When Unrest Begins, Bloggers Roll Their Sleeves Up

As the protests spread across Tunisia for weeks, many international news organizations scrambled to cover the unrest just before President Zine el-Abidine Ben Ali fled on Jan. 14, ending 23 years of authoritarian rule. But Amira al-Hussaini was all over the story.

Ms. Hussaini oversaw a handful of bloggers who gathered information about the mounting protests in Tunisia for Global Voices, a volunteer-driven organization and platform that works with bloggers all over the world to translate, aggregate and link to online content. As part of its reporting, she said, the site turned to Facebook, YouTube and Twitter, where other bloggers and hundreds of ordinary people stepped into the role of citizen journalists and shared their experiences, cellphone photos and videos online.

“There was a whole army of people who did the job of reporters, sharing what was happening on the streets,” said Ms. Hussaini, 38, who lives in Bahrain and is the organization’s regional editor for the Middle East and North Africa.

Soon after the earthquake and tsunami struck Japan on Friday, the volunteer bloggers for Global Voices in East Asia put together special coverage of the devastation, sharing citizen videos and translating posts on Twitter, including calls for help from people stranded on the upper floors of buildings. Over the weekend, with fears fueled by the prospect of a second explosion at a nuclear plant, they monitored the conversation on the social Web, reporting how people were exchanging information to keep safe and questioning the use of nuclear energy in an earthquake-prone region.

“Our job is to curate the conversation that is happening all over the Internet with people who really understand what is going on,” said Rebecca MacKinnon, a former Tokyo bureau chief for CNN who founded Global Voices with Ethan Zuckerman, a technologist and Africa expert, while they were fellows at Harvard’s Berkman Center for Internet and Society. “We amplify, contextualize and translate what these conversations are and why they are relevant.”

Ms. MacKinnon and Mr. Zuckerman both said the network grew out of an international meeting of bloggers held at Harvard in late 2004. They saw an opportunity to leverage content produced on blogs and social media sites like Twitter outside of the United States and to help create a global community for them and their work. “Our goal is to give you the voices of the people in a country like Tunisia, day in and day out, whether they are cementing rebellion or talking about local news and sports scores,” Mr. Zuckerman said. “We don’t parachute in. We are there all the time. “

The organization is now an independently operated nonprofit, financed mostly with private donations and grants from foundations. It is led by Ivan Sigal, who studied the role of citizen media in conflict zones at the United States Institute of Peace, before taking over as executive director in 2008. With no physical office, he oversees a virtual team of about 20 staff editors and more than 300 volunteer bloggers and translators outside the United States.

Mr. Sigal said that the site averages about a half million visits a month. Many of the volunteers also post on their own blogs and social media sites, including Ms. Hussaini, who is known as Justamira on Twitter. He said the organization does not accept any government money. “We want it to be perceived as being neutral,” he said.

Mr. Sigal said that having editors work with volunteer bloggers brought traditional journalistic values to the operation, like checking facts and sources. “But it is less about a finished story and more about a conversation,” he said. “When we build a story, we include links back to the original sources, so you can follow the story as far down as you want to. We want you to leave our site and go find the original, find more.”

Clay Shirky, a professor at New York University and author of “Here Comes Everybody: The Power of Organizing Without Organizations,” said that one of the most important roles that Global Voices has played is translating online content for an international audience.

“This started with the idea to provide broader coverage,” he said. “It turns out that it is much more critical than they had imagined because the other international news sources are being dismantled.”

In addition to news from Japan and the continuing coverage of the rebellion in Libya and violence in Yemen, the site includes stories about the growing influence of online communities on Russian politics, the developing political crisis in the Ivory Coast and International Women’s Day in Colombia. There was also a report from South Korea about why so many people online were discussing a 26-year-old actress who committed suicide in March 2009 and left 50 letters, just made public, listing the people she said had exploited and abused her.

But the unceasing tumult in the Middle East and North Africa in recent weeks has dominated the platform. It has meant 18-hour days for Ms. Hussaini, whose work is now followed closely on the site and on Twitter by journalists from traditional media organizations, including Andy Carvin of NPR, who has been regularly curating and publishing posts on Twitter, creating a news wire about the unrest in the region for weeks.

She spent 12 years working as a news editor for an English-language paper in Bahrain before volunteering at Global Voices as a blogger in 2005. She became editor for the region in 2006 and knows it well. Still, she said that she was caught by surprise that the turmoil across the Middle East unfolded not far from her home in Bahrain.

In Libya, where rebels are now battling the country’s leader, Col. Muammar el-Qaddafi, she said it had been much more difficult to get information, which she said had more to do with fear than with lack of access to the Internet. “The citizen media scene is small in Libya,” Ms. Hussaini said. “We find it very difficult to find voices here and in other places where there is a lot of censorship and a lot of fear from the regime. Bloggers being arrested is a fact of life in some countries.”

For those bloggers from Global Voices who are jailed or run into difficulties because of restrictions on freedom of expression, the organization now offers help. Global Voices Advocacy is run by Sami Ben Gharbia, a highly respected blogger who is a founder of Nawaat, a blog about Tunisia, and an activist who until recently lived in exile from Tunisia for 13 years.

Mr. Zuckerman said that the organization was committed to supporting freedom of speech as well as to keeping up with the developments unfolding all over the world. “People are not always interested in knowing what is happening in Yemen,” he said. “We have been waiting for people to pay attention to this corner of the world for a long time, and now we are ready to tell their stories.”

Robots Do More Prostate Cancer Surgery

Hospitals that buy surgical robots end up performing more prostate cancer operations, suggesting that technology has become a driving force behind decisions about men’s cancer care, new research shows.

The study, published in the journal Medical Care, is the latest report to suggest that how men are treated for prostate cancer appears to be influenced by a variety of factors, including the technology and marketing goals of hospitals and doctors, rather than scientific evidence on benefits and risks.

For men facing prostate cancer, the findings add more uncertainty to an already confusing array of choices for treatment, with little evidence to guide them about whether one is better than another. Current options include surgery to remove the prostate gland, performed with or without the assistance of robots, as well as radiation and hormone therapies. And because prostate cancer is often slow-growing, active surveillance without treatment is also an option for many men.

The new study, conducted by researchers at New York University and other institutions, tracked surgical robot purchases at 554 hospitals, along with the treatment given to more than 30,000 men given a prostate cancer diagnosis from 2001 to 2005.

According to the study, when a hospital acquires surgical robots, men in that region are more likely to have surgery to treat prostate cancer than before the technology was acquired. Buying a robot led to an average increase of 29 operations a year per hospital. Meanwhile, hospitals that didn’t invest in robots performed an average of five fewer operations annually. Although large hospitals may perform hundreds of such operations a year, many of the local and regional hospitals in the study see no more than 100 to 150 cases a year, the study authors said.

One reason for the increase in operations in hospitals that own a surgical robot may be that the technology helps a hospital lure potential surgical patients away from the competition. But the data also suggest that once a hospital obtains a robot, patients who might be candidates for nonsurgical options are more likely to be steered toward robotic surgery instead.

“This may be the medical embodiment of the phrase, ‘If you’re a hammer, everything looks like a nail,’”said the lead study author, Dr. Danil V. Makarov, assistant professor of urology at New York University’s Langone Medical Center. “If you have the technology, it will get used.’’

Researchers note that over all, the number of operations declined slightly during the study period, possibly reflecting a plateau in cancer cases or a shift to other treatments. But when the data were examined at the hospital and regional levels, the researchers found that the purchase of a robot was associated with a pronounced change in treatment trends.

The findings are concerning because surgical removal of the prostate, called radical prostatectomy, can result in a number of complications, including incontinence and impotence. Robotic surgery typically costs about $2,000 more than regular surgery, but it’s not clear whether its outcomes are better, worse or the same as traditional surgery, or how it compares to other treatments or even doing nothing at all.

Some research suggests the robotic procedure reduces hospital stays and blood loss, compared with regular surgery, but studies have also shown that robotic surgery offered no added benefit or worse results. In addition, when the Agency for Healthcare Research and Quality in 2008 compared the effectiveness and risks of eight prostate cancer treatments, including surgery, radioactive implants and active surveillance, no single treatment strategy emerged as superior.

But that hasn’t stopped hospitals from conducting intense marketing campaigns that imply surgery using the high-tech robot gives prostate cancer patients a better result.

Surgical robots are expensive. A surgical robot used for prostate cancer costs $1 million to $2.25 million, according to the N.Y.U. study. In addition, hospitals spend $140,000 annually for a service contract and $1,500 to $2,000 per patient on disposable instruments.

“If you’re a hospital and you get a robot, clearly you want to use it,’’ said Dr. David Penson, a study co-author and director of the Center for Surgical Quality and Outcomes Research at Vanderbilt University. “There are some real pressures here that have nothing to do with science,” he said. “We have this interplay of patients’ fascination with technology coupled with business interests on the part of the hospital and device makers, pushing people to try a new technology perhaps before it’s been fully tested.’’ He said he performs traditional prostate cancer surgery, though his practice offers robotic surgery as well.

Dr. Makarov, who is trained to perform both the traditional and robotic procedures, added that while financial incentives are likely to play a role in which treatments are promoted, patients also often want the newest technological advance, and hospitals are simply responding to that demand.

A study published last year in The Journal of Clinical Oncology tracked the treatment of 11,892 men given a prostate cancer diagnosis. About half the men opted for surgery. Among the remaining men, 14 percent were given hormone therapy; 13 percent were given radioactive seed implants; 12 percent had external-beam radiation; 5 percent had cryoablation, which destroys prostate tissue through freezing; and about 7 percent selected active surveillance, in which the cancer is closely monitored for changes, but no treatment is given.

The researchers found that treatment patterns varied markedly across the clinical sites studied, and those differences could not be explained by measurable factors like severity of disease or patient age.

In addition, recent reports, including an investigation of Medicare billing by The Wall Street Journal and the nonprofit Center for Public Integrity, also suggest that financial incentives to doctors and radiology groups are driving patients to a new form of radiation therapy called intensity modulated radiotherapy, or I.M.R.T. Patients are often referred to I.M.R.T. treatment centers by doctors who have a financial stake in the practice.

“For patients, there are a lot of choices in prostate cancer,’’ said Dr. Makarov. “Knowing that technology can influence both what they want and what their physician may advise them should make them a little more skeptical and maybe make them ask a few more questions.’’