DePuy's handling of hip recall sparks questions

DePuy's handling of hip recall sparks questions
Johnson & Johnson, which could face billions of dollars in costs over an artificial hip recall, is taking an unusual approach to managing the crisis -- one that could limit its financial exposure, legal experts say.
J&J's DePuy Orthopaedics Inc unit recalled its metal ASR hip system a year ago after it failed at a higher-than-expected rate, with some patients experiencing pain, swelling, joint dislocation and sometimes systemic damage to the central nervous system, thyroid and heart.
The company now faces more than 2,000 lawsuits in state and federal court in the United States.
In a highly unusual move, DePuy has hired a third party -- Broadspire Services Inc, which manages workers compensation and other medical claims on behalf of insurance companies and employers -- to administer patient claims for out-of-pocket medical costs associated with the recall.
The move has prompted debate among industry and legal experts. Some see it as an efficient way to outsource a process that is unrelated to making artificial hips. Others see it as a way for J&J to limit payments while gaining control of medical records and other material that could be used against patients in court.
In general, companies and their lawyers handle recalls directly. They answer patient queries and pay claims for reimbursement. Typically, companies accept a treating physician's recommendation when it comes to determining if a device should be removed or replaced.
DePuy's handling of hip recall sparks questions
In DePuy's case, it is Broadspire's physicians, not the patient's own doctor, who, in effect, make the final decision on whether a patient's hip should be replaced. While Broadspire physicians cannot directly override a patient's doctor in terms of treatment, they make the decision on whether to pay. That can effectively rule out surgery for patients who cannot pay.
"Doctors who are evaluating these cases are being paid indirectly by DePuy, and research suggests that even when we are very well-intentioned we can be influenced by conflicts of interest," said Kristin Smith-Crowe, associate professor of management at the University of Utah, who specializes in business ethics. "This is a bit of a red flag in terms of the way this situation is set up."
Lorie Gawreluk, a spokeswoman for DePuy, said Broadspire's role is entirely benign. The company conducts its own reviews to ensure that a patient's hip problems are the result of the recall, and not some other cause, such as a fall.
"Similar to the process insurance companies use to evaluate claims from subscribers, medical records are collected by Broadspire if a patient requests financial assistance," she said in an email. "Broadspire requires no more information than a typical insurance provider would request, and like an insurance provider, Broadspire has a team of reviewers who review claims."
Patients and lawyers argue that the hip recall claims should not be treated in the same way as a standard medical claim. An insurance company, after all, does not decide whether to reimburse policyholders for medical costs related to a problem it caused itself. Moreover, lawyers representing patients say the amount of information being collected by Broadspire is excessive.
"This is an evolving strategy that is outside the norm of what companies have done in the past," said Edward Blizzard, partner with the law firm Blizzard, McCarthy & Nabers. Blizzard is representing plaintiffs in the case.
"Normally a company would not get the kind of information Broadspire is asking for until a case was in litigation, and even if the case was in litigation, in no circumstance would the defendant be allowed to have their own physician talk to the patient's physician privately, as Broadspire is demanding," he said.
Last August, DePuy wrote to orthopedic surgeons asking them to forward to their patients a package of information about the recall. It contained a form letter from doctor to patient, written by DePuy, asking the patient to set up an appointment to discuss any concerns and to bring with them a signed medical release giving the physician permission to share information with DePuy.
"It is important to share this information with DePuy so that DePuy may contact you directly regarding any additional information regarding the ASR Hip System and process your claims efficiently," the letter said. "Please complete the form and bring it with you to your next appointment."
DePuy offered doctors $50 for each completed set of forms.
"I have been doing this work for 35 years and it is almost unprecedented for a large corporate defendant to run out and preemptively attempt to identify potential claimants," said Alex MacDonald, a partner at MacDonald Rothweiler Eisenberg, who helped negotiate billions of dollars in settlements over the diet-drug cocktail Fen-Phen. He is not representing clients in the DePuy case.
"J&J is reaching out to doctors and asking them to use their influence with their patients in the hope that the doctor will help identify potential claimants in a lawsuit," MacDonald said.
DePuy, which is based in Warsaw, Indiana, denies that it is doing anything out of the ordinary, or that it might be seeking to influence doctors with its upfront offer of payment, as some critics charge.
"It is standard practice for, and indeed healthcare professionals require, reimbursement for the costs of producing the medical records," Gawreluk said.
But some doctors say they have not previously been asked by a product manufacturer to persuade patients to give up their privacy rights, or been directly offered payment to do so.
"It made me uncomfortable," said Mark Barba, an orthopedic surgeon at Rockford Orthopedic Associates, a surgical center in Rockford, Illinois. "I've never faced anything like that before. Never."
Some 93,000 people have been implanted with DePuy's ASR hip system worldwide.
With wear, the grinding of the hip's ball-and-socket structure causes metal debris to collect in the tissue surrounding the implant, damaging muscle and tendons and complicating replacement surgery. In some cases, metal ions released into the blood causes broader health problems.
Aubie Brennan, a 56-year-old teacher on the Hawaiian island of Oahu, had replacement surgery for each hip in 2007 and 2008 due to bone deterioration.
In 2009, he began to be plagued by flu-like symptoms, rashes, swollen lips and debilitating fatigue. Doctors were unable to locate the cause. They thought he might have allergies, or be depressed, or poisoned by a substance in the ocean surrounding his home.
But last August, Brennan said he received a letter from his health insurance company, Kaiser Permanente, alerting him to the recall and urging him to come in for tests. These showed that his left hip was crooked and that his blood contained significantly elevated levels of chromium and cobalt ions. The surgeon told him he wasn't sure if the elevated metal levels were causing his symptoms, and to return for further testing in six months.
Brennan could not wait. He sought a second opinion, and in February met with a surgeon at The Queen's Medical Center in Honolulu, the leading medical referral center in the Pacific Basin.
"He looked at my results and said, 'I think you need surgery, on both hips, and you need it now,'" Brennan said. He declined to name either surgeon.
The Honolulu surgeon was not part of Kaiser's network, so Kaiser declined to pay, Brennan said. He turned to Broadspire for reimbursement.
Broadspire told Brennan it would not agree in advance to pay. His only option would be to pay for the surgery himself. Then he would have to submit the doctor's report to Broadspire, whose physicians would review the case and make a decision on whether the procedure had been necessary.
Brennan could not afford to pay the $43,467 that the surgery would have cost -- or take the risk that Broadspire would decline coverage. He canceled the scheduled procedure.
"I was really devastated," he said. "Emotionally, and as far as my job went, it really devastated me."
Ultimately, Kaiser reversed itself and agreed to pay for the surgery, which took place in July.
Broadspire would not comment on individual claims, or its payment process in general. DePuy said patients first file for reimbursement through their insurance company, and DePuy later repays the insurance company.
Over the past two years, J&J -- for decades one of the most trusted brands in America -- has recalled more than 50 products, ranging from Children's Tylenol toinsulin cartridges to contact lenses. The company's handling of the recalls has in some cases sparked Congressional and federal criminal investigations.
Particularly disturbing to regulators was an older "phantom recall" of painkillerMotrin. J&J hired a contractor to secretly buy the product from stores well before it alerted the general public in 2009 that the pills did not dissolve properly.
To critics, DePuy's handling of its hip implant recall is designed to save money by potentially settling claims with patients before they fully understand their legal rights, or the likely cost of their hip-related medical costs in the future.
DePuy is adamant in its denial.
"To be very clear: the sole purpose of the Broadspire process is to assist patients and health care providers as efficiently as possible," Gawreluk said.
David Prince, professor of law at William Mitchell College of Law, said that while the hiring of Broadspire may make economic sense for J&J by saving the company the trouble of gearing up and organizing in-house, it also has the effect of distancing the company from patients.
"By pawning this process off on a third party, they don't have to deal face to face with patients, and may be less sensible to the human cost of what their product has done," he said.
Prince, who has represented both plaintiffs and defendants in the past and specializes in product liability, said he can see both perspectives.
"In a larger sense, this is a clash between the individual and his or her needs, and the broad corporate interest," he said. "If I were a patient I'd be very unhappy if someone I trusted, my own doctor, recommended a procedure and someone stood in the way. I would find that intolerable."
On the other hand, he said, "You can see how the company wants to make sure they only pay what they consider in their own mind legitimate claims."
J&J has taken special charges of about $400 million associated with the ASR recall through the second quarter of this year. The company's litigation expense also includes a component for increased product liability reserves related to the recall. Gawreluk declined to quantify that component or say what DePuy has paid out so far in claims.
Some experts say the ultimate cost to J&J could run to the billions of dollars.
In January 2001, Swiss medical device maker Sulzer Medica AG recalled a hip implant after a manufacturing glitch caused it to loosen. The company settled the case in 2002 for $1 billion. Of the 31,000 patients who received the Sulzer Medica implants, more than 2,760 had them replaced.
The DePuy recall is three times larger and much more complex. The revision rate has not yet been established, but data from a study released in March by the British Orthopaedic Association and the British Hip Society showed the ASR system had a failure rate of up to 49 percent after six years -- nearly four times the rate cited by DePuy when it recalled the device.
DePuy's handling of hip recall sparks questions
"This is the absolute worst thing that ever happened to my practice," Barba, the Rockford surgeon, said of the recall. "It keeps me up at night wondering how to treat these patients whose future is so uncertain. It has been difficult for all of us emotionally."
(Additional reporting by Debra Sherman in Chicago; Editing by Michele Gershberg, Matthew Lewis)


We wouldn't expect the Kardashians to let an event as momentous as Kim's wedding go by without monetizing every single aspect along the way.
And according to the Hollywood Reporter,Kris Jenner orchestrated aseries of eye-popping deals related to the nuptials. As such, not only will the Kardashian Clan not be spending any money on the wedding, they'll be raking in heaps.
-- Exclusive pictures. Rights for photos from the wedding apparently sold for $1.5 million toPeople (which also ran the enagagment photos). We should get our first look at the images Tuesday or Wednesday of this week.
-- Television ads. E! is expected to take in close to $13 million in ad revenue for the wedding special, some of which is sure to find its way into the Kardashian pocketbook.
-- Free stuff. All sorts of companies are willing to provide services for the wedding simply to get their brand some press. Designer Lehr & Black made Kim's invitations, costing them at least $10,000. Kim received $50,000 from Tao to host her bachelorette party there. Hansen's Cakes is gifting them their wedding cake (their cakes typically sell for about $6,000). And, of course, there's the dress: Vera Wang is creating a $20,000+ gown for Kim.
Meanwhile, Kim celebrated with groom-to-be Kris Humphries and about 80 others Thursday night for a three-hour rehearsal dinner, where -- knowing Kris Jenner as we do -- the tab was no doubt picked up by some brand looking for some of that Kardashian buzz.


Laptop battery wearing down? In this week's episode of Upgrade Your Life, Yahoo! News' Becky Worley shows us how to help batteries last longer ... and what to do when they run out! First, the basics
Most laptops use batteries that can last for 3-5 years, or about 1000 charges. (A premium laptop's battery might last longer.) Every time you charge your battery, the total capacity of the battery is diminished. Originally it may have had a run time of 3.5 hours, but after a year it'll run out of juice at 3 hours, even on a full charge.
If your battery capacity has diminished, there are a few things you can do about it. First, you have to correctly gauge how much capacity has been lost. There are free downloads to do this job, like Battery Bar (for Windows PCs) or Coconut Battery (for Macs). These will compare your battery's current maximum capacity to how long it lasted when it was new.
(UPDATE- we originally recommended Battery Eater and while the program works great, their download site has been compromised and we are recommending an alternate program, Battery Bar downloadable from CNET.)
Calibrating your Battery
You can't miraculously reconstitute your battery's capacity. It loses power over time due to chemical reactions taking place in the battery, as it chugs along powering your laptop. You can't undo those changes, but there is one common battery issue you can fix: In many laptops, the operating system's battery meter gets out of sync with how much juice the battery actually has.
Imagine if the gas gauge on your car dashboard was misreading how much gas you actually had in the tank. You'd either run out of gas when you thought you had a quarter of a tank left, or you'd be filling up too frequently. In your laptop, this can mean your laptop shuts down abruptly when the meter says you have 30 minutes left. Or else the meter might warn that you only have 2 minutes of battery life left and shut your laptop down, when it really has another 20 minutes remaining.
Recalibrating gets the battery meter to correctly read the current state of the battery, so you and the operating system know where you stand with existing battery life.
How to recalibrate
First, charge your laptop's battery to full, and leave it that way for at least two hours. Then unplug your laptop, and set its power management settings to never turn off or lower the monitor brightness. (HP has instructions for how do to this on Windows 7 and Vista, as well as Windows XP, while Apple has instructions for Mac laptops on their site.)
You want to drain the battery completely, then let your laptop sit for at least five hours this way -- like, say, overnight. (Just be careful and mute the volume, since some laptops make a warning sound when they're about to run out.) Afterwards, charge it up again, and you should notice a more accurate portrayal of your battery capacity. In some cases, you may even get more life out of it.
Best practices to maintain battery life
You'd think that the best way to keep your laptop's battery from wearing out is to not use it. Right?
As it turns out, batteries are like muscles; they need to be worked out regularly to stay healthy. Ideally, you'd use your laptop unplugged at least once a day, like on a train or bus commute or on the couch in front of the TV. If you're not going to use it, constantly charging your battery is a bad idea; HP recommends on their website that if you're going to leave your laptop plugged in or put up in storage for more than two weeks, you should take the battery out of your laptop.
Past the expiration date
So when is it time to throw out that old battery? The answer, surprisingly, is "never." Laptop batteries contain lots of toxic chemicals, and should never end up in landfills. Fortunately, has a list of environmentally responsible recyclers that will take your old battery with no fuss.
When is it time to replace your battery, then? Use the free utility apps Becky mentioned, and when they say that your battery can only hold around 25% of its original capacity it's probably time for a new one. You can buy a replacement battery from the original laptop manufacturer, and there are plenty of places online that sell discounted PC laptop batteries, like Laptops for Less and Owners of newer Mac laptops can get their laptop's non-removable battery swapped out at any Apple store, with a scheduled appointment.


(Kelly West/AP)
Rick Perry has many ideas about how to change the American government's founding document. From ending lifetime tenure for federal judges to completely scrapping two whole amendments, the Constitution would see a major overhaul if the Texas governor and Republican presidential candidate had his druthers. Perry laid out these proposed innovations to the founding document in his book, Fed Up! Our Fight to Save America from Washington. He has occasionally mentioned them on the campaign trail. Several of his ideas fall within the realm of mainstream conservative thinking today, but, as you will see, there are also a few surprises.
1. Abolish lifetime tenure for federal judges by amending Article III, Section I of the Constitution.
The nation's framers established a federal court system whereby judges with "good behavior" would be secure in their job for life. Perry believes that provision is ready for an overhaul.
"The Judges," reads Article III, "both of the supreme and inferior Courts, shall hold their Offices during good Behavior, and shall, at stated Times, receive for their Services a Compensation which shall not be diminished during their Continuance in Office."
Perry makes it no secret that he believes the judges on the bench over the past century have acted beyond their constitutional bounds. The problem, Perry reasons, is that members of the judiciary are "unaccountable" to the people, and their lifetime tenure gives them free license to act however they want. In his book, the governor speaks highly of plans to limit their tenure and offers proposals about how to accomplish it.
"'[W]e should take steps to restrict the unlimited power of the courts to rule over us with no accountability," he writes in Fed Up! "There are a number of ideas about how to do this . . . . One such reform would be to institute term limits on what are now lifetime appointments for federal judges, particularly those on the Supreme Court or the circuit courts, which have so much power. One proposal, for example, would have judges roll off every two years based on seniority."
2. Congress should have the power to override Supreme Court decisions with a two-thirds vote.
Ending lifetime tenure for federal justices isn't the only way Perry has proposed suppressing the power of the courts. His book excoriates at length what he sees as overreach from the judicial branch. (The title of Chapter Six is "Nine Unelected Judges Tell Us How to Live.")
Giving Congress the ability to veto their decisions would be another way to take the Court down a notch, Perry says.
"[A]llow Congress to override the Supreme Court with a two-thirds vote in both the House and Senate, which risks increased politicization of judicial decisions, but also has the benefit of letting the people stop the Court from unilaterally deciding policy," he writes.
3. Scrap the federal income tax by repealing the Sixteenth Amendment.

The Sixteenth Amendment gives Congress the "power to lay and collect taxes on incomes, from whatever source derived, without apportionment among the several States, and without regard to any census or enumeration." It should be abolished immediately, Perry says.
Calling the Sixteenth Amendment "the great milestone on the road to serfdom," Perry's writes that it provides a virtually blank check to the federal government to use for projects with little or no consultation from the states.
4. End the direct election of senators by repealing the Seventeenth Amendment.

Overturning this amendment would restore the original language of the Constitution, which gave state legislators the power to appoint the members of the Senate.
Ratified during the Progressive Era in 1913 , the same year as the Sixteenth Amendment, the Seventeenth Amendment gives citizens the ability to elect senators on their own. Perry writes that supporters of the amendment at the time were "mistakenly" propelled by "a fit of populist rage."
"The American people mistakenly empowered the federal government during a fit of populist rage in the early twentieth century by giving it an unlimited source of income (the Sixteenth Amendment) and by changing the way senators are elected (the Seventeenth Amendment)," he writes.
5. Require the federal government to balance its budget every year.
Of all his proposed ideas, Perry calls this one "the most important," and of all the plans, a balanced budget amendment likely has the best chance of passage.
"The most important thing we could do is amend the Constitution--now--to restrict federal spending," Perry writes in his book. "There are generally thought to be two options: the traditional 'balanced budget amendment' or a straightforward 'spending limit amendment,' either of which would be a significant improvement. I prefer the latter . . . . Let's use the people's document--the Constitution--to put an actual spending limit in place to control the beast in Washington."
A campaign to pass a balanced budget amendment through Congress fell short by just one vote in the Senate in the 1990s.
Last year, House Republicans proposed a spending-limit amendment that would limit federal spending to 20 percent of the economy. According to the amendment's language, the restriction could be overridden by a two-thirds vote in both Houses of Congress or by a declaration of war.
6. The federal Constitution should define marriage as between one man and one woman in all 50 states.
Despite saying last month that he was "fine with" states like New York allowing gay marriage, Perry has now said he supports a constitutional amendment that would permanently ban gay marriage throughout the country and overturn any state laws that define marriage beyond a relationship between one man and one woman.
"I do respect a state's right to have a different opinion and take a different tack if you will, California did that," Perry told the Christian Broadcasting Network in August. "I respect that right, but our founding fathers also said, 'Listen, if you all in the future think things are so important that you need to change the Constitution here's the way you do it'.
In an interview with The Ticket earlier this month, Perry spokeswoman Katherine Cesinger said that even though it would overturn laws in several states, the amendment still fits into Perry's broader philosophy because amendments require the ratification of three-fourths of the states to be added to the Constitution.
7. Abortion should be made illegal throughout the country.
Like the gay marriage issue, Perry at one time believed that abortion policy should be left to the states, as was the case before the 1973 Supreme Court case Roe v. Wade. But in the same Christian Broadcasting Network interview, Perry said that he would support a federal amendment outlawing abortion because it was "so the soul of this country and to the traditional values [of] our founding fathers."


  • Maria Sharapova of Russia hits a return to compatriot Svetlana Kuznetsova during their third round match of the 2011 Cincinnati Open tennis tournament in Cincinnati, Ohio, August 18, 2011. REUTERS/John Sommers II
    Maria Sharapova of Russia hits a return to compatriot Svetlana Kuznetsova during …
  • Maria Sharapova of Russia hits a return to compatriot Svetlana Kuznetsova during their third round match of the 2011 Cincinnati Open tennis tournament in Cincinnati, Ohio, August 18, 2011. REUTERS/John Sommers II
    Maria Sharapova of Russia hits a return to compatriot Svetlana Kuznetsova during
MASON, Ohio (Reuters) - Maria Sharapova marched into the semi-finals of the Cincinnati Open after crushing Australian Samantha Stosur 6-3 6-2 Friday to set up a last four meeting with fellow Russian Vera Zvonareva.
Sharapova dominated from the start of the 72-minute match against world number 10 Stosur, who lost in last week's Toronto Cup final to Serena Williams.
The Russian, who advanced to her sixth semi-final in 12 tournaments this year, is now projected to return to the top five when the new rankings are released Monday.
"I played a really great match and did many good things today which caused her trouble," Sharapova told reporters.
"I was aggressive; I didn't give her much time to do things that she likes to do when she plays well. I felt like I controlled most of the points."
Sharapova now comes up against a familiar foe in compatriot Zvonareva after the world number two claimed a 6-3 7-6 victory over Slovak Daniela Hantuchova.
In another quarter-final, Germany's Andrea Petkovic defeated Russian Nadia Petrova 7-5 6-1 and will meet either China's Peng Shuai or Serbia's Jelena Jankovic.
(Editing by Larry Fine)


SINGAPORE (AP) — Oil prices fell to near $81 a barrel Friday in Asia, extending a sell-off fueled by investor fears that a slowing global economy will undermine crude demand.
Benchmark oil for September delivery fell $1.11 to $81.27 a barrel at midday Singapore time in electronic trading on the New York Mercantile Exchange. Crude fell $5.20, or 5.9 percent, to finish at $82.38 on Thursday.
In London, Brent crude for October delivery was down 71 cents to $106.28 per barrel on the ICE Futures exchange.
Commodities such as oil fell Thursday as signs of weakening U.S. economic growth raised worries that the country could be headed for a recession. A report on Philadelphia-area manufacturing dropped to its the lowest in two years while home sales tumbled 3.5 percent in July.
Concerns that European banks may face funding difficulties amid the EU's debt crisis also weighed on investor sentiment. The Dow Jones industrial average sank 3.7 percent Thursday and most Asian stock markets fell Friday.
"The world economy has clearly stalled and it is hard to see any meaningful recovery in demand unless commodity prices, and especially oil, continue to weaken," Capital Economics said in a report. "The fragility of the world economy means there is high chance that fresh financial shocks will trigger more falls in commodity markets."
Capital Economics said it expects Brent to fall to $85 during 2012.
Other analysts are more optimistic, pointing to recent signs of strong U.S. crude demand.
"The recent U.S. oil demand numbers do not support the view that the economy has fallen back into recession," Goldman Sachs said in a report. "We expect supply-demand balances to continue to move to critically tight levels in 2012, with prices above recent levels by next year."
In other Nymex trading for October contracts, heating oil fell 1.6 cents to $2.87 per gallon but gasoline futures dropped 0.7 cents to $2.66 per gallon while natural gas for September delivery rose 4.7 cents to $3.94 per 1,000 cubic feet.


Summer driving doesn’t always mean spending hours sitting in traffic and crawling along the interstate on the way to the beach. On the fastest highways in America, some drivers are blazing down stretches of open road at more than 90 mph.

The fastest car on the fastest road in America clocked in at 94 mph heading northbound on Arizona’s Route 79 between Saguaro National Park and Phoenix earlier this year, according to INRIX, a traffic data company that tracks speeds using vehicle GPS data. On this 39-mile stretch — two lanes wide and almost completely straight for its entire length — the fastest drivers regularly reach speeds of 87 to 90 miles per hour. Arizona’s speed limit is 75 mph on rural interstates and 65 mph on urban interstates.

To determine America’s fastest roads, INRIX first looked for stretches of roadway where motorists routinely floor it, then it found the speed range at which each roadway’s fastest 5% of drivers travel. INRIX multiplied that figure by the length of each road to decide the final ranking. The result is a list of roads where drivers put the pedal to the metal over fairly long distances. Inrix counts the same road separately in different travel directions.

INRIX drew information from its crowdsourced Smart Driver Network, which consists of anonymous GPS data points gathered from from 5 million drivers in consumer and commercial vehicles nationwide, from January through June 15.

This year’s fastest drivers are going a bit slower across the board: The average speed across the 10 fastest roads in America was 81 mph, compared to an average of 85 mph during the same period in 2010.

“High gas prices are slowing drivers down,” says INRIX spokesman Jim Bak, who thinks drivers are putting on the brakes to improve fuel economy.

Tom Kloza, an oil and gas expert at Oil Price Information Service, thinks a more likely explanation is that high gas prices are working in concert with the poor economy and high unemployment to keep more young drivers — who tend to speed and engage in the riskiest driving behavior — off the road.

Demand for gasoline in America has fallen since last year, notes Kloza, who thinks cash-strapped drivers between the ages of 16 and 25 may be cutting down on driving based on necessity. Those who are left on the road could be older, and thus slower.

Another factor: police appear to be working harder to enforce the speed limit. On Arizona’s Route 79, Tim Gaffney, spokesman for the Pinal County Sheriff’s Office, which covers the highway’s particularly speedy stretch, says gas prices and “heavy speed enforcement details” have impacted how people are driving.

While Americans aren’t exceeding speed limits as much as they were last year, INRIX says they seem to be going faster on the home stretch.

“As drivers travel slower on average to conserve fuel, we see them going faster at the end of trips as they try to make up time,” says Bak. “Many of our fastest roads this year are on open stretches just before entering major urban centers.” And on stretches of road just outside chronically congested areas like Los Angeles and New York City, traffic is also moving much faster than normal, Bak adds.

Here are the 5 fastest roads in the United States where motorists are driving at full throttle:

5. Arizona State Route 77
Heading North out of Tucson up to the AZ-76/Redington Road interchange near San Manuel Airport

Average speed of fastest 5%: 81 mph
Top speed clocked by INRIX: 81 mph
Length of corridor: 4.8 miles

4. Eastbound MI-5 Michigan Highway
Heading into Detroit from the I-275/I-96 interchange to Telegraph Road

Average speed of fastest 5%: 81 mph
Top speed clocked by INRIX: 83 mph
Length of corridor: 4.9 miles

3. California State Route 73
In both directions between Moulton Parkway and Bear Street

Average speed of fastest 5%: 81 mph
Top speed clocked by INRIX: 85 mph
Length of corridor: 14.8 miles

2. Oklahoma State Highway 33
In both directions just Northwest of Oklahoma City

Average speed of fastest 5%: 83 mph
Top speed clocked by INRIX: 87 mph
Length of corridor: 24

1. Northbound Arizona State Route 79
Between Saguaro National Park and Phoenix

Average speed of fastest 5%: 88 mph
Top speed clocked by INRIX: 94 mph
Length of corridor: 17.6 miles



LONDON (AP) — Britain must confront a culture of laziness, irresponsibility and selfishness which fueled four days of riots that left five dead, thousands facing criminal charges and hundreds of millions of pounds (dollars) of damage, Prime Minister David Cameron acknowledged Monday.
As rival political leaders staked out their response to England's unrest, Cameron pledged to deliver a raft of new policies by October aimed at reversing the "slow-motion moral collapse" which he blames for fostering the disorder.
"This has been a wake-up call for our country. Social problems that have been festering for decades have exploded in our face," Cameron told an audience at a youth center in Witney, his Parliamentary district in southern England.
"Just as people last week wanted criminals robustly confronted on our street, so they want to see these social problems taken on and defeated."
Work and Pensions Secretary Iain Duncan Smith said Monday that he was already examining whether those involved in the riots should have their welfare payments cut, while London mayor Boris Johnson said young people convicted over the disorder would lose their right to use public transport for free.
Cameron pledged to end a culture of timidity in discussing family breakdown or poor parenting, or in criticizing those who fail to set a good example to their children or community.
"We have been too unwilling for too long to talk about what is right and what is wrong," Cameron said. "We have too often avoided saying what needs to be said, about everything from marriage to welfare to common courtesy."
In a rival speech, main opposition Labour Party leader Ed Miliband criticized Cameron's response as overly simplistic, and demanded that lawmakers focus on delivering better opportunities for disaffected young people.
"The usual politicians' instinct — announce a raft of new legislation, appoint a new adviser, wheel out your old prejudices and shallow answers — will not meet the public's demand," said Miliband.
He spoke at his former high school in Camden, north London, half a block from the scene of intense rioting Aug. 8, when shops were trashed and police came under attack.
"Are issues like education and skills, youth services, youth unemployment important for diverting people away from gangs, criminality, the wrong path? Yes, they matter," Miliband said.
The differing approaches to Britain's most serious riots in a generation are likely to dominate the country's annual political conventions, which begin next month. Miliband has called for a full public inquiry into the roots of the riots, while Cameron insists his government is able to adequately examine the issue.
Cameron insists that racial tensions, poverty and the government's austerity program — much of which is yet to bite — were not the primary motivations for the riots across London and other major cities.
Instead, Cameron pointed to gang-related crime, and a widespread failure from Britain's leaders to address deep rooted social issues — including through the country's generous welfare system.
"Children without fathers. Schools without discipline. Reward without effort. Crime without punishment. Rights without responsibilities. Communities without control. Some of the worst aspects of human nature tolerated, indulged — sometimes even incentivized — by a state and its agencies that in parts have become literally demoralized," Cameron said.
He pledged that the government would intervene to help 120,000 of the country's most troubled families before the 2015 national election.
Standing before a backdrop of graffiti, Cameron said Britain's damaged society had for too long been one which "incites laziness, that excuses bad behavior, that erodes self-discipline, that discourages hard work."
Both he and Miliband agreed that, following recklessness by bankers, the lawmakers' expense check scandal, and media phone hacking saga, all sectors of society had a share of the blame.
"Moral decline and bad behavior is not limited to a few of the poorest parts of our society. In the highest offices, the plushest boardrooms, the most influential jobs, we need to think about the example we are setting," Cameron said.
Young people who watched Cameron make his speech appeared unimpressed with his plans.
"He should stop blaming it on everyone else, he should stop living in la-la land," said 17-year-old Jake Parkinson. "If he was doing his job right, this wouldn't be happening."
As police continued to hunt those involved in last week's riots, detectives said they had uncovered a cache of weapons and hidden loot buried in flower beds in Camden. Knives, a hammer, metal bars and two cash registers from a looted cycle store were found after officers combed the area with metal detectors.
A-33-year-old man, Gordon Edward Thompson, was remanded into custody at Croydon Magistrates Court charged with setting fire to a department store that had been in business since 1867 and run by five generations of the same family.
Cameron spoke with the store owner Maurice Reeves, and said Monday he had described "a hundred years of hard work, burned to the ground in a few hours."
In Birmingham, where hundreds of Asian, black and white locals held a peace rally on Sunday, two men and a teenage boy appeared in court Monday charged with murdering three Pakistani men run over and killed during last week's riots.
Haroon Jahan, 20, and brothers Shazad Ali, 30, and Abdul Musavir, 31, died Wednesday after a car struck them at high speed as they guarded shops in west Birmingham, 120 miles (190 kilometers) northwest of London.
The attack raised fears of gang warfare between the area's South Asian and Caribbean gangs because residents identified the car-borne assailants as black. But public appeals for no retaliation, particularly from one victim's father, Tariq Jahan, have helped keep passions at bay.
England's gang-fueled rioting began in London Aug. 6 and spread to several other English cities. Police were criticized for responding too slowly, particularly in London, but eventually deployed huge numbers of officers at riot zones to quell the mayhem.
The Association of British Insurers has estimated the cost from wrecked and stolen property at 200 million pounds ($326 million) but expects the total to rise.
Police were on Monday questioning two men over the fatal shooting of a 26-year-old man during riots in Croydon, south London. Officers were also interviewing a 16-year-old boy arrested Sunday night on suspicion of fatally beating a 68-year-old man who had tried to put out a fire set by rioters in Ealing, west London.
Across the country, about 1,400 people have been charged so far with riot-related offenses and thousands have been arrested. Several courts opened Sunday for the first time in modern history to try to reduce the backlog of cases.
London's police said in the capital alone, a total of 1,593 people had been arrested and 926 charged with offenses.


The past couple of weeks have provided no shortage of drama: the debt-ceiling debate, a ratings downgrade of the U.S., questions about European banks and wild swings in the stock market.
It all makes for a lot of sleepless nights.
Given all the tumult, how can we add more sheep to our evenings? Ultimately, a smart, long-term investment strategy should enable us to weather -- and even take advantage -- of these kinds of storms.
So, how to get there? A lot of times, sitting tight is the best strategy. Anyone trying to time the enormous swings of the past several days has probably discovered that's not very easy. Still, doing nothing doesn't always make us feel more secure.
Here, then, are five strategies that might give you more calm without upending your portfolio.
Examine the amount of cash in your portfolio. Having a rainy-day fund when the world is a bit bonkers helps soothe frayed nerves. A good rule of thumb is to have enough cash on hand to handle about four to six months of your living expenses in case you lose your job.
That may sound like a lot of money, but with so much economic uncertainty in the air, having a cushion makes more sense than ever. If you are light on cash, there are three things to consider.
First, you can sell into market rallies to improve your cash position. We've had several big moves up in the past two weeks, along with several nasty moves lower. We can expect more volatility in the future, so take advantage of the upward swings to ensure you have a good cash position.
Second, you might have some large losses that aren't bouncing back with the broader market when it does rally. You can sell those shares at a loss, and use those losses to offset capital gains when you sell your winners.
Third, gasoline prices will be lower in the coming months. Use the difference in gasoline prices to add to savings. Pretend gasoline is still near $4, so that when you are filling the tank at $3, you devote that extra dollar to building your cash position, rather than spending it on something else.
These companies aren't sexy, but they are steady. Ensuring that you have exposure to this sector will reduce the ups and downs in your investment holdings. The Dow Jones Utility Average has gyrated, along with the rest of the market, but its moves have been smaller.
Moreover, utilities generally provide strong dividend yields, and unlike the yields of nonutility companies, they are historically very dependable. So, even as the utility stocks swoop and fall like other stocks, you can still count on the dividend income, which can provide a bit of solace.
Other dividend-payers
While a bit riskier that utilities, some very large companies with solid track records are paying nice dividends. Among them are Merck (MRK: 31.34, 0.14, 0.45%) (4.9%), Pfizer (PFE: 17.86, 0.05, 0.28%) (4.5%), Johnson & Johnson (JNJ:63.36, -0.08, -0.13%) (3.7%), Verizon (VZ: 34.30, -0.32, -0.92%) (5.7%) andAT&T (T: 28.22, -0.22, -0.77%) (6%).
Not terribly sexy, and there's a chance these stocks could keep trading in a volatile manner. But as with utilities, you get a little income that helps make the pain more bearable.
Gold, which usually jumps when stocks swoon, has shot sharply higher during the latest bout of volatility. Gold has usually jumped when stocks have swooned. That inverse behavior provides a hedge for the rest of your portfolio.
Now, some believe gold may have gotten ahead of itself. It fell sharply on Thursday, for instance, as the stock market raced higher. Still, many elements that support gold remain in place. Difficult fiscal challenges in the U.S. and Europe. A weak dollar. The Fed not raising interest rates until 2013. Uncertainty about the economy. All still there. Gold, like stocks and bonds, will probably continue to bounce around, so don't overplay your gold hand.
If the crazy market and the related economic and political mayhem has you thinking about a drink or grabbing a smoke, you're not alone. It seems that vice does fairly well when everything else is going haywire.
Diageo (DEO: 76.91, 1.75, 2.33%), a big drink company, SABMiller andAnheuser-Busch Inbev (BUD: 54.58, 3.07, 5.96%) have held up better than other stocks, and Diageo pays a decent 2.7% dividend.
Smoke stocks have also done decently. Altria (MO: 25.20, 0.24, 0.96%) is not far off its 52-week high and it sports a hefty 6% dividend. Philip Morris International(PM: 66.63, 1.08, 1.65%), with a 3.7% dividend, hasn't done as well as Altria, but it remains a strong vice play during the current turmoil. The upside may be limited, but they have recently proven their sturdiness.
Lastly, once you feel like you've positioned your portfolio, including your cash position, for a bit more peace of mind, you can then start to think in a more clear-headed manner about opportunities that might present themselves. When panic moves occur, as we've seen on a number of occasions during the past two weeks, values can emerge.
Some stocks with strong prospects that have gotten a lot cheaper include Apple(AAPL: 376.99, 3.29, 0.88%), Caterpillar (CAT: 89.81, 2.56, 2.93%) and General Electric (GE: 15.88, 0.20, 1.28%). It is probably not the best time to be figuring out how to call a bottom in the banking sector, but there are a lot of strong companies that look better than they did two weeks ago.


Richard Ross is resisting the urge to say it, so we'll say it for him. He told you so.
Ross works at the brokerage firm Auerbach Grayson as a "global technical strategist" -- Wall Street jargon for someone who looks at trading patterns and tells clients which investments are good (or bad) bets. With assets of all kinds having soared of late, everything seemed a little pricey to Ross. But one investment in particular caught his eye: silver. Fueled by inflation fears, the metal's price had shot up 170 percent in less than a year; it was rapidly approaching $50 per troy ounce, a price not seen since right before Ronald Reagan's first term. "It's a classic bubble," Ross thought. So late last spring Ross released a research report titled "Silver: Taking Our Chips off the Table."

400 Years of Bubbles

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Two memorable things happened after Ross issued his report. First, he got an e-mail the next day from a reader, with the subject heading "Richard Ross the Dumb---!" Second: Over a two-week stretch starting just after his report came out, the price of silver plummeted almost 30 percent.
You'd think all investors over the age of 25 would, by now, have had the concept of bubbles seared into their brains. Those who didn't get zapped in the tech-stock meltdown almost certainly lost a few layers of skin in the U.S. real estate bubble and the crisis that followed. But it turns out, even painful crashes haven't stopped buyers from driving other assets into bubble land -- at least if you use bubble to describe investments whose prices are higher than fundamentals like supply and demand dictate they should be. And startlingly, some observers say bubbles are forming with more frequency than ever. The $108 billion investment-management firm GMO says an asset reaches bubble territory only when its price far exceeds the historical average. This happens to a typical asset once every 30 years, but the past decade or so has been unusually bubble-rich, with a new one appearing every three or four years. "They occur in bunches, and recently there have been more," says Jeremy Grantham, GMO's chief investment strategist.
Today there are plenty of suspects for a bubblephobe to be wary of -- whether it's the stock market (still up more than 75 percent since its 2009 low), bonds (more expensive than they've ever been by some measures) or gold (worth more than six times as much as in 2000). Experts have various theories on why price run-ups are proliferating. Exchange-traded funds -- groups of assets bundled to trade like a single stock -- have made it easier for performance chasers to buy the hot investment du jour (drawing newbies into silver and gold, for example). Improved technology lets investors move in and out of assets faster, creating bigger price swings. And the financial crisis, itself the spawn of a bubble in housing, has had unanticipated side effects: Investors looking for safe assets flooded into bonds, for instance, driving bond prices into potentially dangerous territory and leaving the investors vulnerable to the potential effects of a downgrade in the federal government's credit rating.
See a bubble, walk the other way -- what's so complicated about that? Plenty, it turns out. It's all but impossible to spot a bubble before it collapses, and experts seldom agree about whether a given investment fits the bill; one analyst's catastrophe-in-the-making is another's new normal. Recently, corporate profits have soared and demand for commodities has rebounded -- both sound reasons why stock and commodity prices should be higher. Plus, values of all kinds of assets tend to move in cycles, so even a sharp slump could be completely ordinary, says Kevin Mahn, chief investment officer of Hennion & Walsh, which manages $2 billion. There's also the risk of fleeing an investment too soon, since bubbles can be profitable on the way up. Legendary speculator George Soros said at the beginning of 2010 that he believed gold was in a bubble, but he waited more than a year before selling off his own big stake.
Of course, whether an asset is officially in a bubble is irrelevant. Selling an overvalued investment before it falls is always a good move -- and so is figuring out which other industries can benefit when a bubble bursts. Here, a look at five assets whose recent price trends have led people to use the B word.
Illustrations by Ryan Etter for SmartMoney. 
Graphics by Emily Cooper for SmartMoney.