DNA Analysis, More Accessible Than Ever, Opens New Doors

Matt Roth for The New York Times

Sam Bosley of Frederick, Md., going shopping with his daughter, Lillian, 13, who has a malformed brain and severe developmental delays, seizures and vision problems. More Photos »

Debra Sukin and her husband were determined to take no chances with her second pregnancy. Their first child, Jacob, who had a serious genetic disorder, did not babble when he was a year old and had severe developmental delays. So the second time around, Ms. Sukin had what was then the most advanced prenatal testing.

The test found no sign of Angelman syndrome, the rare genetic disorder that had struck Jacob. But as months passed, Eli was not crawling or walking or babbling at ages when other babies were.

“Whatever the milestones were, my son was not meeting them,” Ms. Sukin said.

Desperate to find out what is wrong with Eli, now 8, the Sukins, of The Woodlands, Tex., have become pioneers in a new kind of testing that is proving particularly helpful in diagnosing mysterious neurological illnesses in children. Scientists sequence all of a patient’s genes, systematically searching for disease-causing mutations.

A few years ago, this sort of test was so difficult and expensive that it was generally only available to participants in research projects like those sponsored by the National Institutes of Health. But the price has plunged in just a few years from tens of thousands of dollars to around $7,000 to $9,000 for a family. Baylor College of Medicine and a handful of companies are now offering it. Insurers usually pay.

Demand has soared — at Baylor, for example, scientists analyzed 5 to 10 DNA sequences a month when the program started in November 2011. Now they are doing more than 130 analyses a month. At the National Institutes of Health, which handles about 300 cases a year as part of its research program, demand is so great that the program is expected to ultimately take on 800 to 900 a year.

The test is beginning to transform life for patients and families who have often spent years searching for answers. They can now start the grueling process with DNA sequencing, says Dr. Wendy K. Chung, professor of pediatrics and medicine at Columbia University.

“Most people originally thought of using it as a court of last resort,” Dr. Chung said. “Now we can think of it as a first-line test.”

Even if there is no treatment, there is almost always some benefit to diagnosis, geneticists say. It can give patients and their families the certainty of knowing what is wrong and even a prognosis. It can also ease the processing of medical claims, qualifying for special education services, and learning whether subsequent children might be at risk.

“Imagine the people who drive across the whole country looking for that one neurologist who can help, or scrubbing the whole house with Lysol because they think it might be an allergy,” said Richard A. Gibbs, the director of Baylor College of Medicine’s gene sequencing program. “Those kinds of stories are the rule, not the exception.”

Experts caution that gene sequencing is no panacea. It finds a genetic aberration in only about 25 to 30 percent of cases. About 3 percent of patients end up with better management of their disorder. About 1 percent get a treatment and a major benefit.

“People come to us with huge expectations,” said Dr. William A. Gahl, who directs the N.I.H. program. “They think, ‘You will take my DNA and find the causes and give me a treatment.' ”

“We give the impression that we can do these things because we only publish our successes,” Dr. Gahl said, adding that when patients come to him, “we try to make expectations realistic.”

DNA sequencing was not available when Debra and Steven Sukin began trying to find out what was wrong with Eli. When he was 3, they tried microarray analysis, a genetic test that is nowhere near as sensitive as sequencing. It detected no problems.

“My husband and I looked at each other and said, ‘The good news is that everything is fine; the bad news is that everything is not fine,' ” Ms. Sukin said.

In November 2011, when Eli was 6, Ms. Sukin consulted Dr. Arthur L. Beaudet, a medical geneticist at Baylor.

“Is there a protein missing?” she recalled asking him. “Is there something biochemical we could be missing?”

By now, DNA sequencing had come of age. Dr. Beaudet said that Eli was a great candidate, and it turned out that the new procedure held an answer.

A single DNA base was altered in a gene called CASK, resulting in a disorder so rare that there are fewer than 10 cases in all the world’s medical literature.

“It really became definitive for my husband and me,” Ms. Sukin said. “We would need to do lifelong planning for dependent care for the rest of his life.”

This article has been revised to reflect the following correction:

Correction: February 20, 2013

An article on Tuesday about the use of DNA sequencing to identify rare genetic diseases misstated the name of a medicine taken by two teenagers who have a rare gene mutation. The drug is 5-hydroxytryptophan, not 5-hydroxytryptamine.

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Anthem halts plan to require some drug purchases by mail

Anthem Blue Cross is backing off a decision to require some policyholders to buy their prescription drugs from a single mail-order pharmacy — a requirement that the California attorney general's office said may be illegal.

Anthem, California's largest for-profit health insurer, said in November that it was imposing the new rule for so-called specialty medications used to treat major illnesses, such as cancer and HIV/AIDS. The company said the limitation would help keep costs down for patients and businesses.

That may indeed be true. But as I reported last month, California's Unruh Civil Rights Act (Section 51 of the Civil Code) specifies that all people must be treated equally "no matter what their sex, race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status or sexual orientation."

In response, California Atty. Gen. Kamala D. Harris said that any rule that forces some people to buy their meds from one drugstore but allows others to shop elsewhere could violate the law.

"California law clearly states that no one can be discriminated against because of a medical condition," said Lynda Gledhill, a spokeswoman for Harris. "If patients are being required to get their prescriptions from a certain pharmacy because of their condition, that is likely illegal."

Anthem is now notifying people who take specialty medications that it won't require them to buy their drugs from the online pharmacy CuraScript starting March 1, as originally planned.

"Because Anthem has received feedback about this specialty pharmacy program from its members, we are evaluating that input to better serve our members and, for the time being, have eliminated the stated March 1, 2013, required date to use CuraScript for such additional specialty medications," the insurer said in its letter.

Darrel Ng, an Anthem spokesman, said the insurer believes the new requirement is legal. He said the company is only postponing the rule, rather than abandoning it.

"In response to feedback that has been conveyed by our members, which we are in the process of evaluating, we are delaying the March 1 changes in the specialty pharmacy program," Ng said. "We value the input of our members."

He declined to say when Anthem may again try to implement the requirement.

David Balto, former policy director for the Federal Trade Commission, said Anthem will have to make significant changes if it hopes to avoid legal action by Harris' office.

"They recognized that the policy violated the law," he said. "Consumers and pharmacies drew a line in the sand, and Anthem backed down."

Balto, who now works as a Washington antitrust attorney, was retained by retail drugstores to challenge the specialty-med requirement.

Anthem also faces a class-action lawsuit filed by the Santa Monica advocacy group Consumer Watchdog. It alleges that the insurer's policy switch would endanger people with HIV/AIDS by denying them the opportunity to interact with a pharmacist about their medication.

"Blue Cross' announcement is a big relief to HIV/AIDS patients who had a gun to their head to cut off contact with their local pharmacist," said Jerry Flanagan, staff attorney for Consumer Watchdog.

Sections 54 and 55 of the Civil Code state that people with disabilities or medical conditions "have the same right as the general public to the full and free use of the streets, highways, sidewalks, walkways, public buildings [and] medical facilities, including hospitals, clinics and physicians' offices."

Section 12926.1 of the California Government Code specifies that "physical and mental disabilities include, but are not limited to, chronic or episodic conditions such as HIV/AIDS, hepatitis, epilepsy, seizure disorder, diabetes, clinical depression, bipolar disorder, multiple sclerosis and heart disease."

In its first notices to people using specialty meds, Anthem said that "using a retail pharmacy will be considered going out-of-network."

It warned such people that the only way to receive coverage for their drugs would be to shop at CuraScript. Buying medication elsewhere would require them to pay the full cost, Anthem said.

The price of specialty medications can run in the thousands of dollars. Anthem's requirement thus would have forced a specific group of people to buy their drugs at the pharmacy of Anthem's choosing.

Other people with chronic conditions such as diabetes faced no such requirement. It was this seemingly inconsistent approach to drug coverage that raised a red flag for the attorney general's office.

Experts said Anthem was correct in arguing that prices for specialty meds can be better controlled by cutting deals with a single pharmacy. But this placed the interests of the insurer and the pharmacy ahead of those of the patient.

A more equitable solution may be for Anthem to allow people to buy their drugs anywhere, but to offer a discount for drugs purchased from CuraScript. This would provide an opt-out of the CuraScript requirement.

This may not provide as much cost savings as limiting all coverage to CuraScript, but it would likely make the attorney general a whole lot happier.

David Lazarus' column usually runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to david.lazarus@latimes.com.

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Pathway to citizenship likely to be rocky

Los Angeles Times

WASHINGTON — When Jessica Bravo came here this month to talk to her congressman, Rep. Dana Rohrabacher (R-Huntington Beach), about expanding rights for illegal immigrants, their meeting ended in a shouting match and tears.

Bravo, an 18-year-old community college student at Golden West College in Huntington Beach, was smuggled over the border from Mexico by her parents when she was 3. She recently joined hundreds of other young illegal immigrants in a campaign to confront members of Congress and ask them to vote for a pathway to citizenship for 11 million illegal immigrants.

"I just wanted him to know who I was," Bravo said of Rohrabacher, who has a long record of voting against such measures.

In the scheduled meeting with Rohrabacher, Bravo said the congressman stiffened when she said she and her parents came to the U.S. unlawfully. Five minutes into the meeting, Rohrabacher's face turned red, she said, adding that he said he represents citizens and hates illegals.

Rohrabacher disputed her account and said the meeting became heated when a community organizer with Bravo implied he was racist.

"I don't hate anyone," Rohrabacher said in a telephone interview. "Just because you are a wonderful person doesn't mean you deserve to be an American citizen."

Over the next few months, hundreds of illegal immigrants are planning to come to Washington to push for an overhaul of immigration laws. Despite signs that GOP leaders want to change the party's approach to the issue, many of the immigrants will face lawmakers who have long-standing positions against a legalization program.

"We will engage them regardless of their voting record," said Maria Fernanda Cabello, a national organizer for United We Dream, an organization that represents young undocumented immigrants who were brought to the U.S. unlawfully as children.

The organization's members last fall voted to expand its mission beyond passing the Dream Act and decided to push for the broader objective of making it possible for illegal immigrants to become citizens. In March, the group is planning to launch protests in 23 states under the slogan "Eleven Million Dreams."

"We will keep including our parents," said Cabello, whose mother works at a fast-food restaurant in Houston and whose father is a welder. Both are undocumented. Cabello, who came to Texas with her parents when she was 12, was granted a legal work permit in the fall under the Obama administration's "deferred action" program.

"All they are saying is, 'My dream is based on my mom and my dad and my family,'" said Rep. Luis Gutierrez (D-Ill.), who plans to join rallies in New Jersey, Florida, Texas and California in March to push for full citizenship for such residents.

Dozens of organizations that represent illegal immigrants have come together to declare March "National Coming Out of the Shadows Month." Protests are planned for next month in Los Angeles, Chicago, Philadelphia, New York City and Atlanta.

Groups of lawmakers from both parties in the House and the Senate are working behind closed doors to hammer out a bill. A bipartisan group of eight senators has agreed that citizenship must be part of the solution, along with more investment in border security. In the House group, however, some Republicans are considering a program that would legalize illegal immigrants without creating a new way for them to become citizens.

"The people that came here illegally knowingly — I don't think they should have a path to citizenship," Rep. Raul Labrador (R-Idaho) said during a radio interview earlier this month. Labrador, one of two members of the House from Idaho, has been working with the House group to draw up legislation.

"That is not going to fly with us," said Louie Cortes, a 24-year-old law student at the University of Idaho. Cortes was brought to the U.S. unlawfully from Mexico by his parents when he was 1 year old. He was given a work permit in December.

The Idaho agricultural industry relies on illegal immigrants for a lot of its workforce, said Cortes, who is a member of the Dream Bar Assn., an organization of law students who are illegal immigrants. Over the next few weeks, Cortes plans to help organize workers in apple orchards, dairy farms and meat processing plants to launch public rallies in the state.

"Not having the full pathway to citizenship will still deny a lot of immigrants the benefits of being here — like voting," said Cortes.

brian.bennett@latimes.com

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Fergie, Josh Duhamel expecting their 1st child

NEW YORK (AP) — Her hump, her hump, her lovely lady lump: Fergie is pregnant with her first child.

A representative for the Black Eyed Peas singer confirmed the news Monday. Fergie's actor husband Josh Duhamel tweeted about the news with joy, saying: "Fergie and Me and BABY makes three."

The 37-year-old Fergie and 40-year-old Duhamel married in 2009. She joined the Black Eyed Peas when the group released its third album, "Elephunk," in 2003. The foursome is known for its pop-inspired hip-hop tunes like "My Humps," ''I Gotta Feeling" and "Boom Boom Pow."

Fergie launched her solo debut, "The Duchess," to much success in 2006. It featured five Top 5 hits, including "Fergalicious" and "Big Girls Don't Cry."

Duhamel has appeared in the "Transformer" films and most recently in "Safe Haven."

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National Briefing | South: Abortion Curbs Clear Senate in Arkansas

The State Senate voted 25 to 7 on Monday to ban most abortions 20 weeks into a pregnancy. The measure goes back to the House to consider an amendment that added exceptions for rape and incest. The legislation is based on the belief that fetuses can feel pain 20 weeks into a pregnancy, and is similar to bans in several other states. Opponents say it would require mothers to deliver babies with fatal conditions. Gov. Mike Beebe has said he has constitutional concerns about the proposal but has not said whether he will veto it.

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Consumers need better way to fix credit reporting errors

About 10 million consumers, through no fault of their own, have serious errors on their credit reports, raising troubling questions about people's ability to secure loans and the fairness of interest rates they're charged.

In the first study of its kind, the Federal Trade Commission looked at credit reports for 1,001 consumers obtained from the three major credit bureaus — Experian, Equifax and TransUnion.

It found that about a quarter of consumers had at least one "potentially material" error in at least one of the three reports. Such errors included the number of credit-card or mortgage payments a consumer was believed to have missed or the number of loans that were sent to collection agencies.

"We're talking about folks who could have gone into a better credit tier if these errors had been corrected," Paul Pautler, deputy director of the FTC's Bureau of Economics, told me.

These findings are outrageous enough. But they also highlight the shadowy nature of the credit reporting industry, a business with the power to make or break your creditworthiness without ever being required to obtain your permission to compile and sell files on your financial affairs.

And in the digital age, with thousands of corporate databases up for grabs, it's become all too easy for these companies to traffic in garbage information. Again, all without your approval.

"It's unconscionable that 40 million Americans have errors in their credit reports and that 10 million have errors grave enough to cause them to be denied or charged more for credit or insurance or even be denied a job," said Chi Chi Wu, staff attorney at the National Consumer Law Center.

"There needs to be serious and wholesale reform of the credit reporting industry," he said.

Will there be? I put that question to Pautler.

"That's above my pay grade," he replied.

I'm guessing the more than $2 million that Experian, Equifax and TransUnion spent on lobbying last year alone will have some sway over any crackdown on the industry. Political expenditures by the companies were compiled by the Center for Responsive Politics, a watchdog group.

Meantime, people like Deborah Carter of Huntington Beach will continue banging their heads against the credit reporting industry.

When her son recently received an unexpectedly high interest rate to refinance his mortgage, Carter, 58, delved into his credit files and discovered that both Equifax and Experian had lowered his credit score because of seemingly missed payments.

She said Equifax's files showed "recent delinquencies reported on accounts." Experian cited "too many delinquent accounts."

In fact, Carter said, her son had only one missed payment on a single loan six years ago. Yet when she tried to clear things up with Equifax and Experian, she got nowhere. Similarly, complaining to the FTC only produced an acknowledgment of her dispute.

"I've done everything I'm supposed to do as a consumer," Carter said, "and my son has the same credit score and the same inaccurate information."

So how did the credit reporting industry gain so much clout? To understand that, you have to go all the way back to 1898.

That's when a Tennessee grocer named Cator Woolford oversaw creation of a list of customers, including indications of their creditworthiness, for a local grocers' association. It didn't take long for other merchants to express interest in buying the list, and Woolford soon went into the credit reporting business full time.

By 1901, Woolford's Retail Credit Co. was also supplying data to the insurance industry. The company continued to grow over the years and to acquire rival businesses. In 1979, it changed its name to what we know today as Equifax.

TransUnion was born in 1968 as the holding company for Union Tank Car Co., which leased rail cars to other businesses. The company got into the credit reporting game a year later by acquiring the Credit Bureau of Cook County in Chicago, followed by the acquisition of other local credit bureaus nationwide.

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Seawater desalination plant might be just a drop in the bucket

CARLSBAD, Calif. — Dreamers have long looked to the Pacific Ocean as the ultimate answer to California's water needs: an inexhaustible, drought-proof reservoir in the state's backyard. In the last decade, proposals for about 20 desalting plants have been discussed up and down the coast.

But even with construction about to begin on the nation's largest seawater desalination facility, 35 miles north of San Diego, experts say it is doubtful that dream will ever be fully realized.

"While this Poseidon adventure may work out, I don't look for a lot of that," said Henry Vaux Jr., a UC Berkeley professor emeritus of resource economics who contributed to a 2008 National Research Council report on desalination.

The reasons boil down to money and energy. It takes a lot of both to turn ocean water into drinking water, driving the average price of desalinated supplies well above most other sources.

The purified water produced by the Poseidon Resources plant will cost the San Diego County Water Authority more than twice what it now pays the Metropolitan Water District of Southern California for supplies from Northern California and the Colorado River. Over the authority's 30-year contract with Poseidon, San Diego County ratepayers will pay between $3 billion and $4 billion for the desalted water, which is expected to provide no more than a tenth of their overall supply.

Seawater desalination is not new to California. There are number of small coastal plants, used mostly for research or industrial purposes, and a few, such as one on Catalina Island, that provide municipal supplies.

For reasons unique to the region, San Diego County will be the first to stick a big straw into the Pacific. It is at the end of the line for imported water, doesn't have much local groundwater and is perennially battling with Metropolitan, Southern California's wholesaler of imported supplies.

"I do believe it is worth it," said Tom Wornham, board chairman of the county water authority. "I would rather be apologizing to people in 10 years for the rate than the fact they would have no water."

Up the coast, other places have taken a pass on the Pacific. Los Angeles and Long Beach recently shelved seawater desalting plans after concluding that other water sources, such as conservation or recycling, are cheaper and easier to pursue.

Poseidon, a small, privately held company based in Stamford, Conn., started talking about developing a desalination plant in Carlsbad in late 1998. The road to construction has been so long and twisting that Global Water Intelligence, which covers the international water industry, last year listed the project among the "Top 10 Desalination Disasters" of all time.

It took years for the company to get the necessary state and local permits. Environmentalists filed multiple legal challenges, the last of which was only recently resolved in Poseidon's favor. A deal with a number of local water agencies in San Diego County fell apart.

In the end, the Poseidon supplies — up to 56,000 acre-feet a year — will sell for roughly $2,000 an acre-foot, more than double the company's 2004 estimate. (One acre-foot is enough to supply two average homes for a year.) The price will rise with inflation; if energy costs go up, so will the price of water.

On the other side of the Pacific, Australia offers a sobering lesson in the perils of diving too deeply into desalination.

When years of withering drought emptied the country's reservoirs, Australia commissioned six big coastal desalting plants, including some of the world's largest. Then the rains returned. Just as some of the operations were coming on line, they were no longer needed.

Four of the six plants are being idled because cheaper water is available. Australian politicians are bemoaning the desalination binge, complaining that it saddled ratepayers with "hyper-expensive" white elephants they have to pay for regardless of whether the plants are used.

"That's certainly the risk — that we build them when they're not necessary or we build them, frankly, too soon," said Heather Cooley of the Pacific Institute, an Oakland think tank.

Santa Barbara had a similar experience in the early 1990s, when it built a desalination plant during a severe statewide drought that ended before the facility was finished. The $34-million plant, with a tenth of the capacity of the Carlsbad facility, was never used beyond the testing phase, though it could still be brought into service in an emergency.

The $954-million Carlsbad project is being financed with $781 million in tax-exempt construction bonds sold by Poseidon and the water authority. The balance is coming from investors who anticipate a return of about 13%. IDE Americas Inc., the subsidiary of an Israeli firm that runs some of the world's largest coastal desalination facilities in the Middle East, has been hired to design and operate the plant, slated for completion in 2016.

The fresh water will be produced through reverse osmosis, an energy-intensive process that separates salts and contaminants from seawater by forcing it through sand filters and tightly coiled, synthetic membranes peppered with billions of tiny holes a fraction of the width of a human hair. The water will then be pumped inland for distribution — the opposite direction that drinking supplies are usually moved — requiring construction of a 10-mile underground pipeline that the water authority will own and operate.

Poseidon chose the Carlsbad location, next to the Encina Power Station, so it could draw from the power plant's cooling water discharge — thus avoiding the environmental harm of operating its own ocean intake.

But new federal and state environmental regulations are pushing coastal power plants to phase out the use of huge volumes of ocean water for cooling, thwarting that strategy. Poseidon expects the Encina station to be replaced within the decade with a new generating facility employing a different cooling system.

That will mean the desalter will have to pump directly from the ocean, sucking 300 million gallons a day. Of that, 100 million gallons will go through the reverse osmosis process, with half converted to fresh water and half to a concentrated brine. The brine, twice as salty as the sea, will be diluted in a mixing pool with the other 200 million gallons of intake and discharged to the ocean.

Destruction of marine life is a major environmental concern of ocean desalination. Raw seawater is full of tiny organisms, including plankton that form a critical part of the food chain and the young stages of fish and invertebrates. When the water they live in is pumped into a plant, they die.

The Coastal Commission is requiring Poseidon to restore 55 acres of marine wetlands in south San Diego Bay to compensate for the plant's projected effects. The State Water Resources Control Board is also developing new seawater desalination regulations that could force Poseidon to change its intake and discharge systems.

"They took a big risk in building this before the rules are finalized," said Joe Geever of the Surfrider Foundation, which tenaciously fought the Carlsbad proposal in court and argues that water agencies should turn to the ocean only as a last resort — after more environmentally benign sources such as recycling and storm-water capture have been aggressively pursued.

Poseidon, which is trying to line up customers for a similar-size desal plant proposed in Huntington Beach, says it is peddling more than water. "What we're selling is ... a reliability premium that's locally controlled, drought-proof," said Carlos Riva, the company's chief executive.

But even Poseidon doesn't predict that the Pacific will become California's dominant water supply. The state has too many other sources.

"We have quite a bit of water to move around," said Peter MacLaggan, the Poseidon executive who is overseeing the Carlsbad project. "I don't think it's ever going to be a majority of supply or anywhere close to that."

bettina.boxall@latimes.com

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Sheriff: Mindy McCready had apparently shot self

HEBER SPRINGS, Ark. (AP) — Mindy McCready, who hit the top of the country charts before personal problems sidetracked her career, died Sunday. She was 37.

A news release from the Cleburne County Sheriff's Office says that McCready, 37, was found dead Sunday afternoon with what appears to be a single, self-inflicted wound.

Deputies were sent to a home around 4 p.m. and found her body on the front porch. An autopsy is pending.

Coroner Waren Olmstead said he didn't have further information on who was taking care of her two sons.

She arrived in Nashville in 1994 with tapes of her karaoke vocals and earned a recording contract with BNA Records.

In 1996, her "Guys Do It All the Time" hit No. 1 and its dig at male chauvinism endeared her to females. Her other hits included "Ten Thousand Angels," also in 1996, and her album by that title sold 2 million copies.

However, personal problems plagued her beginning in 2004 and included a custody battle with her mother over one of her sons.

McCready took her older son Zander from her mother and the boy's legal guardian, Gayle Inge, in late 2011. She fled to Arkansas without permission over what she called child abuse fears. Authorities eventually found McCready hiding in a residence without permission and took the boy into custody.

She and her boyfriend David Wilson had a son, Zayne, in April of 2012. The older son has a different father.

In May 2010, she was hospitalized briefly after police responded to an overdose call at a home in North Fort Myers, Fla., owned by her mother. This followed a stint on "Celebrity Rehab With Dr. Drew," where she delcared herself clean from drugs.

In 2004, she was charged with obtaining the painkiller OxyContin fraudulently at a pharmacy. She pleaded guilty and was placed on three years' probation.

She violated the probation with a drunken driving arrest in May 2005. Then she attempted suicide in July 2005, overdosed in September 2005 and slit her wrists again in December 2008.

Also that year, McCready was charged in Arizona with hindering prosecution and unlawful use of transportation. Those charges stemmed from an alleged attempt in June 2005 to purchase two high performance boats, but she claimed she was trying to stop a con man.

She made headlines again in April 2008 when she acknowledged a longtime relationship with baseball great Roger Clemens. Published reports at the time said she met the pitcher at a Florida karaoke bar when she was 15 and he was 28 and married.

Growing up in Fort Myers, she took seven years of private vocal lessons and later sang in karaoke bars.

After getting her recording contract, she did concert appearances with top country stars including George Strait, Tim McGraw and Alan Jackson.

Her other singles included "Maybe He'll Notice Her Now," ''A Girl's Gotta Do (What a Girl's Gotta Do)" and "You'll Never Know."

In 1998, she was engaged to actor Dean Cain, but they apparently never married.

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Project Seeks to Build Map of Human Brain

The Obama administration is planning a decade-long scientific effort to examine the workings of the human brain and build a comprehensive map of its activity, seeking to do for the brain what the Human Genome Project did for genetics.

The project, which the administration has been looking to unveil as early as March, will include federal agencies, private foundations and teams of neuroscientists and nanoscientists in a concerted effort to advance the knowledge of the brain’s billions of neurons and gain greater insights into perception, actions and, ultimately, consciousness.

Scientists with the highest hopes for the project also see it as a way to develop the technology essential to understanding diseases like Alzheimer’s and Parkinson’s, as well as to find new therapies for a variety of mental illnesses.

Moreover, the project holds the potential of paving the way for advances in artificial intelligence.

The project, which could ultimately cost billions of dollars, is expected to be part of the president’s budget proposal next month. And, four scientists and representatives of research institutions said they had participated in planning for what is being called the Brain Activity Map project.

The details are not final, and it is not clear how much federal money would be proposed or approved for the project in a time of fiscal constraint or how far the research would be able to get without significant federal financing.

In his State of the Union address, President Obama cited brain research as an example of how the government should “invest in the best ideas.”

“Every dollar we invested to map the human genome returned $140 to our economy — every dollar,” he said. “Today our scientists are mapping the human brain to unlock the answers to Alzheimer’s. They’re developing drugs to regenerate damaged organs, devising new materials to make batteries 10 times more powerful. Now is not the time to gut these job-creating investments in science and innovation.”

Story C. Landis, the director of the National Institute of Neurological Disorders and Stroke, said that when she heard Mr. Obama’s speech, she thought he was referring to an existing National Institutes of Health project to map the static human brain. “But he wasn’t,” she said. “He was referring to a new project to map the active human brain that the N.I.H. hopes to fund next year.”

Indeed, after the speech, Francis S. Collins, the director of the National Institutes of Health, may have inadvertently confirmed the plan when he wrote in a Twitter message: “Obama mentions the #NIH Brain Activity Map in #SOTU.”

A spokesman for the White House Office of Science and Technology Policy declined to comment about the project.

The initiative, if successful, could provide a lift for the economy. “The Human Genome Project was on the order of about $300 million a year for a decade,” said George M. Church, a Harvard University molecular biologist who helped create that project and said he was helping to plan the Brain Activity Map project. “If you look at the total spending in neuroscience and nanoscience that might be relative to this today, we are already spending more than that. We probably won’t spend less money, but we will probably get a lot more bang for the buck.”

Scientists involved in the planning said they hoped that federal financing for the project would be more than $300 million a year, which if approved by Congress would amount to at least $3 billion over the 10 years.

The Human Genome Project cost $3.8 billion. It was begun in 1990 and its goal, the mapping of the complete human genome, or all the genes in human DNA, was achieved ahead of schedule, in April 2003. A federal government study of the impact of the project indicated that it returned $800 billion by 2010.

The advent of new technology that allows scientists to identify firing neurons in the brain has led to numerous brain research projects around the world. Yet the brain remains one of the greatest scientific mysteries.

Composed of roughly 100 billion neurons that each electrically “spike” in response to outside stimuli, as well as in vast ensembles based on conscious and unconscious activity, the human brain is so complex that scientists have not yet found a way to record the activity of more than a small number of neurons at once, and in most cases that is done invasively with physical probes.

But a group of nanotechnologists and neuroscientists say they believe that technologies are at hand to make it possible to observe and gain a more complete understanding of the brain, and to do it less intrusively.

In June in the journal Neuron, six leading scientists proposed pursuing a number of new approaches for mapping the brain.

One possibility is to build a complete model map of brain activity by creating fleets of molecule-size machines to noninvasively act as sensors to measure and store brain activity at the cellular level. The proposal envisions using synthetic DNA as a storage mechanism for brain activity.

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A secret agent reveals her secrets of success

The prospect of a business book written by a former CIA officer fills one with dread at the inevitable 007 anecdotes and labored corporate parallels.

But "Work Like a Spy: Business Tips From a Former CIA Officer," published by Portfolio, turns out to be rather different. There are no gadgets, few cloaks and fewer daggers: Instead it is a bracingly realistic book about people at work. It is short. It is sharp. Better still, it is sensible.

It is also about spying, though only enough to lend a sprinkle of glamour and danger. The book jacket photo shows author J.C. Carleson, an undercover agent for eight years, looking like a real-life Carrie from "Homeland" — without the blond hair and the bipolar disorder.

Yet her stories from the field are as much blunder as conspiracy. The book opens with the heroine as a young case officer in an armed convoy in Iraq. It is 2003 and she is going to inspect a plant that the U.S. is convinced makes biological weapons. They disarm the guards and terrify everyone — only to discover it is a salt factory.

"Salt. (Insert your own expletive of choice here.) Salt!" she writes.

Carleson assures us that not all CIA work is suitable for general adoption: The threatening, lying, trapping, cheating, misleading and detaining that go with the territory should not be tried in the office.

But the spy can teach the general manager about human nature. Spies are simply better at observing people because they have spent more time practicing and because the stakes are too high to screw it up.

By comparison, the rest of us are pretty hopeless, only we don't know it. Reluctantly, I have started to reappraise my own view of myself as a brilliant judge of character and admit that such a belief is a liability.

I've just tried the following exercise: Pick a stranger and try to guess their education, profession, religion, income bracket, marital status and hobbies. Disaster: I was wrong on every score.

Because we cling to this idea that our gut instincts are reliable, we make a lot of avoidable mistakes. We make bad hiring decisions. We talk vaguely about wanting passion and creativity rather than setting to work corroborating resumes and seeking out references. Employers should make a short, precise list of the traits a job requires and hire to fill it. It is all obvious. Yet it takes a spy to point it out.

Less obvious but no less valuable is her tip for job candidates: Get the interviewer to do most of the talking and then hang on their every word. Since hardly anyone can resist talking about themselves to a rapt audience, a job offer is almost bound to follow.

To the public speaker and the salesman, Carleson has further good advice: Never rely on a script and never learn what you are going to say by heart. When you do this you use a different tone of voice, go on to autopilot and all trust is lost in an instant. Carleson is right. I have done this, but never again.

I also liked the observation about newly minted CIA officers (for which read new Harvard MBAs and so on) who emerge from the yearlong training process all swagger and irritating charm. This doesn't wash in the agency, any more than it does elsewhere. More seasoned colleagues slap them down. "Don't try to case officer me," they say.

Not everything from the book can be copied. The CIA keeps its best staff by doing sensible things such as moving people around, giving them interesting work and letting lone wolves be lone wolves.

Yet the perks of being an undercover agent also involve wearing disguises, learning how to crash cars and jump out of aircraft — all of which are big pluses, but not terribly transferable.

The main lesson from "Work Like a Spy" is that we are much more likely to get what we want if we watch other people carefully. It helps to identify the other person's weaknesses, and for this there are some common denominators: "… ego, money, ego, ego … ego, ego, ego."

Lucy Kellaway is a columnist for the Financial Times of London, in which this review first appeared.

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