, August 10, 2010, by Fran Lowry  —  A computerized provider order entry (CPOE) system that uses alerts to warn when the wrong medication has been prescribed can reduce the prescription of potentially inappropriate medications (PIMs) in hospitalized older patients, according to the results of a new prospective study published in the August 9/23 issue of the Archives of Internal Medicine.

“Older people admitted to the hospital are especially vulnerable to adverse drug events (ADEs), which occur in up to 40% of hospital admissions,” write Melissa L.P. Mattison, MD, from Beth Israel Deaconess Medical Center, Boston, Massachusetts, and colleagues. “Some medications may predispose vulnerable older patients to ADEs.” Based on the consensus of a panel of geriatric medicine experts, a proposed list was made up of drugs were identified as medications that should be avoided in older persons. Despite the publication of this list, known as “Beers medications,” “the prescription of [PIMs] to elderly patients remains common,” the authors explain.

The aim of this study was to determine whether a computerized provider order entry drug warning system could decrease the number of orders for PIMs in such a population.

The authors used a prospective before-and-after design among patients aged 65 years or older admitted to their medical center from June 1, 2004, through November 29, 2004 — before the addition of the warning system — and from March 17, 2005, through August 30, 2008 — after the warning system was added.

The investigators studied the ordering patterns for 3 groups of drugs: a larger group of drugs included those on the original Beers medications list that were flagged as not to be used, a second group of Beers medications that were flagged to be used at reduced doses, and a third group of Beers medications that were not flagged.

After the warning system was deployed, there was an immediate and sustained decrease in the rate of orders for the medications that were flagged not to be used, the authors report. The mean (SE) rate of prescribing not-recommended medications dropped from 11.56 (0.36) to 9.94 (0.12) orders per day (difference, 1.62 [SE, 0.33] orders per day; P < .001). There was no evidence that this effect waned over time, the authors write.

They also found a modest decrease in the use of unflagged medications, and no change in the rate of prescriptions of medications flagged to be used at reduced doses.

Before the start of the warning system, the most commonly prescribed inappropriate drug was diphenhydramine. This accounted for about one third of all prescriptions, the authors note.

“Both its use and the use of other targeted medications dropped markedly after implementation of the warning system, although we had insufficient power to examine other medications individually,” the authors write.

They also note other limitations in their data. One is the inability to determine the dose of lorazepam and ferrous sulfate — 2 drugs that were flagged to be prescribed at a reduced dose. As a result, it was not possible to know with certainty whether the targeted dose reductions were achieved with these drugs. In addition, the drug warning system was used at an academic center that uses medical trainees and physician extenders to order most medications. Therefore, whether similar results would be seen in centers where attending physicians place most of the orders or in institutions that do not use a CPOE system is unknown. Finally, the data do not show whether adverse drug events were prevented by the warning system, and whether the medications that were ordered were, in fact, clinically required.

The authors suggest that an important area of future study would be to improve understanding of scenarios in which it is clinically appropriate and reasonable to prescribe the medications on the Beers list, “even to older adults.”

They conclude that a CPOE system with specific, targeted, and straightforward warnings “can dramatically yet selectively reduce the prescriptions of PIMs in vulnerable hospitalized older patients,” and add that such systems “may represent a tool for improving the safety of hospitalized older adults.”

The study was supported by a grant from the Harvard Clinical and Translational Science Center, from the National Center for Research Resources The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:1331-1336.

The New York Times, August 10, 2010, by Denise Grady  —  Christian Volpe was shopping with his wife when an alarm started beeping to warn that only 15 minutes of battery power were left on the implanted heart pump that was keeping him alive.

Mr. Volpe, 67, a slight, gray-haired man, looked in his car for the bag he always keeps nearby with spare batteries. But, no bag. In his mind’s eye he saw exactly where he had left it, to make sure he would not forget it, on a chair near the door back home — an hour and a half away. He thought of the clever little hand pump he had been given to keep his mechanical heart going in an emergency. It, too, was in the missing bag. Standing in the parking lot, he could hear one thing. Beep. Beep. Beep.

“I have to admit, I panic,” he said.

Mr. Volpe is one of thousands of Americans who have had these pumps, called left ventricular assist devices, surgically implanted to help their failing hearts. Former Vice President Dick Cheney is another. Sometimes the pumps are used to keep people alive until a transplant becomes available, but in other cases they are meant to remain as long as the patient lives.

Mr. Volpe, a retired subway conductor who had had two heart attacks and two bypass operations, had an assist pump implanted in October 2009 by Dr. Yoshifumi Naka at NewYork-Presbyterian/Columbia hospital.

The pump is placed near the patient’s own heart. A power line emerges about waist level and connects to a controller, a mini-computer which plugs into a pair of one-and-a-half-pound, 12-volt batteries. Patients wear a black mesh vest over their clothing that holds the controller and batteries. The pump Mr. Volpe had, a HeartMate XVE, made by Thoratec, could run for about four hours on two batteries. The pumps cost $70,000 to $80,000, usually covered by insurance.

That day in the parking lot in December, in Fishkill, in upstate New York, Mr. Volpe was too far from Columbia to get there in time. But his wife phoned its heart-pump clinic, and nurse practitioners told her to call 911 for an ambulance to the nearest hospital.

Mr. Volpe knew that if the pump stopped, he was not likely to die immediately; his own heart, though weak, would probably keep him alive. But he was still in real danger, because clots would form in the mechanical heart if it quit, and cause a stroke if they escaped into his bloodstream.

Dr. Donna Mancini, Mr. Volpe’s cardiologist and director of the heart failure and transplant program at NewYork-Presbyterian/Columbia, said the hospital had not encountered a situation like this before.

“But with these devices getting more use, it may arise,” Dr. Mancini said.

Right now, Dr. Mancini said, Columbia has 45 patients with pumps who are waiting for transplants. Just a few years ago, there were only 10.

She said she did not know why, but this year fewer donor hearts have become available than in the past, leaving more patients dependent on the pumps. Usually, the hospital performs 80 to 100 transplants a year.

“This year we’re on a course that will probably yield around 60 transplants,” Dr. Mancini said, adding that there were about 150 patients on Columbia’s waiting list.

Nationwide, 3,138 people are waiting for heart transplants, according to the United Network for Organ Sharing. Last year, 2,211 received new hearts.

Thoratec said that in the past decade or so, a total of 6,000 XVE devices and 5,000 of a newer model, the HeartMate II (the one Mr. Cheney has) had been implanted.

An ambulance took Mr. Volpe to Vassar Brothers Medical Center in Poughkeepsie. But that hospital does not implant assist pumps, and had no batteries or hand pump. Doctors there, advised by Columbia, began dripping in a blood-thinning drug, heparin, to prevent clots.

Meanwhile, Khristine Orlanes, a nurse practitioner at Columbia, began trying to find another patient with an assist pump who was close enough to bring Mr. Volpe a set of batteries in time.

She called Robert Bump, 61, a building contractor who worked near Poughkeepsie. He had six spare batteries in a knapsack.

“I’m on my way,” Mr. Bump said.

An electrician offered to drive, and they tore off in his pickup truck. The electrician called a state trooper friend, told him the story and said, “We’re not stopping.”

A police car met them partway to Poughkeepsie and escorted them. They made the half-hour trip in about 20 minutes.

Mr. Bump strode into the emergency room and spotted Mr. Volpe on a gurney, surrounded by doctors, nurses and his frantic wife. The alarm was still beeping. A doctor, noticing Mr. Bump’s black-mesh vest and the controller, said, “Oh, he’s got one, too.”

Mr. Volpe, who had no idea what plans had been hatched on his behalf, said: “I see this big fellow walk in. I recognized the outfit right away.”

Mr. Bump snapped the batteries in place and said, “O.K., you’re good.”

There was a small round of applause in the emergency room. Mr. Volpe could not stop saying thank you.

His pump, due to run out in 15 minutes, had somehow lasted nearly an hour, but apparently had just minutes left when Mr. Bump arrived.

The two men had different pump models that happened to use the same batteries. If Mr. Bump had been using a newer version of the batteries for his model, they would not have been compatible with Mr. Volpe’s.

“Mr. Volpe’s stars were aligned that day,” Mr. Bump said. “There is some reason that gentleman needs to be here.”

On July 24, after nearly a year on his assist pump, Mr. Bump made it to the top of the waiting list and received a transplant at NewYork-Presbyterian/Columbia. At the hospital, his wife overheard the spouse of another transplant patient say that she, too, was from upstate.

Mr. Bump’s wife mentioned that her husband had helped another patient from the same area who needed batteries for an assist pump.

“That was my husband,” the other woman said.

By coincidence, Mr. Volpe had also just received a transplant.

Last week, the two were up and about, in good spirits. Both said they owed their lives to the assist pumps — but were thrilled to be free of them. Both were desperate for showers, after nearly a year of sponge baths. They would not miss the vests, either. On more than one occasion, Mr. Bump had had to reassure strangers that he was not wearing a bomb.

Leaving a sitting room at the hospital last Thursday, Mr. Bump rose first and offered Mr. Volpe a hand getting up.

“No thanks,” Mr. Volpe said softly, smiling. “You gave me enough help, Robert.”

Measuring-Tape Position for Waist (Abdominal) Circumference in Adults, August 10, 2010, by Laurie Barclay MD  —  Waist circumference (WC) is a risk factor for mortality in older adults, regardless of body mass index (BMI), according to the results of a large US cohort study reported in the August 9/23 issue of the Archives of Internal Medicine.

“[WC], a measure of abdominal obesity, is associated with higher mortality independent of [BMI],” write Eric J. Jacobs, PhD, from the American Cancer Society in Atlanta, Georgia, and colleagues. “Less is known about the association between WC and mortality within categories of BMI or for the very high levels of WC that are now common.”

Using the Cancer Prevention Study II Nutrition Cohort, the investigators evaluated the association between WC and mortality among 48,500 men and 56,343 women, aged at least 50 years. Between 1997 and the end of follow-up in 2006, there were 9315 deaths in men and 5332 in women.

Risk for mortality was more than doubled for very high levels of WC after adjustment for BMI and other risk factors. Among men, relative risk (RR) of mortality was 2.02 (95% confidence interval [CI], 1.71 – 2.39) for WC 120 cm or larger compared with WC less than 90 cm. Among women, RR was 2.36 (95% CI, 1.98 – 2.82) for WC 110 cm or larger compared with WC less than 75 cm.

Within all categories of BMI, WC was positively associated with mortality. A 10-cm increase in WC in men was associated with RRs of 1.16 (95% CI, 1.09 – 1.23) for normal (BMI, 18.5 kg/m2 to <25 kg/m2), 1.18 (95% CI, 1.12 – 1.24) for overweight (BMI, 25 kg/m2to <30 kg/m2), and 1.21 (95% CI, 1.13 – 1.30) for obese (BMI, ≥30 kg/m2) BMI. For women, RRs were 1.25 (95% CI, 1.18 – 1.32), 1.15 (95% CI, 1.08 – 1.22), and 1.13 (95% CI, 1.06 – 1.20), respectively.

Limitations of this study include reliance on self-report and measurement for WC, observational design, possible confounding by factors associated with both larger WC and higher mortality, and possibly low generalizability because all study participants were 50 years or older, and nearly all were white.

“Results from this large prospective study emphasize the importance of WC as a risk factor for mortality in older adults, regardless of whether the BMI is categorized as normal, overweight, or obese,” the study authors write. “Our results suggest that, regardless of weight, avoiding gains in WC may reduce risk of premature mortality.”

The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:1293-1301.


Phys Ed: The Men Who Stare at Screens

“ It should not come as a shock to anyone familiar with the laws of special relativity, which state that as you get up out of your office chair, and thus move closer to the speed of light, you age less quickly!”

The New York Times, by Gretchen Reynolds  —  In 1982, researchers affiliated with the Cooper Institute in Dallas surveyed a large group of well-educated, affluent men. The researchers were interested in the men’s exercise habits, but they also asked, almost incidentally, about their indolence. Specifically, they inquired about how many hours each day the men spent watching television or sitting in a car. (This was before you could do both at once.) Over the years, the survey’s main results were used to reinforce a growing body of science about the health benefits of regular exercise.

But the information about the amount of time the men spent being inactive remained largely unexplored. Recently, however, scientists from the University of South Carolina and the Pennington Biomedical Research Center in Baton Rouge, La., parsed the full data. In a study published in May in the journal Medicine and Science in Sports and Exercise, they reported that, to no one’s surprise, the men who sat the most had the greatest risk of heart problems. Men who spent more than 23 hours a week watching TV and sitting in their cars (as passengers or as drivers) had a 64 percent greater chance of dying from heart disease than those who sat for 11 hours a week or less. What was unexpected was that many of the men who sat long hours and developed heart problems also exercised. Quite a few of them said they did so regularly and led active lifestyles. The men worked out, then sat in cars and in front of televisions for hours, and their risk of heart disease soared, despite the exercise. Their workouts did not counteract the ill effects of sitting.

Most of us have heard that sitting is unhealthy. But many of us also have discounted the warnings, since we spend our lunch hours conscientiously visiting the gym. We consider ourselves sufficiently active. But then we drive back to the office, settle at our desks and sit for the rest of the day. We are, in a phrase adopted by physiologists, ‘‘active couch potatoes.’’

The amount of time that most Americans spend being inactive has risen steadily in recent decades. A 2009 editorial in the British Journal of Sports Medicine reported that, on average, adults spend more than nine hours a day in oxymoronic ‘‘sedentary activities.’’ For studies like these, scientists categorize activities by the number of METs they demand. A MET, or metabolic equivalent of task, is a measure of energy, with one MET being the amount of energy you burn lying down for one minute. Sedentary behaviors demand one to one and a half METs, or very little exertion.

Decades ago, before the advent of computers, plasma TVs and Roombas, people spent more time completing ‘‘light-intensity activities,’’ which require between one and a half and three METs. Most ‘‘home activities,’’ like mopping, cooking and changing light bulbs, demand between two and three METs. (One exception is ‘‘butchering animals,’’ a six-MET activity, according to a bogglingly comprehensive compilation from 2000 of the METs associated with different activities.) Nowadays, few of us accumulate much light-intensity activity. We’ve replaced those hours with sitting.

The physiological consequences are only slowly being untangled. In a number of recent animal studies, when rats or mice were not allowed to amble normally around in their cages, they rapidly developed unhealthy cellular changes in their muscles. The animals showed signs of insulin resistance and had higher levels of fatty acids in their blood. Scientists believe the changes are caused by a lack of muscular contractions. If you sit for long hours, you experience no ‘‘isometric contraction of the antigravity (postural) muscles,’’ according to an overview of the consequences of inactivity published this month in Exercise and Sports Sciences Reviews. Your muscles, unused for hours at a time, change in subtle fashion, and as a result, your risk for heart disease, diabetes and other diseases can rise.

Regular workout sessions do not appear to fully undo the effects of prolonged sitting. ‘‘There seem to be different pathways’’ involved in the beneficial physiological effects of exercising and the deleterious impacts of sitting, says Tatiana Warren, a graduate student in exercise science at the University of South Carolina and the lead author of the study of men who sat too much. ‘‘One does not undo the other,’’ she says.

You can, however, ameliorate the dangers of inactivity with several easy steps — actual steps. ‘‘Look for ways to decrease physical inactivity,’’ Ms. Warren says, beyond 30-minute bouts of jogging or structured exercise. Stand up. Pace around your office. Get off the couch and grab a mop or change a light bulb the next time you watch ‘‘Dancing With the Stars.’’

The New York Times, August 10, 2010, by Tara Parker-Pope  —  Sleep spindles, shown here between the red lines, are a distinctive brain wave pattern that resembles yarn wrapped around a dowel and may influence whether noise interrupts your sleep.

Why can some people sleep through noises like a honking car or flushing toilet, while others are awakened by the lightest sound?

To find the answer, sleep researchers at Massachusetts General Hospital conducted an unusual study of 12 self-described deep sleepers. After tests confirmed that the healthy volunteers were solid sleepers, they took part in a three-night study in the university’s sleep laboratory. The participants spent the night in a luxurious and comfortable room reminiscent of a hotel suite with soft pillows and cozy sheets. But the room also included four speakers positioned near the top of the bed.

During the night, the deep sleepers were subjected to 14 different recorded sounds, like street traffic, toilets flushing, an ice machine dispensing and an airplane flying overhead. Next door, the researchers monitored their sleep patterns and brain waves.

As expected, all of the participants slept relatively well, but there were differences in how they responded to the noisy interruptions. Some of the sleepers didn’t wake up even when a sound was blasted at 70 decibels; others were awakened by sounds at 40 or 50 decibels. By comparison, a relatively quiet room with the whir of a central air-conditioner represents about 30 decibels of sound.

The researchers discovered that the difference in a sleeper’s reaction to noise could be predicted by the level of brain activity called “sleep spindles.’’ A sleep spindle is a burst of high-frequency brain activity generated from deep inside the brain during sleep. (They are called spindles because the researchers who identified the brain wave pattern in the 1930s thought it resembled yarn wrapped around a dowel.) The source of the spindles is the thalamus, a part of the brain that sends sensory information to the rest of the cortex.

Before the study, the Massachusetts researchers theorized that the spindles are the brain’s way of preventing sensory information from passing through the thalamus and waking the rest of the brain during sleep. They found that the sleepers who experienced the most sleep spindles during the night were also the soundest sleepers and were least likely to be awakened by noise, according to the report, which appeared in the latest issue of Current Biology.

The finding is important because it sheds new light on the brain-based differences between light and deep sleepers.

“I hear complaints a lot as a sleep doctor that noises are interrupting people’s sleep all the time,’’ said Dr. Jeffrey M. Ellenbogen, chief of the division of sleep medicine at Harvard Medical School. “What is it in the brain that makes it have less response to noise at night, and how can we enhance that natural occurring brain-based process to help people sleep?” he said.

Scientists already know that most people become lighter sleepers with age, most likely because older people experience less “slow wave sleep,’’ which is the deepest stage of sleep. People also produce fewer sleep spindles as they age. But even when controlling for the stage of sleep a person was in, the number of sleep spindles still predicted their risk for awakening because of noise.

More research is needed, but the findings suggest that a better understanding of sleep spindles could lead to new behavioral or drug therapies for people with sleep disorders. For instance, future studies may try to determine whether diet, exercise or other behaviors may influence the number of sleep spindles a person produces during the night. The findings also raise questions about the current crop of sleep medications, which work essentially by sedating the entire brain. But the study shows that the natural sleep patterns associated with the best sleep occur when the thalamus is highly active.

“Sleep works through a symphony and orchestra of events in the brain,” Dr. Ellenbogen said. “To give someone a medication that causes global sedation, I’m not sure in the end is going to be the best thing we can offer people. The best thing we can offer them is to leverage naturally occurring sleep states and enhancing them.”

The Claim: Exercise More During the Day, and You Will Sleep Better at Night

The New York Times, by Anahad O’Connor  —  THE FACTS:  It has long been said that regular physical activity and better sleep go hand in hand. Burn more energy during the day, the thinking goes, and you will be more tired at night.

But only recently have scientists sought to find out precisely to what extent. One extensive study published this year looked for answers by having healthy children wear actigraphs — devices that measure movement — and then seeing whether more movement and activity during the day meant improved sleep at night. The results should be particularly enlightening to parents.

The study found that sleep onset latency — the time it takes to fall asleep once in bed — ranged from as little as roughly 10 minutes for some children to more than 40 minutes for others. But physical activity during the day and sleep onset at night were closely linked: every hour of sedentary activity during the day resulted in an additional three minutes in the time it took to fall asleep at night. And the children who fell asleep faster ultimately slept longer, getting an extra hour of sleep for every 10-minute reduction in the time it took them to drift off.

Studies on adults have reached generally similar results, showing that an increase in physical activity improves sleep onset and increases sleep duration, particularly in people who have trouble sleeping.

THE BOTTOM LINE Studies suggest that being more physically active can lead to better sleep.


Federal Communications Commission chairman Julius Genachowski, seen here, told reporters that any resolution “that doesn’t preserve the freedom and openness of the Internet for consumers and entrepreneurs will be unacceptable.” . Photographer: Andrew Harrer/Bloomberg

August 10, 2010, by Amy Thomson (Bloomberg) — Darrell West, vice president of governance studies at the Brookings Institution, talks with Bloomberg’s Mark Crumpton and Julie Hyman about a joint policy proposal by Verizon Communications Inc. and Google Inc. for how Internet traffic should be handled after participating in talks with U.S. officials on Web policy that yielded no results. The “compromise proposal” restricts Internet-service providers from selectively slowing Web content that travels over their wires, but wouldn’t apply such limits to Internet use on mobile phones, according to a blog post by the companies today. (Source: Bloomberg)

Verizon Communications Inc. and Google Inc. urged U.S. regulators to leave wireless-Internet services outside most policies that are designed to prevent carriers from making some Web sites perform better than others.

The companies issued a “compromise proposal” for so-called net-neutrality rules. The plan would restrict Internet-service providers from selectively slowing content that travels over their wires, but wouldn’t apply such limits to Web use on mobile devices, according to a blog post by the companies today. They would also exempt new offerings beyond traditional Internet and TV services, such as health-care monitoring.

Google and Verizon argue that the mobile-Internet market is more competitive and changing rapidly, and therefore different from the wireline market. Critics say the proposal would let Verizon and other carriers discriminate against certain traffic, possibly favoring their own services.

“This is exactly what net-neutrality supporters have feared all along — an open door for Internet providers to control content indiscriminately,” said Josh Silver, executive director of Free Press, a non-profit group in Washington focused on policy and the media. “This is an attempt by Google and Verizon to self-regulate the same way the banks did in the run up to the banking crisis.”

Verizon and Google had been adversaries over the issue. New York-based Verizon was among the cable and phone carriers saying they need leeway on the delivery of Web content to protect performance of their networks. Google led content providers and advocacy groups that say restrictions are required so communications companies don’t favor their own online offerings or those of partners that pay for higher speeds.

Failed Talks

Last week, U.S. regulators ended closed-door discussions with companies on Internet regulation, saying they didn’t result in a “robust framework” to preserve the openness of the Internet. Among participants were AT&T Inc., Verizon, Google, Skype Technologies SA, and the National Cable & Telecommunications Association, representing companies led by Comcast Corp. and Time Warner Cable Inc.

The Federal Communications Commission negotiated with the companies over rules proposed by Chairman Julius Genachowski to regulate how phone and cable companies handle Web traffic such as Google’s YouTube videos. Genachowski told reporters in Washington last week that any resolution “that doesn’t preserve the freedom and openness of the Internet for consumers and entrepreneurs will be unacceptable.”

FCC spokeswoman Jen Howard declined to comment today.

Business Allies

Google and Verizon have become business allies through Verizon Wireless, the largest U.S. wireless carrier. Mobile phones that use software from Google, owner of the largest Internet search engine, helped Verizon’s profit this year.

Earnings for Verizon beat estimates last month as its wireless unit promoted phones running on Google’s Android software, including Droids from Motorola Inc. and HTC Corp., to compete against AT&T’s iPhone from Apple Inc.

Carriers such as Verizon, which have spent billions of dollars building high-speed networks, are trying to affect the FCC’s policies to be able to earn a return on their investments.

Google and Verizon’s exclusion of wireless services from the policy proposal veers from the FCC’s principles, which don’t make a distinction between wireline and wireless connections, said Sherwin Siy, deputy legal director for Public Knowledge, a Washington-based consumer watchdog for digital rights.

“There’s no reason the same rules of being fair and nondiscriminatory shouldn’t apply in the wireless scheme as well,” Siy said. Preserving the success of Android is “certainly foremost in their minds,” Siy said.

‘Still-Nascent’ Market

Google and Verizon said the Government Accountability Office would report to Congress annually on developments in wireless broadband and whether the rules protect customers.

“Wireless broadband is different from the traditional wireline world, in part because the mobile marketplace is more competitive and changing rapidly,” the companies said. “In recognition of the still-nascent nature of the wireless broadband marketplace, under this proposal we would not now apply most of the wireline principles to wireless.”

Consumer Watchdog, a consumer group based in Santa Monica, California, said the proposal “completely undermines the future of the Internet” because the wireless use of the Web is gaining in popularity.

Verizon already agreed to some net-neutrality principles when it obtained spectrum for its so-called fourth-generation wireless service, which will provide high-speed mobile broadband in some markets later this year.

‘Differentiated’ Services

Verizon and Google also proposed excluding “additional, differentiated online services” that might include new health- care, gaming and entertainment services and smart grids from the net-neutrality requirements. The companies said there would be safeguards in place to ensure that such services are distinguishable from traditional broadband access and that the rules aren’t designed to circumvent the FCC.

The plan would hurt consumers because it would create a two-tiered structure for the Internet, Consumer Watchdog said.

“There would be a so-called ‘Public Internet,’ but then the ISPs would be allowed to offer new premium services outside that basic service,” the group said in an e-mailed statement. “How long do you think anything of interest would be available on the ’Public Internet’?”

Verizon, which co-owns its wireless business with Vodafone Group Plc, rose 31 cents to $29.86 at 4 p.m. on the New York Stock Exchange. Google, based in Mountain View, California, gained $5.13 to $505.35 on the Nasdaq Stock Market.

To contact the reporter on this story: Amy Thomson in New York at




Statement from Google…


A joint policy proposal for an open Internet

Monday, August 9, 2010 at 1:38 PM ET


Posted by Alan Davidson, Google director of public policy and Tom Tauke, Verizon executive vice president of public affairs, policy, and communications

The original architects of the Internet got the big things right. By making the network open, they enabled the greatest exchange of ideas in history. By making the Internet scalable, they enabled explosive innovation in the infrastructure.

It is imperative that we find ways to protect the future openness of the Internet and encourage the rapid deployment of broadband. Verizon and Google are pleased to discuss the principled compromise our companies have developed over the last year concerning the thorny issue of “network neutrality.”

In October, our two companies issued a shared statement of principles on network neutrality. A few months later we submitted a joint filing to the FCC, and in an April joint op-ed our CEOs discussed their common interest in an open Internet. Since that time, we have listened to all sides of the debate, engaged in good faith with policy makers in multiple venues, and challenged each other to craft a balanced policy framework. We have been guided by the two main goals:

     1. Users should choose what content, applications, or devices they use, since openness has been central to the explosive innovation that has made the Internet a transformative medium.

     2. America must continue to encourage both investment and innovation to support the underlying broadband infrastructure; it is imperative for our global competitiveness.

Today our CEOs will announce a proposal that we hope will make a constructive contribution to the dialogue. Our joint proposal takes the form of a suggested legislative framework for consideration by lawmakers, and is laid out here. Below we discuss the seven key elements:

First, both companies have long been proponents of the FCC’s current wireline broadband openness principles, which ensure that consumers have access to all legal content on the Internet, and can use what applications, services, and devices they choose. The enforceability of those principles was called into serious question by the recent Comcast court decision. Our proposal would now make those principles fully enforceable at the FCC.

Second, we agree that in addition to these existing principles there should be a new, enforceable prohibition against discriminatory practices. This means that for the first time, wireline broadband providers would not be able to discriminate against or prioritize lawful Internet content, applications or services in a way that causes harm to users or competition.

Importantly, this new nondiscrimination principle includes a presumption against prioritization of Internet traffic – including paid prioritization. So, in addition to not blocking or degrading of Internet content and applications, wireline broadband providers also could not favor particular Internet traffic over other traffic.

Third, it’s important that the consumer be fully informed about their Internet experiences. Our proposal would create enforceable transparency rules, for both wireline and wireless services. Broadband providers would be required to give consumers clear, understandable information about the services they offer and their capabilities. Broadband providers would also provide to application and content providers information about network management practices and any other information they need to ensure that they can reach consumers.

Fourth, because of the confusion about the FCC’s authority following the Comcast court decision, our proposal spells out the FCC’s role and authority in the broadband space. In addition to creating enforceable consumer protection and nondiscrimination standards that go beyond the FCC’s preexisting consumer safeguards, the proposal also provides for a new enforcement mechanism for the FCC to use. Specifically, the FCC would enforce these openness policies on a case-by-case basis, using a complaint-driven process. The FCC could move swiftly to stop a practice that violates these safeguards, and it could impose a penalty of up to $2 million on bad actors.

Fifth, we want the broadband infrastructure to be a platform for innovation. Therefore, our proposal would allow broadband providers to offer additional, differentiated online services, in addition to the Internet access and video services (such as Verizon’s FIOS TV) offered today. This means that broadband providers can work with other players to develop new services. It is too soon to predict how these new services will develop, but examples might include health care monitoring, the smart grid, advanced educational services, or new entertainment and gaming options. Our proposal also includes safeguards to ensure that such online services must be distinguishable from traditional broadband Internet access services and are not designed to circumvent the rules. The FCC would also monitor the development of these services to make sure they don’t interfere with the continued development of Internet access services.

Sixth, we both recognize that wireless broadband is different from the traditional wireline world, in part because the mobile marketplace is more competitive and changing rapidly. In recognition of the still-nascent nature of the wireless broadband marketplace, under this proposal we would not now apply most of the wireline principles to wireless, except for the transparency requirement. In addition, the Government Accountability Office would be required to report to Congress annually on developments in the wireless broadband marketplace, and whether or not current policies are working to protect consumers.

Seventh, and finally, we strongly believe that it is in the national interest for all Americans to have broadband access to the Internet. Therefore, we support reform of the Federal Universal Service Fund, so that it is focused on deploying broadband in areas where it is not now available.

We believe this policy framework properly empowers consumers and gives the FCC a role carefully tailored for the new world of broadband, while also allowing broadband providers the flexibility to manage their networks and provide new types of online services.

Ultimately, we think this proposal provides the certainty that allows both web startups to bring their novel ideas to users, and broadband providers to invest in their networks.

Crafting a compromise proposal has not been an easy process, and we have certainly had our differences along the way. But what has kept us moving forward is our mutual interest in a healthy and growing Internet that can continue to be a laboratory for innovation. As policy makers continue to formulate the rules of the road, we hope that other stakeholders will join with us in providing constructive ideas for an open Internet policy that puts consumers in charge and enhances America’s leadership in the broadband world. We stand ready to work with the Congress, the FCC and all interested parties to do just that.