Adderall, a Drug of Increased Focus for N.F.L. Players





The first time Anthony Becht heard about Adderall, he was in the Tampa Bay locker room in 2006. A teammate who had a prescription for the drug shook his pill bottle at Becht.




“ ‘You’ve got to get some of these,’ ” Becht recalled the player saying. “I was like, ‘What the heck is that?’ He definitely needed it. He said it just locks you in, hones you in. He said, ‘When I have to take them, my focus is just raised up to another level.’ ”


Becht said he did not give Adderall another thought until 2009, when he was playing in Arizona and his fellow tight end Ben Patrick was suspended for testing positive for amphetamines. The drug he took, Patrick said, was Adderall. Becht asked Patrick why he took it, and Patrick told Becht, and reporters, that he had needed to stay awake for a long drive.


Those two conversations gave Becht, now a free agent, an early glimpse at a problem that is confounding the N.F.L. this season. Players are taking Adderall, a medication widely prescribed to treat attention deficit hyperactivity disorder, whether they need it or not, and are failing drug tests because of it. And that is almost certainly contributing to a most-troubling result: a record-setting year for N.F.L. drug suspensions.


According to N.F.L. figures, 21 suspensions were announced this calendar year because of failed tests for performance-enhancing drugs, including amphetamines like Adderall. That is a 75 percent increase over the 12 suspensions announced in 2011 and, with a month to go in 2012, it is the most in a year since suspensions for performance-enhancing drugs began in 1989.


At least seven of the players suspended this year have been linked in news media reports to Adderall or have publicly blamed the drug, which acts as a strong stimulant in those without A.D.H.D. The most recent examples were Tampa Bay cornerback Eric Wright and New England defensive lineman Jermaine Cunningham last week.


The N.F.L. is forbidden under the terms of the drug-testing agreement with the players union from announcing what substance players have tested positive for — the urine test does not distinguish among types of amphetamines — and there is some suspicion that at least a few players may claim they took Adderall instead of admitting to steroid use, which carries a far greater stigma. But Adolpho Birch, who oversees drug testing as the N.F.L.’s senior vice president for law and labor, said last week that failed tests for amphetamines were up this year, although he did not provide any specifics. The increase in Adderall use probably accounts for a large part of the overall increase in failed tests.


“If nothing else it probably reflects an uptick in the use of amphetamine and amphetamine-related substances throughout society,” Birch said. “It’s not a secret that it’s a societal trend, and I think we’re starting to see some of the effects of that trend throughout our league.”


Amphetamines have long been used by athletes to provide a boost — think of the stories of “greenies” in baseball clubhouses decades ago. That Adderall use and abuse has made its way to the N.F.L. surprises few, because A.D.H.D. diagnoses and the use of medication to control it have sharply increased in recent years.


According to Dr. Lenard Adler, who runs the adult A.D.H.D. program at New York University Langone Medical Center, 4.4 percent of adults in the general population have the disorder, of which an estimated two-thirds are men. Birch said the number of exemptions the N.F.L. has granted for players who need treatment for A.D.H.D. is “almost certainly fewer” than 4.4 percent of those in the league.


The rates of those with the disorder fall as people get older; it is far more prevalent in children and adolescents. A report from the Centers for Disease Control and Prevention, using input from parents, found that as of 2007, about 9.5 percent or 5.4 million children from ages 4 to 17 had A.D.H.D. at some point. That was an increase of 22 percent from 2003. Boys (13.2 percent) were more likely to have the disorder than girls (5.6 percent).


Of children who currently have A.D.H.D., 66.3 percent are receiving medication, with boys 2.8 times more likely to receive medication. Those 11 to 17 years old are more likely to receive medication than younger children.


But Adderall, categorized by the Drug Enforcement Administration as a Schedule II controlled substance because it is particularly addictive, is also used by college students and even some high school students to provide extra energy and concentration for studying or as a party drug to ward off fatigue.


Dr. Leah Lagos, a New York sports psychologist who has worked with college and professional athletes, said she had seen patients who have used Adderall. She said she believed the rise in its use by professional athletes mimicked the use by college students. Just a few years ago, she said, it was estimated that 1 in 10 college students was abusing stimulants like Adderall and Ritalin. That estimate, Lagos said, has almost doubled.


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IHT Rendezvous: Another 'nail house' in China gets hammered

HONG KONG — A renowned “nail house” in eastern China was finally hammered to the ground on Saturday, as the authorities demolished the house that was sitting smack dab in the middle of a new roadway.

The duck farmers who owned the five-story house, Luo Baogen and his wife, had refused to sell when local officials began buying up property in 2008 for a new highway in Zhejiang Province. More than 450 homeowners in the neighborhood took the government’s relocation offer, reportedly about $35,000 each.

But Mr. Luo resisted, even as construction began last year. The road, leading to a new train station outside the city of Wenling, was completed anyway — completely encircling the Luo house in a strange, bulging loop of tarmac.

Homes like Mr. Luo’s are known in China as nail houses “because such buildings stick out and are difficult to remove, like a stubborn nail,” according to Xinhua, the official Chinese news agency.

His refusal to move became something of a cause célèbre in China, especially on social media, and he was seen as a symbol of resistance to government land grabs, illegal midnight demolitions and rapacious development.

Mr. Luo’s home still had electricity and water, unlike other nail houses whose owners usually relent when their utilities are cut off.

Late last week, however, the couple agreed to move, accepting about $42,000 and a plot of ground for a new house, Xinhua said. New reports said Mr. Luo, 67, had originally put the value of his house at 600,000 renminbi, or about $96,000.

There was no clear or immediate explanation of why he gave in, although Xinhua quoted him as saying, “It was never a final solution for us to live in a lone house in the middle of the road. After the government’s explanations, I finally decided to move.”

Another Chinese nail house, in the sprawling city of Chongqing, drew nationwide attention in 2007 when its owner, a plucky woman named Wu Ping, refused to surrender her house for a new commercial development.

She was the lone holdout among 280 homeowners, and her husband, Yang Wu, stayed in the house as excavation went on around him. Their house eventually came to sit atop a free-standing mesa of land, and Mr. Yang was essentially marooned up there.

Ms. Wu brought him food, water and propane, which he hauled up on ropes, and he defiantly flew a Chinese flag above the house. Five stories below, Ms. Wu gave impassioned interviews and staged impromptu news conferences.

As my former colleague Howard W. French Jr. reported at the time, Ms. Wu’s defiance struck the same sort of nerve as Mr. Luo has:

It has a universal resonance in a country where rich developers are seen to be in cahoots with politicians and where both enjoy unchallenged sway. Each year, China is roiled by tens of thousands of riots and demonstrations, and few issues pack as much emotional force as the discontent of people who are suddenly uprooted, told that they must make way for a new skyscraper or golf course or industrial zone.

What drove interest in the Chongqing case was the uncanny ability of the homeowner to hold out for so long. Stories are legion in Chinese cities of the arrest or even beating of people who protest too vigorously against their eviction and relocation. In one often-heard twist, holdouts are summoned to the local police station and return home only to find their house already demolished.

Even the state-run newspaper China Daily seemed to sympathize, writing at the time that “experts believe that the outcry reflects a growing dissatisfaction among common people about the way sites are commandered and buildings demolished. On China’s portal Web sites like Sina, 85 percent of those polled showed support for the couple.”

Ms. Wu reached a settlement with the developer in April 2007, her home was promptly demolished and she became a national celebrity.

Eminent domain is a sensitive issue in many countries, of course, and a handful of Japanese farmers have held on to their small parcels for decades, despite efforts to expand Narita Airport outside Tokyo. Farmers, activists and leftist students fought the police to block construction at Narita in the 1970s, and one riot there left three police officers dead.

“The original plan drafted by the government in the 1970s envisioned three runways at Narita,” The Japan Times reported in April. “But it was unable to acquire the necessary land due to violent opposition from local residents and farmers, forcing it to open with just a single runway in May 1978.”

A second, short, provisional runway was built in time for the 2002 World Cup, but since then, the paper said, “the airport has relied entirely on a single 4,000-meter strip for all passenger and cargo flights.”

Part of the resistance efforts included the building of huts on the contested land, and in a compromise reached more than 40 years later, two of those huts were demolished last week.

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The Boy Genius Report: Microsoft is blowing it and RIM could too












Who would have thought a couple of years ago that Research In Motion (RIMM) would be on the ropes and Microsoft (MSFT) could be getting close? Well, me… but not many others. Microsoft’s latest strategy of trying to make a no compromise tablet has resulted in, you guessed it, compromise. It’s not as polished as an iPad, it’s more limited in almost every possible way, it’s slow, clunky, unresponsive at times, offers a worse display, weighs more, and is thicker. Plus it costs over $ 100 more when you factor in a Touch Cover or Type Cover keyboard. Plus, you can’t even run Windows applications even though you get the actual Windows desktop.


The best part is the Surface Pro. An even more expensive version of the Surface, an even thicker version of the Surface, and an even heavier version of the Surface, and you get a fan to cool your heating tablet when you’re doing your Excel speadsheets or when Outlook keeps freezing — oh my god why does it freeze so much when you’re typing — and you get half the battery life of the current Surface model.












There’s a very big issue with Microsoft’s strategy of no compromise, because time and time again this company fails to realize that the reason Apple (AAPL) is winning is because Apple choses to compromise.


Apple chooses to throw out the USB port, the DVD drive, the kickstand, the fan, the Intel processor. Apple understands that laptops are still useful but at this point in the game, the only use for a multitouch laptop should be in the trackpad. Microsoft is trying to introduce the Surface Pro as your new laptop, except it doesn’t work well is a variety of situations, especially on your lap. Plus, consumers don’t care, and with enterprises and large companies (and small companies) not rushing out to buy brand new computers or brand new software licenses for their employees and workstations due to cost, and the fact that more and more employees are bringing in their own laptops and also asking for Macs, Microsoft has a tremendous problem.


Compounding Windows 8′s failure is the fact that Microsoft is still not prepared for the consumerization of the enterprise world, Microsoft’s bread and butter, and the reason why Microsoft has $ 60 billion in cash. As Windows licenses erode and Office sales slow, Microsoft isn’t going to have another hugely profitable business to rely on — that’s why this is so scary.


Switching to RIM, the company is actually doing a lot of things right in my book. I respect that everyone there has been huddled up, focused on a single product and operating system and put all of their time into getting it as right as they can. Whether that means anything at all, we’ll soon see; RIM has probably been one of the worst players in the mobile space as far as execution is concerned but Thorsten Heins seems to have a better grasp on where the company can take advantage in different markets and at what price point, though RIM’s market share is declining so rapidly that not even BrickBreaker can save the company there.


I have two concerns from a very high level (in-depth thoughts at a later date) about BlackBerry 10 and the devices RIM is introducing on the hardware front. First off, going with a touch only phone first sends the wrong message to me. What is RIM’s biggest strength? Some would say email, some would say security, most would say the keyboard. Introducing a brand new operating system, with a brand new smartphone that doesn’t feature RIM’s fantastic keyboard feels like a marketing blunder. If there is one single reason BlackBerry owners (yes! they do still exist) still have a BlackBerry, it’s for the keyboard.


Yes, I know, there is a QWERTY BlackBerry 10 smartphone coming just a couple of weeks or months after the first touchscreen device, but these two should have been joined at the hip at the very minimum.


My other concern is RIM is already showing a break in the company’s focus by introducing two different screen sizes from the gate. The BlackBerry L-series will have a 1280 x 768 screen resolution and the BlackBerry N-series have a 720 x 720-pixel display. In my time playing with an N-series prototype, this square resolution felt incredibly awkward and it’s now two screen sizes that RIM’s developer community has to account for when making apps. Add this to the fact that RIM has enough trouble getting developers on board — of course Microsoft is having trouble there, too — and this feels like it’s not the most optimal scenario.  


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Police: Chiefs' Belcher kills girlfriend, self

KANSAS CITY, Mo. (AP) — It began like any other Saturday for the Kansas City Chiefs during the NFL season, their general manager and coach at work early to put final touches on this weekend's gameplan. Then they got a call to hurry to the parking lot.

The two men rushed through the glass doors of Chiefs headquarters and came face-to-face with linebacker Jovan Belcher, holding a handgun to his head.

Belcher had already killed his girlfriend and sped the short distance to Arrowhead Stadium, right past a security checkpoint guarding the entrance. Upon finding his bosses, Belcher thanked general manager Scott Pioli and head coach Romeo Crennel for giving him a chance in the NFL. Then he turned away and pulled the trigger.

The murder-suicide shocked a franchise that has been dealing with controversies now made trivial by comparison: eight consecutive losses, injuries too numerous to count, discontent among fans and the prospect that Pioli and Crennel could be fired at season's end.

Authorities did not release a possible motive while piecing together the case, other than to note that Belcher and his girlfriend, 22-year-old Kasandra M. Perkins, had been arguing frequently.

The two of them left behind a 3-month-old girl. She was being cared for by family.

The Chiefs issued a statement that said their game Sunday afternoon against the Carolina Panthers would go on as scheduled, even as the franchise tried to come to grips with the awfulness of Belcher's death.

"The entire Chiefs family is deeply saddened by today's events, and our collective hearts are heavy with sympathy, thoughts and prayers for the families and friends affected by this unthinkable tragedy," Chiefs chairman Clark Hunt said in brief a statement.

A spokesman for the team told The Associated Press that Crennel plans to coach on Sunday.

"I can tell you that you have absolutely no idea what it's like to see someone kill themselves," said Kansas City Mayor Sly James, who spoke to Pioli shortly after the shootings.

"You can take your worst nightmare and put someone you know and love in that situation, and give them a gun and stand three feet away and watch them kill themselves. That's what it's like," James said. "It's unfathomable."

Chiefs quarterback Brady Quinn told The Kansas City Star that when the team met later Saturday morning, Crennel broke the news to them.

"It was obviously tough for coach to have to tell us that," Quinn said. "He really wasn't able to finish talking to us. We got together and prayed and then we moved on."

But Quinn said the team was so stunned, it was hard to digest what had happened.

"It's hard mostly because I keep thinking about what I could have done to stop this," he said. "I think everyone is wondering whether we would have done something to prevent this from happening."

The 25-year-old Belcher was from West Babylon, N.Y., and played college football at Maine. He signed with the Chiefs as an undrafted free agent, made the team and hung around the past four years, eventually moving into the starting lineup. He played in all 11 games this season.

The NFL released a statement expressing sympathy and pledging "to provide assistance in any way that we can." The players' association has also been in touch with members of the Chiefs.

"We sincerely appreciate the expressions of sympathy and support we have received from so many in the Kansas City and NFL communities, and ask for continued prayers for the loved ones of those impacted," Hunt said. "We will continue to fully cooperate with the authorities and work to ensure that the appropriate counseling resources are available to all members of the organization."

The drama unfolded early Saturday when authorities received a call from a woman who said her daughter had been shot multiple times at a residence about five miles from the Arrowhead complex. The call came from Belcher's mother, who referred to the victim as her daughter.

"She treated Kasandra like a daughter," Kansas City police spokesman Darin Snapp said, adding that the woman had recently moved in with the couple, "probably to help out with the baby."

Police then got a phone call from the Chiefs' training facility, and Belcher's description matched the suspect description from the initial address. Snapp said officers pulled into the practice facility parking lot in a matter of minutes, in time to witness the suicide.

"Pioli and Crennel and another coach or employee was standing outside and appeared to be talking to him," Snapp said. "The suspect began to walk in the opposite direction of the coaches and the officers and that's when they heard the gunshot. It appears he took his own life."

The coaches told police they never felt in any danger.

"They said the player was actually thanking them for everything they'd done for him," Snapp said. "He was thanking them and everything. That's when he walked away and shot himself."

Members of the Chiefs mostly laid low Saturday, but a few reacted on Twitter.

"I am devastated by this mornings events," Pro Bowl linebacker Tamba Hali wrote. "I want to send my thoughts and prayers out to everyone effected by this tragedy."

A large group of Belcher's friends and relatives gathered Saturday at his boyhood home on Long Island.

His family turned the front yard into a shrine, with a large poster of Belcher, an array of his trophies, and jerseys and jackets from Kansas City, Maine and West Babylon High.

"He was a good, good person ... a family man. A loving guy," said family friend Ruben Marshall, who said he coached Belcher in youth football. "You couldn't be around a better person."

At least 20 people gathered for a large group hug in the driveway.

"He was a tremendous player and all those things, and his accolades speak for themselves, but he lit up when he spoke about his mom, or when he hugged his family after games," said Dwayne Wilmot, who was Belcher's position coach at Maine and is now an assistant coach at Yale.

"It's difficult to talk about Jovan in the past tense," he told the AP. "There's going to be unanswered questions, the why's of this tragedy. It'll never be truly known to us."

Wilmot said he'd stayed in touch with Belcher the past few years through social media.

"He was someone who took genuine pleasure in bringing happiness to others," Wilmot said. "I was so excited when he became a father, because I knew he'd be a great father."

His girlfriend's Facebook page shows the couple smiling and holding the baby.

Belcher is the latest among several players and NFL retirees to die from self-inflicted gunshot wounds during the past few years. The death of star linebacker Junior Seau, who shot himself in the chest in at his California home last May, sent shockwaves around the league.

Seau's family, like those of other suicide victims, donated his brain tissue to medical authorities to determine if head injuries he sustained playing football might be linked to his death. That report has not been released, although an autopsy showed no underlying hemorrhaging or bruises on Seau's brain.

Belcher did not have an extensive injury history, though he was listed as having a head injury on a report from Nov. 11, 2009. Belcher played four days later against the Oakland Raiders.

Earlier this year, the NFL provided a grant to help establish an independently operated phone service that connects players, coaches, team officials and other staff with counselors trained to work through personal and emotional crises. The NFL Life Line is available 24 hours a day.

The season has been a massive disappointment for the Chiefs, who were expected to contend for the AFC West title. They're 1-10 and mired in an eight-game skid marked by injuries, poor play and fan upheaval. During the past few weeks there have been constant calls for Pioli and Crennel to be fired.

It's unknown how the Chiefs plan to pay tribute to Belcher during Sunday's game.

"His move to the NFL was in keeping with his dreams," said Jack Cosgrove, who coached Belcher at Maine. "This is an indescribably horrible tragedy."

___

Associated Press Writers Heather Hollingsworth and Frank Eltman contributed to this report.

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Online: http://pro32.ap.org and http://twitter.com/AP_NFL

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As Companies Seek Tax Deals, Governments Pay High Price





In the end, the money that towns across America gave General Motors did not matter.




When the automaker released a list of factories it was closing during bankruptcy three years ago, communities that had considered themselves G.M.’s business partners were among the targets.


For years, mayors and governors anxious about local jobs had agreed to G.M.’s demands for cash rewards, free buildings, worker training and lucrative tax breaks. As late as 2007, the company was telling local officials that these sorts of incentives would “further G.M.’s strong relationship” with them and be a “win/win situation,” according to town council notes from one Michigan community.


Yet at least 50 properties on the 2009 liquidation list were in towns and states that had awarded incentives, adding up to billions in taxpayer dollars, according to data compiled by The New York Times.


Some officials, desperate to keep G.M., offered more. Ohio was proposing a $56 million deal to save its Moraine plant, and Wisconsin, fighting for its Janesville factory, offered $153 million.


But their overtures were to no avail. G.M. walked away and, thanks to a federal bailout, is once again profitable. The towns have not been so fortunate, having spent scarce funds in exchange for thousands of jobs that no longer exist.


One township, Ypsilanti, Mich., is suing over the automaker’s departure. “You can’t just make these promises and throw them around like they’re spare change in the drawer,” said Doug Winters, the township’s attorney.


Yet across the country, companies have been doing just that. And the giveaways are adding up to a gigantic bill for taxpayers.


A Times investigation has examined and tallied thousands of local incentives granted nationwide and has found that states, counties and cities are giving up more than $80 billion each year to companies. The beneficiaries come from virtually every corner of the corporate world, encompassing oil and coal conglomerates, technology and entertainment companies, banks and big-box retail chains.


The cost of the awards is certainly far higher. A full accounting, The Times discovered, is not possible because the incentives are granted by thousands of government agencies and officials, and many do not know the value of all their awards. Nor do they know if the money was worth it because they rarely track how many jobs are created. Even where officials do track incentives, they acknowledge that it is impossible to know whether the jobs would have been created without the aid.


“How can you even talk about rationalizing what you’re doing when you don’t even know what you’re doing?” said Timothy J. Bartik, a senior economist at the W.E. Upjohn Institute for Employment Research in Kalamazoo, Mich.


The Times analyzed more than 150,000 awards and created a searchable database of incentive spending. The survey was supplemented by interviews with more than 100 officials in government and business organizations as well as corporate executives and consultants.


A portrait arises of mayors and governors who are desperate to create jobs, outmatched by multinational corporations and short on tools to fact-check what companies tell them. Many of the officials said they feared that companies would move jobs overseas if they did not get subsidies in the United States.


Over the years, corporations have increasingly exploited that fear, creating a high-stakes bazaar where they pit local officials against one another to get the most lucrative packages. States compete with other states, cities compete with surrounding suburbs, and even small towns have entered the race with the goal of defeating their neighbors.


While some jobs have certainly migrated overseas, many companies receiving incentives were not considering leaving the country, according to interviews and incentive data.


Despite their scale, state and local incentives have barely been part of the national debate on the economic crisis. The budget negotiations under way in Washington have not addressed whether the incentives are worth the cost, even though 20 percent of state and local budgets come from federal spending. Lawmakers in Washington are battling over possible increases in personal taxes, while both parties have said that lower federal taxes on corporations are needed for the country to compete globally.


The Times analysis shows that Texas awards more incentives, over $19 billion a year, than any other state. Alaska, West Virginia and Nebraska give up the most per resident.


For many communities, the payouts add up to a substantial chunk of their overall spending, the analysis found. Oklahoma and West Virginia give up amounts equal to about one-third of their budgets, and Maine allocates nearly a fifth.


In a few states, the cost of incentives is not significant. But several of them have low business taxes — or none at all — which can save companies even more money than tax credits.


Far and away the most incentive money is spent on manufacturing, about $25.5 billion a year, followed by agriculture. The oil, gas and mining industries come in third, and the film business fourth. Technology is not far behind, as companies like Twitter and Facebook increasingly seek tax breaks and many localities bet on the industry’s long-term viability.


Those hopes were once more focused on automakers, which for decades have pushed cities and states to set up incentive programs, blazing a trail that companies of all sorts followed. Even today, G.M. is the top beneficiary, public records indicate. It received at least $1.7 billion in local incentives in the last five years, followed closely by Ford and Chrysler.


A spokesman for General Motors said that almost every major employer applied for incentives because they help keep companies competitive and retain or create jobs.


“There are many reasons why so many Ford, Chrysler and G.M. plants closed over the last few decades,” said the G.M. spokesman, James Cain. “But these factors don’t mean that the companies and communities didn’t benefit while the plants were open, which was often for generations.”


Mr. Cain cited research showing that the company received less money per job than foreign automakers operating in the United States.


Questioned about incentives, officials at dozens of other large corporations said they owed it to shareholders to maximize profits. Many emphasized that they employ thousands of Americans who pay taxes and spend money in the local economy.


For government officials like Bobby Hitt of South Carolina, the incentives are a good investment that will raise tax revenues in the long run.


“I don’t see it as giving up anything,” said Mr. Hitt, who worked at BMW in the 1990s and helped it win $130 million from South Carolina.


Today, Mr. Hitt is the state’s secretary of commerce. South Carolina recently took on a $218 million debt to assist Boeing’s expansion there and offered the company tax breaks for 10 years.


Mr. Hitt, like most political officials, has a short-term mandate. It will take years to see whether the state’s bet on Boeing bears fruit.


In Michigan, Gov. Rick Snyder, a Republican in his first term, has been working to eliminate most business tax credits but is bound by past awards. The state gave General Motors $779 million in credits in 2009, just a month after the company received a $50 billion federal bailout and decided to close seven plants in Michigan.


G.M. can use the credits to offset its state tax bill for up to 20 years. “You don’t know who will take a credit or when,” said Doug Smith, a senior official at the state’s economic development agency. “We may give a credit to G.M., and they might not take it for three years or 10 years or more.”


One corporate executive, Donald J. Hall Jr. of Hallmark, thinks business subsidies are hurting his hometown, Kansas City, Mo., by diverting money from public education. “It’s really not creating new jobs,” Mr. Hall said. “It’s motivated by politicians who want to claim they have brought new jobs into their state.”


For Mr. Hall and others in Kansas City, the futility of free-flowing incentives has been underscored by a border war between Kansas and Missouri.


Soon after Kansas recruited AMC Entertainment with a $36 million award last year, the state cut its education budget by $104 million. AMC was moving only a few miles, across the border from Missouri. Workers saw little change other than in commuting times and office décor. A few months later, Missouri lured Applebee’s headquarters from Kansas.


“I just shake my head every time it happens, it just gives me a sick feeling in the pit of my stomach,” said Sean O’Byrne, the vice president of the Downtown Council of Kansas City. “It sounds like I’m talking myself out of a job, but there ought to be a law against what I’m doing.”


Outgunned by Companies


For local governments, incentives have become the cost of doing business with almost every business. The Times found that the awards go to companies big and small, those gushing in profits and those sinking in losses, American companies and foreign companies, and every industry imaginable.


Workers are a vital ingredient in any business, yet companies and government officials increasingly view the creation of jobs as an expense that should be subsidized by taxpayers, private consultants and local officials said.


Even big retailers and hotels, whose business depends on being in specific locations, bargain for incentives as if they can move anywhere. The same can be said for many movie productions, which almost never come to town without local subsidies.


When Oliver Stone made the 2010 sequel to “Wall Street,” in his mind there was only one place to shoot it: New York City. Nonetheless, the film, a scathing look at bankers’ greed, received $10 million in tax credits, according to 20th Century Fox.


In an interview, Mr. Stone criticized subsidies for industries like banking and agriculture but defended them for Hollywood, saying that many movies can be shot anywhere and that their actors and crew members pay state income taxes. “It’s good,” Mr. Stone said of the film subsidies. “Or like basically the way business is done. I don’t understand what the moral qualm is.”


The practical consequences can be easily seen. The Manhattan Institute for Policy Research, a conservative group, found that the amount New York spends on film credits every year equals the cost of hiring 5,000 public-school teachers.


Nationwide, billions of dollars in incentives are being awarded as state governments face steep deficits. Last year alone, states cut public services and raised taxes by a collective $156 billion, according to the Center on Budget and Policy Priorities, a liberal-leaning advocacy group.


Incentives come in many forms: cash grants and loans; sales tax breaks; income tax credits and exemptions; free services; and property tax abatements. The income tax breaks add up to $18 billion and sales tax relief around $52 billion of the overall $80 billion in incentives.


Collecting data on property tax abatements is the most difficult because only a handful of states track the amounts given by cities and counties. Among them is New York, where businesses save an estimated $1.1 billion a year in property taxes. The American International Group, the insurance company at the center of the 2008 financial crisis, continued to benefit from a $23.8 million abatement from New York City at the same time it was being bailed out with $180 billion in federal money.


Since 2000, The New York Times Company has received more than $24 million from the city and state.


In some places, local officials have little choice but to answer the demands of corporations.


“They dictate their terms, and we’re not really in a position to question their deal terms,” Sarah Eckhardt, a commissioner in Travis County, Tex., said of companies she has dealt with recently, including Apple and Hewlett-Packard. “We don’t have the sophistication or the resources to negotiate with a company that has the wherewithal the size of a country. We are just no match in negotiating with that.”


Local officials can find themselves across the table from conglomerates like Shell Oil and Caterpillar, the world’s largest maker of construction equipment.


Shell has been offered a tax credit worth as much as $1.6 billion over 25 years from Pennsylvania, which competed with West Virginia and Ohio for an energy production facility. Royal Dutch Shell, the parent company, made $31 billion in profits in 2011 — about $3.5 million every hour. The company’s chief executive made $13.1 million last year, according to Equilar, an executive compensation firm. Pennsylvania predicts that the plant will create thousands of long-term jobs, but it did not require them in exchange for the tax credit.


Caterpillar has received more than $196 million in local aid nationwide since 2007, though it has chastised states, particularly its home base, Illinois, for not being business-friendly. This year, Caterpillar announced a new plant in Georgia, which offered $44 million in incentives. Local counties chipped in free land and other aid, including $15 million in tax breaks and $8.2 million in road, water and sewer repairs.


The company, whose profits are soaring, recently froze workers’ pay for six years at several locations, arguing that it needed to remain competitive. A spokesman for the company, Jim Dugan, said it employed more than 50,000 people and invested billions of dollars nationwide.


Local officials typically have scant information about the track record of corporations, like whether they lived up to job assurances elsewhere. And some officials acknowledged that they did not know to what extent incentives were a deciding factor for companies.


“I don’t know that there’s a way to know other than talking to the businesses, and the businesses telling us that that was a factor in creating jobs,” said Ken Striplin, the city manager of Santa Clarita, Calif., which gives tax breaks in a designated enterprise zone. “There’s no box that says ‘I would have created this job without the enterprise zone.’ ”


California is one of the few states that have been cutting back on incentives. But that does not mean its cities are following suit. When Twitter threatened to leave San Francisco last year, officials scrambled to assuage the company.


Twitter was not short on money — it soon received a $300 million investment from a Saudi prince and $800 million from a private consortium. The two received Twitter equity, but San Francisco got a different sort of deal.


The city exempted Twitter from what could total $22 million in payroll taxes, and the company agreed to stay put. The city estimates that Twitter’s work force could grow to 2,600 employees, although the company made no such promise.


A Twitter spokeswoman said the company was “very happy to have been able to stay in San Francisco.” City officials did not respond to inquiries.


Like many places, San Francisco has been cutting its budget. Public parks have lost about $12 million in recent years, though workers at Twitter will not lack for greenery. The company’s plush new office has a rooftop garden with great views and amenities. Enjoying the perks, one employee sent out a tweet: “Tanned on Twitter’s new roof deck this morning as some dude served me smoothie shots. This is real life?”


A Zero-Sum Game


It was the company every state had to have. In 1985, General Motors was looking for a spot to manufacture its Saturn, a new compact car that would compete with Japanese imports and create thousands of American jobs.


Incentives were not in wide use, and several states had only recently begun to allow more of them.


In fact, when G.M. announced the search, its chairman, Roger Smith, said the perks would not be a predominant factor. “Tax breaks can’t make a silk purse out of a sow’s ear,” Mr. Smith told The Detroit Free Press. He said G.M. planned to avoid states that had large debts or lackluster schools.


Undeterred, some 30 states stepped forward in what became a full-out competition. One official, Bill Clinton, then the governor of Arkansas, traveled to Detroit offering income tax credits and sales tax exemptions worth nearly $200 million.


Mr. Smith essentially kept his word and chose Tennessee, which had put together a relatively small package. Reid Rundell, a retired G.M. executive, said in a recent interview that it had come down to geography. “The primary factor was distribution for incoming parts, as well as outgoing vehicles,” Mr. Rundell said.


But the gates had been opened. In 1992, South Carolina lured BMW with a $130 million package; the next year, Alabama got Mercedes-Benz at a price tag that topped $300 million.


“What the auto incentives did back then was really raise the profile of economic incentives both within companies, in government and in the public’s eye,” said Mark Sweeney, who worked for the South Carolina Commerce Department in the 1990s and now advises companies on obtaining government grants.


By 1993, governors were regaling one another at a national conference with stories of deals beyond the auto industry, including a recent bidding war for United Airlines that drew more than 90 cities. The airline had set up negotiations in a hotel, and its representatives ran floor to floor comparing bids, said Jim Edgar, then the governor of Illinois.


Mr. Edgar said he had called for a truce, concerned that the practice was unfair to companies that did not receive incentives. But many states would not sign on, he said, particularly those in the South, where businesses were moving.


“If you’ve got some states doing it, it’s hard for the others not to do it,” Mr. Edgar said. “It’s like unilaterally disarming.”


Soon after, economists at Federal Reserve branches were questioning the use of incentives. One, in Minnesota, used mathematical proofs and game theory to show that competition between states did not increase overall economic value. Several other economists have since called the practice a zero-sum game.


A group of taxpayers in Michigan and Ohio went as far as suing DaimlerChrysler after Ohio and the City of Toledo awarded the automaker $280 million in the late 1990s. The suit argued that it was unfair for one taxpayer to be given a break at the expense of all others.


The suit made its way to the Supreme Court, and G.M. and Ford signed on to briefs supporting Daimler, as did local governments. The National Governors Association warned the court that prohibiting incentives could lead to jobs moving overseas. “This is the economic reality,” the association said in a brief.


The governors offered no hard evidence of the effectiveness of tax credits, but the Supreme Court did not consider whether they worked anyway. In 2006, the court concluded that the taxpayers did not have the legal standing to challenge Ohio’s tax actions in federal court.


The tab for auto incentives has grown to $13.9 billion since 1985, according to the Center for Automotive Research, a nonprofit group in Ann Arbor, Mich. G.M., the top recipient, was awarded $3.3 billion of the aid. Since 1979, automakers also closed more than 267 plants in the United States, about half of which still sit empty, according to the center.


The auto industry and some local officials have long argued that auto companies create so many jobs and draw in so many supporting suppliers that all taxpayers benefit. Even if companies shut down years later, as Saturn did in Tennessee for a few years, the trade-off is worth it, they said.


“I do believe that if a state ever is going to create incentives,” said Lamar Alexander, who was Tennessee’s governor in 1985 when Saturn selected the state, “the auto industry would be by far the No. 1 target, because an auto assembly plant is a money target.”


Still, Mr. Alexander, now a United States senator, said that recruiting a large factory today would be more expensive. “It has changed a lot,” he said. “It’s almost become a sweepstakes.”


G.M. Gets Into the Act


G.M. may have initially minimized the role of local dollars, but as the company’s financial problems grew, incentives became a big part of its math.


The actions of the company were described in more than two dozen in-depth interviews with former company officials, tax consultants and governors and mayors who have dealt with G.M.


The automaker’s real estate division, Argonaut Realty, oversaw the hunt for the most lucrative deals. Up and down the corporate ladder, employees were encouraged to push governments for more, according to transcripts of public meetings and interviews. Even G.M. plant managers knew that the future of their facilities depended in part on their ability to send word of big discounts back to Detroit.


Union representatives were enlisted to attend local hearings, putting a human face on the jobs at stake. G.M.’s regional tax managers often showed up, armed with tax abatement wish lists and highlighting the company’s gifts to local charities.


“We knew what our investment of X amount meant to the community, and we knew we needed to partner with the community to be successful,” said Marilyn P. Nix, who worked as a real estate executive at G.M. for 31 years until retiring in 2005.


At the top of G.M., executives reviewed the proposals from various locations and went where the numbers added up.


“I know people like to blame the industry for taking advantage of the incentives, but you go back to what your fiduciary responsibility is to the stockholders,” Ms. Nix said. “As long as you’ve got people that are willing to better the deals, the management owes it to their stockholders to try to get the best economic deal that they can.”


For towns, it became a game of survival, even if the competition turned out to be a mirage.


Moraine, Ohio, was already home to a G.M. plant in 1997 when the company pushed hard for additional incentives. G.M. said it was looking for a place to accommodate more manufacturing.


Wayne Barfels, the city manager at the time, said a G.M. representative had told officials that Moraine was competing with Shreveport, La., and Linden, N.J. After the local school board approved property tax breaks, The Dayton Daily News reported that the other towns had not been in discussions with G.M.


The school board considered rescinding the deal, but allowed G.M. to keep it after a company official apologized. In 2008, G.M. shut the Moraine facility.


In towns where General Motors remains, local officials praised the company. “I can say they have been a great partner to us,” said Virg Bernero, the mayor of Lansing, Mich. “It would do something to the psyche of this community if they were not here. I mean, I just praise God every day.”


Looking to lure businesses beyond automakers, states have routinely bolstered their incentive tool kits. In 2010 alone, states created or expanded about 40 tax credits and exemptions, according to the National Conference of State Legislatures.


The nature of the credits has also changed. New ones are geared toward attracting technology and green energy companies, but it is hard to know whether 15 years down the road they will thrive or wind up stumbling like the automakers. And many modern companies, like those in digital technology, can easily pack up and leave.


“I don’t see anything that suggests that Twitter and Facebook are better bets in the long run,” said Laura A. Reese, the director of the Global Urban Studies Program at Michigan State University. Ms. Reese advises local governments to invest in residents through education and training rather than in companies where “it’s hard to pick winners.”


Yet states try to do it all the time. In 2010, Rhode Island, which has the nation’s second-highest unemployment rate, recruited Curt Schilling, a former Red Sox pitcher, to move his video game company from Massachusetts. The company, 38 Studios, had never released a game and was not making money, but the governor at the time had the state guarantee $75 million in loans.


The company failed and dismissed all of its roughly 400 workers this May. Rhode Island taxpayers are now on the hook for the loans.


Officials said part of the difficulty was that communities do not get much say in a company’s business strategy.


“We, as communities, stake our futures with these people who are supposed to know what they’re doing, and sometimes they don’t,” said Arthur Walker, a businessman in Shreveport and former chairman of the city’s chamber of commerce.


Mr. Walker and other officials in Shreveport know firsthand. In 2000, they were worried that G.M. would close a plant in their area and responded with a generous proposal: the city would cut the company’s gas bill and provide work force training grants. In addition, G.M. would benefit by a recent increase in one of the state’s income tax credits.


Eager to encourage innovation, Shreveport officials suggested ways the city could assist G.M. in building electric cars. “We wanted to be part of the future,” said Mr. Walker, whose brother worked at the plant.


G.M. took the city’s incentives but not its business advice and began building the giant Hummer there.


“We knew they needed to build green cars — I mean, who builds a Hummer for the 21st century?” Mr. Walker said. “It was a losing proposition that we found ourselves in. We couldn’t win because those people weren’t making the correct business decisions, in my view. When it didn’t work, we’re the ones left holding the bag.”


The Hummer was discontinued in 2010, and the Shreveport factory closed this August, the final victim of G.M.’s bankruptcy.


Ypsilanti’s Losing Battle


For much of the last 20 years, Doug Winters has been agitating for General Motors to be held accountable.


Mr. Winters, the attorney for Ypsilanti Township and several other places around Ann Arbor, has lived in Ypsilanti all his life. His grandmother labored at the local plant, Willow Run, during World War II, when it made bomber planes. People in town still proudly point out that a woman known as Rosie the Riveter worked there as well. After the war, when G.M. moved into the plant to manufacture its automatic transmission system, his father got a job.


Mr. Winters loves the history of Willow Run but hates what he views as corporate hypocrisy: G.M. asked for government help on the one hand and then appealed to free-market rationales for closing shop.


Over the years, Ypsilanti granted G.M. more than $200 million in incentives for two factories at Willow Run, Mr. Winters said. “They had put basically a stranglehold on the entire state of Michigan and other places across the country by just grabbing these tax abatements by the billions,” he said. “They were doing it with a very thinly disguised threat that if you don’t give us these tax abatements, then we’ll have to go somewhere else.”


Ypsilanti first sued G.M. in the 1990s to prevent the company from closing the factory at Willow Run that made the Chevrolet Caprice.


The town had granted the company tax incentives after the factory manager argued that G.M.’s ability to compete with other carmakers was at stake, documents in the lawsuit show. The tax break and “favorable market demand,” said the plant manager, Harvey Williams, would allow the automaker to “maintain continuous employment.”


Nevertheless, G.M. shut the factory. A lower court found in favor of Ypsilanti, but the ruling was reversed on appeal. The judge said that a company’s job assurances “cannot be evidence of a promise.”


In 2010, when the company closed the remaining factory at Willow Run, Mr. Winters sued again. This time, Ypsilanti argued that the automaker should have been forced to close overseas factories instead, especially since American taxpayers had bailed out G.M. In addition, Ypsilanti sought to recover money from G.M., saying the company had agreed to reimburse the town for some incentives if it left.


So far, Ypsilanti’s claims have not been addressed. They were complicated by G.M.’s bankruptcy, which allowed the carmaker to emerge as a new company and leave some of its liabilities and contractual obligations behind.


When asked whether the new G.M. has civic responsibilities to its former factory towns, Mr. Cain, the company spokesman, said: “Our obligation to the communities where we do business is to run a successful business. And when we prosper, it allows us to do more than just turn the lights on and make cars.”


He also said that since the bailout, “G.M. has invested more than $7.3 billion in its U.S. facilities, and we’ve created or retained almost 19,000 jobs in communities all over the country.”


Matthew P. Cullen, who oversaw real estate and economic development for G.M. until he left the company in 2008, said the automaker was aware of its impact on communities. He said that what happened with G.M. was the result of an entire industry changing and that there had been no bad intentions.


“If you go forward in good faith doing everything you can and make the investment, then you’re partners,” Mr. Cullen said. “Sometimes partnerships in business work, and they work for 60 years. And in some cases, they don’t, and it doesn’t make you a bad partner.”


Some towns that are still dealing with the fallout of plant closings might disagree. In Pontiac, Mich., tax revenues have fallen 40 percent since 2009 after the old G.M. knocked down buildings on its property, resulting in lower tax assessments, according to the city’s emergency manager.


In Ypsilanti, an entity set up to sell off G.M. property is marketing the plant as valuable. At the same time, it has been arguing for lower property taxes on the grounds that its plant is not worth much.


Ypsilanti’s supervisor, Brenda Stumbo, said the township would be stung hard by further revenue cuts. Ypsilanti has already slimmed down its Fire Department, and city workers are juggling multiple jobs. There are seven to 10 home foreclosures a week, giving the township the highest foreclosure rate in the county, Ms. Stumbo said.


“Can all of it be traced back to General Motors?” she said, listing auto suppliers that closed after G.M. did. “No, but a great deal of it can.”


Nonetheless, Ms. Stumbo said that if G.M. would bring jobs back to town, she would be willing to grant the company more incentives.


But Mr. Winters is not so sure. He said he would never support more incentives without stronger protections for Ypsilanti. “They’ve done a lot of damage to a lot of people and a lot of communities, and they’ve basically been given a clean slate,” he said. “It’s a ‘get out of jail free’ card.”

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Hogan leads Stanford past UCLA 27-24 to win Pac-12

STANFORD, Calif. (AP) — Kevin Hogan has taken Stanford to a place Andrew Luck never could.

Hogan threw for 155 yards and a touchdown and ran for 47 yards to help the eighth-ranked Cardinal beat No. 17 UCLA 27-24 in the Pac-12 championship game Friday night.

As a defender barreled into him, Hogan hurled a 26-yard tying touchdown to Drew Terrell on third-and-15 early in the fourth quarter. Jordan Williamson kicked his second field goal from 36 yards with 6:49 remaining for the go-ahead score to seal Stanford's first conference title since the 1999 season.

The Cardinal (11-2) will play the winner of the Big Ten title game between Nebraska and Wisconsin in the Rose Bowl on Jan. 1.

UCLA's Brent Hundley threw for 177 yards and a costly interception that set up a Stanford touchdown. He still almost brought the Bruins (9-4) back, but Ka'imi Fairbairn missed a 52-yard field goal wide left in the closing moments for a disappointing loss.

Hogan completed 16 of 22 passes to beat a fourth ranked opponent in his fourth straight start since unseating Josh Nunes at quarterback. After the Cardinal rolled past UCLA 35-17 last Saturday at the Rose Bowl, it took all 60 minutes for another victory in the rare rematch.

The heavy rain that pounded the Bay Area most of the day relented most of the night, and a tarp that covered the field until about 3 hours before kickoff. Scattered showers still kept the grass slightly slick.

The surface never seemed to slow down the Bruins, who ran for 284 yards behind Jonathan Franklin 194 yards on the ground. The most yards rushing Stanford allowed this season had been 198 in an overtime victory at Oregon two weeks ago.

Not matter.

The Cardinal won its seventh straight game to advance to their third different BCS bowl in as many seasons — a run that began behind coach Jim Harbaugh and Luck, the No. 1 overall pick of the Indianapolis Colts. Before that, the Cardinal had only won 10 games three times — 1992, 1940, 1926 — in program history.

The Bruins made the final road block more difficult than expected.

UCLA converted a pair of third downs before Franklin burst through the middle for a 51-yard touchdown. He carried safety Jordan Richards the final 5 yards into the end zone to give the Bruins a 7-0 lead on the game's opening drive.

Stanford answered in a hurry when Hogan ran 14 yards on a read-option keeper to convert a long third down, fullback Ryan Hewitt bulldozed through the line on a fourth-and-1 and Stepfan Taylor took a short pass 33 yards inches shy of the goal line. On the next play, Hogan faked a handoff and rolled untouched for the tying touchdown.

Before the Cardinal offense even found their seats on the sideline, Hundley ran 48 yards and scrambled for a 5-yard TD to put UCLA back in front, 14-7. With the Bruins about to go ahead two scores, Ed Reynolds intercepted Hundley's pass and returned it 80 yards to set up Taylor's short TD run.

Officials ruled that Reynolds, who ran three interceptions back for a touchdown this season, was tackled by Hundley short of the goal line and a replay challenge by Stanford coach David Shaw was inconclusive. Reynolds moved into a tie with Oregon State's Jordan Poyer for the Pac-12 lead with six interceptions.

Williamson kicked a 37-yard field goal as the first half expired to give Stanford a 17-14 lead. Fairbairn answered with a field goal from 31 yards on UCLA's opening drive of the second half.

Franklin capped a 12-play, 80-yard drive with a 20-yard TD run late in the third quarter. That gave the Bruins a 24-17 and put Stanford on the brink of its first home loss this season.

Instead, the Cardinal came back in impressive fashion.

Hogan heaved the long touchdown to Terrell on third down.

Stanford stuffed UCLA three-and-out and Terrell returned the punt 18 yards to the Bruins 43. That set up Williamson's winning 36-yard field goal with 6:49 remaining.

Stanford stopped UCLA again, and Hogan ran for 11 yards on third-and-2 to help Stanford drain the clock some more before punting back to the Bruins one final time from their own 19 with 2:18 remaining.

Tight end Joseph Fauria caught a pass over the middle on fourth-and-7 and lateraled the ball to Jordon James to complete a 17-yard pass. That helped set up Fairbairn's field goal, which never looked on target.

Stanford has beaten the Bruins five straight games. UCLA was going for its first conference championship since 1998.

The Bruins still had to feel better about their showing than last year's league title game, when they lost 49-31 at Oregon in lame duck coach Rick Neuheisel's weird finale — the Bruins had a 6-6 record and only advanced out of the South Division because crosstown rival Southern California was finishing a two-year postseason ban for NCAA violations

The announced crowd of 31,622 was the lowest at 50,000-seat Stanford Stadium since the Cardinal drew 30,626 against Sacramento State on Sept. 4, 2010.

___

Antonio Gonzalez can be reached at: www.twitter.com/agonzalezAP

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Medicare Is Faulted in Electronic Medical Records Conversion





The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.







Mike Spencer/Wilmington Star-News, via Associated Press

Celeste Stephens, a nurse, leads a session on electronic records at New Hanover Regional Medical Center in Wilmington, N.C.







Centers for Medicare and Medicaid Services

Marilyn Tavenner, acting administrator for Medicare.






The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.


But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.


Medicare “faces obstacles” in overseeing the electronic records incentive program “that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the investigators concluded. The report was prepared by the Office of Inspector General for the Department of Health and Human Services, which oversees Medicare.


The investigators contrasted the looser management of the incentive program with the agency’s pledge to more closely monitor Medicare payments of medical claims. Medicare officials have indicated that the agency intends to move away from a “pay and chase” model, in which it tried to get back any money it has paid in error, to one in which it focuses on trying to avoid making unjustified payments in the first place.


Late Wednesday, a Medicare spokesman said in a statement: “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable. Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance.”


The government’s investment in electronic records was authorized under the broader stimulus package passed in 2009. Medicare expects to spend nearly $7 billion over five years as a way of inducing doctors and hospitals to adopt and use electronic records. So far, the report said, the agency has paid 74, 317 health professionals and 1,333 hospitals. By attesting that they meet the criteria established under the program, a doctor can receive as much as $44,000 for adopting electronic records, while a hospital could be paid as much as $2 million in the first year of its adoption. The inspector general’s report follows earlier concerns among regulators and others over whether doctors and hospitals are using electronic records inappropriately to charge more for services, as reported by The New York Times last September, and is likely to fuel the debate over the government’s efforts to promote electronic records. Critics say the push for electronic records may be resulting in higher Medicare spending with little in the way of improvement in patients’ health. Thursday’s report did not address patient care.


Even those within the industry say the speed with which systems are being developed and adopted by hospitals and doctors has led to a lack of clarity over how the records should be used and concerns about their overall accuracy.


“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. The association, which contends more study is needed to determine whether hospitals and doctors actually are abusing electronic records to increase their payments, says it supports more clarity.


Although there is little disagreement over the potential benefits of electronic records in reducing duplicative tests and avoiding medical errors, critics increasingly argue that the federal government has not devoted enough time or resources to making certain the money it is investing is being well spent.


House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.


In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.” She said Medicare was trying to determine whether electronic records had been used in any fraudulent billing but she insisted that the current efforts to certify the systems and address the concerns raised by the Republicans and others were adequate.


This article has been revised to reflect the following correction:

Correction: November 30, 2012

An article on Thursday about a federal report critical of Medicare’s performance in assuring accuracy as doctors and hospitals switch to electronic medical records misstated, in some copies, the timing of a statement from a Medicare spokesman in response to the report. The statement was released late Wednesday, not late Thursday.



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New Georgia Government Starts Punishing Members of Old


Justyna Mielnikiewicz for The New York Times


Georgians in the office of Archil Kbilashvili, the nation’s new prosecutor, to file complaints.







TBILISI, Georgia — These days, when the Georgian prosecutor’s office opens, people are lined up, clutching plastic bags full of documents. One after another, they are presenting their case that President Mikheil Saakashvili’s government stripped them of something: a state job, a piece of land, an apartment. Most of them want to see someone punished.




The promise that officials would be punished helped propel the billionaire Bidzina Ivanishvili to victory in October parliamentary elections, dislodging the group of politicians who had controlled Georgia for nine years. Mr. Saakashvili conceded the loss and agreed to enter the opposition, and for the first time in Georgia’s post-Soviet history, power changed hands legally.


About two months later, the Georgian experiment — to many in the West, a last hope for building democracy in inhospitable post-Soviet terrain — hangs in the balance.


Mr. Ivanishvili has embarked on the project of prosecuting former officials more swiftly than anyone expected, saying he cannot ignore the public’s demand for justice. But numerous cases are targeting political rivals, since Mr. Saakashvili remains president until next October. The authorities have already charged 23 officials from Mr. Saakashvili’s government with crimes like corruption and torture, and they may prosecute his former interior minister, who is also the leader of the Parliament’s main opposition party.


Alexander Rondeli, a political analyst, said Mr. Ivanishvili was following in the winner-take-all tradition of Georgian politics.


“In Georgia, the political enemy is an enemy. I don’t think it gives a very good image to this country, but it is our culture,” said Mr. Rondeli, president of the Georgian Foundation for Strategic and International Studies. “It’s clear now that the new political force wants to annihilate the previous one. So that is completely clear. It does not look very much like democracy, but they say that the rule of law is higher.”


It was apparent there would be some kind of legal reckoning if Mr. Saakashvili lost power. Though his government was embraced in the United States and Europe for its pro-Western orientation, complaints mounted at home, especially about police brutality and the lack of due process in the justice system.


This fall, video was released showing prison inmates being beaten and sodomized by guards, releasing a huge wave of public anger. Rights activists have long complained that officials acted with impunity in grave cases, like the death of Sandro Girgvliani, a bank executive who was abducted by law enforcement officers in 2006 after an altercation.


As a candidate, Mr. Ivanishvili promised to deliver justice swiftly, sometimes claiming he could create an independent court system in as little as a year. Asked how, he told Forbes, “You have to jail one minister — two, max — to show everyone that there will be no forgiveness. Show that there’s political will up there, and it will all line up quickly.”


Georgia’s new prosecutor, Archil Kbilashvili, said that more than 3,000 criminal complaints had been filed against former officials over the last month, and he planned to triple the number of investigators in the division handling misuse of authority. If there is a criticism he hears most often from Georgians, he said, it is that he is acting too slowly.


As an example, he offered the case of Bacho Akhalaia, a much-feared former defense and interior minister who fled the country after the elections, evidently expecting to be arrested. When news got out that Mr. Akhalaia had returned, Mr. Kbilashvili said, he had been in his job for just five days when he was inundated with “many, many phone calls” asking why he had not ordered Mr. Akhalaia’s arrest.


“I said I have no evidence against him, he is a free citizen of this country,” Mr. Kbilashvili said. Still, the next day, Mr. Akhalaia was arrested based on the relatively mild charges of striking a sergeant with a knife handle and publicly beating servicemen. After that, new allegations began to flow in from citizens who were “somehow encouraged” to testify against Mr. Akhalaia, Mr. Kbilashvili said.


Two prominent legal rights groups have already warned that Mr. Ivanishvili’s team is approaching questions of justice too hastily. Tamar Chugoshvili, of the Georgian Young Lawyers’ Association, said her group withdrew from a parliamentary effort to compile a list of political prisoners for release, because a two-week deadline made it “impossible to really study the cases in detail.”


Olesya Vartanyan contributed reporting.



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Falcons pick off Brees 5 times, beat Saints 23-13

ATLANTA (AP) — The Atlanta Falcons raced to a 17-0 lead and the defense made it stand up, picking off five of Drew Brees' passes and ending his NFL-record touchdown streak with a 23-13 victory Thursday night.

The Falcons moved to the brink of clinching the NFC South and dealt a big blow to the Saints (5-7) and their fading playoff hopes. William Moore had two of the five interceptions, which were the most of Brees' career and came four days after he had two passes picked off and returned for touchdowns in a loss to San Francisco.

Brees had thrown a touchdown pass in 54 consecutive games. He had an apparent scoring pass to Darren Sproles late in the first half, but it was nullified by a penalty.

Michael Turner scored on Atlanta's opening possession, Tony Gonzalez hauled in a touchdown pass from Matt Ryan, and Matt Bryant booted three field goals, including a 55-yarder.

The Falcons defense did the rest.

Thomas DeCoud, Sean Weatherspoon and Jonathan Babineaux also had interceptions for Atlanta, which will clinch the NFC South with a month to go in the regular season if Tampa Bay loses to Denver on Sunday.

Brees had a couple of games with four picks, but nothing like this. He finished 28 of 50 for 341 yards.

The defending NFC South champion Saints lost their second in a row and will likely have to win out to have even a faint hope of making the postseason during a tumultuous year that was marred by a bounty scandal and a season-long suspension for coach Sean Payton.

After winning so many close games, the Falcons started this one as if they were intent on a rout.

Ryan completed a pass on the first play from scrimmage, then turned it over to a running game that has struggled most of the season. Turner burst around right end for a 35-yard gain. Jacquizz Rodgers broke off two straight 14-yard gains. Finally, it was Turner going in standing from 3 yards out, giving Atlanta a quick 7-0 lead.

That was Turner's 58th touchdown in five seasons with the Falcons, breaking the team record he had shared with Terance Mathis.

Atlanta struck again in the opening minute of the second period. Julio Jones hauled in an 18-yard throw from Ryan, setting up a 17-yard touchdown pass to Gonzalez in the back of the end zone. He beat former teammate Curtis Lofton, then just flipped the ball over the goalposts instead of his customary basketball dunk.

Brees' second interception, this one a sloppy pass behind running Chris Ivory that deflected into the arms of Sean Weatherspoon, set up Bryant's 45-yard field goal for a 17-0 lead.

Then, suddenly, the game completely changed.

For the rest of the second quarter and most of the third, the Saints totally dominated. Mark Ingram scored on a 1-yard run, capping an 11-play, 80-yard drive, and New Orleans should have tacked on more points at the end of the half. But Brees made a rookie-like mistake with 12 seconds remaining, dumping a pass over the middle to Sproles with no timeouts. He was wrapped up at the Atlanta 3 and the clock ran out before the Saints could spike the ball.

But New Orleans got the ball to start the second half, and Brees went back to work. This time, he made a couple of nifty moves to avoid sacks, completing six passes on an 83-yard drive consuming 15 plays and more than 6 1-2 minutes. But the Falcons defense held again, forcing Garrett Hartley to boot a 21-yard field goal that cut it to 17-10.

Hartley connected again from much farther out on the Saints' next possession, a 52-yarder that brought New Orleans even closer.

The Falcons, meanwhile, couldn't do anything offensively. They failed to pick up a first down on five straight possessions, a stretch in which the Saints had a 289-30 lead in total yards and a staggering 18 first downs.

Finally, it was the Atlanta defense that turned things around late in the third.

Brees rolled to his right and threw over the middle, but Moore picked off the pass and returned it to the New Orleans 16. Ryan connected on first-down throws to Gonzalez and Roddy White to set up Bryant's field goal.

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Follow Paul Newberry on Twitter at www.twitter.com/pnewberry1963

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Phys Ed: Keeping Your Eye on the Ball

Recently, researchers in England set out to determine whether weekend golfers could improve their game through one of two approaches. Some were coached on individual swing technique, while others were instructed to gaze fixedly at the ball before putting. The researchers hoped to learn not only whether looking at the ball affects performance, but also whether where we look changes how we think and feel while in action.

Phys Ed

Gretchen Reynolds on the science of fitness.

Back in elementary school gym class, virtually all of us were taught to keep our eyes on the ball during sports. But a growing body of research suggests that, as adults, most of us have forgotten how to do this. When scientists in recent years have attached sophisticated, miniature gaze-tracking devices to the heads of golfers, soccer players, basketball free throw shooters, tennis players and even competitive sharpshooters, they have found that a majority are not actually looking where they believe they are looking or for as long as they think.

It has been less clear, though, whether a slightly wandering gaze really matters that much to those of us who are decidedly recreational athletes.

Which is in part why the British researchers had half of their group of 40 duffers practice putting technique, while the other half received instruction in a gaze-focusing technique known as “Quiet Eye” training.

Quiet Eye training, as the name suggests, is an attempt to get people to stop flicking their focus around so much. But “Quiet Eye training is not just about looking at the ball,” says Mark Wilson, who led the study, published in Psychophysiology, and is a senior lecturer in human movement science at the University of Exeter in England. “It is about looking at the ball for long enough to process aiming information.” It involves reminding players to first briefly sight toward the exact spot where they wish to send the ball, and then settle their eyes onto the ball and hold them there.

This tight focus on the ball, Dr. Wilson says, blunts distracting mental chatter and allows the brain “to process the aiming information you just gathered” and direct the body in the proper motions to get the ball where you wish it to go.

A quiet, focused eye, in other words, seems to encourage a quiet, focused mind, which then makes for more accurate putting.

And in fact, after Dr. Wilson had his golfing volunteers practice for hours on either specific aspects of stroke technique or on focusing their gaze and not worrying about technique, those who had worked on their gaze were more accurate than those who had fine-tuned their technique. Those trained to focus also had lower heart rates and less muscle twitchiness, indicating less performance anxiety.

Similar results have been reported among soccer penalty kickers, who, like golfers, need to precisely place a ball but have the added distraction of a peripatetic, obstructive goalie. Many players tend to glance at the goalie as they prepare to shoot. Their eyes are not quiet, and their aim is affected.

But in a study published last year in the journal Cognitive Processing, collegiate players who were instructed to look briefly toward one of the upper, far corners of the goal and then immediately back to the ball, ignoring the goalie, significantly improved their shooting accuracy and reduced by 50 percent the number of times the goalie blocked their try, compared to teammates who didn’t quiet their gaze.

It did not seem to matter, says Greg Wood, also of the University of Exeter, who led the study, that kickers were glancing briefly toward where they planned to shoot, potentially telegraphing their intentions to the goalie. “An accurate shot kicked with typical speed will reach the goal in approximately 400 milliseconds, leaving the goalie with insufficient processing and response time,” he says. Players needn’t disguise intent if their aim is true.

Of course, merely keeping your eye on the ball won’t induce it to roll or rise to the desired location if you employ miserable technique. No amount of laser-eyed focus will get one of my putts to land. But what is interesting about Quiet Eye-style training, Dr. Wilson says, is that it can allow recreational and novice athletes with rudimentary skills to progress rapidly.

Specifically, Dr. Wilson says, after having extensively studied just how the best golfers look, he now teaches novice golfers at his lab to “keep their gaze on the back of the ball, which is the contact point for the putter, for a brief period before starting the putting action” — long enough to, for instance, “say ‘back of the cup’ to themselves,” he says. The golfers are told to hold that position throughout the putting stroke and, he says, “importantly, after contact for a split second. I often ask golfers to rate the quality of their contact on the ball from 1 to 10, before they look up to see where the ball went.”

Inexperienced putters who followed these instructions improved much more rapidly, he says, than those who merely practiced putts repeatedly.

“It seems so obvious,” Dr. Wilson says. “It is almost too simple. People assume that they are doing all of this already. ‘You mean I should look at the ball?’ Duh!”

But, he concludes, “the fact is that many people do not look at the right place at the right time.”

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U.S. Is Weighing Stronger Action in Syrian Conflict


Francisco Leong/Agence France-Presse — Getty Images


Rebels in northern Syria celebrated on Wednesday next to what was reported to be a government fighter jet.







WASHINGTON — The Obama administration, hoping that the conflict in Syria has reached a turning point, is considering deeper intervention to help push President Bashar al-Assad from power, according to government officials involved in the discussions.




While no decisions have been made, the administration is considering several alternatives, including directly providing arms to some opposition fighters.


The most urgent decision, likely to come next week, is whether NATO should deploy surface-to-air missiles in Turkey, ostensibly to protect that country from Syrian missiles that could carry chemical weapons. The State Department spokeswoman, Victoria Nuland, said Wednesday that the Patriot missile system would not be “for use beyond the Turkish border.”


But some strategists and administration officials believe that Syrian Air Force pilots might fear how else the missile batteries could be used. If so, they could be intimidated from bombing the northern Syrian border towns where the rebels control considerable territory. A NATO survey team is in Turkey, examining possible sites for the batteries.


Other, more distant options include directly providing arms to opposition fighters rather than only continuing to use other countries, especially Qatar, to do so. A riskier course would be to insert C.I.A. officers or allied intelligence services on the ground in Syria, to work more closely with opposition fighters in areas that they now largely control.


Administration officials discussed all of these steps before the presidential election. But the combination of President Obama’s re-election, which has made the White House more willing to take risks, and a series of recent tactical successes by rebel forces, one senior administration official said, “has given this debate a new urgency, and a new focus.”


The outcome of the broader debate about how heavily America should intervene in another Middle Eastern conflict remains uncertain. Mr. Obama’s record in intervening in the Arab Spring has been cautious: While he joined in what began as a humanitarian effort in Libya, he refused to put American military forces on the ground and, with the exception of a C.I.A. and diplomatic presence, ended the American role as soon as Col. Muammar el-Qaddafi was toppled.


In the case of Syria, a far more complex conflict than Libya’s, some officials continue to worry that the risks of intervention — both in American lives and in setting off a broader conflict, potentially involving Turkey — are too great to justify action. Others argue that more aggressive steps are justified in Syria by the loss in life there, the risks that its chemical weapons could get loose, and the opportunity to deal a blow to Iran’s only ally in the region. The debate now coursing through the White House, the Pentagon, the State Department and the C.I.A. resembles a similar one among America’s main allies.


“Look, let’s be frank, what we’ve done over the last 18 months hasn’t been enough,” Britain’s prime minister, David Cameron, said three weeks ago after visiting a Syrian refugee camp in Jordan. “The slaughter continues, the bloodshed is appalling, the bad effects it’s having on the region, the radicalization, but also the humanitarian crisis that is engulfing Syria. So let’s work together on really pushing what more we can do.” Mr. Cameron has discussed those options directly with Mr. Obama, White House officials say.


France and Britain have recognized a newly formed coalition of opposition groups, which the United States helped piece together. So far, Washington has not done so.


American officials and independent specialists on Syria said that the administration was reviewing its Syria policy in part to gain credibility and sway with opposition fighters, who have seized key Syrian military bases in recent weeks.


“The administration has figured out that if they don’t start doing something, the war will be over and they won’t have any influence over the combat forces on the ground,” said Jeffrey White, a former Defense Intelligence Agency intelligence officer and specialist on the Syria military. “They may have some influence with various political groups and factions, but they won’t have influence with the fighters, and the fighters will control the territory.”


Jessica Brandt contributed reporting from Cambridge, Mass.



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Bonds, Clemens, Sosa on Hall ballot for first time

NEW YORK (AP) — The most polarizing Hall of Fame debate since Pete Rose will now be decided by the baseball shrine's voters: Do Barry Bonds, Roger Clemens and Sammy Sosa belong in Cooperstown despite drug allegations that tainted their huge numbers?

In a monthlong election sure to become a referendum on the Steroids Era, the Hall ballot was released Wednesday, and Bonds, Clemens and Sosa are on it for the first time.

Bonds is the all-time home run champion with 762 and won a record seven MVP awards. Clemens took home a record seven Cy Young trophies and is ninth with 354 victories. Sosa ranks eighth on the homer chart with 609.

Yet for all their HRs, RBIs and Ws, the shadow of PEDs looms large.

"You could see for years that this particular ballot was going to be controversial and divisive to an unprecedented extent," Larry Stone of The Seattle Times wrote in an email. "My hope is that some clarity begins to emerge over the Hall of Fame status of those linked to performance-enhancing drugs. But I doubt it."

More than 600 longtime members of the Baseball Writers' Association of America will vote on the 37-player ballot. Candidates require 75 percent for induction, and the results will be announced Jan. 9.

Craig Biggio, Mike Piazza and Curt Schilling also are among the 24 first-time eligibles. Jack Morris, Jeff Bagwell and Tim Raines are the top holdover candidates.

If recent history is any indication, the odds are solidly stacked against Bonds, Clemens and Sosa. Mark McGwire and Rafael Palmeiro both posted Cooperstown-caliber stats, too, but drug clouds doomed them in Hall voting.

Some who favor Bonds and Clemens claim the bulk of their accomplishments came before baseball got wrapped up in drug scandals. They add that PED use was so prevalent in the 1980s, 1990s and early 2000s that it's unfair to exclude anyone because so many who-did-and-who-didn't questions remain.

Many fans on the other side say drug cheats — suspected or otherwise — should never be afforded the game's highest individual honor.

Either way, this election is baseball's newest hot button, generating the most fervent Hall arguments since Rose. The discussion about Rose was moot, however — the game's career hits leader agreed to a lifetime ban in 1989 after an investigation concluded he bet on games while managing the Cincinnati Reds, and that barred him from the BBWAA ballot.

The BBWAA election rules allow voters to pick up to 10 candidates. As for criteria, this is the only instruction: "Voting shall be based upon the player's record, playing ability, integrity, sportsmanship, character, and contributions to the team(s) on which the player played."

That leaves a lot of room for interpretation.

Bonds, Clemens and Sosa won't get a vote from Mike Klis of The Denver Post.

"Nay on all three. I think in all three cases, their performances were artificially enhanced. Especially in the cases of Bonds and Clemens, their production went up abnormally late in their careers," he wrote in an email.

They'll do better with Bob Dutton of The Kansas City Star.

"I plan to vote for all three. I understand the steroid/PED questions surrounding each one, and I've wrestled with the implications," he wrote in an email.

"My view is these guys played and posted Hall of Fame-type numbers against the competition of their time. That will be my sole yardstick. If Major League Baseball took no action against a player during his career for alleged or suspected steroid/PED use, I'm not going to do so in assessing their career for the Hall of Fame," he said.

San Jose Mercury News columnist Mark Purdy will reserve judgment.

"At the beginning of all this, I made up my mind I had to adopt a consistent policy on the steroid social club. So, my policy has been, with the brilliance in the way they set up the Hall of Fame vote where these guys have a 15-year window, I'm not going to vote for any of those guys until I get the best picture possible of what was happening then," he wrote in an email.

"We learn a little bit more each year. We learned a lot during the Bonds trial. We learned a lot during the Clemens trial. I don't want to say I'm never going to vote for any of them. I want to wait until the end of their eligibility window and have my best idea of what was really going on," he said.

Clemens was acquitted this summer in federal court on six counts that he lied and obstructed Congress when he denied using performance-enhancing drugs.

Bonds was found guilty in 2011 by a federal court jury on one count of obstruction of justice, ruling he gave an evasive answer in 2003 to a grand jury looking into the distribution of illegal steroids. Bonds is appealing the verdict.

McGwire is 10th on the career home run list with 583, but has never received even 24 percent in his six Hall tries. Big Mac has admitted to using steroids and human growth hormone.

Palmeiro is among only four players with 500 homers and 3,000 hits, yet has gotten a high of just 12.6 percent in his two years on the ballot. He drew a 10-day suspension in 2005 after a positive test for PEDs, and said the result was due to a vitamin vial given to him by teammate Miguel Tejada.

Biggio topped the 3,000-hit mark — which always has been considered an automatic credential for Cooperstown — and spent his entire career with the Houston Astros.

"Hopefully, the writers feel strongly that they liked what they saw, and we'll see what happens," Biggio said last week.

Schilling was 216-146 and won three World Series championships, including his "bloody sock" performance for the Boston Red Sox in 2004.

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AP Baseball Writer Janie McCauley and AP Sports Writers Arnie Stapleton and Dave Skretta contributed to this report.

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