State Supreme Court wants Arizona donors audited

SACRAMENTO — An Arizona group was scrambling late Sunday to keep secret the individuals behind its $11-million donation to a California campaign fund after California's Supreme Court, in a rare and dramatic weekend action, ordered it to turn over records that could identify the donors.

The order followed days of frenzied legal battles between California regulators, who have tried to get documents related to the anonymous contribution before election day, and attorneys for the Arizona nonprofit who have resisted delivering them.

The showdown continued into the night Sunday, with no records produced nearly seven hours after the justices' late-afternoon deadline. Lawyers for the nonprofit said they were trying to comply even as they rushed to ask the U.S. Supreme Court to halt to the audit.

The $11 million went to a committee that is fighting tax increases proposed by Gov. Jerry Brown in Proposition 30 and promoting an initiative that could limit political spending by unions, Proposition 32. The donation has been among the most controversial moves of this election season, with Brown railing against the "shadowy" contributors at campaign appearances.

The case, which has the potential to reshape a growing sector of political giving, has put California at the forefront of a national debate over concealed political donations. Ann Ravel, chairwoman of the state Fair Political Practices Commission, which initially sued the Arizona group, called the California high court's decision historic.

It all began with a complaint from activists at Common Cause, who said the $11-million donation from Americans for Responsible Leadership violated a new California regulation. Federal law allows nonprofits to keep the identities of their donors confidential, but a rule implemented here in May says contributors must be identified if they give to nonprofits with the intention of spending money on state campaigns.

The matter has rocketed from court to court as Ravel's commission fought to obtain the Arizona group's records. The seven justices of the state Supreme Court, based in San Francisco, made the unusual decision to consider the matter over the weekend. On Sunday afternoon, they held a conference call to discuss it.

Shortly after 3 p.m., they ordered Americans for Responsible Leadership to produce — in less than an hour — the records sought by Ravel, a Brown appointee. The justices did not explain their unanimous decision, indicating in their order that they would consider the legal issues in a later, more detailed ruling.

But no records were delivered as a team of auditors and lawyers waited in the commission's Sacramento office, prepared to dig into the nonprofit's emails, text messages, financial statements and meeting minutes. Their task would be to comb the disclosures for any sign that the contribution violated the new California regulation.

If the Arizona group was found to be in violation, the state planned to direct the nonprofit to disclose the donor names and was ready to back up the directive by seeking another court order, if needed, Ravel said.

Lawyers for Americans for Responsible Leadership balked at the California court's order, preferring to ask the U.S. Supreme Court to weigh in on the case before turning over anything. In the early evening, they asked the California jurists for more time — at least until 9 a.m. Monday — to comply.

That would provide enough time, they said, to request an emergency stay from the nation's high court. Attorneys defending the nonprofit group wrote to Washington outlining their case.

"Disclosure in this highly charged political environment and in the face of an unprecedented and vehemently legally contested investigation is impermissible viewpoint discrimination and plainly violative of ARL's First Amendment rights," Thad Davis, a lawyer for the nonprofit, said in his letter to the U.S. Supreme Court.

Justice Anthony Kennedy has authority over Western states and can issue a stay in this case.

Meanwhile, the state court told the Arizona group there would be no extension.

At risk of being in contempt of the state court, lawyers for the nonprofit said they would begin an "attempt to comply with the order."

"While we are working to deliver the records, we still believe the FPPC does not have the authority to take such an action," said Matt Ross, a spokesman for the group's legal team, in a statement Sunday night.

Ravel said she had staff members prepared to work all night to review whatever the Arizona group produced.

A career government lawyer, Ravel is hardly known in Sacramento as a firebrand. But the Arizona group says in its court filings that she is conducting a "one-woman media onslaught, rabblerousing and prejudging, including 'tweeting' her incendiary view."

State authorities are keeping the pressure on as election day looms.

California Atty. Gen. Kamala Harris, whose office is helping to represent the Fair Political Practices Commission in court, said in an interview that the Arizona group's legal maneuvers are "an effort to obstruct the process and run out the clock."

chris.megerian@latimes.com

maura.dolan@latimes.com

Times staff writer Evan Halper contributed to this report.

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Have Your Say: TenderTree Can Help You Pick a Caregiver

At this point practically every restaurant, shop, or handyman service has a Yelp, Google, or Angie’s List review to help us decide who gets our money. But when it comes to a far more important and subtle kind of decision, finding the right person to take care of an elderly or disabled friend or relative, the internet offers very little guidance.

Startup TenderTree is hoping to be that guide. A Summer graduate of incubator 500 Startups, TenderTree is doing the same for hiring a home care provider that UrbanSitter has done for finding a babysitter – helping people find and hire a qualified worker online and at a lower cost.

When someone needs to hire a caregiver, it’s typical to go through a government or non-profit agency. The problem, says TenderTree founder Andy Argawal, is that you rarely have a say about who comes into your home. You can always send back a care provider that you don’t think is a good fit, but you don’t get the chance to check someone out before they walk in the front door. TenderTree, Argawal says, is different because it lets customers pick out and hire professional caregivers based on their qualifications and personalities.

For Jim Cadena, a customer who used TenderTree to find assistance for his 92-year-old mother, the ability to pick out and personally interview who he hired was the best feature of the service. “Agencies are daunting, and they just send you people without you getting a choice,” he says. Cadena says the process of finding someone was as simple as posting the job description on TenderTree, sifting through responses, and interviewing a few candidates. The level of quality of the caregivers was much higher than what he experienced with agency workers, and the price was far lower, he added.

On average most agencies charge between $15 and $30 per hour for caregiver services, according to a recent study. (Cadena says he’s paid $28 per hour). Agency-hired workers only take home about half of those wages, says Robert Woods, a home-care provider who used to work for an agency and now gets jobs through TenderTree. On the platform, providers set their own rate and the company takes a small cut of their earnings. Though Argawal wouldn’t disclose the exact percentage TenderTree takes, he says much of it goes toward insuring each caregiver with a $3 million policy – it’s clearly a volume play for the startup. TenderTree is looking to create as large a marketplace as possible for caregivers and those in need of their help, and take its small piece of the action.

TenderTree also handles all the payroll tax paperwork and deducts payments from a customer’s credit card at the end of each week. Workers log their hours on the platform, and the customer approves them for payment.

Before offering them up for hire, TenderTree does extensive criminal background checks and skills verifications on every person accepted into the program. Unlike a pet sitter or babysitter, caregivers often need to have specific training and certifications to handle a patient’s medical needs.

The types of care providers available on TenderTree range from companions who cook, clean and provide conversation, to certified aides who can assist the elderly and disabled with feeding and bathing. At the most skilled end of the spectrum are licensed nurses who provide in-home medical care. There’s also speech and occupational therapists available for hire that can assist with developmental and physical disabilities.

TenderTree launched its private beta in March 2012, and has had “thousands” of customers and caregivers sign up. Currently the service is available for customers in the San Francisco Bay Area that pay out of pocket for home care, not those paying with insurance plans or government aid. That is the biggest barrier to the startup’s plans to scale broadly. If it really has the goal of helping the largest number of people – both patients and caregivers – it will need to find a way to accept the forms of payment that most people use.

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Chelation Therapy Shows Slight Benefit in Heart Disease Clinical Trial

LOS ANGELES — To the surprise of many cardiologists, a controversial alternative therapy proved beneficial to people with heart disease, reducing the rate of death and cardiovascular problems in a clinical trial, researchers said on Sunday.

The benefit of the treatment, known as chelation therapy, barely reached statistical significance, and there were questions about the reliability of the study. Even the investigators in the trial said the results were insufficient by themselves to justify recommending use of the treatment.

Still, the unexpected finding should provide some vindication to the National Institutes of Health for sponsoring the $30 million study, which was plagued by delays and problems.

“There may be a biological effect and that biological effect should be taken seriously,” and “pursued with additional research,” Dr. Gervasio A. Lamas of Mount Sinai Medical Center in Miami, the lead investigator, said at a news conference here at the annual scientific meeting of the American Heart Association.

Dr. Elliott Antman, representing the heart association, applauded the National Institutes of Health for sponsoring the study while also expressing caution. “Intriguing as these results are, they are unexpected and should not be interpreted as an indication to adopt chelation therapy into clinical practice,” said Dr. Antman, a cardiologist at Brigham and Women’s Hospital in Boston.

Chelation therapy involves the infusion of agents that remove metals from the bloodstream.

More than 100,000 Americans with heart disease undergo chelation therapy each year, at a cost of about $5,000 per course of treatment, experts here said. The hypothesis is that chelation can remove the calcium that is a contributor to arterial plaques.

But skeptics said there was not enough evidence backing chelation therapy to even begin a clinical trial. Proponents of the study said that since chelation therapy was already widely used, it should be subject to the same rigorous scientific testing used to study conventional pharmaceuticals.

And some skeptics were not persuaded at all. Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, said the study was “fatally flawed,” with many of the doctors involved being on the fringes of medicine and many patients dropping out of the trial. He said if people got the mistaken idea from the study that chelation was beneficial “it would be a public health catastrophe.”

The study, which began enrolling patients in 2003, was plagued by problems from the start. It fell way behind its goal of recruiting nearly 2,400 patients in three years. The trial was also suspended in 2008 for investigations by government agencies, one over conduct at trial sites and the other about whether patients were being adequately informed that chelation can cause death. The study was allowed to resume the next year, after some changes were made.

The trial ended up with 1,708 patients at 134 centers in the United States and Canada. The patients all had had previous heart attacks.

Half the patients received the chelation therapy, a synthetic amino acid called disodium ethylene diamine tetra acetic acid, or EDTA, as well as other substances. These were given by infusion every week for 30 weeks, followed by 10 more infusions at intervals of two to eight weeks. The other half received infusions of placebo.

After a follow-up of 55 months, 26 percent of those who received chelation therapy had died, suffered a heart attack or stroke, had a procedure to reopen a coronary artery or had been hospitalized for angina. That was less than the 30 percent for those who received a placebo, a difference that was barely statistically significant.

Doctors said there were reasons for caution.

Virtually all the of difference between the treatment and the placebo groups occurred in the third of patients who had diabetes. The placebo contained some sugar, which conceivably could have harmed the diabetics. Also, at least within the first two years, the chelation therapy did not improve physical functioning or psychological well being, according to surveys of the patients.

Dr. Mark A. Creager, a cardiologist at Brigham and Women’s Hospital who was not involved in the study, said the chelation infusion also contained a high dose of vitamin C and the blood thinner heparin. It could be that one of those ingredients, not the chelation agent, were responsible for any benefit, he said.

Dr. Lamas, the lead investigator, said the chelation treatment was well tolerated. But he said investigators did not yet know why some patients receiving the therapy dropped out of the trial.

Another study presented at the heart meeting on Sunday found coronary bypass surgery superior to the use of stents for patients with diabetes and multiple heart blockages.

The trial involved 1,900 patients followed for five yeas. About 27 percent of those who received stents either died or had a heart attack or stroke, compared with about 19 percent of those undergoing bypass surgery. There was an increase in stroke risk with surgery, but that was outweighed by fewer deaths and heart attacks.

Previous studies had already suggested that surgery was better for diabetic patients with severe coronary disease, and practice guidelines already say it is “reasonable” to choose surgery. But the new study, sponsored by the National Institutes of Health, shows the same result even using modern drug-covered stents.

About 700,000 Americans undergo artery opening procedures for more than one blood vessel each year, and about 25 percent of them have diabetes, according to the investigators.

The study results were also published online by the New England Journal of Medicine. Johnson & Johnson and Boston Scientific provided the stents used in the study.

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A Media Vow of Election Night Restraint Despite Social Media Clamor

This has been the year of the big media gaffe.

NBC News edited a 911 tape of George Zimmerman in a way that implied race as a factor in the Trayvon Martin shooting. CNN and Fox News falsely reported that the Supreme Court had struck down the individual mandate at the heart of the Obama administration’s health care law. ABC News wrongly suggested a link between a mass shooting in Colorado and the Tea Party. Just last week during the storm, CNN repeated a false rumor about flooding at the New York Stock Exchange.

Now the media are gearing up for election night, the finale of the year’s biggest story. It’s a chance to regain some credibility — presuming, of course, that television networks and other news organizations get their state-by-state projections right. They all say they will, still mindful of the mistakes made in 2000, when the networks prematurely called Florida for Al Gore and then George W. Bush.

The same precautions that were put in place after 2000 will be in place again this Tuesday. At NBC, for instance, the statisticians at the “decision desk” that makes projections “are literally sealed off from the rest of us,” said Mark Lukasiewicz, the senior vice president of specials for NBC News.

Different this time will be the level of noise on the Web, where armchair and professional pundits alike will react to the election results in real time. On election night in 2008, a few Web sites, including Slate and Time.com, stated the obvious — that Barack Obama was going to win the presidency — well before the TV networks and major newspapers said so. In large part that’s because the networks and newspapers were waiting for the polls to close on the West Coast.

They will abide by the same principle again on Tuesday night, ruling out any such pronouncement before 11 p.m. Eastern. But more Web sites and individual users will most likely try to call the race early, creating a cacophony on social networking sites like Facebook and Twitter.

A memo on Saturday to employees of The Associated Press, the country’s biggest news wire service, asked them to refrain from adding to the noise by posting to Twitter about other news outlets’ calls. “If A.P. has not called a particular state or race, it’s because we have specifically decided not to, based on the expertise and data we have spent years developing,” the memo read.

In calling a state for Mr. Obama or Mitt Romney, news organizations will consider several data sources, including exit poll results and raw vote totals — “a brain trust of data,” said Ingrid Ciprian-Matthews, the vice president for news for CBS News.

Executives at the major networks said in interviews that they don’t expect to be able to project a winner at 11 p.m. this year, given the closeness of the presidential race in several swing states. “I’m not even going to guess what time it will be,” said Marc Burstein, the senior executive producer for special events at ABC News. He predicted an abundance of caution this year because of the trend of early voting in many states.

For election night ABC is uniquely situated in Times Square, which filled up with supporters of Mr. Obama on election night in 2008. This time, too, “I expect a gigantic crowd,” Mr. Burstein said. NBC is expecting the same at Rockefeller Plaza, which it has re-christened Democracy Plaza with exhibits and video screens, just as it did in 2004 and 2008.

All of the executives interviewed said they would be entirely comfortable making projections after their competitors. “In a close contest, we’ll simply wait,” said Sam Feist, the Washington bureau chief for CNN. And all of them cited the journalism chestnut that it’s better to be right than first. “It’s always lovely when the two coincide,” said Ms. Ciprian-Matthews of CBS, “but everybody here is absolutely on the same page: accuracy comes first.”

Fox News did not respond to an interview request.

CNN, which was criticized for crowding its studio with anchors and analysts in 2008, will have more reporters in the field this time, including a half-dozen in Ohio alone. Reprising what it called “ballot cams” on primary nights, CNN will have crews at “key voting and vote-counting locations” in battleground states, Mr. Feist said.

“We proved during the primaries that doing real reporting on those nights can make a difference,” he said.

No matter the outcome, some partisans will claim that the election is illegitimate, if the election year rhetoric is to be believed. Continuing an effort that started in 2004, networks and other news outlets will ask the public to alert them to voter irregularities and allegations of voter suppression. “We have an entire team working on those stories,” Mr. Lukasiewicz of NBC said.

Dozens of news and opinion Web sites will offer essentially live coverage on election night, some with TV-like newscasts and others with live blogs. But the biggest audiences are still expected to tune to the big three broadcast networks, ABC, CBS and NBC, and the big three cable news networks, Fox News, MSNBC and CNN.

Four years ago, Brian Williams was the anchor on NBC, Charles Gibson on ABC and Katie Couric on CBS. Mr. Williams is back for his second presidential election night as anchor, but Mr. Gibson, who retired three years ago, will not; heading the coverage instead will be the pair that sat alongside him in 2008, Diane Sawyer and George Stephanopoulos. Ms. Couric, now of ABC, will join them from time to time with social media reaction — a role that did not exist on the network’s coverage last time.

On CBS, Scott Pelley will anchor his first presidential election night. It’s also the first time for Rachel Maddow, on MSNBC, and Bret Baier and Megyn Kelly, on Fox News. On PBS, Gwen Ifill and Judy Woodruff will make up national television’s first two-woman anchor team on election night.

Half a dozen smaller channels will also have hours of live election talk, as will countless local stations — paid for in part by the revenue from innumerable election ads. Discussing the extent of the coverage, Mr. Feist of CNN said, “You cannot find an available high-definition satellite path for Tuesday night in this country. There are none left. The country is at capacity.”

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Keeping 007 relevant in a changed world

NEW YORK — Early in "Skyfall," Judi Dench's M pulls aside our embattled hero, played once again with suave ennui by Daniel Craig, and wonders whether the world still needs either of their services. As Bond wraps his head around that idea, he looks searchingly at his boss. "So this is it?" he wonders. "We're both played out?"

Questions about relevance dangle throughout the new James Bond movie, which opens in the U.S., after a crescendo of marketing, on Nov 9. Field agents are of diminishing importance in an era of cyber-spying and drone warfare, and the uniqueness of Bond's gadgets has been diluted at a time when everyone and their great-aunt carries an iPhone.

PHOTOS: James Bond through the years

Yet as the film franchise turns 50 (yes, someone born the year "Dr. No" came out is now eligible to join AARP) themes of retirement and sell-by dates aren't simply screenplay fodder — they pertain to the franchise itself.

After strong early reviews and solid overseas business, the latest Bond adventure sweeps into theaters with blockbuster expectations. But even if the Sony release blows the doors off the box office like, well, 007 making a grand entrance, it can't hide what those who worked on it quietly acknowledge — making this movie was a more difficult and delicate undertaking than ever.

No longer is a successful Bond movie simply a matter of dialing up clever dialogue and dazzling set pieces. Facing a world that would be unrecognizable to those behind the early Ian Fleming adaptations, Bond filmmakers and actors grapple on many levels with how to keep the series fresh.

They must find ways for a tuxedo-wearing, martini-swilling protagonist to stay relatable while a global downturn rages. They need to project a contemporary degree of villainy in a world where the threat of Islamist terrorism is, for a variety of reasons, not as easily portrayed as the enemies and fears of the Cold War.

They want to retain at least a hint of gravitas after years of Austin Powers and Johnny English.

Maybe most important, they struggle with how to avoid what might be called the quaintness trap — staying relevant in a cinema culture that has seen the rise of splashy CG action movies on the one hand and modern truth-seekers a la Jason Bourne on the other.

"The theme of our story is that we have to question if the old classic things still work," said Javier Bardem, who plays the villain in "Skyfall," directed by Sam Mendes. "It's implied in every character in this movie. But it's also the question about the James Bond franchise."

New obstacles

For years, Barbara Broccoli, the longtime producer and steward of the spy series (total box office: about $5 billion), knew that she wanted a film for the franchise's 50th anniversary. "Bond 23," as "Skyfall" soon became known, was a way of honoring her late father, Albert "Cubby" Broccoli, who died in 1996 and was heavily responsible for putting Fleming's work on the screen. It also offered a third act in the Craig-led Bond.

About three years ago, with the blessing of studio MGM, Broccoli and stepbrother/fellow producer Michael Wilson hired the longtime Bond writers Neal Purvis and Robert Wade, along with "The Queen" scribe Peter Morgan. At nearly the same time they brought on Mendes, the British director of "American Beauty" who was in a slump after his young-marrieds drama "Away We Go" flopped in 2009.

Then MGM filed for bankruptcy, and suddenly everyone was frozen in place. (To avoid legal action from creditors, Mendes was retained off the books as a "consultant.")

PHOTOS: The Bond girls

"It was a nightmare," Broccoli recalled. "This was one of those situations that's really frustrating — when all the delays have nothing to do with the making of the movie." Craig's attitude was even more bleak. "I thought OK, we might have to say goodbye to this," he said in an interview in New York several weeks ago. "And that made me really sad." In the hiatus, Morgan left, replaced by the veteran John Logan ("Hugo").

MGM was finally reconstituted with new owners. But now came another problem: how to make Bond dramatically relevant again. The franchise wasn't just long in the tooth — it was coming off a disappointing entry in 2008's "Quantum of Solace." Craig acknowledged in the interview that the movie wasn't "satisfying." Wilson said that, after witnessing the critical reception, he thought, "Oh God, we really screwed this up."

A big reason for that was Bond's nemesis. During the decades that the series provided a catharsis for the Soviet threat, it was easy to put a face on the menace. But since the Iron Curtain fell — and especially after the attacks of Sept. 11 — that was a lot tougher.

In "Casino Royale," Craig's initiation, filmmakers used a clever work-around: They channeled the demons that would normally reside in the villain into the hero. Craig's Bond was grimmer and darker, which not only made for a compelling character but for some juicy zeitgeist stuff, Bond's beleaguered air matching our post-Sept. 11 anxiety.

In "Quantum," writers essentially opted out, creating villains and stakes that had little to do with the headlines (they involved a Bolivian coup and the arcana of water rights.) The film was rushed into production after the writers strike — "you shouldn't try to rewrite whole sections of the story while you're shooting," Craig noted dryly — and the results were wobbly.

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Head Hunter: Rare Specimens From a World-Class Skull Collection

If you were to go clicking down Alan Dudley’s anonymous-looking English street in Google’s Street View, there’d be no reason to stop outside his anonymous-looking English home. But inside, in a space no bigger than a child’s bedroom, Dudley has amassed one of the world’s most impressive private collections of skulls -- some 2,500 of them, incredibly well-organized and impeccably preserved. A good chunk of the animal kingdom is represented -- fish, reptiles, birds, and mammals fill the space.

British journalist Simon Winchester’s first reaction to the collection was horror. “I thought, ‘This is macabre, this is horrible, this is grotesque,’ because I was, I think like most of us, brought up to associate skulls with piracy or warning or danger or death,” Winchester says. “But then you see beneath the muscle and the skin something so beautiful, so finely constructed, that you can understand the fascination that someone like Dudley has. It may sound rather corny, but it gives you a new reverence for life.”

Winchester was so moved that he, along with an ex-BBC producer, created an app that showcased the collection. Though highly regarded when it launched last year, the app didn’t sell particularly well. But publishers in New York were interested in the material. When he was asked to turn the app into a book, Winchester happily agreed. The result is Skulls: An Exploration of Alan Dudley’s Curious Collection, which was published earlier this month. The book features hundreds of Dudley’s skulls, supplemented with rarer specimens and Winchester’s writings on skull lore and history. We spoke to Winchester about what he learned and the most interesting skulls he discovered. These are some of his favorites.

Above:

Winchester loves “the extraordinary canine teeth that look like horns but are actually teeth which curve back into its own head and make it look utterly weird.”

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AnnaLynne McCord to get “Scorned” With Billy Zane in new thriller

LOS ANGELES (TheWrap.com) – AnnaLynne McCord is about to become a woman “Scorned.”

“90210″ star McCord has signed on for the revenge thriller “Scorned,” alongside “Titanic” star Billy Zane and Viva Bianca from Starz’s “Spartacus.”

McCord and Zane will play Sadie and Kevin, a couple whose romantic weekend at a lake house takes a sideways turn when a text message from Sadie’s best friend (played by “Bianca”) to Kevin reveals a lurid love affair between the two, sending Sadie on a vengeance spree.

“Scorned” will be directed by Mark Jones, the creator and director of the beloved “Leprechaun” horror-movie series.

Jones likened the project to “sophisticated” thrillers such as “Fatal Attraction” and “Misery.”

“Having done horror with comedy, I wanted to delve into something more sophisticated along the lines of ‘Fatal Attraction’ and ‘Misery,’ and develop a multi-dimensional, twisted character in our lead villain (McCord), who I feel brings an original and incredibly unique take on her character,” Jones said.

Lightning Entertainment will handle international sales of the film, with Lightning’s Audrey Delaney and Marc Bienstock executive-producing.

Movies News Headlines – Yahoo! News

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Opinion: Seeing Things? Hearing Things? Many of Us Do

HALLUCINATIONS are very startling and frightening: you suddenly see, or hear or smell something — something that is not there. Your immediate, bewildered feeling is, what is going on? Where is this coming from? The hallucination is convincingly real, produced by the same neural pathways as actual perception, and yet no one else seems to see it. And then you are forced to the conclusion that something — something unprecedented — is happening in your own brain or mind. Are you going insane, getting dementia, having a stroke?

In other cultures, hallucinations have been regarded as gifts from the gods or the Muses, but in modern times they seem to carry an ominous significance in the public (and also the medical) mind, as portents of severe mental or neurological disorders. Having hallucinations is a fearful secret for many people — millions of people — never to be mentioned, hardly to be acknowledged to oneself, and yet far from uncommon. The vast majority are benign — and, indeed, in many circumstances, perfectly normal. Most of us have experienced them from time to time, during a fever or with the sensory monotony of a desert or empty road, or sometimes, seemingly, out of the blue.

Many of us, as we lie in bed with closed eyes, awaiting sleep, have so-called hypnagogic hallucinations — geometric patterns, or faces, sometimes landscapes. Such patterns or scenes may be almost too faint to notice, or they may be very elaborate, brilliantly colored and rapidly changing — people used to compare them to slide shows.

At the other end of sleep are hypnopompic hallucinations, seen with open eyes, upon first waking. These may be ordinary (an intensification of color perhaps, or someone calling your name) or terrifying (especially if combined with sleep paralysis) — a vast spider, a pterodactyl above the bed, poised to strike.

Hallucinations (of sight, sound, smell or other sensations) can be associated with migraine or seizures, with fever or delirium. In chronic disease hospitals, nursing homes, and I.C.U.’s, hallucinations are often a result of too many medications and interactions between them, compounded by illness, anxiety and unfamiliar surroundings.

But hallucinations can have a positive and comforting role, too — this is especially true with bereavement hallucinations, seeing the face or hearing the voice of one’s deceased spouse, siblings, parents or child — and may play an important part in the mourning process. Such bereavement hallucinations frequently occur in the first year or two of bereavement, when they are most “needed.”

Working in old-age homes for many years, I have been struck by how many elderly people with impaired hearing are prone to auditory and, even more commonly, musical hallucinations — involuntary music in their minds that seems so real that at first they may think it is a neighbor’s stereo.

People with impaired sight, similarly, may start to have strange, visual hallucinations, sometimes just of patterns but often more elaborate visions of complex scenes or ranks of people in exotic dress. Perhaps 20 percent of those losing their vision or hearing may have such hallucinations.

I was called in to see one patient, Rosalie, a blind lady in her 90s, when she started to have visual hallucinations; the staff psychiatrist was also summoned. Rosalie was concerned that she might be having a stroke or getting Alzheimer’s or reacting to some medication. But I was able to reassure her that nothing was amiss neurologically. I explained to her that if the visual parts of the brain are deprived of actual input, they are hungry for stimulation and may concoct images of their own. Rosalie was greatly relieved by this, and delighted to know that there was even a name for her condition: Charles Bonnet syndrome. “Tell the nurses,” she said, drawing herself up in her chair, “that I have Charles Bonnet syndrome!”

Rosalie asked me how many people had C.B.S., and I told her hundreds of thousands, perhaps, in the United States alone. I told her that many people were afraid to mention their hallucinations. I described a recent study of elderly blind patients in the Netherlands which found that only a quarter of people with C.B.S. mentioned it to their doctors — the others were too afraid or too ashamed. It is only when physicians gently inquire (often avoiding the word “hallucination”) that people feel free to admit seeing things that are not there — despite their blindness.

Rosalie was indignant at this, and said, “You must write about it — tell my story!” I do tell her story, at length, in my book on hallucinations, along with the stories of many others. Most of these people have been reluctant to admit to their hallucinations. Often, when they do, they are misdiagnosed or undiagnosed — told that it’s nothing, or that their condition has no explanation.

Misdiagnosis is especially common if people admit to “hearing voices.” In a famous 1973 study by the Stanford psychologist David Rosenhan, eight “pseudopatients” presented themselves at various hospitals across the country, saying that they “heard voices.” All behaved normally otherwise, but were nonetheless determined to be (and treated as) schizophrenic (apart from one, who was given the diagnosis of “manic-depressive psychosis”). In this and follow-up studies, Professor Rosenhan demonstrated convincingly that auditory hallucinations and schizophrenia were synonymous in the medical mind.

WHILE many people with schizophrenia do hear voices at certain times in their lives, the inverse is not true: most people who hear voices (as much as 10 percent of the population) are not mentally ill. For them, hearing voices is a normal mode of experience.

My patients tell me about their hallucinations because I am open to hearing about them, because they know me and trust that I can usually run down the cause of their hallucinations. For the most part, these experiences are unthreatening and, once accommodated, even mildly diverting.

David Stewart, a Charles Bonnet syndrome patient with whom I corresponded, writes of his hallucinations as being “altogether friendly,” and imagines his eyes saying: “Sorry to have let you down. We recognize that blindness is no fun, so we’ve organized this small syndrome, a sort of coda to your sighted life. It’s not much, but it’s the best we can manage.”

Mr. Stewart has been able to take his hallucinations in good humor, since he knows they are not a sign of mental decline or madness. For too many patients, though, the shame, the secrecy, the stigma, persists.

Oliver Sacks is a professor of neurology at the N.Y.U. School of Medicine and the author, most recently, of the forthcoming book “Hallucinations.”

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Google Casts a Big Shadow on Smaller Web Sites

Annie Tritt for The New York Times

Jeffrey G. Katz, the chief executive of Wize Commerce, seen with employees. He says that about 60 percent of the traffic for the company’s Nextag comparison-shopping site comes from Google.

In a geeky fire drill, engineers and outside consultants at Nextag scrambled to see if the problem was its own fault. Maybe some inadvertent change had prompted Google’s algorithm to demote Nextag when a person typed in shopping-related search terms like “kitchen table” or “lawn mower.”

But no, the engineers determined. And traffic from Google’s search engine continued to decline, by half.

Nextag’s response? It doubled its spending on Google paid search advertising in the last five months.

The move was costly but necessary to retain shoppers, Mr. Katz says, because an estimated 60 percent of Nextag’s traffic comes from Google, both from free search and paid search ads, which are ads that are related to search results and appear next to them. “We had to do it,” says Mr. Katz, chief executive of Wize Commerce, owner of Nextag. “We’re living in Google’s world.”

Regulators in the United States and Europe are conducting sweeping inquiries of Google, the dominant Internet search and advertising company. Google rose by technological innovation and business acumen; in the United States, it has 67 percent of the search market and collects 75 percent of search ad dollars. Being big is no crime, but if a powerful company uses market muscle to stifle competition, that is an antitrust violation.

So the government is focusing on life in Google’s world for the sprawling economic ecosystem of Web sites that depend on their ranking in search results. What is it like to live this way, in a giant’s shadow? The experience of its inhabitants is nuanced and complex, a blend of admiration and fear.

The relationship between Google and Web sites, publishers and advertisers often seems lopsided, if not unfair. Yet Google has also provided and nurtured a landscape of opportunity. Its ecosystem generates $80 billion a year in revenue for 1.8 million businesses, Web sites and nonprofit organizations in the United States alone, it estimates.

The government’s scrutiny of Google is the most exhaustive investigation of a major corporation since the pursuit of Microsoft in the late 1990s.

The staff of the Federal Trade Commission has recommended preparing an antitrust suit against Google, according to people briefed on the inquiry, who spoke on the condition they not be identified. But the commissioners must vote to proceed. Even if they do, the government and Google could settle.

Google has drawn the attention of antitrust officials as it has moved aggressively beyond its dominant product — search and search advertising — into fields like online commerce and local reviews. The antitrust issue is whether Google uses its search engine to favor its offerings like Google Shopping and Google Plus Local over rivals.

For policy makers, Google is a tough call.

“What to do with an attractive monopolist, like Google, is a really challenging issue for antitrust,” says Tim Wu, a professor at Columbia Law School and a former senior adviser to the F.T.C. “The goal is to encourage them to stay in power by continuing to innovate instead of excluding competitors.”

SPEAKING at a Google Zeitgeist conference in Arizona last month, Larry Page, the company’s co-founder and chief executive, said he understood the government scrutiny of his company, given Google’s size and reach. “There’s very many decisions we make that really impact a lot of people,” he acknowledged.

The main reason is that Google is continually adjusting its search algorithm — the smart software that determines the relevance, ranking and presentation of search results, typically links to other Web sites.

Google says it makes the changes to improve its service, and has long maintained that its algorithm weeds out low-quality sites and shows the most useful results, whether or not they link to Google products.

“Our first and highest goal has to be to get the user the information they want as quickly and easily as possible,” says Matt Cutts, leader of the Web spam team at Google.

But Google’s algorithm is secret, and changes can leave Web sites scrambling.

Consider Vote-USA.org, a nonprofit group started in 2003. It provides online information for voters to avoid the frustration of arriving at a polling booth and barely recognizing half the names on the ballot. The site posts free sample ballots for federal, state and local elections with candidates’ pictures, biographies and views on issues.

In the 2004 and 2006 elections, users created tens of thousands of sample ballots. By 2008, traffic had fallen sharply, says Ron Kahlow, who runs Vote-USA.org, because “we dropped off the face of the map on Google.”

As founder of a search-engine optimization company and a recipient of grants that Google gives nonprofits to advertise free, Mr. Kahlow knows a thing or two about how to operate in Google’s world. He pored over Google’s guidelines for Web sites, made changes and e-mailed Google. Yet he received no response.

“I lost all donations to support the operation,” he said. “It was very, very painful.”

A breakthrough came through a personal connection. A friend of Mr. Kahlow knew Ed Black, chief executive of the Computer & Communications Industry Association, whose members include Google. Mr. Black made an inquiry on Mr. Kahlow’s behalf, and a Google engineer investigated.

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