The Daredevils Without Landlines — And Why Health Experts Are Tracking Them

Stephen Blumberg, associate director for science in the division of Health Interview Statistics at the CDC's National Center for Health Statistics

Nearly half of U.S. homes don’t have a landline and rely on cellphones instead, according to a federal report out this week.

The number predictably has been climbing over the years, now surpassing even the households with both a landline and a mobile phone. And it’s tracked — of all agencies — by the Centers for Disease Control and Prevention.

The CDC’s National Center for Health Statistics records all kinds of trends about the state of Americans’ health. One of its surveys traces the decline of landlines and what kinds of health habits are common to mobile-only homes. (Hint: the drinking and smoking kind.)

How did the CDC become the expert on the rise of the cellphone use? I spoke with Stephen Blumberg, who’s been leading this research. The interview has been edited for length and clarity.

So you’re the guy who’s basically monitoring the slow death of the landline.

I guess I am.

Stephen Blumberg, associate director for science in the division of Health Interview Statistics at the CDC’s National Center for Health Statistics Centers for Disease Control and Prevention hide caption

toggle caption Centers for Disease Control and Prevention

Why does the CDC study this?

You’re definitely not the first one to ask that. Back in 2003, we recognized that the telephone-based surveys conducted by the CDC would be missing a ever-growing segment of the population (that didn’t have a landline phone). We looked to find a survey that would answer the questions about who this population is and what their health characteristics are.

The National Health Interview Survey is an in-person survey with more than 40,000 households annually. And because it’s conducted face-to-face by Census Bureau interviewers, it contacts landline households, wireless-only households, households that have no service at all. That made it an ideal vehicle for tracking the prevalence of the characteristics of the wireless-only population.

Since then, all of the major telephone surveys that CDC conducts now include cellphone numbers … but we’re the one survey in the federal statistical system that is tracking this estimate and so we continue to do so.

In effect it started out of your own necessity?

That’s correct. For telephone surveys, at first we were able to make adjustments for the exclusion of the individuals, or what’s known as coverage bias — because we knew that they were younger, they were more likely to live in rented housing, they were more likely to be low-income. And so we could make adjustments.

What we started to recognize, however, fairly quickly is that in fact, their health characteristics were different, even when you controlled for all of those demographic differences. People who are wireless-only are more likely to smoke, they’re more likely to binge drink, they’re more likely to be uninsured. In effect, they are more likely to engage in risk behaviors.

All the daredevils are dropping their landlines!

You know, we can’t say for certain, perhaps at that time dropping the landline was in effect risky behavior!

It would make sense for it to be a factor of youth, no?

Well, except when we controlled for age, we still saw these differences. Essentially, if we just looked at young people, we still saw that those young people who were wireless-only were more likely to drink and more likely to smoke than young people who had landlines.

Somebody once suggested that it would be interesting to try to extend preventive health messages to wireless-only individuals and try to target them for health promotion activities, but I don’t know that anybody has actually done that.

So is it related to income?

We know that there’s an income effect; however, part of that, if not all of that is a function of age and living status. So young adults living in rented housing are more likely to be wireless-only. Those people are also more likely to have lower incomes than older adults who own their home.

We certainly see that lower-income households are more likely to be wireless-only. We think that’s primarily the function of age and household tenure, but we also recognize that it costs money to have both a landline and a wireless phone, and those people who are looking to save money may recognize that a wireless phone gives them more functionality than a landline phone.

Are you still seeing that correlation with risky behavior or are we maybe approaching a point where only having a cellphone is more of a factor of convenience?

We still see it in the general data, so if you take a look at the report, you can see that 29 percent of wireless-only adults are binge-drinkers whereas only 18 percent of adults living in landline households drink heavily.

And what’s the value of this information to the CDC?

It’s a reminder to us that for our telephone surveys we still need to be vigilant to include proper proportions of wireless-only households. That’s the primary benefit at this point.

We continue to track (the information about wireless-only households) because it increases the accuracy of the health data we collect in our survey.

In the years that you’ve studied these households, has something about the data surprised you?

I don’t know that surprise is the word. But we’ve been tracking this for 12 years now. I think we had expected that by now we would see some leveling off in the prevalence of wireless-only households -– we don’t see any evidence yet that that’s occurring.

So people are still dropping landlines?

That’s correct.

I would have actually thought that by now, we would only see a small percentage of people even having landlines.

I’m guessing you’re fairly young.

I haven’t had a landline in a very long time. Though I’m talking to you over a landline now.

And yet I’m talking to you on a cellphone!

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Hospital Injury Rates Plateau, After 3 Years Of Decline

Behind-the-scenes work to reduce injuries and infections in hospitals has paid off. Further improvements may be more challenging.

Behind-the-scenes work to reduce injuries and infections in hospitals has paid off. Further improvements may be more challenging. iStockphoto hide caption

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The rate of avoidable complications affecting patients in hospitals leveled off in 2014, after three years of declines, according to a federal report released Tuesday.

Hospitals have averted many types of injuries where clear preventive steps have been identified, but they still struggle to avert complications with broader causes and less clear-cut solutions, government and hospital officials said.

There were at least 4 million infections and other potentially avoidable injuries in hospitals last year, the study estimated. That translates to a preventable problem in about 12 of every 100 hospital stays.

Among the most common complications that were measured — each occurring a quarter million times or more — were bedsores, falls, bad reactions to drugs used to treat diabetes and kidney damage that develops after contrast dyes are injected through catheters to help radiologists take images of blood vessels.

The frequency of hospital complications last year was 17 percent lower than in 2010 but the same as in 2013, indicating that some patient safety improvements made by hospitals and the government are sticking. But the lack of improvement raised concerns that it is becoming harder for hospitals to further reduce the chances that a patient may be harmed during a visit.

“We are still trying to understand all the factors involved, but I think the improvements we saw from 2010 to 2013 were very likely the low-hanging fruit, the easy problems to solve,” said Dr. Richard Kronick, director of the federal Agency for Healthcare Research and Quality, or AHRQ, which conducted the study.

The Obama administration has been focusing on lowering the rates of medical infections and injuries as it tracks a slew of patient safety initiatives created by the 2010 federal health law. Those include Medicare penalties for poor-performing hospitals, wider use of electronic records to help track patient care and prevent mistakes, and grants to collaborations of medical providers formed to improve the quality of patient care and identify the best ways of addressing each type of problem.

The AHRQ report calculated national rates for 27 specific complications by extrapolating from 30,000 medical cases that officials examined. Decreases in infections, medicine reactions and other complications since 2010 have resulted in 2.1 million fewer incidents of harm, 87,000 fewer deaths and $20 billion in health care savings, the report concluded.

“Those are real people that are not dying, getting infections or other adverse events in the hospital,” said Dr. Patrick Conway, chief medical officer for the Centers for Medicare & Medicaid Services.

Some of the most significant progress was made in lowering the number of infections from central lines inserted into veins — down 72 percent from 2010. Medical researchers have proven that these infections can be virtually eliminated if doctors and nurses follow a clear set of procedures.

Infections from urinary catheters decreased by 38 percent and surgical site infections dropped by 18 percent. In all three cases, the reductions exceeded the goals set by the administration. Conway noted that hospitals had a financial motivation to cut these infections as they are used to determine whether hospitals get Medicare bonuses and penalties each year.

However, hospitals have not made headway in trimming the numbers of falls or pneumonia cases in patients breathing through mechanical ventilators, the report found. And the rates of adverse drug reactions and complications during childbirth were higher than what the administration estimated they should be for 2014.

Conway said that complications are difficult to address because they involve tradeoffs that can cause other problems. For instance, he said, hospitals have to balance efforts to reduce falls with the need to help unstable patients improve their ability to walk. “We’ve got to work with providers to figure out what’s the sweet spot that can keep mobilization occurring but decrease the rate of falls,” he said.

Even though overall complication rates were flat, the report found that some types of injuries became less common in 2014. One was the number of blood clots that form after surgery and travel to the lung; those rates dropped by 30 percent in a year.

In some areas, the report is more optimistic about infection declines than is the Centers for Disease Control and Prevention, which tracks the same infections but uses different methods and different years of comparison. The CDC has reported that urinary tract infections caused by catheters became slightly more prevalent through 2013, while the AHRQ method has found a substantial drop, said Dr. Jennifer Meddings, an assistant professor at the University of Michigan Health System who studies hospital infections. “This is what’s very confusing to hospitals,” she said. “Different data gets picked in different reports.”

Maulik Joshi, an executive at the American Hospital Association, predicted that complications will become even rarer in future years. “Hospitals are working on projects that are just not reflected in these data points,” he said.

But a few conditions became more prevalent in 2014. Infections from methicillin-resistant Staphylococcus aureus bacteria, known as MRSA, increased by 55 percent to an estimated 17,000 incidents last year. The number of times a catheter punctured a femoral artery during an angiography increased by 25 percent to 74,000, the report estimated.

“We think we addressed a lot of the areas where there was a strong evidence base on how to improve patient safety,” Conway said. “We’ll now have to tackle that next wave that has multiple causes.”

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The Thistle & Shamrock: The Gathering

Jennifer and Hazel Wrigley.
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Jennifer and Hazel Wrigley. Courtesy of the artist hide caption

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From cottage hearthsides in the pre-broadcasting age to the pubs and back porches of today’s session scene, enjoy music that celebrates the gathering of family and friends. Hear from Jennifer and Hazel Wrigley, Donal Lunny, Capercaillie and more.

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EU Investigating Tax Deal Between Luxembourg, McDonald's

A sign points to a McDonald's restaurant in Rome in 2011. Regulators say the restaurant chain essentially has avoided paying taxes on its European profits for years.

A sign points to a McDonald’s restaurant in Rome in 2011. Regulators say the restaurant chain essentially has avoided paying taxes on its European profits for years. Amy Sancetta/AP hide caption

toggle caption Amy Sancetta/AP

European regulators have launched an investigation into Luxembourg’s tax treatment of McDonald’s, saying the fast-food giant’s franchise office has paid virtually no taxes on franchise profits it earned in Europe and Russia since 2009.

It’s the latest in a series of investigations into corporate tax avoidance schemes by the European Commission, which has also targeted Starbucks and Apple.

“A tax ruling that agrees to McDonald’s paying no tax on their European royalties either in Luxembourg or in the U.S. has to be looked at very carefully under EU state aid rules,” said Commissioner Margrethe Vestager, who heads the European Commission’s competition bureau.

Regulators say authorities in Luxembourg, where McDonald’s Europe Franchising office is located, determined in March 2009 that the company should be exempt from corporate taxes because its profits were also taxed in the United States.

The company was required to submit proof every year that it actually paid US taxes on its profits, according to the statement. It stated:

“However, contrary to the assumption of the Luxembourg tax authorities when they granted the first ruling, the profits were not to be subjected to tax in the US. While under the proposed reading of Luxembourg law, McDonald’s Europe Franchising had a taxable presence in the US, it did not have any taxable presence in the US under US law.”

A subsequent ruling by Luxembourg in September 2009 said McDonald’s no longer even had to submit proof it was paying U.S. taxes.

Since then, the company has paid no taxes on virtually all of its European income, despite hefty profits of 250 million euros in 2013 alone, the E.C. said. Investigators will determine whether this gave McDonald’s an unfair advantage over its competitors, violating European law.

In a statement e-mailed to NPR, McDonald’s said the allegations it paid no taxes are untrue:

“McDonald’s complies with all tax laws and rules in Europe and pays a significant amount of corporate income tax. In fact, from 2010-2014, the McDonald’s Companies paid more than $2.1 billion just in corporate taxes in the European Union, with an average tax rate of almost 27%.

“Additionally, we pay social, real estate and other taxes. Our independent franchisees, who own and operate approximately 75% of our restaurants in Europe, also pay corporate tax and many other taxes.

“We are subject to the same tax laws as other companies and are confident that the inquiry will be resolved favorably.”

Luxembourg said it gave no special tax treatment to Europe, but said it would cooperate with the investigation.

The McDonald’s probe is the latest in a series of investigations by Europe into possible tax avoidance by large multinationals.

In October, the E.C. ordered Starbucks and Fiat to pay millions of dollars in back taxes, ruling that the companies benefited from illegal tax arrangements with the Netherlands and Luxembourg.

Regulators are also expected to release the results of investigations into alleged tax avoidance by Apple and Amazon next year.

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Top CIA 'Spymasters' Agree: We Can't Kill Our Way Out Of Terrorism

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Filmmakers Chris Whipple and Jules Naudet discuss their Showtime documentary, Spymasters, which features 12 former CIA directors discussing the tough choices they’ve had to make in fighting terrorism.

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Netflix Wishes You A 'Murray Christmas' In A Cheerful, Irony-Free Holiday Special

Paul Shaffer, George Clooney and Miley Cyrus are among the guests who join Bill Murray in A Very Murray Christmas, available Friday on Netflix.
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Paul Shaffer, George Clooney and Miley Cyrus are among the guests who join Bill Murray in A Very Murray Christmas, available Friday on Netflix. Ali Goldstein/Netflix hide caption

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A Very Murray Christmas is directed and co-written by Sofia Coppola, who also worked with Bill Murray on the movie Lost in Translation. In that film, Murray played an actor in Japan, reluctantly doing a series of commercials there, and not at all happy.

In A Very Murray Christmas, Murray starts out in much the same mood — he’s in his room at New York’s Carlyle Hotel, killing time with old friend Paul Shaffer, who’s noodling at the piano. Outside, a snowstorm is raging. Inside, Bill Murray is pouting and singing a somber Christmas song.

When I heard that Bill Murray was doing a Christmas special for Netflix, my first thought, I’ll admit, was: “Why?” Is that something he’d really want to do? And, as it turns out, that’s the way A Very Murray Christmas begins. He’s playing a version of himself who’s accepted a booking for a TV Christmas special, live from the Café Carlyle — and now that the day has arrived, the scheduled guests have not, because of a winter storm that’s stopped the city in its tracks.

That’s the basic premise. But it expands from there, in a way that’s clever and enjoyable enough not to spoil by describing it in advance. Before the one-hour special is over, though, A Very Murray Christmas does indeed find a way to make room for more than its share of special guest stars, including George Clooney, Chris Rock and Miley Cyrus.

What I DO want to reveal about this special in advance is its overall tone –- which, quite appropriately, takes a cue from the Charles Dickens classic A Christmas Carol. Murray, who long ago starred in the movie Scrooged, once again starts out here as a curmudgeon, but eventually finds a way to get caught up in the holiday spirit.

TV holiday specials used to be all over the tube, back when there were TV tubes, and they didn’t require much: a few stars, a few Christmas carols, and maybe a production number or two. That’s the very formula followed by Very Murray Christmas — but with a twist. And, most important, without irony.

This isn’t Bill Murray in the guise of his smug nightclub crooner from Saturday Night Live. This is Bill Murray in the guise of Bill Murray, enjoying himself with friends like musician Schaffer, who first worked with Murray back in the ’70s. And with Clooney, who gets to join with Murray on a playful duet, and sing the title refrain of a little ditty called “Santa Claus Wants Some Lovin’.”

They’re having fun, but they’re not being sarcastic here, or making fun of the holiday special itself. When Stephen Colbert did a Comedy Central holiday special, it was wonderful, but it was part homage, part satire. Murray, in this special, essentially is playing it straight, even when he’s clowning around, and asking his guests to do likewise.

Even the comedy bits are performed at face value — and sometimes, when you might be expecting some sort of ironic subtext from a musical performance, you get full-out sincerity instead, as when Cyrus sings “Silent Night”, accompanied only by Shaffer at the piano.

The surprise way this holiday special shifts, and changes in both tone and setting, is actually very sweet — and so is this entire special. A Very Murray Christmas is an unexpectedly tender little TV jewel from the man who built his early career on being a wisecracking cynic.

If you remember the holiday specials of old with any sort of fondness, you’ll like what Murray is up to on Netflix this season. And even if you don’t have any twinges of nostalgia for those TV specials from the ’60s and ’70s, or if you’re too young to remember them, I suspect you’ll enjoy A Very Murray Christmas anyway. I can be a pretty cynical guy myself — and even I had a good time watching it.

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Former Coal CEO Blankenship Found Guilty Of Conspiracy In Mine Disaster Case

Federal prosecutors said Don Blankenship operated Massey Energy as a “lawless enterprise.” He’s seen here leaving a federal courthouse in Charleston, W. Va., on Nov. 17, when the jury began deliberations. Kara Lofton/West Virginia Public Broadcasting hide caption

toggle caption Kara Lofton/West Virginia Public Broadcasting

More than two weeks after they received the case, the jury in the trial of former Massey Energy CEO Don Blankenship has delivered a mixed verdict in the case, finding Blankenship guilty of “conspiring to violate federal mine safety standards, a misdemeanor charge that carries up to a year of jail time,” as West Virginia Public Broadcasting reports.

Blankenship was acquitted of two counts of making false statements, meaning he’ll now face far less than the potential 30-year prison term prosecutors sought over the 2010 explosion at the Upper Big Branch mine, which killed 29 miners.

News of the verdict came around mid-day Thursday, after the jury announced for the second time that it was deadlocked. Responding to that notice earlier this week, U.S. District Judge Irene Berger issued an Allen charge to the jurors, urging them to consider both the majority and minority opinions — and to consider a partial verdict, as

An Allen charge refers to the instructions given by a judge when a case is at risk of having a hung jury. In this case, the jury’s deliberations spanned a five-day break for the Thanksgiving holiday.

The panel began its deliberations on the afternoon of Tuesday, Nov. 17 — and the case seemed headed toward a mistrial after just one full day of deliberations, when the jurors sent a note to the judge on Nov. 19 saying they couldn’t agree on a verdict and asking how long they should continue to try.

The defense moved for a mistrial at that point, but Judge Berger rejected the motion. A similar motion was put forth Friday afternoon, which Berger also rejected.

The authorities say Blankenship, 65, closely managed the Upper Big Branch mine, which was linked to hundreds of safety violations. Blankenship was charged with conspiracy to violate federal mine safety standards and to defraud the U.S. government for his company’s profit and his personal gain.

When a federal grand jury indicted him one year ago, the charges also included “lying to the Securities and Exchange Commission about the company’s safety practices and stock purchases,” as NPR’s Howard Berkes reported.

Summarizing the closing arguments, West Virginia Public Broadcasting’s Ashton Marra reported:

“Local U.S. Attorney Booth Goodwin called ex-Massey Energy CEO Don Blankenship an outlaw in his closing remarks, telling jurors he operated one of the nation’s largest coal producers as a ‘lawless enterprise.’ The prosecution’s case attempted to depict Blankenship as a micromanager who pushed production over safety.

“The defense argued the government has produced no direct proof Blankenship was involved in any conspiracy, only reams of paper, referring to the thousands of pages of evidence the prosecution has entered in the case.”

The case went to the jury more quickly than anticipated, after “Blankenship’s defense team rested its case without calling a single witness,” as our colleagues at West Virginia Public Broadcasting report in a summary of the trial.

In contrast, the prosecution called 27 witnesses over more than three weeks of testimony.

Blankenship was indicted months after former Massey Energy mine superintendent Gary May was sentenced to 21 months in prison and ordered to pay a $20,000 fine, in a plea deal that saw May admit to “ordering a company electrician to disable a methane monitor on a mining machine so it could continue to cut coal without automatic shutdowns.”

In September of 2013, another former Massey executive, David Hughart, was sentenced to 42 months in prison in a separate plea agreement in which he “admitted to being part of a corporate conspiracy to evade surprise mine safety inspections by giving advance warning to miners underground.”

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UK wartime leader Winston Churchill refused to pay his tailor's bills

Snow lies on the head and shoulders of a statue of Sir Winston Churchill Britain’s former World War II Prime Minister, in central London December 28, 2000.

Reuters/File


Refusal to pay the bills of one’s tailor was famously almost a point of honor among English gentlemen in past centuries and Winston Churchill was no exception, newly released archives show.

Britain’s World War Two leader had racked up a bill of 197 pounds by 1937 – around 12,000 pounds ($18,000) at today’s prices – with Savile Row tailor Henry Poole and Co before he was finally asked to pay up.

He took offense, refused to settle the bill and never darkened Poole’s door again.

Despite the arrears, the tailor had continued to make clothes for Churchill, said James Sherwood, a historian who has examined Poole and Co’s archives.

“Churchill said it was for morale, it was good for us [Henry Poole] to dress him and he wasn’t aware we were short of cash. He never did pay, and never came back – he never forgave us,” Sherwood added on Poole’s website.

Churchill, who led the British government during the war and again in the 1950s, was in exalted company when it came to not settling tailors’ bills.

The son of author Charles Dickens, for example, ran up a bill with Poole which eventually had to be paid by his father.

When he was prince of Wales in the 1870s, King Edward VII, made “infrequent payments on account that accumulated over years”. When a bill was eventually sent to the prince, he withdrew his custom and only came back 20 years later when he became king.

Other famous – and better behaved – customers of the tailor included author Bram Stoker, Prussian Prime Minister Prince Otto von Bismarck, American banker J.P. Morgan and Emperor Haile Selassie I of Ethiopia, who was visited in person by the tailors in Ethiopian capital Addis Ababa.

When company founder Henry Poole died, his high-profile clients owed him a huge amount and the firm was in a bad financial situation, the archives show.

The last surviving letter from Poole, written in 1875, said: “there will be nothing much to leave behind me. I have worked for a prince and for the public and must die a poor man.”

The archives, which go back to 1865, have been dusted off, rebound and the public can view them by appointment for the first time at Poole’s in Savile Row, central London.

(Reporting by Lisa Barrington; editing by Stephen Addison)

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