IOC President Rogge to meet with wrestling leader

LAUSANNE, Switzerland (AP) — IOC President Jacques Rogge will meet with the head of wrestling's governing body to discuss ways the sport can fight to save its place in the 2020 Olympics.

The IOC executive board removed wrestling from the program of the 2020 Games on Tuesday, cutting it from the list of 26 sports at last year's London Olympics.

The decision, which still must be ratified by the full IOC in September, has been widely criticized by wrestling organizations around the world.

Rogge said Wednesday he's been contacted by Raphael Martinetti, the president of international wrestling federation FILA, and was encouraged by the sport's determination to remain in the games.

"We agreed we would meet at the first opportunity to have discussions," Rogge said at a news conference at the close of a two-day board meeting. "I should say FILA reacted well to this disheartening news for them.

"They vowed to adapt the sport and vowed to fight to be eventually included in the 2020 slot."

Wrestling, which remains on the program for the 2016 Olympics in Rio de Janeiro, still has a chance to stay on the list for 2020 — if it manages to convince the IOC to reverse the board's decision.

Wrestling now joins seven other sports in applying for one opening on the 2020 program: a combined bid from baseball and softball, karate, squash, roller sports, sport climbing, wakeboarding and the martial art of wushu.

The IOC executive board will meet in May in St. Petersburg, Russia, to decide which sport or sports to propose for 2020 inclusion. The final vote will be made at the IOC general assembly in September in Buenos Aires, Argentina.

IOC officials said it's possible the board could decide to put forward three sports for consideration, including wrestling.

"The vote of yesterday is not an elimination of wrestling from the Olympic Games," Rogge said. "Wrestling will participate in the games in Rio de Janeiro. To the athletes who train now, I say, 'Continue training for your participation in Rio. Your federation is working for the inclusion in the 2020 Games.'"

Rogge was asked whether Tuesday's decision marked an end to wrestling in the Olympics.

"I cannot look into a crystal ball into the future," he said. "We have established a fair process by which the sport that would not be included in the core has a chance to compete with the seven other sports for the slot on the 2020 Games."

Rogge said he was fully aware of the backlash to the decision against wrestling, a sport which dates back to the ancient Olympics and featured in the inaugural modern games in 1896.

The head of the Russian Olympic Committee said Wednesday he would write to Rogge to appeal the IOC board's decision. Wrestling has been one of Russia's strongest sports: Soviet and Russian wrestlers have won 77 gold medals.

"We knew even before the decision was taken whatever sport would not be included in the core program would lead to criticism from the supporters of that sport," Rogge said.

The board voted after reviewing a report by the IOC program commission that analyzed 39 criteria, including TV ratings, ticket sales, anti-doping policy and global participation and popularity. With no official rankings or recommendations contained in the report, the final decision by the 15-member board may have included political and sentimental factors.

Modern pentathlon — a five-sport discipline dating back to the 1912 Games — had been widely expected to face removal from the program but lobbied successfully to save its status.

Juan Antonio Samaranch Jr., the son of the former IOC president, is a vice president of the International Modern Pentathlon Union and a member of the IOC board.

FILA said Tuesday it was "greatly astonished" by the decision, adding that the federation "will take all necessary measures to convince the IOC executive board and IOC members of the aberration of such decision against one of the founding sports of the ancient and modern Olympic Games."

The last sports removed from the Olympics were baseball and softball, voted out by the IOC in 2005 and off the program since the 2008 Beijing Games. Golf and rugby will be joining the program at the 2016 Games in Rio.

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

---

Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

---

This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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DealBook: Switzerland to Require Banks to Hold More Capital to Offset Mortgages

LONDON – Switzerland said on Wednesday that Swiss banks would be required to hold additional capital for residential mortgages amid concerns that the country’s booming property market was overheating.

The country, which already has more stringent capital rules for its banks than other European nations, said lenders would be required to hold an additional 1 percent of risk-weighted assets to make the financial system more stable in light of an “excessive rise in prices in the real estate market and exorbitant mortgage debt.” Banks have until Sept. 30 to comply.

Property values in Switzerland have been rising as investors spooked by the uncertainties of the economic crisis in the euro zone sought a more stable places for their money.

Greater demand for Swiss homes has pushed up prices at a time of low interest rates and led many buyers to take on larger mortgages. The Swiss central bank has been unable to cool the market by increasing borrowing rates because of an overvalued Swiss currency.

An index created by the Swiss bank UBS measuring the likelihood of a Swiss property bubble was “clearly in the risk zone,” the bank wrote in a note to investors this month.

In the final three months of 2012, house prices soared to six times the annual average Swiss household income compared with about four times in 2000, according to the bank. It called the ever-rising demand for properties not intended for personal use “remarkable.”

The government said it was following a recommendation by the Swiss National Bank to increase the capital buffers. “The sustained growth in mortgage debt and rise in real estate prices of residential properties has led to imbalances which pose a significant risk to the stability of the banking sector and to that of the economy,” the government said in a statement.

Mortgage debt has been growing faster than the economy, and mortgage volume in relation to income has reached “risky” levels, the government said, adding that residential property prices had risen more than what was justified by fundamental factors.

UBS and Credit Suisse, Switzerland’s biggest banks, both said this month that they were working on increasing their capital buffers and that the suggested increase would not change their plans.

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India Ink: Image of the Day: Feb. 12

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Wrestling body reacts to Olympic rejection

LAUSANNE, Switzerland (AP) — The governing body of wrestling says the IOC's move to drop the sport is an "aberration" against a founding event of the Olympics.

Known by its French initials FILA, the organization says it is "greatly astonished" by the IOC executive board decision.

FILA says it will take "all necessary measures" to convince IOC members to maintain wrestling's Olympic status when they meet in Buenos Aires, Argentina, in September.

Still, FILA President Raphael Martinetti faces criticism when his ruling board meets this weekend in Thailand.

Russian federation leader Mikhail Mamiashvili says FILA is the problem, and Martinetti's tasks include defending "wrestling's place before the IOC."

German official Jannis Zamanduridis says "a piece of the Olympic idea is dying with this decision."

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

---

Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

---

Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

---

This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

Read More..

DealBook: Barclays to Cut 3,700 Jobs in Overhaul

8:13 a.m. | Updated

LONDON – Barclays announced a major restructuring that will eliminate 3,700 jobs and close several business units, as the bank reported a big loss in the fourth quarter of 2012.

The overhaul of its operations comes after a series of scandals at the bank, including the manipulation of benchmark interest rates, which led to the resignation of the firm’s former chief executive, Robert E. Diamond Jr.

In a bid to reduce its exposure to risky trading activity, Barclays plans to close a number of operations in Europe and Asia, including a tax-planning unit that has been criticized for tarnishing the firm’s reputation.

“There will be no going back to the old way of doing things,” the chief executive, Antony P. Jenkins, told reporters at a news conference in London on Tuesday. “We will never be in a position again of rewarding people for activities inconsistent with our values.”

Despite the revamp of its operations and a new emphasis on values, the bank plans to retain the majority of its investment banking unit, particularly its operations in Britain and the United States. The division generated roughly 60 percent of the bank’s adjusted pretax profit in 2012.

Barclays will close four business divisions, while another 17 units will either be closed, sold or pared back in response to subdued market activity, Mr. Jenkins said. In total, the expected layoffs across the bank’s operations represent around 3 percent of the firm’s global work force.

The investment banking division is to be among the hardest hit, where about 1,800 employees are expected to be laid off. The job cuts will primarily fall on the bank’s Asian and European equities divisions, as well as its agricultural commodities trading operations. Almost 90 percent of the reductions already have been made, according to Christopher G. Lucas, the bank’s departing chief financial officer.

Mr. Jenkins refused to comment specifically on the position of Rich Ricci, the head of Barclays investment banking, whose name has surfaced in the inquiry into the bank’s role in the rate-rigging scandal.

“No one can predict the future, but I am confident in the team around me,” Mr. Jenkins said. “Who knows what could happen in a year’s time.”

The restructuring plan includes an additional 1,900 job cuts in the bank’s European retail and business banking unit, where Barclays plans to close roughly 30 percent of its Continental branch network.

The reductions have been focused in areas where Barclays does not compete globally with other international banks or where the firm could experience reputational damage like the recent rate-rigging scandal and the inappropriate sales of loan insurance to customers.

“Not much of this is surprising,” said Ian Gordon, a banking analyst at Investec in London. “They are not removing any of the material activities from the investment bank.”

The recent scandals that have engulfed the bank weighed down the firm’s fourth-quarter earnings.

Barclays posted a net loss of £835 million ($1.3 billion) in the last three months of 2012, compared with a profit of £356 million in the period a year earlier.
The results were hampered by the need to set aside additional capital to compensate costumers who were inappropriately sold loan insurance and for small businesses that were improperly sold complex interest-rate hedging products. Barclays also took a charge against the value of its own debt.

Excluding the adjustments, the bank’s pretax profit for the fourth quarter would have been £1.1 billion, almost double the amount in the period a year earlier.
For 2012, the bank reported an annual net loss of £1 billion, compared with a £3 billion profit for 2011. The annual loss resulted from provisions to cover legal costs related to the rate-rigging scandal and other improper activities.

The bank added that it would reduce annual costs by around 10 percent, to £16.8 billion, by 2015. Its share price rose almost 6 percent in afternoon trading in London on Tuesday.

Barclays said it had reduced bonuses across its operations by 16 percent for 2012, compared with the previous year. In its investment banking division, total bonuses fell 20 percent, with the average bonus in the unit standing at £54,100, a 17 percent reduction, according to a company statement.

The bank added that it had cut compensation awards because of risks facing several business units, including the rate-rigging scandal.

In a settlement with American and British authorities in June, Barclays agreed to pay fines totaling $450 million after some of its traders manipulated the London interbank offered rate, or Libor, for financial gain. Some of the firm’s managers also altered the rate to portray the bank in a healthier financial position than it actually was.

The investment banking division reported a pretax profit of £858 million in the fourth quarter, compared with a pretax profit of £267 million in the fourth quarter of 2011. Pretax profit at the bank’s retail and business banking unit rose 17 percent, to £732 million, while pretax profit in its corporate banking division almost tripled, to £107 million.

Mr. Jenkins acknowledged that some of the firm’s past actions had fallen short. He added that the investment banking division would remain at the heart of the firm’s future operations, though wrongdoing would not be tolerated.

“The old ways weren’t the right way to behave nor did they deliver the right results,” Mr. Jenkins said. “Individuals must take responsibility for their own behavior.”

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The Lede: Latest Updates on the Pope’s Resignation

The Lede is providing updates on Pope Benedict XVI’s announcement on Monday that he intends to resign on Feb. 28, less than eight years after he took office, the first pope to do so in six centuries. (Turn off auto-refresh to watch videos.)

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Eagles, QB Vick agree to restructured deal

PHILADELPHIA (AP) — Quarterback Michael Vick, who was slated to earn $16 million next season, has agreed to a restructured deal with the Philadelphia Eagles.

Vick, who was injured and inconsistent last season, eventually giving way to rookie Nick Foles, now has a three-year contract, and will compete with Foles to see who runs new coach Chip Kelly's offense this season.

Vick, who returned to start the season finale vs. the New York Giants in December because Foles was injured, finished the season with 2,362 yards passing, 12 touchdowns and 10 interceptions. The Eagles finished 4-12 and in last place in the NFC East.

Andy Reid was fired as coach the day after the season ended, and Kelly was hired last month. Vick, who will be 33 when next season begins, is still elusive when healthy, and seems equipped to run Kelly's aggressive, up-tempo offense that he is bringing to the Eagles from Oregon.

Either way, Kelly was noncommittal at his opening press conference on Jan. 17 on the quarterback situation.

"I'm going to look at everybody," he said. "If you can throw the ball and run, I'm going to take you out there. We're going to look at everything we can do to put the best product on the field and that's what it's all about. I've followed Michael's career and I understand what a talent he is. But there is nothing that's on the board right now, there's nothing that's off the board right now.

Vick was signed by Philadelphia in 2009, and became the starter in 2010. He led the Eagles that season to an NFC East title, and a memorable 38-31 December win over the Giants in which he rallied the team from a 21-point deficit.

"Our sole focus and goal is that we're going to put an offense on the field that's going to score points," Kelly said. "That's basically what we're going to do and whoever that is, I don't know that. There's nobody ruled in, there's nobody ruled out."

All told, Vick has started 35 games for Philadelphia over the last three seasons. Foles has started six. The Eagles scored just 280 points last season as they endured an eight- and a three-game losing streak. Only Arizona (250) scored fewer in the NFC.

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Well: Price for a New Hip? Many Hospitals Are Stumped

Jaime Rosenthal, a senior at Washington University in St. Louis, called more than 100 hospitals in every state last summer, seeking prices for a hip replacement for a 62-year-old grandmother who was uninsured but had the means to pay herself.

The quotes she received might surprise even hardened health care economists: only about half of the hospitals, including top-ranked orthopedic centers and community hospitals, could provide any sort of price estimate, despite repeated calls. Those that could gave quotes that varied by a factor of more than 10, from $11,100 to $125,798.

Ms. Rosenthal’s grandmother was fictitious, created for a summer research project on health care costs. But the findings, which form the basis of a paper released on Monday by JAMA Internal Medicine, are likely to fan the debate on the unsustainable growth of American health care costs and an opaque medical system in which prices are often hidden from consumers.

“Transparency is all the rage these days in government and business, but there has been little push for pricing transparency in health care, and there’s virtually no information,” said Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa, who wrote the paper with Ms. Rosenthal. He added: “I can get the price for a car, for a can of oil, for a gallon of milk. But health care? That’s not so easy.”

President Obama’s Affordable Care Act focused primarily on providing insurance to Americans who did not have it. But the high price of care remains an elephant in the room. Although many experts have said that Americans must become more discerning consumers to help rein in costs, the study illustrates how hard that can be.

“We’ve been trying to help patients get good value, but it is really hard to get price commitments from hospitals — we see this all the time,” said Jeff Rice, the chief executive of Healthcare Blue Book, a company that collects data on medical procedures, doctors visits and tests. “And even if they say $20,000, it often turns out $40,000 or 60,000.”

There are many caveats to the study. Most patients — or insurers — never pay the full sticker price of surgery, because insurance companies bargain with hospitals and doctors for discounted rates. When Ms. Rosenthal balked at initial high estimates, some hospitals produced lower rates for a person without insurance.

But in other ways the telephone quotations underestimated prices, because they did not include the fees for outpatient rehabilitation, for example.

In an accompanying commentary, Andrew Steinmetz and Ezekiel J. Emanuel of the University of Pennsylvania acknowledged that there was “no justification” for the inability to provide estimates or for the wide range of prices. But they said that more rigorous data on quality — like infection rates and unexpected deaths — were required to know when high prices were worth it.

“Without quality data to accompany price data, physicians, consumers and other health care decision makers have no idea if a lower price represents shoddy quality of if it constitutes good value,” they wrote.

But, broadly, researchers emphasized that studies had found little consistent correlation between higher prices and better quality in American health care. Dr. Cram said there was no data that “Mercedes” hip implants were better than cheaper options, for example.

Jamie Court, the president of the California-based Consumer Watchdog, said: “If one hospital can put in a hip for $12,000, then every hospital should be able to do it. When there’s 100 percent variation in sticker price, then there is no real price. It’s about profit.”

Dr. Cram said the study did contain some good news: some of the country’s top-ranked hospitals came up with “bargain basement prices” in response to repeated calls. “If you’re a good consumer and shop around, you can get a good price — you don’t have to pay $120,000 for a Honda,” he said.

But that shopping can be arduous in a market not set up to respond to consumers. To get a total price, Ms. Rosenthal often had to call the hospital to get its estimate for on-site care, and a separate quote from doctors. And many were simply perplexed when she asked for a price upfront, Ms. Rosenthal said, adding, “The people who answered didn’t know what to do with the question.”

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