleton funeral: 'God is our refuge'









The funeral of slain teen Hadiya Pendleton began today amid large crowds, long lines and heavy security prompted by the attendance of first lady Michelle Obama.

While family and friends kept the focus on the 15-year-old girl who was shot dead in a South Side park, the first lady's appearance inevitably brought attention to anti-gun efforts nationwide.


Hadiya's pastor, Courtney C. Maxwell from the Greater Deliverance Temple Church of Christ, opened the services about 11:15 a.m. after a heart-shaped balloon was placed near her casket.
 
He thanked everyone for being at the Greater Harvest Baptist Church, including elected officials. “The family says thank you and God bless you.’’ He asked for round of applause for the Pendleton family.
 
“Only God can keep you and strengthen you, for God is our refuge and our strength,’’ the pastor said. 


The pastor said Hadiya was “genuine and real.’’

“She was energetic, loved music, loved the arts,’’ the pastor said.

After the pastor spoke, a female reverend dressed in white addressed the crowd and a choir behind her began singing.

“Blessed are they that mourn, for they shall be comforted,’’ she said, as the choir sang after her.

Another man, who identified himself as an assistant pastor of the Life Center church, read from scriptures.

“She is more precious than rubies. … Her ways are of pleasantness,’’ he said.








About 11:30 a.m., Pastor Elder Eric Thomas of the host Greater Harvest Baptist Church spoke to the mourners and described Hadiya as a “beloved angel.’’
 
“Her life has not been in vain,’’ Thomas said.
 
A female singer and organist the played a religious song, as about 30 others in the choir, all dress in white, stood and swayed gently from side to side before the large cross that was draped in white.


Kenya Edwards, who identified herself as a radio personality and a friend, read a poem called “Walking,’’ which was written for Hadiya by Zora Howard.

Afterwards, Edwards said: “Ladies and gentlemen, it’s time for us to start walking. It’s time to take a stand.’’

Then two girls who appeared to be Hadiya's classmates and friends performed a poem they wrote for her, which began by comparing violence in Chicago to that of Iraq.
 
The girls then took turns to speak each part of the poem: “Dear Hadiya. I wish you were still here with me. That smile … that you smile so confidentially.’’

They also spoke to the killer: “Know that you killed an innocent person."

It ended when they both said: “We’re sorry Hadiya. We miss you,’’ and sat down to applause.

Hundreds of mourners had lined up early to pay respects to Hadiya, who was a majorette for King College Prep's band and performed during President Barack Obama's inauguration festivities just days before she was slain, shot in the back while hanging out with friends at a North Kenwood neighborhood park.

Thirty minutes before the doors were set to open, hundreds stood waiting in line amid heavy security to get into Greater Harvest Baptist Church in the Washington Park neighborhood, about two miles from where the 15-year-old girl was gunned down last month. Among the groups of high school-age students waiting in the line was the King College Prep majorettes team, who came together in their yellow and black majorette coats.

Guests who were invited by the family were given orange wristbands and were able to enter through a shorter security line. Classmates and friends of Pendleton were given green wristbands and allowed to enter through that same line.

Trinity Dishmon, 40, said her daughter Deja, 15, and Hadiya were close friends in middle school. The two girls stayed in touch and were texting about their upcoming 16th birthdays while Hadiya was in D.C. for the president's inauguration in January.

"Hadiya was a gift to everyone that knew her," Dishmon said, tearing up. "These last 12 days have been unbelievably numbing. It's not six degrees of separation anymore, it's one. It's just unreal."

Dishmon said she feared that the day was less about the teenager and more about a larger issue.

"This is Hadiya's day and should be about her -- not something sensational," Dishmon said. "But maybe by honoring her life we can help make a difference."

Inside the church, Hadiya’s silver casket was placed in the front, surrounded by flowers and two large hearts, one with her picture on it. Behind the casket, a TV screen showed pictures of Hadiya with her family, from birth to her teenage years.

At 9:09 a.m., friends, students and others with wristbands were allowed to file down the aisle to view the body. Her young friends were seated in the front pews, directly behind the casket. Her classmates and friends filled the middle section of the church — 11 rows in all. Members of the Crystal Elegance Majorette squad held on to each other as they filed down the aisle in pairs to view the body.

A funeral director wearing a suit and white gloves came outside at 9:40 a.m. to announce to the hundreds still waiting in line that the church was “at capacity.” Those still in line could come in and view the body, he said, but would have to leave before the services.

The funeral procession arrived at about 9:45 a.m., including three limousines and dozens of cars.

The first lady’s motorcade pulled into the church parking lot at about 10:15 a.m. She went in through a separate side entrance at the rear of the church, stepping directly from a vehicle into the building.

At about the same time, the funeral director came back out and announced to the hundreds still waiting in line that no one else would be allowed inside — not for the viewing or the funeral.


The family filed down the aisle a little after 10 a.m. and viewed the body in the still open casket. The pastor led the procession down the aisle chanting "the Lord is my shepherd" as soft organ music played in the background.

Ushers walked down the aisle handing out tissues, and those without wristbands were asked to give up their seats so that family members could be seated in the sanctuary. Every seat was filled by 9:45 a.m.

Purple, Hadiya’s favorite color, is represented in many of the flowers in the church and the lining of her casket. Ushers handed out a glossy funeral program booklet printed on purple paper. The front cover says "Celebrating The Life Of ... Hadiya Zaymara Pendleton.” Inside are more than 50 photos of Hadiya throughout her life.
 
Her obituary printed in the booklet describes her work in the church and even her favorite foods: Chinese, cheeseburgers, ice cream and Fig Newtons. It includes tributes from her grandmother, her cousin and an aunt as well as close friends. According to the program, the speakers are to include Illinois Secretary of State Jesse White.
 
The back of the program has a copy of a handwritten note from President Barack Obama: "Dear Cleopatra and Nathaniel, Michelle and I just wanted you to know how heartbroken we are to have heard about Hadiya's passing. We know that no words from us can soothe the pain, but rest assured that we are praying for you, and that we will continue to work as hard as we can to end this senseless violence. God Bless.”

Gov. Pat Quinn entered from the upstairs balcony, went up to greet the family and then stood for a brief moment over the casket, looking at Hadiyah.

Other dignitaries entering the church were Ill. Attorney General Lisa Madigan and Rev. Michael Pfleger, a longtime community activist on the South Side and pastor of St. Sabina Catholic Church in Chicago. Rev. Jesse Jackson stood at the front near the casket with members of the family for a while and then took a seat in the audience behind the family. 


Prior to the service, the first lady met privately with about 30 of Hadiya's friends and classmates, and then with members of Hadiya's family, according to a White House official.


Just before the funeral began, the first lady, Mayor Rahm Emanuel and Cook County Board President Toni Preckwinkle could be seen seated near one another other and near the casket. Colorful bouquets of flowers were placed near the casket.

Michelle Obama, wearing dark blue, was then seen standing, comforting someone, possibly the pastor.


Even after those outside were told they would not be allowed in, many continued to gather around the church's front gate.

Some began to file out, having to hop over the metal barricades to exit the long line.

One man asked the funeral staff member if he could at least have a pamphlet from the funeral before he left.

"Oh sir, those are long gone. They only printed 1,500," the funeral staff member said.

Activists, religious groups and others passed out printed material to those standing in line. Some kept the papers, others were left on the snowy ground as the crowds left.

Michelle Obama's attendance puts Chicago solidly in the middle of a national debate over gun violence that has polarized Congress and forced President Obama to take his gun control initiatives on the road to garner more public support.

The first lady's visit is being seen not only as a gesture of condolence to the family but as part of an effort to draw attention and support for the president's gun initiatives.

But the visit also meant scores of security, police and Secret Service agents, metal detectors and other security measures.

Other dignitaries expected to attend the funeral included Secretary of Education Arne Duncan and Valerie Jarrett, senior adviser to Barack Obama.

The church is surrounded by an iron fence and all of the openings -- a pedestrian gate in the front, front and side doors to the church, and a driveway to the north -- are guarded by city police or men in white shirts, ties and long black coats. Chicago police vehicles -- two wagons, a handful of squads and SUVs -- guarded the outside of the church while other vehicles circle the block.

Chicago police staffing the event are wearing dress blues -- a blue overcoat with pockets that allow access to the duty belt, creased navy pants, and a hat.

King College Prep math and engineering teacher Alonzo Hoskins stood quietly in line with others. He said he taught Hadiya in his first-period geometry class, where he now has an empty desk.

"She was full of life," Hoskins said.

Hoskins looked at the sea of people that preceded him in line. "I want to support the family. For me, this isn't about the dignitaries," Hoskins said.

"But I don't know if I'll even get in."

Some waiting in line for the funeral said they didn't know the Pendletons personally but felt some connection to the teenager's death.

Earl Worthington, 51, said his mother was an elementary school teacher in Chicago and would have embraced a driven young student like Hadiya.

“She's the type of girl my mother would have produced in her class,” Worthington said. “I feel a connection to Hadiya's death through my mother. I feel my mother is with her right now in heaven.”

Nate Weathers, 16,  Jeramy Brown, 16, and Antoine Fuller, 15, all stood in line to see their former classmate. The three young men said they attended Carter G. Woodson Middle School with Hadiya.

“This tears me up,” Fuller said. “She was my 7th grade crush.”

Brown described Hadiya as “sweet and innocent.”

“Something like this should have never happened to her,” Brown said.

Police took two men into custody after they got into an altercation near the back of the long line of mourners waiting to get into the church. One man was agitated, complaining about the long wait to get in. A second man confronted him and they began shoving each other before police intervened.


Local and national pool reports contributed.

chicagobreaking@tribune.com


Twitter: @chicagobreaking 



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