Opinion: A Health Insurance Detective Story

I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?

After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?

The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.

Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.

But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?

A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.

Here’s a snapshot of my surreal experience:

NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.

Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”

I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.

NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.

NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.

My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.

NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.

Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.

But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.

NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.

CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.

NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.

Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.

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John McAfee Plays Hide-and-Seek in Belize

Photo Illustration by The New York Times

John McAfee, right, a pioneer in computer security who lives in Belize, is a “person of interest” in the murder of his neighbor. More Photos »

DANIEL GUERRERO promised during his campaign for mayor here to clean up San Pedro, the only town on this island, a 20-minute puddle jump from the mainland. But if he ever runs for re-election, don’t expect him to mention that vow.

“I meant clean up the trash, the traffic, that sort of thing,” he says. “I didn’t mean this.”

“This” is a full-blown international media frenzy and the kind of mess that no politician could have seen coming. It started on Nov. 11, the morning that Gregory Faull, a 52-year-old American, was found dead, lying face up in a pool of blood in his home. He had been shot in the head. His laptop and iPhone were missing. A 9-millimeter shell was found nearby.

What happened next turned this from a local crime story to worldwide news: The police announced that a “person of interest” in the investigation was a neighbor, John McAfee, a Silicon Valley legend who years ago earned millions from the computer virus-fighting software company that still bears his name.

A priapic 67-year-old, with an improbable mop of blond-highlighted hair and a rotating group of young girlfriends, Mr. McAfee quickly melted into the island’s lush green forest. Then, for Belizean authorities, the real embarrassment began.

Asserting his innocence, Mr. McAfee became a multiplatform cyberdissident, with a Twitter account, and a blog at whoismcafee.com with audio links, a comments section, photographs and a stream of invective against the government and the police of Belize. He has done interviews on podcasts, like the “Joe Rogan Experience,” and offered a $25,000 reward for information leading to the arrest of “the person or persons” who killed Mr. Faull. He has turned lamming it into a kind of high-tech performance art.

“I am asking all people of conscience to read this blog, especially the links in the ‘Background’ section,’ and see the ugly truth unfolding here,” he posted on Nov. 18. “Speak out. Write your congressmen. Write the prime minister. Do what you can.”

Before he went underground, Mr. McAfee led a noisy, opulent and increasingly stressful life here. He was known for the retinue of prostitutes who he says moved in and out of his house, and for employing armed guards, some of whom stood watch on the beach abutting his house. He also kept a pack of untethered dogs on his property who barked at and sometimes bit passers-by.

Two days before the murder, someone had poisoned a handful of those dogs. As it happens, Mr. Faull had complained about the animals, as well as the guards and the constant late-night inflow and outflow of taxis on the dirt path that runs behind his and Mr. McAfee’s homes — a path so tiny that it’s supposed to be off-limits to cars.

Mr. Faull had shown up at the town council office a few weeks ago with a letter decrying the din and the dogs, as well as Mr. McAfee’s guns and behavior. Nothing came of it.

“We were planning to meet with John McAfee and hand him the letter,” Mr. Guerrero said. “But it never happened. We were busy doing other work.”

In hindsight, that looks like a blunder. Mr. McAfee has since said on his blog that he had no choice but to flee because police and politicians in Belize are corrupt and eager to kill him. As proof, he has written at length about a late April raid that the country’s Gang Suppression Unit conducted at a property of his on the mainland, in a district called Orange Walk.

Some McAfee watchers have a different theory — namely, that he grew paranoid and perhaps psychotic after months of experimenting with and consuming MDPV, a psychoactive drug. These experiments were described in detail by Mr. McAfee himself, under the pseudonym “Stuffmonger” in a forum on Bluelight, a Web site popular with drug hobbyists.

So, here’s one hypothesis: Rich man doses himself to madness while seeking sexual bliss through pharmacology. Then shoots neighbor in a rage. Case closed, right? Ah, but those Bluelight posts were a ruse, Mr. McAfee would later blog, just one of the many pranks he has perpetrated over the years — part of a bet with a friend to see if he could create Bluelight’s largest-ever thread.

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Economic Frustration Simmers Again in Tunisia

Moises Saman for The New York Times

People in Tunis and across the country are struggling with high unemployment and inflation.

TUNIS — Tahar Bayahi, who runs Tunisia’s largest grocery store chain, spent the days right after the revolution toting up his losses: one-quarter of his 60 stores nationwide incinerated and another quarter pillaged.

Yet his company, Magasins Général, turned right around to rebuild, pouring $40 million and nine months into the effort. “It’s true that we were badly affected, but it opened up a far larger horizon,” Mr. Bayahi said over lunch on a sunny lakeside terrace. “What was important was that the change would bring us to a new epoch much faster.”

Nearly two years after riots that began over economic frustration and unemployment toppled the Tunisian government and started the Arab Spring, the frustration that people here are not better off is starting to overflow again. The gross domestic product is down, unemployment is up, debt and inflation are growing and social unrest simmering.

Last week, the government sent troops into Siliana, south of the capital, after four days of violent protests, mainly over demands for jobs and more government investment, turned violent. Thousands participated and hundreds were injured in clashes with the police.

President Moncef Marzouki, acknowledging Friday on television that the government had not “met the expectations of the people,” expressed concern that unrest could spread to other towns in the underdeveloped interior.

“Tunisia today is at a crossroads,” he said. “Tunisia today has an opportunity that it must not miss to be a model because the world is watching us, and we mustn’t disappoint.”

Unemployment remains the biggest economic problem and catalyst for unrest. A vicious circle imperils all the Arab nations with unfinished revolutions: political unrest scares off the investors needed to create jobs.

Since President Zine el-Abidine Ben Ali was ousted in January 2011, the unemployment rate has risen to 18 percent from 13 percent, meaning about 1.8 million people are out of work.

More troubling, a third of the unemployed are college graduates, according to Said Aidi, minister of the economy for much of 2011. By 2015, an estimated 100,000 new graduates will seek jobs annually, while even before the revolution at most 20,000 graduates a year found work matching their degrees.

“Ben Ali ignored the blinking red lights on the economy, and that is what got him thrown out,” said Karim Ben Smail, the owner of a modest publishing company. “The unemployed are an army in a country the size of Tunisia.”

The numbers are not all bad, however. The economy contracted by 1.8 percent in 2011, beset by problems like a 30 percent drop in the number of tourists, according to the World Bank. It predicts 2.2 percent growth this year, however, and a close-to-normal 4.6 percent by 2014 should conditions stabilize.

But a new constitution has yet to be written, and elections have been postponed until at least next June. Periodic riots — especially the sacking of the United States Embassy in September in response to a video made in the United States mocking the Prophet Muhammad — have left investors sitting on their wallets and kept tourists at home. A State Department travel advisory warned Americans against visiting Tunisia.

Bracing for further unrest, Magasins Général rebuilt its stores with shatterproof glass, heavy metal shutters and 20-foot walls topped by barbed wire.

Before the revolution, the company felt disadvantaged because its closest competitors, franchises of the giant French retailers Carrefour and Monoprix, enjoyed closer ties to the ruling family, Mr. Bayahi said. Both opened superstores while his applications languished.

After the revolution, he expected permits to sail through, particularly since his two proposed superstores meant more than 1,400 jobs. Instead, officials tell him “it is being studied,” just like before the revolution, he said.

While Mr. Bayahi blamed a combination of government incompetence and foot dragging for the delay, economic experts cited an additional reason. Small neighborhood shops potentially hurt by big chains extend credit to poor customers, helping to maintain social peace.

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The Kids Are All Right: How Social Media Created a Generation of Activists

This week marked the nation’s inaugural  “Giving Tuesday,” a UN sponsored initiative, which utilized social media to encourage businesses, schools, and community members to give back. The effort resulted in $ 10 million worth of donations made in a single day, a 53 percent increase over the same day last year.

Conceived as a means to promote activism and charity, the campaign’s use of social media to spread its message is most likely a large part of the initiative’s success. 

Certainly people from every age group use Twitter and Facebook, but social media activism is especially resonant with young adults. According to TBWA, people between the ages of 18-29 strongly identify as activists and count social media as their first point of engagement when they learn about a new cause.

MORE: ‘Tis Always the Season to Give: Creating a Corporate Culture That Gives Back

In fact, about half believe that activism is important to their personal identity and about a third look to it as a means of socializing and relating to one another.

But more than identifying with activism, this younger generation’s aptitude for social media can effect real change. Look at the Susan G. Komen Foundation. Earlier this year, when the organization announced it would pull its funding for breast cancer screenings from Planned Parenthood, cutting off medical access for millions of women, Twitter and Facebook lit up with vitriolic statements, claiming the organization had become a puppet of the religious right. The ensuing bad press proved to be too much and within days, the organization reversed its decision and issued a public apology.

Similarly, when Florida law enforcement officials refused to arrest George Zimmerman after he fatally shot Trayvon Martin, the case lay dormant for almost a month. But an online petition started by Martin’s parents went viral and galvanized a nation demanding justice for the boy’s death. Zimmerman was arrested and charged as a result.

For all we hear about “kids these days” and their irresponsible use of social media−posting questionable pictures of themselves doing kegstands or letting Twitter corrode their ability to hold a thought for more than a nanosecond−it turns out that most are using it to express a genuine passion for changing the world around them. And they’re succeeding.

And these trends extend well beyond the U.S. That same age group in other countries shows similar interests in contributing to larger causes. China’s young adults for instance, lead the world in online political discussions and offline they donate the most money to charities. India’s younger generation ranks the first in the world when it comes to staying informed, and they’re the most optimistic about the impact their activism has on the world around them.

It seems that our youngest generation of adults are the ones leading the charge when it comes to effectively making a difference.

Do you consider yourself an activist? Let us know in the Comments what social causes inspire you to get involved.

Related Stories on TakePart:

• Secret Santas: Profiles in Anonymous Holiday Generosity

• Rwanda Genocide Survivor Wins Grant for Giving Back

• 40 U.S. Billionaires Pledge Half of Fortunes to Charity

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A Bay Area native, Andri Antoniades previously worked as a fashion industry journalist and medical writer.  In addition to reporting the weekend news on TakePart, she volunteers as a webeditor for locally-based nonprofits and works as a freelance feature writer for TimeOutLA.com. Email Andri | @andritweets | TakePart.com

Social Media News Headlines – Yahoo! News

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KC police: Chiefs player involved in shootings

KANSAS CITY, Mo. (AP) — A 25-year-old Kansas City Chiefs player shot his girlfriend early Saturday, then drove to Arrowhead Stadium and turned the gun on himself as two team officials were confronting him, police said.

Kansas City police Supervisor Andrea Khan would not release the name of the player involved and the condition of the two parties was not immediately known.

Police spokesman Darin Snapp said authorities received a call Saturday morning from a woman who said her daughter had been shot multiple times at a residence about five miles away from the Arrowhead complex. Snapp said a call was then received from the Chiefs' practice facility.

Upon arriving, Snapp said that police witnessed a black male in a car with a handgun to his head talking to two Chiefs officials. That's when police heard a gunshot.

Arrowhead Stadium has been lockdown since about 8 a.m.

"We can confirm that there was an incident at Arrowhead earlier this morning," the Chiefs said in a statement. "We are cooperating with authorities in their investigation."

The season has been a massive disappointment for the Chiefs, who were expected to contend for the AFC West title.

But they're just 1-10 and mired in an eight-game losing streak that has been marked by devastating injuries and fan upheaval, with constant calls the past few weeks for general manager Scott Pioli and coach Romeo Crennel to be fired.

Kansas City is scheduled to host the Carolina Panthers on Sunday.

The Chiefs have been ravaged by injuries, led the league in turnovers, can't settle on a quarterback and are dealing with a full-fledged fan rebellion. The Twitter account for a fan group known as "Save Our Chiefs" recently surpassed 80,000 followers, about 17,000 more than the announced crowd at a recent game.

Things have been so bad this season that Crennel fired himself as defensive coordinator.

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

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Media Decoder Blog: Robert Thomson to Be Chief of News Corporation's New Publishing Company

Robert Thomson, the top editor at The Wall Street Journal and Dow Jones and a confidante of News Corporation’s chairman and chief executive, Rupert Murdoch, is expected to be named chief executive of the media conglomerate’s newly spun-off publishing company.

Mr. Thomson will run the separate, publicly traded company, which will include The Journal, The New York Post, HarperCollins and a suite of lucrative television assets in Australia. The announcement is expected as early as Monday, according to a person briefed on the company’s decision-making.

Mr. Thomson took over at The Journal in 2008, soon after News Corporation completed its $5.6 billion acquisition of Dow Jones. He serves as managing editor of The Journal and editor in chief of Dow Jones, which also publishes Barron’s and the Dow Jones Newswires.

Gerard Baker, a deputy managing editor at the Journal, will take over for Mr. Thomson at The Journal, said the person briefed on the decisions, who could not discuss private conversations publicly.

At The Journal, Mr. Baker has overseen Washington and political coverage, among other topics. He previously wrote a neoconservative column for The Times of London, also owned by News Corporation, and served as Washington bureau chief at The Financial Times, where Mr. Thomson was the top editor of the United States edition.

Mr. Thomson began his career at News Corporation in 1979 as a reporter at The Herald in Melbourne, Australia. He and Mr. Murdoch are both Australian, and have taken family vacations together. Mr. Murdoch is often seen in Mr. Thomson’s office in the Journal newsroom.

In his tenure at The Journal, Mr. Thomson increased circulation by broadening the newspaper’s focus beyond business to include more general-interest and lifestyle news. He oversaw an expansion of the newsroom budget, added photographs to go along with the paper’s signature dot drawings and introduced a local New York section.

Mr. Murdoch will serve as chairman of the publishing company and remain chief executive of the entertainment company, which will include News Corporation’s movie studio, Fox Broadcasting and cable channels like FX and Fox News.

News Corporation plans to complete its split, which was announced in June, in mid-2013. Additional announcements about the publishing company’s board and cash structure are expected before the end of the year.

A News Corporation spokeswoman declined to comment on the expected appointments, which were first reported in The Journal.

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Israel Moves to Expand Settlements in East Jerusalem

Rina Castelnuovo for The New York Times

From his home in East Jerusalem last year, Haj Ibrahim Ahmad Hawa looked at the separation barrier surrounding Jerusalem with the Israeli settlement of Maale Adumim in the background. More Photos »

JERUSALEM — As the United Nations General Assembly voted overwhelmingly to upgrade the Palestinians’ status Thursday night, Israel took steps toward building housing in a controversial area of East Jerusalem known as E1, where Jewish settlements have long been seen as the death knell for a two-state solution to the Israeli-Palestinian conflict.

A senior Israeli official, speaking on the condition of anonymity, said on Friday that the decision was made late Thursday night to move forward on “preliminary zoning and planning preparations” for housing units in E1, which would connect the large settlement of Maale Adumim to Jerusalem and therefore make it impossible to connect the Palestinian cities of Ramallah and Bethlehem to Palestinian neighborhoods of East Jerusalem. Israel also authorized the construction of 3,000 housing units in other parts of East Jerusalem and the West Bank, the official said.

The prime minister’s office refused to comment on whether the settlement expansion — first reported on Twitter by a reporter for the Israeli daily Haaretz — was punishment for the Palestinians’ success in upgrading its status from nonmember observer entity to nonmember observer state at the United Nations, but it was widely seen as such. The United States, one of only eight countries that stood with Israel in voting against the Palestinians’ upgrade, has for two decades vigorously opposed construction in E1, a 3,000-acre expanse of hilly parkland where a police station was opened in 2008.

In Washington, a State Department official criticized the move. “We reiterate our longstanding opposition to settlements and East Jerusalem construction,” he said. “We believe it is counterproductive and makes it harder to resume direct negotiations and achieve a two-state outcome.”

Hagit Ofran, who runs the Settlement Watch project of Peace Now, called E1 a “deal breaker for the two-state solution” and denounced the decision as “disastrous.”

“Instead of punishing the Palestinians, they are actually punishing Israel,” Ms. Ofran, who is Israeli, said in an interview. “Instead of taking advantage of this bid in the U.N. and calling for negotiations to get to a two-state solution, this government is choosing to take actions that might prevent the possibility of a two-state solution.”

But Dani Dayan, leader of Israel’s settler movement, welcomed the news, saying it was “a very important Israeli interest to develop E1.”

He described the two-state solution as “an existential threat to Israel” and said the E1 development was “beneficial for peace because a two-state solution is a prologue for another bloody confrontation.”

“The fear to develop the communities is not rational,” Mr. Dayan said. “The opposition to the settlements has become a kind of religious dogma for the West.”

Even Mr. Dayan, however, said he did not like the idea of expanding settlements “as a sort of retaliatory or punitive step.”

“Under the circumstances that we understand the government operates, I think it’s O.K.,” Mr. Dayan added. “We have a legal and a political and a moral right to build. It’s strategic for Jerusalem; to strengthen Jerusalem is the only horizon. We don’t see it as an obstacle to peace.”

Michael R. Gordon contributed reporting from Washington.

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Saints' Vilma, Smith attend Williams hearing

WASHINGTON (AP) — Right from the start, the NFL said Gregg Williams was in charge of a pay-for-pain bounty system with the New Orleans Saints.

The former defensive coordinator — who told the league about others' involvement — was being cross-examined Friday by lawyers for players appealing their suspensions in the case.

And two of those players, Saints linebacker Jonathan Vilma and defensive lineman Will Smith, attended Williams' session.

"We all know why we're here today," Vilma said Friday on his way into the hearing.

The hearing is part of the latest round of player appeals overseen by former NFL Commissioner Paul Tagliabue. Former Saints assistant coach Mike Cerullo faced questions Thursday, when lawyers for the league and for players spent more than nine hours in a Washington office building.

Tagliabue and various lawyers declined to comment Thursday or Friday.

Vilma and Smith traveled to Washington after playing in New Orleans' 23-13 loss at Atlanta on Thursday night.

Neither player was required to attend Friday, but Smith said this week that "part of the things that we wanted all along was to face our accusers."

Vilma and Smith — along with two former Saints, free-agent defensive lineman Anthony Hargrove and Cleveland Browns linebacker Scott Fujita — were suspended by the NFL for the Saints' cash-for-hits program that the league says Williams ran from 2009 to 2011.

Smith, suspended four games, and Vilma, suspended for the entire current season, have been playing while their appeals are pending.

The NFL has described Vilma and Smith as ringleaders of a performance pool designed to knock targeted opponents out of games. The league has sworn statements from Williams and Cerullo saying Vilma offered $10,000 to anyone who knocked quarterback Brett Favre out of the NFC championship game at the end of the 2009 season.

NFL Commissioner Roger Goodell issued the initial suspensions, which also included a full-season ban for Saints head coach Sean Payton.

Lawsuits brought by Vilma and the NFL Players Association to challenge Goodell's handling of the case, including his decision in October to appoint Tagliabue as the arbitrator for the appeals, are pending in federal court in New Orleans.

On Thursday, U.S. District Judge Ginger Berrigan gave the parties until Monday to answer questions about whether the NFL's collective bargaining agreement prevents a commissioner from handing out discipline for legal contact, and whether the CBA's passages about detrimental conduct are "ambiguous, hence unenforceable."

In March, the NFL announced that its investigation showed the Saints put together a bounty pool of up to $50,000 to reward game-ending injuries inflicted on opponents. "Knockouts" were worth $1,500 and "cart-offs" $1,000 — with payments doubled or tripled for the playoffs, the league said.

According to the league, the pay-for-pain program was administered by Williams, with Payton's knowledge. At the time, Williams apologized for his role, saying: "It was a terrible mistake, and we knew it was wrong while we were doing it."

Later that month, Payton became the first head coach suspended by the league for any reason — banned for all of this season without pay — and Williams was suspended indefinitely.

Williams was known for his aggressive, physical defenses as a coordinator for Tennessee, Washington, Jacksonville and New Orleans, and during his time as head coach of Buffalo. In January, he was hired by St. Louis to lead their defense.

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Connect with Howard Fendrich on Twitter at http://twitter.com/HowardFendrich

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

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Hockey Coaches Defy Doctors on Concussions, Study Finds

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which will be published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The teams were not named in the study, in which an independent specialist physician was present at each game and was empowered to pull any player off the ice for examination if a potential concussion was observed.

The men’s team, with 25 players and an average age of 22, played a 28-game regular season and a 3-game postseason. The women’s team, with 20 players and an average age of 20, played 24 regular-season games and no playoff games. Over the course of the season, there were five observed or self-reported concussions on the men’s team and six on the women’s team.

Researchers noted several instances of coaches, trainers and players avoiding examinations, ignoring medical advice or otherwise obstructing the study, even though the players had signed consent forms to participate and university ethics officials had given institutional consent.

“Unless something is broken, I want them out playing,” one coach said, according to the study.

In one incident, a neurologist observing the men’s team pulled a defenseman during the first period of a game after the player took two hits and was skating slowly. During the intermission the player reported dizziness and was advised to sit out, but the coach suggested he play the second period and “skate it off.” The defenseman stumbled through the rest of the game.

“At the end of the third period, I spoke with the player and the trainer and said that he should not play until he was formally evaluated and underwent the formal return-to-play protocol,” the neurologist said, as reported in the study. “I was dismayed to see that he played the next evening.”

After the team returned from its trip, the neurologist questioned the trainer about overruling his advice and placing the defenseman at risk.

“The trainer responded that he and the player did not understand the decision and that most of the team did not trust the neurologist,” according to the study. “He requested that the physician no longer be used to cover any more games.”

In another episode, a physician observer assessed a minor concussion in a female player and recommended that she miss the next night’s game. Even though the coach’s own playing career had ended because of concussions, she overrode the medical advice and inserted the player the next evening.

According to the report, the coach refused to speak to another physician observer on the second evening. The trainer was reluctant to press the issue with the coach because, the trainer said, the coach did not want the study to interfere with the team.

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Senate Judiciary Committee Approves Overhaul of Electronic Communications Privacy Act

J. Scott Applewhite/Associated Press

Patrick Leahy, chairman of the Senate Judiciary Committee, is leading an e-mail privacy effort.

The bill is not expected to make it through Congress this year and will be the subject of negotiations next year with the Republican-led House. But the Senate panel’s approval was a first step toward an overhaul of a 1986 law that governs e-mail access and that is widely seen as outdated.

Senator Patrick Leahy, the Vermont Democrat who is chairman of the committee, was an architect of the 1986 law and is leading the effort to remake it. He said at the meeting on Thursday that e-mails stored by third parties should receive the same protection as papers stored in a filing cabinet in an individual’s house.

“Like many Americans, I am concerned about the growing and unwelcome intrusions into our private lives in cyberspace,” Mr. Leahy said. “I also understand that we must update our digital privacy laws to keep pace with the rapid advances in technology.”

Mr. Leahy held a hearing about two years ago on whether and how to update the 1986 law, called the Electronic Communications Privacy Act. But the effort has moved slowly, in part because some law enforcement officials have opposed restricting an investigative tool now used increasingly.

Under the law, authorities need to obtain a search warrant from a judge — requiring them to meet the high standard of showing that there is probable cause to believe that a subject is engaged in wrongdoing — only when they want to read e-mails that have not yet been opened by their recipient and that are fewer than 180 days old.

But the law gives less protection to messages that a recipient has read and left in his or her account. In some cases, officials may obtain a court order for such material merely by presenting a judge with facts suggesting the messages are relevant to an investigation; in other cases, prosecutors can issue a subpoena demanding the materials without any court involvement.

Senator Leahy’s bill would generally require prosecutors to obtain a search warrant from a judge, under the stricter probable-cause standard, to compel a provider to turn over all categories of e-mails and other private documents.

The Center for Democracy and Technology, a nonprofit organization that advocates for electronic privacy rights, hailed the committee vote as “historic.”

In a statement, Gregory T. Nojeim, director of the center’s program on security and technology, said it “sets the stage for updating the law to reflect the reality of how people use technology in their daily lives. It keeps the government from turning cloud providers into a one-stop convenience store for government investigators and requires government investigators to do for online communications what they already do in the offline world: get a warrant before reading postal letters or searching our homes.“

Still, the ranking Republican on the committee, Senator Charles Grassley of Iowa, argued that the bill does not strike the proper balance between privacy and public safety. He expressed concerns that changing the standard of proof for obtaining e-mails would inhibit certain investigations, such as child pornography or child abduction cases.

Mr. Leahy argued that the bill does not alter criminal and antiterrorism laws related to search warrants, including exceptions in emergencies where time is of the essence. But he also said the bill was a starting point and he was open to further negotiations. The panel approved it by a voice vote.

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