Friday, May 16, 2008

Five common ticketing errors -- and how to avoid them

(Tribune Media Services) -- As far as mistakes go, the one Janet Gordon recently made didn't seem like a big deal. She booked an airline ticket from Toronto to London under the name "Jan."

But what happened next could only be summed up in one word -- "chaos" -- says her husband, David.

"It was a major hassle," remembers Gordon, a human resources director for a college in Swansea, England. At almost every turn, the couple had to explain why the name on Jan's ticket didn't match her passport. "The computers wouldn't allow us to check in and issue a boarding card," he says.

In a business where slip-ups are almost as common as surcharges, the wrong-name-on-my-ticket error is a standout. You don't have to look far for ticketing mistakes in an age of do-it-yourself booking. Take it from me: not only do I write the Travel Troubleshooter column, a question-and-answer feature that helps people solve real-world problems, but I'm also an expert on errors.

I'll get to my own shortcomings in a minute. But right now, let's review the five biggest booking blunders -- and how they could have been prevented:

Wrong name on my ticket

Before 9/11, airlines and security personnel -- and I use the term "security personnel" loosely -- might have let a nickname or even a maiden name on a ticket slide. No longer. If you have the wrong name on your ticket, you're probably grounded. And there are two reasons for this: security and greed.

The Transportation Security Administration wants to be sure the same person who bought the ticket, and who was screened, is boarding the plane. But when there's an inexact match, the airline can either charge a $100 "change" fee or force you to buy a new ticket. In an industry where every dollar counts, the exact-name rule is the government's gift to cash-starved air carriers.

That's the situation Gordon was confronted with, even when it was obvious that "Jan" and "Janet" were one and the same. There were suggestions that a new ticket might need to be purchased. "We didn't let it get to that," he recalls. Instead, he asked to speak with a supervisor who could finally fix the codes so that the ticket and passport matched up. How did all of this happen in the first place? Turns out Jan Gordon had signed up for a frequent flier account under her informal name, so when she booked an award ticket, it also used her informal -- and inaccurate -- name.

How to avoid it? Triple-check the name on your ticket. Make sure your computer doesn't autofill another name and that the name on your passport or driver's license matches up with your ticket.

Booking a ticket on the wrong airline

Believe it or not, people board the wrong flight every day. I'm not even talking about codeshare flights, which is industry-speak for booking a ticket on one airline but then flying on a "partner" airline with different rules and maybe lower service standards. I'm talking about simply making the wrong choice of airline.

For example, the elite-level business traveler who is accustomed to being treated like royalty when he flies on his preferred carrier might want to stay away from a budget airline. "I gave Southwest a try and I hated it," they'll write to me. "I'm never flying with them again." Of course not. If you don't like flight attendants with a sense of humor, peanut snacks and on-time flights, you'll probably hate Southwest, too. On the flip side, I hear from travelers who book tickets on full-service network airlines and then complain about the price. Which is silly. How else do you think an airline is going to pay for all of that service?

How to avoid it? Watch for the codeshare designation when you book online and do a little research before buying an airline ticket. That way, your expectations won't be too high. Or too low. Also, consider using an experienced travel agent.

The city switcheroo

Selecting the wrong city pairs -- going from point 'B' to point 'A' instead of from 'A' to 'B' -- is another common error. Jennifer Hyde bought four tickets on Delta Air Lines through Orbitz. But instead of booking them from Boston to Baltimore she inadvertently switched cities, rendering the tickets completely useless. "Needless to say, neither Orbitz nor Delta is doing anything to help," she says. Hyde, a homemaker from Newton, Massachusetts, would have to pay a change fee for each ticket, plus any fare differential, to make things right. Not good.

How could someone switch cities? It's easy. To an inexperienced Web user -- and OK, let's be completely honest here, even to some experienced users -- those pull-down menus on travel sites can be utterly confusing. When you're typing in airport city codes like BWI and BOS, it's easy to forget which airport goes where. (But it could be worse -- Hyde might have ended up with a ticket to the familiar-looking BAL city code, which would have taken her to Batman, Turkey.) Point is, if you're not paying attention, or if you're dyslexic, you could click "accept" all the way through the reservation process and you wouldn't know you messed up until it was too late.

How to avoid it? Pay attention! If you're easily distracted maybe you should be working with a qualified travel agent instead of booking yourself. And read your confirmation immediately. If you spot a mistake, your agent might be able to undo it at no charge.

Buying a ticket that's too restrictive

Booking the wrong kind of ticket is yet another common error. Airline sites often assume you want to purchase the cheapest and most restrictive fare, so that's the first quote you're usually offered. The pricier, fully refundable tickets are buried deeper in the site, which is too bad. For air travelers whose plans might change, these are the best selections.

Why should you pay more for a ticket? Because if your plans change and you're holding a nonrefundable ticket, it will be practically worthless. Every day I field a question from an air traveler who would have benefited from this advice. They ask the airline to make exceptions to its refundability rules. They make up excuses. They throw tantrums. It almost never works.

How to avoid it? If you can't buy the right ticket, at least buy the right insurance policy. It might protect you if you change plans.

Wrong date

Like the wrong city switcheroo, the wrong date problem is an epidemic among air travelers. Part of the reason is simple absentmindedness: choosing the sixth month instead of the seventh month and then not reading the subsequent screens.

But part of the reason is that airline Web sites are anything but user-friendly. Reader Nancy Smythe wrote to me recently about her flight from West Palm Beach, Florida, to London, which she booked directly online through the airline. It turns out the carrier had sold her a ticket it couldn't deliver -- her connection times were too short. So it agreed to rebook her on a later flight. But when it sent her the new ticket, it had the wrong date on it. When she pointed out the mistake, she was asked to pay a change fee. "This wasn't my error," she says. So why should she pay for it? Smythe's experience reveals the maddening secret of ticketing mistakes. The airline will try to make you pay for an error -- even if it's not yours.

How to avoid it? Wake up and read the screen! No, seriously. This can usually be avoided by just reviewing your itinerary before you click the "book" button.

So look out for wrong names, wrong airlines, wrong cities, wrong dates and wrong expectations. Easy for me to say, right?


I've made every mistake in the book -- and then some -- when it comes to travel. All of the above errors are on my record. And let me also add that my mistakes aren't limited to travel. I have some big-time screw-ups to my name that extend into my professional and personal life. Hey, don't we all?

But as I look at the subject of mistakes in general, and ticketing mistakes in particular, I'm not worried about the ones we make once and learn from and are unlikely to repeat.

It's the ones that we make over and over for no other reason than that we're just easily manipulated -- those are the screw-ups that infuriate me.

(Christopher Elliott is the ombudsman for National Geographic Traveler magazine. This column originally appeared on You can read more travel tips on his blog, or e-mail him at

Original here

10 Surprising Health Benefits of Sex

The health benefits of sex extend well beyond the bedroom. Turns out sex is good for you in ways you may never have imagined.

When you're in the mood, it's a sure bet that the last thing on your mind is boosting your immune system or maintaining a healthy weight. Yet good sex offers those health benefits and more.

That's a surprise to many people, says Joy Davidson, PhD, a New York psychologist and sex therapist. "Of course, sex is everywhere in the media," she says. "But the idea that we are vital, sexual creatures is still looked at in some cases with disgust or in other cases a bit of embarrassment. So to really take a look at how our sexuality adds to our life and enhances our life and our health, both physical and psychological, is eye-opening for many people."

Sex does a body good in a number of ways, according to Davidson and other experts. The benefits aren't just anecdotal or hearsay -- each of these 10 health benefits of sex is backed by scientific scrutiny.

Among the benefits of healthy loving in a relationship:

1. Sex Relieves Stress

A big health benefit of sex is lower blood pressure and overall stress reduction, according to researchers from Scotland who reported their findings in the journal Biological Psychology. They studied 24 women and 22 men who kept records of their sexual activity. Then the researchers subjected them to stressful situations -- such as speaking in public and doing verbal arithmetic -- and noted their blood pressure response to stress.

Those who had intercourse had better responses to stress than those who engaged in other sexual behaviors or abstained.

Another study published in the same journal found that frequent intercourse was associated with lower diastolic blood pressure in cohabiting participants. Yet other research found a link between partner hugs and lower blood pressure in women.

2. Sex Boosts Immunity

Good sexual health may mean better physical health. Having sex once or twice a week has been linked with higher levels of an antibody called immunoglobulin A or IgA, which can protect you from getting colds and other infections. Scientists at Wilkes University in Wilkes-Barre, Pa., took samples of saliva, which contain IgA, from 112 college students who reported the frequency of sex they had.

Those in the "frequent" group -- once or twice a week -- had higher levels of IgA than those in the other three groups -- who reported being abstinent, having sex less than once a week, or having it very often, three or more times weekly.

3. Sex Burns Calories

Thirty minutes of sex burns 85 calories or more. It may not sound like much, but it adds up: 42 half-hour sessions will burn 3,570 calories, more than enough to lose a pound. Doubling up, you could drop that pound in 21 hour-long sessions.

"Sex is a great mode of exercise," says Patti Britton, PhD, a Los Angeles sexologist and president of the American Association of Sexuality Educators and Therapists. It takes work, from both a physical and psychological perspective, to do it well, she says.

4. Sex Improves Cardiovascular Health

While some older folks may worry that the efforts expended during sex could cause a stroke, that's not so, according to researchers from England. In a study published in the Journal of Epidemiology and Community Health, scientists found frequency of sex was not associated with stroke in the 914 men they followed for 20 years.

And the heart health benefits of sex don't end there. The researchers also found that having sex twice or more a week reduced the risk of fatal heart attack by half for the men, compared with those who had sex less than once a month.

5. Sex Boosts Self-Esteem

Boosting self-esteem was one of 237 reasons people have sex, collected by University of Texas researchers and published in the Archives of Sexual Behavior.

That finding makes sense to Gina Ogden, PhD, a sex therapist and marriage and family therapist in Cambridge, Mass., although she finds that those who already have self-esteem say they sometimes have sex to feel even better. "One of the reasons people say they have sex is to feel good about themselves," she tells WebMD. "Great sex begins with self-esteem, and it raises it. If the sex is loving, connected, and what you want, it raises it."

6. Sex Improves Intimacy

Having sex and orgasms increases levels of the hormone oxytocin, the so-called love hormone, which helps us bond and build trust. Researchers from the University of Pittsburgh and the University of North Carolina evaluated 59 premenopausal women before and after warm contact with their husbands and partners ending with hugs. They found that the more contact, the higher the oxytocin levels.

"Oxytocin allows us to feel the urge to nurture and to bond," Britton says.

Higher oxytocin has also been linked with a feeling of generosity. So if you're feeling suddenly more generous toward your partner than usual, credit the love hormone.

7. Sex Reduces Pain

As the hormone oxytocin surges, endorphins increase, and pain declines. So if your headache, arthritis pain, or PMS symptoms seem to improve after sex, you can thank those higher oxytocin levels.

In a study published in the Bulletin of Experimental Biology and Medicine, 48 volunteers who inhaled oxytocin vapor and then had their fingers pricked lowered their pain threshold by more than half.

8. Sex Reduces Prostate Cancer Risk

Frequent ejaculations, especially in 20-something men, may reduce the risk of prostate cancer later in life, Australian researchers reported in the British Journal of Urology International. When they followed men diagnosed with prostate cancer and those without, they found no association of prostate cancer with the number of sexual partners as the men reached their 30s, 40s, and 50s.

But they found men who had five or more ejaculations weekly while in their 20s reduced their risk of getting prostate cancer later by a third.

Another study, reported in the Journal of the American Medical Association, found that frequent ejaculations, 21 or more a month, were linked to lower prostate cancer risk in older men, as well, compared with less frequent ejaculations of four to seven monthly.

9. Sex Strengthens Pelvic Floor Muscles

For women, doing a few pelvic floor muscle exercises known as Kegels during sex offers a couple of benefits. You will enjoy more pleasure, and you'll also strengthen the area and help to minimize the risk of incontinence later in life.

To do a basic Kegel exercise, tighten the muscles of your pelvic floor, as if you're trying to stop the flow of urine. Count to three, then release.

10. Sex Helps You Sleep Better

The oxytocin released during orgasm also promotes sleep, according to research.

And getting enough sleep has been linked with a host of other good things, such as maintaining a healthy weight and blood pressure. Something to think about, especially if you've been wondering why your guy can be active one minute and snoring the next.

Original here

O.K., Avatar, Work With Me

WHEN Nintendo released the Wii 18 months ago, it upended the notion of what video games could be. Moving beyond the sunlight-deprived young men at gaming’s core, Nintendo appealed to the rest of the world with an intuitive, family-friendly entertainment experience.

Women, parents, even nursing-home residents have been drawn to the Wii’s simple evocations of games such as tennis and bowling. The Wii has become the best-selling game machine of the current generation, selling more than 25 million worldwide, and remains scarce on store shelves across the nation.

Now Nintendo’s latest brainchild, Wii Fit, could send similar ripples through the home-fitness market. Scheduled to be released in North America next week, Wii Fit is not meant to replace a gym. But in a world of $3,000 elliptical machines and $150-an-hour personal trainers, it has at least a chance of becoming a global, affordable, mass-market interactive home-fitness system. (On its overseas debut last month, it became one of the fastest-selling games ever in Britain.)

Exercising with Wii Fit is like having a Bob Harper or a Denise Austin who talks back — gently cajoling you through exercises, praising, nudging, even reminding you to eat a banana once in a while. It also lets you see how you stack up against friends or family members; each user creates a cartoony avatar called a “Mii.”

The system costs $90, plus $250 for the basic Wii console. It uses a television and a sensitive “balance board” placed on the floor to present a few dozen activities, from push-ups to yoga, to more entertaining challenges like balance games and aerobic contests. Nintendo is not aiming Wii Fit at people with a serious exercise regimen. Rather, it is meant to appeal to the person busy with work and family who just wants to have fun getting a little toned at home.

Believe me, I could use some help. As a video game journalist, I live in a world where Buffalo wings, potato chips and jalapeño poppers are considered food groups. The closest I get to serious exercise is flopping around at concerts like a lumpy, overeducated flounder.

Then again, most Americans aren’t really in great shape either. So I felt I could reasonably reflect the broad mass market (if you will) in testing whether a silicon coach has the potential to rescue millions of Americans from decrepitude.

To help me evaluate the system, Thursday Styles recruited two fitness professionals, an avid exerciser and one work-at-home parent to try Wii Fit at the Chelsea Piers sports complex in Manhattan. Here is what we thought:


Shira Weiss, a 33-year-old mother of two who works out of her home in Teaneck, N.J., as a publicist for small businesses, wants Wii Fit because it fits both her lifestyle and her doorway. “Before having the kids, I used to work out every day — I belonged to a gym — but now it’s really only when I have a chance,” she said. “Let me put it this way: I clean with vigor. I like aerobic exercise and would like a treadmill. But we tried to get one, and the door of our house was too narrow. It just wouldn’t fit, and my husband was like, ‘Forget the treadmill.’ ”

She eyed the 12” by 20” Wii Fit board. “But this could work,” she said.

Wii Fit’s almost 50 exercises are divided among four categories: strength training, aerobics, balance games and yoga. Each user creates a personal profile, including a potential weight loss (or gain) goal. The system tracks a user’s weight and body-mass index as well as their performance on individual exercises. To help prevent novices from overextending or frustrating themselves, only a few exercises are initially available in each category; more advanced activities are unlocked only after completing simpler options.

Ms. Weiss found her groove in Wii Fit’s aerobics section. She proved a quick study with the hula hoop game (gyrating in circles), before finding her long-sought treadmill replicated in the running game. In Wii Fit, running does not use the board. Rather, the user puts the TV-remote-size Wii controller in her pocket or hand and runs in place while the motion-sensitive controller serves as a pedometer. On screen, the user runs through a bucolic park while a pacesetter beckons the player onward. For longer runs, users can watch television while the Wii tracks their progress.

“I enjoyed it,” Ms. Weiss said. “It’s more interesting than running on a treadmill because it gives you something to look at. It’s like an interactive exercise game. In some ways, it’s like playing Nintendo, but with your body.”

BOTTOM LINE Wii Fit could be the right choice for exercise amateurs trying to get in shape in the living room.


Luke McCambley, 18, knows he is an anomaly.

“You don’t find many art-school gym rats, but I guess I qualify,” he said.

Mr. McCambley, a student at the School of Visual Arts in New York, was the only Wii Fit tester who actually owns a Wii. But he also belongs to a Crunch downtown, works out six days a week, and is studying to become a personal trainer.

So it wasn’t surprising he had little problem with various strength exercises like push-ups and leg twists. He aced balance games like skiing and heading soccer balls, and looked like he could punch through the screen in his aerobic boxing session.

“I go to the gym, so I don’t need this, but for someone who doesn’t want to leave the living room it would be great,” he said. “Over all, I liked it a lot. It seems really well-designed for the people it’s for. I worked up a sweat with a couple of the exercises.”

He added: “If you really committed to the strength exercises, you could actually get some results. That said, if you’re really looking to get fit, join a gym. But this would be great for mothers, or if they want their kids to get a little more in shape.”

BOTTOM LINE Serious athletes don’t need Wii Fit, but you (or your children) might like it.


Wii Fit is not, however, the right choice if you want to impress Cyndi Lee, 54, the founder of Om Yoga in New York.

Before trying the system, she eyed the board and declared, “It’s too small.” Nonetheless, she sailed through a progression of Wii Fit’s yoga poses, including the half-moon, warrior, tree and sun salutation. For each pose, at least one of the user’s feet or hands is usually on the board.

Afterward, her main concern seemed to be that Wii Fit reduces yoga to a collection of physical exercises rather than presenting yoga as a comprehensive approach to physical, mental and emotional wellness.

“This is a little dumbed down and they are teaching more from a fitness or gym perspective,” she said. “They’re saying things like, ‘Tighten your glutes,’ which we would never say in yoga.”

Ms. Lee also spied what she called incorrect elements within some poses. “Like with the warrior pose they show the knee going past the foot, which is a big no-no,” she said.

BOTTOM LINE Wii Fit will not make you a yogi.


Sharone Huey, 51, an exercise physiologist at the Sports Center at Chelsea Piers, spent the most time with Wii Fit. Over two days, she watched most other sessions and spent at least two and a half hours with the system herself.

Her initial skepticism evolved into a somewhat surprised admiration.

“Actually I think it’s pretty good,” she said. “You can definitely get a workout. When I started doing it, I realized all the activities were pretty much on point. There were some things I didn’t like, like the alignment in a couple of places. But over all, I thought they did a good job and this will be a good tool for people who can’t make it to the gym.”

“I can see this in a seniors center or senior community and it would be very interesting to be able to set up a whole class of people on boards, tracking their progress,” said Ms. Huey, who reigned supreme as the week’s hula-hoop champion.

“The big thing is so many people buy a treadmill or some other exercise machine and in two weeks it becomes an expensive clothes rack,” she said. “This makes exercise fun and I think it will help to motivate a lot of lazy folks.”

Among them, potentially other members of the Huey family. “I’ll get this for my lazy sisters,” she said.

BOTTOM LINE Watch for the Chelsea Piers Wii Fit class coming soon (maybe, just maybe).


And what about Mr. Lumpy Flounder himself? Around this time last year, I went to West Virginia to write about a plan there to install the aerobic video game Dance Dance Revolution in every school in the state. When I got back I thought, “O.K. let’s see if I’ll exercise regularly at home on D.D.R.”

I lasted a week. The problem was there were days when I just didn’t want to dance to electronic house music for half an hour. Wii Fit just might be different (though more than one tester commented on Wii Fit’s somewhat cheesy music). For me, the key is that one can approach Wii Fit like a game. In its sheer variety of activities, you can always find something to do. It beckons me to unlock the different exercises, to get four stars in snowboarding, to get through six more jackknife crunches.

I’ve spent about seven hours with Wii Fit recently and I’m still doing it. The step exercises remain my strong suit, though I’m still trying to figure out how to use my balance to navigate my floating bubble through the canyon without popping. I’m even running a little.

But I realize that in an exercise program no manner of electronic frippery (or fancy workout clothes) can make up for old-fashioned motivation. If I stop using Wii Fit, it won’t be because the graphics or the sound were bad. It will just mean I got tired of exercising, and no mere product will be at fault. Will I achieve the modest weight loss goal I’ve set? I can only hope so.

And no, I won’t tell you what it is.

Original here

The Ultimate Cure

The neurotech industry is engaged in a $2 trillion race to fix your brain. Many players will fail, but the payoff will be huge for those who succeed.

Don Debethizy
Cellerant Therapeutics is a clinical-stage biotechnology company with a portfolio of products based on the regulation of …
The Company is engaged in the discovery, development, manufacture, distribution and sale of a diversified line of products …
Primary executive:
Robert Essner,
A holding company, which is engaged in research and development, manufacture and sale of products in the health care field. …
Primary executive:
William C. Weldon,
A biopharmaceutical company engaged in the design, discovery and development of NNR Therapeutics(tm), a new class of drugs …
Primary executive:
Dr. J. Donald deBethizy, Ph.D.,
A biopharmaceutical company, which is engaged in the discovery and development of cell-based therapeutics to treat damage …
Primary executive:
Martin M. McGlynn,
A research-based, global pharmaceutical company which discovers, develops, manufactures and markets prescription medicines for humans and animals.
Primary executive:
Jeffrey B. Kindler,
Delivering more than two decades of implant innovation to over 60,000 people, Cochlear is built upon a foundation of success.
The Company and its subsidiary is engaged in the creation, discovery, development, manufacture and marketing of pharmaceutical …
The Company discovers, develops, manufactures and sells products in one segment of pharmaceutical products.
Primary executive:
Sidney Taurel,

Deep in Big Tobacco country, I’m talking to a former chief scientist for R.J. Reynolds about new wonder drugs for the brain that are inspired by, of all things, nicotine. We’re huddled in a futuristic steel-and-glass building in Winston-Salem, North Carolina, that looks like an alien starship next to the abandoned storefronts and empty brick cigarette factories of this faded town. I’m skeptical. Now C.E.O. of a company called Targacept, the ex-Reynolds man, Don deBethizy, is describing a class of drugs called nicotinics, which he says can restore the memory of Alzheimer’s patients, control pain, and improve attention spans. What’s more, they may boost cognition and memory in healthy people.

It seems far out even for the neurotechnology industry, a rapidly growing cluster of companies—small upstarts as well as pharmaceutical giants—that want to alter your gray matter and make billions of dollars in the process. These firms are trying to adapt groundbreaking research into the basic workings of the brain to new drugs for ailments ranging from insomnia to multiple sclerosis. Some companies are trying to regrow portions of the brain using stem cells. Others have developed implants to insert into a person’s head to control seizures and restore hearing. Cyber­kinetics Neurotechnology Systems, a Foxborough, Massachusetts, company, implanted electrodes into the brain of a quadriplegic that allowed him to operate machines with his thoughts. (View an interactive feature showing brain researchers’ latest efforts.)

DeBethizy’s jump-out-of-his-seat gusto makes me want to believe him.Yet I can’t shake the image of the Nick Naylor character in Thank You for Smoking, the film based on Christopher Buckley’s satirical novel about a spinmeister and apologist for the tobacco industry. Targacept’s birth was a by-product of deBeth­izy’s attempts at Reynolds to create a “safe” cigarette and find positive uses for nicotine. Neuroscientists and investors I spoke to vouch for deBeth­izy and insist that Targacept is among the hottest companies in the brain business and a leader among several outfits developing nicotinics. So here I am in this dog-eared burg to learn more about an industry that may not only hold the key to treating some of the most serious maladies of our time but also challenge society’s—and regulators’—opinions of whether drugs should be used to enhance healthy brains as well as treat illness.

Targacept is one of about 500 brain­tech companies going after the estimated $2 trillion that it costs globally when brains atrophy, degenerate, experience depression, cause convulsions, register pain, trigger anxiety, or simply fail to work as well as we would like. The size of the market is huge, according to data from the World Health Organization and others, which report that more than 1 billion people suffer from brain-related ailments each year. That number has grown rapidly during the past generation, as neurodisorders like depression have gone from being underdiagnosed to perhaps over­diagnosed, and Western populations, along with their brains, have aged. It’s hard to believe, but even in our Prozac nation, possibly tens of millions of people who might need brain meds aren’t getting them. In some parts of the developing world, the figure could be as high as 90 percent. (View a pop-up graphic that shows the revenue breakdown of drug treatments and disease.)

Neurotech’s returns are already enormous. In 2006, the industry brought in more than $120 billion—about $101 billion from drugs and the rest from neurodevices ($4.5 billion) and neurodiagnostics ($15 billion)—up 10 percent from the previous year, reports NeuroInsights, a market research and investment advisory firm. But industry analysts insist that this figure hardly begins to suggest the potential. For Alz­heimer’s, a disease currently without an effective treatment for about 4.5 million sufferers in the U.S., 40 companies—including behemoths like Eli Lilly, GlaxoSmithKline, and Wyeth, as well as Targacept and a gaggle of similar upstarts—are testing 48 new drugs in human trials in a quest for the Prozac of dementia. The push has brought many small to midsize biotech firms together in partnerships with larger pharmaceutical companies to pursue everything from pain-control compounds derived from chili peppers to an antistroke medicine developed from vampire-bat saliva. There is so much activity in neurotech that last fall it got its own index, NERV, on the Nasdaq, tracking the performance of 30 leading brain companies based in the United States. Analysts estimate that the sector should continue to grow by about 10 percent a year, which would produce a brain-industrial complex worth more than $300 billion in the next 10 years.

For now, though, brain businesses are still more likely to lose money than to make it. The failure rate is startling even for the pharmaceutical industry, which is accustomed to tremendous risk. Ninety-two percent of drugs that enter human clinical testing for the central nervous system—basically brain drugs—flop, compared with 89 percent for drugs across all categories, according to a study in Nature Reviews, a science journal. At the same time, the total cost of bringing one C.N.S. drug to market is nearly twice the average for all drugs—$1.6 billion as opposed to $800 million. The risk, along with the generally volatile economic climate, has helped send NERV tumbling more than 18 percent since its inception last September.

Still, investors see the immense size of potential markets and have swallowed hard, pumping billions of dollars into neurotech, hoping for that giant payback. (Hit the jackpot with a new anxiety-disorder med that’s better than the current batch and has fewer side effects, and you have a potential market of 40 million Americans and 400 million people worldwide.) “People invest because a success is usually a huge success,” says Ellen Baron, a venture capitalist with Oxford Bioscience Partners in Boston, which has invested in Targacept and other early-stage neuro companies. The top 20 C.N.S. drugs each earn more than a billion dollars per year, she notes. “This new science will produce breakthroughs, and everyone feels the potential to create a truly paradigm-shifting treatment,” Baron says. “But when? Nobody knows.”

Neurotechnology as its own industry sector is the brainchild, so to speak, of Zack Lynch, a former software marketing executive who lectures widely on future business trends. He believes that we are at the beginning of a brain wave that will dominate at least the next century or two. Lynch came up with several cute names for the advances he anticipates, such as cogniceuticals, for drugs that focus on improving decisionmaking, learning, attention span, and memory processes; emoticeuticals, which influence feelings, moods, motivation, and awareness; and sensoceuticals, which can restore and extend the capacity of senses for people who have impaired vision, smell, taste, and hearing. In 2005, he and his wife, Casey, a former biotech executive, founded NeuroInsights. Later, they started the Neurotechnology Industry Organization, a policy and lobbying group that has 70 companies as members.

After several months of negotiation with a top Nasdaq official, the couple convinced the exchange to launch the NERV index in September. Its leaders include Biogen Idec, a neuro-titan with a current market cap of $19.4 billion that’s developing treatments for (among other things) multiple sclerosis and Parkinson’s, and Shire, which makes the amphetamine Adderall and has a market cap of $10.6 billion. At the even more volatile bottom are companies with market caps of $250 million or so. Only companies with more than 50 percent of their revenues coming from neuro products are allowed on the index, so big pharmaceutical concerns like GlaxoSmithKline and Johnson & Johnson, despite having blockbuster brain drugs, don’t make the cut.

J&J, Glaxo, and Lilly, however, lead the list of the top five companies in neuro­tech revenues, a group that collectively earned $30.1 billion in 2006, 25 percent of all neuro sales. Pfizer is next, with $6 billion in sales in 2006, though that is down from $8.1 billion in 2004, before its patents for big sellers like Zoloft (for depression) and Neurontin (for epilepsy) expired. Wyeth rounds out the group, with almost $3.8 billion in sales.

I meet the Lynches one afternoon at a coffee shop in the Noe Valley neighborhood of San Francisco, a block or two from the NeuroInsights world headquarters in the basement of their home. Both in their mid-thirties, the two met in a calculus class at U.C.L.A. when they were freshmen. Zack first recognized the link among companies with neural products while giving his PowerPoint presentations about the future of technology at meetings and conferences.

The Lynches tend to talk as one brain, left and right, and they agree that turning neuroscience into cash and cures requires patience. “But I think a time is coming—or may be here—when our understanding of the brain will get to the point where we can more successfully make targeted drugs,” says Casey, a petite woman with dark hair and a practical, left-brained demeanor that balances her husband’s more right-brained, pie-in-the-sky fervor. “This will profoundly change medicine, and possibly who we are,” Zack says.

The couple’s new push is to get more federal dollars channeled toward the industry. Zack has been traveling back and forth to Washington, sometimes taking along neurotech C.E.O.’s, to promote a $1 billion “national neurotechnology initiative” that Representative Patrick Kennedy, a Rhode Island Democrat, recently announced he will introduce in Congress. The legislation asks the federal government to spend $200 million a year for five years on neurotech, including $30 million for the Food and Drug Administration to train more experts, $80 million for the National Institutes of Health to coordinate the neuroresearch efforts that are now run by 16 different institutes, and $75 million to increase small-business grants for neurotech companies.

Treatments for the mind are hardly new. Before modern times, remedies included the exorcism of evil spirits, bleedings to rid the body of bad humors, and opium smoking to alleviate “melancholy.” In the mid-20th century, physicians tried crude and often destructive “cures,” now discredited, such as lobotomy—removing sections of the brain believed to be causing neuroses.

In the 1950s and ’60s, psychiatry was revolutionized by the invention of antidepressants and tranquilizers. The progression of new drugs continued into the ’70s and ’80s, especially with the development of the blockbuster class of antidepressants called selective serotonin reuptake inhibitors, which includes Prozac. Approved by the F.D.A. in 1987, Prozac, as well as other S.S.R.I.’s—like Zoloft and Paxil—prolongs the action of serotonin, a neurotransmitter, which has beneficial effects on such problems as depression, attention-deficit disorder, and anxiety. Critics of S.S.R.I.’s argue that they don’t work for many patients, that they are being overprescribed, and that they can cause side effects such as loss of libido and (according to controversial findings) suicidal thoughts in teenagers.
But since the late ’80s, few new classes of drugs to treat brain maladies have made it to market, and many diseases remain either undertreated or, like Alzheimer’s and Huntington’s disease, not treated effectively. The industry now faces the challenge of parlaying two decades’ worth of breakthrough research on the basic workings of the brain into new and better treatments—a process that is often thwarted by the complexity of the brain. “We target a drug that is supposed to do one thing, and we find out it does five more things we didn’t expect,” says Sam Barondes, director of the Center for Neurobiology and Psychiatry at the University of California at San Francisco and the author of Mood Genes.

Much of the industry’s financial success in recent years has come from drugs that differ only slightly from longtime neuro-blockbusters, some of which are losing their patent protection. Patents expiring in 2008 include Risperdal, a schizophrenia drug from J&J’s Janssen unit, annual sales of which are approaching $4.2 billion. “The new products are coming, but the big numbers are still in the Prozac category,” says Martha Farah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania.

Some of the most interesting advances are being made not in drugs but in devices and other treatments. Late last year, StemCells Inc., a Palo Alto, California, company, announced that it had successfully transplanted stem cells into a human brain and that the patient had recently completed a one-year follow-up exam. Five other patients have also been injected with HuCNS-SC, as the company calls its human stem-cell product. All of the patients suffer from Batten disease, a genetic malady that leaves children’s brain cells without a critical enzyme and eventually causes seizures, loss of motor skills and mental capacity, blindness, and finally death. In previous studies with mice, the stem cells took hold and produced the missing enzyme. “These trials are just the beginning for stem-cell therapies in the brain and elsewhere,” says Antoun Nabhan, a former venture capitalist for Sagamore Bioventures who has invested in and sits on the board of Cellerant Therapeutics, one of StemCells’ competitors. But stem-cell treatments for more-common brain diseases are at least five years away, Nabhan says.

Earnings for neurodevices are only 4 percent of what neuromeds bring in, but for a few diseases, the impact has been miraculous. Take cochlear implants. Located in the inner ear, the cochlea translates sound waves into electrical signals that are channeled to the brain to be processed into the opening swell of a Mozart concerto or raindrops beating on a window. People with damaged or congenitally malformed cochleas were condemned either to near silence or to the use of imperfect hearing aids until the 1970s, when the first cochlear devices were surgically implanted. These had an electrical apparatus that fed signals into the audio nerve through electrodes. The latest versions of the devices use tiny computers to process even complex sounds like music into signals that the brain can recognize. More than 100,000 people have had the cochlear devices implanted worldwide (out of the millions affected), and many go from being deaf or near-deaf to being able to hear most sounds and function as if they had no hearing deficit. The device, which costs $20,000 or more, has annual sales totaling $550 million, and sales are growing 15 percent a year. Leading makers include Advanced Bionics, Cochlear, and Med-El.

One truly out-there device is Cyber­kinetics’ BrainGate, which was implanted into the brain of Matt Nagle, a quadriplegic patient, in an F.D.A.-approved trial. The device enabled him to control a computer cursor with only his thoughts. The BrainGate, which was connected to the computer by a wire, uses tiny electrodes to read electrical impulses from the brain’s motor cortex. In 2005, I visited Nagle—a former high-school football star who was paralyzed as a result of injuries he suffered during a brawl on a beach in Weymouth, Massachusetts—and I watched as he gave the mental command to move his arm up and down. The machine translated these thoughts into up and down cursor motions. As Nagle got better at controlling the device, he became able to write emails and operate controls for lights and a television. He could even control a prosthetic arm. But the BrainGate was cumbersome, difficult to calibrate between brain and machine, and sometimes left Nagle feeling frustrated. The company is now recruiting patients for additional trials.

All the uncertainty of the industry hasn’t dampened the enthusiasm of Targacept’s Don deBethizy, who toils with his team of scientists just up the street from the R.J. Reynolds headquarters, a 1929 skyscraper considered an Art Deco marvel in its day, with gilt tobacco leaves on the lobby’s ceiling. Targacept broke off from R.J.R. Nabisco in August 2000, just 36 hours before the unit was to be eliminated during the messy merger process that started when Kohlberg Kravis Roberts acquired the tobacco giant in 1989. At the last minute, drug giant Aventis stepped in with a $70 million partnering deal to save Targacept and its leading Alz­heimer’s compound, which was then in Phase 1 human trials. (This drug was later killed after the unit was unable to successfully breach the blood-brain barrier, a common problem for would-be neuromeds.) After becoming an independent company, Targacept raised $123 million in three rounds of private capital investment and $72 million from stock offerings. Milestone deals with AstraZeneca to develop cognitive-disorder meds and with GlaxoSmithKline to develop treatments for pain, obesity, smoking cessation, addiction, and Parkinson’s make up the remainder of Targacept’s financing.

As deBethizy explains, nicotinic receptors control or influence memory, attention span, mood, sensitivity to pain, inflammation, movement, and cell survival. “These receptors act like volume switches,” says Merouane Bencherif, Targacept’s vice president for Preclinical Research. Nicotinic drugs work by increasing neurotransmitter activity, Bencherif says, meaning more is around to zap the receptors to improve memory and mood. Turning down neurotransmitter activity reduces pain or inflammation.

Currently, Targacept has four compounds in human trials. Their connection with nicotine? “There isn’t really a connection anymore,” says deBethizy. The compounds are chemically unrelated to nicotine, but their action in activating the receptors mimics what nicotine does.

One of Targacept’s leading compounds is designed to improve cognitive activity in patients with Alzheimer’s disease; another is for schizophrenia. Both are in human trials. So far, the drugs have worked well for those with the diseases, but the Alz­heimer’s compound has also had an effect on healthy control subjects, whose scores on cognitive and memory exams improved significantly. The company also tested the compound on people who went to a memory clinic with mild age-associated memory impairment—the natural loss of memory that comes with normal aging. The mini-trial was a success: “People on 50 milligrams consistently said they remembered things better,” deBethizy says.

Several other companies are developing meds that could treat brain-function slowdown in the elderly and might also enhance brain function in younger people. These firms include Memory Pharmaceuticals, Cortex Pharmaceuticals, and Lilly. “We are working on glutamate receptor medicines for memory and cognition,” says Steve Paul, president of Lilly Research Laboratories. “This is a big future growth area for us.”

But the drugs’ success with healthy people raises a number of regulatory and ethical questions. The F.D.A. evaluates drugs based on how effectively they treat disease, not on whether they enhance healthy brains. Benedetto Vitiello, a psychiatrist and researcher at the National Institute of Mental Health who has also sat on neuropharma advisory panels for the F.D.A., acknowledges that many people face cognitive loss as part of normal aging. But the condition is often subtle and hard to quantify, he says. This may be one reason that the F.D.A. has been reluctant to list age-related cognitive loss as an official approved designation for new drugs, deBethizy suggests. He expects the F.D.A. to one day recognize it as an approved disease, “but right now,” he says, “no one wants to spend the resources on a drug that may not be approved.”

Yet mind-meds that can enhance mental functions are already used by healthy people. Through what’s known as off-​label use, legal prescriptions are written for conditions the drugs weren’t approved to treat. Physicians are allowed to prescribe any drug for any illness they see fit, but companies are barred from promoting drugs for unapproved uses.
A more recent drug being widely used off-label is Cephalon’s Provigil. This high-tech medicine is approved for narcolepsy and a sleeping disorder that develops when people work odd shifts. Provigil, however, is widely prescribed for other conditions, ranging from depression and A.D.D. to jet lag. In late 2007, Cephalon agreed to pay a $425 million settlement to the government after the firm’s sales force was accused of marketing Provigil and two other drugs to physicians to use for unapproved maladies. “It would behoove the federal government to get ahead of the enhancement issue now,” says Zack Lynch. “Provigil is just the beginning.”

A larger debate is percolating over what would happen if a pill could turn most people into brainiacs. “I don’t believe in cognitive enhancement for people who are well,” says memory expert and Nobel laureate Eric Kandel, a professor at Columbia University. “These should be pharma products for sick people.” N.I.H. neuroscientist Jordan Grafman agrees: “If you manipulate the brain, it can change who we are.”

Others say enhancers can’t be stopped. “The record is clear. Wherever there have been new agents that enhance our functioning, mental or physical, even when they’re risky like steroids, there are people who will use them,” says U.C.L.A. bioethicist Gregory Stock, author of Redesigning Humans: Our Inevitable Genetic Future and a strident advocate for enhancement. “Why shouldn’t people use them if they don’t hurt us?”

Back in the less surreal world of their favorite San Francisco coffee shop, Zack and Casey Lynch tell me that their organization delisted four companies a mere three months after the neurotech index joined Nasdaq, highlighting the fact that those who would make money from our brains face a brutal reality. “It’s a tough industry,” Zack says with a sigh, as Casey crosses out the delisted companies and writes down the new ones on the chart they had given me. “But the future is clear,” he says, quickly recovering his zeal, reminding me of Don deBethizy and the other neuro-cheerleaders. “This is going to work. The effects are going to be profound.”

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Taming That Overwhelming Urge to Smoke

Regis Duvignau/Reuters

It may be easy to start smoking, but quitting is a bit trickier.

In Brief:

The brain of an addicted smoker treats nicotine as if it is essential for survival.

Genetic traits may predispose some smokers to stronger addiction.

Most smokers try to quit unaided, resulting in a high failure rate.

If you smoke, no one needs to tell you how bad it is. So why haven’t you quit? Why hasn’t everyone?

Because smoking feels good. It stimulates and focuses the mind at the same time that it soothes and satisfies. The concentrated dose of nicotine in a drag off a cigarette triggers an immediate flood of dopamine and other neurochemicals that wash over the brain’s pleasure centers. Inhaling tobacco smoke is the quickest, most efficient way to get nicotine to the brain.

“I completely understand why you wouldn’t want to give it up,” said Dr. David Abrams, an addiction researcher at the National Institutes of Health. “It’s more difficult to get off nicotine than heroin or cocaine.”

Smoking “hijacks” the reward systems in the brain that drive you to seek food, water and sex, Dr. Abrams explained, driving you to seek nicotine with the same urgency. “Your brain thinks that this has to do with survival of the species,” he said.

Nicotine isn’t equally addictive for everyone. A lot of people do not smoke because they never liked it to begin with. Then there are “chippers,” who smoke occasionally but never seem to get hooked. But most people who smoke will eventually do it all day, every day.

New discoveries in genetics may explain why certain people take to smoking with such gusto and end up so addicted. Some people, for instance, produce a gene-encoded enzyme that clears nicotine from their bloodstreams rapidly, so they tend to smoke more and develop stronger addictions. Others possess special receptors in the brain that bond extra tightly with nicotine, giving them an especially intense high that makes it harder to quit.

Drug makers are exploiting the science of addiction to create novel treatments to help smokers quit. The newest stop-smoking medication, the first to be approved in 10 years, is called Chantix. Available by prescription, Chantix masquerades as nicotine well enough to occupy the brain’s nicotine receptors, where it may lessen cravings. Real nicotine, when it comes along, cannot find enough free receptors to do its thing.

Chantix seems to have a higher success rate than Zyban, an antidepressant that helps to balance dopamine levels. And recently released federal guidelines to doctors for helping smokers quit reported that the drug, combined with the nicotine replacement patch and use of nicotine nasal spray or gum as needed, produced higher long-term abstinence than the patch alone.

Doctors have written millions of prescriptions for Chantix, though enthusiasm for the drug was tempered by reports of suicide and bizarre behaviors in people taking it. The reports prompted the Food and Drug Administration to issue a safety warning about Chantix early in 2008.

“That’s something that needs to be taken very seriously, but it needs to be put in the context of what happens if you don’t quit smoking,” said Dr. Michael Fiore, a smoking cessation specialist at the University of Wisconsin and chairman of the government panel that issued the new guidelines. Dr. Fiore used to consult for Pfizer, the maker of Chantix, but said he cut those ties in 2005. He still prescribes the drug but now takes care to discuss the safety warning with patients.

Dr. Nancy Rigotti was involved in Chantix studies conducted at Massachusetts General Hospital in Boston, where she directs the Tobacco Research and Treatment Unit. “Those trials mostly enrolled people who were pretty healthy,” she said. “They did not include people with depression or much of a history of depression.”

Dr. Rigotti said it was possible that varenicline, the generic name for Chantix, “might have more psychiatric side effects in certain groups of people.”

Continued research should help to resolve lingering concerns about the safety of Chantix. Meanwhile, experts continue to recommend the old standbys: nicotine replacement gums, patches, nasal sprays, inhalers and lozenges, which have been proved to be safe.

Nicotine by itself does not cause cancer, heart disease or other major health problems linked to smoking; other chemicals in tobacco smoke are to blame. Nicotine replacement can be used alone or with prescription medications or, for best results, combined with counseling. Recent evidence suggests that using two forms simultaneously, like the patch and gum together, works better than either alone.

Although nicotine replacement products do not require a prescription, the F.D.A. limits where and how they are sold. They are also expensive.

“It’s so much easier to go down to the corner store and get a pack of cigarettes than it is to get access to evidence-based treatment,” Dr. Fiore said.

This year, the New York State health commission petitioned the F.D.A. to revise its rules so that nicotine gum, patches and lozenges could be sold anyplace that sells cigarettes, and at prices comparable to a cigarette pack. The agency is currently reviewing the petition.

Still, no treatment works for everyone. And even with the most successful treatments, only about 30 percent of attempts to quit last more than six months. Compared with willpower alone, however, that’s a huge improvement. Fewer than one in 10 smokers who go it alone manages to go six months without a cigarette. Most do not make it past a week.

When longtime smokers finally do quit, they soon realize that not smoking doesn’t necessarily make them nonsmokers. That’s what counseling is for — learning to function without nicotine and to cope with the cues that trigger smoking urges.

Most important, former smokers have to rediscover that it is possible to enjoy life without cigarettes, although the yearning may never die completely.

“I’m an ex-smoker,” Dr. Abrams said, “and I still miss it.” said.

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5 mistakes women make at the doctor's office

Empowered Patient, a regular feature from CNN Medical News correspondent Elizabeth Cohen, helps put you in the driver's seat when it comes to health care.


Even well-educated women sometimes freeze up in the doctor's office, says Dr. Christiane Northrup.

ATLANTA, Georgia (CNN) -- For 10 years, Barbara's gut told her she needed to get a new doctor for her daughter, and for 10 years, she didn't listen, even as her daughter got sicker and sicker.

The doctor had diagnosed irritable bowel syndrome when Barbara's daughter was 13. Day after day, year after year, she had bloody diarrhea.

At age 23, weighing just 112 pounds at 6 feet tall, her daughter became so sick and malnourished she ended up in the hospital. Barbara's intuition told her the doctor wasn't giving her daughter the right treatment, but she just couldn't tell him.

"It was like my tongue was bolted to my bottom mouth, and I couldn't get the words out. I didn't want to offend him. I was paralyzed," said Barbara, a high-ranking university administrator.

"I'm well-educated. I have a Ph.D. I make decisions easily, and I say 'no' easily. But in this situation, it was like I had a different personality. I felt like I'd reverted to childhood," she added.

Research on women's interaction with doctors is limited, but a number of women's health experts say they had noticed trends among female patients that didn't see as frequently in men.

Feeling paralyzed and voiceless in the doctor's office is one of the major health care mistakes women make, says Dr. Christiane Northrup, author of "Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing."

"Even very well-educated women freeze up and don't speak up" in some cases, she said.

Here, from Northrup and other women's health specialists, are five mistakes women make at the doctor's office.

1. Women don't question doctors

"Being at a doctor's office often puts the patient in the position of 'child' and the doctor in a position of 'parent,' " Northrup said.

Northrup's solution: "Always take someone with you who will ask the questions you are afraid to ask."

When you're alone, Robin DiMatteo, a distinguished professor of psychology at the University of California, Riverside, has this suggestion. "Say to the doctor, 'I realize I don't have the medical skills that you do, but this doesn't make sense to me logically. Can we think this through together?' "

2. Women tend to over-research

According to the Pew Internet Project, women are more likely to look up health information on the Internet. In a telephone survey, 69 percent of women said they'd looked up information about a specific disease or condition, compared with 58 percent of men.

Although doing your own research is a good thing, Dr. Pamela Peeke says her female patients are more likely to become overwhelmed by what they read.

"Women are much more likely to come in with hundreds of pages of Internet printouts under their arms, and they've become convinced they have all sorts of diseases," she said.

The solution: Some experts recommend doing research on the Internet and writing down the most important points rather than carrying in numerous printouts. That way, you can have a more focused conversation with your doctor.

3. Women don't recognize gender bias

Several studies have shown that women's medical problems are more likely to be interpreted as emotional issues or complaining.

"You should recognize that there is doctor bias," advised Dr. Nieca Goldberg, author of "Women are Not Small Men." "You don't want to go to a doctor who says, 'Now, honey, it's not all that bad.' "

Goldberg says she remembers going to a doctor who made a remark like that. "I said, 'I don't think we'll be continuing this visit,' " she remembered.

4. Women interpret their own symptoms

Goldberg says she's seen this over and over again: Instead of just giving the doctor the facts, women sometimes also offer their own interpretations, which can put their own health at risk.

For example, she's seen women who are having heart attacks tell the doctor that they think it's just indigestion. "This could be dangerous if you're in the ER having a heart attack," Goldberg says. "You don't want to lead the doctor down the wrong path."

Goldberg's advice: Just state the facts, and let the doctor do the interpreting. There'll be time for questions afterwards if you think the doctor's diagnosis is wrong.

5. The mother of all mistakes: Women don't trust their intuition

This is what happened to Barbara, who asked that her last name not be used for fear of retribution from other doctors in her small town.

She says her gut told her that her daughter's doctor didn't have the right diagnosis. When she and her daughter finally found a new doctor, he said her daughter didn't have irritable bowel syndrome at all; she had ulcerative colitis.

Last year, surgeons removed her daughter's colon. Her bloody diarrhea is gone, and her daughter now weighs a healthy 158 pounds.

"There are literally hundreds of situations in which a woman's gut intuition is spot-on, but she talks herself out of it so as not to make waves," Northrup said. "We women are suckers for wanting to be loved."
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