A backyard nuclear shelter? Yes, paranoia does sell








One sterling quality of American businesses is that they'll try to make money from anything.


Paranoia, for instance. So say hello to Ron Hubbard, the owner of Montebello-based Atlas Survival Shelters, which converts huge corrugated metal tubes up to 50 feet long into fully equipped, all-the-comforts-of-home underground shelters at a price of up to about $78,000 each, not including shipping and interment.


You may have spotted the Atlas shop from the 5 Freeway as you're heading into downtown. There's a corrugated tube out front, painted bright yellow and looking like a tipped-over corn silo. High on the exterior wall facing the road is a banner declaring that the shelters offer protection from nuclear blasts, nuclear fallout, EMP (that's electromagnetic pulses, which can foul electrical systems), solar flares, mobs, looters, earthquakes and chemical warfare. If there's anything left off that list, it's probably not worth worrying about.






"People who buy my shelters are not radical crazy people," Hubbard told me recently as he guided me around the Montebello shop. "I get maybe three crazy calls a year. They're practical people."


Hubbard, 50, is a big Texan with a toothy grin and the friendly enthusiasm of someone trying to sell you something. He'll expound cheerily on the basic practicality, not to mention the sheer joy, of having a 40-foot corrugated steel drum buried 20 feet deep in your yard and tricking it out with a big-screen TV and Internet connection for those long days and nights hunkered down against nuclear blasts, the Chinese army or domestic looters. His shelters also offer such necessities as microwave ovens, space for a year's worth of provisions and high-grade air filtration.


"We don't know where our country will go," he said. "If we're going to be attacked, my shelters will protect you from Sarin gas or super flu. If we go bankrupt and we don't pay China, that could be the start of World War III. We could attack Iran or back Israel, and that could start a war. This is insurance. Why do we carry insurance on our homes? Just. In. Case."


Hubbard doesn't describe these dystopias as though he actually believes in them, but rather with the air of a salesman trying out any buzzword that might trigger a deal. During the couple of hours we were together, he described his products serially as underground condos, second homes, combination second homes and bomb shelters, man caves, man caves that happen to be bombproof, weekend cabins and hunting cabins.


Atlas Survival Shelters hasn't turned a significant profit yet. Hubbard said it made no money in the start-up year of 2011, was modestly in the black last year and may show a profit for 2013. But the business is unusual enough that it has won featured spots on several reality shows. An episode on A&E Network's "Shipping Wars" shows a team of moving experts trying to figure out how to transport a 32-foot shelter on their flatbed truck. During the episode Hubbard regales them with the virtues of the unit's escape-hatch feature, a second portal that opens only from the inside, in case of an attack.


"Somebody sees you going down; while they're trying to smoke you out, you're going to the back tunnel, you're gonna come up through an escape hatch that's hidden underground, you can shoot 'em in the back. Pretty cool, huh?" (Remarked one of the show's plainly creeped-out female cast members, "Remind me to never pay him a visit.")


More recently, Atlas was featured on an episode of the National Geographic Channel series "Doomsday Preppers," which chronicles the lifestyles of the scared and nervous. Hubbard's customer is described in network publicity as Brian Smith, a father of 12 "preparing for a total collapse of the U.S. monetary system."


Hubbard got into the underground shelter business a little more than a year ago after years of selling wrought-iron doors from the same location, operating as Hubbard Iron Doors. That business was brought low by the poor economy and cheap Chinese knockoffs, Hubbard says. It filed for bankruptcy in 2011; Hubbard says it's now owned and run by his brother, though the two companies share space with each other.


While he was casting about for a new business, Hubbard said, he happened across a brochure for Radius Engineering International, a Texas company that manufacturers fiberglass shelters mostly for business, government and military buyers. But the Radius products were expensive — they run from $150,000 up to millions, depending on the design and capacity. Hubbard thought he could do better on price while turning out a more appealing hideaway.


He's still trying to get a feel for the market, however. With his six or seven full-time workers, he can turn out one shelter a week. Orders, he said, come in at somewhere between one a month and one a week, more in periods of publicity-driven paranoia — during the run-up to the supposed Mayan apocalypse at the end of December, he said, calls jumped up to one a day.


The joke was on the callers, however, because Hubbard's six-week lead time meant that no one who called because they had just seen a Mayan feature on TV could get a shelter built, much less on site and in the ground, in time to beat the end of the world. Luckily, the apocalypse was a bust.


And for all that he plays up Armageddon in all its possible varieties in his sales pitch, doomsday may not be that great a marketing tool. "If I just sold bomb shelters, there would be about this big of a market." Hubbard holds his thumb and forefinger a half-inch apart. "But if I say, 'man cave,' 'wine cellar,' 'getaway,' then I get the recreational shelter owner too."


He says most of his calls come from retired military men, doctors, lawyers and business owners — possibly because the latter are among the few categories of buyers with the wherewithal to plunk down $60,000 or $70,000 for a man cave/bomb shelter, plus installation.


The size of the overall shelter market is unclear, in part because its promoters make a point of secrecy about whom they sell to and where. Privately held Radius has claimed to sell more than $30 million worth of shelters a year, but you have to take their word for it.


Then there are firms like Vivos Group, a Del Mar, Calif., company that claims to have started survivalist communities in three states — but they appear to be sort of co-op arrangements in which you have to apply to be considered for "co-ownership" of your refuge community. Once you're chosen, they'll let you know where to go when the end times come.


"This is just the threshold of something that's going to become common," Hubbard said, putting a hopeful spin on his words as though aware that paranoia may be peaking today, but gone tomorrow. "So I say, don't buy a bomb shelter. Buy an underground cabin, and enjoy it."


Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.






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Paid apps are history






This week marked an important moment in the evolution of the iOS app market. As Pages just slipped out of the iPad top 10 highest grossing apps chart, there are now no paid apps among the ten applications that generate most revenue on the iPad. When the iPad application market was born a few years ago, it was dominated by relatively stiffly priced applications, mimicking the PC software or game console software markets. But over the past couple of years, app vendors have realized that free apps with clever in-app purchasing hooks create much more revenue than paid apps.


[More from BGR: BlackBerry 10 browser smokes iOS 6 and Windows Phone 8 in comparison test [video]]






The same applies to the iPhone — there is only one paid app among the twenty highest grossing iPhone apps today. It is notable that some of the highest grossing apps have relatively low download volumes. Clash of Clans has been the top-grossing iPad application for all of January, but it is only ranked 53rd on the iPad download chart. Hay Day is the seventh-biggest application when it comes to revenue generation on the iPhone, but is only ranked at #104 when it comes to download volume.


[More from BGR: Galaxy S IV benchmarks may confirm 1.8GHz CPU and Android 4.2]


Leading app developers have figured out how to decouple download volume from revenue generation by creating free games that seduce their fans into paying steadily for in-app features. The types of of games that require a $ 0.99 or a $ 2.99 fee per download are turning into something resembling nostalgia items. For a stark example of how badly the revenue generation power of paid apps has faded, consider that the current #1 paid app on iPhone, Wood Camera, is 46th on the iPhone chart that lists top-grossing apps.  The future belongs to free apps.


This article was originally published on BGR.com


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J.J. Abrams to produce Lance Armstrong biopic


LOS ANGELES (AP) — He's already gotten the Oprah treatment. Now Lance Armstrong is headed for the silver screen.


Paramount Pictures and J.J. Abrams' production company, Bad Robot, are planning a biopic about the disgraced cyclist, a studio spokeswoman said Friday.


They've secured the rights to New York Times reporter Juliet Macur's upcoming book "Cycle of Lies: The Fall of Lance Armstrong," due out in June. Macur covered the seven-time Tour de France winner for over a decade.


No director, writer, star or start date have been set.


Armstrong is in the midst of a two-part interview with Oprah Winfrey in which he admits to using performance-enhancing drugs to reach his historic victories, something he'd defiantly denied for years. The International Olympic Committee stripped him of his 2000 bronze medal this week.


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Business Briefing | Medicine: F.D.A. Clears Botox to Help Bladder Control



Botox, the wrinkle treatment made by Allergan, has been approved to treat adults with overactive bladders who cannot tolerate or were not helped by other drugs, the Food and Drug Administration said on Friday. Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity. “Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence,” Dr. Hylton V. Joffe, director of the F.D.A.’s reproductive and urologic products division, said in a statement. “Today’s approval provides an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.”


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A backyard nuclear shelter? Yes, paranoia does sell








One sterling quality of American businesses is that they'll try to make money from anything.


Paranoia, for instance. So say hello to Ron Hubbard, the owner of Montebello-based Atlas Survival Shelters, which converts huge corrugated metal tubes up to 50 feet long into fully equipped, all-the-comforts-of-home underground shelters at a price of up to about $78,000 each, not including shipping and interment.


You may have spotted the Atlas shop from the 5 Freeway as you're heading into downtown. There's a corrugated tube out front, painted bright yellow and looking like a tipped-over corn silo. High on the exterior wall facing the road is a banner declaring that the shelters offer protection from nuclear blasts, nuclear fallout, EMP (that's electromagnetic pulses, which can foul electrical systems), solar flares, mobs, looters, earthquakes and chemical warfare. If there's anything left off that list, it's probably not worth worrying about.






"People who buy my shelters are not radical crazy people," Hubbard told me recently as he guided me around the Montebello shop. "I get maybe three crazy calls a year. They're practical people."


Hubbard, 50, is a big Texan with a toothy grin and the friendly enthusiasm of someone trying to sell you something. He'll expound cheerily on the basic practicality, not to mention the sheer joy, of having a 40-foot corrugated steel drum buried 20 feet deep in your yard and tricking it out with a big-screen TV and Internet connection for those long days and nights hunkered down against nuclear blasts, the Chinese army or domestic looters. His shelters also offer such necessities as microwave ovens, space for a year's worth of provisions and high-grade air filtration.


"We don't know where our country will go," he said. "If we're going to be attacked, my shelters will protect you from Sarin gas or super flu. If we go bankrupt and we don't pay China, that could be the start of World War III. We could attack Iran or back Israel, and that could start a war. This is insurance. Why do we carry insurance on our homes? Just. In. Case."


Hubbard doesn't describe these dystopias as though he actually believes in them, but rather with the air of a salesman trying out any buzzword that might trigger a deal. During the couple of hours we were together, he described his products serially as underground condos, second homes, combination second homes and bomb shelters, man caves, man caves that happen to be bombproof, weekend cabins and hunting cabins.


Atlas Survival Shelters hasn't turned a significant profit yet. Hubbard said it made no money in the start-up year of 2011, was modestly in the black last year and may show a profit for 2013. But the business is unusual enough that it has won featured spots on several reality shows. An episode on A&E Network's "Shipping Wars" shows a team of moving experts trying to figure out how to transport a 32-foot shelter on their flatbed truck. During the episode Hubbard regales them with the virtues of the unit's escape-hatch feature, a second portal that opens only from the inside, in case of an attack.


"Somebody sees you going down; while they're trying to smoke you out, you're going to the back tunnel, you're gonna come up through an escape hatch that's hidden underground, you can shoot 'em in the back. Pretty cool, huh?" (Remarked one of the show's plainly creeped-out female cast members, "Remind me to never pay him a visit.")


More recently, Atlas was featured on an episode of the National Geographic Channel series "Doomsday Preppers," which chronicles the lifestyles of the scared and nervous. Hubbard's customer is described in network publicity as Brian Smith, a father of 12 "preparing for a total collapse of the U.S. monetary system."


Hubbard got into the underground shelter business a little more than a year ago after years of selling wrought-iron doors from the same location, operating as Hubbard Iron Doors. That business was brought low by the poor economy and cheap Chinese knockoffs, Hubbard says. It filed for bankruptcy in 2011; Hubbard says it's now owned and run by his brother, though the two companies share space with each other.


While he was casting about for a new business, Hubbard said, he happened across a brochure for Radius Engineering International, a Texas company that manufacturers fiberglass shelters mostly for business, government and military buyers. But the Radius products were expensive — they run from $150,000 up to millions, depending on the design and capacity. Hubbard thought he could do better on price while turning out a more appealing hideaway.


He's still trying to get a feel for the market, however. With his six or seven full-time workers, he can turn out one shelter a week. Orders, he said, come in at somewhere between one a month and one a week, more in periods of publicity-driven paranoia — during the run-up to the supposed Mayan apocalypse at the end of December, he said, calls jumped up to one a day.


The joke was on the callers, however, because Hubbard's six-week lead time meant that no one who called because they had just seen a Mayan feature on TV could get a shelter built, much less on site and in the ground, in time to beat the end of the world. Luckily, the apocalypse was a bust.


And for all that he plays up Armageddon in all its possible varieties in his sales pitch, doomsday may not be that great a marketing tool. "If I just sold bomb shelters, there would be about this big of a market." Hubbard holds his thumb and forefinger a half-inch apart. "But if I say, 'man cave,' 'wine cellar,' 'getaway,' then I get the recreational shelter owner too."


He says most of his calls come from retired military men, doctors, lawyers and business owners — possibly because the latter are among the few categories of buyers with the wherewithal to plunk down $60,000 or $70,000 for a man cave/bomb shelter, plus installation.


The size of the overall shelter market is unclear, in part because its promoters make a point of secrecy about whom they sell to and where. Privately held Radius has claimed to sell more than $30 million worth of shelters a year, but you have to take their word for it.


Then there are firms like Vivos Group, a Del Mar, Calif., company that claims to have started survivalist communities in three states — but they appear to be sort of co-op arrangements in which you have to apply to be considered for "co-ownership" of your refuge community. Once you're chosen, they'll let you know where to go when the end times come.


"This is just the threshold of something that's going to become common," Hubbard said, putting a hopeful spin on his words as though aware that paranoia may be peaking today, but gone tomorrow. "So I say, don't buy a bomb shelter. Buy an underground cabin, and enjoy it."


Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.






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Home sweet home or merely a teardown?









The courtyard patio at the classic California Spanish house was ringed by camellia bushes. In the living room, the fireplace boasted genuine Malibu tile and in the dining room, the original thin-planked oak floors gleamed.


Listed for sale at $2.6 million, the immaculately maintained, three-bedroom home — a blend of traditional and modern stylings in one of Santa Monica's toniest neighborhoods — could go either way: to a family who falls in love with its character. Or to a builder, as a teardown.


"It's a tweener," real estate agent John Hathorn said Sunday. "We're seeing both buyers."





This celery-green Spanish with the barrel tile roof was among three properties with open houses Sunday on the Westside. Judging by the crowds, the real estate downturn on the Westside, if it ever existed, is over. Hordes showed up for each viewing, complaining that almost nothing was on the market.


Spaniard Mila Jimenez said she and her husband could get more for their money on the Westside than in Madrid or Amsterdam. An older couple from Mandeville Canyon wanted to relocate where they could buy a loaf of bread without mounting an overland expedition. Several viewers were eager to live near their workplaces to avoid the Westside's horrendous traffic.


Judging by the number of empty lots on the Westside with cranes idled over piles of dirt, the teardown phenomenon is also revving back up. This comes as no surprise. The reasons for teardowns are simple: Somebody thinks they can make more money or live better by knocking down a house and building a newer, bigger and shinier one. Way bigger: many of the new houses are gargantuan, built out as close as they can get to the lot lines to maximize resale value down the line.


What was eye-popping were the prices people will pay for the privilege of ripping down a home. One Brentwood fixer-upper featured misbegotten design choices such as square bathroom tile in a light mauve and a gaping Jacuzzi tub. The fireplaces in the living room and bedroom were hung with rusty chain curtains, and mold was growing on the garage ceiling. It was listed at $1.5 million.


"I hope that comes with a bulldozer," said one viewer.


A young man in commercial real estate named Farz said the house had "potential." Clutching his girlfriend Tina's hand, Farz said you could start by putting in a second floor, then "three or five years down the line, tear it down and built it up again." Tina, a physician, agreed, saying she's living with her family nearby and wants to remain in the area.


Up close, teardowns make economic sense. A two-physician couple pushing a bubbly 4-month-old in a stroller explained that with interest rates under 3%, mortgage payments on a million-dollar property would be roughly equivalent to rents in Brentwood and Santa Monica, $3,000 to $4,000 a month. Building a new home can be cheaper than renovating.


But stepping back, it's striking to realize that while tens of thousands of people who lost in the recession are still fighting to hang on to their homes, others are lining up to tear them down. L.A. real estate spans two worlds: one in which owning a house — any house — is the dream of a lifetime, and another in which a house is just a nuisance.


A few streets away from the fixer-upper, a charming Cape Cod-style house — white, with a picket fence and dormer windows — was also listed at $1.5 million.


A psychology professional and a physician had lived in the home. It was in impeccable repair and full of loving details. A framed copy of an ode a son had written to the couple's marriage hung on the wall. A Chinese elm shaded the brick patio, and a kelly green lawn sloped deep and wide back to a thicket of citrus and other trees.


But it, too, faced at least the possibility of being torn down, though the agent, Dolly Niemann, said its chances were probably better than many other homes of its vintage.


However, a potential bidder had already asked about removing the tree out back, suggesting demolition is on the table.


Back at the Santa Monica Spanish open house, an Anna-Wintouresque real estate woman in giant sunglasses dropped by and opined that the celery-colored house was doomed.


"It's under-built for the neighborhood," she said. "The kitchen is nothing."


"Two words, it's not functional, and it's not for modern living," her male business partner said (they declined to be identified, saying they're well-known in Westside real estate circles.)


Sure, if your routine includes yoga classes, boot camp, charity balls, cocktail parties, volunteer work, school drop-offs and pickups, your wardrobe is not going to fit in 1930s-scale closets. Not to mention the shoes.


The house next door to the Spanish already sold as a teardown. Its replacement, a humongous oblong building, looms over its neighbor, blocking out air and sun.


Granted in Santa Monica, replacement houses are often more artfully designed. Hathorn said the latest thing in teardown replacements are traditional features such as coffered ceilings and wainscoting.


But even the professionals sometimes feel a twinge: Saundra lives in Brentwood and works in real estate so she gets the teardown calculus. She showed up at the showing of the Cape Cod house, which she thinks is so cute she often drives past just to view it. But she was horrified it might go as a teardown.


"That would be so sad," she said.


gale.holland@latimes.com





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ASUS in talks with Microsoft to develop a Windows Phone 8 smartphone






The PC industry is in shambles and manufacturers have begun to explore new options to increase revenue. According to The Wall Street Journal, ASUS (2357) is in talks with Microsoft (MSFT) on a licensing deal to offer Windows Phone 8 device. This makes sense for ASUS since smartphone shipments increased by nearly 50% in 2012, compared to a mere 3.2% growth in computer shipments, and the company already has experience in the mobile world after developing a variety of Android tablets.


[More from BGR: Cable companies called ‘monopolies that stifle competition and innovation’]






Benson Lin, the company’s corporate vice president of mobile communication products, revealed in a recent interview that ASUS was hoping to bring its PadFone, a smartphone that can dock into a larger tablet, to the Windows 8 ecosystem.


[More from BGR: Clash of the bantams: The bloody smartphone battle that will take shape in 2013]


“With our Padfone concept, the phone plus tablet, I think it makes sense for Windows 8,” Lin said. “There is no target timeline…but we are interested in making Windows phones.”


The executive also said that ASUS has been in talks with a variety of American carriers in the hopes that its smartphones will launch in the United States in 2013.


This article was originally published on BGR.com


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Robert Wagner not interviewed in new Wood inquiry


LOS ANGELES (AP) — Robert Wagner has declined to be interviewed by detectives in a renewed inquiry into the drowning death of his wife Natalie Wood three decades ago, an investigator said Thursday.


Wagner was interviewed by authorities soon after Wood's drowning in 1981, but the actor is the only person who was on the yacht the night Wood died who has not spoken to detectives as part of the latest inquiry, despite repeated requests and attempts, sheriff's Lt. John Corina said.


Blair Berk, an attorney for Wagner and his family, said the actor had cooperated with authorities since his wife died.


Detectives began re-investigating the case in November 2011. Since then investigators have interviewed more than 100 people, but Wagner has refused and Corina said the actor's representatives have not given any reason for his silence.


The detective's remarks provided new insight into the case that has remained one of Hollywood's enduring mysteries. Earlier this week, coroner's officials released an updated autopsy report that had been under a security hold. It detailed why Wood's death had been reclassified from an accidental drowning to a drowning caused by "undetermined factors."


"Mr. Wagner has fully cooperated over the last 30 years in the investigation of the accidental drowning of his wife in 1981," Berk said in a prepared statement. "Mr. Wagner has been interviewed on multiple occasions by the Los Angeles sheriff's department and answered every single question asked of him by detectives during those interviews."


After 30 years, Berk said, neither Wagner nor his daughters have any new information to add. She said the latest investigation was prompted by people seeking to exploit and sensationalize the 30th anniversary of the death.


The renewed inquiry came after the yacht's captain Dennis Davern told "48 Hours" and the "Today" show that he heard Wagner and Wood arguing the night of her disappearance and believed Wagner was to blame for her death.


Authorities have not identified any suspects in the case.


Wood, 43, was on a yacht with Wagner, Christopher Walken and the boat captain on Thanksgiving weekend of 1981 before she somehow ended up in the water.


Corina said Walken gave a prepared statement and spoke to detectives for an hour.


Detectives have also interviewed other actors who knew both Wagner and Wood to learn more about their relationship.


Corina said detectives have tried at least 10 times to interview Wagner but have been refused. He said some of the refusals have come from the actor's attorney, and that detectives at one point traveled to Colorado to try to speak with Wagner but were unsuccessful.


Corina said the latest inquiry had turned up new evidence.


"Most of the people we've talked to were never talked to 30 years ago," he said. "We've got a lot of new information."


Asked if the information might lead to criminal charges, Corina said that would be up to prosecutors if they are presented a case.


"All we can do is collect the facts," he said. "We're still trying to collect all the facts."


Corina said new people have emerged with information each time the case is in the news. Detectives would like to interview other people who haven't agreed to talk, he said.


Coroner's officials released an update autopsy report on Monday that detailed the reasons Wood's death certificate was changed last year from a drowning death to "drowning and other undetermined factors."


The updated report states the change was made in part because investigators couldn't rule out that some of the bruises and marks on Wood's body happened before she went into the water.


"Since there are unanswered questions and limited additional evidence available for evaluation, it is opined by this medical examiner that the manner of death should be left as undetermined," Chief Medical Examiner Dr. Lakshmanan Sathyavagiswaran wrote in the report completed in June.


Officials also considered that Wood wasn't wearing a life jacket, had no history of suicide attempts and didn't leave a note as reasons to amend the death certificate.


Wood was famous for roles in films such as "West Side Story" and "Rebel Without a Cause" and was nominated for three Academy Awards.


Conflicting versions of what happened on the yacht have contributed to the mystery of her death. Wood, Wagner and Walken had all been drinking heavily in the hours before the actress disappeared.


Wagner wrote in a 2008 memoir that he and Walken argued that night. He wrote that Walken went to bed and he stayed up for a while, but when he went to bed, he noticed that his wife and a dinghy that had been attached to the yacht were missing.


"Nobody knows," he wrote. "There are only two possibilities; either she was trying to get away from the argument, or she was trying to tie the dinghy. But the bottom line is that nobody knows exactly what happened."


___


Anthony McCartney can be reached at http://twitter.com/mccartneyAP


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Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

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Herbalife says fourth-quarter profit will exceed expectations









Herbalife Ltd. forecast that fourth-quarter earnings will come in higher than expected but said expenses could rise as the nutritional supplement distributor ramps up its fight with activist hedge-fund manager William Ackman.


The Los Angeles company said Thursday it also plans to buy back shares, a sign that management believes the stock is undervalued. It's a much-needed boost for a company that's been mired in a battle with an investor who says the company is on its way downhill.


"Herbalife is a financially strong and successful company, having created significant opportunities for distributors and positively impact the lives and health of our consumers over our history," company Chief Executive Michael Johnson said in a statement.





Herbalife said it expected fourth-quarter earnings of $1.02 to $1.05 a share, higher than Wall Street's expectation of $1.01 a share. Sales for the fourth quarter are expected to rise 19.9%, the company said, and its taxes will be lower than projected. The company plans to begin repurchasing shares Tuesday.


The company also said it expected expenses to be temporarily higher "because of recent events."


Herbalife has been battling allegations by Ackman, who said in a December presentation that the company is a glorified pyramid scheme. He's sold short about 20 million shares of the stock, expecting the company to tank. Herbalife is also reportedly being investigated by the Securities and Exchange Commission.


A week ago in Manhattan, Johnson and other Herbalife executives rebutted Ackman's points one by one, proving, they said, that Herbalife has a stable business model and is not scamming anyone. Shares of the company, which had been slumping, began rising again after Johnson's presentation.


Ackman foe Carl Icahn stepped into the controversy this week, taking a stake in Herbalife, according to reports. Icahn could not be reached for comment.


Investors showed mixed reaction to Herbalife's preliminary earnings Thursday. The stock initially shot up in morning trading but leveled off in the afternoon and closed down $1.54, or 3.4%, at $43.52.


Herbalife will release its final fourth quarter results Feb. 19.


Analysts such as Timothy Ramey, of D.A. Davidson & Co., say they're optimistic about the company's future. Ramey also adjusted his expectations of the company's earnings.


In 2013, earnings will be $4.85 a share, up from his previous estimate of $4.55, he said in a note. He also adjusted his forecast for 2012 earnings to $4.05 a share from $4.03.


Ramey said he expects Herbalife stock to thrive once it emerges from the current controversy, which he expects will happen in 2013. In five years, the stock could hit $180, he said.


"There has never been a period of greater scrutiny for Herbalife," he wrote.


alana.semuels@latimes.com





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